VI

Question 1

SIRS criteria

Answer 1

at least 2 of:

• temp >101.3
• pulse>90
• respirations>20
• WBC>12,000

Question 2

what occurs in first week after patient with severe burns

Answer 2

hyperglycemia, muscle wasting, protein loss, hyperthermia and increased energy expenditure

Question 3

main causes of infection after burns

Answer 3

staph aureus and pseudomonas aeruginosa

Question 4

criteria that indicate sepsis

Answer 4

worsening hyperglycemia, leukocytosis, thrombocytopenia, mild hypothermia, tachypnea and tachycardia

Question 5

characteristics of serum sickness

Answer 5

fever, urticaria, arthritis, and nephritis

Question 6

treatment for cardiac tamponade from pericardial fluid

Answer 6

pericardiocentesis or surgical pericardiotomy

Question 7

first step with variceal bleeding

Answer 7

inserting two large bore IV needles

Question 8

medical control of bleeding varices

Answer 8

vasoconstrictors like terlipressin, octreotide, or somatostatin

Question 9

what space in the neck is most dangerous to have an infection

Answer 9

retropharyngeal space because spreads to posterior mediastinum resulting in acute necrotizing mediastinitis

Question 10

ludwigs angina

Answer 10

infection in submandibular space

Question 11

how do sedative medications worsen hypovolemia

Answer 11

relax the venous capacitance vessels and cause circulatory failure by decreasing venous return

Question 12

what indicates need for escahrotmoy

Answer 12

when pressure is 25-40 mmHg

Question 13

test to determine if eschar from burn is constricting

Answer 13

doppler US

Question 14

what is postoperative cholestasis

Answer 14

benign condition that develops after a major surgery with hypotension, extensive blood loss into tissues, massive blood replacement

Question 15

why are you jaundiced with postoperative cholestasis

Answer 15

increased pigment load, decreased liver funtionality and decreased bilirubin excretion

Question 16

treatment for penile fracture

Answer 16

emergent urethrogram to assess for urethral injury and emergent surgery to evacuate hematoma and to mend tunica albuginea

Question 17

components of glascow coma scale

Answer 17

eye opening, verbal response, motor response

Question 18

cushingnoid features

Answer 18

buffalo hump, central obesity, moon facies, weight gain

Question 19

what should be avoided in patients taking chronic glucocorticoids prior to surgery

Answer 19

etomidate because can inhibit steroid synthesis and cause acute adrenal crisis

Question 20

clinical signs of perioperative adrenal insufficiency

Answer 20

unexplained nausea, vomiting, abdominal pain, hyponatremia, hyperkalemia, hypoglycemia, hypotension

Question 21

insulin induced hypoglycemia signs after surgery

Answer 21

dizziness, diaphoresis and fatigue

Question 22

man with abdominal pain. no guarding or rebound, bowel sends present with increased intensity at peak of pain, mild fever and abdomina XR how multiple air fluid levels

Answer 22

Small bowel obstruction

need immediate surgical obstruction if suspect strangulation

Question 23

findings to suspect strangulation of small bowel

Answer 23

fever, tachycardia and leukocytosis and metabolic acidosis

Question 24

anterior spinal cord syndrome

Answer 24

lose motor, and pain and temp to lower limbs because lost supply from anterior spinal artery

Question 25

see air under diaphgrams or pneumoperitoneum

Answer 25

need to immediately surgically explore. could be perforated ulcer or viscous organ

Question 26

presentation of mediastinitis

Answer 26

post op 2 weeks with fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge

Question 27

CX mediastinitis

Answer 27

widened mediastinitis

Question 28

how to Tx postop mediastinitis

Answer 28

drainage, surgical debridement with immediate closure, and prolonged antibiotic therapy

Question 29

best control for afib

Answer 29

beta blockers or amiodarone

Question 30

signs of postpericardiotomy syndrome and Tx

Answer 30

fever, leukocytosis, tachycardia and chest pain | NSAIDS or steroids treat the inflammation

Question 31

triad of leriche syndrome

Answer 31

bilateral hip, thigh and buttock claudication, impotence and symmetric atrophy of bilateral lower extremities due to chronic ischemia

Question 32

what nerve can be damaged to remove a parotid tumor

Answer 32

facial nerve, will get facial droop

Question 33

tic douloreux

Answer 33

trigeminal neuralgia, short bursts excrutiating, lancinating pain lasting from minutes to second. from 2nd and 3rd branches trigeminal

Question 34

when do you give the tetanus vaccine AND the imunoglobulin

Answer 34

if the wound is dirty or severe AND uncertain if completed tetanus childhood vaccines

Question 35

fever within first week of surgery is usually from what

Answer 35

nosocomial infections like pneumonia UTIs

Question 36

presentation malignant hyperthermia

Answer 36

high fever, muscle rigidity, rhabdomyolysis, metabolic acidosis, hemodynamically instability

Question 37

likely cause of prosthetic joint infection if within 3 mo of the arthroplasty

Answer 37

staph aureus

Question 38

likely cause of delayed onset prosthetic joint infection

Answer 38

staph, proprionibacterium spcies, enterococci

Question 39

urethritis/enteritis, arthritis, conjunctivitis

Answer 39

chlamydia or salmonella causing reactive arthritis

Question 40

if patients arm is abducted passively then asked to slowly lower and arm drops

Answer 40

supraspinatus tear

Question 41

popeye sign

Answer 41

biceps muscle belly prominent in mid upper arm because long head biceps ruptured

Question 42

what muscle causes winged scapula

Answer 42

paralysis serratus anterior

Question 43

klumpkes palsy is damage to what

Answer 43

inferior trunk of the brachial plexus originating from C8 and T1 cervical roots

Question 44

describe klumkes palsy

Answer 44

weakness and atrophy of the hypothenar and interosseous muscles characterize this palsy

Question 45

pilonidal disease

Answer 45

infection in hair follicles that form abscesses and rupture forming tracts midline post sacral intergluteal region need to drain

Question 46

suppurative hidradenitis

Answer 46

multiple painful nodules and pustules of axillae and groin

Question 47

bowens disease

Answer 47

squamous cell carcinoma of skin

Question 48

pagets bone disease

Answer 48

osteitis deformans osteolast activity increased woven bone at many sites and bowing with fractures

Question 49

most common presentation of pagets disease of bone

Answer 49

pain of long bones that may result in arthritis of hip or knee

Question 50

lab findings in pagets disease of bone

Answer 50

increased alk phos and normal Ca and phosphorus levels

Question 51

XR pagets disease of bone

Answer 51

enlargement of the bones of the skull-- frontal bossing

Question 52

how can pagets disease of bone lead to hearing loss

Answer 52

from the cochlear nerve being impinged by the enlarging temporal bone

Question 53

what syndrome predisposes to renal cell carcinoma

Answer 53

von hippel lindau

Question 54

what syndrome predisposes to pulmonary hemorrhage

Answer 54

goodpastures