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when to use fiberoptic bronchoscope

when securing an airway if there is subcutaneous emphysema in the neck (sign of trachobronchial tree disruption)


clinical indicators of thermal and smoke inhalation injury include

1. burns on the face
2. singeing of the eyebros
3. oropharyngeal infl
4. blistering of carbon deposits
6. HbCO more than 10%
7. history of confinement in a burning building


indicatiors for cytoscopy

1. gross hematuria with no evidence of glomerular or infection
2. microscopic hematuria with no evidence of glomerular disease or infection but increased risk for malignancy
3. reccurent UTI
4. obstructive symptoms with suspicion for stricture, stone
5. irritative symptoms without UTI
7. abnormal bladder imaging or urine cytology


tic douloureux

aka trigeminal neuralgia
- manifests with short burst of excruciating, lancinating pain lasting from sec to minuts in the distribution of 2nd 3rd branches of the V nerve (etiology: compression of V)


postoperative fever - MNEMONIC

Wind (day 1-2) (lungs): Atelectasis, postoperative pneumonia
Water (day 3-5): UTI
Walk (day 5-7): DVT / PE + IV ACCESS LINES
Wound (day 7): surgical site infection
Weird (8-15): drug fever or deep abscess
Wonder (drugs/products): drug fever, blood products, IV lines


1. Leyding tumor produces
2. Yolk sac produces
3. choriocarcinoma produces
4. seminoma

1. estrogens, testosterone
2. AFP
3. HCG
4. placental ALP, mildly HCG


bladder injury - intra or extraperitoneal

dome (upper) --> intraperitoneum
neck, anterior wall or anterolateral --> extaperitoneum


Valvular insuf (incompetence)

the MCC of lower extremity edema --> worsens throughout the day and resolves overnight when the patient is recumbent


extremity vascular trauma - clinical manifestation

hard signs: observed puslatile bleeding, presence of bruit/thrill over injury, expanding hematoma, signs of distal iscemia
soft signs: history of hemorrhage, diminished pulses, bone injury, neurologic abnormalities


extremity vascular trauma - evaluation

if hard signs or hemodynamic instability: surgical expolation
otherwise: injured extremity index, CT or conventional angiography, Dupplex Doppler


Herniation syndromes - types

1. Cingulate (subfalcine) herniation under falx cerebri
2. Downward transtentorial (central) herniation
3. Uncal herniation
4. cererbellar tosilar herniation into the foramen


necrotizing fasciitis - clinical manifestation

- often antecedent history of minor trauma
- erythema of the overlying skin
- swelling + edema
- pain out of proportion to emanination findings
- systemic symptoms (FEVER + HYPOTENSION)



muscle abscess
similar presentation to necrotizing fasciitis, with fever, erythema, swelling + pain
limited to 1 muscle group and does not spread rapidly


prostetic joint infection - MC organisms

early: s. aures, gram (-) robs, anaerobes
delayed: coagulase (-) staph, enterococcim, propionibacerium species
late: staph aureus, gram (-) robs, beta hemolutic strep


RF for postoperative pulm complications

1. older than 50
2. emergency surgery or duration more than 3 h
3. HF
5. Poor general health


clinical indicators of thermal and smoke inhalation injury include

1. Burns on the face
2. singeing of the eyebros
3. oropharyngeal infl
4. blistering or carbon deposits
6. HbCO levels more than 10%
7. History of confinement in a burning building


spontaneous pneumothorax - management

2 cm or smaller: observation + O2
large + stable: needle aspiration or chest tube


tracheobronchial tear - sign

Hamman sign --> audible crepitus on cardiac ausculation
sternum tenderness


MC clavicle fractures are at ... (area) / how to treat every area

midline 3rd
fractures of the middle 3rd: nonoperatively with a brace, rest and ice
fractures of the lateral 3rd: open reduction and internal fixation


rotator cuff syndrome - pain with

abduction and external rotation


prepaterllar bursitis

anterior knee pain, tenderness, erythema, localized swelling, common in occupations requiring repetitive kneling
- it is often due to S. aureus
- active motion is often decreased and painful, passive is normal
- culture (-) --> NSAID + rest
- culutre (+) --> drainage + antibiotics