Shelf Flashcards
1
Q
Tx of hemorrhagic shock in urban setting
A
Surgery THEN volume replacement
2
Q
Subdural hematoma management
A
ICP monitor
Elevate head 30 degrees
Hyperventilate
Avoid fluid overload
Administer furosemide or mannitol
3
Q
Rib fracture treatment
A
Local nerve block and epidural catheter
4
Q
Pulmonary contusion
A
Pt with blunt thoracic trauma who presents with deteriorating blood gases and a white, patchy, alveolar infiltrate on CXR; also has decreased breath sounds
Can appear up to 2 days after injury but can also be on the day of
Tx: Fluid restriction; diuretics
⭐️Should also check for a comorbid aortic transection
5
Q
Given to any patient with a penetrating injury of an extremity
A
Tetanus shot
6
Q
Test to order on a patient who fell from a height and has a broken tibia or fibula
A
Lumbar or thoracic spine x ray
7
Q
Marjorlin ulcer
A
SCC developed form a ️Chronic skin ulcer
Presents as a pt. With an ulcer of many years that continuously heals and breaks down
8
Q
Tx of Breast cancer in a pregnant woman
A
Just go with surgical excision and chemo later
9
Q
Thyroid nodules
A
Get an FNA
Lobectomy if follicular Cancer
10
Q
Tx. Of meconium ileus
A
Gastrografin enema
- treats and diagnoses
- shows pellets of meconium in the terminal ileum
- works by drawing fluid in and dissolving the meconium
11
Q
Tx for obstructive arterial embolization
A
Emboli tommy with a fogarty catheter
-Add fasciotomy if it’s been 6 hours
12
Q
Strabismus Tx
A
Corrective glasses
Instantly correct deficit
13
Q
Workup for SCC of the oral mucosa
A
Triple endoscopy
- Presents in alcoholics who have rotten teeth often as a metastatic node in the neck
- may also show hoarseness, painless ulcers in the mouth, unilateral earaches
Tx: Resection; chemotherapy
14
Q
BCC biopsy
A
Must make sure to get the edge of the lesion
15
Q
Where do Branchial cleft cysts occur?
A
Along the SCM
16
Q
Suspected in a pt. With unilateral sensory hearing loss and no history of exposure to loud noises
A
Acoustic neuroma
17
Q
Acute epididymis
A
Severe testicular pain of sudden onset with fever and pyuria
⭐️Cord will also be tender
-unlike in testicular torsion
Tx: Antibiotics and US (to rule out torsion)
18
Q
Wound to the head, what management is required?
A
Angiogram to assess the Vasculature
19
Q
Exploratory laparotomy is indicated in abdominal blunt trauma if what is present?
A
Peritoneal irritation
20
Q
Pt. With a penetrating urologic injury
A
Requires surgical exploration
21
Q
Chemical burn Tx
A
Irrigate asap
Even before they come to the ER
22
Q
Day 5 of post op from laparotomy and salmon-colors fluid is weeping from the wound
A
Wound dehiscence
-Wound should be tape and re operated on to prevent evisceration of abdominal contents
23
Q
Woman with a metastatic lesion to the bone needs what workup
A
MRI
24
Q
Tx of ureteral stones larger than 7mm
A
Shockwave lithotripsy
25
Abdominal compartment syndrome
️Occurs when lots of fluids or blood have been administered during a prolonged laparotomy; the abdomen cannot be closed due to tension on the tissues
- Place a temporary mesh cover
- Can present at PoD 2
- May present as sutures cutting thru the tissue, hypoxia, or renal failure
26
Desired UOP for burn pt
1-2ml/kg/hr
27
Concern with bilateral, comminuted femoral shaft fractures
Shock
28
Pt with a fractured hip but also with a poorly controlled secondary condition
Can delay emergency surgery for 72 hrs
Conditions included COPD, a-fib, pulmonary edema, pneumonia
29
GCS
Eyes:
4- spontaneous
3- verbal command
2- respond to pain
1- no response
Verbal:
5- oriented
4- confused
3- inappropriate words
2- incomprehensible words
1- no speech
Motor;
6- obeys command
5- localized
4- Withdraws to pain
3- flexure
2- extension
1- none
30
Tx for prolonged pancreatic pseudo cyst
Endoscopic drainage
31
Pts with blunt, hemodynamically stable trauma should get what test
FAST
32
Uncal herniation
Cushing's reflex
CN III palsy
Ipsilateral hemiparesis
Contralateral homonymous hemianopsia
Coma
33
CN III palsy
Mydriasis
Down and out gaze
34
Cushing's reflex
HTN
Bradycardia
Respiratory depression
35
Blunt genitourinary traum
Usually a renal contusion ,laceration, or vascular injury; presents as CVA tenderness and hematuria
Workup: Urinalysis, CT with contrast
36
Pts with a lower sc injury need this
Urinary catheter
37
Pt with constant back pain, obstructive jaundice, and weight loss
Pancreatic tumor
- Get a CT
- If it's negative, get a MRCP to rule out probs with the ampulla of vater or cholangiocarcinoma
38
Hypernatremia correction
Use 1/2 NS w/ D5W
-For every 3mEq/L above 149, there is 1 L of fluid loss
39
Cystosarcoma phyllodes
Firm, rubbery and movable mass presenting in a woman with lack of routine care in her 20s
- grow and distort the Breast but they do not invade
- malignant potential so they must be removed
40
Congenital diaphragmatic hernia Tx
Intubation, low-pressure ventilation, NG suction
⭐️If predicted to be severe at birth, treat with extra corporeal membrane oxygenation
41
Acute transplant rejection Tx
Steroid boluses
Antithymocyte agents
OKT3 (antilymphocyte agent)
42
Pt passing a ureteral stone who develops fevers, chill,vans flank pain
Obstruction progressing to an infection
⭐️EMERGENCY
Tx: Ureteral stent; percutaneous nephrostomy
43
Venous stasis ulcer
Develops in Pts with varicose veins
-Duplex scan for work up
Tx: Pressure stockings, debridement
44
Ogilvie Syndrome
Paralytic ileus of the colon in elderly, Alzheimer's Pts who are sedentary following surgery or a broken hip
-Imaging shows a massively dilated colon
Tx: Fluid and electrolyte correction
Colonoscopy (sucks out air)
Recital tube
45
Test performed for PVD
Abi
- divides the higher ankle systolic pressure by the higher brachial artery pressure
- 1.30 indicates calcified vessels
46
Reason why you would not perform orotracheal intubation on an unstable pt
Severe facial trauma
- Ok if there is cervical trauma and the neck is stabilized
- if there is facial trauma, do a cricothyroidotomy
47
Posterior urethral injury
Most commonly ️Occurs at the bulbomembranous jnxn
Sx: Blood at the urethral meatus, inability to void, perineal or scrotal hematoma, high riding Prostate on DRE
Dx: Retrograde urethrogram
48
Gilbert Syndrome
Most common inherited disorder of bilirubin conjugation
-️Decreased UDP-glucuronsyltransferase activity
Sx: Intermittent episodes of jaundice provoked by stress like surgery, infxn, fasting, exercise
Benign in nature and requires no treatment
49
Tx of epidural hematoma
Emergent surgical hematoma Evacuation
50
Retroperitoneal hematoma
Presents in patients with a recent cardiac catheterization, Anticoagulation with heparin, sudden onset of hypotension, tachycardia, flat neck veins, and back pain
- ️Occurs due to ️Bleeding at the arterial puncture site at the femoral artery above the inguinal ligament
- ️Occurs within 12 hours of the procedure
Tx: Supportive
51
Timeline causes of post op fever
<2 hrs: Prior trauma, infection, blood product administration (febrile non hemolytic transfusion reaction), malignant hyperthermia
>24 hours: Nosocomial infection, SSI, MI, DVT, PE
> One week: C. DIF, drug fever, PE, DVT
>One month: Viral infxn, rare infection
52
Leriche Syndrome
Arterial occlusion at the bifurcation of the aorta into the common Iliacus
Triad: Bilateral hip, thigh, and butt claudication, impotence, and atrophy of the bilateral lower extremities due to ️Chronic ischemia
53
Pilonidal disease
Edematous, infected hair follicle in the inter gluteal region becomes occluded and infxn spreads subcutaneously and forms an abscess that ruptures and causes a pilonidal sinus tract
Affects young,bourse males with sedentary lifestyles
Sx: Painful, fluctuant mass slightly above the anus in the intergluteal region, mucoid or purulent drainage
Tx: I&D
54
Treatment for variceal hemorrhage
1. Place 2 large bore IV catheters
2. Volume resuscitation, IV Octreotide, and antibiotics
3. Urgent endoscopic therapy
55
Imaging test for penile fracture
Retrograde urethrogram
To evaluate suspected urethral injury
56
Primary spontaneous pneumothorax Tx
Small (<2 cm): Supplemental O2
Large: If hemodynamically stable ➡️ Needle aspiration or chest tube placed in the second or third intercostal space in the Midclavicular line
If unstable ➡️ Tube thoracostomy
57
Contraindications to surgery in general
DKA, Coma
Malnutrition (albumin <3, transferrin <200)
Smoking (stop 8 weeks before surgery)
58
Goldmans index
Tells you who is at the greatest risk for surgery
1. CHF (if echo shows <35%)
2. MI in the past 6 months
3. Arrhythmias
4. Age > 70
5. Emergent surgery
6. AOrtic stenosis
59
Assist control vent setting
Sets the tidal volume and and rate but if a patient takes a breath, the vent only Gives the volume
60
Pressure support on vent
Pts body controls the rate but a boost of pressure is given; used to wean Pts off ventilators
61
PEEP
Pressure given at the end of a breathing cycle to keep the alveoli open; used in ARDS and CHF
62
Causes of increased anion gap metabolic acidosis
```
Methanol
Uremia
Diabetic Ketoacidosis
Polyethylene glycol
Infection, iron, isoniazid, inborn error of metabolism
Lactic acidosis
Ethylene glycol
Salicylate
```
63
Signs of Hypokalemia
Paralysis, ileus, ST depression, U waves
64
Maintenance IV levels
First 10 kgs ➡️ 100ml/Kg/day
Next 10 ➡️ 50ml/kg/day
All above 20 ➡️ 20 ml/kg/day
65
Risks of prolonged TPN
Acute acalculous cholecystitis
Zinc deficiency
66
1st workup with electrical burn
EKG
67
What should be done on a pt. With a GCS < 8
Intubation
68
Neck trauma zones
Zone III: Above the angle of the mandible
-get an arteriography and triple endoscopy
Zone II: at the angle of the mandible-cricoid
-get Doppler us and exploratory surgery
Zone I: below the cricoid
-get an aortography
69
Fractures that go to the OR
Depressed skull fractures
Femoral neck fractures
Interotrochanteric fractures
Open fractures
Severe displacement
70
Causes of fever on POD 1
Atelectasis: treat with mobilization and incentive spirometry, is usually low grade fever
Necrotizing fasciitis: ️Occurs along Scarpa's fascia, give IV penicillin and debride in OR
Malignant hyperthermia: give Dantrolene
71
Fever on POD 3-5
Pneumonia: culture sputum, a give MOXIFLOXACIN until it returns
UTI: Urine culture and broad spectrum abx
72
Fever on POD >7
Central line infxn: pain and tenderness at IV site
-pull line, blood cultures, antibiotics to cover staph
Cellulitis: pain at incision site with induration and drainage
-blood culture, start antibiotics
Dehiscence: pain at incision site, seepage of salmon-colored fluid
-surgical ️EMERGENCY, go to OR, antibiotics, primary c,laure of fascia
Abdominal abscess: unexplained fever
-CT with contrast, diagnostic laparotomy, drain
73
Lights criteria
Pulmonary effusion is transudative if...
- LDH <200
- LDH effusion/serum <0.6
- protein effusion/serum <0.5
74
Benign lung nodules
Popcorn calcifications = hamartoma
Concentric calcification = old granuloma
Well circumscribed
75
MCC of lung cancer in nonsmokers
Adenocarcinoma
76
Lung cancer metastasis locations
Liver, bone, brain, adrenals
77
Patient with lung cancer, kidney stones, constipation
SCC with Paraneoplastic PTHrP
78
Patient with lung cancer, shoulder pain, Ptosis, constricted pupil, and facial edema
Superior sulcus syndrome from small cell carcinoma
79
Old smoker presenting with Hyponatremia, moist mucous membranes, and no JVD
SIADH from small cell carcinoma
80
ARDS Dx and Tx
PaO2/FiO2 <200
Bilateral alveolar infiltrates on CXR
PCWP <18
Tx: Mechanical ventilation with PEEP
81
Esophageal varices Tx
Endoscopic Sclerotherspy or banding
Do not do these prophylactic ally
82
Female athlete triad for stress fracuture
Low caloric intake
Hypomenorrhea/amenorrhea
Low bone density
83
Burn wound sepsis
Presents as fever, tachycardia, tachypnea, increased blood glucose and WBC, ️Decreased platelets, oliguria, and mental status changes
Tx: Broad spectrum abs
-Likely a gram neg org after 5 days
84
Anatomic snuffbox muscles
Medial- Extensor pollicis Longus
Lateral-Extensor pollicis brevis, abductor pollicis longus
85
Confirmation of a scaphoid fracture if the x ray is negative
MRI
86
Ileus
Functional defect in bowel motility without any associated obstruction; presents as N/V, distension, obstipation, and Hypoactive bowel sounds
-Common postoperative due to opiate administration, inflammatory mediator action,and hypokalemia
87
Prosthetic joint infection
```
Early onset (within 3 months): Presents as wound drainage, erythema, swelling, fever
-Staph aureus, GNRs, anaerobes
```
Delayed: Presents as joint pain,implant loosening
-Staph epidermidis, Enterococci
88
Post op Atelectasis lab values
Slightly basic pH
️Decreased pO2
Slightly ️Decreased pCO2
89
Dumping syndrome
Rapid emptying of hypertonic gastric contents; is a post-gastrectomy syndrome that occurs in many Pts
-Caused by loss of the normal action of the pyloric sphincter due to injury or surgical bypass leading to the shifting of fluid into the SI from the vascular space
Sx: Abdominal pain, diarrhea, nausea, hypotension, tachycardia, dizziness, confusion, fatigue, diaphoresis
Tx: Small meals, high carb, fiber, and protein diet (avoid sugars)
90
Acute Mesenteric ischemia
Can occur due to embolism from cardiac valve vegetations during endocarditis or from Pts with AFib
Sx: Sudden onset of severe periumbilical pain that is out of proportion to the expected exam, hematochezia,
Lab: Leukocytosis, elevated amylase and phosphate, metabolic acidosis, elevated lactate
Dx: CT
91
Post op infection in dehydrated old patients
Acute bacterial parotitis
Prevent with adequate hydration and oral hygeine
92
Complicated of AAA repair
Bowel ischemia
-Loss of IMA during surgery and no collateral circulation causes
Sx: abdominal pain, bloody diarrhea, fever, Leukocytosis
93
Most common complication of appendectomy
Infections, intrabdominal abscess with laparoscopic procedure
94
Follow up after diagnosis of a broken clavicle
Angiogram
95
Ischemic colitis
Abdominal pain and bloody diarrhea following a vascular procedure
RFs: Old age, chronic renal Disease, atherosclerotic disease, vascular surgery, MI
Sx: Mild pain and tenderness, hematochezia, diarrhea, lactic acidosis
Dx: CT shows thickened bowel wall and double halo
Colonoscopy shows mucosal pallor, petechiae, and hemorrhage
Tx: Supportive, IV antibiotics, colon resection
96
Blow to the lower abdomen
Consider rupture of the dome of the bladder
Leads to chemical peritonitis
97
Reynolds pentad
RUQ pain
Jaundice
Fever
Hypotension
AMS
Describes cholangitis
Tx: Ciprofloxacin and metronidazole
98
Think of this with gastric varices
Splenic vein thrombosis
And this could possibly be caused by ️Chronic pancreatitis
99
Suspected if stomach ulcers don't resolve
Zollinger Ellison
-Test with a secretin stimulation test which would normally decrease Gastrin levels
100
Whipples triad
Fasting hypoglycemia <50
Symptoms including sweat, tremors, hunger
Relief of symptoms after glucose administration
-If you see these, it's an insulinoma
101
RUQ pain, night sweats, palpable liver
Consider entamoeba histolytica
-Tx with metronidazole
102
Large livers cysts and fevers in an immigrant
Echinococcus
Transmitted thru dog feces
103
Traumatic splenic rupture
Consider with left lower rib fracture and intrabdominal hemorrhage
May also have diaphragmatic irritation
104
Most common site of carcinoid tumor
Appendix
Symptoms only appear when there are liver mets
Look out for diarrhea, dementia, dehydration, dermatitis
105
Volvulus Tx
Decompression from below if not strangulated; surgery if it doesn't work or is strangulated
Most commonly ️Occurs in the secum or sigmoid
106
Signs of PE
Right heart strain
️Decreased vascular markings
Sinus tachycardia
Low co2 and O2
107
Varicocele
Soft scrotal mass with a bag of worms appearance
⭐️Decreases in size when laying down, increases when standing or with Valsalva
US: Retrograde venous flow, tortuous tubules, dilation of the Pampiniform plexus
⭐️More common on the left due to nutcracker syndrome
Tx: Gonadal vein ligation, scrotal support and NSAIDS if you don't care about kids
108
Meningioma
Benign primary brain tumor that is usually well-circumscribed and a homogenously enhancing mass on MRI; can be calcified or appear hyper dense
Tx: Resection
109
Suspected diaphragmatic rupture
Check CXR for loops of bowel in the chest and shifting of the mediastinum
Will not always have bowel tho, sometimes it's just an elevation of he left hemi diaphragm
Also follow up with a CT scan
110
Hematuria in a AAA
️Occurs due to the formation of an aorta Caval fistula to the IVC causing venous congestion to Retroperitoneal structures like the bladder
➡️hematuria
111
Paralytic ileus
Presents as abdominal pain following a traumatic injury, surgery, ischemia, and Hypokalemia
Sx: N/V, abdominal distention,constipation, obstipation, absent bowel sounds
112
Dangers of Retropharyngeal abscess
Thrombosis to the internal jugular and deficits in CN IX, X, XI, XII after spread to the carotid sheath
Acute necrotizing mediastinitis because the Retropharyngeal space drains here
⭐️LIFE THREATENING ️EMERGENCY
113
Tx of septic shock
IV fluids
- important to restore adequate tissue perfusion
- given as boluses
Identify underlying infxn and treat
Sx: Fever, tachycardia, hypotension, poor UOP, lactic acidosis, ️Decreased albumin
114
Compartment syndrome signs and symptoms
Pain out of proportion
Pain on passive stretch
Increase swelling
Parasthesia
Uncommon: ️Decreased sensation, motor weakness, paralysis, ️Decreased distal pulses
115
Mediastinal widening with a big aorta and history of blunt thoracic trauma
Think aortic rupture
Sx: Anxiety, tachycardia, HTN
Possible deviation of the trachea or nasogastric tube
116
Acute mediastinitis
Possible complication of cardiac surgery that is due to intra operative wound contamination
Sx: Fever, tachycardia, chest pain, Leukocytosis, sternal purulent wound drainage, widened mediastinum
Tx: Surgical debridement, antibiotics
117
Emphysematous cholecystitis
Form of acute cholecystitis where there is infection with gas producing bacteria like Clostridium
RFs: Vascular compromise, Immunosuppresion, gallstone
⭐️may detect crepitus in the RUQ
118
Torus palatinus
Benign bony growth located on the midline suture of the hard palate
Due to genetic and environmental factors
Usually present for a long time, is nontender, and feels bony
Can easily ulcerate with trauma and have trouble healing
119
Anal fissure Tx
High fiber diet
Adequate fluid intake
Stool softeners
⭐️Sitz bath
⭐️Topical anesthetics and vasodilators (nifedipine, nitroglycerin)
Lateral sphincterotomy if all else fails
120
Hint for abnormal neck masses
7 days= inflammation
7 months= Cancer
7 years= congenital
121
MCCo malignant tumor of the parotid
Mucoepidermoid carcinoma
Causes pain and CN VII palsy
122
Newborn with scaphoid abdomen and respiratory distress
Diaphragmatic hernia
123
Why give epinephrine with lidocaine?
Prevent possible systemic absorption which may cause
Tongue numbness
Seizure
Hypotension
Bradycardia
Arrhythmia
⭐️ DO NOT PUT EPI IN FINGERS TOES OR PENIS
124
Person who has trouble breathing after epidural or is bradycardia
"High block"
125
Pts who qualify for immediate burn excision and grafting
Pts with small wounds with clearly defined margins
126
Interotrochanteric fracture treatment
ORIF and post op thrombosis prophylaxis
127
Pts who qualify for immediate burn excision and grafting
Pts with small wounds with clearly defined margins
128
Interotrochanteric fracture treatment
ORIF and post op thrombosis prophylaxis
129
Pts who qualify for immediate burn excision and grafting
Pts with small wounds with clearly defined margins
130
Interotrochanteric fracture treatment
ORIF and post op thrombosis prophylaxis
131
Pts who qualify for immediate burn excision and grafting
Pts with small wounds with clearly defined margins
132
Interotrochanteric fracture treatment
ORIF and post op thrombosis prophylaxis
133
Pts who qualify for immediate burn excision and grafting
Pts with small wounds with clearly defined margins
134
Interotrochanteric fracture treatment
ORIF and post op thrombosis prophylaxis
135
Zenker diverticulum
Presents as ️Chronic regurgition and halitosis
️Occurs due to a pulsion diverticulum
Tx: bisect the transpharyngeal muscle
136
Pt who has trouble swallowing liquids but no solids
Achalasia
Usually due to a loss of Auerbach's plexus in the esophageal smooth muscle
Most common motility disorder of the esophagus
Manometers shows increased LES pressure; barium swallow shows classic birds beak
137
Workup for gastric ulcer
Biopsy; could be Cancer
138
Octreotide effect on esophageal varices
Lowers portal vein pressure
139
Gastric cancer
Commonly in the antrum; usually presents with Virchows or Sister Mary Joesph node on tests
RFs: ️Chronic gastritis, h. Pylori, nitrates in diet
140
"biliary gas"
Gallstone ileus
Do a cholecystectomy, ileostomy, and take out the stone at the ileocecal valve
141
Other potential causes of lower GI bleed you don't think of
Diverticulosis ( usually right sided)
Angiodysplasia (usually left sided)
142
If unable to take gallbladder out immediately and pt is unstable, what do you do?
Cholecystotomy tube
143
Post op comps from cholecystectomy
Biliary stricture- Pt with symptoms of cholecystitis post op; treat with choledochojejunostomy
Biliary leak- Get Hida or us
144
Cholangiocarcinoma
Presents with painless jaundice
US shows dilated Intrahepatic ducts but normal common bile duct
145
Hemobilia
Presents with RUQ pain, jaundice, and GI ️Bleeding
Usually iatrogenic or traumatic
Control bleed with embolization
146
Nodular lesion with a central scar on the liver that is radiating outwards on imaging
Focal nodular hyperplasia
Only resect if it is excessively large, causing symptoms, and shows signs of potential rupture
147
Prognostic factor for heart failure in a patient with an AV fistula
Size of the fistula
148
Necrotizing Fascitis
Can present with red streaks going up arms
Will be cause by Strep pyogenes
149
Along with increased risk of aspiration, what else has an increased risk on the ventilator?
Abscess formation after infection
150
Perioral cyanosis in a pt with a ️Chronic VSD
Thinks eisenmeger syndrome
151
If any biopsy site comes back with positive borders
Reexcise the site until borders are negative, then do chemo and radio
152
Hypomagnesemia
Possible cause of Hypocalcemia when no other signs are found
153
Two days after operation, a patient presents with confusion, cyanosis, sob, fever, hypoxia, and diffuse Ronchi on lung exam.
Pneumonia
Probs due to a suppressed coughing mechanism
154
Pt presents with Condyloma acuminatum possibly
Should biopsy to rule out SCC
155
Pt who has a jejunostomy and needs feeding
Give them enteral tube feedings thru the ostomy tube
156
Toxic Synovitis
Inflammation of the hip joint that occurs in pediatric Pts after a viral infection
Pt may have a low grade fever
157
Pt who presents with an increased bilirubin and ap who also has ulcerative colitis
Think primary Sclerosing Cholangitis due to UC giving her a pANCA
158
️Chronic GERD can cause Barrett's but what else can it cause?
Esophageal strictures
These can lead to dysphagia and regurgitation of solid food
159
Pts who are in pain and also depressed
Treat their pain and the depression might get better
160
The boards may present the answer of a FAST exam as what?
Ultrasonography
161
Treatment of abdominal compartment syndrome
Temporary bowel coverage and an absorbable mesh
162
Suppurative thrombophlebitis
Excise the infected vein and give antibiotics
163
Comps of aaa surgery
Prerenal failure if clamped above the renal arteries
Impotence from nerves crossing with the iliacs
Anterior spinal syndrome
Ischemic colitis from ima disruption.
Graft infection presenting with fever and inflamed incision
Aortoenteric fistula (massive GI ️Bleeding)
164
Hurthle cells on thyroid biopsy
Get a Lobectomy if it's an adenoma; total thyroidectomy
165
Psammoma bodies on thyroid FNA
Papillary carcinoma; total thyroidectomy
166
Amyloid deposits on thyroid FNA
Medullary carcinoma; total thyroidectomy and men workup
167
Sestamibi scan
Determines which parathyroid gland is enlarged before operating in the setting of Hypercalcemia
-minimally invasive so not a bad idea to do this first
If only three glands can be found, look around ya dingus
-Don't forget, renal failure can cause a secondary Hyperparathyroidism
Still treat with partial parathyroidectomy
168
Prolactinoma
Most common pituitary tumor
Tx: Bromocriptine, Cabergoline, surgery if all else fails
169
Liechtenstein hernia repair
Uses a tension free prosthetic mesh to reapproximate the abdominal wall; very popular
Still can't do heavy lifting for 6 weeks
Still risk of nerve transection
170
Spontaneous pneumothorax Tx
Chest tub first time
Bluebectomy the second time
171
Lung Empyema
Think strep pneumoniae if community acquired or staph aureus if hospital
Treat like an abscess
172
Pleural effusion without heart failure in an older person
Cancer until proven otherwise
173
Anterior Mediastinal masses
Thymoma: will also have MG
Teratoma: make sure to get BhCG and AFP levels
Lymphoma: Biopsy
May do a thyroid scan because there could be some tissue here
Middle mediastinal masses are Cardiac or lung related
174
Congenital lobar emphysema
Baby with big bullae on their lungs; needs resection
175
What else can you see a double bubble sign with?
Midgut malrotation or Volvulus
Can also see an abnormal ligament of Treitz, bilious vomiting, bloody stool
176
Tx for biliary atresia
Kasai procedure
177
Pulmonary contusion Tx
Intubate and manage pain
178
Flail chest Tx
Peep
179
Kid who hit his abdomen on the handlebars of his bike
Duodenal hematoma
Can obstruct the duodenal lumen; upper GI series will show a "coiled spring" of 2nd and 3rd portions of the duodenum
Tx: Observe and NPO if stable; surgery if not
180
Retroperitoneal hematoma Tx
Penetrating trauma ➡️ Surgery
Blunt ➡️ Explore
181
Supracondylar humerus fracture can damage what
Median nerve
Branchial artery
182
Thoracic Outlet Syndrome
Pt will have neurologic Sx. (Can't grab things, atrophy of hand muscles) and vascular Sx (pulselessness, ulcers)
Tx: PT, surgery if seriously severe
183
Initial workup of intermittent claudication
Doppler studies to look for a pressure gradient to establish an ankle-brachial index
If gradient is
184
Parkland formula
Calculates the amount of fluids to give to a burn pt
%BSA x wt x 4cc
Give half over first 8 hrs, rest over 16 hrs
185
️Topical antibiotic prophylaxis for burns
Silver Sulfadiazine
Around eyes? ➡️ ️Topical antibiotic (normal)
186
Pt who receives a blood transfusion and develops fever, n/v, hyperbilirubinemia 3 days later
Delayed hemolytic transfusion reaction
Usually due to incompatibility with minor RBC antigens
187
Toxic lidocaine doses
4-5 mg/kg
With EPI ➡️ 7 mg/kg
188
TPN complications
Hyperglycemic, Hyperosmotic nonketotic coma
Elevated LFTs (reduce transfusion rate)
Dry and scaly skin (give more lipids)
189
Vent rate goals
Pco2 = 40 (if too high, they are Underventilated)
Po2 (increased with peep or fio2)
190
Dobutamine use
Cardiogenic shock
Causes peripheral vasodilation and increased inotropy
191
Paradoxic aciduria
Seen with bowel obstruction when the pt vomits and loses acid and fluid BUT the kidneys excrete H+ still in an attempt to retain Na+
192
Hidrsdenitis Suppurativa
Chronic skin disease characterized by collections of abscesses affecting under the arms, breasts, or butt; usually occurs in outbreaks
Can form fistulas or tracts
Occur due to irritations like acne
Treat modestly
193
First thing to do after placing a portable cheat catheter
Get an X-ray to make sure it's in the right place
194
Pt with low UOP and signs of AKF following surgery
Possible volume depletion, kidneys aren't being perfumed
Look at the Pts hemoglobin to check this
195
Ludwig angina
Abscess in the floor of the mouth with a threat to the airway
Tx with incision and drainAge
196
Bell's palsy treatment
Antivirals and/or steroids
197
Pt with a 19 year history of GERD and presenting with the symptoms of esophageal stricture. What is the initial step in management?
ESOPHAGOSCOPE AND BIOPSY
NEED TO RULE OUT CANCER
198
Management of intermittent claudication
Smoking cessation
Recommendation of a walking program
Cilostazol, pentoxyphylline
199
Coin like lesions on X-ray of an asymptomatic woman (probs one at the jnxn of every bronchus)
Sarcoidosis
200
Pt on 1/2 NS post op who develops ️Decreased UOP
Give them a Bolus of NS
201
Best study for cervical trauma
Lateral x ray
Ct scan used if you are already going to scan the head anyways
202
Pt with sunburn without blistering
Just observe it you fucking moron
203
Cornual pregnancy
Carries the risk of spontaneous abortion and rupture as ectopic pregnancies so the boards may consider them one and the same
204
Pt who is on ️Chronic corticosteroid therapy ( say someone with lupus) who develops hypotension after anesthesia administration
This patient needs corticosteroids because their adrenals are suppressed and can't respond to stress
⭐️CLASSIC PRESENTATION⭐️
205
Pt who receives massive amounts of blood and starts bleeding from every puncture site
Pt has thrombocytopenia
Dilution effect
206
Possible cause of PVCs
Hypercapnia
Think of this in a patient who might have Ventilatory insufficiencies
207
Pt with low hematocrit but presents with an unstable abdomen
I don't give a fuck do an ex lap
208
Pt with diarrhea who recently received antibiotics, any antibiotics
CLASSIC C DIF YOU DUMB FUCK
209
Unstable pt with signs of blood in the thoracic cavity
Treat it just like the abdomen; open this motherfucker
210
Pt with RLQ pain and WBCs in their urine
Consistent with the presentation of appendicitis
211
Treatment for patient with suspected pituitary apoplexy
Urgent replacement of steroids followed by regular hormones
212
Parinaud syndrome
Loss of upward gaze
Sunset eyes
Often indicates a pineal gland tumor
213
Causalgia
Constant, burning, agonizing pain that does not respond to analgesics developing in an area where there was a crushing injury
Tx: Surgical sympathetomy
214
Right sided cardiac ️fibrosis with flushing, wheezing, and diarrhea
Probable carcinoid tumor
215
Septic shock treatment
IV NS boluses to get systolic pressure > 90
IV antibiotics
Failure to respond to IV fluids? ➡️ Dopamine
216
Peritonitis signs and symptoms
Guarding
Rigidity
Reduced bowel sounds
Rebound tenderness
217
Old man with chills, fever, dysuria, urinary frequency, diffuse low back pain, and an exquisitely tender prostate on rectal exam
Acute bacterial prostatitis
Tx: IV antibiotics
218
Diagnosis and treatment of posterior urethral valves
Voiding cysts urethrogram
Tx: Endoscopic fulguration, resection
219
Vesicoureteral reflux management
Long time antibiotics until it self resolves
220
Management of BPH
Tamsulosin (alpha blocker)
Finasteride
TURP
221
Only positive total contraindication to organ transplantation
Positive HIV status
-Even hepatitis livers can be given to other people with hepatitis
222
Monitoring acute rejection for heart transplants
Routine ventricular biopsies
-Once symptoms develop, it's too late
223
Monitoring of acute rejection in liver Pts.
If liver enzymes rise, first get us and doppler to make sure it isn't of obstructive or thrombotic nature
224
Usual source of ️Bleeding in a Hemothorax
The lung, also typically will stop on its own
225
Look out for this with a sternal fracture
Myocardial contusion
226
Pt with subcutaneous emphysema in their chest after receiving an endoscopy
Probs an iatrogenic esophageal perforation
227
Air embolism scenarios
Pt with chest trauma on a respirator
Central vein line placement
Supraclavicular node biopsy
Tx: Cardiac massage, prevent by keeping a pt in the Trendelenburg position when entering the subclavian vein
228
What do you do if you get a positive FAST test?
Surgical exploration of some kind
229
Older man with iron deficiency anemia
Work up for colorectal cancer
230
Pt who has had UC for 8 years
Colonoscopy every year
Probably prophylactic Colectomy
231
Surgical treatment for internal hemorrhoids
Banding
232
Pt who has had UC for 8 years
Colonoscopy every year
Probably prophylactic Colectomy
233
Surgical treatment for internal hemorrhoids
Banding
234
Pt who has had UC for 8 years
Colonoscopy every year
Probably prophylactic Colectomy
235
Surgical treatment for internal hemorrhoids
Banding
236
Caudal displacement of the left main bronchus
Aortic dissection sign
⭐️UNUSUALLY HIGH BLOOD PRESSURES ARE A SIGN OF AORTIC RUPTURE
237
Management for acute Mesenteric ischemia
Exploratory celiotomy
238
Pt with internal hemorrhoids that are not significant but the patient is also over 50
DO A COLONOSCOPY; NEED TO PROVE THERE ISNT UNDERLYING CANCER
239
Pt with a lap choley who did not have an IOCP performed and presents two weeks later with signs of jaundice
Choledocholithiasis; dumbshits forgot the stone
240
Pt who is going to undergo serious surgery can have his intra operative risk of an MI assessed by what test?
Radionuclide scan with thallium and dipyridamole
241
What anesthetic provides the longest duration of analgesia?
Bupivacaine
242
Hidrsdenitis Suppurativa involves what glands?
Apocrine sweat glands; these are the sweat glands found in mature areas whereas eccrine ones are found everywhere
243
Cystadenoma found in the pancreas
Remove it, could become Cancer
244
Treatment for severe ovarian torsion
Some sort of exploratory surgery
245
What happens when there is excessive nasogastric suction?
Metabolic acidosis; due to the fact that the body is getting ️Decreased nutrients
Take the motherfucker out
246
Common cause of infertility in male with lumpy mass in BALSAC
Varicocele
247
Choledochal cyst
Present as a mass next to the gall bladder somewhere in the tract; produce abnormal lab values depending on the obstruction
Typically not too painful, question will have to describe it as a cystic structure
Tx: Removal
248
Best management of pelvic fracture with ongoing ️Bleeding
ARteriographic embolization
249
Treatment of bladder injury
Extraperitoneal ➡️ Foley cath
Intraperitoneal ➡️ Surgery
250
Possible sequelae of renal injury
Av fistula formation ➡️ CHF
251
Scrotal hematoma
Observation; unless testicle is proven to be ruptured
252
Treatment of compartment syndrome after a crushi injury
IV fluids
Diuretics
Alkalinization of the urine
Helps the Myoglobinuria and Hyperkalemia
253
First aid for a venomous snake bite
Just splint it and nothing else
Then gene CROFAB antivenin when possible
254
Black widow spider antivenin
Calcium gluconate
255
Brown recluse spider bite
Skin ulcer with necrotic center, may need surgery
256
Most important factor of gold mans index
JVD, treat with BBs, ACEIs p, digoxin
Followed by:
```
Previous MI
PVCs
Age > 70
️EMERGENCY surgery
Aortic valve stenosis
```
257
Nutritional RFs for surgery
Loss of > 20% body weight
Serum albumin < 3
Transferrin < 200
Tx: 4-5 days of nutritional support actually helps, 7-10 if possible
258
DKA with a septic process
Treat the sepsis along with the DKA even if it requires surgery
259
Treatment of MI perioperatively
️EMERGENCY angioplasty
260
Diagnosis and management of renal artery stenosis
Tx: Fibromuscular dysplasia? ➡️ Stent
Renal stenosis in old man ➡️ ACEIs and arbs
261
Treatment of Pheochromocytoma
Start a and b blockade before resecting
262
Aortic stenosis
Presents with chest pain, syncope, or CHF in an old man possibly with CAD
Tx: Replacement
263
Mitral stenosis
Commonly arises from rheumatic fever
Can lead to CHF and or a-fib
Tx: Medical
Balloon valvuloplasty
Replacement (mechanicals need anticoag; bovine don't)
264
CAD management
1 or 2 vessels ➡️ stent, Clopidogrel
3 vessels or left descending ➡️ CABG
265
Immediate treatment of aspiration
Bronchoscopic Lavage to remove particulate matter followed by bronchodilators and respiratory support
Done to prevent chemical injury
266
Blunt trauma who becomes increasingly difficult to bag
Intra operative tension pneumothorax
267
Pt who hasn't urinated after surgery 6 hrs later, first step in management
Foley cath
268
Evisceration management
Cover bowels in saline wrap and emergently operate
269
Factors preventing fistula healing
Foreign body
Epithelialization
Tumor
Infection, irradiated tissue, IBD
Steroids
270
Treatment of Hyponatremia
Rapidly developing ➡️ Careful infusions of hypertonic saline
Slowly ➡️ Fluid restriction
271
Rate limit of k+ administration
10 meq/hr
272
Hyperkalemia treatment
Hemodialysis
But while you're waiting, IV calcium and insulin
273
AAA sizes
3. 5➡️ screen q1yr
4. 5➡️ screen q6month
5. 5➡️ operate
Growing at a rate of greater than .5/6months➡️ operate
274
Aortic dissection triad
Tearing chest pain
Asymmetric blood pressures
Widened mediastinum
275
PVD testing
1. ABI
2. Duplex
3. CT angiogram
276
Acute limb ischemia management
1 Duplex
2 CT angiogram
Treat with embolectomy or tPA and follow up to check for compartment syndrome
277
Medulloblastoma Tx
Resection followed by radiation
Radiation because Medulloblastoma can seed thru the spinal tract
278
Pt who develops a fever after esophagoscopy
Presentation of perforation
Perform a water soluble contrast upper GI study
279
Pt who has milky chylous fluid in their abdomen
Presentation of lymphoma or lymphatic prob
Ascites would be clear fluid
280
Atrial Myxoma presentation
Pt with a physiologically split S2 and a low pitched rumbling diastolic murmur best heard at the apex that DISAPPEARS WHEN THE PATIENT LAYS ON HIS RIGHT SIDE
Typically will also present with a Cancer presentation or tuberous sclerosis
281
High output congestive heart failure
Pt will have sob, shallow respirations, normal is bp, JVD, crackles in the lungs, and an s3 and s4 (indicating high output)
These Pts will likely have had too many fluids infused or have some sort of av shunt
282
Globus tumor
Hemangioma underneath the nailbeds; exquisitely painful
283
Nipple sensory innervation
T4
284
Aldosteronoma
Can also present with increased bun and hco3
285
Lung cancer with Hypercalcemia
SQUAMOUS CELL CARCINOMA
286
Charcot effusion
"Neuropathic joint"
Triggered by a combo of mechanical, vascular, and biological factors leading to loss of sensation to the foot with a ️Chronic history of joint swelling and bony hypertrophy, there will also be osteopenia
Most commonly caused by diabetes but also syringomyelia, tabes dorsalis
Pulses will be intact usually, there will be no ulcerations
287
Borheave syndrome
Prolonged forceful vomiting that leads to esophageal perforation
Low sternal pain and epigastric pain of sudden onset soon followed by fever, Leukocytosis
⭐️very common after esophagoscope and may also present with emphysema in the lower neck
Contrast swallow is diagnostic
288
Sigmoid Volvulus x ray
"Parrots beak"
Hugely distended upper right colon
289
Large, thin walled and distended gall bladder
Think malignant obstruction of the gall bladder
290
Ampullae cancer
Malignant obstructive jaundice alongside anemia and blood in the stools
Dx: Endoscopy
291
Acute ascending Cholangitis treatment
IV abs, ERCP, followed by ️EMERGENCY cholecystectomy
Look for an extremely elevated AP
292
Treatment of biliary colic
Anticholinergics followed by elective cholecystectomy
293
Epididymitis causes
Under 35 ➡️ STD, treat with ceftriaxone and Azithromycin
Over 55 ➡️ E. Coli, treat with Cipro
294
Test to order for urinary stones
CT scan
295
Nocturnal asthma
Sign of GERD
296
Heller Myotomy
Surgery to relieve the increased LES pressure found in GERD
297
Esophageal biopsy results and Tx
Metaplasia ➡️ High dose PPIs
Dysplasia ➡️ Ablation
Adenocarcinoma ➡️ Resect
And always follow up with fundoplication
298
Dx of bore heaves
Gastrografin
Then barium
Then EGO
299
Ischemia-Reperfusion syndrome
️Occurs due to reperfusion after a period of ischemia and after something like an embolectomy and the increased perfusion pressure swells the fascial compartment
Diagnosed with compartment pressure > 30
300
Diagnosis of diaphragmatic rupture
X ray
Follow up ct of chest
Can happen weeks after the initial injury
301
Varicocele findings
Increases in size with standing and Valsalva
️Decreases in size when laying down
⭐️Dilation of the Pampiniform plexus
⭐️ Does not Transilluminate
302
Hydrocele
Peritoneal fluid collection between the parietal and visceral layers of the tunica vaginalis
Fluid is easily Transilluminated ⭐️
303
Drug to use with Cholelithiasis if pt is not a surgical candidate
Ursodeoxycholic acid
Say it the pt is really old or has really bad liver disease or some shit
304
Treatment of acute cholecystitis in non surgical candidates
Cholecystotomy
305
Choledocholithiasis Tx
ERCP
Also will do a cholecystectomy but don't forget the ERCP
306
Acute infectious pancreatitis treatment
Imipenem if infectious
307
️Chronic pancreatitis comps
Diabetes
Steatorrhea
Constant pain
308
Fibrocystic Breast disease
Bilateral Breast tenderness related to the menstrual cycle with lumps that come and go
If you perform an aspiration of a consistent mass and the fluid is clear, you're done
If bloody or mass persists, send it for cytology
309
Drug to give a woman post mastectomy
Premenopausal ➡️ Tamoxifen
Postmenopausal ➡️ Anostrazole
310
DCIS treatment
Typically a total mastectomy so you don't miss any Cancer but you do not need to do axillary sampling unless you find Cancer
311
Diarrhea with c dif
Actually isn't bloody it's just watery
