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22 Cards in this Set
- Front
- Back
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Q: What is the most commonly injured part of the duodenum in blunt abdominal trauma?
Q: Why? Q: What is the best way to confirm Dx? |
A: 2nd part - b/c it is retroperitoneal and therefore the least mobile
A: CT scan of Ab w/ contrast |
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Q: What is Dx of a presentation of sudden onset back pain that may be followed by syncope?
Q: What would be the next step in management? |
A: AAA
A: Laparotomy - should not be delayed for a presumptive Dx of AAA and should be take straight to OR - when hypotension is present w/ a pulsatile mass --> no further studies are indicated - 50% mortality |
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Q: What is the next step in management if a trauma patient does not respond to fluid administration?
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A: Surgical Intervention
- Hypotension not responsive to fluid administration following to trauma is suggestive of ongoing occult blood - treat w/ emergent surgical intervention to stop any further hemorrhage |
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Q: Does a patient w/ a breast mass that produces a nonbloody aspirate and disappears completely on aspiration need further evaluation?
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A: No - just observe for recurrence.
- Breast masses associated with Fibrocystic disease often occur and resolve rapidly. - On exam, cysts are tender and mobile. Aspiration - serous and non bloody. |
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Q: What are four char. of necrotizing surgical infection?
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A:
1. Intensive pain in wound. 2. Dec. sensitivity at edges of wound. 3. cloudy-gray discharge. 4. Sometimes crepitus - Surgical exploration is urgent to assess the extent of the process and debridement. |
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Q: What are the goals of therapy for occlusive arterial disease of the lower extremitites?
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A:
1. Relief of pain 2. Prevent limb loss 3. Maintain bipedal gait. |
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Q: What is best treatment of intermittent claudication?
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A: ASA and exercise
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Q: What is a + sign of Trendelenburg? What is it caused by?
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A: Drooping of the contralateral hemipelvis below its normal horizontal level during monopedal stance.
- It is caused by weakness or paralysis of the Gluteus medius/minimus m., innervated by Superior Gluteal n. |
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Q: What are some common causes of colonic ischemia following procedures? What do they present with?
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A: 1. loss of collateral circulation.
2. mainipulation of vessels with surgical instruments. 3. prolonged aortic clamping 4. impaired blood flow thru Inferior mesenteric artery. - Patient would report dull pain over ischemic bowel as well as hematochzia. Colonoscopy shows discrete segment of cyanotic and ulcerated bowel. |
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Q: Contrast meniscal tears to ligamentous tears?
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A: M- occur during a distinctly recalled acute knee injury often associated with a popping sensation.
L- may be associated with a popping sensation, but has rapid joint swelling due to hemarthrosis. |
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Q: What is the next step in management after stabilizing a patient with clinical evidence of spinal cord injury?
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A: high dose of methylprednisolone within 8 hours of spinal cord injury.
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Q: How does Anterior Cord Syndrome present itself?
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A: Is char. by selective damage to corticospinal and spinothalamic tracts. These tracts course anteriorly of spinal cord and transmit motor and pain/temp sensation, respectively.
-Clinically, is suggested by paralysis and loss of pain and temp sensation below the level of injury while posterior columns functions such as fine touch, vibration, pressure and proprioception are preserved. |
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Q: Why should a fracture of a long bone be assessed urgently?
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Q: Gentle traction to attempt alignment of fragments of a fractured long bones is important to prevent vascular and neuro damage (i.e. radial n., brachial a.)
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Q: How does Paget's disease of bone present?
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A: Typically asymm.
Dx made with bone specific Inc. Alk Phos. -Symptomatic present with pain associated with fracture or with arthritis resulting from bone deformity. -Classically, hearing loss may occur due to damage to cochlear n. --> enlargement of temporal bone and impingement of internal auditory meatus. |
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Q: What is a common postgastrectomy complication?
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A: Dumping syndrome (50%) - involves rapid emptying of hypertonic gastric content to duodenum and smal intestine. This process leads to fluid shift from intravascular space to small int., release of intestinal vasoactive polypeptides and stimulation of autonomic reflexes.
- Dietary changes help majority of patients - includes small frequent meals and avoidance of simple carbs. |
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Q: Edema, stasis dematitis, and venous ulcerations char. what?
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A: Lower extremity venous insufficiency - due to valve incompetence. Classically occurs on medial leg superior to medial mallelous.
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Q: What should you suspect after blunt trauma to chest, if x-ray shows a deviated mediastinum with a mass in left lower chest?
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A: Diaphragmatic perforation with herniation of abdominal viscera.
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Q: What would a perforated peptic ulcer present with?
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A: SUDDEN ONSET severe epigastric pain --> spreads over the whole abd. due to chemical peritonitis.
- Upright ab x-rays classically show free air under the diaphragm. |
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Q: Nasopharyngeal cancer is common in what population and associated with what viral infection?
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A: Mediterranean and Far eastern descent and Epstein- Barr virus.
- also associated with smoking and with chronic nitrosamine consumption (salted fish). |
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Q: What is Slipped Capital Femoral Epiphysis (SCFE)?
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A: Displacement of femoral head on neck due to disruption of proximal femoral growth plate. Commonly seen in obese males.
-Knee, not hip pain is a common complaint. Exam shows loss of abduction and internal rotation of the hip. -Acute SCFE is an emergency to be treated with external screws to prevent avascular necrosis of femoral head and chondrolysis. |
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Q: What is the first step in evaluation of all patients over 35 with a palpable breast lump with family hx?
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A: mammogram, then ultrasound if nonpalpable.
- FNA/ excisional bx if suspicious on mammogram |
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Q: How do benign breast lesions like fibroadenoma present vs. malignant lesions?
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A: Benign - can be rubbery, firm, freely mobile
Malignant - hard, irregular, and fixed. |
