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Flashcards in Pestana Q's Deck (102):
1

Airway management if patient is talking

Does not need to be secured

2

EMS should do what when patient is in shock and close to a trauma center

Take them right away

3

What type of shock is anaphylaxis

Vasomotor

4

Best tx of subdural hematoma

Monitor intracranial pressure
Elevate Head
Hyperventilate
Do no diurese to the point of lowering systemic pressure

5

Best treatment for rib fracture

Stop the pain so the patient can breath

6

White out on lungs days after chest wall trauma

Pulmonary contusion

7

If bleeding during trauma surgery, what do you give

10 units PRBC
10 units FFP and platelets

8

First test for urethral trauma

Retrograde urethrogram

9

Treatment of bullet to extremities if not near vessels

Tetanus prophylaxis and cleaning of wound

10

Treatment of clavicle fracture

figure of eight device or sling

11

Intertrochanteric fracture of right hip tx

ORIF and post op anticoagulation

12

Exam sign for compartment syndrome

Excruciating pain when toes are passively extended

13

Severe nutritional depletion shown by? Tx for operation to be possible

Loss of 20% body weight over past few months
Serum albumin below 3
Anergy to skin antigens
Serum Transferrin less than 200
Tx: 7-10 days of preoperative nutritional support

14

3 problems of an externally draining abdominal fistula

Fluid and electrolyte loss
Nutritional depletion
Erosion and digstion of belly wall

15

Treatment for metabolic alkalosis after vomiting

Normal saline and KCL

16

Symptoms of internal vs external hemorrhoids

External hurts
Internal bleeds

17

Best tx for small breast ca in 2nd trimester of pregnancy

Surgery, defer the rest
(can do chemo)

18

Best first test for a movable lump in the neck

FNA

19

First test in young woman with HTN and hypokalemia

Serum renin aldosterone

20

Most common type of esophageal atresia

Blind pouch in upper esophagus and fistula b/w lower esophagus and tracheobronchial tree

21

Meconium ileus x-ray apperance and diagnostic test

x-ray: multiple dilated loops of small bowel and ground glass appearance
dx: Gastrografin enema (also treats by drawing in fluid and dissolving the pelvis)

22

Vascular ring symptoms in newborns

stridor, respiratory distress, crowning respiration (where baby assumes a hyperextended position)

23

FEV1 to make lung cancer operatable

800 mL (per lung)

24

Tx for complete distal artery occlusion

Embolectomy with fogerty catheter
(add fasciotomy if several hours passed before revascularization)

25

Skin cancer that is raised and waxy

Basal cell

26

Strabismus in an older child indicates

Exaggerated convergence caused by refraction difficulties, fixed by corrective lenses

27

Workup of SCC of oral mucosa

Triple endoscopy
Seen in old men who smoke and drink and have rotten teeth
Often first sign is metastatic node in the neck

28

What is ludwig angina

Abscess in the floor of the mouth (threat to airway)

29

Preferred tx for chronic mitral stenosis

Surgical commisuratomy or ballon valvuloplasty

30

Best test to confirm aortic dissection

Spiral CT

31

Cavernous sinus thrombosis symptoms

Diplopia (from EOM paralysis) in patients with sinusitis

32

Acute epididymitis presentation and management

Fever, pyuria, swollen testis (but testis in normal position)
Do US to rule out torsion and give Ab

33

Colicky pain after a young guy drinking his first beers

Ureteropelvic junction obstruction

34

best dx for skin cancer

full thickness biopsy at the edge of the lesion

35

Branchial cleft cyst description

Anterior edge of SCM muscle
Sometimes has a opening and blind tract in the skin overlying them

36

Cystic hygroma features

large, mushy, ill defined mass as the base of the neck that occupies the entire supraclavicular area
*CT before removing to be sure no mediastinal invasion*

37

What type of chemo for testicular cancer

Platinum based

38

When is acute rejection seen

5 days - 3 months
*Technical problems more common*

39

What is it when a testicle is in the canal at birth, but can easily be pulled to where it belongs

Overactive cremasteric muscle, not an undescended testicle

40

When does blunt trauma to the abdomen require and exploratory lap

When signs of peritoneal irritation (acute abdomen) devlop

41

How are penetrating urethral injuries explored

Surgery

42

RUQ mass that moves up and down in a baby most likely?

Malignant liver tumor
Afp will be elevated

43

Deep unmovable RUQ mass in baby likely

Wilms tumor or neuroblastoma
CT to figure out

44

Easiest way to biopsy breast mass

Mamographically or monographically guided multiple core biopsies

45

Genu varum normal ages

Bowlegs - up to age 3

46

Genu valbus normal ages

knock knee- up to 8

47

Dinner fork fracture

Colles fracture - fall on outstretched hand in older women, fracture of the distal radius

48

What happens when femur is driven backwards (hitting dash in car wreck)

Posterior dislocation of the hip
*Leg internal rotated*

49

What can palmar fascial nodules be felt in

Dupuytren contracture

50

Two clinical findings used to predict operative mortality in those with liver disease

1. Encephalopathy
2. Ascites

51

3 lab findings used to predict operative mortality in pt's with liver dz

Albumin, INR, Bili

52

Child class mortalities

A: 10%
B. 30%
C: 80%

53

Tx of pyogenic liver abscess? likely 2/2?

Percutaneous drainage
Likely 2/2 gall bladder disease

54

When are umbilical hernias normal in children

When they are 2-5 years old

55

Test if mammogram is indeterminate

Radiographically guided core biopsy

56

What must follow lumpectomy for breast cancer

Radiotherapy

57

When to biopsy vs resect lymph nodes in breast cancer removal

If not palpable, sentinel node biopsy
If palpable, resection

58

Test for persistant headache or bone pain in women who recently had breast cancer

MRI to look for mets

59

3 possible things that can be seen in a newborn with bilious vomiting and a "double bubble"

1. Duodenal atresia
2. Annular pancreas
3. Malrotation (also will se a normal gas pattern distal)

60

Bilious vomiting and multiple air-fluid levels throughout abdomen in newborn

Intestinal atresia

61

Subdural hematoma + retinal hemorrhages in baby

Shaken baby (child abuse)

62

Chronic constrictive pericarditis presentation

DOE, hepatomegaly, ascites
Square root sign (equalization of pressures b/w heart chambers)

63

Excruciating back pain in a patient with a large AAA means

Aneurysm is already leaking

64

First manifestation of squamous cell of oral mucosa

Metastatic neck nodes

65

What should never be done on squamous cell carcinoma of the oral mucosa? what do you do instead

Never do open biopsy - will interfere with surgical approach of the tumor
FNA instead

66

Two year old with any unilateral ENT signs

foreign body

67

Brain vs inner ear dizziness

Brain: unsteadiness but room stable
Inner ear: room is spinning

68

Bradycardia and Hypertension from brain mass caused by

Cushing reflex

69

Signs of brain tumor with shorter timeline likely? Best test

Think brain abscess
Use CT head (works as well as MRI and cheaper)

70

Most common reason for a newborn boy to not urinate during the first day of life

Posterior urethral valves

71

What establishes prostate Ca diagnosis

transrectal needle biopsy

72

Most common tool to take out large ureteral stones? Who can't get it

Extracoporeal shock wave lithotripsy (ESWL)
Can't do on pregnant woman, heavy bleeders, and cm large stones

73

Who gets chronic subdural hematomas? why?

Very old and severe alcoholics
Shrunken brain is rattled around the head by minor trauma, tearing venous sinuses

74

What do you do if abdominal compartment syndrome develops during ex lap

Place a temporary cover over the abdominal contents

75

High riding prostate means

Urethral injury

76

How do you diagnose a bladder injury

Retrograde cystogram, including post void films

77

Imaging for suspected posterior shoulder dislocation

Axillary or scapular lateral views

78

When can femoral shaft fractures cause shock

If bilateral and comminuted

79

What is needed for displaced ankle fractures

Open reduction and internal fixation

80

Most common herniated disk areas

L4-S1

81

Worst single predictive finding for cardiac risk before surgery

Jugular venous distension

82

Watch out for development of what in malignant hypothermia

Myoglobinuria

83

Zero urinary output usually caused by

mechanical problem, rather than a biological one

84

Best fluid for severe dehydration

D5 1/2 NS

85

What should be added to Nissen procedure if severe dysplastic changes are seen

radiofrequency ablation

86

Medical Tx for rectal fissure

Dialtezam

87

Blood per rectum in child likely? what test

Likely Mekel's
Start workup with technetium scan, looking for ectopic gastric mucosa

88

First test after US shows dilated gall bladder? Next?

CT abdomen for pancreatic cancer
If neg, ERCP to look for bile duct or ampulla cancer

89

When does a pancreatic abscess develop

Fever and leukocytosis 10 days after pancreatitis onset

90

Real problem with congenital diaphragmatic hernia? Tx

Hypoplastic lung (will still have fetal type circulation)
Wait 3-4 days to allow maturation
Extracorporeal membrane oxygenation

91

What is necrotizing entercolitis

Seen in premature infants when they're first fed
Rapidly dropping platelet count (sign of sepsis in babies)
Surg if abdominal wall erythema and air in portal vein seen

92

Only way to rule out bladder cancer

Cytoscopy

93

RCC odd features

hypercalcemia, erythrocytosis, elevated liver enzymes

94

Acute rejection tx

Anti-thymocyte serum and steroid bolus

95

Sudden chills and fever spike in renal stone indicates? tx?

Indicates obstruction and infection
Place nephrostomy tube or uretal stent

96

Venous stasis ulcer description and tx

Indurated and hyper pigmented skin over medial malleolus that isn't painful
Duplex scan for workup, then physical support to keep the veins empty

97

What is Ogilvie syndrome

Paralytic ileum of colon seen after surgery in senile elderly
Fluid and electrolyte revelation, then colonoscopy to suck out air and place long rectal tube

98

First step in workup for disabling intermittent claudication

doppler studies to look for ABI
If bad do CT angio or MRI angio

99

What should be suspected in adult with "mild" generalized acute abodomen

Primary peritonitis
*cultures of peritoneal fluid will only show a single organism*

100

Scalloping of ribs seen in

Coarctation of the aorta

101

Diagnostic test for Hirschsprung's

Full thickness biopsy of rectal mucosa

102

Two most common brain tumors in children

1. Medulloblastoma (cerebellar syndromes)
2. Ependymoma (knee chest position to open flow of CSF)