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Flashcards in UW7 Deck (198):
1

How do you confirm a dx of psoas abscess?

CT scan

1

What is the surgical standard of care for SCC

Moh's Micrographic surgery

1

What nerve is responsible for the Trendelenburg sign?

Superior gluteal nerve (innervates gluteus maximus and medius)

1

What should be done in a hemorrhaging pt before intubating them? Why?

Bolus with IVF because the CVP is already low in hemorrhage so placing them on ventilator will increase the intrathoracic pressure even more leading to possible cardiac arrest

2

What humeral fractures are associated with compartment syndrome? What long term complication may arise from this?

Supracondylar fractures; Volkmann's Ischemic contracture (dead muscle all replaced by fibrous tissue)

2

What is the appropriate mgmt of SBO

Admit, place NGT, make NPO and put on IVF as NGT will cause ongoing fluid losses with hypokalemic hypochloremic metabolic alkalosis

2

What is the most accurate test for intraductal papilloma? What is seen on US?

Retrograde galactogram; oftentimes, NOTHING!

2

What is the most common cause of death in Ludwig angina?

Asphyxiation. Due to posterior displacement of tongue

2

What needs to be given to any pt prior to surgery who is on chronic steroids (i.e. greater than 3 weeks)

Stress doses of steroids

3

What is the likely cause of acute pain and swelling in the midline sacrococcygeal area? Cause? Tx?

Pilonidal cyst infected; due to friction in the area; Tx is I/D with excision of the sinus tracts

4

Why should a hip dislocation be promptly reduced?

Decrease risk of AVN

4

What is the MC cause of post-rhinoplasty whistling?

Septal perforation (Note Wegeners, Leprosy, and congenital syphilis also often have septal issues with a saddle nose deformity)

5

What virus can cause AIHA?

EBV

6

What are the radiologic signs of acalculous cholecystitis? Tx?

GB wall thickening, distention, and pericholecystic fluid; percutaneous cholecystostomy acutely and later definitive tx with cholecystectomy

6

What is the most common cause of mesenteric ischemia?

Embolic as opposed to thrombotic, Afib is MC with lodging into SMA

6

A vertebral burst fracture is associated with which neurologic syndrome?

Anterior Cord Syndrome (total loss of motor fxn distal to the lesion with preservation of proprioception)

7

What is important to rule out when making a dx of hypoparathyroidism?

There must be normal renal fxn; i.e. hypocalcemia and hyperparathyroidism IN THE PRESENCE OF NORMAL RENAL FXN

7

When tx inhalational smoke injury why should you have a low threshold for intubation?

Progressive edema of laryngeal structures may preclude intubation further down the line if truly needed

7

What drug should be given in Afib RVR with acute CHF?

Digoxin; BB and CCB would be CI; However, the digoxin can increase contractility and provide rate control from increased vagal tone

7

In whom must you be careful giving etomidate to for rapid sequence intubation?

Pts with HPA axis suppression (i.e. on chronic corticosteroids)

8

T/F high dose steroids are indicated in severe burn injuries; why or why not

FALSE; they are immunosuppressive and diabetogenic; burn victims already at increased risk infxn and in their hypermetabolic phase will have excess cortisol and hyperglycemia any way

9

Surgical length greater than ____ is a risk factor for post-op PNA

3 hours

9

What is an important complication that may occur when an arterial puncture site is made ABOVE the inguinal ligament?

Retroperitoneal hematoma (can present like AAA rupture); since hematoma formation always an issue at arterial puncture sites and above the inguinal ligament it can extend retroperitoneally

9

What is an important study to obtain in any pt s/p MVA or fall from great heights?

CXR to rule out aortic trauma

10

Why may a perforated duodenal ulcer present similarly to acute pancreatitis? What is a major diff?

Both are retroperitoneal processes; duodenal ulcer perf would likely be more painful but also not assoc with N/V as much as pancreatitis and if there was vomiting it would probs be coffee ground emesis

11

What makes diverticulitis complicated?

When assoc. with abscess formation, perforation, obstruction, fistula formation, or medically refractory dz; if collection 3cm then IR drainage

11

What should you always think of when a pt has fx of the first or second rib?

Potential aortic or carotid injury; these are very hard to break so implies a very large force!

11

What is the MC complication of thyroidectomy?

Hypocalcemia; be esp. careful in pts with malabsorption as they may already have impaired calcium homeostasis

12

How is the presentation of acute mesenteric ischemia diff from ischemic colitis?

Ischemic colitis is often painful but not nearly as bad as acute mesenteric ischemia; also mesenteric ischemia does not always present with bleeding sometimes not until later

13

What is the most important diagnostic study to perform after the ABCs in chest trauma?

CXR

14

What is a common cause of forefoot pain in the female athlete triad

Stress fx

15

How does a blunt trauma pt get air embolism?

The blunt trauma can result in a communication between blood vessels and the airways leading to air in the vasculature; often presents AFTER positive pressure ventilation is induced

16

How do you treat a rectal lesion less than 5 cm from the anal verge? Why?

Abdominoperineal resection with end colostomy; it is too distal to treat with low anterior resection with maintenance of any sort of sphincter mechanism

16

When does screening colonoscopy start in pts with known FMHx of FAP?

10; these pts can be full of polyps by age 20

16

What is the proper tx of diphenhydramine OD?

Physostigmine to reverse the anticholinergic effects and probably intermittent catheterizations prn urinary retention

18

Explain the hypermetabolic phase that occurs after burns

There is an increase in catecholamine release and cortisol that causes increased protein wasting

19

What exactly causes a post-op ileus?

There is excess sympathetics because you have violated the peritoneum; additionally post-op narcotics don?t help the situation

21

What needs to be ordered in any pt with blunt chest trauma and signs of acute CHF or shock?

Urgent echocardiogram

21

How should you deal with hip fx in the elderly with comorbid conditions?

Surgery can be delayed up to 72 hours to treat acute medical conditions

22

What is important to do in any pt with spinal cord injury to monitor VS

Bladder catheterization

23

What is the number one cause of death in burns?

Hypovolemic shock

25

How do you evaluate penetrating thoracic injury below the nipple with hemodynamic instability?

Exploratory laparatomy because below the nipple is abdomen; indicated when there is hemodynamic instability, peritoneal signs, or clear evisceration

27

What can fat necrosis look like histologically?

Foamy macrophages and fat globules; if seen in breast after trauma just observe

28

How do you manage penetrating trauma to abdomen with instability

Ex lap; no need for CT or even US (FAST) because there is obvious intraperitoneal bleeding

30

What is the typical timeline for ventilator associated PNA and what is the MC bug?

usually after 48 hours of intubation; P. aeruginosa

30

What is Leriche syndrome?

Due to aortoiliac occlusive disease it is bilateral hip, thigh, and buttock pain with wasting and impotence

31

What is the most likely route of infection of psoas abscess? Describe the physical signs based on palpation

Hematogenous with S. aureus most common i.e. from cellulitis of thigh etc.; deep palpation required to elicit tenderness because is a retroperitoneal process

31

How do you manage hydroceles in kids?

If under 12 months it tends to resolve spontaneously; after 12 months it should be closed surgically to avoid developing indirect inguinal hernia

32

Describe the CXR findings of pulmonary contusion

Initially after injury may be normal, often worsen with fluid administration secondary to third spacing; later CXR will show a fluffy infiltrate (white out)

34

Why should a cricothyroidotomy eventually be converted to a formal tracheostomy?

Prolonged use of the cricothryoidotomy can lead to subglottic stenosis

36

What is triple therapy for H. pylori

Amoxicillin, Clarithromycin, and PPI

36

What are some signs of thermal injury to the airway? What does this tell you?

Presence of soot, ash, frank burns, or singed nasal hair; this is an airway emergency and rapid sequence intubation is needed

36

What is bleeding in diverticular bleed?

The vasa recta

37

What does fever, chills, and deep abdominal pain suggest

Retroperitoneal process

38

What is the Bosniak classification system used for?

Evaluates renal cysts on the basis of radiographic findings; contrast enhancing lesions are usually Bosniak III-IV and more likely malignant

39

How do you manage early dumping syndrome?

It is usually self limiting so first you do dietary modification with more frequent smaller meals, then octreotide, then if truly refractory can convert to a Roux-en-Y

40

What do you do for a pelvic fx with hemodynamic instability?

Monitor response to IVF and follow serial H/H. You should never explore the hematoma as bleeding is usually from several of the smaller vessels and not usually amenable to tx

40

Define massive hemoptysis? What should be done and why?

> 600 ml blood; you should do a bronchoscopy (for tamponade/cautery) with the bleeding lung in the dependent position; you do this bc the main risk assoc. with massive hemopytsis is asphyxiation

41

What is the first step for a nondisplaced scaphoid fx or suspected scaphoid fx without radiologic evidence?

Thumb spica cast 7-10 days then rescan

41

How does gastric outlet obstruction usually present?

Post-prandial pain, early satiety and vomiting (often due to edema from ulcer)

42

How do you manage a contrast enhancing renal cyst?

Nephrectomy or nephron sparing nephrectomy; this is a Bosniak III-IV lesion so risk for malignancy is high

44

Why do you have to be careful with IVF in flail chest?

There is likely underlying pulmonary contusion and overagressive volume rescuscitation can cause third spacing into it

45

What is the mgmt of penis fracture?

Retrograde urethrogram followed by surgical exploration of the penis

46

What is the likely cause of shock when the PCWP increases after IVF administration?

Cardiogenic

47

What is the 4-2-1 rule of maintenance fluid replacement

4 ml/kg for first 10 kg; 2 ml/kg for 10-20 kg and then 1 ml/kg for each kg after that

48

Explain the following interventions for lowering ICP? 1) Head elevation 2) Sedation 3) IV mannitol 4) Hyperventilation 5) Removal of CSF

1) increases venous outflow from brain 2) decreases metabolic demand 3) osmotic diuresis which removes free water 4) removal of CO2 allows for vasoconstriction 5) Shunt placement

49

How would you treat coagulopathy in pancreatic cancer? Cirrhosis?

Vitamin K since it is due to malabsorption due to CBD blockage therefore supplementation will work? In cirrhosis the liver is shot so giving vitamin K wont really help, you need to give FFP

51

Trochanteric bursitis occurs near insertion of what muscle?

Gluteus medius (innvervated by superior gluteal n. i.e. trendelenburg sign)

52

What goal is a labeled RBC scan trying to achieve?

Localize the bleeding when colonoscopy failed to visualize a source so that either mesenteric angio can be done or repeat colonoscopy

52

How does central cord syndrome present? What predisposes to it?

Hyperextension injuries in pts with pre-existing degenerative changes; paralysis of upper extremities more than lower

53

What is the mgmt of acute mediastinitis s/p CABG?

Surgical Debridement with immediate closing and prolonged abx

54

What happens when a pt with flail chest gets intubated and put on positive pressure ventilation?

The paradoxical respiratory motion will correct

56

What is the next best step in diagnosing subacute knee pain s/p twisting injury?

MRI, likely medial meniscus

58

What is the most likely type of parotid neoplasm to be there if it is recurrent?

Pleomorphic adenoma

59

Why does general anesthesia increase risk of gastric aspiration?

It impairs laryngeal functioning

60

What if rib fracture pain is not adequately controlled with NSAIDs? Major risk of this tx?

Intercostal nerve block; PTX

61

How do you manage Legg-Calves-Perthes dz

Conservative tx with observation and bracing; SURGERY INDICATED WHEN FEMORAL HEAD NOT IN ACETABULUM

61

What is the next best step in abdominal trauma if a pt is hemodynamically stable after a fluid challenge?

CT scan; esp. with splenic injury because you want to grade the injury so you can hopefully salvage rather than take it out

61

What is an interval appendectomy and when is it used?

Appendectomy in a situation in which a pt has presented with ruptured appendix; so they drain it via IR drainage and then wait 6 weeks after the abdomen has cooled down and do an "interval appendectomy"

61

Why do meniscal injuries cause late knee joint swelling as opposed to ACL?

Not well perfused, ACL has a vessel

62

What is the most important goal in rib fx? Why?

Adequate pain control to prevent splinting, atelectasis, and pneumonia

63

What is a pulsatile mass located below the inguinal ligament?

Femoral artery aneurysm

65

What labs are required in a pt to treat them with IFN alpha and emtracitabine for chronic HCV? What is the better regimen and why?

You need detectable viral load with both INR and creatinine less than 1.5; now tenofovir and entacavir are used and are ok for use in decompensated cirrhosis

66

What causes lipodermatosclerosis?

Erythrocyte extravasation secondary to venous HTN leads to hemosiderin deposition

67

What are some good physical findings that can help diff DVT from compartment syndrome?

neurologic signs often affected in compartment syndrome

68

A CXR with an NGT in the chest after trauma indicates what?

Traumatic rupture of the diaphragm; do ex lap with repair and repair of other injuries

69

What is seen on colonoscopy for ischemic colitis?

Cyanotic bloody mucosa with sharp transition points

70

What is the cause of thigh pain in a pt with a pulsatile mass lying just below the inguinal ligament?

Compression of the femoral nerve (anterior thigh pain) by femoral artery aneurysm

72

What abdominal landmark is important to feel for a AAA?

AAA should be a pulsatile mass at or above the umbilicus

72

What is the best way to confirm a dx of fat embolism syndrome?

Normally you can base it off the clinical picture but technically you can confirm with fat droplets in urine

73

What is the cause of Ludwig angina? Tx? Major concern?

Usually strep and anaerobes from an infected molar; remove the molar and give abx; major concern is airway obstruction due to posterior displacement of the tongue

74

What do you give preoperatively to pts with hemophilia A?

DDAVP (note that you may anticipate a low UOP)

75

What is the next step in mgmt after placing a central line?

Check a portable CXR

76

What do you do if a pt needs to be intubated and has a ptx?

Place thoracostomy first because positive pressure ventilation often worsens the ptx

78

If there is tracheal deviation how do you know based on clinical exam whether it is from tension pneumo vs. hemothorax?

Tension ptx will be hyperresonant whereas hemothorax will be dull

80

How would you differentiate post-pericardiotomy syndrome from acute mediastinitis?

Post-pericardiotomy syndrome occurs several weeks s/p CABG and is autoimmune in nature

81

How is it that a ruptured AAA could present with gross hematuria?

It can dissect through the retroperitoneum causing an aortocaval fistula with the IVC leading to distention of the bladders venous plexus with gross hematuria

82

What will you typically see on CT of acute pancreatitis?

Enlarged pancreas with stranding of adjacent fat planes

83

Name 3 drugs that should be held prior to cardiac stress test?

Nitrates, BB, and CCB as they all affect the severity of ischemia

85

When is it safe to start anticoagulation in a post op pt

48-72 hours in a hemodynamically stable pt

86

How do you manage fracture of metatarsal heads? Why?

Usually can be managed conservatively because the surrounding metatarsals act as splints and nonunion is pretty uncommon; rest and pain control

88

What is the most important prognostic indicator for compartment syndrome

time to fasciotomy

89

Explain the mechanism of diffuse axonal injury? What is the most accurate test?

Sudden deceleration causes shearing due to different densities between gray matter and white matter leading to hemorrhage; MRI is the most accurate though CT will most likely pick it up

90

How can you tell if a cold leg was from embolus or thrombosis?

Embolic causes tend to present with acute pain, often the pt can tell you exactly where they were; thrombosis is a more insidious process and will occur slower

92

What is the best mgmt for 1st time uncomplicated diverticulitis?

Clear liquid diet with 7-10 d abx that cover anaerobes and gram negative (i.e. moxifloxacin or amoxacillin clavulanate)

93

Why would you not give neostigmine in a pt who has developed ileus secondary to pancreatitis?

It will contract the sphincter of oddi and lead to worsening of pancreatitis

95

What nerve is affected in tarsal tunnel syndrome?

Tibial n

96

Discuss the surgical mgmt of carcinoid tumors

Carcinoid tumor 2 cm then needs right hemicolectomy

97

What is the best mgmt for a pt with maxillary or mandibular fx and poor SaO2? What potential issue should be anticipated?

Cricothyroidotomy; CO2 retention, draw serial ABG

99

What is the best initial test for workup of PAD?

ABI; Arterial US is typically used later on when planning for invasive procedures

100

What is torus palatinus? What is the tx?

It is an exostosis of the midline suture of the hard palate; the epithelium may ulcerate due to poor blood supply; surgery indicated if it is symptomatic

101

When does TRALI develop? What is it?

Typically within 6 hours of transfusion; resp distress with noncardiogenic (normal PCWP) pulmonary edema

103

How is invasive monitoring of ICP done?

With a ventriculostomy

103

T/F: delayed capillary refill is an early sign of blood loss?

False only occurs when about 15% blood volume lost; tachycardia is one of the earliest

104

How can duodenal hematoma present after trauma?

Basically with an obstruction due to bleeding between submucosal and muscular layers

105

What is the cause of medial thigh pain in an obturator hernia?

Howship-Romberg sign; compression of obturator n

105

What is the one abnormality that may be seen on neuroimaging for pseudotumor cerebri?

Empy sella

106

How does raising the head of the bed affect FRC

Increases FRC (good for fat fucks) and takes pressure off the diaphragm allowing for more alveolar expansion

107

What bugs tend to cause emphysematous cholecystitis? Typical group?

Clostridium; elderly DM II

109

What is the classic physical finding for gastric outlet obstruction?

Abdominal succussion splash

110

What is SCC arising within a burn wound or assoc with Crohn's fistula called?

Marjolin ulcer

111

What is the next best step when the physical exam is classic for appendicitis?

Laparoscopic appendectomy; you don?t need CT but can be used if picture not clear

112

What is the most likely part of the bladder to rupture and why?

Bladder dome due to an attenuated area caused by the urachus embryologically (becomes median umbilical ligament)

113

What is the cause of shock in a post-op pt until proven otherwise?

Presumed to be hemorrhage until proven otherwise

114

What is the preferred mgmt of MCL tears

Bracing with early ambulation is preferred over surgery

115

Which IBD is most heavily assoc with rectal bleeding

UC

116

What is the most common route of infxn for endocarditis, osteomyelitis, muscle abscesses, and septic joints?

Hematogenous

118

What is the MC cause of syringomyelia in an adult?

Old SPC trauma that underwent cystic degneration (in kid it is Chiari Malformation)

120

What is the next best step if axr shows free air

Ex lap; CT is of little use and it may not even identify the site of injury

121

What structure is most likely injured in a supracondylar fracture?

Brachial artery

122

What is the cause of the snapping sound in a penis fracture? Why does it bend?

Rupture of the tunica albuginea covering the corpus cavernosum; it bends because a hematoma forms

123

How should you dx a pt with suspected ruptured AAA who is unstable?

Do a FAST at the bedside then take to surgery

124

What are 4 diseases that are due to follicular occlusion (i.e. hair follicles)?

Hidradenitis suppurativa, Pilonidal dz, Dissecting folliculitis, Acne congoblata

125

What are the MC causes of post-op fever immediately after surgery?

Malignant hyperthermia and transfusion rxns

126

Why may a pt with Courvosier's sign have elevated PT?

Pancreatic CA with CBD dilation will result in decreased absorption of ADEK so no K = elevated PT

127

Explain abdominal distention in a pt with ureteral colick?

Can be ileus secondary to vagal reaction

128

Discuss the mgmt of fluid collections in complicated diverticulitis

If less than 3 cm collection you can give IV abx and observe; If greater than 3 cm then you can do IR drainage; if not better in 5 days then surgery

129

How can you prevent acute bacterial parotitis in a surgical pt?

Provide adequate fluid hydration and oral hygiene pre and postoperatively

130

What needs to be added to the preop orders in a pt who needs emergent ex lap but is on warfarin?

FFP

131

What would you expect to see on CXR of pt s/p CABG with tachycardia and sternal wound drainage?

Mediastinal widening, this is acute mediastinitis

132

What is required to have carcinoid syndrome? Tx for sx?

Mets to liver; Octreotide for symptoms

133

What is the most significant etiology for morbidity in pts with traumatic brain injury?

Diffuse Axonal Injury (punctate hemorrhages at gray-white jxn)

135

In words, what is the respiratory quotient?

The rate of CO2 produced to O2 consumed; depends on what is being used to make ATP (if close to 1.0 it is carbs); a respiratory quotient can make it tough to wean a pt from the vent

137

If you have strong clinical evidence for gastric CA what is the next best step?

EGD for tissue confirmation; likely then CT for staging with decision made based on that; limited stage gets resection high stage gets chemo and palliative surgery

138

What should you think if a pt has new onset JVD and hypotension unresponsive to fluids?

Possible cardiac tamponade

140

What does diffuse rebound tenderness indicate

Generalized peritonitis = immediate surgery

140

What should you be thinking for a pneumothorax that persists despite placement of a chest tube?

Rupture of a tracheobronchial structure

141

What is a good basic test for rotator cuff tears?

Drop arm test

142

What test is used to confirm iatrogenic esophageal rupture?

Water soluble contrast esophagogram; first test is CXR though

143

What is the Tx of a pt with a Mulder sign in the foot?

Bar or padded shoe in BOTH shoes to ensure even walking; this is tx for a Morton Neuroma (mechanical induced neuropathic degeneration)

145

What is the clicking sound of Morton Neuroma called

Mulder Sign

146

What kind of peritonitis is present if there is bladder rupture? Radiation to the L shoulder is called what?

Chemical peritonitis; Kehr sign

148

In general, how do obstructions of hollow organs tend to present?

With writhing and colicky pain in which the pt just cant seem to get comfortable

149

How do you manage spinal ischemia s/p repair of thoracoabdominal AAA?

Emergent MRI with placement of lumbar drains to decrease SPC pressure

150

What side do diaphragmatic ruptures occur on?

L side bc liver protects R

150

What is the likely etiology of a subacute septic joint in a prosthetic limb?

S. epidermidis; S. aureus and P. aeruginosa tend to have much more rapid onset

151

What kind of cancer is nasopharyngeal carcinoma? Associations?

Undifferentiated SCC; EBV and Asians

153

Explain the pathophysiology of increased risk of renal stones in Crohn's dz

The fat malabsorption means more fat in the gut lumen which chelates calcium to essentially form soap; this leaves the oxalate unbound by calcium and is freely resorbed back into bloodstream where it can precipitate out in the kidneys as calcium oxalate

154

What is the cause of fever, leukocytosis and parotid inflammation?

Acute Bacterial Parotitis most often due to S. aureus

155

How is an SBO different from an ileus of critical illness, radiographically?

SBO will have air-fluid levels with high pitched bowel sounds and NO air in colon and rectum; Ileus of critical illness develops in critical illness and has air in colon

156

What test would best confirm that there is an acute hemolytic transfusion rxn?

Coombs

158

What is the best way to evaluate bleeding that is thought to be from a small bowel source (i.e. after all other tests are negative)

Capsule endoscopy

160

How do you manage an episode of paroxysmal HTN in a pt with pheochromocytoma?

FIRST you must give an alpha blocker then give a beta blocker as giving BB alone will lead to unopposed alpha with worsening of HTN

161

What should NEVER be used for rapid sequence intubation in a pt on chronic steroids?

Etomidate as it can inhibit steroid synthesis and increase risk for adrenal crisis

162

What is the best way to diagnose anterior cord syndrome? What is the MC cause?

MRI; vertebral burst fx

164

In the trauma setting a pt who is hypotensive and still is after fluid challenge, what is the cause? Next step?

Ongoing hemorrhage so take to surgery; if pt also has JVD you want to be thinking of tension ptx or cardiac tamponade

165

What is the most effective tool to prevent post-op PNA

Incentive spirometry

166

What is a good first step in an oliguric pt?

Switch out the catheter then IV bolus if suspect prerenal azotemia

168

What may compensate blood supply to limb after burn? Tx?

Formation of eschar; Escharotomy (just incise the eschar not all of the fascia, i.e. not a fasciotomy)

169

Explain the cause of tachypnea when a pt has atelectasis?

The shallow breathing decreases recruitment which then causes mucus plugging, this causes hypoxia which increases the respiratory drive

170

If you suspect retroperitoneal hematoma s/p arteriotomy what is the best dx test?

Non-contrast CT

171

What is the preferred surgical mgmt for recurrent duodenal ulcers?

Parietal cell vagotomy (highly selective vagotomy) and this preserves stomach tone and peristalsis

172

Why is 100% O2 via nonrebreather useful for smoke inhalation

Decreases the half life of carboxyhemoglobin (note if > 20 you need to do hyperbaric O2)

173

What is true of CT scans for detection of pancreatic injuries

Often are missed in first 6 hours s/p injury

174

What is the major difference between medial tibial stress syndrome and a tibial stress fx?

Point tenderness indicates stress fx

175

What is the classic sequelae to leaving nasal packing in too long after a rhinoplasty?

Development of Toxic Shock Syndrome (S. aureus super antigen binds MHC II and TCR leading to cytokine storm)

175

How do you diagnose central vein thrombosis?

Magnetic resonance venography

176

What 3 things are tested in GCS

Best eye opening, best motor response, best verbal response

177

What may develop in a hyperextension injury in a pt with preexisting degenerative changes?

Central Cord Syndrome with PARALYSIS MORE IN THE UPPER EXTREMITIES THAN LOWER

178

Explain the physiology of the HIDA scan

Hydroxy Imino Diacetic acid is absorbed by bloodstream and secreted by hepatocytes into bile. In acute cholecysitis the GB would not be visualized since there is an obstructing stone

180

What is the next best step for dx of suspected pancreatic CA?

CT scan; note that endoscopic US can also be useful

181

How do you tx perforated appendix without abscess? With abscess?

Emergent appendectomy with post op IV Abx and delayed primary closure; Percutaneous drainage (if not getting better over several days may require surgery)

182

What should you be thinking if there is a sternal fx with tachycardia and new onset bundle branch block? Mgmt?

Myocardial contusion; aimed at complications

183

What is the best advice to give a pt who has just severed their finger?

Put the finger in saline moistened gauze and then put it on ice this will allow it to be viable for 24 hours

184

Why would a pt with s/s of pheochromocytoma have elevated calcitonin?

May be assoc with MEN2A (pheo, medullary thyroid CA (calcitonin is the marker), hyperparathyroidism)

185

What is the best initial test in any young woman presenting with appendicitis like pain?

B-hCG as it could be ectopic or because she may be pregnant (with intrauterine pregnancy) in which case you still don?t want CT

187

What are some signs of end organ dysfunction what would make sepsis into severe sepsis?

decreased UOP or rising BUN CR, platelets drop below 80,000, hypoxemia, hypotension, metabolic acidosis

188

Why may PE p/w acute onset JVD? Echo finding?

RV strain; McConnels sign

189

What is the most important question to ask if a resident tells you that a pt has a scaphoid fx?

Displaced or nondisplaced?

190

What is the tx for phimosis and paraphimosis?

Circumcision

191

What is required (biologically) for a pt to survive when there is aortic trauma?

Intact adventitial layer

192

How does mesenteric ischemia often present?

Sudden onset periumbilical pain OOP to physical exam

193

What gene is amplified in neuroblastoma what is the surgical mgmt?

N-myc (trascription factor); Nephrectomy with ipsilateral adrenalectomy

194

How can you CONFIRM a dx of traumatic rupture of diaphragm

CT chest abdomen i.e. done if the AXR or CXR suggests this

195

What is the number one cause of death in the setting of burns with adequate fluid resuscitation (pt is euvolemic)

Superimposed bacterial infection (sepsis) i.e. P. aeruginosa

196

What is the most important initial step anytime a pt with active TB presents?

Respiratory isolation

197

Why may worsening hyperglycemia indicate sepsis?

Increasing insulin resistance occurs

198

Though a parietal cell vagotomy is often better than truncal vagotomies and selective vagotomies, what is the main issue when used as tx for medically refractory PUD?

This type of surgery has the highest recurrence rate