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Pestanas Extras Flashcards

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1
Q

If airway needed in pt w/ potential cervical spine injury, what do you do first?

A

Secure airway before dealing w/ cervical spine injury

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2
Q

Fiberoptic bronchoscope for airway mandatory when…

A

subcutaneous emphysema in neck - sign of major traumatic disruption of tracheobronchial tree

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3
Q

quickest and safest way to temporarily gain access to airway if intubation can’t be done normally

A

cricothyroidotomy (reluctant if

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4
Q

CVP in tension pneumothorax and pericardial tamponade

A

high (note: there IS respiratory distress w/ tension ptx, but not w/ tamponade)

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5
Q

Tx for cardiogenic shock

A

circulatory support - add’l fluid and blood in this setting would be lethal!!

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6
Q

Flushed “pink and warm” shock pt - what type of shock?

A

Vasomotor shock

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7
Q

Linear skull fracture tx

A

None (if closed); open - wound closure; comminuted or depressed - OR

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8
Q

Mgt significance of base of skull fracture

A

Assess integrity of c spine (CT); avoid nasal endotracheal intubation

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9
Q

chronic subdural hematoma in who

A

very old or severe alcoholics (shrunken brain)

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10
Q

stab wounds to upper and middle neck zones in asx pts - mgt?

A

observation

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11
Q

burst fracture of vertebral body think

A

anterior cord syndrome

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12
Q

Thoracotomy/surgery needed for hemothorax when

A

1500mL or more when chest tube inserted or 600mL in drainage over ensuing 6 hrs

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13
Q

If big deceleration injury, concern for

A

traumatic rupture of aorta

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14
Q

Air emoblism prevention

A

trendelenburg position when great veins at base of neck are to be entered

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15
Q

Only 3 places where 1500mL of blood could “hide”

A

abdomen, thighs, pelvis

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16
Q

pelvic hematoma mgt

A

left alone if not expanding

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17
Q

mgt of penetrating urologic injuries

A

as a rule surgically explored and repaired

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18
Q

respiratory burns - dx? how to decide whether respirator needed?

A

fiberoptic bronchoscopy for dx; ABG for respirator decision

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19
Q

tx for snakebite if envenomation

A

draw blood for ype and crossmatch, coag studies, liver and renal fn, antivenin (CROFAB)

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20
Q

tx for black widow bite

A

IV calcium gluconate

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21
Q

tx for brown recluse spider bite

A

dapsone; surgical excision possibly but should be delayed till full extent of damage evident (up to 1 wk)

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22
Q

Hand cut from punching someone - tx?

A

extesnive irrigation and debridement in OR

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23
Q

genum varum - what? when normal?

A

bowlegs, normal up to age 3; beyond that is blount disease (surgery)

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24
Q

Genu valgus - what? when normal?

A

knock-knee, normal b/w 4-8yo, no tx needed

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25
osteogenic sarcoma - age, location, x ray typical
10-25yo, around knee,sunburst x-ray
26
ewing sarcoma - age, location, x ray typical
5-15yo, diaphyses of long bones, onion-skinning xray
27
multiple myeloma - dx? tx?
xrays are diagnostic - multiple punched-out lytic lesions; tx chemo, thalidomide if chemo fails
28
colles fracture is a fracture of which bone? tx?
distal radius; tx closed reduction and long arm cast
29
femoral neck fracture complication?
especially if displaced can compromise very tenuous blood supply of femoral head (faster healing and earlier immobilization w/ replacing femoral head w/ prosthesis)
30
intertrochanteric fractures mgt
open reduction internal fixation , post-op anticoagulation
31
why do you need emergency reduction of posterior hip dislocation?
tenuous blood supply of femoral head -> avascular necrosis
32
tx for gas gangrene
IV penicillin, extensive emergency debridement, hyperbaric oxygen
33
morton neuroma - inflammation of what?
common digital nerve
34
ARDS mgt
PEEP but avoid excessive volume (barotrauma); find source of sepsis and correct
35
post-op hypernatremia caused by
large, unreplaced water loss, e.g. surgical damage to posterior pituitary w/ urecgonized diabetes insipidus
36
paralytic ileus prolonged by
hypokalemia
37
presumed paralytic ileus not resolving after 5-7d most likely
early mechanical bowel obstruction due to adhesions
38
how to estimate water loss based on hypernatremia
every 3 mEq/L of serum sodium concentration is above 140 represents about 1` L of water lost
39
safe speed limit of potassium administration
10 mEq/h
40
most cases of metabolic alkalosis can be corrected by
abundant intake of KCl (allows kidney to correct problem); rarely ammonium chloride or 0.1 N HCl
41
key finding to establish edematous nature of pancreatitis
elevated hematocrit (vs lower hematorcrit for hemorrhagic pancreatitis)
42
when to do necrosectomy if necrotic pancreas
wait at least 4 wks
43
prior to surgery for pheochromocytoma must prep with
alpha blockers
44
CXR w/ scalloping of ribs think
coarctation of aorta
45
GERD w/ severe dysplastic changes tx
radiofrequency ablation plus laparoscopic nissen fundoplication
46
Carcinoid dx
24hr urinary 5-hydroxyindoleacetic acid
47
Heart sx for carcinoid
right sided heart valvular damage -> prominent jugular venous pulse
48
Abx for cdif
Metronidazole tx of choice, vanc alternative
49
SCC of anus tx
Nigro chemoradiation protocol (90% success rate), surgery if residual tumor (rare)
50
Only cause of severe abdominal pain AND blood in lumen of gut?
ischemic process affecting bowel (e.g. mesenteric ischemia)
51
tx of primary peritonitis
abx, not surgery
52
parrot beak air-filled loop in RUQ is
volvulus of sigmoid
53
abdominal bleeding + birth control pills think
hepatic adenoma - tendency to rupture/bleed inside abdomen (CT -> surgery)
54
malignant obstructive jaundice looks like what on sonogram?
large, thin-walled, distended gall bladder (courvoisier-terrier sign)
55
how to biopsy ampullary cancers?
endoscopy
56
dx of malrotation
contrast enema or upper GI study (more reliable but more risky)
57
firstborn boy 3wks old w/ nonbilious projectile vomiting after each feeding
hypertrophic pyloric stenosis
58
exertional syncopal episodes classic for
aortic stenosis
59
Definition of "abdomen" gunshot wound
any entrance or exit wound below level of nipple line
60
Intraabodominal gunshot unjury best assessed by
exploratory laparotomy
61
Metabolic alkalosis (e.g. from loss of gastric juice) correction
abudnant intake of KCl (e.g. NS + KCl)
62
Mechanical intestinal obstruction tx
NPO, NG suction, IV fluids w/ observation for strangulation (surgery w/in 24hrs of complete obstruction or w/in a few days for partial)
63
obstructive jaundice caused by stones mgt
sonogram -> endoscopic retrograde cholangiopancreatography (ERCP) + sphincterotomy to remove common duct stone, then cholecystectomy
64
thyroid nodule diagnostic method
FNA (if benign, follow but don’t intervene, if malignant/indeterminate then thyroid lobectomy)
65
arterial LE emoblization from distant source mgt
tx w/in 6 hrs; doppler; early incomplete occlusion - clot busters; complete obstructions - embolectomy w/ fogarty catheter, consider fasciotomy
66
what to avoid if suspected base of the skull fracture
nasal aendotracheal intubation
67
Penetrating urologic injuries mgt
as a rule surgically explored and repaired
68
Bromocriptine
Dopamine agonist, can be used for prolactinoma, parkinson's, pituitary tumors
69
Hypernatremia mgt
If slowly D51/2NS, if rapid, D51/3NS or even D5W
70
When to repair AAA?
5-6cm or growing 1+cm/yr
71
prolactinoma tx
bromocriptine (or similar); transnasal, trans-sphenoidal surgical removal if want to get pregnant or don't respond to bromocriptine
72
workup for acromegaly
somatomedin C and pituitary MRI; surgical removal preferred, radiation an option
73
loss of upper gaze and sunset eyes - what? called?
Tumor of pineal gland, "Parinaud syndrome"
74
Dx and mgt of brain abscess
CT (more expensive MRI not needed); actual resection required
75
causalgia several months after
crushing injury
76
SAH workup
1) CT 2) Arteriogram 3) Clipping/Coiling
77
UTI obstruction and infection mgt
IV Abx, Immediate decompression
78
vesicoureteral reflux tx
treat infection w/ empiric abx, then voiding cystouretherogram. if reflux, long term abx until kid "grows out of problem"
79
Workup of hematuria
CT scan then cytoscopy
80
BHP urinary retention first line therapy
alpha blockers; alpha-reductase inhibitors for very large glands
81
Most common cause of pneumaturia
fistulization b/w bladder and GI tract, most commonly sigmoid colon, most commonly from diverticulitis
82
first line therapy for acute rejection
steroid boluses

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