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42 Cards in this Set

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BPH
s/s
sequelae
tx
Painful urination, decrease force of stream, hesitancy,dribble

Causes retention which leads to repeated UTI and hydronephrosis or kidney damage.

First make sure bladder is empty. Use foley and if this does not work use suprapubic tap

Second give Drugs
1)alpha blocker:-zosin
2)GnRH analogues: flutamide & finasteride

Finally if UTI's are chronic and kidney is getting damaged do TURP
Dysuria w/ perineal pain DDX
Two categories Fever and Non

Fever
1) Acute & chronic bacterial prostatitis from ecoli or pseudomonas
-Cultures are +
-Prostate tender

No Fever
1)Cystitis:
-Culture +

2)Non bacterial prostatitis
-culture -ve
-Have leukocytes(foamy macrophages)

3)Prostadynia(normal prostate)
-negative for culture & cells
Decreased breath sound workup
Thorax conditions depend on the type of percussion

1) Dull=hemothorax: give fluid

2) Hyper: If stable do chest tube w/ x-ray. If unstable then tension(hypotention, JVD) then do needle into pleural space
Cryptorchism
Tx
<1 year=Leave alone
>1 year=Do orchipexy to prevent malignancy and infertility
Hydrocoele vs. Varicocoele
S/S
Dx
Tx
Try to transilluminate all scrotal masses first then do U/S.

1) Transilluminate:
Hydrocoele(processes vaginalis remnant):Asymptomatic & illuminates.
-No tx

Varicocoele(pampinoform venous plexus remnant):Painful bag of worms that does not illuminate and disappears in supine position.
-Surgical Repair
Erection mechanism
Point and Shoot
Parasympathetics=Erection
Sympathetics=Ejaculation
Impotence
-Causes
2 types: Psychogenic and Non.

Psycho=morning erection and can mastubate(b/c of anxiety or stress)

Non-Psycho=
1) Atherosclerosis(Leriche syndrome w/ buttock atrophy & claudication)
2) DM =Vascular or Neuro
3) Meds: SSRI or Antihypertensive
Nephrolithiasis
S/S
Stone types
Tx
Flank pain to groin, Hematuria
-Calcium: Hyperparathyroidism
-Struvite: Proteus staghorn
-Uric Acid: Gout, TLS, Leukemia
-Cysteine: homocystinuria

Dx: KUB b/c 70% Radiopaque

Tx: Fluid, narcotics and try to let pass. If cannot do lithotrypsy
Hypospadia & Epispadia
Hypo: Below
Epi: Above

Tx: Surgical correction
Potter Syndrome
B/l renal & lung agenesis w/ limb and facial deformities secondary to Oligohydraminos in utero
Scrotal mass workup
S/S
Dx
Markers
Tx
A painless scotal mass in a 20-40 year old male is usually cancer (mumps is painful):

LDH: Seminoma
B-Hcg: Choriocarcinoma
AFP: Yolk Sac
1) TI(only hydro TI)
2) U/S

Tx: Remove if Cx
Urethral injury in Trauma
S/S
Tx
No foley must use retrograde urethrogram

High riding or ballottable prostate

Blood at Meatus

Scrotal eccomyosis
Subdural hematoma
S/S
pathophys
Dx
Tx
Trauma or Alcoholic/Elderly w/ head trauma Hx

-dural venous sinus bridging veins
-Crescent shaped
-Just Out(no lucid interval)

Dx: CT head no contrast

Tx:
1) Midline dev or aniscoria -evacuate

2) No dev: Lower ICP(Hyperventilate,Reverse trendelenburg,Mannitol & furosemide)
Epidural hematoma
S/S
pathophys
Dx
Tx
Trauma causing out then lucid then out.

-Bust temporal bone and middle meningeal Artery
-Lens shaped

Dx: CT head no contrast

Tx:
1) Midline dev or aniscoria -evacuate

2) No dev: Lower ICP(Hyperventilate,Reverse trendelenburg,Mannitol & furosemide)
Penetrating Abdominal trauma
Gun: Exploratory lap

Stab: Exploratory lap if unstable or CT w/ contrast of abdomen if stable followed by lap if positive.
DIC during surgery
Give Fresh frozen Plasma and platelet packs especially if they have had alot of packed RBC's because these contain no platelets
Rib Fracture/Flail Chest
Management
Do local block to prevent hypoventilation and atelectasis.

If flail chest intubate and give Positive pressure ventilation.
Pulmonary contusion
Lungs are whited out on x-ray & patient in respiratory distress after high impact trauma(usually have broken ribs)
Incontinence Types
1) Stress: Leak w/ exertion or sneeze

Weak pelvic floor from multiparity. see uterine prolapse or cystocoele on examination

2) Urgency: Always have to go
even at night.
Fever w/ UTI: Acute cystitis
No fever or UTI: Detrusor irritability(#1 in elderly)

3)Overflow: diabetic who dribbles when bladder is full b/c nerves shot
Consequence of a tourniquet
Causes tissue hypoxia and acidosis which can lead to systemic vasodilation and hypotention
Carotid stenosis
S/S
Dx
Tx
Carotid bruit that presents w/ TIA or amaroux fugaux(shade over eyes).

Dx: Carotid doppler or MRA

Tx:
>70% stenosis & not disabled from the stroke CEA

<70% stenois give ASA
AAA
S/S
Dx
Tx
Abd pain and pulsatile Mass

Dx: CT w/ contrast abdomen

Tx: Hypotensive/leak/>5cm=operate
Stable & <5cm then serial U/S
Leriche syndrome
SS
Dx
Tx
Buttock atrophy and claudicaion w/ impotence secondary to aortoilliac occlusive disease

Tx: Aortioilliac bypass graft
Claudication Tx
Pain w/ exertion: Mod lifestyle
Pain at rest: revascularize
Mesenteric Ischemia
S/S
Dx
Tx
Painful to eat so lose weight

CT shows bowel wall thickening,gas in bowel wall and narrow lumen.

Tx: Revascularization to prevent infarction
PE workup
EKG(R/O MI) & O2 sat then
ABG(wide A-a gradient) then
V/Q scan and then
heparin
Penetrating trauma workup
-Clean wound & tetanus
-Check vessels w/ doppler arteriogram

Vessels ok
Electrical burn workup
Give lots of fluids to prevent renal failure from myogloinuria
Chemical burn workup
Copious irrigation with tap water
Thermal burn workup
100% O2 then fluid then tetanus
1)Red w/o blister: clean

2)red w/ blister:Ag sulfadiazine or Ag nitrate or neomyacin

3)Black & painless
-Escharotomy
-Skin Graft
-Monitor peripheral pulses to prevent compartment syndrome
Bladder Cancer
Types
Risk Factors
Dx
Painless hematuria w/o a flank mass

Transitional cell
Squamous Cell

TCC RF(aromatic hydrocarbons): -smoking
-rubber factory
-aniline dye

SCC RF(Schistosoma in middle east)

cystoscopy w/ biopsy
When to transfuse
Give packed RBC if Hct <30 to get patient to level of 30.
ACL & PCL
s/s
dx
Knee unstable and patient hears a pop.

ACL: Ant drawer test
PCL: Post drawer test or Lachman
MCL
lateral blow
-abduct w/ VALGUS stress test
LCL
Medial blow
-adduct w/ VARUS stress test
Knee injury workup
Clinically asess w/ tests
MRI
Arthroscopy
Complication of doing TIPS in alcoholic
Coma from high ammonia levels as blood from gut now distributes into the brain
Pericardial tamponade
S/S
Dx
Tx
Stabbed at heart w/ muffled heart sounds, hypotention, JVD & pulsus paradoxus(BP falls w/ inspiration).

Stable: Echo to confirm
Unstable: Pericardiocentesis
SBO
SS
Dx
Rf
Tx
abd pain w/ N-V and hyperactive bowel sounds from increased peristalsis.

Dx: KUB see dilated loops of bowel w/ air in stepladder fashion

RF: Adhesion or hernia incarceration

Tx; Fluids-NG tube & NPO if peritoneal signs develop do surgery.
Post Splenectomy complication
Subphrenic abscess causing fever, high white count and pain in the L shoulder.
Low urine output post surgery
Dehydration causing pre-renal azotemia(BUN:CR ratio>20:1)
Pancreatic Pseudocyst
s/s
tx
History of abdominal trauma
Weeks later get epigastric pain, early satiety and a large abdominal mass

Drain mass w/ endoscopic anastamosis.