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170 Cards in this Set
- Front
- Back
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Which esophageal sphincter has a greater resting pressure, upper or lower?
|
Upper 100mmHg compared to Lower 25mmHg
pg 548 |
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What makes esophageal and chest pain notoriously similar?
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The innervation of the heart mirrors the esophagus
pg 548 |
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There are two pathologic groups of dysphagia. What are they and describe them?
|
Transfer dysphagia- difficulty in initiating a swallow
Transport dysphagia- impared movement of bous pg 548 |
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If a person c/o dysphagia and states they only have difficulty with swallowing food not liquid, which type is the concern for?
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Transport
pg 549 |
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45yo M w/ new onset dysphagia, gradual worsening, + weight loss, and supraclavicular lymph nodes. What is the concern for?
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Esophageal CA (squamous cell 95%, adenocarcinomas 5%)
pg 549 |
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57yo F with hx of GERD that has recently been improving enough to stop her nexium, but worsening dysphagia with food. What is the concern and txmt?
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Esophageal stricture - r/o CA, and dilation
pg 549 |
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62yo M c/o inability to swallow food, worsening halitosis, and feeling of something stuck in his throat. What is the concern?
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Zenker's Diverticulum
pg 549 |
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What are the three most common causes of neuromuscular dysphagia?
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1) CVA
2) Polymyositis 3) Dermatomyositis pg 549 |
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What is the most common esophageal dysmotility disorder and txmt?
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Achalasia- dilation, medication, inj of botulinum, or surgical myringotomy
pg 550 |
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54yo F c/o sudden onset chest pain, worse after eating, N/V, and having difficulty swallowing. EKG WNL. What is the next step?
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Cardiac enzymes, r/o cardiac before esophageal
pg 550 |
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___ is responsible for 10-15% of esophageal perforations, but __ is the most common cause.
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Boerhaave syndrome, Iatrogenic
pg 551 |
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T/F: Mediastinal emphysema is commonly detected by exam and radiography in lower esophageal perforations.
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False: less commonly detected, but it's absence does not r/o perf
pg 551 |
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This is a full thickness perforation of the esophagus after a sudden rise in pressure. Usually due to cough, vomiting or straining.
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Boerhaave's Syndrome
pg 551 |
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A high degree of suspicion is necessary for a child <2yr who refuses to eat, vomiting, gagging, choking, stidor, drooling and neck pain for what and txmt of choice?
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Ingested foreign body, emergent endoscopy
pg 552 |
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For distal esophageal objects, __ has been used to relax lower sphincter tone and allow passage of the object.
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Glucagon
pg 553 |
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T/F: Success rates of glucagon therapy are high, in the setting of waiting for endoscopy.
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False: may be no better than watchful waiting
pg 553 |
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T/F: In the impacted food bolus, the use of proteolytic enzymes (meat tenderizers) to dissolve a meat bolus is contraindictated.
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True
pg 553 |
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Most button batteries should pass within __ hrs and require follow up xrays in __ hrs to ensure passage.
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72hrs, 48hrs
pg 553 |
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What does the Amer Soc of Gastro guidelines recommend for removal of an ingested sharp object?
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removal by endoscopy while in the stomach or duodenum due to high perf rate (35%)
pg 554 |
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This is the elevated levels of bilirubin in the circulation, leading to bile pigment deposits in the skin, sclerae and mucous membranes.
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Jaundice
pg 566 |
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Hyperbilirubinemia can occur for one of three reasons, which are?
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overproduction, inadeqate cellular processing, or decreased excretinon of bilirubin
pg 567 |
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What are the most common causes of hepatic jaundice?
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viral infection, ingested toxin, and alcohol.
pg 567 |
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How do acute and chronic hepatitis differ in presentation?
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Acute - nausea, vomit, RUQ
Chronic- ab pain, distension, abnormal bleeding pg 568 |
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How are the different Hepatitis viruses transmitted?
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A- fecal-oral (improper food handling)
B- sexually transmitted/ needles C- contaminated bld D- coinfects with HepB pg 568 |
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In addition to ___ poisoning, there are a variety of medications, herbals, and dietary supplements that have been associated with acute hepatitis and liver failure.
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APAP
pg 568 |
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The __ __ is the most lethal of the more than 50 types of mushrooms.
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Amanita phalloides "death cap"
pg 569 |
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__ ___ ___ is a subtle yet crucial diagnosis to make because it has a high mortality rate in liver failure pts.
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Spontaneous bacterial perotinitis
pg 569 |
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Which type of hepatorenal syndrome is more deadly?
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Type 1
pg 570 |
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What is the thought to be the driving factor behind hepatic encephalopathy?
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accumulation of nitrogenous waste normally metabolized by the liver
pg 570 |
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What labs are markers for liver function?
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ALT, AST, ALP, PT/INR, indirect and direct bilirubin (conj and unconj)
pg 571 |
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What does an increased total and indirect bilirubin signify?
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either overwhelming supply of unconjugated bilirubin or injury ot the hepatocytes that damages capacity to conjugate
pg 571 |
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What does a direct and total bilirubin increase signify?
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Obstruction preventing secretion (gallstone or biliary atresia)
pg 571 |
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An __ : __ ratio greater than two is common in alcoholic hepatitis b/c alcohol stimulates AST production.
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AST:ALT ration
pg 571 |
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Which liver enzyme is more specific for hepatic injury?
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ALT, b/c AST is also found in the heart, smooth muscles, kidneys and brain
pg 571 |
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ALP or AP (Alk Phos) is a nonspecific marker that can be increased with biliary obstruction, cholestasis, bone, placenta, intestine, and kidneys. What level elevation indicates gallbladder?
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4x normal
pg 571 |
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LDH is a nonspecific liver marker, what can cause elevated LDH and unconjugated bilirubin?
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hemolysis
pg 571 |
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T/F: Ammonia serves as a level that reliably correlates with worsening hepatic fxn of the cirrhotic pt.
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False: does NOT, more a generalized marker for decline than a useful diagnostic tool
pg 571 |
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In liver dz, __ __is tested for cell count, glucose, protein, Gram staining, and culture to identify bacterial perotinitis.
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ascitic fluid
pg 571 |
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A total white count >__ /mm3 or a neurtophil count > __ /mm3 diagnoses spontaneous bacterial peritonitis.
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>1000, >250 (low glucose or high protein suggest infection
pg 571 |
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T/F: Urobilinogen and blood on a urine dip stick supports screening for liver dz.
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False: blood tinged urine will give false positive urobilinogen
pg 572 |
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What is fever, diffuse ab pain and tenderness in a pt with liver dz and ascities until proven otherwise?
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Spontaneous bacterial perotinitis
pg 572 |
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What is the mainstay therapy for hepatic encephalopathy and what is/are dose/ route?
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Lactulose 20g PO (in water or carbonated drink) or PR (dilute 300ml of syrup w/ 700ml water, retain enema for 30min)
pg 572 |
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__ needs to be treated if the pt w/ liver dz has uncontrollable bleeding or is scheduled to undergo a procedure w/ potential bleeding.
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coagulopathy
pg 572 |
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This syndrome occurs as part of the pre/eclampsia spectrum in pregnant women, typically third trimester. HA, malaise, N/V, HTN, RUQ pain.
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HELLP snydrome
Hemolyosis, Elevated LFTs, Low Platelets pg 573 |
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What is the difinitive txmt for HELLP syndrome?
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delivery of the fetus
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Travelers outside the US, present with ab pain, N/V/D or fever are at risk for liver dz by parasite, particulary ___.
|
schistosomiasis (waterborne parasite invades the portal venules.
pg 573 |
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T/F: Removal of liquid contents is useful in cases of GI bleeding, but not all pts w/ GI bleeding require NG aspiration.
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True
pg 601 |
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Which type of UGIB does not require NG aspiration?
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Slow rates of bleeding, such as coffee ground emesis or blood-streaked emesis
pg 602 |
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What three types of pt's would benefit from NG aspiration?
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1)GI bleed w/ hematemesis
2)Massive rectal bleeding & hemodynamic instability 3) SBO pg 602 |
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When passing the NG tube what does coughing, inability to speak indicate?
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trachea placement
pg 602 |
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Which method is preferred for removal of pill fragments from the stomach, NG or OG?
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Oralgastric lavage w/in 1 hr, large bore than NG tube
pg 603 |
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Endoscopy, octreotide, and somatostatin has decreased the use of __ for esophageal varices bleeding.
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Sengstaken-Blakemore tube
(esophageal balloon) pg 603 |
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What are some risks of large volume therapeutic paracentesis?
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hyponatremia, renal impairment, and encephalopathy
pg 604 |
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If a pt has __ or __, correct dificiency before paracentesis.
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coagulopathy or thrombocytopenia
pg 604 |
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If a feeding tube falls out, most tracks mature after __ - __ weeks, and should not be attempted to replace before then.
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2 - 3 weeks
pg 605 |
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If unable to replace the J or G- tube, what shoud be done and how do you confirm placement?
|
next tube size smaller then 20-30ml of water soluble contrast (gastrografin) w/ supine ab xray in 1-2min
pg 605 |
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|
If a Foley cath is used to replace a feeding tube, the balloon SHOULD or SHOULD NOT be inflated?
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SHOULD NOT
pg 605 |
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|
What are the 5 W's of post surgical fevers?
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Wind (PNA), Water (UTI), Wound (infx), Walking (DVT), and Wonder Drugs (drug fever or pseudomembranous colitis)
pg 606 |
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The ___ should be informed about all postoperative wound complications.
|
operative surgeon
pg 607 |
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This postop complication is difficult to distinguish from wound infx, is painful and has wound drainage. Cultures are negative.
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hematoma
pg 608 |
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Wounds associated with entering the ___, ___, or ___ tracts have higher risks of infxn.
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respiratory, GI, or GU tracts
pg 608 |
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56yo DMII M presents 2 days after hernia repair with extreme ab pain, 166/98, 112, 22, 99.9. No erythema or drainage over surgical site. Pain out of proportion to exam. CT shows fascial thickening, gas trackings, and focal fluid collections. Concern and txmt?
|
Necrotizing fasciitis - triple abx therapy (PCN or Cephalosporin + Aminogly + Clindamycin
pg 608 |
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Postop day 4, watery, bloody diarrhea with crampy ab pain. Concern is for what, how to dx, and treat?
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Clostridium difficile, tissue sample is gold standard but usually found with stool culture, Metronidazole
pg 608 |
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Any operation in to the peritoneal cavity can cause __, a function obstruction.
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ileus
pg 609 |
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Small bowel fnx returns after __hrs and colonic fxn after __ - __ days after ab surgery.
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24hrs and 3-5 days
pg 609 |
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A common complication after __ gastric bypass surgery is dumping syndrome.
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Roux-en-Y
pg 610 |
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Pt's presenting soon after cholecystectomy w/ pain, pancreatitis, and jaundice may have a retained ___.
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stone
pg 610 |
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|
Most common causes of rhabdo are (10)?
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1) ETOH/ drugs (80%), 2) meds, 3) msc dz, 4) trauma, 5) neuroleptic malign sny, 6)seizures, 7) immobility, 8) infx, 9) exercise, 10) heat injury pg 622
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|
|
What are the two most common infectious agents responsible for rhabdo?
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Influenza overall, Legionella (bacterial cause)
pg 622 |
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What is the common terminal event, pathophys, that results in increased intracellular Ca+ and muslce necrosis in rhabdo?
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disruption of the ATP-ase pump and calcium transport
pg 623 |
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What is the most sensitive lab for detecting muscle injury relating to rhabdo?
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elevated CK above 5x normal
pg 623 |
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Why is a urine dipstick not helpful in dx of rhabdo?
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urine dip stick does not differ btwn myoglobin and hemoglobin and RBCs.
suspect if dip shows RBCs but micro has none pg 623 |
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Once the pt is in the ED, what is the treatment of choice for rhabdo?
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aggressive IVF rehydration for 24-72hrs and electrolyte management
pg 624 |
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What is the infusion and urine output goals for rhabdo txmt?
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IVF - 2.5mL/kg/hr
UOP - 2mL/kg/hr pg 624 |
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T/F: Calcium should be replaced early in the txmt of rhabdo pts with hypocalcemia.
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False: Calcium is intracellularly shifted and will diffuse extracellularly once IVF are given
pg 624 |
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This is a common painful urological emergency characterized by sudden inability to pass urine with pelvic distension.
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Acute Urinary Retention
pg 640 |
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Sympathetic innervation, responsible for control of lower urinary tract, originates from __ to __ vertebrae.
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T10 to L2
pg 640 |
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What is the most common cause of acute urinary retention in men?
|
BPH
pg 641 |
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What both treats and helps diagnose acute urinary retention?
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bladder catheter
pg 641 |
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When should you consult with urology for acute urinary retention?
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event caused by urethral stricture, meatal stenosis, urethral injury, prostate CA, acute prostitis, uro postop complications pg 642
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When should the urethral cath be placed in an acute urinary retention pt s/p urological procedure.
|
After the urologist is called
pg 642 |
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If failure to pass uretheral cath several times what is the next step in the acute urinary retention pt?
|
suprapubic cath
pg 642 |
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What alpha blocker has been found to improve urine output in acute urinary retention pts?
|
alfuzosin 10mg qd
pg 642 |
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|
What are some causes of acute urinary retention?
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obstructive, infectious, meds, neurogenic, traumatic, psych
pg 644 |
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|
Feelings of urgency or bladder spasms can be treated with?
|
Oxybutynin (Ditropan)
pg 645 |
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What is absolutely necessary when discharging a pt with acute urinary retention with a Foley cath and leg bag?
|
instructions for emptying the leg bag
pg 645 |
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What are two serious complications of lithotripsy that cause severe flank pain, HoTn, and syncope and what is txmt?
|
Perinephric and renal hematomas, call uro for possible embolization and nephrectomy
pg 657 |
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What is Steinstrasse when refering to postlithortipsy?
|
"street of stones" dispersal of stone fragments that can become lodged causing pain, N/V and possible infx
pg 657 |
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67yo M s/p TURP c/o difficulty urinating and passing clots. What is the txmt and if failure next step?
|
irrigate the bladder via foley, if fails to clear bleeding or obstruction call urology
pg 657 |
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Prolonged irrigation of the bladder requires monitoring what?
|
serum electrolytes to asses for hyponatremia
pg 657 |
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What are most catheters made of?
|
Latex, but silicone are available for pt's w/ allergies
pg 658 |
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What is the prevelance of bacteruria for long term catheter placement (>30days)?
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100%
pg 658 |
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When is it acceptable to treat asymptomatic bacteruria in a pt w/ short term catheter?
|
if pregnant or undergoing a urologic procedure
pg 658 |
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__ is universal in pt's w/ long term caths, in the absence of symptoms, it should not be used to diagnose UTI.
|
Pyuria
pg 658 |
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Concern for pyleonephritis in a pt with a cather, fever and UTI on UA should prompt what?
|
removal of the catheter if feasible or replace catheter if in place >7 days
pg 658 |
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What oral abx are acceptable in catheter associated UTIs in clinically stable pts?
|
Cipro 500mg BID 10days or Augmentin 875mg BID 10days
pg 68 |
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In a clinically unstable catheter pt with UTI what medications should be given?
|
Broad spec abx- amp 1g q4-6h + gent 1mg/kg q8h, zosyn 3.375g q 6h, or cipro 400mg q12h
pg 658 |
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An obstucted catheter can lead to infx stones, bladder trauma, and clots. What are some txmt options?
|
repeated bladder irrigations, methenamine, removal of cath if all else fails
pg 659 |
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How can the urethra be injured during catheter placement?
|
if the retention balloon is inflated in the urethra
pg 660 |
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In an uncircumcised male, you must make sure to do what after catheter placement?
|
ensure the foreskin is repositioned after catheter placement
pg 660 |
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Never introduce a urethral urinary drainage cath through an ___ urinary sphincter.
|
artificial
pg 662 |
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Diagnosis of infection should be made on evidence of symptomatic infection based on __, __ pain, change in chronic symptoms or positive ___.
|
fever, flank pain, positive culture
pg 663 |
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The percent of women receiving prenatal care in the 1st trimester is ___ and the precentage of women with late or no prenatal care has ___.
|
decreased, increased
pg 690 |
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What must be r/o in every women of child bearing age, despite chief complaint?
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pregnancy
pg 691 |
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What does G7P 5-1-1-5 mean?
|
7 pregnancies
5 deliveries 1- preterm 1- abortion 5 - living pg 691 |
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The normal fetal heart rate is __ to __ bpm.
|
120-160bpm
pg 692 |
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T/F: A positive serum quant or qualitative HCG confirms a normal intrauterine pregnancy.
|
False: A sinlge positive serum HCG plus ultrasound can confirm
pg 692 |
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How many weeks can you estimate a women is when the fundus is palpated at the umbilicus?
|
20weeks
pg 693 |
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Serum HCGs can detect concentrations as low as __ to __ mIU/mL.
|
10-20mIU/mL
pg 693 |
|
|
What is the analgesic of choice in pregnancy?
|
APAP
pg 694 |
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|
Names some signs/symptoms in pregnancy thta need prompt evaluation (10)?
|
1. change in fetal movement
2. fever, chills 3. refractory emesis, 4. visual changes 5. ab pain, 6. significant HA 7. anasarca 8. dysuria 9.vag bld 10. abnormal vag d/c pg 694 |
|
|
Which type of vaccines are contraindicated in pregnant pts?
|
live virus vaccines
pg 694 |
|
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Can tetnus toxoid alone or in combination with diphtheria toxoid be given during pregnancy?
|
Yes
pg 694 |
|
|
Which sugar substitute is metabolized to phenylalanine, which in high concentrations can cause fetal damage?
|
aspartame
pg 695 |
|
|
What are some uterotonic medications that can be given?
|
Oxytocin 10units IM, Misoprostol 1000mcg PR once, Carboprost 250mcg IM q 15-90min (2mg max)
pg 704 |
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|
What some tocolytic agents that can be give to pregnant pts to supress contractions?
|
Terbutaline 0.25mg SC q 30min (4 dose max), ampicillin, or erythromycin
pg 704 |
|
|
What are the antihypertensive's of choice in pregnancy?
|
Hydralazine 5mg IV q 20min, Labetalol 20mg IV doubled q10min (max 80mg bolus or 220mg), pg 704
|
|
|
What are the preferred anticonvulsants during pregnancy?
|
Magnesium sulfate 4-6g IV loading over 15min, w/ 2g/h infusion, Phenytoin 10-15mg/kg, pg 704
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|
|
What is Nagele's rule for estimating the date of delivery?
|
first day of LMP subtract 3 months and add 7 days
pg 704 |
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What should be immediately monitored in a pt presenting in active labor?
|
materal and fetal vital signs
pg 704 |
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A ___ fetal heart tone is an indicator of fetal distress and an emergent obstetric consult.
|
decreased
pg 704 |
|
|
What should be done before speculum exam in a pregnant, vaginal bleeder?
|
ultrasound to r/o placenta previa
pg 704 |
|
|
If rupture of membranes is suspected, should a sterile speculum exam and/or a digital exam be done?
|
Yes - speculum
No - digital pg 705 |
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It is particularly important to __ digital exams in the preterm pt in whom prolonged gestation is desired.
|
avoid
pg 705 |
|
|
What is a fully dilated cervix in cm?
|
10cm
pg 705 |
|
|
What position is preferable in the pregnant pt after examination?
|
left lateral decub to avoid compression of venous return
pg 705 |
|
|
What happens when amnotic fluid is placed on nitrazine paper?
|
turns dark blue to due pH of 7.0-7.4. vag fluid normally 4.5-5.5
pg 705 |
|
|
What is another method to confirm rupture of membranes, other than nitrazine paper?
|
ferning, sodium chloride crystals on slide
pg 705 |
|
|
What else must be checked for in the amnotic fluid?
|
meconium (thick, greenish brown fluid)
pg 705 |
|
|
Rupture of fluid prior to delivery is premature rupture of membrabenes. What is it called < 37weeks?
|
preterm, premature ruputre of membranes.
pg 705 |
|
|
Prolonged fetal bradycardia (<110bpm) lasting > __min is indication for C-section.
|
5min
pg 706 |
|
|
T/F: If the fetal head is visible during contractions or the cervix is fully dilated and effaced the pt must be rushed to obstetrics for delivery.
|
Fasle- have obstetrics rush to ED
pg 706 |
|
|
There is insufficient evidence, but when should an episiotomy be used (2)?
|
1. expedite delivery due to fetal distress
2. shoulder dystocia pg 706 |
|
|
What is the preferred method to clear meconium in a newborn with a depressed condition?
|
intubation and suction
pg 706 |
|
|
Why must you control the infant during delivery?
|
so it's not dropped...retarded bold statement
pg 707 |
|
|
The umbilical cord is double clamped __cm from the umbilicus and transected with sterile scissors.
|
3cm
pg 707 |
|
|
When should APGAR scores be calculated and what is normal?
|
APGAR at 1 and 5 min, 7-10 pts is normal
pg 708 |
|
|
What is the APGAR for a newborn with arms and legs moving, 110bpm, coughing and pulling away, bluish hands, slow breathing?
|
7pts
A- 1pt (limited movement) P- 2pts (>100bpm) G- 2pts (irritability) A- 1pt (normal, except extrem) R- 1pt (slow, irreg) pg 708 |
|
|
T/F: If the umbilical cord is prolapsed before delivery you must attempt to reduce the cord b/c it is life-threatening to the fetus.
|
False: never attempt to reduce the cord. attempt to lift fetal body part that is compressing cord and transport for surgery, hand in place
pg 708 |
|
|
What is the McRoberts maneuver and when should it be used?
|
legs sharply flexed up to the abdomen, in the lithotomy position while applying suprapubic pressure. Used for shoulder dystocia
pg 708 |
|
|
If the McRoberts and suprapubic pressure fail to dislodge fetal shoulder, what can be attempted next?
|
Woods corkscrew maneuver.
pg 709 |
|
|
What is the main point to remember in cases of breech presentation?
|
keep hands away and let delivery happen spontaneously.
pg 709 |
|
|
What two breech positions are considered not safe for delivery and why?
|
footling and incomplete breech due to possibility of cord prolapse or incomplete cervical dilation
pg 709 |
|
|
Survival of the newborn increases for each week completed from 21 week (__%) to 25 weeks (__%).
|
0% to 75%
pg 709 |
|
|
What are the top 3 causes of vaginitis in women?
|
1. bacterial vaginosis
2. candidiasis 3. trichomoniasis pg 711 |
|
|
34yo F c/o thin, whitish vaginal d/c with foul odor x 4 days. You suspect BV. What location do you collect from and how do you confirm?
|
Sample from side wall of vagina, confirm >20% clue cells, positive whiff test
pg 711,12 |
|
|
Sampling from the ___ ___ may yield inaccurate results b/c semen, bld, medications, and mucus can alter the pH.
|
posterior fornix
pg 711 |
|
|
What are the txmt options for bacterial vaginosis infxn?
|
Metronidazole 500mg BID x 7days, or Clindamycin cream 2% one applicator nightly x 7 days, pg 713
|
|
|
What is the most common symptom of vaginal candida infxn's in women?
|
Vaginal pruritis
pg 713 |
|
|
How do you diagnose and treat vaginal candida?
|
d/c thick cottage cheese, pseudohyphae on slides
Txmt: Clotrimazole, Miconazole,Nystatin, or Fluconazole, pg 713,14 |
|
|
T/F: Regarding Candida infx, single dose treatment with oral fluconazole is as effective as topical treatments but cannot be used in pregnancy.
|
True
pg 714 |
|
|
This vaginal infx is associated with preterm delivery, low birth weights, PID, herpes, HPV, and HIV.
|
Trichomonas vaginitis
pg 714 |
|
|
How do you dx and tx trichomonas?
|
microscopy = motile trichomonads, or rapid antigen test
txmt - Metronidazole 2g PO x 1, or 500mg BID x 7days pg 714 |
|
|
22yo F c/o bumps in the groin that are painful and hard. Denies fever, chills, vag d/c or bleeding. What is the concern for and txmt?
|
Bartholin gland cyst/ abscess
txmt: incision and drainage if well formed abscess, otherwise broad spec abx, pain meds and warm compresses, pg 716 |
|
|
What is the most common location for breast CA to appear?
|
upper outer quadrant
pg 720 |
|
|
What is the abnormal d/c of milky substance called and due to?
|
Galactorrhea - due to elevated prolactin levels
|
|
|
What needs to be done in a female c/o galactorrhea and blurry vision?
|
MRI or CT head for mass
pg 721 |
|
|
T/F: Pueperal mastitis is an infx of the areola, usually caused by staph, and is an indication to stop breast feeding until improved.
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False: breast emptying and hand washing are treatments and there is no need to routinely stop breastfeeding
pg 721 |
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T/F: Treatment options for mastitis are incision and drainage, pain meds, and abx.
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False: Mastitis is an inflammatory response and lacks fluid collection unlike abscesses. No I&D indicated, pg 722
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56yo F returns to ED after diagnosis of mastitis 3 days prior. She was told to return if pain meds and Keflex did not improve symptoms. what is the concern for?
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Breast CA, requires surgical consult
pg 723 |
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What are the 4 main abx used in breast infxns?
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1. Dicloxacillin 250mg, 2. Cephalexin 500mg, 3. Clindamycin 300mg, 4. Bactrim DS, pg 722
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A large retroaerolar abscess is seen on ultrasound. What may be required for drainage?
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general anesthesia
pg 723 |
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Unilateral bloody nipple d/c in a 24yo F is what?
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Breast CA until proven otherwise
pg 724 |
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A palpable breast mass with or without lymphadenopathy, skin uclers, mass fixation, fixed axillary nodes or ipsilateral arm edema should prompt what?
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urgent surgical referral
pg 725 |
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What should be cautiously performed or deferred in a female pt undergoing fertility txmt?
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the pelvic exam due to possiblity of rupturing large ovarian follicles
pg 726 |
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27yo F c/o extreme ab pain gradually worsening last 2 days. VS: 136/86, 110, 18, 102.1, 97%. She had a salpingectomy 4 days ago. What is the dx until proven otherwise?
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bowel injury
pg 726 |
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Differentiate wound disruption, dehiscence and evisceration.
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Disruption - breakdown of any layer of the surgical incision
Dehiscence- disruption of all layers Evisceration- complete breakdown with bowel or omentum protruding pg 728 |
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Women who are Rh negative require Rh immunoglobulin __ mcg IM, after spontaneous or induced abortion.
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300mcg IM
pg 729 |
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23yo F recently underwent US guided oocyte retrieval and now reports 10lbs weight gain in 1 week, ab distension, SOB, and difficulty peeing. what is this rare but life threatening syndrome?
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ovarian hyperstimulation syndrome
pg 730 |
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Why is the bimanual exam contraindicated in females undergoing fertility txmt?
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high risk of fragile ovarian rupture or hemorrhage
pg 730 |
