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2step > Surgery > Flashcards

Surgery Flashcards

1
Q

Bladder Cancer 65 yo smoker @ trigone, expected finding?

A

Bilateral Hydronephrosis via prolonged urinary retention

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2
Q

Beaten up in the face, decreased facial sensation over lower chin and jaw

A

Mandibular fracture distal to inferior alveolar nerve (3rd branch of trigeminal n.)

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3
Q

Hypovolemic/ hypotensive post surgery, decreased urine outflow

A

3rd spacing vs. renal failure -> bolus fluid challenge -> improve BP vs no improvement / or urinary Na ( 40 renal)

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4
Q

Signs of vascular injury requiring immediate surgery

A

absent pulses, bruit, thrill, active hemmorrhage/hematoma expanding, distal ischemia (cold/pale, paresthesia, pain, paralysis)

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5
Q

Signs of stable vascular injury but require vessel imaging

A

hx of hemmorrhage at scene, stable hematoma, decreased pulses / asymetric, proximal to major vessel, associated nerve deficit, ABI

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6
Q

Steroid use, pneumoperitoneum (air under diaphram)

A

Ulcer hx, perforated, immediate abdominal laparotomy

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7
Q

Age >40, hematochezia, constipation, weight loss, stool caliber change

A

Colon cx, Left side

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8
Q

Pt w glass eye, or missing toe (surgical), presents w liver mets

A

Melanoma: marker Tyrosinase

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9
Q

Pneumoturia

A

Colovesicular fistula (via crohns, diverticulitis, iatrogenic, foreign body, cancer) -> CT abdomen/pelvis

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10
Q

Pringle Maneuver: clams portal triad… still bleeding?

A

triad (portal vein, hepatic artery, common bile duct) yet Hepatic veins (to IVC) is not blocked and bleeds

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11
Q

Nausea Vomiting, Abd distention? –> SBO workup? Mng?

A

Abd Xray: dilated loops of bowl. NPO, NG tube decompression. Surg for severe/ worrisome ischemia

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12
Q

hypotensive /pale 28yof on birth control w vomiting and distended/ tender abdomen

A

Rutpured hepatic adenoma, benign, a/w OCP use, glycogen storage dz 1, bleed into abdomen

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13
Q

Painless obstructive jaundice (dilated biliary duct/ high alk phos). Dilated thin walled gallbladder w/o stones

A

Malignancy ie. Cancer of the head of the pancreas -> CT Scan

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14
Q

Flank pain, radiating to thigh and scrotum, Hematuria

A

Nephrolithiasis -> CT non contrast

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15
Q

RUQ pain, cholecystites w/ stones, 1 week later: bilious vomiting, air in biliary tree, dilated bowel loops

A

Gallstone Ileus -> Fistula between biliary tract and bowel-> Pneumobilia

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16
Q

Fat, Female, Forty, Fertile, colicky abd pain a/w fatty foods

A

Gallstones: confirm w/ R upper abd ultrasound, Rx: Antibiotics, IVF for cholecystitis (+fever, leukocytosis)

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17
Q

Post op abd pain / distended, nausea, constipation, dilated large bowel

A

Oglivie syndrome - colonic pseudo obstruction: Rx IV Neostigmine 2m over 10min

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18
Q

High spinal anesthetic -> hypotense / flushed, 0 central venous pressure

A

Sympathetic block -> vasodilation -> vasomotor shock Rx. Peripheral vasoconstrictor alpha agonists and IVF

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19
Q

Intra-op tachycardia, hypotensive, low urine output, decreased cardiac output, increased vascular resistance

A

Cardiogenic shock -> Rx Dobutamine (beta1 agonist) -> increased contractility and output

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20
Q

Pituitary adenoma resection -> lethargic, confused, comatosed, increased urine, dry mucosa

A

Central diabetes insipitus -> hypernatremia -> CNS pathology, Rx: IVF, Desmopressin

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21
Q

Hx chronic hepatitis B/C, cirrhosis, hepatotoxins + sx wt loss, RUQ discomfort

A

Hepatocellular carcinoma (HCC) -> monitro AFP (alpha feto- protein)

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22
Q

Inspiratory arrest w/ palpation of RUQ abd

A

Murphy’s sign: acute cholecystitis

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23
Q

Shortened leg, externally rotated -> displaced fx neck of R femur Mx?

A

Arthroplasty (prosthetic replacement) given the risk of avascular necrosis, tenuos blood supply to femoral head

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24
Q

Kid falls on outstretched arm -> supracondylar humeral fx -> closed reduction -> pain/palor/cold forearm -> ?

A

Compartment sx -> untreated (faschiotomy) -> ischemic injury: Volkman’s contracture: necrosed muscle replaced by fibrotic tissue

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25
Q

Boy 4-10 hip/groin/knee pain + antalgic gait

A

Legg-Calve-Perthes Avascular necrosis of femoral head

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26
Q

Boy 10-15 groin knee pain, chubby, hip flexed/thigh external rotated, internal rotation difficult

A

Slipped capital femoral epiphysis (SCFE) - Rx. pin femoral head

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27
Q

Hypotension w pulsatile abdominal mass

A

Ruptured AAA -> emergent laparotomy / surgical repair

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28
Q

MVC midshaft femoral fx Mx?

A

Closed intramedullary fixation of the femoral shaft

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29
Q

Airway for apneic pt w head n neck injury

A

Orotracheal intubation or cricothyroidectomy

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30
Q

AAA repair, next day febrile, LLQ pain, bloody diarrhea, leukocytosis

A

Ischemic Bowel: CT: thickening of bowel wall, colonoscopy cyanotic mucosa w hemorrhagic ulceration; surgical rx colon resx colostomy

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31
Q

Palpable crepitus at mediastinum, protracted vomiting

A

Pneumomediastinum, perforated esophagus (Boerhaave’s sd.)

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32
Q

Valgus stress test: increased laxity, tender medial knee

A

Medial Collateral Ligament tear

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33
Q

Varus stress test: increased laxity, tender lateral knee

A

Lateral Collateral Ligament tear

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34
Q

Sudden onset diffuse abdominal pain, air under diaphragm

A

Perforated gastric ulcer

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35
Q

Unilateral hip pain, middle aged adult, exacerbated by external pressure to upper lateral thigh

A

Trochanter bursitis

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36
Q

Abdominal trauma, adolescent, duodenal hematoma with obstruction Mx?

A

NG suction + parenteral nutrition (isolated hematoma)

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37
Q

Pt febrile RLQ pain, 5 days post appendicitis sx presentation

A

Perforated / complicated appendicites: Rx IVF + Cefotetan (enteric G-, anaerobes)

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38
Q

Abd trauma, epigastric pain, N&V, air in retroperitoneum

A

Duodenal Rupture: CT w contrast

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39
Q

Popping sound on passive flexion/extension of knee joint

A

Meniscal tear -> MRI / arthroscopy

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40
Q

MVC Deceleration chest trauma, decreased breath sounds, palpable mediastinal crepitus (subQ emphesyma), pneumothorax despite chest tube

A

Tracheobroncial injury / rupture -> high resolution CT -> surgical repair

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41
Q

Post trauma, decreased breathing / chest pain / discomfort, lower, mediastinal deviation, lower lobe atelectasis

A

CXR: mediastinal deviation, hemidiaphrag, bowel gas above L diaphragm -> CT contrast / barium swallow : perforated diaphragm w herniation -> surgical repair

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42
Q

Grand-mal seizure, shoulder pain, arm adducted and internally rotated

A

Posterior dislocated shoulder

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43
Q

Bone pain, diabetic, elevated ESR and leukocytosis

A

Chronic osteomyelitis

44
Q

Teen, bone pain, afebrile, joint swelling erythema, normal ESR, elevated AlkPhos, metaphysis of long bones

A

Osteogenic sarcoma (osteosarcoma), destructive lesions w periosteal formation & elevation (Codman’s triangle), sunburst pattern

45
Q

Teen, bone pain, systemic fever/wt loss, diaphysis of long bones (spine, pelvis)

A

Ewing sarcoma: small round blue cell malignancy, osteolytic onion skin pattern

46
Q

Excess hair/easy bruisablitiy, elevated cortisol, High dose dexamethasone -> ACTH still elevated

A

Small Cell Cancer of the Lung -> chemo / radiation

47
Q

Infiltrating ductal cx breast mass >4cm

A

Mastectomy w axillary sampling

48
Q

Herniation felt in the lateral aspect w examiner’s finger in the external inguinal ring

A

Direct inguinal hernia: direct through floor/posterior wall of inguinal (Hesselbach’s) triangle (inferior epigastric laterally, rectus abdominis medially, inguinal ligament inferiorly)

49
Q

Herniation felt by examiner’s finger in the external inguinal ring

A

Indirect inguinal hernia: defect in deep inguinal ring, incomplete closure of processus vaginalis, contents into scrotum/labia

50
Q

Progressive dysphagia solids&liquids, bird’s beak barium study

A

Achalasia: loss of inhibitory neurons in LES -> fail to relax: endoscopic pneumatic dilation, surgical myotomy / fundoplication

51
Q

Ranson’s criteria

A

WBC>16000, Glu>200, AST>25, LDH>350, Age>55

52
Q

Alcoholic, steatorrhea, intermittent intense epigastric pain, diabetes

A

Chronic pancreatitis! most accurate test: Secretin -> bicarb rich pancreatic secretion (- test) if functional; CT best initial

53
Q

Male w trauma to perineum / unstable pelvis (fx), unable to void, possible blood at meatus/ penile/ scrotum, high riding prostate

A

Trauma to urethra: must get retrograde urethrogram before foley!

54
Q

Distended, diffusely tender abd, mitral stenosis + irregular pulse, acidotic

A

Afib -> mesenteric thromboembolism -> bowel ischemia -> metabolic acidosis: emergent exploratory laparotomy, (mesenteric angio if stable w/o signs of ischemic bowel)

55
Q

Tender painful spot in 3rd interspace of foot between 3rd/4th toes

A

Morton’s neuroma, avoid high heels, surgical removal

56
Q

Obese old man, blood in stool, anemic, increased AlkPhos & bilirubin, dilated intra & extra -hepatic ducts

A

Duodenal cx obstructing common bile duct @ ampulla of Vater -> abd US -> endoscopy w/ biopsy

57
Q

Crushing injury, months later intense constant burning pain

A

Causalgia: reflex sympathetic dystrophy - sympathetic block relieves sx/ dx -> sympathectomy

58
Q

Incidental finding: dilated distal ureter

A

Megaureter: more common in males -> asymptomatic / hydronephrosis -> kidney failure

59
Q

Increased parathyroid hormone in postmenopausal femal, increased Ca

A

Parathyroid adenoma, Rx. Surgical removal, or Estrogen/progesterone, Raloxifen, Bisphosphonates -> decreased Ca

60
Q

Postsurgical sx hypothyroid w low T4

A

Potential adrenal insufficiency, give Steroids, before T4. ACTH if pituitary insufficiency is the cause

61
Q

Jaundiced, pruritis, wt loss, RUQ pain, conjugated hyperbilli, transaminases, hx sclerosing cholangitis, hepatomegaly

A

Obstructive jaundice 2/2 cholangiocarcinoma @confluence of hepatic ducts: US inconclusive-> CT or MRCP: ductal dilation/ small gallbladder -> ERCP cytologic dx

62
Q

Asymptomatic Bacteriuria, pregnant, E Coli

A

Nitrofurantoin, Cephalosporin (cefpodoxime), Sulfisoxazole, Amoxicillin, Amoxicillin-Clavulanate, Fosfomycin

63
Q

8 yo w/ melena, RLQ pain, intussusception, volvulus, or obstruction near the terminal ileum

A

Meckel’s Diverticulum: dx: Techtenium Pertechtinate, sx: 2 inches long., 2 feet from the ileocecal valve., 2% of population, first 2 years of life. 2 types of epithelia (gastric/pancreatic).

64
Q

Pt w/ (infection/surgery/trauma/stroke/tumor) sx. Hyponatremia, increased FENa, hypo-osmolality; fluid restriction ineffective

A

SIADH: if can’t tolerate loop diuretics, sodium tablets, give ADH antagonist: Demecocycline or Lithium

65
Q

Pt (critically ill/ post op/ hypovolemic/ sedated) abd pain, vomiting, leukocytosis, fever

A

Acalculous cholecystitis via bile stasis; US: distended gallbladde, thickened wall; Percutaneous Cholecystostomy, or if possible/stable Cholecystectomy

66
Q

High fever, jaundice, RUQ pain (charcot’s triad), high AlkPhos, mental status changes

A

Acute Cholangitis: Choledocholithiasis (stone in common bile duct), distended C bile D. on US; ERCP dx & rx

67
Q

Intermittent crampy abd pain/ bloody diarrhea; US: dilated intra/extra hepatic ducts, high AlkPhos, jaundice

A

Primary Sclerosing Cholangitis, a/w: IBD, Ulcerative Colitis, increased risk of colonic cx and cholangio cx

68
Q

Urinary frequency, dribbling, hesitancy, large prostate, distended bladder

A

Overflow incontinence: alpha antagonist (tamsulosin, doxazosin, terazosin), 5alpha-reductase inhibitor (finasteride) for BPH

69
Q

Pain, edematous arm, worst with raising arm above head, recent hx weight lifting

A

Thoracic Outlet Sd: venous->edematous; neuro TOS->paresthesia, muscular atrophy, Arterial TOS-> pulseless, ischemic

70
Q

Cold tingling muscle pain, visual & equilibrium rpoblems, maybe syncope

A

Subclavian steal sx

71
Q

LLQ abd mass, neuro deficits in L leg, increased urine epi/norepi metabolites, café au lait lesions

A

Adrenal gland pheochromocytoma -> MRI confirms (Type 1 Neurofibromatosis) v. Extra-adrenal pheo: only epi metabolite in urine

72
Q

Gunshot wound bellow 4th intercostal / nipple

A

Exploratory Laparotomy

73
Q

Post-op CABG day 10: Chest pain, fever, leukocytosis, widened mediastinum

A

Acute mediastinitis: throacotomy for drainage/debridement, antibiotics

74
Q

MVC LE weakness (ant corticospinal), loss of pain/temp (spinothalamic), proprioception/vibration is intact (dorsal column)

A

Anterior cord sx: immediate rx w/ methylprednisone. Confrimed on CT. Also post aortic aneurism repair

75
Q

MVC blunt chest trauma, increased PCWP, hypotensive, tachycardic

A

Cardiogenic shock (MI, arrhythmia, contusion, compression) -> IVF to increase PCWP to 15-20, Ionotropics Dobutamine / Dopamine

76
Q

MVC deceleration, hypertense UE, hoarse voice

A

Aortic rupture -> hematoma -> compressing: vessels - pseudocoarction & L recurrent laryngeal

77
Q

MVC blow to pelvis, full bladder, abd pain referred to L shoulder

A

Intraperitoneal rupture of bladder dome -> peritonitis -> irritating diaphragm w shoulder pain (Kehr’s sign)

78
Q

Blunt trauma to abdomen, intial CT negative. 1 week later: chills, fever, deep abd pain

A

Pancreatic laceration/contusion/crush injury -> pseudocyst -> retroperitoneal abcess -> percutaneous drainage/culture -> surgical debridement

79
Q

Mexican w atraumatic severe hemoptysis, cxr opacity in R lower lobe

A

M. Tuberculosis -> rigid bronchoscopy -> control bleeding / airway

80
Q

Chest trauma, JVD, tachy, hypotensive despite fluids

A

Pericardial Tamponade -> cardiogenic shock; rx. Pericardiocentesis / pericardiotomy

81
Q

Swollen painful calf post femoral artery embolectomy

A

Ischemic-Reperfusion sx -> interstitial/ intracellular edema -> tissue swelling -> compartment sx (pain, pallor, pulseness, paresthesia, paralysis); fasciotomy

82
Q

MVC, hours later develops tachycardia, tachypnia, hypoxia; cxr patchy uni/bilateral alvolar infiltrates

A

Pulmonary contusion; tachypnea, decreased CO2 & alkalosis; monitor, intubation /ventilation if severe

83
Q

Senior w cervical spondylosis post MVC hyperextension injury, w/ UE weakness

A

Central cord sx: damage to central portions of corticospinal pathway

84
Q

Petechia in upper body, dyspnea, confusion, fracture of long bones

A

Fat Embolism: petechial rash, dyspnea, tachypnea, severe respiratory distress, subconjuctival hemorrhage, fever, pulmonary infiltrates on cxr

85
Q

Severe onset substernal pain, widened mediastinum, medistinal air / crepitus, taking K/Cl, hx HIV

A

Esophageal perforation: Gastrograffin (H2O sol contast) study; Hamman’s sign - crunching sound on heart auscultation (pneumomediastinum); atibiotics, surgery

86
Q

MVC, pelvic, rib fx, hypotense 80/40 post fluids, FAST/ peritoneal lavage: no intraperitoneal blood/ organ damage

A

Pelvic Angiography: for dx and repair of retroperitoneal bleeds

87
Q

MVC, hypotense, distended abd, no bowel sounds

A

Hemorrhagic abdomen -> exploratory laparotomy

88
Q

Colicky/periodic abd pain/ constipation 3 days, N&V 6h, episodic high pitched bowel sounds, increased amylase, mildly acidotic

A

Complete SBO: requires surgical corrections; metabolic acidosis: ischemic strangulated bowel loop -> lactic acidosis

89
Q

Acute flank pain, hematuria, vomiting, hx Crohn’s dz, abd pain

A

Nephrolithiasis - Calcium Oxylate stones; fat malabsorption - Ca binds fat in lumen, increased unbound Oxalate absorption in blood -> stones

90
Q

Asian w recent neck swelling, mass on posterior nasal cavity, undiff cx.

A

Nasopharyngeal carcinoma; strong a/w EBV (epsteinbarvirus), smoking, nitrosamines

91
Q

Supracondylar fx Humerus, post reduction -> forarm pain, palor, cold

A

Acute compartment sx needs fasciotomy, may progress to Volkman’s ischemic contracture - dead muscle replaced by fibrous tissue

92
Q

Values suggesting post op-hypovolemia

A

FENa500, UNa/Cr>20, UBUN/Cr>20

93
Q

Hyer-reflexia, paresthesia, muscle spasm, tetany, prolonged QT, T-wave inversion; chovstek (facial nerve spasm), Trousseau (pressure cuff, forarm spasm)

A

Hypocalcemia; adjust Ca for low Albumin (add 0.8 for each 1.0 decrease in albumin); IV Ca Gluconate

94
Q

Hyer-reflexia, paresthesia, muscle spasm, tetany, prolonged QT/PR, ST depression, flat/inverted P, torsades

A

Hypomagnesemia

95
Q

Pt with Von Willebrands, preop treatment?

A

DDAVP (vasopressin analogue) releases vWB factor, shortens bleed time; cryoprecipitate

96
Q

Severe weight loss from cx, parenteral nutrition side effects

A

Refeeding syndrome: insulin increase, electrolyte shift: decreased phosphate, magnesium, potassium, hyperglycemia, hyperchloremic acidosis

97
Q

Hemophelia A pre-op treatment?

A

DDAVP with Aminocaproic acid (inhibitor of fibrinolysis)

98
Q

Hemolytic transfusion reaction

A

Give mannitol and fluids: clear hemolyzed redcells (from clumping at glomeruli), hypotensive resuscitation; alkalinize urine w NaBicarb

99
Q

Hypoglycemia, weakness, lasstitude, hyperkalemia, hyponatremia, fever, wt loss, vomiting, dehydration

A

Adrenocortical insufficiency, Addisons, chronic steroid use, acute stress (surgery); U Na decreased, no response to ACTH

100
Q

Acute renal failure post aortic angiography, increased ESR, proteinuria, FENa>1

A

Cholesterol atheroembolism to renal artery, intra-renal acute renal failure

101
Q

Extubation criteria

A

Minute ventilation 20

102
Q

Factors shifting O2 dissociation curve to the right

A

Acidosis, increased PCO2, increased temperature; (2,3 DPG shifts left)

103
Q

mnemonic for postoperative fever is the “6 W’s”

A

Wind (pneumonia and atelectasis), Water (UTI), Wound, Wonder drugs (i.e., erythromycin, isoniazid, penicillin, captopril, aspirin, allopurinol, heparin), Walking (DVT), and “What happened” (medical interventions).

104
Q

Pt recovering from acute pancreatitis, secondary to gallstones; management?

A

Once stable perform cholecystectomy

105
Q

Post op fever, decreased UO, tachypnea, hypotension, AG metabolic acidosis; dx, rx?

A

Lactic acidosis septic shock; normal saline IVF 1st, add broadspectrum antibiotics

106
Q

Post op pt develops hypotension, tachypnea, initial tachycardia then bradycardia, new onset RBBB, JVD; dx; complications?

A

Massive thromboembolism; RBBB - RHF - decreased preload -LHF - decreased CO - cardiogenic shock and bradycardia - CNS unresponsive, dilated pupil, death

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