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Flashcards in U-World Deck (109):
1

Who is most likely to get acute bacterial parotitis? Most common agent?

Dehydrated post op patients and the elderly
S aureus most common agent

2

ABI diagnostic for PAD

ABI

3

Besides ABCs, what must always be done in trauma pt's

Rigid fixation of the cervical spine

4

Drug fever facts

Ass w/ use of anticonvulsants, antibiotics (b-lactams, sulfas) or allopuinon
Typically 1-2 weeks after initiation of therapy

5

Cushing's reflex signs

Hypertension, bradycardia, and respiratory depression following inc ICP

6

What herniates in transtentorial herniation

Parahippocampal uncus

7

What causes the classic coloration of stasis dermatitis

Erythrocyte extravasation causing hemosiderin deposition

8

Most common early sign of venous stasis? late disease?

Xerosis early
Lipodermatosclerosis and ulcerations later

9

Heparin regimen after first DVT

Started then transitioned to >3 months warfarin therapy with INR goal 2-3

10

When do you start heparin after surgery

48-72 hours

11

Charcot's triad

Fever, severe jaundice, and RUQ pain
For ascending colangitis
(+ confusion and hypotension for Reynold's pentad)

12

First line tx in preventing post-op pneumonia

Incentive spirometry

13

Non-displaced scaphoid fracture mgmt

Wrist immobilization for 6-10 weeks
If x-ray neg, immobilize for 7-10 days and follow up X-ray

14

Artery and nerve likely damaged in anterior shoulder dislocation

Axillary

15

3 main contributors to post op ileus

1. Increased splanchnic nerve sympathetic tone following violation of peritoneum
2. Local release of inflammatory mediators
3. Post op pain meds

16

Pro-motility antibiotic

Erythromycin

17

Next step after inconclusive FAST? If neg?

DPL
If neg - look for signs of extra-abdominal hemorrhage

18

Multiple air-fluid levels on abdominal x-ray

Small bowel obstruction

19

Inc lactic acid in SMO indicates

Sign of strangulation --> go to OR

20

Treatment of choice for sphincter of Oddi dysfunction

ERCP with sphincterotomy

21

Most common site of acute mesenteric ischemia? Gold standard for Dx?

SMA
*pain out of proportion to exam findings*
Mesenteric angiography is gold standard for diagnosis

22

Key reason for intubation in airway burn patients

Progressive airway edema may preclude intubation later in patients clinical course

23

Abdominal succussion splash a sign of? dx test?

Pyloric stricture
Endoscopy is dx test

24

3 symptoms of retroperitoneal abscess

fever, chills, and deep abdominal pain

25

What does not help in diagnosis of pancreatic trauma

Serum amylase values

26

Atelectasis blood gas picture

Respiratory alkalosis due to increased work of breathing

27

Patchy alveolar infiltrate after chest wall trauma

Pulmonary contusion

28

CXR of pericardial tamponade

Normal cardiac silhouette without tension pneumothorax

29

Most common pediatric fracture? Risks?

Supracondylar humerus fractures
Risk of entrapment of brachial artery or median nerve

30

Femoral nerve action and senstation

Lex flexion at the hip and extension at the knee
Gets medial aspect of thigh and lower leg

31

CXR for aortic injury

Widened mediastinum and left sided hemothorax

32

Acute back pain + profound hypotension

AAA rupture

33

What is dumping syndrome

After gastrectomy, emptying of hypertonic gastric content into duodenum --> fluid shift into small intestine, stimulating autonomic reflexes (cramps, weakness, diaphoresis)

34

Best time to take out gallbladder in cholecystitis

Within 72 hours

35

Posterior urethral injury is associated with what kind of fractures

Pelvic

36

Who can have a delayed presentation to diaphragmatic rupture

Children

37

What can increase FRC after surgery besides spirometry

Elevating the head of the bed, chest physiotherapy, and coughing

38

Virus assocaited with nasopharyngeal carcinoma

EBV
*seen in far east and mediterranean*

39

Hypotension after cardiac cath with back or flank pain? Dx test

Retroperitoneal hematoma
CT abdomen/pelvis

40

Cancer that arises from a non-healing burn would

SCC

41

Strangulation def

Loss of blood supply to the bowel wall

42

Blood loss % for orthostatic hypo? General hypo + Tachy

Ortho: 20-30%
Resting tach: 30-40%

43

How much blood can one hemithorax hold

50% of blood volume

44

Leriche syndrome triad

Bilateral LE claudication, impotence, and symmetric atrophy of the bilateral LE

45

Cause of subacute presentation of delayed onset prosthetic joint infection? Tx?

Staph epi
Removal of the infected prosthesis

46

Most commonly injured nerve in mid-shaft of the humerus fracture

Radial nerve
*Weakness in extension - drop wrist*

47

Ulnar nerve injury causes

Claw hand

48

Immediate fever after surgery (101-103) likely?

Transfusion reaction

49

Paget's lab

Elevated bone specific alk phos

50

Most common cause of lower extremity edema

Venous insufficiency (valvular incompetence)

51

Unstable fall in elderly with broken hip first step

Cardiac workup (concerning for syncope)

52

Rapid decompensation after subclavian catheter placement could be

Tension pneumothorax -> do needle decompression

53

Neck pain, fever, and limited neck mobility secondary to pain

Retropharyngeal abscess

54

Where should a needle thoracostomy be performed

Second intercostal space (b/w 3rd and 4th ribs) at the midclavicular line

55

First step in limb ischemia treatment

Heparin bolus followed by continuous heparin infusion

56

PEEP in hypovolemic shock

Bad, decreases venous return to heart, thus decreasing preload

57

Procedure of choice for bad lung bleeding

Bronchoscopy - identifies site of bleed and helps attempt early therapeutic intervention
*Thoractomy after*

58

Superficial unilateral hip pain exacerbated by external pressure to upper lateral thigh (like when lying in bed)

Trochanteric bursitis

59

After trauma, slightly elevated PCWP that increases greatly after volume repletion

Left ventricular dysfunction caused by myocardial contusion

60

First two indicators of hypovolemia

Tachycardia and peripheral vascular constriction

61

Most common predisposing factor for aortic dissection

Hypertension

62

Most common cause of hypoparathyroidism

Post-surgical
*hypocalcemia and hyperphosphatemia in presence of normal renal function*

63

Serum PO4 in vit D def

Usually low

64

Most common bone to be affected by stress fracturs

Tibia

65

Colonoscopy of bowel ischemia

Discrete segment of cyanotic and ulcerated bowel

66

Patients who present with appendicitis >5 days after onset of symptoms have a high incidence of?

Perforation with abscess formation

67

Nasal septum perforation likely a result of?

Septal hematoma

68

Standard treatment approach for complicated diverticulitis with abscess formation

CT guided percutaneous drainage

69

Most feared complication of retropharyngeal abscess

Infection into the mediastinum --> can lead to acute necrotizing mediastinitis

70

Type of hypoxia narcotics can cause

Alveolar hypoventilation
(normal A-a gradient and respiratory acidosis)

71

What is torus palantinus

Benign bony growth located on the midline suture of the hard palate

72

Most important early steps in flail chest

Pain control and supplemental oxygen
*PEEP causes flail chest to move normally*

73

Oliguria and inc. BUN > Cr ratio post op likely? Rule out what first

Likely acute pre-renal from hypovolemia
Rule out catheter obstruction

74

Tx for duodenal hematoma

NG tube with parenteral nutrition

75

4 T's for mediastinal mass diff fx

Thymoma
Teratoma (and other germ cell tumors)
Thyroid neoplasm
Terrible lymphoma

76

Seminoma tumor marker

Elevated b-HCG
(Normal AFP)

77

RLQ pain without guarding or rigidity could be

Psoas abscess
Do CT abdomen

78

MCC of blood nipple discharge

Intraductal papilloma
*US can be normal b/c can only pickup 1 cm and greater*

79

Odd pancreatic Ca features

constant, gnawing epigastric pain that is frequently worse at night
Anorexia with weight loss
Jaundice

80

All patients with a clavicle fracture should have what? Why?

Careful neuromuscular exam (angiogram and physical for neuro)
Rules out injury to underlying brachial plexus and subclavian artery

81

Penile fracture tx

Retrograde urethrogram followed by surgical exploration of the penis

82

Ab x-ray of paralytic ileus shows

air-fluid levels and distended gas filled loops of both the small and large intestines

83

What is the RQ

Respiratory quotient: depends on the proportion of metabolic fuels being oxidized for ATP
1.0 = predominant oxidation of carbs and net lipogenesis
>1 carbs
0.8 = protein
0.7 = lipids

84

Amputated finger prep

Wrap part in saline-moisturized gauze, seal in a plastic bag, and place on ice

85

Positive arm drop sign in shoulder injury indicats

Rotator cuff tear

86

Long thoracic nerve injury causes

Winged scapula

87

Who gets acalculous cholecystitis? Tx?

Critically ill patients -> Tx if Ab and percutaneous cholecystostomy followed by cholecystectomy when medical condition stabilizes

88

Acalculous cholecystitis likely from

Cholestasis and gallbladder ischemia leading to secondary infection by enteric organisms, leading to edema and necrosis

89

What causes bowel ischemia after AAA repair

Inadequate colonic collateral arterial perfusion to left and sigmoid colon after loss of IMA during aortic graft placement

90

Mediastinitis presentation

Post op (w/in 14 days) with fever, tachycardia, CP, leukocytosis, and sternal wound drainage

91

Mediastinitis treatment

Drainage, Surgical debridement and antibiotic therapy

92

3 most reliable signs of blunt abdominal trauma

Abdominal pain
Tenderness
Peritoneal signs

93

Valgus stress test for what ligament

MCL

94

Hypoparathyroidism characterized by?

Low calcium and elevated PO4 levels in presence of normal renal function

95

Most common complication of thyroidectomy

Hypocalemia

96

Prolonged surgery followed by hypotension, extensive blood loss into tissues, and massive blood replacement likely

Postoperative cholestasis

97

Parotid surgery involving the deep lobe of the parotid gland carries and significant risk of?

Facial nerve palsy resulting in facial droop

98

What is indicated for circumferential full-thickness burns of an extremity with an eschar? Why?

Escharotomy
Eschar formation can compromise circulation, causing significant edema distal to burn

99

When is a penetrating would considered to involve the abdomen

Any below the 4th intercostal space (i.e below the nipples)

100

What can aortic dissection cause when it extends into the major vessels

Impending stroke, acute renal failure, and LE weakness or paraplegia

101

Most important steps in management of lactic acidosis from septic shock

IV normal saline with or without vasopressor therapy to maintain pressure and Ab to correct underlying infection

102

Why shouldn't you put a foley in w/ suspect urethral trauma

Predisposes patient to abscess formation and worsening of the urethral damage

103

What is eschar

Firm necrotic tissue classical formed on exposed tissue following burn wounds

104

Quickest way to reverse warfarin anti-coagulation

Infusion of FFP

105

When to give T-dap shot vs T-dap + Tetanus Ig

Tdap + tetanus IV in severe dirty wound and unclear immunization history
Just Tdap if pt had a booster 5 years ago with dirty wound or 10 years with mildly clean wound

106

How does short term hyperventilation decrease ICP

Causing cerebral washout of CO2, leading to vasoconstriction and decreased cerebral blood flow

107

When do patients have risk of adrenal insufficiency following surgery

Daily prednisone > 20 mg taken for > 3 weeks

108

What is Kehr's sign

Abdominal pain that refers to the shoulder from subdiaphragmatic peritonitis
*must be peritoneal*

109

Only part of the bladder that is peritoneal

Bladder dome