Step 2 Surgery Flashcards
(149 cards)
1
Q
What cord damage are pts at risk of with degenerative joint disease in the cervical spine? What are the S/S?
A
Central Cord Syndrome: weakness pronounced in the upper > lower extremities from damage to central corticospinal tracks (leading to arm predominant sympt) and lateral decussating spinothalamic tracks (causing specifically loss of pain and temp).
Older pts are at risk with DJD with injury involving hyper flexion of the neck.
2
Q
Dx: pt with a hx of blunt chest trauma, elevated jugular veins, hypotension unresponsive to IV fluids, distant heart sounds.
Why do some have Normal or abnormal Cxray?
Trmt?
A
Acute pericardial tamponade.
Normal Xray if ACUTE b/c it only takes 100-200 mL of fluid to cause symptx of pericardial tamponade. VS Chronic fluid build up (2/2 malignancy or renal probs) giving the pericardium time to stretch and retain more fluid (1-2L). Fluid compresses chambers to cause decrease blood flow into the heart (causing JVD) and poor CO (refractory hypotension)
Immediate surgical pericardotomy or pericardiocentesis
3
Q
What do the S/S of suspected intraperitoneal bleed look like 2/2 blunt abdominal trauma? Which 2 organs are MC causing the bleeding? How would you manage the pt?
A
Abdominal distention, abdominal ecchymoses, and hypoactive BS = S/S
Spleen/Liver
Use fluid resuscitation first. If unstable, use FAST (focused assessment with sonogram for trauma) to assess the heptorenal, splenorenal, or infra peritoneal areas for free fluid. If non-confirmatory, Diagnostic Peritoneal Lavagae (DPL) can be done. If the pt is STABLE, a CT can be done in place of this. If any of the above is positive = ex lap
4
Q
Tracheal deviation could be from what three things? With distended neck veins, what two things could it be? W/ suspected TPnthx, what do you do first? What if they remain hemodynamically compromised s/p your first step?
A
Tracheal deviation could result from opposite side TPnthx or hemothorax or sam sided lung collapse.
W/ distended neck veins, cardiac tamponade or Tpnthx.
Immediate needle decompression in the 2nd/3rd intercostal space in midclavicular line or 5th intercostal space in midaxillary line. Chest tube placement THEN follows.
Do a FAST to look for missed pericardial tamponade if still unstable.
5
Q
S/P surgery a pt has hyperactive reflexes after needing multiple transfusions, what electrolyte abnormality is suspected? Why?
A
Hypocalcemia 2/2 citrate in transfused blood will bind the calcium.
6
Q
Sarcoid can also present with diffuse interstitial infiltrates, uveitis, erythem nodosum, and patchy rales….T/F?
A
True
7
Q
Three causes of RUQ pain s/p cholecystectomy?
A
1) Sphincter of Oddi Dysfunction - seen with increased manometry reading of sphincter
2) Retained Common Bile Duct Stones
3) Functional Pain = dx of exclusion
8
Q
Pts with AF should be risk stratified with what system? How do you manage respective levels?
A
CHADS2 = CHF/Hypertension/Age>75/DM/Stroke or TIA (2 pts)
For 0 pts = no anticoag or aspirin
For 1 pt = anticoag or aspirin
For 2 or more = anticoag
Anticoag = warfarin, Rivaroxaban Dabigatran, Apixaban
9
Q
ARDS is caused by? Respiratory trmt re: PEEP and TV?
A
Inflammatory mediators from local or systemic sepsis, trauma or inflammation. This causes increased alveolar capillary permeability and bilateral fluffy infiltrates.
Mechanical ventilation with a PEEP from 5 - 15 may be necessary with a TV of 6ml/kg. Watch out for barotrauma or PNThx.
10
Q
What kind of tremor increases at the very end of goal-directed activities like reaching for an object, drinking from a glass, finger-to-nose testing?>
A
Essential tremor - give propanolol
11
Q
During the work-up of hyperthyroidism, what is your best initial medication mgmt for the symptomatic pt?
A
Propanolol to help control symptoms while you work them up. Want a radio iodine uptake study unless pregnant, then would start PTU instead.
12
Q
Child with headaches and hypertension with a to-fro murmur auscultated in the CVA, MC’ly = ?
A
Fibromuscular Dysplasia - can hear the venous hum at the CVA 2/2 well-developed collaterals. Right renal artery is usually more affected. See string of beads on angiography.
13
Q
All hemodynamically unstable pt with penetrating abdominal trauma warrant?
A
Immediate exploratory laparotomy
14
Q
MC Causes of osteo in kids? Other causes? What is they had a prosthesis?
A
Stap Aureus = MCC. Others = GBS and E. Coli in infants and Strep Pyogenes in children. Strep Epidermitis if prothesis present.
15
Q
Pulsatile mass in the right groin area?
A
Femoral artery aneurysm - below the inguinal ligament. It may be associated with AAA; it’s the 2nd MC aneurysm following popliteal aneurysm.
16
Q
Stroke on the non-dominant parietal cortex most likely causes a pt that does what?
A
Hemineglect
17
Q
Man presenting with a hx of being sick, unilateral lymphadenopathy, “hot potato voice”, and deviated uvula = dx? Mgmt?
A
Peritonsilar abscess 2/2 tonsillitis. Needle peritonsillar aspiration
18
Q
What are pts with Hasimoto’s Thyroiditis at risk for x60? What does it look like on U/s?
A
Lymphoma of the thyroid; pseudo cystic pattern on U/S - present with compressive symptoms, don ought sign on CT (wrapping around trachea) can be missed by needle aspiration so a core biopsy is necessary
19
Q
Hypothyroidism increases the risk of what additional lab findings?
A
Hyperlipidemia, hyponatremia, and asymptomatic elevation in CK and LFT’s.
20
Q
What PE signs would differentiate SBO from paralytic ileus?
A
Auscultated tinkling and visible peristaltic waves
21
Q
What drug do you give to decrease dermatitis herpetiformis?
A
Dapsone
22
Q
Pts with prolonged QT are at increased risk of syncope, ventricular arrhythmias (torsades) and sudden cardiac death - trmt for those asympotmatic and symptomatic?
A
All its should receive Beta blockers and specifically avoid potassium channel blockers (could worsen the QT prolongation). If symptomatic, long-term pacemaker placement should be considered
23
Q
Syndrome with sudden death, congenital sensorineural deafness, and QT interval of 600 = ?
A
Jervell and Lange-Nielsen
24
Q
Metabolic causes of prolonged QT?
A
Hypocalcemia, Hypokalemia, and Hypomagnesemia
25
Kawasaki Disease Dx:
Fever >5 days + 4 of the following:
- bilateral nonexudative conjunctivitis
- mucositis (fissured/injected lips, injected parynx, and strawberry tongue)
- cervical lymphadenopathy with at least one LN being > 1.5 cm
- erythematous polymorphous rash
- extremity edema or erythema
Trmt = aspiring + IVIG; also get baseline Echo with repeat in 6-8 weeks; also watch out for Reye's Syndrome (hepatic encephalopathy 2/2 aspirin)
Complications = coronary artery aneurysms and MI's
26
Acromegaly has what feared complication? Other complications? What's the excessive factor that leads to bone and soft tissue overgrowth?
Congestive Cardiac Failure - 2/2 insulin-like GF I (IGF-I)
Other complications = hypertension, respiratory causes, and malignancy
27
A widened pre vertebral space with drooling, truisms (can't open mouth fully), muffled/hoarse voice = beware of? MCpathogens?
Retropharyngeal Abscess! Polymicrobial with strep. progenies and staph aureas. Presents with hx of recent infxn.
28
Exposure to dirt/sand where cats and dogs have been with a new onset of erythematous papule with subsequent serpiginous, reddish brown elevated lesions in an ascending track makes you think of?
Cutaneous Larva Migrans = Ancylostoma Braziliense
29
Acalculous cholecystits RF's?
Hospitalized its with extensive burns, severe trauma, prolonged TPN, prolonged fasting, and mechanical ventilation.
30
Think of this whenever you have an isolated and asymmetric arthritis in the presence of urethritis, conjunctivitis, or mouth ulcers…What else might you see on PE? Trmt?
Reactive Arthritis = seronegative spondyloarthropathy - affects knee and sacroilliac joints MC'ly. Enthestitis might also present (tendon insertion pain). Sterile synovial analysis.
Give NSAIDS
31
MCC of vitreous hemorrhage?
Diabetic retinopathy. Will see poor visibility of the funds, floating debris, dark red glow, only light perceived by pt.
32
What to do if myasthenia gravis pt doesn't respond first to pyridostigmine/neostigmine? What would you give to induce remission?
Then can move to corticosteroids. Only use plasmapheresis to (a) stabilize the patient before thymectomy or (b) myasthenia crisis
Steroids or thymectomy
33
Chronic malabsorptive diarrhea (steatorrhea, flatulence, abd distention), protein losing enteropathy, weight loss, migratory non-deforming arthitis, lymphadenopathy, and low grade fever = ? See on bx?
Whipple's Disease 2/2 Tropheryma Whippelii - dx with small intestinal biopsy and PCR - would show PAS-positive macrophages containing non-acid fast gram positive bacilli.
34
Pt with suspected lung cancer and hypertension, hypokalemia, elevated blood glucose, and proximal muscle wasting = ?
Small-cell lung cancer producing ectopic ACTH - high levels of cortisol can work on the mineralocorticoid receptor to cause hypertension and hypokalemia.
35
Differentiate patellofemoral stress syndrome vs. patellar tendonitis, and traction apophysitis...
PFS is seen in runners and is exacerbated by walking down-hill or down stairs but X ray shows nothing. PT shows point tenderness just on the inferior pole of the patella. And the last is the true Osgood-Schlatter disease where rapid development causes traction/pulling of an immature tubercle causing it to lift up or fragment.
Treat with stretching, NSAIDS, and rest
36
Trmt of Lambert Eaton?
Plasmapharesis and immunosuppressive therapy.
*Wouldn't see myasthenia gravis in a pt with lung cancer sympt
37
Pts with mullerian a genesis have a blind ended vagina and normal uterus/ovaries and female phenotype with XX genotype. Why can't it be androgen insensitivity, 5-alpha reductase def?
These both have XY genotype.
38
How does Nocardia appear on gram stain and who is at risk? Trmt/proph?
It's a gram positive partially acid fast filaments -(crooked/branching beads). AIDS, lymphoma, or transplant pts are at risk - props/trmt = Bactrim
39
Hyperkalemia + non-anion gap metabolic acidosis with very mild/mod renal insufficiency = ? Associated disease? Problem with what?
This is Type 4 RTA = hyperkalemic non-anion gap metabolic acidosis 2/2 to dysfunction in the distal collecting tubule (where aldosterone acts) so H+ and K+ are retained 2/2 to commonly associated DM which causes juxtaglomerular damage resulting in hyporenin hypoaldosteronism.
40
Loop diuretics cause what electrolyte imbalance? Laxative abuse?
Hypokalemia and metabolic alkalosis
Hypokalemia and non-anion metabolic acidosis
41
T/F - can go straight to surgery with classic appendicitis?
True - only get CT if not classic presentation
42
When to get a plasma exchange in pt with MS?
If refractory to high-dose corticosteroids
43
trmt of Mumps?
Supportive
44
What distinguishes Folate and B12 def?
MMA and homocystein elevated in B12 but only homocysteine in folate. Also, folate can become depleted faster (3-4mo) vs. 3-4 yrs with B12. Strict vegetarians are at risk of B12 def.
45
Eczema Herpeticum = ?
Primary herpes simplex virus that is associated with atopic dermatitis. Numerous umbilicated vesicles over the area of the healing atopic dermatitis are typical with fever and adenopathy.
*THIS CAN BE LIFE THREATENING IN INFANTS - give acyclovir
46
Ataxia, dysarthria, scoliosis, hammer toes = ? MCC of death?
Friedreich's Ataxia - Concentric Hypertrophic Cardiomyopathy
47
Pain from duodenal ulcers _____ with food vs. gastritis and gastric ulcers?
decreases
48
Bullous myringitis?
Serous filled blisters on the tympanic membrane
49
Best trmt for molluscum contagiosum?
Curettage and application of liquid nitrogen
50
Miliaria = ?
Heat rash - superficial aggregated small vesicles, papules, or pustules over the trunk which are associated with burning and itching - commonly seen in people living in warm moist climates.
51
Management of Pancreatic Pseudocyst?
It normally resolves spontaneously but should be drained if it becomes infected, lasts for > 6 weeks, or is > 5cm in diameter. Feared complication is it erodes into blood vessel.
52
Watch out for this in a post-op pt with decreased urinary output, abdominal pain, elevated BUN and Cr…? Trmt?
Post-operative Urinary Retention = common complication of surgery and anesthesia. Increased risk with age and high fluid intake.
Get a potable bladder scan. Next step would be to cath the pt.
53
Norepinephrine use in a hypovolemic patient can cause what 3 problems?
Vasoconstriction in tips of distal extremities, renal failure, and mesenteric ischemia.
54
Rapid onset of severe pain and vision loss in one eye, headache, seeing halos around lights, injected eye and the pupil is dilated and not responsive ?
Acute Angle Glaucoma
55
Tartrate resistant acid phosphatase stain + CD11c marker = ?
Hairy Cell Leukemia (enlarged spleen seen)
56
What kind of seizure would be provoked by hyperventilation?
Absence seizure - EEG shows spike and wave form
57
Juvenille Myoclonic epilepsy is seen in whom?
Mostly kids in the morning after being sleep deprived and have unilateral or bilateral myoclonus
58
Huntington's Chorea has what characteristic feature on CT?
Atrophy of the caudate
59
How does thyroglobulin help you in the work up of thyroid disease?
If there is low uptake on the RAIU scan, elevated levels of thyroglobulin will tell you if it's an endogenous process vs. low levels meaning it's coming from an exogenous source
60
Tendons in the carpal tunnel?
Flexor digitorum profundus, Flexor digitorum superficialis, and flexor pollicis longus
61
Brown Sequard syndrome is associated with damage to what nerve tracts?.
lateral spinothalamic tracts causing contralateral loss of pain and temperature
62
What would help you differentiate restrictive vs. hypertrophic cardiomyopathy?
LV volume is normal In restricted, and the wall size may be symmetrically thickened vs. inter ventricular septum being the thickest part in hypertrophic cardiomyopathy
63
Two CC of brain abscess pathogens?
Streptococcus and Bacteroides (anaerobic)
64
How would you manage a pt presenting > 5 days after signs of appendicitis?
Interval appendectomy if they are clinically stable and give IV abx, bowel rest, and percutaneous drainage (maybe)…do this 2/2 likelihood of them have a ruptured appendix with a contained abscess
65
Give pneumococcal how often in pts with liver disease?
1 dose with repeat five years later
66
Besides the typical Marjolin ulcer, what other things have been found to be associated with SCC?
Osteomyelitis, Radiotherapy scars, and venous ulcers
67
Alcohol and tobacco history with palpable cervical LN = most likely cancer?
SCC - get panendoscopy
68
Whats the next step in managing bone pain in prostate cancer who have undergone orchiectomy?
Radiation
69
With someone presenting with signs of blood loss and malignant lymphoproliferative disorder, suspect what? trmt?
Autoimmune hemolysis is commonly seen as "warm autoimmune hemolytic anemia" (IgG against RBCs)- associated with CLL or NHL
Give prednisone and if refractory, splenectomy
70
Drug induced chronic renal failure is MC'ly caused by? Urinalysis ?
Analgesic nephropathy - pt has polyuria with sterile pyuria (WBC seen and casts w/o bacteria) - can also see papillary necrosis
71
Someone between the age of 5 - 40 with new mood swings, liver failure, and brownish to gray/green rings of fine granular copper deposits in the cornea =? Gold std? Trmt? Associations?
Wilson's disease (genetic mutation causing defect in ceruloplasmin)! Person can also display signs of parkinsons.
Gold std dx = liver biopsy with hepatic copper > 250. Also confirms with presence of low ceruloplasmin < 20
Give d-penicillamine or Trientine to chelate copper. Oral zinc also recommened to prevent Cu absorption. Liver transplant may be only trmt for those in fulminant hepatic failure.
72
Move to endoscopy with dyspepsia if these alarm symptoms are present...
Age > 55, wt loss, gross or occult bleeding, anemia, dysphagia, persistent vomiting or early satiety…otherwise be more conservative (breath test or stool assay for H Pylori)
73
Trmt for hyperclacemia 2/2 malignancy?
Hydration, calcitonin and bisphosphonate therapy (interferes with osteoclast activity) when levels are > 12….< 12 doesn't require trmt aggressively
74
Needle Cricothyroidotomy is preferred to surgical cricothyroidotomy in children < ?
12 yrs
75
Use orotracheal intubation with cervical spine injuries unless you see?
Maxillofacial trauma (severe), hemorrhage in retropharyngeal space, significant airway edema
76
Tinnititus, Fever, Tachypnea, Nausea, and GI irritation with an overdoes =?
Aspirin (Salicylate) overdose causes resp. alkalosis and anion gap metabolic acidosis
77
With suspected intra-abdominal bleeding 2/2 splenic injury, if the pt responds to fluids via SBP > 100 mmHg, what should be done next?
Abdominal CT - only if they are hemodynamically unstable to you go straight to laparotomy
78
Parinauds syndrome = ? Associated with? What kind of endocrine abnormalities are seen?
Paralysis of the vertical gaze with possible association with pupil disturbances and eyelid retraction (Collier's sign). Located around superior colliculus and CN III - MC caused by germinomas and pinealomas. See HPA axis interruption with increased sex hormones (coarse hair, pubertal hair), and sometimes beta=hCG and consequent Leydig cell stimulation.
79
Stepping on a nail and later developing osteomyelitis = ?
Pseudomonas! Especially if they are wearing shoes!
80
Rhizopus is MC'ly seen in what pts and originates in what part of the body?
Diabetic pts have this grow in the paranasal sinuses and extend into the orbit and brain
81
Pts with UC should start colonoscopy screening when? And then maintained at what intervals? Worsening signs of prognosis?
Start after 8 years of dx regardless of age for risk of adenocarcinoma. Then get one every 1-2 years. Worse prognosis if PSC is present.
82
Causes of Ductopenia? (decreased qty of Bile Ducts)
MC = PBC in adults. Other causes = failing liver transplantation, Hodgkin's disease, Graft verses host disease, sarcoid, CMV, HIV, etc.
83
Signs of necrotizing wound?
Intense pain, fever, hypotension, tachycardia, decreased sensitivity around edges of wound, cloudy gray discharge, tense edema subcutaneous gas with crepitus….SURGERY INDICATED!!!
84
Uncontrolled infection of the skin, orbit, or sinus can cause? What would you see? Imaging choice?
Cavernous Sinus Thrombosis. See headache, papilledema, V, binocular palsies, periorbital edema, decreased/increased sensation. Get an MRI. Broad specturm antibiotics to prevent cerebral herniation. Red flag symptoms = severe HA, bilateral periorbital edema and CN 3,4,5,6 defecits
85
________ Is a mechanically induced degenerative neuropathy commonly seen in runners that present with pain b/w 3rd/4th toes reproducible with palpation on PE.
Morton Neuroma - hear a clicking sound with pain when palpating plantar area of 3rd/4th metatarsal and squeezing those toes together
86
SIBO is 2/2 to what two things?
Anatomic abnormalitis/changes or dysmotility disorders. Gold Std = Jejunal aspirate with > 10^5 organisms. Associated with strictures/surgery/DM/scleroderm/AIDS/advanced age
The glucose breath test would also show immediate high results from the proximal migration of bacteria into the small intestines
Trmt = 7-10 days of Augmentin or Rifaximin
87
PNAs occuring in the same place make you think of?
Something that's causing obstruction, get imaging (CT)to assess for signs of malignancy, bronchiectasis, adenopathy, etc
88
Pts who smoke and were plumbers, electricians, carpenters, pipe fitters, and insulation workers, construction, shipbuilding, and rubber = risk of?
Bronchogenic carcinoma 2/2 asbestosis exposure. Mesothelioma is LESS common than lung cancer!!!
89
Foot drop is commonly caused by?
Peripheral neuropathy. Also common peroneal nerve involvement is common with any root involvement that contributes to this nerve (L4 - S2).
Can also be seen in Charcot Marie Tooth Disease
90
Duodenal hematomas are seen classically after? Do what with them?
Trauma. Most spontaneoulsy resolve in 1-2 weeks
91
This disease is transmitted primarily by ______ in the US and causes Hydrophpobia and Aerophobia ith pharyngeal spasms. Trmt?
Rabies. Raccoons. Give Rabbies IG and the vaccine to save their life - will see ascending paralysis
92
Postgastrectomy complication involving cramps, weakness, lightheadedness and diaphoresis = ?
Dumping syndrome - 2/2 hyertonic gastric content into the duodenum so fast
93
Cat bites should be treated prophylactically with five days of?
Amoxacillin/Clavulanate
94
EPO side effects:
Worsening hypertension, headaches, flu-like symptoms and red cell aplasia.
95
Trmt for malignant Otitis Externa>
IV Cipro
96
Trmt of choice for pregnant or lactating women or for kids < 8 with Lyme disease?
Amoxicillin
97
Trmt choice for conjunctivitis in infants 13 days old?
Oral erythromycin for suspected neonatal Chlamydial conjunctivitis
98
Severe pancreatitis can result in...
Local release of activated pancreatic enzymes that enter the vascular system and increase permeability leading to acute drop in fluids - see abdominal distention
99
Those wishing to not undergo surgery for unilateral adrenal adenoma can get what therapy?
Mineralocorticoid antagonists = spironolactone or eplerenone or amiloride or triamterene
100
Pt with hx of RA would have what on renal biopsy?
Amyloidosis!!!! Deposits of apple-green birefringence under polarized light after staining with Congo red
101
Trmt of MALT lymphoma?
Omeprazole, Clarithromycin and Amoxicillin
102
Post-op cholestasis occurs in what setting?
S/p prolonged surgery with hypotension, extensive blood loss, and massive blood replacement
103
Pts with symptomatic 3rd degree heart block should be managed with?
Temporary pacemaker
104
Normal JVP?
< 3cm above sternal angle
105
Mortality benefit meds for s/p MI:
Aspirin, B-Blcokers, ACEi, Lipid lowering statin….
Also add clopidogrel in UA/NSTEMI/ p/o PCI pts = anti-platelet by blocking ADP
106
3 causes of renal colic w/o stones on Xray?
1) Radiolucent stones (uric acid, xanthine)
2) small calcium stones < 3mm
3) non-stone ureteral obstruction
107
Treatment of uric acid stones?
hydration, alkalization of the urine, and low purine diet. Use potassium citrate! Allopurinol can be added in addition if refractory.
108
When do you consider giving:
1) FFP
2) Platelet Transfusion
3) Desmopressin
4) PRBC's
1) to reverse ACUTELY warfarin (ie emergent surgery)
| 2) Plt < 50,000 (bleeding pt or < 7
109
Only time where a thoracentesis ISN'T done first to investigate it's cause?
CHF - trial of diuretics
110
Four T's of anterior mediastinal mass?
Thymoma, Terrible Lymphoma, Teratoma, Thyroid Neoplasm
Teratoma category = other germ cell tumors. Seminoma's DONT have AFP, but can have bHCG
111
Chronic, progressive non-tender mass that extends through planes of tissue (MC'lythe mandible) creating a fistula and draining sinus tracts = ? RF?
Trmt?
*Sulfur granules
Cervical Actinomyces
RFs = dental caries, infected tooth, local trauma, gingivitis, DM, immunosupression, malnutrition, irradiation
Gram + anaerobic filamentous branching bacteria
Trmt = 12 wks of Penicillin - maybe surgery if severe
112
Initial Hematuria =
Terminal Hematuria =
Total Hematuria =
1) injury to urethra
2) injury to bladder
3) injury in kidneys or ureters
113
Child who has Hep B will have what type of GN?
Membranous!!!
114
Amitriptyline can cause what kind of urinary problem?
Retention b/c it's a TCA, which has anticholinergic properties inhibiting detrusor contraction and urethra relaxation
115
Guy has problem and pain with reaching or lifting his arm above his head with hx of repetitive actions like this = ? Clue? Definite dx?
Rotator Cuff Tendonitis
Improves with lidocaine injection. MRI
*adhesive capsulitis can even move the arm bc of fibrosis
116
DKA dx and initial management?
pH < 7.3, + ketones, and Glucose > 250
Normal saline (0.9%) and insulin
117
Considerations for surgical trmt for AS?
Syncope, Angina, and Dyspnea - treat with Aortic Valve Replacement
118
Causes of thyrotoxicosis = ? Elevated T3/4, low TSH, low uptake on scan
MC = subacute lymphocytic (painless) thyroiditis (MC'ly in PP women)
Subacute Granulomatous Thyroiditis = painful
Other = levothyroxine overdose and iodine induced thyrotoxicosis
119
Hypotension can lead to what liver path?
Shock liver - sky high LFTs (2,000's)
120
Cholesterol emboli happen when and with what symptoms?
S/P procedures normally and cause "mottling" of the skin: lived reticular is, blue toe syndrome, abdominal pain. Can develop pancreatitis. Increased eosinophils and decreased complement suggest the dx.
121
MC valvular prob in IE?
MR
122
MC problem seen with meconeum ileus in the future (what is this disease)?
Sinopulmonary disease 2/2 Cystic Fibrosis
* bc freq infections needing aminoglycosides (for pesudo) can also see a lot of its developing hearing loss too!
123
When would you do a diagnostic peritoneal lavage?
In presence of a non-confirmatory FAST with a patient having BLUNT abdominal trauma.
*ANY PENETRATING WOUND BELOW THE NIPPLES AND HEMODYNAMICALLY UNSTABLE - EXPLORATORY LAP!
124
Timeframe for fibrinolytics vs PCI>
PCI = 90 min door to balloon
Thrombolytics = 30 min door to needle
125
One of the major hematological complications of Infectious Mono = ?
Autoimmune Hemolytic anemia and thrombocytopenis = 2/2 cross reactivity of EBV-induced Ab's against RBC's and platelets = IgM cold-agglutinin AB's = Anti-I antibodies which lead to complement mediated destruction of RBCs = Coombs +
126
Severe blunt trauma can cause what kind of injury that would show up as dyspnea, tachyponea, CP, hypoxemia WORSENED by fluids with patchy irregular alveolar infiltrates>?
Pulmomary Contusion
127
PBC associated with?
Sjogren, Raynauds, Scleroderma, Celiacs, autoimmune thyroid disease and hypothyroidism.
128
Dementia, gait disturbance, and incontinence ?
Normal pressure hydrocephalus = decreased absorption of CSF
Memory loss with no focal defects
129
Where are bronchogenic cysts, thymomas, and neurogenic tumors found?
middle, anterior, and posterior mediastinum respectively
130
Who to not use Succinylcholine in?
Crush or burn victims that were in their accident more than 8 hrs ago (enough time for rhabdo to start; demyelinating syndromes (Guillain Barre) and Tumor Lysis Syndrome - causes increased risk of hyperkalemia b/c its a depolarizing neuromuscular blocker
131
This is the most prevalent predisposing factor to orbital cellulitis?
Bacterial sinusitis
132
What veins are MC source of PE?
Deep veins of proximal leg = iliac, femoral, and popliteal
133
Diarrhea, hypokalemia, leg crams, decreased stomach acid, facial flushing, and redness ?
VIPoma - replace IV fluids and attempt to stop diarrhea with octreotide - if no mets, attempt surgery
134
Optic neuritis presents with?
Severe pain, acute loss of vision, swollen disk, central scotoma, and pupillary abnormalities
135
Meds causing hyperkalemia?
NSAIDS, ACEi, ARBs, Amiloride, non-selective beta adrenergic, Digoxin
136
When to give Ca gluconate for elevated K?
Levels > 7, ECG changes, or rapid increase from tissue breakdown
137
Blood Transfusion Reactions:
1) fever/chills within 6 hrs no hemolysis
2) Fever, flank pain, DIC, within 1 hr, + coombs, hemolysing
3) mild feverm, 2-10 days after, coombs +
4) rapid shock, angioedema, urticaria, resp distress - few seconds
5) Uritcaria, flushing, angioedema, pruritis W/O shock
1) Febrile Nonhemolytic = MC = cytokine accumulation in blood storage
2) ABO incompatability
3) Delayed Hemolytic 2/2 anamnestic antibody response (body has seen it before)
4) Anaphylactic - 2/2 recipient anti-IgA antibodies
5) Urticarial/allergic 2/2 IgE Ab's and mast cell activation
138
Ascending aortic aneurysms patho vs. descending?
cystic medial necrosis (aging) or connective tissue (marfan, ehlers-danlos)
Atherosclerosis, hytn, hypercholesterolemia, smoking
139
Sudden onset of unilateral facial paralysis with usability to raise eyebrow, or close eyes, drooping of mouth, and disappearance of nasolabial fold + decreased tearing, hyperacusis, and loss of taste sensation = ?
Bells Palsy = peripheral nerve problem vs. if pt can still raise eye brows etc means its a central nerve problem and further neuro workup is needed!
140
Someone on a thiazide diuretic with chalky white nodules that are painful = ?
Chronic tophaceous gout! These diuretics block renal clearance of uric acids
141
Palpable step off seen on PE with back pain and neurogenic dysfunction = >
Spondylolithesis
142
_____ causes increase renal ammonia production in hepatic enceph. This metabolic alkalosis converts ammonia to ammonium therefore it's important to...
replace potassium, give lactulose, or rifaximin
143
Impairment in vision in one eye where color perception is inhibited, pain with eye movement. Afferent pupillary defect and central scotoma...
Optic Neuritis - more common in pts with MS
144
Trigeminal neuralgia trmt?>
Carbamazepine
145
What to do next after initially diagnosing Myasthenia Gravis>
CT - look for thymoma
146
SIADH trmt?
Fluid restriction and salt tablets for mild disease; severe = hypertonic saline
147
Severe jaundice, fever, and RUQ pain = ? Can see this with hypotension and confusion too…trmt
Ascending Cholangitis - supportive care and antibiotics but if this doesn't work do ERCP to decompress the biliary tree
148
Episodic flushing, wheezing, diarrhea, and valvular heart disease ith TR = ?
Carcinoid Syndrome - can become deficient in Niacin
Cutaneous telangiectasias can also be seen
149
Arterial/venous thrombosis + thrombocytopenia with recent hospitalization = ?
HIT2
