CK

Question 1

pre surgery - cardiovascular RF

Answer 1

1. EF below 35
2. recent MI (must be 6months before, if not, admit to ICU to optimize)
3. CHF (optimize medically)

Question 2

cardiovascular tests needed prior to surgery

Answer 2

1. EKG
2. stress test
3. echo for stractural disease and EF
   if under 35 yearsol with no history –> only EKG

Question 3

pre surgery - when PFT

Answer 3

1. known lung disease

2. smoking

Question 4

pre surgery in patients in dyalisis

Answer 4

dialysis 24 hour before

Question 5

intubation in facial trauma

Answer 5

crycothyroidotomy

Question 6

intubation in cervical trauma

Answer 6

with flexible bronchoscopy

Question 7

SIRS criteria

Answer 7

2 or more

1. body Q less than 36 or more than 38
2. HR more than 90
3. tachypena more than 20 or PCO2 less than 32
4. wbc less than 4 or more than 12

Question 8

Barium in esophagus leakage

Answer 8

Never

Question 9

Tests contraindicated in diverticulitis

Answer 9

Barium enema + coloniscopy

Question 10

Most accurate test for cholecystitits

Answer 10

HIDA

Question 11

Methylnatrexone (Relistor)

Answer 11

Alleviate obstruction from stool impaction in patients on chronic opioids

Question 12

Fecal incontinence

Answer 12

Continuous or recurrent uncontrolled passage of fecal material (more than 10 ml) for at least 1 month in an individual older than 3

Question 13

fecal incontinence - diagnosis

Answer 13

• clinical history combined with flexible sigmoidoscopy or anoscopy as the best initial test
• the most accurrate is anorectal manometry
• if history of anatomy injury –> endorectal manometry

Question 14

fecal incontinence - treatment

Answer 14

3 forms

• medical therapy: bulking agents (fibers)
• biofeedback: exercises + muscle strenthening
• if fails: sugery

Question 15

SIRS criteria

Answer 15

2 or more

1. body Q less than 36 or more than 38
2. HR more than 90
3. tachypena more than 20 or PCO2 less than 32
4. wbc less than 4 or more than 12

Question 16

SIRS - interpretation

Answer 16

2 criteria = SIRS
2 criteria + source of infection = sepsis
2 criteria + source + organ dyfunction = severe septis
2 criteria + source + organ dyfunction + hypotension = septic shock

Question 17

shock is not only tachycardia and hypotension

Answer 17

also end organ dysfunction

Question 18

types of shocks (and skin and PCWP)

Answer 18

1. hypovolemic: pale and cool, low
2. cardiogenic: pale + cool, high
3. neurogenic: warm, low
4. septic: warm + faint, no change

Question 19

types of shocks and treatment

Answer 19

1. hypovolemic: fluids + pressors
2. cardiogenic: treat cardiac problem
3. neurogenic: fluids + pressors
4. septic: fluids + pressors + antibiotics

Question 20

how to find the type of shock

Answer 20

skin?

1. pale/cool –> PCWP: elevated: cardiogenic, low: hypovolemic
2. warm/flushed –> CO changes:
   - low: neurogenic
   - elevated: low PCWP in anaphylaxis, no change in PCWP in septic

Question 21

sings associated with abd trauma and descripion

Answer 21

1. cullen sign: periumbilical
2. grey turner: flank
3. kerh: pain in left shoulder
4. balance sign: dull percussion on the let and shifting dullness on the right
5. seatbelt sign: bruising

Question 22

sings associated with abd trauma and cause

Answer 22

1. cullen sign: retroperitoneal hemor
2. grey turner: retroper hemor
3. kerh: splenic rupture
4. balance sign: splenic ruptur
5. seatbelt sign: deceleration injury

Question 23

balance sign

Answer 23

dull percussion on the let and shifting dullness on the right
- in splenic rupture

Question 24

mallory weiss sybdrine vs Boerhave in diagnosis

Answer 24

gastrografin esophgogram:

leakage onky in boerhave

Question 25

management of AAA

Answer 25

- 3-4 cm: U/S every 2-3 years - 4-5,4 cm, U/S or CT every 6-12 monhts - 5,5 or more: surgery

Question 26

general rules in fractures therapy

Answer 26

1. closed reduction: mild without displacement 2. open reduction and internal fixaton: severe with displacement or misalignment of bone pieces 3. open: skin must be closed and bone must be set in the operating room with debridement

Question 27

types of fracture

Answer 27

1. comminuted: multiple pieces (crash injuries) 2. stress 3. compression 4. pathologic: from minimal trauma (metastasis) 5. open (high risk of bacterial infection, SURGERY)

Question 28

shoulder injuries - types + etiology

Answer 28

1. anteriod dislocation: any injury that causes strain (MC) 2. posterior dislocation: seizure or elect burn 3. clavicle fracture: trauma 4. scaphoid fracture: falling on an outstretched hand

Question 29

shoulder injuries - types + treatment

Answer 29

1. anteriod dislocation: shoulder relocation + immobilization 2. posterior dislocation: traction and surgery in pulses or sensation are diminished 3. clavicle fracture: simple arm sling 4. scaphoid fracture: thumb spica cast

Question 30

shoulder injuries - types + sings + symptoms

Answer 30

1. anterior dislocation: externally rotated 2. posterior dislocation: medially rotated 3. clavicle fracture: pain over location 4. scaphoid fracture: pain

Question 31

anterior vs posterior dislocation regarding rotation

Answer 31

anterior: externally posterior: internally

Question 32

trigger finger

Answer 32

acutely + painful finger | try steroid injections first --> if fail --> surgery

Question 33

Dupuytren contraction - treatment

Answer 33

surgery

Question 34

diagnostic tests of fat embolism

Answer 34

1. PO2 under 60 2. infiltrates in chest x-ray 3. urine analysis: fat droplets