Qx

Front 1

central venous catheterization:
1. 1st thing you do after installing it
2.where is proper placement?
3. possible complications

Back 1

1. CXR to ensure proper placement
2. superior vena cava
3/ arterial puncture, pneumothorax, hemothorax, thrombosis, air embolism, sepsis, vascular perf, and myocardial perf -> tamponade

Front 2

abx for mastitis

Back 2

dicloxacillin or cephalos

Front 3

anaphylactic rxn, how do you administer epi?

Back 3

IM! not subq

Front 4

Acute mediastinitis
1. how does it present
2. Tx

Back 4

1. complication post cardiac Qx that presents with fever, tachycard, CP, leukocytosis, and sternal wound drainage or purulent discharge

2. surgical debridement and Abx

Front 5

Acute pancreatitis:
1. causes
2. Tx
3.Dx
4. if gallstone detected what next?

Back 5

1. biliary pancreatitis (ie gallstone pancreatitis), ROH consumption, hyperTGs, and recent ERCP
2. 1st supportive: IVF, NG tube sxn, NPO, analgesia
3. ROH Hx, or if none then US to detect gallstones (CT is inferior to US here)
4. ERCP. then, stable pt.s should undergo laparoscopic cholecystectomy b4 DC to prevent recurrent pancreatitis

Front 6

Diaphragmatic rupture
1. how does it happen?
2. which side more commonly?
3. how does pt. present
4.Dx

Back 6

1. usually MVA
2. left side bc. right is protected by liver
3. respiratory distress, sometimes nausea and vomiting, pain radiating to shoulder
4.CXR shows: nasogastric tube in pulmonary cavity is Dxic. Or barium swallow or CT w/ contrast is Dxic

Front 7

developmental dysplasia of the hip (DDH):
1. Risk factors
2. maneuvers used to assess
3. radiological dx
4. Tx

Back 7

1. white, female, 1st born, breech, FHx of DDH.
2. barlow and ortolani
3. <4 mo yo - US; >4 mo yo = XR
4. hip harness or spica cast

Front 8

acalculous cholecystitis:
1. condition seen when:
2. clinical signs of dz.
3. Dx

Back 8

1.multiorgan failure, severe trauma, surgery, burns, sepsis, prolonged perenteral nutrition
2. fever, leukocytosis
3. CT will show gallbladder distention, GB wall thickening, and presence of pericholecystic fluid

Front 9

scaphoid fracture
1. how it happens
2. Tx
3. XR

Back 9

1- falls on outstretched hand
2- spica cast for 7-10 days
3- then XR bc. can take 10 days for abnormalities to show up on XRs

Front 10

esophageal perforation:
1.symptoms
2. causes
3. Dx

Back 10

1. CP,epigastric pain, abnormal XR, + Hamman sign (subQ emphysema)
2. boerhaave syn., pill esophagitis, barret esophagitis -> esoph ulcer, infxs esophageal ulcer (candida in HIV pt.s), ingestion of toxic substances
3. esophageal perforation is confirmed with gastrograffin (H2O soluble) esophagogram

Front 11

splenic injury:
1.what do you do?

Back 11

1.is he hemodynamically stable?
2.yes -> CT to document splenic rupture
no -> emergent exploratory lap

Front 12

Small bowel obstruction:
1. Tx for partial vs complete
2. S&S

Back 12

1. partial:NG tube decompression and observation; complete: surgical correction via laparotomy.
2.colicky abdo pain with hyperactive bowel sounds attributable to peristaltic rushes, N&V, abdo distension, obstipation for complete

Front 13

Cardiac cath:
1. how to perform
2. complications, minor and major

Back 13

1. cannulate femoral artery to access cardiac vessels.
2. Minor: hemostasis @ access site, hematoma formation, AV fistula, arterial thrombosis, perforation of heart or great vessels, AKI, contrast allergy
Major:MI, stroke, death

Front 14

Acute GI perforation and pt. taking warfarin.
Another scenario: Pt. w/ hx of liver dz and ruptured and bleeding esophageal varicies. What do you do?

Back 14

give FFP to reverse anticoag, NG tube decompression, IV fluids and Abx pre-operatively.

Front 15

preop Qx eval
1.Cardiovascular
2.pulmonary
3.Renal

Back 15

1.- <35yo w/ No Hx of cardiac dz: EKG
- >35 or <35 w/ Hx of cardio dz:
EKG, stress test (look for ischemia), Echo (structural dz and Ejxn frxn)
-EF <35% : risk factor
-recent MI: wait 6 mo.s w/ regular stress tests
2. quit smoking 6-8 wks b4
3. if dialysis pt.: dialyze 24 hrs b4 Qx

Front 16

Trauma: ABC assessment
A. (1) if facial trauma (2) cervical spine injury
B.
C.

Back 16

A.(1) cricothyroidotomy (2) still give orotrach tube but with FLEXIBLE brochoscopy
B. O2 sat >90%
C. 2 large bore IVs

Front 17

hypovolemic shock:
1.skin appearance
2.CVP
3.SVR
4.HR
5. CO
6.LVEDP or PCWP
7. TX
8. common cause

Back 17

1. pale and cool
2. dec
3. inc (bc no blood flowing thru)
4. inc
5.dec (nothing to push out)
6. dec
7. fluids and pressors
8. hemorrhage

Front 18

cardiogenic shock:
1.skin appearance
2.CVP
3.SVR
4.HR
5. CO
6.LVEDP or PCWP
7. TX
8. common cause

Back 18

1.pale and cool
2. inc
3. inc
4. inc
5. dec
6. dec
7. dobutamine
8.MI, CHF

Front 19

neurogenic shock:
1.skin appearance
2.CVP
3.SVR
4.HR
5. CO
6.LVEDP or PCWP
7. TX
8. common cause

Back 19

1. warm
2. dec
3. dec
4. inc
5. dec
6. dec
7.fluids and pressors, NE?
8.spinal cord injury (cervical or thoracic)

Front 20

septic shock:
1.skin appearance
2.CVP
3.SVR
4.HR
5. CO
6.LVEDP or PCWP
7. TX
8. common cause

Back 20

1.warm
2.decrease
3.dec
4.inc
5.inc
6.no change
7. abx fluids and pressors
8. e. coli, staph. A.

Front 21

Bowel obstrxn:
1.signs and sym
2.Dxic tests:
-hallmark sign
-best initial test
3. Tx

Back 21

1.nausea, vomiting, intermittent severe crampy abdo pain, fever hyperactive bowel "tinkling" sounds, Hypovolemia for 3rd spacing
2.-hallmark sign: elevated lactate with marked acidosis
-abdo XR : multiple air fluid levels w/ dilated loops of s.bowel
3.(1)NPO, (2) NG tube, (3)IVF for 3rd spacing fluid loss, (4) emergent Qx

Front 22

child deH2Oion
Tx

Back 22

<ed skin turgor, dry mucus membranes, tachyheart
Tx an IV bolus of Normal Saline

Front 23

64 yo pt. w/ symptoms of anemia and hypovolemia w/ Hgb of 8.1 g/L and evidince of ongoing bleeding. what do you do?

Back 23

administer PRBCs:
-maintaining Hgb > 10 g/L (Hct >/= 30%) in old people and pt.s w/ cardiac dz.
-Hgb >7 g/dL in pt. w/ normal cardiac fnxn

Front 24

Tension pneumo.
signs
define
Tx
What if Tx doesn't work?

Back 24

signs: distended neck veins and trachea away from insult
= one way valve created allowing air to enter but not escape
Tx: needle into 2nd intercostal space, next is tube thoracostomy
If unsuccessful: if hemodynamilcally unstable after above Tx, suspect pericardial tamponade

Front 25

Post op atelectasis
signs
labs
prevention

Back 25

signs: impaired cough and shallow breathing
labs: hypoxemia, resp Alk, and abnormal CXR
prevention: breathing excercises

Front 26

breathing exercises and incentive spirometry prevent

Back 26

post op atelactasis, post op PNA

Front 27

pulmonary contusion
S&S
CXR:

Back 27

S&S: dyspnea, tachypnea, CP, hypoxemia WORSENED BY IV VOLUME EXPANSION
CXR: irregular alveolar infiltrates (opacities)

Front 28

Fat embolism
S&S
when does it usually occur

Back 28

S&S: resp distress, MENTAL STATUS CHANGE, PETECHIA
When: 12 - 72 hours after insult

Front 29

steps in managing blunt abdo trauma (BAT) w/ stable vitals:

Back 29

1. primary and secondary survey (ie ABCs)
2. 2 large bore IVs
3. NG tube and foley
4. CT abdo and pelvis
5. stat H&H, blood type and cross

Front 30

steps in managing blunt abdo trauma (BAT) w/ unstable vitals:

Back 30

1. primary and secondary survey (ie ABCs)
2. Assess for and manage pelvic fracture
2. FAST (focused assessment w/ sono for trauma):
-blood in pelvis -> emergent lap
-no blood in pelvis -> possible retroperitoneal hemorrhage -> angio w/ possible embolization; if angio is normal -> CT of pelvis and abdo
- if FAST inconclusive: DPL (Dxic peritoneal lavage)

Front 31

Ludwig's angina:
=
cause
MCC of death

Back 31

infxn of submandibular and sublingual glands. source of infxn is infected tooth (mandibular molar). MCC of death: asphyxiation

Front 32

paralytic ileus
AKA
S&S
Causes

Back 32

AKA adynamic ileus
S&S: absent bowel sounds w/ gaseous distention of small and large bowels
Causes: classic cause = abdo Qx. other cause: RETROPERITONEAL HEMORRHAGE ASSOC.D W/ VERTEBRAL FRACTURE