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MTB Flashcards

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1
Q

Which Cardivascular criteria are important to assess in preop eval for surgery?

A

EF <35%
Recent MI: must defer 6 months
CHF: Medically optimize pt with ACE, BB, Spironolactone

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2
Q

What pre-op tests are necessary for pt < 35 yoa and no risk factors?

A

EKG only

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3
Q

What is workup for pt with cardiac dz hx?

A

EKG
Stress test
Echo

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4
Q

What is pre-op Risk assessment for pts with lung dz or smokers?

A

PFTs - assess VC

Pt must quit smoking 6-8 wks prior to surgery

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5
Q

What is pre-op Risk assessment for pts with renal dz?

A

Hydrate - IVF pre and during surgery

Dialysis pts - dialyze pt 24 hrs prior to surgery

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6
Q

What is first line in securing airway in pt w no facial trauma?

A

Orotracheal intubation

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7
Q

What is first line in securing airway in pt w facial trauma?

A

Cricothyroidotomy

Percutaneous tracheostomy

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8
Q

What is first line in securing airway in pt w cervical spine injury?

A

Orotracheal tube via flexible bronchoscopy

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9
Q

What is the goal oxygen saturation?

A

Above 90%

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10
Q

What are the criteria for Hypovolemic shock?

A

Pale and cool
Increase: SVR, HR
Decrease: CVP, CO, LVEDP/PCWP
Tx: Fluids and pressors

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11
Q

What are the criteria for Cardiogenic shock?

A

Pale and cool
Increase: CVP, SVR, HR, LVEDP/PCWP
Decrease: CO
Tx: tx cardiac problem

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12
Q

What are the criteria for Neurogenic shock?

A

Warm
Increase: HR
Decrease: CVP, SVR, CO, LVEDP/PCWP
Tx: Fluids and pressors

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13
Q

What are the criteria for septic shock?

A 
Warm and faint
Increase: HR, CO
Decrease: CVP, SVR
NO change: LVEDP, PCWP
Tx: Fluids, Abx, pressors
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14
Q

What is the MCC of cardiogenic shock?

A

Myocardial Infarction

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15
Q

What is the MCC of septic shock?

A

E.coli

Staph aureus

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16
Q

What is the MCC of neurogenic shock?

A

spinal cord injury

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17
Q

What is the most common cause of hypovolemic shock?

A

Massive hemorrhage

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18
Q

Bruising in the flank with abdominal trauma?

A

Grey Turner Sign

Retroperitoneal Hemorrohage = blood collections for pancreatitis

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19
Q

Bruising around umbilicus with abdominal trauma?

A

Cullen Sign
Hemorrhagic pancreatitis
Ruptured AAA

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20
Q

Pain in left shoulder with abdominal trauma?

A

Kehr sign

Splenic rupture

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21
Q

Dull percussion on the left and shifting dullness on the right with abdominal trauma?

A

Balance sign

Splenic rupture

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22
Q

Bruising where seatbelt was with abdominal trauma

Seen in what injury?

A

Seatbelt sign

Deceleration injury

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23
Q

Best initial test for evaluation free air under diaphragm

A

Upright CXR

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24
Q

What does free air under diaphragm indicate?

A

Perforation of the bowel

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25
When is AXR useful ?
Bowel Perforation | Intestinal Obstruction - i.e. ileus
26
What is the MC indication for intubation in trauma pt?
AMS
27
Workup for trauma pt with oxygen saturation less than 90?
1. Increase oxygen flow rate 2. Obtain ABG 3. Determine cause of hypoxia using hx
28
Pale, cold, shivering pt w/diaphoresis, hypoTN, tachycardia?
Hypovolemic shock
29
Causes of bleeding in hypovolemic pt?
Large volume blood in abdomen | Thigh post diaphyseal fx of femur
30
What injuries seen with thoracic trauma?
Pericardial tamponade | Tension Pneumothorax
31
Distended neck veins or high CVP seen in?
Pericardial tamponade | Tension Pneumothorax
32
What to do if pericardial tamponade?
1. CXR for enlarged heart 2. Immediate pericardiocentesis tap or window 3. EKG for electrical alternans 4. VS for pulsus paradoxus
33
What is electrical alternans?
Fluid in pericardium causes ventricular axis changes | Alteration of QRS amplitude or axis b/t beats and possible wandering baseline
34
What is pulsus paradoxus?
Drop in SBP >10mmHg during Inspiration
35
DDX for pulsus paradoxus?
Pericardial tamponade Constrictive Pericarditis COPD/Asthma exacerbation
36
Respiratory distress, Tracheal deviation, absent breath sounds, hyperresonance to percussion?
Tension Pneumothorax
37
Tx for Tension pneumothorax?
Large-bore needle or IV catheter into pleural space | Then place chest tube
38
Do we wait for CXR for dx in tension pneumothorax?
Never.
39
Management of circulation in Abdominal trauma?
1. Control site of bleeding - apply direct local pressure if known 2. Fluid resuscitation - 2 Large IV lines - Give fluids and blood - type and screen 3. Insert Foley 4. Abx
40
What to suspect in pt who is warm and flushed, hypotensive, tachycardic, hx of medical use, spinal anesthesia or exposure to allergen? TX?
Vasomotor shock | Tx: Vasocostrict and fluids
41
What is diagnostic test for Pericardial tamponade?
Echo
42
Trauma w/penetration to pericardium, secondary to broken ribs,knives, bullet wounds?
Pericardial Tamponade
43
Diff b/t Pneunothorax and tension pneumothorax?
Tension Pneumothorax - one-way leak causes tracheal deviation away from affected lung Tx: P - Chest tube placement TP - Needle decompression
44
Trauma pt with absent breath sounds and dullness to percussion?
Blood in pleural space = Hemothorax
45
CXR and CT finding on Hemothorax?
Blunting of costophrenic angle
46
Tx for hemothorax?
Chest tube drainage | possible thoracotomy
47
Trachea shifts toward involved lung?
Atelectasis
48
When do we see spontaneous pneumothorax?
Secondary to COPD Acute onset chest pain and SOB Affected side - breath sounds reduced, chest hyper-resonant to percussion
49
Pathophysiology of spontaneous pneumothorax?
Cigarette smoke causes chronic airway inflammation and respiratory bronchiolitis -> chronic destruction of alveolar sacs -> form large alveolar blebs -> rupture and leak into pleural space
50
Blood at the urethral meatus and high riding prostate - next step in management?
Retrograde urethrogram
51
High riding prostate indicative for what?
Prostate and prostatic urethra torn; membranous urethral injury
52
What is a RUG?
Retrograde injection of radiopaque contrast into urethra | visualize rupture of urethra or urethral stricture
53
What is radiopaque?
stops or reduces passage of xrays | Appear white on xray - i.e. bones
54
Next best step in pt with acute mesenteric ischemia?
Angiography
55
Post traumatic child presents with epigastric pain and vomiting?
BAT - duodenal hematoma - blood b/t submucosal and muscular layer -> obstruction Resolves spontaneously w/in 1-2 wks Tx: NG tube suction w/TPN
56
Abdominal pain after eating and bloody diarrhea?
Mesenteric ischemia
57
Best initial test in mesenteric ischemia?
CT Abdomen
58
Most accurate test in mesenteric ischemia?
Angiography
59
Tx for mesenteric ischemia?
IV Normal Saline | Surgery to remove necrotic bowel
60
Most common abdominal locations for infarction?
Watershed areas: Splenic flexure - LUQ Hepatic flexure
61
What are some causes of Mesenteric ischemia?
A fib | SMA - MC vessel
62
Pt with hx of severe incessant vomiting (alcoholism) and substernal chest pain shortly after?
Boerhaave syndrome
63
Snap, crackle, pop heard on palpation of clavicle?
Clavicular FX
64
Rapid increase in intraesophageal pressure w/negative intrathoracic pressure caused by vomiting?
Esophageal perforation
65
CXR finding of cardiac tamponade
Enlarged heart

Surgery (2 decks)

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