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42 Cards in this Set
- Front
- Back
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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 |
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Dysuria w/ perineal pain DDX
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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 |
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Decreased breath sound workup
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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 |
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Cryptorchism
Tx |
<1 year=Leave alone
>1 year=Do orchipexy to prevent malignancy and infertility |
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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 |
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Erection mechanism
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Point and Shoot
Parasympathetics=Erection Sympathetics=Ejaculation |
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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 |
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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 |
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Hypospadia & Epispadia
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Hypo: Below
Epi: Above Tx: Surgical correction |
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Potter Syndrome
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B/l renal & lung agenesis w/ limb and facial deformities secondary to Oligohydraminos in utero
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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 |
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Urethral injury in Trauma
S/S Tx |
No foley must use retrograde urethrogram
High riding or ballottable prostate Blood at Meatus Scrotal eccomyosis |
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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) |
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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) |
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Penetrating Abdominal trauma
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Gun: Exploratory lap
Stab: Exploratory lap if unstable or CT w/ contrast of abdomen if stable followed by lap if positive. |
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DIC during surgery
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Give Fresh frozen Plasma and platelet packs especially if they have had alot of packed RBC's because these contain no platelets
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Rib Fracture/Flail Chest
Management |
Do local block to prevent hypoventilation and atelectasis.
If flail chest intubate and give Positive pressure ventilation. |
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Pulmonary contusion
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Lungs are whited out on x-ray & patient in respiratory distress after high impact trauma(usually have broken ribs)
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Incontinence Types
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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 |
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Consequence of a tourniquet
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Causes tissue hypoxia and acidosis which can lead to systemic vasodilation and hypotention
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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 |
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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 |
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Leriche syndrome
SS Dx Tx |
Buttock atrophy and claudicaion w/ impotence secondary to aortoilliac occlusive disease
Tx: Aortioilliac bypass graft |
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Claudication Tx
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Pain w/ exertion: Mod lifestyle
Pain at rest: revascularize |
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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 |
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PE workup
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EKG(R/O MI) & O2 sat then
ABG(wide A-a gradient) then V/Q scan and then heparin |
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Penetrating trauma workup
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-Clean wound & tetanus
-Check vessels w/ doppler arteriogram Vessels ok |
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Electrical burn workup
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Give lots of fluids to prevent renal failure from myogloinuria
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Chemical burn workup
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Copious irrigation with tap water
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Thermal burn workup
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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 |
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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 |
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When to transfuse
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Give packed RBC if Hct <30 to get patient to level of 30.
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ACL & PCL
s/s dx |
Knee unstable and patient hears a pop.
ACL: Ant drawer test PCL: Post drawer test or Lachman |
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MCL
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lateral blow
-abduct w/ VALGUS stress test |
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LCL
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Medial blow
-adduct w/ VARUS stress test |
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Knee injury workup
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Clinically asess w/ tests
MRI Arthroscopy |
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Complication of doing TIPS in alcoholic
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Coma from high ammonia levels as blood from gut now distributes into the brain
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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 |
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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. |
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Post Splenectomy complication
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Subphrenic abscess causing fever, high white count and pain in the L shoulder.
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Low urine output post surgery
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Dehydration causing pre-renal azotemia(BUN:CR ratio>20:1)
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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. |
