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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?

CT abdomen
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 ?

tracheobronchial rupture


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?

acute mediastinitis
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?

bowel ischemia/infaction
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?

early cholecystectomy


anterior mediastinal masses

teratoma (+ other germ cell tumors)
thyroid neoplasm
terrible lymphoma


^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?

CNIII (oculomotor)


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:

throughout: renal/ureteral
late: bladder/prostate
early: urethral


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


complications of supracondylar humerus fractures (MC fx in kiddos!- FOOSH)

brachial artery + median nerve injury (entrapment)
leads to loss of brachial and radial pulses
cubitus varus deformity
rare: compartment syndrome --> Volkmann contracture