General Surgery Flashcards
(414 cards)
1
Q
middle aged adult + superficial unilateral hip pain that is exacerbated by external pressure to the upper lateral thigh
A
trochanteric bursitis
2
Q
how does trochanteric bursitis present?
A
hip pain when pressure is applied (as when sleeping) and with external rotation or resisted abduction.
3
Q
what is trochanteric bursitis?
A
inflammation of the bursa surrounding the insertion of the gluteus medius onto the femur’s greater trochanter
4
Q
what population does slipped capital femoral epiphysis affect?
A
obese male children during late childhood or early adolescence
5
Q
WHat nerves supply the upper lateral thigh causing superficial referred pain?
A
- lateral femoral cutaneous
2. iliohypogastric
6
Q
By what mechanism does the following lower ICP?
Head elevation
A
increased venous outflow from the head
7
Q
By what mechanism does the following lower ICP?
Sedation
A
decreased metabolic demand and control of HTN
8
Q
By what mechanism does the following lower ICP?
Intravenous mannitol
A
Extraction of free water out of the brain tissue -> osmotic diuresis
9
Q
By what mechanism does the following lower ICP?
Hyperventilation
A
CO2 washout leading to cerebral vasoconstriction
10
Q
Cerebral blood flow increases via what mechanisms?
A
- Hypercapnia
- Increased metabolic demand
- Hypoxia through vasodilation
11
Q
coag negative staph most commonly gains access to the blood via what??
A
indwelling femoral triple lumen catheter
12
Q
femoral catheter infections are more commonly caused by what?
A
enteric organisms
13
Q
how soon after the onset of a new drug do you see drug fever?
A
one to two weeks
14
Q
drug fever is most commonly associated with what?
A
- Anticonvulsants
2. TMP-SMX
15
Q
what is the most common presentation of intraductal papilloma?
A
a form of benign breast disease presents w intermittent bloody discharge from one nipple
16
Q
what are the common causes of paralytic ileus?
A
- Exaggerated intestinal rxn after abdominal surgery
2. Retroperitoneal hemorrhage associated with vertebral fracturs
17
Q
What does abdominal x-ray show in pts w paralytic ileus?
A
- air fluid levels
- distended gas-filled loops of both the small and large intesines
18
Q
what is the tx of choice for paralytic ileus?
A
- bowel rest
- supportive care
- tx of secondary cause of the ileus
19
Q
What is the cause of nursemaid elbow?
A
subluxation of head of radius at the elbow joint
20
Q
what is the tx of nursemaid elbow?
A
Closed reduction:
- First extend and distract the elbow
- Supinate the forearm
- Hyperflex the elbow with your thumb over the radial head in order to feel the reduction as it occus
21
Q
What is Kehr sign?
A
intraabdominal pathology causing peritonitis and irritation of the diaphragm
- irritation of the parietal peritoneum covering the undersurface of either hemidiaphragm can be referred to the ipsilateral shoulder bc the phrenic nerve originates from the C3-C5 spinal levels
22
Q
what is the only part of the bladder covered by peritoneum and thus can cause peritonitis?
A
bladder dome
23
Q
which part of the bladder is most susceptible to rupture and why?
A
- bladder dome
- the dome has a developmental hiatus where the urachus originates during embryonic life
24
Q
what is the most common site of extraperitoneal bladder rupture?
A
bladder neck
25
What is the gold standard for evaluating mesenteric ischemia?
mesenteric angiography
26
what is the typical presentation of mesenteric ischemia?
severe abdominal pain after eating and relatively normal abdominal exam
27
what is the respiratory quotient?
the steady state ratio of carbon dioxide produced to oxygen consumption per unit time
28
what does a RQ close to 1 indicate? 0.8? 0.7?
1= carbohydrates are the major nutrient being oxidized
0. 8 = proteins
0. 7 = fatty acids
29
how is RQ important in mechanically ventilated patients?
- overfeeding, esp with carbs, causes excessive CO2 production and makes weaning from ventilation more challenging
- this is important in pts w preexisting lung disease as well
30
what is the RQ in sepsis? why?
less than 1, bc sepsis is a hypermetabolic hypercatabolic state where both fat and protein are broken down
31
what are the presenting sx of severe CO poisoning after smoke inhalation?
1. COnfusion -> COma
2. Wheezes
3. Seizure
4. Heart failure or arrythmias
32
what are the sx of moderate CO poisoning?
1. HA
2. Nausea
3. Dyspnea
4. Malaise
5. Altered mentation
6. Dizziness
33
how does one diagnose CO poisoning?
confirmed clinically and by documenting elevated carboxyhemoglobin level (>3% nonsmokers, >15% smokers)
34
tx of CO poisoning?
100% oxygen w facemask
35
DRE finds a tender, fluctuant mass palpable only with the tip of the examining finger?
abscess in the rectovesical pouch
36
What are the sx of a anorectal abscess compared to a rectovesical abscess?
```
Anorectal: perineal pain + fluctuant mass palpable on the perineum
- pain w ambulation and defecation
- urinary retention
Rectovesical: lower abdominal pain
- malaise, low grade fever
- tender pelvic mass on rectal exam
```
37
if pt has signs of PAD and ABI is normal, what should be the next step?
exercise testing with repeat ABI
38
ABI of:
1-1.3
<0.4
1-1.3 = normal
50% occlusion in a major vessel
<0.4 = limb ischemia
39
Presenting signs of a posterior shoulder dislocation versus anterior?
Posterior: flattening of anterior shoulder
- prominent coracoid process
- arm held adducted and internally rotated, cannot externally rotate
Anterior: most common,
- pt holds arm abducted and externally rotated
40
what does radiograph show w posterior dislocation of shoulder?
1. Light bulb sign: Internal rotation of humeral head with circular appearance
2. Rim sign: widened joint space >6mm
3. Trough line sign: 2 parallel cortical bon lines on the medial aspect of the humerus
41
what is a marjolin ulcer?
squamous cell carcinoma within burn wounds
42
what fibers are most often damaged in syringomyelia?
1. spinothalamic tract (pain and temperature)
| 2. upper extremity motor fibers
43
what are the most common causes of syringomyelia?
1. Arnold Chiari malformations
| 2. Previous spinal cord injuries: most often MVA w whiplash
44
what is the most sensitive finding for blunt aortic injury on radiograph?
mediastinal widening (in the setting of MVA or falls >10ft)
45
sx of compartment syndome?
1. severe pain that is worsened on passive ROM
2. Paresthesias
3. Pallor
4. Paresis
all of the affected limb
46
how do you diagnose compartment syndrome? tx?
use needle and pressure transducing catheter system
pressures >30mmHg may result in cessation of blood flow
- tx emergently by fasciotomy
47
what are postop measures used to decrease the risk of pneumonia?
all encourage lung expansion:
1. Incentive spirometry* first line
2. Deep breathing exercises
3. CPAP
4. Intermittent positive pressure breathing
48
what is the difference between pulmonary contusion and ARDS?
Pulmonary Contusion: within first 24hrs, unilateral
| ARDS: 24-48 hours, bilateral
49
what is the tx for mastitis?
1. Analgesics
2. Antibiotics: Dicloxacillin or cephalosporin
3. Continued nursing
50
What is Kehr sign?
Left shoulder pain referred from splenic hemorrhage irritating the phrenic nerve and diaphragm
51
what are the risk factors for nasopharyngeal carcinoma?
1. EBV!!!!!!!! huge.
2. Smoking
3. Chronic nitrosamine consumption (diets rich in salted fish)
52
acute pain and swelling of the midline sacrococcygeal skin and subcutaneous tissues
pilonidal cyst infection
53
pilonidal cysts are most prevalent in whom?
young males with a lot of body hair
54
tx of pilonidal cysts?
drainage of abscesses and excision of sinus tracts
55
perianal fistulae are generally located where?
within 3cm of the anal margin
56
tx of duodenal hematoma?
- most resolve spontaneously in 1-2 weeks so just nasogastric suction and parenteral nutrition
57
in what population do you normally see acalculous cholecystitis?
Pt's chronically hospitalized in the ICU with any:
1. Multiorgan failure
2. severe trauma
3. Surgery
4. Burns
5. Sepsis
6. Prolonged parenteral nutrition
58
what is the suspected pathogenesis of acalculous cholecystitis?
1. Cholestasis and gall bladder ischemia ->
2. Secondary infection by enteric organisms ->
3. Edema of the gall bladder serosa ->
4. Necrosis of the gall bladder
59
5 W's of postop fever?
1. Wound infection
2. Wind (atelectasis)
3. Water (UTI)
4. Walking (DVT)
5. Wonder drugs!
60
most common cause of postop fever within 1 day of surgery?
atelectasis
61
What is the workup for postop fever?
1. CBC
2. Blood and urine cultures
3. Urinalysis
4. CXR
62
how do you correct for low albumin in the setting of hypocalcemia?
Corrected Ca = 0.8 (normal albumin - observed albumin) + Observed Ca
63
in acidosis, what happens to the ionized fraction of Ca?
increases
64
in alkalosis what happens to the ionized fraction of Ca?
decreases
65
what are some causes of hypocalcemia?
1. Acute pancreatitis
2. Necrotizing fasciitis (massive soft-tissue infections)
3. Acute/chronic renal failure
4. Pancreatic/small bowel fistulas
5. Severe alkalosis (decrease in ionized fraction)
66
what ECG changes does one observe in hypocalcemia?
prolonged QT interval
67
what are some causes of hypercalcemia?
1. Hyperparathyroidism
2. Cancer: breast & multiple myeloma
3. Drugs (thiazides)
68
what is the biggest danger of TPN?
infection
69
```
estimations of basal energy expenditure (BEE):
Nml Males:
Nml Females:
Nonstressed patient
Postsurgery
Trauma/sepsis/burns
Fever
```
```
Nml Males: 25 kcal/kg/day
Nml Females: 22 kcal/kg/day
Nonstressed patient: BEE x 1.2
Postsurgery: BEE x 1.3-1.5
Trauma/sepsis/burns: BEE x 1.6-2.0
Fever: 12% increase per *C
```
70
```
what is the RQ of:
Lipids-
protein-
carbs-
balanced diet-
```
Lipids- 0.7
protein- 0.8
carbs- 1.0
balanced diet- 0.83
71
what is the RQ?
ratio of carbon dioxide released to oxygen consumed per unit metabolism of a substrate
72
what is the fuel for enterocytes? colonocytes? immune modulating agents?
Enterocytes: glutamine
Colonocytes: short chain fatty acids
Immune modulating: omega 3 fatty acids
73
causes of anion gap metabolic acidosis?
```
MUDPILES
Methanol/metabolism errors
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron/Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
```
74
what are the 4 major processes that cause anion gap metabolic acidosis?
1. Ketoacidosis
2. Lactic acidosis
3. Renal failure
4. Intoxication
75
what are the causes of normal anion gap metabolic acidosis?
```
HARDUP
Hyperparathyroidism
Adrenal insufficiency/anhydrase inhibitors
Renal tubular acidosis
Diarrhea
Ureteroenteric fistula
Pancreatic fistulas
```
76
how do you calculate the anion gap?
AG = Na - (Cl + HCO3)
77
what are the two mechanisms of metabolic alkalosis?
1. Loss of H+ from kidneys or GI tract
| 2. Gain of HCO3: TPN, PRBCs, lactated ringers
78
What are the causes of respiratory alkalosis?
```
MIS(HAP)3S
Mechanical overventilation
Increase in ICP
Sepsis
Hypoxia/hyperpyrexia/heart failure
Anxiety/ascites/asthma
Pregnancy/Pain/Pneumonia
Salicylates
```
79
Barium swallow = corkscrew shaped
diffuse esophageal spasm
80
classic triad of achalasia?
1. Dysphagia
2. Regurgitation
3. Weight loss
81
tx of choice for achalasia?
Heller's myotomy: esophagomyotomy
82
what are the two false diverticula in the esophagus?
1. Zenkers: pharyngoesophageal
2. Epiphrenic
= pulsion diverticula
83
when would you tx asymptomatic zenkers diverticulum?
when it's >2cm
84
tx of zenkers diverticulum?
1. Cervical pharyngocricoesphageal myotomy (incising the cricopharyngeus
followed by:
- Diverticulopexy: larger diverticula
- Diverticulectomy: largest diverticula
85
how do you differentiate between postop ileus and postop bowel obstruction?
```
ileus = hypoactive or absent bowel sounds
obstruction = hyperactive tinkling sounds
```
86
what are the causes of postop ileus following bowel surgery?
1. Increased splanchnic sympathetic tone following violation of the peritoneum
2. Local release of inflammatory mediators
3. Postop narcotic use
87
poor glucose control can cause what bowel condition?
gastroparesis: characterized by early satiety, nausea, and postprandial vomiting
88
what antibiotic is used as a promotility agent?
erythromycin
89
what DA antagonist has promotility effect?
metoclopramide
90
what is morton neuroma?
not a neuroma- but is associated with pain between the 3rd and 4th toes on the plantar surface and a clicking sensation (Mulder sign) when simultaneously palpating this space and squeezing he joints
91
what is tarsal tunnel syndrome?
compression of the tibial nerve as it passes through the ankle
- caused by a fracture of the bones around the ankle
- sx = burning, numbness, and aching of the distal plantar surface of the foot or toes (and sometimes calf)
92
what is tenosynovitis?
inflammation of the tendon and its synovial sheath
- seen in hands and wrist joints following a bite or puncture wounds
- pain, esp w flexion and extension
93
what is tic douloureux?
trigeminal neuralgia- short bursts of excruciating, lancinating pain lasting from seconds to minutes in the distribution of the second and third branches of the trigeminal nerve.
- most likely external compression of the trigeminal nerve
94
what is strabismus?
improper alignment of the eyes
95
if you suspect a ruptured AAA in a pt, but theyre unstable for a CT scan, what can you do?
bedside ultrasound
96
what abnormal lab values do you see in acute pancreatitis?
1. Elevated amylase and lipase
2. Elevated WBC
3. Mild azotemia
4. Hocalcemia
97
major thoracic trauma + tachypnea + paradoxical thoracic wall movements that correct with positive pressure mechanical ventilation
Flail chest!
= multiple contiguous ribs are fractured in two or more locations
= hypoxemia + hyperventilation
98
tx of flail chest?
pain control and supplemental O2
| + intubation with mechanical positive pressure in most pts
99
EKG shows absent P waves, irregular rhythm, and inverted T waves, what is it?
```
A Fibb
(T wave inversions could also be due to her longstanding HTN)
```
100
what is Legg-Calve-Perthes disease? classic presentation?
idiopathic avascular necrosis of the femoral capital epiphysis
- seen in boys 4-10 (5-7)
- classically presents as hip, groin or knee pain + an antalgic gait
101
what is the tx of legg-calve parthes disease?
usually conservatively with observation and bracing
| surgery when the femoral head is not well contained with the acetabulum
102
what pt population is SCFE most likely to present in?
obese adolescent male with complaints of pain
103
How does osteosarcoma usually present on radiograph?
Codman's triangle in metaphyses of long bones
104
How does Ewings sarcoma present on radiograph?
tumor seen within diaphyses of long bones
105
Pt w recent cardiac surgery presents with fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge.
Acute mediastinitis!
| - due to intraoperative wound contamination
106
what does CXR show in acute mediastinitis?
a widened mediastinitis
107
tx of acute mediastinitis?
surgical debridement with immediate closure and prolonged antibiotic therapy
108
when does postoperative acute mediastinitis usually present?
within 14 days of the surgery
109
when does postpericardiotomy syndrome present? tx?
a few weeks following a procedure with pericardium incision
| tx: NSAIDs and pericardial puncture if tamponade occurs
110
what population is most prone to developing acute bacterial parotitis?
1. Dehydrated post-operative patients
| 2. Elderly
111
pt presents w flaccid paralysis after aortic surgery?
spinal cord ischemia- rare complication of vascular surgery
112
what is the artery of adamkiewicz?
the most prominent thoracic radicular artery and arises from the aorta to supply the anterior spinal arteries in the T9-T12 region
- thus this artery is susceptible during thoracic surgery, causing spinal cord ischemia and flaccid paralysis
113
what are the risk factors for spinal cord infarction in a pt undergoing thoracic AA repair?
1. Hypotension in the perioperative period
2. Increased spinal canal pressure
3. Aortic cross clamping or occlusion
114
how do pts w spinal cord ischemia usually present?
1. Abruptly onset flaccid paralysis
2. Bowel/bladder dysfxn
3. Sexual dysfxn
4. possible hypotension
5. Loss of tendon reflexes
115
what is the next step when spinal cord ischemia is suspected?
1. Emergent MRI
| 2. supportive care and lumbar drains to reduce spinal pressure
116
what is the pressure threshold to perform escharotomy in burn victims w compartment syndrome?
25-40mm Hg
117
what is the most commonly injured nerve in fracture of midshaft of the humerus?
radial nerve
118
what imaging modality is used to see uric acid stones?
CT scan! theyre radiolucent
119
what is Volkmann's ischemic contracture?
the final sequel of compartment syndrome in which the dead muscle has been replaced with fibrous tissue
120
pt postop rhinoplasty develops whistling noise during respiration??
nasal septal perforation- usually from a septal perforation or a septal abscess
121
what is the definition of oliguria in someone w/out preexisting intrinsiv kidney disease?
<6cc/kg
| per day
122
what are the steps in management of suspected prerenal azotemia?
1. Change foley catheter
| 2. Careful fluid challenge (bolus IV fluids)
123
what is the most common bone in the body to be affected by stress fractures?
Tibia
124
when do you typically see postop atelectasis at its worst?
second postop day and can last up to 5days!
125
what are the common CXR radiographic findings in esophageal rupture?
1. Pleural effusion (usually l sided)
2. Pneumomediastinum
3. Pneumothorax
126
what is the test of choice for diagnosing esophageal perforation/rupture?
water soluble esophagram
127
What are the signs for an AAA?
1. Profound hypotension
2. Abdominal or back pain
3. Syncope
4. Pulsatile mass
128
What are the symptoms of fat embolism? (6)
1. Severe respiratory distress
2. Petechial rash
3. Subconjunctival hemorrhage
4. Tachycardia
5. Tachypnea
6. Fever
129
How do you confirm diagnosis of fat embolism?
1. presence of fat droplets in urine OR
| 2. Presence of intraarterial fat globules on fundoscopy
130
when do fat embolisms usually occur after fracture of long bone?
12-72 hours
131
what is hamman sign?
crunching sound on auscultation of the heart due to mediastinal emphysema
132
how do you treat complicated diverticulitis with abscess formation?
percutaneous abscess drainage under CT guidance
133
define and list the triad of leriche syndrome?
(arterial occlusion at the bifurcation of the aorta into the common iliac arteries)
1. bilateral hip, thigh and buttock claudication
2. impotence
3. symmetric atrophy of the bilateral lower extremities due to chronic ischemia
134
what nerve is responsible for knee extension and hip flexion?
femoral nerve!
135
what nerve is at risk for injury in an anterior dislocation of the humeral head?
axillary
136
what is and how do you manage a hydrocele?
a fluid collection within the processus or tunica vaginalis
| - management = reassurance and observation, most spontaneously resolve by the age of 12months
137
CXR shows widened mediastinum, large left sided hemothorax, deviation of the mediastinum to the R and disruption of the normal aortic contour
aortic injury secondary to rapid deceleration of the chest
138
varicocele is dilation of what veins? pathophys?
dilatation of pampiniform plexus
- incompetence of valves of these veins
- occurs most frequently on the left side
139
what are the criteria for SIRS?
1. Temp greater than 38.5*C (101.3*F) OR less than 35*C (95*F)
2. Pulse greater than 90
3. Respirations greater than 20
4. WBC >12,000 OR >10% bands OR <4,000
must have two of the 4 criteria
140
when is SIRS considered severe?
```
when there is end organ damage:
1 Oliguria
2. Hypotension
3. Thrombocytopenia (plt <80,000)
4. Metabolic acidosis
5. Hypoxemia
```
141
what does SIRS look like in a burn pt?
also have a hypermetabolic response:
1. Hyperglycemia
2. Muscle wasting
3. Protein loss
4. Hyperthermia
5. Increased energy expediture
142
what is the greatest danger in massive hemoptysis?
Asphyxiation due to the airway flooding with blood
143
what is ludwig angina?
rapidly progressive bilateral cellulitis of the submandibular and sublingual spaces
- comes from infected 2nd or 3rd mandibular molar
144
presenting symptoms of Ludwig angina? (4)
1. Fever
2. Dysphagia
3. Odynophagia
4. Drooling
145
management of fracture of the scaphoid bone?
wrist immobilization for 6-10 weeks
146
young individual with a fleshy immobile mass on the midline hard palate
torus palatinus
| surgically remove if symptomatic
147
what is vanishing bile duct syndrome?
primary biliary cirrhosis: rare disease involving progressive destruction of the intrahepatic bile ducts
148
what is the hallmark of primary biliary cirrhosis?
ductopenia (most common cause of it) other causes of ductopenia include failed liver transplant, hodgkins, sarcoid, CMV infxn, HIV and medication toxicity
149
how does one manage small nonbleeding esophageal varices?
prophylaxis with nonselective beta blockers (nadolol or propanolol)
150
how does one manage BLEEDING esophageal varices?
endoscopic sclerotherapy?
151
what medication is used for actively bleeding esophageal varices?? mechanism?
Octreotide: analog of simvastatin
| causes splanchnic vasoconstriction and reduced portal blood flow by inhibiting the release of glucagon
152
what should you be highly suspicious of in a pt with hx of chronic cirrhosis with ascites who develops abdominal discomfort or altered mental status?
Spontaneous bacterial peritonitis
153
what are 6 classes of drugs that can cause pancreatitis?
1. Diuretics: furosemide, thiazides
2. Drugs for IBD: sulfasalazine, 5-ASA
3. Immunosuppressive agents: azathioprine, L-asparaginase
4. Dugs used by pt w hx of seizure or bipolar: valproic acid
5. Dugs used by AIDS pts: didanosine, pentamidine
6. Antibiotics: metronidazole, tetracycline
154
what type of bilirubin is excreted in the urine?
conjugated (bc its water soluble and only loosely bound to albumin)
155
What is rotor syndrome?
- benign condition in which there is a defect in hepatic storage of conjugated bilirubin
- increased conj bili on plasma and excreted in urine
- LFTs are normal
- no tx
156
what is the major cause of chronic diarrhea in HIV-infected patients with CD4 counts less than 180?
Cryptosporidium parvum
157
what anitbody do you see in primary biliary cirrhosis?
anti-mitochondrial
158
what is the tx of choice for primary biliary cirrhosis?
usodeoxycholic acid
159
what viruses are associated with acute pancreatitis? (6)
1. Mumps
2. Hepatitis B
3. HIV
4. Coxsackievirus
5. CMV
6. HSV
160
painless jaundice in a pt with conjugated hyperbilirubinemia and markedly elevated alk phosph
think intraabdominal malignancy obstructing biliary system (order a CT to confirm dx)
161
what are two history clinical clues that are characteristic of esophageal dysmotility seen in scleroderma?
1. Sticking sensation in throat
| 2. dysphagia + heartburn
162
what are the two manometric findings in scleroderma esophageal dysmotility?
1. Absence of peristaltic waves in the lower 2/3 of the esophagus
2. Significant decrease in the lower esophageal sphincter tone
163
What are 3 drugs that can cause SIADH?
1. Cyclophosphamide
2. Carbamazepine
3. SSRIs like fluoxetine
164
angiodysplasia is often seen in what two patient populations?
1. Underlying aortic stenosis
| 2. End stage renal disease
165
PAS-positive material in the lamina propria of the small intestine
Whipple;s disease: t whippelii
166
treatment of diffuse esophageal spasm?
1. Antispasmodics
2. Dietary Modulation
3. Psychiatric counseling
167
first like therapy for H pylori associated PUD?
1. Amoxicillin plus clarithromycin
| 2. PPI
168
which medications may cause hyperkalemia? (3)
ACE inhibitors
Angiotensin receptor blockers
Spironolactone
169
what is a common electrolyte abnormality found in cushings syndrome? how do you treat?
hypokalemia = corticosteroids will bind to aldosterone receptors in the kidney and cause renal potassium wasting
- tx: spironolactone (aldosterone antagonist)
170
tx of IBD toxic megacolon?
```
IV corticosteroids
IVF
Abx
bowel rest
- subtotal colectomy w/ end ileostomy if colitis doesnt resolve)
```
171
what medications increase the risk for NASH?
1. Corticosteroids
2. Amiodarone
3. Diltiazem
4. Tamoxifen
5. HAART
172
Drug of choice for Primary biliary cirrhosis?
Ursodeoxycholic acid
173
back pain + anemia + renal dysfunction + elevated ESR + hypercalcemia -> constipation
multiple myeloma
174
what are the best screening markers for acute hepatitis B infection?
HBsAg
| anti-HBc
175
what electrolyte abnormality is most commonly found during or immediately after surgery in pts requiring multiple blood tansfusions?
hypocalcemia
176
what does the EKG show in severe hypokalemia?
U waves
177
what arrythmia occurs w hyperkalemia?
asystole
178
what abnormal lab values can you see in SBO?
mild leukocytosis and modest increase in amylase
179
what vitals and lab values indicate risk of impending strangulation in SBO?
fever, tachycardia, leukocytosis
| metabolic acidosis
180
what are the specific modalities used to stop variceal bleeding? (3)
1. Vasoconstrictors: octreotide and vasopressin
2. Endoscopic variceal ligation
3. Variceal sclerotherapy
181
first line treatment for bleeding pts with a coagulopathy?
FFP
182
what are the two types of metabolic alkalosis? how do you differentiate between the two?
1. Saline-resistant: has excess mineralcorticoid causing H and K and Na retention, kidneys then respond by excreting both Na and Cl = HIGH urine chloride
2. Saline-responsive: LOW urine Cl (<20mEq/L) due to hypovolemia and hypochloremia
183
what metabolic state is contraindicated for the use of hyperkalemia? why types of ppl are at high risk for this state?
succinylcholine
1. Patients w crush or burn injuries more than 8 hours old (rhabdomyolysis)
2. Demyelinating syndromes (Guillan barre)
3. Tumor lysis syndrome
184
what are common conditions associated with sudden onset A Fibb?
1. Hypertensive heart disease
2. Hyperthyroidism
3. Drugs (Amphetamines, cocaine, theophylline)
4. Post cardiac surgery
185
steps in treating hyperkalemia?
1. IV calcium gluconate
2. Insulin and glucose (or beta 2 agonists)
3. Sodium Bicarbonate
4. Kayoxalate
186
4 Causes of peptic strictures
1. GERD
2. Radiation
3. Scleroderma
4. Caustic ingestions
187
How is the diagnosis of Wilson's disease confirmed?
1. Low serum ceruloplasmin
2. Increased urinary copper excretion or Kayser-Fleischer rings
* thus must perform measurement of serum ceruloplasmin levels and slit lamp examination
188
what are 4 complications of acute pancreatitis?
1. Pleural effusion
2. ARDS
3. Ileus
4. Renal Failure
189
why does hypomagnesemia cause refractory hypokalemia?
Mg is an important cofactor for potassium uptake and maintenance of intracellular potassium levels
*must correct Mg level in order to correct hypokalemia
190
What two conditions cause hypomagnesemia?
1. Chronic alcoholism
| 2. Intake of diuretics
191
Hypoalbinemia can cause what electrolyte abnormality?
hypocalcemia bc ca is largely albumin nound
192
what is another name for wilsons disease?
hepatolenticular degeneration
193
Symptoms of Zinc deficiency?
1. Alopecia
2. Abnormal taste
3. Bullous/pustulous lesions surrounding body orifices
4. Impaired wound healing
194
What deficiencies result from long term TPN use?
Zinc and Selenium (cardiomyopathy)
195
How does end organ damage occur in acute severe pancreatitis?
1. Local release of pancreatic enzymes enters the vascular system and increases permeability
2. Large volumes of fluid migrate from the vascular system to the retroperitoneum
3. Inflammatory mediators also enter the vascular system causing widespread vasodialtion, capillary leak, shock, and assoc end-organ damage
196
what are major hereditary risk factors for pancreatic cancer?
1. BRCA 1 & 2
| 2. Peutz-Jeghers syndrome
197
What are the environmental factors that increase risk for pancreatic cancer?
1. Smoking!!!!
2. Chronic pancreatitis
3. Obesity
198
tx for hepatitis C?
Pegylated IFN + ribavirin
199
Tx for hepatitis B?
Entecavir and tenofovir
200
How does one calculate the anion gap?
AG = Na - (HCO3 + Cl)
201
what is winters formula and how is it used?
PaCO2 = 1.5 (HCO3) +8
| = calculating the PaCO2 required to compensate for a pt's respiratory acidosis/alkalosis
202
what are the main drugs known to cause esophagitis? 6
1. Tetracyclines
2. Aspirin & NSAIDs
3. Alendronate
4. Potassium Chloride
5. Quinidine
6. Iron
203
hallmark = massive increase in the transaminases with modest accompanying elevations in total bilirubin and alk phosph
ischemic hepatic injury
204
central versus nephrogenic DI
Central: decreased production of ADH from trauma, hemorrhage, infxn, tumors
Nephroenic: renal ADH resistance, from hypercalcemia, hypokalemia, renal dx and meds
205
what medications are known to cause nephrogenic DI? 5
1. Lithium
2. Demeclocycline
3. Foscarnet
4. Cidofovir
5. Amphotericin
206
where does the bleeding come from in a mallory weiss tear?
tears in the submucosa of the distal esophagus and proximal stomach causes bleeding from submucosal arteries
207
most common complication of PUD?
hemorrhage
208
symptoms of VIPoma?
1. Diarrhea
2. Hypokalemia -> leg cramps
3. Decrease in the amount of acid in the stomach
209
dog + liver cyst
hydatis cyst
| tx: surgical resection under coverage of albendazole
210
young mom complains of pain along radial side of wrist, assoc with wrist flexion and thumb extension
Dequervians tenosynovitis
211
ulnar fascial nodules felt in a scandenavian man
dupuytrens contracture
212
an abscess in the pulp of the index finger- what is it and how do you fix?
Felon abscess
| requires IMMEDIATE surgical decompression, can lead to necrosis of the tissue
213
what is game keepers thumb? tx?
most commonly a skiing injury where thumb is jammed leading to ulnar collateral ligament injury
- tx: cast!!! can lead to arthritis
214
what is jersey finger? tx?
when you make a fix the distal phalanx of the ring finger doesnt flex with the others
tx: splinting!
215
what is mallot finger? tx?
cannot extend the distal phalanx
| rx: splinting
216
what is trigger finger? tx?
R middle finger is acutely flexed, woman unable to extend it when she tries she feels a painful snap
tx: steroid injections
217
what is the most likely triggering event for MI during surgery?
hypotension
218
what are the ABG findings in a massive pulmonary embolus?
hypoxemia and hypocapnea
219
what kind of IV resuscitation do you give someone w delirium tremens?
5% alcohol and 5% dextrose
220
acute water intoxication?
carefully infuse hypertonic saline and give mannitol
221
pt not in shock but is oliguric- what two classical things do you think about? how do you diagnose?
1. Acute renal failure
2. Behind on fluids- thus measure urinary Na concentration, Na concentration of urine is >40 bc kidney unable to concentrate
- can also calculate the FeNa (failure if >1, dehydrated if <1)
222
what metabolic abnormality can perpetuate paralytic ileus?
hypokalemia
223
what is ogilveys syndrome?
very common- massive colonic dilatation in elderly people who arent active and now postop = massive distention of the colon
224
management of ogilveys syndrome?
colonoscopy- decopmresses the bowel, long rectal tube left in place
225
what is the difference between anastomotic leak and a fistula?
anastomotic leak is assoc w fever!
226
what would prevent a fistula from healing?
```
FETID:
Foreign body
Epithelialization
Tumor
Infection/irradiated
Distal obstruction
```
227
hyperkalemia- 4 treatments!
1. Calcium Gluconate
2. Insulin + Glucose
3. Kay-oxolate
4. Sodium Bicarb
228
Vigorous fluid replacement:
if alkalotic?
if acidic?
```
Alkalotic = normal saline
Acidic = ringers lactate
```
229
how do you diagnose boerhaaves syndrome?
gastrograffin swallow, but bad resolution so if this is negative just go ahead with the barium swallow
230
what types of polyps can be left alone?
juvenile and peutz-jeghers
231
when would you operate in crohns disease?
- perforation
- obstruction
- bleeding
- fistula formation
232
what antibiotics are used to kill c diff?
metronidazole or vancomycin
233
management of SCC of the anus?
neoadjuvant chemotherapy with radiation followed by resection (Nigrel protocol)
234
what is the nigrel protocol?
neoadjuvant chemotherapy with radiation followed by resection of anal cancer
235
if suspect stress ulcers, what workup?
endoscopy followed by angiogram to embolize vessels that are feeding the bleeding areas
236
whats the difference between primary bacterial peritonitis and perforation peritonitis?
bacterial grows one organism where as perf grows multiple, sample fluid in abdomen from ascites
237
very old person w abdominal pain, think of 2 conditions:
1. Sigmoid Volvulus
| 2. Mesenteric ischemia
238
Management of sigmoid volvulus?
proctosigmoidoscopic exam to untwist bowel, if recurs then sigmoid resection
239
what is the blood marker for hepatocellular carcinoma?
AFP
240
7 months pregnant suddenly bleeds into abdomen and goes into shock
visceral aneurysm
241
cancer obstructing the biliary tract can be 1 of 3 cancers:
1. Cancer of head of pancreas
2. Cholangiocarcinoma: at head of common bile duct into lumen
3. Adenocarcinoma growing into the ampulla of vader
242
if suspect cancer in biliary tract and CT is nondiagnostic, what do you do next?
ERCP
243
4 things seen on US to confirm diagnosis of pancreatitis?
1. Presence of stones
2. Pericystic fluid
3. Gallbladder wall thickening
4. Dilated duct
244
difference between urinary amylase/lipase versus serum lipase?
serum: peaks within 12 hours and back to normal within 2 days
urinary: goes up around day 2-3 and peaks at day 4-5
245
how do you diagnose hemorrhagic pancreatitis?
Hct <45
246
what is the final pathway to death in a pt w hemorrhagic pancreatitis? what do we do to prevent
abscess! do daily CT scans, at the earliest indication of pus = drain it!
247
pt had pancreatitis a few days ago and now has a fever?
abscess
248
what are the 4 sequelae of pancreatic pseudocyst?
1. Go away by itself: within 6 weeks
2. Massive rupture
3. Erode into major vessels so it bleeds
4. Pancreatic juice becomes infected -> abscess -> sepsis -> death
249
pancreatic pseudocysst is still there after 6 weeks, what do you do?
endoscopic internal cystogastroscopy
250
severe necrolytic migatory dermatitis for several years + mild diabetes, thin
Glucagonoma
251
4 instances of htn that surgery is the correction
1. Hyperaldosteronism
2. Pheochromocytoma
3. Coarctation of the aorta
4. Renal vascular HTN
252
how do you diagnose hyperaldosteronism?
high aldosterone and low renin
253
what could cause hyperaldosteronism?
Hyperplasia- manage medically
| Adenoma- manage surgically
254
workup of pheochromocytoma?
24hr urine collection for metenephrine and VMA
| ct scan of adrenals
255
diagnosis of Coarctation of the aorta?
spiral CT
256
tx of renal vascular HTN?
dilation and stenting
257
excessive salivation hours after birth, choking ata first feeding
esophageal atresia
258
what are the associated malformations of TE fistula?
```
VACTR
Vertebral anomalies
Anal anomalies
Cardiac anomalies
Tracheal esophageal anomalies
Renal and radial anomalies
```
259
baby with large abdominal defect to the R of the umbilicus, normal cord that goes right to baby
gastroschisis
260
baby with defect to the right of the umbilicus, umbilical cord goes to the sack and not the baby
omphalocele
261
treatment of omphalocele?
Silo!- every day push bowel in a little bit more
262
how do you diagnose malrotation?
barium enema from below
263
double bubble sign + green vomiting = 1 of what 3 etiologies?
1. Duodenal atresia
2. Annular pancreas
3. Malrotation
264
premature baby + abdominal problems = almost always
necrotizing enterocolitis
265
when do you go to the OR in an infant w necrotizing enterocolitis?
when shoes signs that bowel has died- abdominal wall erythema, air in biliary tree, or pneumoperitoneum
266
how do you diagnose hypertrophic pyloric stenosis?
US not barium!
267
tx of hypertrophic pyloric stenosis?
ranstid fiber myotomy
268
how do you diagnose biliary atresia in an infant?
HIDA scan one week after phenobarb therapy (powerful choleretic- stimulates bile production)
269
diagnosis of hirschbrungs? tx?
diagnosis = full thickness rectal mucosa biopsy
| tx: take to surgery even if theyre one day old! remove part of colon that doesnt have innervation
270
fixed split second heart sound + recurrent respiratory infections
ASD
271
3month old with large pansystolic heart murmur at the L sternal boarder, + failure to thrive
VSD
272
murmur that isnt usually heard on the day of birth but heard soon there after
VSD
273
when wouldn't you surgically repair a VSD?
when its the small variant thats found low in the muscle of the ventricle- these usually fix themselves
274
when would you NOT use indomethacin to close a PDA?
when the baby has CHF bc indomethacin takes too long
275
continuous machinery murmur in baby w bounding peripheral pulses
PDA
276
5 R -> L shunts in babies
1. Tetrology of Fallot
2. Transposition of the great vessels
3. Truncus arteriosus
4. Total analogous pulm venous congestion
5. Tricuspid atresia
277
what is the age difference between tetrology of fallot and transposition of theg reat vessels?
```
tetrology = 5-6yr old
transposition = few days old
```
278
does aortic stenosis need a valve replacement or repair? what are the indications?
Replacement!!
Indications:
1. If pressure gradient >50mmHg across the valve
2. First signs of CHF: angina or syncope
279
acute versus chronic aortic valve insufficiency?
Acute = medical EMERGENCY valve replacement due to endocarditis
280
how do you manage mitral stenosis?
valve repair (w commisurotomy) versus replacement
281
what is the tx of flail chest?
fluid restriction and use of diuretics (bc means theres underlying pulmonary contusion = very sensitive to fluid overload)
282
absolute contraindication to surgery?
DKA (or sky high glucose) or diabetic coma
283
measures of nutritional status (3) which are contraindications to surgery
1. Albumin 20% of weight)
| 3. Transferrin <200
284
Contraindications to surgery? 1 absolute and 3 others
1. DKA (Absolute)
2. Poor nutrition
3. Severe liver failure (measure bili, PT, ammonia)
4. Smoker (2 months before surgery)
285
What is Goldman's index? what is the most important factor of this?
tells you about a pts risk of surgery and weighs benefits
| - Biggest predictor = CHF
286
what is the biggest predictor of perioperative mortality?
EF! <35%
287
what are the top three predictors of perioperative mortality?
1. CHF (EF)
2. MI within 6 months (EKG)
3. Arrhythmia
4. Old (>70yrs)
5. Surgery is emergent
6. Aortic Stenosis: listen for murmur
288
what is the murmur of aortic stenosis?
late systolic crescendo-decrescendo murmur that radiates to the carotids, increases with squatting and decreases with preload
289
what meds should you stop before surgery?
1. Aspirin/warfarin
2. NSAIDs
3. Metformin (risk of lactic acidosis)
4. Vitamin E
290
why do we check BUN and creatinine before surgery?
uremia interferes with platelet function so increased risk of postop bleeding = uremic platelet dysfunction
- seen in BUN >100
291
what does the coag panel show in uremic platelet dysfunction?
platelets are normal but a prolonged bleeding time
292
what is pressure support vent setting and when is it important?
pt rules the rate but a boost of pressure is given (8-20)
| - important for weaning from vent
293
what is PEEP and when is it used?
- pressure given at the end of cycle to keep alveoli open (5-20)
- used in ARDS or CHF
294
3 things that could cause HYPERvolemia and HYPOnatremia?
1. CHF
2. Nephrotic syndrome
3. Cirrhosis
295
HYPOvolemia and HYPOnatremia?2
Diuretics and Vomiting
296
Normal volume status and hyponatremia? 3
1. SIADH (CXR for lung ca)
2. Addisons
3. Hypothyroidism
297
how do you treat normo/hypervolemic hypernatremia?
fluid restriction and diuretics and stop offfending cause
298
how do you treat HYPOvolemic hyponatremia?
normal saline
299
when do you use hypertonic saline?
1. Symptomatic hyponatremia (seizures)
| 2. Na <110
300
what is the appropriate rate of infusing Na?
0.5-1mEq/hr OR 12-24mEq/day
301
how do you treat hypernatremia?
replace w D5W or hypotonic fluid
302
electrolyte abnormality: prolonged QT interval
hypocalcemia
303
electrolyte abnormality: shortened QT
hypercalcemia
304
electrolyte abnormality: ST depression & U waves
hypokalemia
305
how do you tx hypokalemia? rate?
give K but monitor renal fxn w Cr
| max rate is 40mEq/hr
306
electrolyte abnormality: peaked T waves, prolonged PR and QRS, sine waves
hyperkalemia
307
tx of hyperkalemia? 4
1. Give Ca-gluconate
2. Insulin and glucose (or albuterol or b2 agonist)
3. Kayexalate- poop out K
4. Sodium Bicarb
308
best maintenance fluid?
D5 in 1/2NS + KCl
309
Risks of TPN?
1. Acalculus cholecystitis
2. Hyperglycemia
3. Liver dysfunction
4. Zinc deficiency
310
hypercoagulable state that causes edema, HTN and foamy pee?
nephrotic syndrome (losing protein in urine aka losing clotting factors)
311
clotting disorder in old people, what do you think of?
cancer
312
whats special about anti-thrombin III deficiency?
CANNOT give them heparin! it wont work
313
most common inheritable clotting disorder?
Factor V leiden
314
young woman with multiple spontaneous abortions, what clotting disorder?
lupus anticoagulant
315
post op, decreased platelets, increased clotting,
| tx?
HIT (low platelets + clotting), occurs w/in 5-14 days of heparin
treat: agatroban, leparudin
316
isolated decrease in platelets in young woman
ITP
317
normal platelets but increased bleeding time and PTT
vonWillebrands!
318
low platelets, increased PT, PTT, BT, low fibrinogen, high Ddimer, schistocytes
DIC!
319
causes of DIC? 3
1. gram negative sepsis
2. disseminated carcinomatosis
3. OB stuff
320
topical burn med that doesnt penetrate eschar and can cause leukopenia?
Silver sulfasalazine
321
topical burn med that penetrates eschar but hurts like hell?
mafenide
322
what is a side effect of silver sulfasalazine?
leukopenia
323
topical burn med that doesnt penetrate eschar and causes hypoK and hypoNa
silver nitrate
324
what are the side effects of silver nitrate?
Hypokalemia & Hyponatremia
325
best first step for electrical burn?
EKG- if abnormal then monitor on telemetry for 48hrs
326
if see myoglobinuria in a burn patient, what do you think and what do you want to check?
Acute tubular necrosis
| Check K! produced when cells break down
327
if see cutaneous emphysema in stab wound to neck, what is first thing you do and how?
intubate! with a fiberoptic broncoscope
328
indications to take someone w a hemothorax to the OR (2)
1. >1.5L from chest tube
| 2. Greater than 200cc/hr over the first 4 hours
329
treatment for pulmonary contrusion?
good pulmonary toilet
330
treatment of flail chest?
O2 and pain control via nerve block
331
when do you suspect air embolism? 4 instances
1. Lung trauma
2. Vent use
3. Removing central line
4. Heart vessel surgery
332
a patient has confusion, petechial rash in chest, axilla and neck and acute SOB after car accident
fat embolism
333
EKG shows electrical alternans, and pulsus paradoxus
Pericardial tamponade
334
workup of penetrating neck trauma: zone 3
- above the angle of the mandible
| - check aorta (aortigram) and triple endoscopy
335
workup of penetrating neck trauma: zone 2
between angle of mandible and cricoid
| - do 2D doppler to check vessels and exploratory surgery possibly
336
workup of penetrating neck trauma: zone 1
below cricoid
| - check aorta (aortography)
337
handlebar sign makes you worry about what?
pancreatic rupture
338
pt w epigastric pain, stable, blunt trauma to abdomen, and abdominal CT shows retroperitoneal fluid?
consider rupture of duodenum
339
if do retrograde cystogram and see extraperitoneal extravasation of dye what do you do?
bed rest and foley
340
if do retrograde cystogram and see intraperitoneal extravasation of dye what do you do?
go to OR emergently
341
Ortho fractures that go to the OR? 4
1. Depressed skull fracture
2. Severely displaced or angulated fracture
3. Any open fracture (bone sticking out)
4. Femoral neck or intertrochanteric fracture
342
boxers fracture?
4th or 5th metacarpal neck fracture
343
POD1- high fever (104) and very ill appearing? tx?
necrotizing fasciitis
| tx: OR! debride and IV PCN
344
how does nec fasc spread?
in SubQ along scarpas fascia
345
common bugs that cause nec fasc?
strep and clostridium
346
POD1 high fever (>104) and muscle rigidity
malignant hyperthermia
| caused by halothane or succinylcholine
347
genetic defect leading to malignant hyperthermia? tx?
ryanodine receptor gene defect
| tx: danrolene Na
348
marjolins ulcer?
squamous cell carcinoma in a chronic ulcer
349
surgical requirements for stage 3-4 pressure ulcers?
Albumin >3.5
| Bacterial load <100k
350
what is cause if thoracentesis from pleural effusion has a: low pleural glucose?
rheumatoid arthritis
351
what is cause if thoracentesis from pleural effusion has a: high lymphocytes?
TB
352
what is cause if thoracentesis from pleural effusion has blood?
cancer or PE
353
Lights criteria for pleural effusion: determines whether or not its transudative
Transudative if:
| - LDH <0.5
354
indications for surgery in a lung abscess?
1. Abx fail
2. Abscess >6cm
3. If empyema is present
355
lung nodule: popcorn calcification
hamartoma (common and benign)
356
most common lungcancer in nonsmokers?
adenocarcinoma- occurs in scars of old pneumonia
357
where is adenocarcinoma of the lungs usually found and where does it met to?
found peripherally
| - mets to liver, bone, brain, adrenals
358
effusion from lung shows exudative with high hyaluronidase
adenocarcinoma of lung
359
pt with kidney stones, constipation, malaise, low PTH and central lung mass?
squamous cell carcinoma: paraneoplastic syndrome (parathyroid related peptide)
360
patient with shoulder pain, ptosis, constricted pupil and facial edema, smoker, central lung nodule
Superior sulcus syndrome from small cell carcinoma
361
pt with ptosis better after 1 minute of upward gaze and central lung nodule
Lamber Eaton Syndrome from small cell carcinoma- abx to pre-syn Ca channel
362
old smoker presenting with Na = 125, moist mucus membranes, no JVD
SIADH from small cell carcinoma= euvolemic hyponatremia
363
CXR showing peripheral cavitation and CT showing distant mets
Large Cell Carcinoma
364
3 criteria to diagnose ARDS?
1. Bilateral fluffy infiltrates on CXR
| 2. PaO2/FiO2 <18 (r/o cardiac)
365
Tx of ARDS?
PEEP
366
best test to evaluate for Boerhaaves?
CXR and gastrograffin esopharam
367
medical treatment for gastric varices?
octreotide or somatostatin
368
tx of incidental varices see on endoscopy?
NOTHING do not prophylactically band asx varcies, give beta blockers
369
what type of hiatal hernia needs surgery?
type 2= paraesophageal thats become strangulated/obstructed
370
gastric varices are associated with what?
splenic vein thrombosis (after chronic pancreatitis)
371
what is Dieulafoys?
vessel erodes into stomach leading to hematemisis
372
best test to diagnose duodenal ulcers?
endoscopy with biopsy (CLO test)- bc it can also exclude cancer
373
best test to diagnose SE SYndrome?
Secretin suppression test- see elevated gastrin still, (secretin is supposed to suppress it)
374
tx of SMA syndrome?
restoring weight and nutrition
| last resort: roux-en-y
375
complications of pancreatitis?
1. Pseudocyst
2. Hemorrhage
3. Abscess
4. ARDS
376
Complication of chronic pancreatitis?
can cause splenic vein thrombosis which leads to gastric varices
377
Courvoisiers sign?
palpable nontender gallbladder, itching and jaundice
| - obstructive symptoms from tumor in head of pancreas
378
trousseau's sign?
migratory thrombophlebitis associated with pancreatic cancer
379
what is whipples triad?
- used to diagnose insulinoma
1. Symptoms: sweating, tremors, hunger,
2. BGL<45
3. Symptoms resolve with glucose administration
380
characteristic rash in glucagonoma?
necrolytic migratory erythema
381
symptoms of glucagonoma 3
hyperglycemia, diarrhea, weight loss
382
type 1 choledochal cysts
fusiform dilation of the CBD
| tx w xcision
383
type 4 choledochal cysts?
Caroli's disease: cysts are intrahepatic ducts
| - needs liver transplant
384
risk factors for cholangiocarcinoma?
1. Primary sclerosing cholangitis (UC)
| 2. Liver flukes
385
AST & ALT high s/p hemorrhage, surg, or sepsis
shock liver
386
surgical procedure for portal HTN?complication?
TIPS
| complication: encephalopathy (bc prevents clearance of ammonia)
387
tx of hepatic encephalopathy?
lactulose
388
when do you do surgery for a hepatic adenoma?
when its large or the pt wants to become pregnant
389
liver bacterial abscess most commonly caused by what 3?
1. E coli
2. Enterococcus
3. Bacteroides
390
RUQ pain, profuse sweating, rigors, palpable liver
Entamoeba histolytica
| tx: metronidazole
391
Pt from mexico presents w RUQ pain and large liver cysts
Enchinococcus
mode of transmission: dog feces
lab findings: eosinophilia, + casoni skin test
tx: albendazole and surgery tor emove the ENTIRE cyst, rupture can cause anaphylaxis
392
treatment of ITP?
steroids first
| if relapse: splenectomy
393
nutritional deficit in carcinoid syndrome?
Niacin: Pellagra (diarrhea, dementia, dermatitis)
| tryptophan is used to make niacin and serotonin
394
when do you do surgery in SBO?
1. Peritoneal signs
| 2. No improvement in 48hours
395
tx of ogilvies syndrom?
if >10cm, need decompression w NG tube and neostigmine (watch for bradycardia) or colonoscopic dcompression
396
massively dilated cecum?
ogilvies
397
what medications are given for IBD to induce remission? maintain remission?
Induce: Corticosteroids
Maintain: ASA and sulfasalzine
398
Crohns disease- med given for any ulcer or abscess?
Metronidazole
399
Meds given for SEVERE IBD?
Azathioprine
6MP
Methotrexate
400
When is surgery indicated in a AAA?
if >5cm or growing >4mm/yr
401
how does papillary thyroid cancer spread? follicular?
papillary: lymph
follicuar: blood
402
what predisposes pt to thyroid lymphoma?
hashimotos thyroiditis
403
when do you surgically excise an adrenal nodule?
if >6cm or functional
404
Type of melanoma: best prognosis & most common
superficial spreading
405
Type of melanoma: poorest prognosis
nodular
406
Type of melanoma: palms, soles, mucous membranes in darker races
Acrolintiginous
407
Type of melanoma: head and neck, good prognosis
Lentigo Maligna
408
how and where does soft tissue sarcoma spread?
to lungs hematogenously
409
what other disorder is umbilical hernia associated with?
congenital hypothyroidism
410
what is the pathophys behind malrotation?
bowel doesnt rotate 270* ccw around SMA
411
where dont you give epinephrine along w local anesthesia?
fingers
nose
penis
toes
412
side effects of merperidine?
metabolite can lower seizure threshold esp in pt with renal failure
- used for general anesthesoa
413
side effects of succinylcholine?
- general anesthesia
| - can cause malignant hyperthermia and hyperK (not for burn or crush vitcim)
414
side efects of halothane?
can cause malignant hyperthermia (dantroline Na), liver toxicity
- general anesthesia
