Flashcards in Uworld Deck (49):
RUQ pain, CT scan showing gaseous distension in SB/LB, GB distended with some pericholecystic fluid, no gallstones, think?
acalculous cholecystitis: occurs in severely ill pts, likely due to cholestasis and GB ischemia-->infection/necrosis
tx: abx + percutaneous cholecystOSTOMY followed by cholecystectomy when pt improves
5 hrs after cardiac cath pt develops hypotension, ^HR, back pain, diaphoresis, flat neck veins, think ?
retroperitoneal hematoma due to bleeding from arterial access site (femoral)
dx: noncontrast CT of abdomen/pelvis or U/S
what to do next with pt with blunt abdominal trauma + high risk features and negative FAST?
high risk features: abdominal wall bruising, tenderness, guarding, hypotension, pleuritic CT, anemia
*most likely splenic rupture!*
if unstable: ex-lap
initiation of PPV can cause what changes in the heart?
decrease in RV preload due to ^intrathoracic pressure
results in decreased CO
EXTRA-axia well-circumscribed dural-based mass that is partially calcified on neuroimaging think? how to treat?
meningioma (+/- HA, FNDs, seizure)
tx: surgical resection
mets typ. INTRAaxial and multiple (radiation + CT scan of body)
chemo for GBM, medullo. (more malignant)
pneumomediastinum, subQ emphysema, persistent PTX even after chest tube placement, think ?
causes of hemoptysis
pulm: bronchitis, PE, bronchiectasis, lung cancer
CV: mitral stenosis, AVM, coagulopathy
infectious: TB, lung abscess
systemic: Wegener's, Goodpasture, SLE, vasculitis
hemoptysis pt is intubated, blood fills ET tube, what to do next?
bronchoscopy: can ID the bleed site and can tx while in there (tamponade, electrocautery)
if fails THEN pulm. arteriography
if that fails THEN thoracotomy
UG injury after pelvic rami fracture, think ?
EXTRAperitoneal bladder injury (EPBI)
gross hematuria, urinary retention
INTRAperitoneal involves the dome: will present with peritoneal signs
what deficit seen with anterior shoulder dislocation?
axillary n. injury: teres minor and deltoid, so weakened shoulder abduction
what deficit with mid-shaft humerus fx or poorly fitting crutches?
radial n. injury: extensor deficit of wrist and digits
what deficit with fracture of medial epicondyle of humerus?
ulnar n.: "claw hand"
findings with SBO that indicate emergent surgical exploration
changes in the character of pain, fever, hemodynamic instability, guarding, ^WBC, metabolic acidosis
otherwise: NPO, NG tube, IVF
cardio changes in hypovolemic shock
decreased preload and CO causes the heart to compensate with ^HR, ^SVR
also, decreased filling volume in the LV causes the heart to compensate with increasing the EF
post-op atelectasis is usually due to ?
accumulation of pharyngeal secretions, tongue prolapse, airway tissue edema, residual anesthetic effects, post-op pain inhibiting deep breathing/coughing
acid/base derangement seen with atelectasis?
they hyperventilate to compensate for the hypoxemia: respiratory alkalosis with low pCO2
labs in mesenteric ischemia
^WBCs, ^Hgb (hemoconcentration), ^amylase, metabolic acidosis due to ^lactate
acute calf pain and paresthesias following a LE embolectomy, think?
ischemic-reperfusion syndrome (form of compartment syndrome)
embolus would have decreased pulses distal to occlusion, DVT is often asymptomatic and has only "vague aching pain"
what to do if penetrating abdominal trauma and negative FAST + high risk features?
high risk features: hemodyn. instability, peritoneal signs, evisceration, blood from NG tube or rectal exam
(in contrast to blunt trauma, in which you would do CT unless hemo. unstable-->ex-lap)
fever, chest pain, ^WBCs, mediastinal widening following cardiac sx, think? what to do next?
drainage, surgical debridement, abx therapy
infection from retropharyngeal abscess can spread to ?
posterior mediastinum via extension through the alar fascia
any penetrating trauma below the nipples is considered abdomen and requires ? in unstable pts
what may be the first signs of a burn wound infection?
change in burn wound appearance or loss of skin graft
fever 1-6 hrs post op think?
febrile nonhemolytic transfusion reaction
others: prior infection/trauma, inflammation due to sx, malignant hyperthermia, meds (anesthetics)
bloody diarrhea + abdominal pain POD #1 surgical repair of infrarenal aortic aneurysm, think?
if inadequate collateral perfusion after loss of IMA during aortic graft placement
in contrast, C. diff is not bloody and takes 4-5 ds after abx initiation
Pilonidal disease vs perianal abscess
pilonidal: painful mass above anus in the crack with pus/bloody drainage
perianal: fever, mass at the anal verge (inside)
ischemic colitis typically follows an episode of hypotension and affects what areas on the colon?
may see what on CT?
splenic flexure and rectosigmoid junction (watershed areas)
thickened bowel +/- air in bowel wall on CT, may confirm with colonoscopy (may see cyanotic mucosa and hemorrhagic ulcerations)
patient with n/v, air in the biliary tree, hyperactive bowel sounds, dilated loops of bowel, think?
gallstone ileus, form of SBO
dx: CT scan tx: removal of stone + cholecystectomy
in contrast, emphysematous cholecystitis has fever, RUQ pain +/- ileus, not HYPERactive bowel sounds
eval of GU trauma + micro hematuria: stable vs unstable
stable: U/A and CT abd/pelvis with contrast
unstable: IVP then surgery
RUG if gross hematuria, difficulty urinating, blood at the meatus, suprapubic pain, dysuria, retention (evidence of urethral injury)
if classic appendicitis presentation, what to do next?
lap appy, no need for imaging unless unsure, it is a clinical diagnosis
nausea, weakness, palpitations, diaphoresis after meals in post-gastrectomy pt, think?
dumping syndrome, loss of normal pylorus functioning, dumping into duodenum/sm. intestine
tx: small meals with complex carbs, protein
gallstone pancreatitis, what to do next?
anterior mediastinal masses
teratoma (+ other germ cell tumors)
^B-hCG and ^AFP with anterior mediastinal mass
mixed germ cell tumor
what to do with complicated diverticulitis with abscess formation?
CT-guided percutaneous drainage
if fails, surgical drainage
anticoagulation in DVT tx in pt with ESRD
unfractionated heparin to warfarin
atelectasis results from ? after surgery
shallow breathing and impaired cough due to pain
uncal herniation can cause paralysis of what CN?
burns may compromise vascular supply, how?
circumferential, full-thickness burns may lead to compartment syndrome due to constriction of venous/lymphatic drainage
acute b/l flaccid paralysis and loss of pain/temp with UMN signs (days-wks later), think?
spinal shock, anterior spinal cord infarction
complication of thoracic aortic aneurysm sx
vibr/proprio typically intact
PPV can lead to what cardiac change
acute loss of RV preload due to ^^intrathoracic pressure
pt with should pain after abdominal trauma, think?
referred pain from peritonitis (C3-5)
i.e. rupture of the dome of the bladder (intraperitoneal)
timing of hematuria:
what do increasing levels of paCO2 do to CBF?
^paCO2 increases CBF (vasodilation)
hyperventilating decreases paCO2, causing vasoconstriction and reduced CBF/ICP
if think diaphragmatic rupture on CXR, what to do next?
CT chest to confirm
what to do if flail chest
PPV to improve oxygenation, it also causes the flail segment to move normally
medial meniscus vs medial ligament tear
meniscus: typically shows small effusion and creptitus, locking/catching
ligament: tenderness and laxity +/- ecchymosis
rotator cuff tendonitis vs tear
both will have pain with abduction + external rotation
tear: WEAKNESS with external rotation as well