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334 Cards in this Set
- Front
- Back
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When to perform CEA |
asxs >80% sxs >50% |
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Celiac a |
hepatic, splenic, L gastric a |
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SMA |
small bowel, ascending & transverse colon |
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IMA |
distal colon |
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What to do with tumor found on EGD |
staging with US& CT or PET chest/abd |
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Siewart Classification of GE Jxn |
I >1 cm above GE Jxn II w/in 1 cm proximal & 2 cm distal to GE jxn III >2cm distal to GE Jxn |
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Siewart class I Tx |
esophagectomy |
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Siewart Clss II Tx |
esophagectomy w/partial resection |
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Siewart class III TX |
total gastrectomy |
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layers of esophagus |
lamina propria muscularis mucosa submucosa |
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esophageal CA MC types |
MC developing: Squamous MC US: adenocarcinoma |
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RF squamous cell CA |
tobacco, alcohol, chemical burns
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tx to squamous cell CA |
sensitive to radiation, reoccurence |
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serum gastrin increase think ... |
zollinger ellison syndrome |
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Type of peptic ulcers with low acid secretion |
Type I gastric body, lesser curvature IV high on lesser curvature |
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Type of ulcers with high acid secretion |
Type II gastric body, duodenal ulcer III prepyloric region |
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type of ulcers from NSAIDs |
V anywehre in stomach
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MC type of ulcer & its Tx |
Type I Distal gastrectomy |
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tx for high acid secteting tumors |
(II&III) truncal vagotomy I also runs rick of hemorrhage, obstruction, perforation |
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common type of ulcer in elderly |
IV high on lesser curvature |
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V stuff |
hypochlorhydia, increased operative mortality, excision of ulcer on gastrectomy, NSAIDs and coconut with H pylori, rarely surgical |
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tx h pylori |
omeprazole, amoxicillin, clarithromycin ome, metron,clarithro omepr, amoc, metron
(OAC, OMC, OAM) |
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surgical indications ulcer |
1.) GI hemorrhage 2.) Perforation 3.) Intractable Pain 4.) Obstruction |
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MCC primary hypothyroidism |
post-surgical |
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Other causes of primary hypothyroidism |
2.) autoimmine 3.) congentital absence (digeorges) 4.) defective Ca sensing 5.) non-autoimmune destruction d/t infiltrative dz: hemochromatosis, wilsons, neck radiation |
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drugs causing vit D deficiency |
phenytoin carbamazepine rifampin
Sr phosphate decreased in vit deficiency |
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CKD electrolyte changes |
hyperphosphatemia hypocalcemia secondary hyper PTH |
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secondary hyperparathyroidism |
insufficient ca increase PTH decrease phos |
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Class I Blood Loss |
1000mL <20% SMP compensated HR <100 RR 14-20 UO >30 CNS nml/anxious cap refill NML |
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Class II Blood Loss |
1000-1500 20-30% SBP orthostatic HR >100 RR 20-30 UO 20-30 CNS agitated Cap refill delay/cool |
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Class III Blood Loss |
1500-2000 30-40% SBP Decreased HR >120 RR 30-40 UO 5-20cc CNS confused cap refill sig. delay/cool |
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Class IV Blood Loss |
>2000 >40% SBP very decreased HR >140 RR >40 UO anuria CNS conf./obtunded Cap refill sig delay/cold |
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Cardiogenic shock signs |
decreased CO causes elevated venous filling pressures and JVD |
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cardiac tamponade |
rest vent filling, elevated JVP and elevated JVD |
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nasopharyngeal CA -type? -RF? -s/s? -etio? |
squamous cell mediterranean or far east descent asxs till advanced, mets usually by dx EBV |
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mechanical ileus on PE |
tinkiling BS |
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ileus |
hypoactive BS
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drug to enhance gastric emptying |
metoclopramide |
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when to drain diverticulitis with abscess |
>3cm CT guided, smaller abx and obs. And if drainage does not imprve by 5th day then surgery for drainage and debridement |
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ABI of waht dx of PAD in sxs its ? |
<0.90 |
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what does the MCL resist? |
valgus angulations (abduction) |
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Diagnosis of Boerhaave Syndrome? |
1st - CXR will show L pleural effusion, pneumomediastinum and PTX 2nd - Water soluble contrast (doesnt irritate pleura) esophagram |
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Tx Boerhaave Syndrome |
If perforation present, primary closure of esophagus & drainage of mediastinum ust be attempted w/in 6hs to prevent mediastinitis |
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Injury mechanism of ACL |
rapid deceleration of directional , pivoting with with foot planted |
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sxs acl |
popping, swelling, effusion, ant laxity of tibia relative to femur (ant drawer , lachman) |
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tx acl |
MRI and surgery RICE ( rest, ice, compression and elevation) |
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Torus Palatinus |
midline suture of hard palate benign bony growth (exostosis) MC younger pts women and asians sugery if sxs interferes with speech or eating
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Retroperitoneal abscess |
fever chills and DEEP abd pain blunt pancreatic injury not detected initially, devitalized tissue or a pseudo cyst secondarily infected
tx: immediate percutaneous drainage catheter, culture, ultimately surgical debridement |
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small bowl injury |
duodenal hematoma abd obstruction |
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LGIB |
diverticulosis angiodysplasia, ishcemia infections and neoplams |
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Meniscal injury |
locking of knee joint on extension, ROM limited, +mcmurrays sign |
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trachea deviation, red BS, dullness to percussion |
hemothorax |
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Breast CA IIa Tx |
2-5cm surgery and adjuvant therapy or systemic therapy prior to locoregional therapy |
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Breast Ca Staging |
I <2cm no mets, no nodes IIA <2cm in diameter with mobile axillary nodes OR 2-5cm no nodes IIB 2-5cm in diameter with mobile axillary nodes or >5 no nodes IIIA >5cm with mobile axillary nodes or any size with fixed axillary nodes no mets IIIB skin edema chest wall invasion / fixation inflamm ca, ulceration any tumor with + ipsiateral internal mammary lymph nodes IV distant mets (includ ipsilateral supraclavicular nodes) |
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Triple Receptor NEgative Breast Ca is common in who |
premenopausal and AA and hispanics |
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MGMT in Stage I or II Breast Ca |
ALNB, or SLNB II at risk for recurrence with locoregional theraoy only so offered chemo |
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Breast Ca stage III or IV Tx |
surgery followed by chemo, neoadjuvant chemo followed by surgery FACAC taxotere + HER2 if needed dose dense 1-2 weeks better antiestrogen for 5 years after completion of adjuvant A1 - aromatase inhibitors |
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INdirect Hernia S/S |
defect = patent processus vaginalis scrotal swelling, labial swelling lateral to inf epigastrics |
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direct hernia |
hesselbacs - medial to inf epigastrics 1= epigastrics 2=rectus sheath 3=inguinal ligament |
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femoral hernia |
coopers inguiinal femoral vein lacunars
protrudes below inguinal ligament |
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littre hernia |
groin hernia containing meckels diverticulum or appendix |
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richter hernia |
herniation of part of bowel wall thru defect in anter abd wall constriction of wall can lead to necrosis |
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spigelian hernia |
jjust lateral to rectus sheath at smilunar line with lower limit pf post rectus sheath |
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obturator hernia |
MC in multiparity older women, part hip flexed and ext roated abducted = how ship - romberg |
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MC type of malgnant melanoma |
superficial spreading 70% |
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other types of melanoma |
nodular sclerosis - aggressive vertical lentigo maligna - long radial growth phase, goodprognosis acral lentiginous - AA, asians and hispanics, palsm soles of hands and feet and nail beds |
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melanoma in situ |
<0.5cm |
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Stage I and II skin cancer |
surgery |
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stage III skin cancer |
surgery adjuvant limited, intron 2A |
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Stage IV melanoma cancer |
6-9mo, high dose interleukin-2 BRAF and MAP |
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Acute Epidural Hematoma |
pupil fixed / dilated on side of hematoma ETIO: meningeal arteries DX CT Scan - biconvex shape TX: emergency surgical decompression , fatal w/in hours if not |
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Acute Subdural Hematoma |
Unconscious at site, regains consciousness, then coma. increasing HA then confusion fixed dilated pupil of affected side Emergency craniotomy, booracute prognosis etio : bridging veins CT: creschetn shape |
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Chronic Subdural Hematoma |
senile over weeks after trauma surgical decompression and spectacular improvement |
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Base of Skull Fx |
coma, racoon eyes, CSF from nose/ears, ecchymosis behind ear CT cervical spine XR neurosurgery consult and abx |
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If trauma to precordial area ... |
skip window and do thoracotomy |
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elderly man p/w massive MI in cardiogenic shock |
verify high CVPs, EKG, enzymes, coronary care unit DONT give IVF, ue thrombolytics if offered. |
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Tension PTX, Plain and Hemo sounds |
Tension: tympanic Plain: Resonant Hemo: Dull, CXR one single air fluid level |
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vasomotor shock |
stung by bees hives after PCN pt going to sx to get spinal anetheisa BP low, HR up, warm and flushed no pale and cold, low cvp TX: vasoconstrictres, volume replacement wouldnt hurt |
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where to put chest tubes in plain and stable PTX |
high in pleural cavity |
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Hemothorax |
NO BS at base, dull to percussion CXR then Ct at base should be little bld retrieved and even smaller amnt later |
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If hemoPTX CT drains a lot then a lot again |
Surgery to ligate vessel usually intercostal |
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Closed truama distended neck veins |
tention PTX with penetratin trauma, tympanic to percussion, rib fx can act as penetrating, Ctube right away , xrays later to look for wide mediastinum/aortic rupture |
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Tx Flail Chest |
fluid restriction, diuretics, colloid over crystalloid prn resp support
DONT PICK mechanical support mech, BL ctubes etc... |
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"White out" on CXR |
pulm contusion may not be visible at time of trauma MGMT: fluid restriction (using colloid) diuretics, resp support the later is key with intubation mech vent and peep |
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Sternal Fx |
crucnching feeling or crepitation elicited by papation CSC myocardial contusion and traumatic rupture of aorta w/up: MI AKG, cardiac enzymes, CT scan, TEE or arteriogram for aortic rupture |
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mod resp distress no BS on L Chest percussion unremarkable, CXR - air fluid levels in left chest |
Diaphragmatic Rupture always on left. NG tube will curl up into l chest surgical repair |
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king size trauma hard to fx bone (first rib, sternum, scapula) & widened mediastinum |
aortogram tx emergeny surgical repair |
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blunt trauma, PTX, progreesive emphysema all over upper chest and neck |
traumatic rupture of trachea or major bronchus CXR confirms fiberoptic broncosocopy to cx dx and level or injury and to secure airway, then surgical repair |
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When to do exp lap on penetrating abd wound |
everytime indwelling bladder cath, big bore venous line, fluid admin, dose of broad spec abx |
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penetrating truaama below nipple |
Needs full work up for chest (CXR, poss Ctube) AND abd exp lap |
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Tenderness LL Chest, rib fx 8-10, hypotension, tachycardia |
ruptured spleen -if responds to IVF doesnt need blood - CT, cont obs and serial CT scans -"crashing" peritoneal lavage, US-exp lap |
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vacc if spleen removed
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remember: try to repair rather than remove esp in children -pneumovax -h flu b -meningococcus |
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guarding and rebound in all 4 quarants |
blood in belly or abd contents from ruptured viscus |
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trauma pt with bld in meatus |
pelvic fx no foley Needs retrograde urethrogram |
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pelvic fx, bld in meatus, scrotal hematoma, sensation he wants to urinate but cant, DRE shows high riding prostate |
Posterior Urethral Injury retrograde urethrogram TX: suprabubic cath, repaur delayed 6 mo |
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pelvix fx, bld in meauts, scrotal hematoma |
anterior urethral injury retrograde urethrogram repaired right awy |
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No bld in meatus bu gross hematuria after foley insertion |
bladder injury, req retrograde cystogram |
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gross hematuria |
kidney injury, retrograde cystogram will be normal, dx with CT scan only sx if renal pelvis is avulsed or pt exsanguinating |
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microhematuria in kids |
needs to be investigated via US |
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scrotal hematoma |
ruptured or not US, if ruptured then sx |
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Large penile shaft hematoma w/nml glans, occured during sex |
fx or tunica albuginea sx meergency |
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kids vs adults 3rd degree burns |
kids = deep bright red adults = white and leathery |
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electircal bruns other concern |
myoglobinuria needs IVF, diuretics ocmotic if choice (mannitol) perhaps alkalinazation of urine
always bigger than appear need sx debride. |
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resp burns |
bronchoscopy and resp support dry white eleathery circmferential will dev massive edema TX> compulsive comintoring of perph pulses and cap filling escharotomies at bedside w/ first sign of compromised circ. |
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moist blisters painful to touch |
2nd degree burn, silvadene |
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Parkland formula |
4cc per kg of body wight % of burned area (up to 50% ) kids head 2x as big and legs pick up slack ringers lactate half dose in 8 hrs give colloids 2nd day monitor cvp and UO cc/kg/hr
head = 9 arm=9 leg=18 trunk=36 |
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when are add'l fluids needed in burn mgmt |
uo 2cc/kg/hr electrical burns escharotomy wound care = sulphamyelon deep penetration (cartilage_ rehab starts on day 1 |
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small 3rd degree burn |
early excision and grafting |
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human bite |
sx exploration by surgeon |
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basal cell |
waxy, punched out, full thickness bx, surgical excision w/clear margins |
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squamous cell |
ulcer, bx, 1 cm margins, local radiation |
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melanoma |
bx, margin free of local excision if superficial clarks 1-2 <0.75mm wide local 2-3cm if deep |
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if mets to liver with no primary tumor |
h/o missing tow, glass eye, enucleation of a tumor = melanoma |
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fibroadenoma |
young female, rubbery mass, moves with palpation, dx FNA, core bx or excisional bx |
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Cystosarcoma Phyllodes |
dx core or incisional bx, margin free excision, mexico, can become malignant sarcomas |
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bldy nipple dc |
intraductal papilloma mammogram for non palpable resxn |
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eczematous lesion around areola |
pagets |
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baby with white pupil |
ddx cataract? ophthamologist NOW for possible retinoblastoma |
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huge eyes |
congenital glaucoma |
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acute glaucome |
needs opthamologist now diamox, pilocarpine drops or mannitol |
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floaters |
retinal detachment |
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loss of sight |
embolic occlusion of retinal artery -breath into paper bag, someone press hard on eye and release repeatedly |
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mallory weiss tear |
EG jxn DX EGD, photocoag if needed |
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boerhaaves |
can also happen from instrumental perf |
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vague epigastric discomfort and weight loss |
CA of stomach, EGD w/bx |
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Carcinoid Syndroem |
flushing, diarrhea, HF, bronchoconstriction etio endogenous secretion of serotinin and kallikrein dx serum 5-hiaa >25mg in a day |
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decrease caliber and blood coated stool |
l colon Ca |
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4+ occult blood |
r colon ca |
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Pre malignant polyps |
1- familial polyposis 2-gardners 3-villous adenoma 4-adenomatous (FGVA) |
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Benign |
Juvenile Peutz-Jeghers Inflammatory Hyperplastic (JHIP) |
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pseudomembranous colitis from overgrowth of c diff |
proctosig can show typical pic b4 cult TX: DC Clinda start vanc, or metronidazole, avoid lomotil |
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anal itching discomfort pain |
external hemorrhoids but any blood per rectume must r/o CA! |
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pain with defecation, bld streaks stook refuses PE |
anal fissures r/o CA anesthesia exam TX: Lateral internal spincterotomy |
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perianal pain, BM, painful chills and fever |
ischiorectal abscess tx drainage, exam under anesthesia to r/o CA PE: hot tender, red, fluctuant mass b/w anus and ischial tuberosity |
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fistula in ano |
r/o ca with procto sig elective fistulotomy |
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squamous call CA of anus |
h/o immuno suppression fungating mass out of anus, rock hard lymph nodes, weight loss bx nigroprotocol of preoperative chemo and radiation |
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for all UGI bleeds start with |
egd |
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melena unstable |
NG first |
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GI w/o active |
upper and lower endoscopy |
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Peds GI BLeed |
meckels radioactive labeled technitium scan - one that IDs gastric mucosa |
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stress ulcer |
long hops course prevention = ph>4, H2A, antacids, both s/s vom blood Dx EGD tx" may req angio embolization of left gastric aa |
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acute abd |
R/O LL PNA with CXR and MI with EKG, nice to have nml amylase tx exp lap |
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cirrhotic liver with ascites in adult nephrosis and ascited in child |
primary peritonitis cult ascitic fluid and use trgated abc |
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perf duodenal ulcer |
sudden onset, free air, abd pain, bo bs tx emergent exp lap |
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Ureteral colic |
flank colicky pain of sudden onset, radiates to inner thigh and scrotum Dx microscopic hematuria, KUB, US traditioanly IVP |
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recurrent diverticulitis |
resxn or colostomy |
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severe abd distension, n/v, colicky abd pain, -bm/flatus, tympanic and, +hyperactive BS |
sigmoid volvulus xray: distended loops of small bowel and large bowel gas shadow located in RUQ, tapers towards LLQ w shape or parrots beak TX procsig should relieve obstruction or rectal tube eventually sx to prevent recurrence |
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a fib, acute abdomen silent bw, diffuse ttp, mild rebound, trace bld, per rectume, acidosis |
mesenteric ischemia dx xray distended small bowelr and distended colon uo to mid transverese not much can be done |
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h/o cirrhosis, malise RUQ discomfort, 20lbs weight loss palpable mass over liver |
liver CA CT resn if confiend to one lobe |
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hepatic adenoma (ruptured) |
pmh long use of BC CT and surgery |
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liver abscees after chol |
pyogenic ct guided drainage |
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amebic abscess in liver |
mexico metronidazole |
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Total bili elevated unconjugated elevated conjugated nothing no bile in urine |
hemolytic jaundice |
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total bili up unconjugated up conjugated up alk phos up SGOT and SGPT up |
Hepatocellular Jaundice -recent trip abroad -serologies to determine type of hepatitis |
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Progressive jaundice present for weeks: Labs: t bili up direct up indirect up but not as much as direct min elv SGOT alk phos at first 2x nml now 6x nml US: dilated intrahepatic ducts and finding of gallstones |
obstructive jaundice |
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T bili up up direct up up indirect up min elv sgot alk phos 6x nml wight loss asxs |
silent obstructive jaundice dilated intrahepatic ducts, dilated extrahepatic ducts thin walled gallbladder Dx CT and ERCP -If CT unremarkable and ERCP shows narrow area in distal CBD and nml pancreatic duct Dx: cholangiocarcinoma of lower end of CBD TX: pancreaodudenectomy (whipple) get brushings of CBD for cytologix dx |
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progressive jaundice 2 weeks TB up direct up indirect up but not as much as direct min elev sgot alk phos 20x nml slight anemia +occult US : dilated intrahepatic ducts dilated extrahepatic, very distended thin walled G |
ampullary CA tx surgery egd
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Progressive jaundice TB up up direct up up indirect up min elv sgot alk phos 8x nml weight loss h/o persistent nagging pain epigastrium and upper back us dilated intrahepatic ducts, dilated extrahep , distended thin walled gb
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pancreatic CA of head DX: CT, ERCP, pbstruction of both CBD and pancreatic duct |
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transisnt cholangitis |
passed CBs, sjalog ng chills, high phosphatase, bit of bilary pancreatitis high amylase dx US TX: cont to get well elevtive cholecystectomy deteriorates stone in ampulla or vader, ERCP and pshyincterotomy |
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GALAW |
Glucose> 200 AST>250 LDH>350 Age>55 WBC>16 |
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CHOBBS |
Ca<20 HCt>10% drop O2 <60mmHg BUN increase 1.8 or more Base Deficit >4meq Seq fluids >6L |
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discomfort, early satiety, PMH recent tx acute pancreatitis pr trauama |
pancreatic pseudo cyst us poss CT if drainage IR |
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steattorrhea, calfication of pancreas on XR |
chornic pancreatitis stop etoh replacement of pancreatic enzymes ERCP |
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Post Op Fever Timeline |
Day 1: atelectasis 3: UTI 4: DVT 5: wound dehiscence 0 clear pinkish salmon colored fluid 7: wound Infxn 2 weeks: Deep abscess Ct and IR drainage
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hyperthyroid labs |
low tsh high t3 t4 |
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Ca high, low phos "stones bones groans..." |
Parathyroid Adenoma PTH determination sistimibi scan
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buffalo hump, mood facies, amenorrhea, HTN, bruised extremities, central obesity |
Cushings Dx: AM and PM Cortisol levels Dexamethasone duppression test & MRI - pit microadenomas TX: removal via trans nasal, trans spehnoidal route |
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h/o multiple non healing peptic ulcers |
Gastrinoma (zollinger ellision) Dx serum gastrin CT or MRI of pancreas to find tumor |
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decreased blood sugar increased insulin LOW C peptide |
exogenous insulin admin |
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Decreased blood sugar increased insulin increased C peptide |
insulinoma CT or MRI to find tumor in pancrea surgical removal |
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Glucagonoma |
migratory necrolytic dermatities, mild stomatitis dm DX: measure glucagon levels, CT/MRI for tumor in pancreas surgery if inoperable somatostatin with sxs and streptozocin for chemo |
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increased aldosterone decreased renin hypokalemia
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hyperaldosteronism, poss adenoma hyperplasia - not surgical, tx aldactone adenoma - surgical CT and MRI for sx |
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HA, Pallor, HTN, palpitations |
pheo 24 hr urine, metanephrine and VMA CT of adrenals alpha blockers, before eventaul sx |
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incresed BP in arms, nml in legs |
coarctation of aorta cxr, scalloping of ribs aortogram suregry |
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increased bp in youth, doesnt respond to medsm bruit over upper abd |
renovascular htn d/t fibromuscular dysplasia arteriogram precedes surgical correction of balloon dilation
renovascular HTN d/t arteriosclerotis plaque of renal artery or arteries BL in older pts |
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8 hrs after birth, excessive salivation, NG tube baby gram XR shows tube coiled back on self in upper chest, air in GI tract |
tracheo esophageal fistula (MC type w/proximal blind esophageal pouch and distal TE fistula) DX: R/O VACTER (vertebral, anal, cardiac, TE< renal/radial echo heart), US kidneys, PE anus Then off to surgery |
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Imperforate anus |
r/o VACTER look for fistula, determines surgery |
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tachypnea, cyanosis, schapid abdomen bs in left chest cxr shows bowel in thorax |
congenital diaphragmatic hernia TX: hypoplastic lung, better to waith 36-48 hours to do surgery to transistion from fetal to newborn ciculation in meantime intub careful hyper vent sed ng suction |
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large abd wall defect, matted mass of edmatous bowel loops |
gastrochisis |
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shiny thin, membranous sac @ mass of umbilical cord, inside sac, liver looops of nml looking bowel |
omphacele |
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mast medallion of mucosal occupying lower abd wall urine |
extrophy or urinary bladder, repair needsto be in < 48 hrs |
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green vomiting |
duodenal atresia - "double bubble" annular pancreas w/complete obstruction - emergency surgery , look for other cong. anamolies |
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large fluid in stomach and smaller one in 1st portion of duodenum and air in distal bowelbeyond duodenum and air in distal bowel beyond duodenum in loops that are non distended |
double bubble seen in duodenal atreais 0 incomplete obstruction -annular pancea -malrot dx-contrast enema dx if not water soluble ( gastrographin) UGI |
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green vom 1st dol no meconium passage and distension xr multiple air fluidlevels and distended loops |
intestinal atresia etio: vasc anomaly in utero |
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a few drops out in first month or 2 |
necrotizing enterocolitis -premature, feeding intolerance abd distention |
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abd pain that refers to L shoulder |
sugg intraabdominal path peritonitis and irrigation of diaphragm (Kehr) phrenic N c3-c5 bladder dome covered in peritoneum can cause peritonitis |
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mc site of peritoneal bladder rupture
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bladder neck |
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bladder parts that are extraperitoneal |
bladder neck ant bladder wall psuedomembranous urethra ant urethra
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thin erythematous plaque w/ well def irregular borders overling scale of crust |
Bowen's Dz squamous cell CA in situ of skin |
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Decrease strength, and diminished pain and temp in arms/hands/cape preservation of dorsal column fxn (light touch, vibration, position sense) |
Syrinomyelia - dz process where CSF drainage from central cord canal is disrupted leading to a fluid filled cavity compr. surrounding neural tissue
MCC: arnold chiari malformation & h/o spinal cord injury (whip lash) |
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upper and lower MN defects w NO loss of sensory fxn twthicn mm weakness and cramping |
ALS |
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disc degeneration in pts >40, neck pain and stiffness spinal stenosis -neuro deficits |
cervical spondylosis |
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unilateral radiculopathy from compression of N root, unilateral pain and weakness in distrubution of involved likley no sensory findings |
herniated disk |
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random asym. white matter lesions, nystagmus and scanning of speech are common sys |
MS relapsing remitting course common @ least 2 separate lesions req for dx |
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fall on outstretched arms, can't lower arms smoothly |
rotator cuff injury |
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biceps mm belly prominent mid upper arm -weakness in supination -forearm flexion preserved |
rupture of tendon of long head of biceps "popeye sign" |
|
|
swelling ecchymosis crepitus over fx |
humeral neck fx |
|
|
winged scapula, paralists of serr ant,
|
injury to long thoracic n -mcc iatrogenic during alnb |
|
|
sudden upward pulling on arm "klumpkes palsy" |
lower inferior trunk brachial plexus, c8-t1 |
|
|
weakness/atrophy hypotheniar and interosseous "claw hand" |
ulnar N damage |
|
|
tachycardia, new BBB, arrhythmia, sternal fx |
myocardial contusion |
|
|
PTX that doesnt resolve with Ctube, pneumomediastinum and sc emphysema |
bronchial rupture |
|
|
strabismus |
CN III, IV and VI brainstem lesions |
|
|
0-2 hours fever post op |
-prior trauma/ infxn -bld products -malignant hyperthermia |
|
|
24hrs - 1 week post op fever |
-nosocomial, -HAS c perferinges SSI -MI,PE, DVT |
|
|
1wk - 1 mo post op infxn |
-ssi catherter -c diff drugfever -pe dvt |
|
|
delayed > 1 mo post op infxn |
-viral -indolent organism |
|
|
FEna <1 and >1 |
<1 prerenal azotemia >1 intrinsic renal dz |
|
|
dilation of pampiniform plexus, dull or dragging discomfort, bag of worms |
varicocele |
|
|
edema in dep areas, scrotum legs |
hypoalbuminemia |
|
|
fluid in tunica vaginalis will transiluminate size increased with valsalva , reducible |
hydrocele |
|
|
painless fluid filled sacs contained sperm , sup pole of testes classically transilum. |
spermatocele |
|
|
benign breast dx mc perimenopausal s/s intermittent bldy diarrhea from nipplr 1 |
intraductal papilloma |
|
|
post menopausal women, nipple DC , breast mass, dont penetrate basement membrane |
ductal CA in situ |
|
|
DC from bippled but eczematous changes from nipple |
pagets |
|
|
1-2 3-5 4-6 >7 |
PNA UTI DVT wound wonder drugs |
|
|
compression of contralateral crus cerebri oculomotor III |
ipsilateral hemiparesis, early mydriasis, loss of parasym inner, ptosis down and out gaze of ipsilateral pupil d/t unopposed trochlear and abducens |
|
|
ipsilateral post artery |
contraletral hemonymous hemianopsia |
|
|
retic formation |
loc coma
|
|
|
prosthetic joint infxn early vs late |
early <3mo -s aureus gream i rods, anearobes
late coag - staoh proprioibacterium entrococci |
|
|
Severe SIRS |
End organ damage when: -oliguria -<90sbp -thrombocytopenia <80 -met acid -hypoxemia |
|
|
sreum sickness |
feer urticaria, arthritis, nephritis immune complex against heterologous proteins |
|
|
Fx of Humeral midshaft, use of imp fitted crutches, wrist drop, sensory loss on post arm, forarm and lat dorsal hand |
Radial N injury |
|
|
Fx of medial epicondyl or distall dep lac to ant wrist "claw hand" paralysis of intrinsic m of hand and sensory loss to coral/ventral medical hand |
ulnar N injury |
|
|
lat cord of brachial plexus, innv biceps brachialis and coracobrachialis |
musculocutaneous |
|
|
blocking bbal shot; longer abduct/ ext of rotation glenohumeral |
axillary N |
|
|
PCWP in hypovolemic shock and cardiogenic shock |
hypovolemic decreased cardiogenic increased |
|
|
mechanical induced neuropathic degen w/sxs including numbness and burning of toes, rad from met heads to 3rd and 4th toes clinickgin |
morton neuroma -metatarsal support, if fails then sx |
|
|
arterial thrombosis vs emboli timing |
thrombosis - insidious emboli - acute |
|
|
decreased Ca intake |
decreased Ca and phos |
|
|
hip thigh and buttocks claudication |
leriche syndrome |
|
|
dashboard injury |
PCL |
|
|
MCL |
do valgus stress test |
|
|
LCL rare |
varus stress test |
|
|
retropeironeal organs less cly injured
|
duodenum, pancreas |
|
|
long bone fx, tachypnea, tachycardia , hypotension, mental status change, thrombocytopenia, petechial |
fat emboli ; fat droplets in urine ; B/L pulm infiltrates TX resp support heparin, steroids, dextran |
|
|
trendelenberg sign |
pelvic dropping neuromuscluar dz, impingement of trauma, to sup gluteal N inflam myo |
|
|
mm of post thigh, leg and plantar foot, (flexion) sensation to leg (except medial) and plantar foot |
tibial N |
|
|
mm medial thigh (gracillus) , adductor longus , brevis, ant portion of adductor magnus, sensation over medial thigh |
obturator N |
|
|
ant lat thigh, sens to anterolat leg and dorsum of foot |
superficial/deep peroneal N |
|
|
ant comp thigh, knee extension and hip flexion, sen to ant thigh and medial leg via saph branch |
femoral N |
|
|
Ct shows min punctate hemorrhage w / blurring of gray-white matter |
diffuse axonal injury , rapid dece l |
|
|
duodenal hematoma |
direct blunt trauma, epigastric pain, repeated vom NG and TPN |
|
|
how to correct flail chest |
PPV |
|
|
hyperextension elerly, preexisintg defen, weakness in upper extrem, > than lower selectve loss of pain and temp sensation in arms |
central cord syndrome |
|
|
BL spastic motor paresis distal to lesion usually d/t occlusion of ant spinal cord |
ant ventral cord syndrome |
|
|
hemisection of cord d/t penetrating injury, ipsilateral weakness, spasticity loss of vibration sense and proprioception contralateral: loss of pain and temp sensation |
brown sequard syndroem |
|
|
AMS?LOC Sz |
cerebral contusion |
|
|
BL loss of vibratory sence weakness, paresthesias urinary incontincence, or retention, |
posterior cord syndrome ( CC: MS, vasc disruption (vertebral dissection) |
|
|
breast trauama or sx, microcalcification, fat globules, foamy histiocytes |
fat necrosi of breast uncommon |
|
|
secondary arthritis of hip/knee, increased alk phos, nml Ca and Phos,, increased head size, HA cranial N palsies hearing loss d/t damage or chocler n |
pagets dz of bone |
|
|
idopathic avascular necrosis of femus |
legg calve perthes sx, obs bracing |
|
|
prix mm weakness and calf pseudohypertrophy |
DMD MC childhood myopathy |
|
|
imm inability to bear weight |
ACL |
|
|
preemie dev feeding intolerance and abd distention and rapidly dropping plt |
tx with indomethacin for PDA, has nec entero TX: Stop feeding, broad spec ABX, IVF / nutrition, sx if dev abd wall erythema air in bilairy tree of pneumo peritoneum |
|
|
baby with feeding intolerance and bilious vomiting, X ray shows dialted looks of bowel and "ground glass: appearance in lower abdomen |
CF - GASTROGRAFIN ENEMA MAY BE DX AND THERAPEUTIC -if unsuccessful then sx |
|
|
3 wk old trouble feeding bilous vominitng "double bubble" |
malroation, TX: contrast enema to verify and emergency syrgery |
|
|
3 wk old projectile vom, eager to feed after vim, olive mass |
pyloric stenosis -check electrolytes for hypoK, and hypocholeremic met aklk -correct -rehydrate -ramsted pyloromyotomy |
|
|
8 wk old persisten jaundice bili up, conj up, US r/o masses, - hepatitis, sweat test nml
|
biliary atresia HIDA, PC liver bx , exp lap
|
|
|
2 mo old chronic constpiation abd distenstion plain xrays show gas in dilated loops of bowel thruout abd rectal exam followed by expulsion of stool and flatus w/remarkable improvement of distention |
Hirshsprungs Dx with barium enema define nml looking aganglionic distal colon and abn looking thickness bx of rectal mucosa |
|
|
9mo colicky abd pain , currant jelly stools |
intusseption |
|
|
7yo passes large bldy BM |
meckels radioisotope scan looking for gastric mucosa in lower abd |
|
|
cystic mass of neck at level of hyoid bone when mass palpated at same time tongue pulled connect ion |
thyroglossal duct cyst TX: sistrunk operation |
|
|
fluctuant round mass on side of neck neneath and in front of sternoumastoid mm |
brachialcleft cyst curgical removal |
|
|
mushy fluid filled mass at base of neck , supraclavicular areaand seesm to go deep into neck and chest |
Cystic HYgroma 0CT CHEST to see how deep and surgery |
|
|
smokes, etoh rotten teeth, mass anteromedially to sternomastoid mm at level of upper notch of thyroid cartilage, persistent unilatera learache OM, painless ulcer in mouth |
met SCC to jugular chain node from prim in mucosa of head/neck -DONT BX, FNA OKAY -need to do triple endoscopy |
|
|
unilat sen hearing loss |
acoustic n neuroma |
|
|
slow progressive paralysis of facial N on one side evnt paralysis |
neoplastic, -gadolinum enhanced MRI - sensitive for white matter lesions |
|
|
firm mass in front of ear, deep painless no loss of fxn |
Pleomorphic adenoma (mixed tumor) -Tx: FNA, but parotid mass should be bx by head and neck surgeon |
|
|
hard fixed parotid mass, constant pain, lfn paralysis, rock hard lympho nodes in neck |
Cancer of parotid -bc by head and neck |
|
|
ludwigs angina tx |
tacheostomy and ID of abscess |
|
|
Cavernous sinus thrombosis or orbital cellulitis |
high dose abx, sugical I&D of paranasal sinuses |
|
|
epistaxis nose picking |
anterior, phenyleprhine and pressure |
|
|
epistaxis denies nose picking |
post bleed -septal perf from cocaine -or posterior juvenil nasopharyngeal angiofibroma ENT |
|
|
epistaxi secondary to HTN |
lower BP call ENT |
|
|
12yo -pulm flow systolic murmur -fixed split 2nd heart sound -h/o colds URI |
ASD -echo -surgical closure |
|
|
"failure to thrive" 3mo old -Lound pansystolic heart murmur at LSB CXR increased pulm vasc
|
VSD -echo and surgical closure |
|
|
3 day old -preemie -trouble feeding and pulm congestion -boudning peripheral pulses continuous machinery murmur |
PDA -echo -surgical closure or indomethacin |
|
|
small for age 6yo -bluisigh hue to lips and tips of ifngers -clubbing and spells of cyanosis relieved by squating systolic ejection murmur in L3ICS CXR: small heart, dim pulm vasc EKG: RVH |
tets |
|
|
cyaonotic kids MC |
1. Tets 2. transpo 3. truncus arteriosus 4. total anomalous pulm venous connection 5. tricuspid atresia k |
|
|
kid went home from hospital then found to be cyanotic |
tets
|
|
|
blue from moment of birth |
transposition dx with echo |
|
|
-elderly -h/o angina / exertional syncope -harsh midsystolic murmur 2ics LSB
|
AS -Echo -surgical valve replacement if grad >50mmHg or first indication of CHF, angina or syncope |
|
|
-wide PP -blowing high-pitched diastolic murmur at 2ICS LLSB at full expiration |
Chronic Aortic Insufficiency -Echo: L Vent dilatation TX: aortic valve replacement
|
|
|
CHF over days more common in IVDU -loud diastolic murmur R2ICS |
Acute aortic insuffiency d/t endocardidits -valve replacement and abx for long time |
|
|
DOE, orthopnea, cough, hemoptysis -thin cachetic, a fib -low pitched rumblind diastolic murmur h/o rheumatic fever |
MS -echo -mitral valve replacement |
|
|
doe, orthopena, a fib h/o MVP apical high pitched holosytolic rad to axillae |
MR -echo -annuloplasty or valve replacement |
|
|
Squamous Cell Ca of lung, req FEV1? |
> 800 |
|
|
small cell Ca tx |
radiation and chemo (not surgery) |
|
|
coldness tingling, in hand transitional vertigo blurred vision diff art speech, claudication of arm with post brain sxs |
subclavian steal syndrome -angio -surg |
|
|
ascending dissesvting aorta vs descenfing |
ascending = emergency surgery descending = ICU for HTN |
|
|
TIA dx and TX |
angio and CEA |
|
|
TIA with vertebrals |
vertigo, diplegia, blurred vision, disarthria, instabiity of gait -arteriogram -aortic arch study -surg |
|
|
sudden severe singular nuchal rigidity |
SAH ct, angio, clip aneuryms |
|
|
brain tumor meds while awaiting surgery |
mannitol, hyperventilation and decadron |
|
|
12yo short for age, bitemporal hemanopsi and caldified lesion above sella in xrays of head |
craniophayngioma -mri and pit surg |
|
|
amenorrhea, galactorrhea |
prolactinoma -measute prolactin MRI -trans nasal, transpshenoilal if inoperable then bromocriptine |
|
|
acromegaly dx and tx |
GH pit surgery |
|
|
6 mo h/o HA visual loss, amen, hypotn, BL pallor of optic NN, BL hemaniopsias, BL adrenal ectomies for cushings |
Nelsons syndrome -MRI, transnasal.sphenoidal to remove pit
(microadenomas grew bc only adreal were removed orig) |
|
|
preogressive severe, gen HA, worse in AM, projectile vomintg, lost upper gaze "sunset eyes" |
Pineal Gladn Tumor or Parinauds syndrome MRI and surg |
|
|
cerebellar fxn affected most tumors in children located here knee chest postion truncal ataxia |
post fossa tumor MRI and surg |
|
|
what can help min perm damage agter spinal cord injuries? |
corticosteroids |
|
|
leg pain with walking and relieved with rest, specificaly sitting down/bending over |
neurogenic claudication -mri, surg decom cauda equina |
|
|
crushing injury, contastant burning , pain ,cold moist cyanotic |
causalgia (reflex sympathetic distrophy) -sympathetic block = dx -sympathectomy = curative |
|
|
tx legg calve perthes |
contain femoral head in acetabulum with casting and splintg |
|
|
slipped capital femo head epiphysis |
ap and lat xr pin fem head in place |
|
|
acute hematogenous osteo |
febrile illness, no h/o truama, loc pain in bone, --------DO bone scan |
|
|
sunburst |
osteogenic sarcoma or ewings sarcoma |
|
|
pathological fx work up |
means bone tumor -x rays of break -whole body scans for primary -look for obs |
|
|
OPen fx tx |
needs to be cleaned in OR <6 hrs |
|
|
Posterior Dislocation of Shoulder |
XR axillary or scapular lat view cant move arm but in nml internally roated position |
|
|
disp. of femoral neck fx |
in elderly better to have metal prostesis |
|
|
intertrochanteric fx |
can be pinned together and expected to hea l |
|
|
post dislocation of knee |
concern for popliteal artery -pulses, arteriogram, prompy reduction |
|
|
stress fx |
wont show up on xr for 2 weeks cast x ray in 2 weeks |
|
|
femur fx and any fx |
always get 90 degree X-rays (AP AND LAT) always include joints above and below check other bones in same line of force (lumbar spine |
|
|
acute epididymitis |
severe pain scrotal contents ml postion r/o torsion tx with abx |
|
|
obstruction of urinary tract |
known ureteral stone to pass spontaneously fever, chills, flank pain uro emergency IV Abx decomp with ureteral stent or percutaneous nephrostomy |
|
|
pyelonephritis |
admit IV abx US to look for obstruction |
|
|
Acute bacterial prostatitis |
chills, fever, dysuria, urinary freq, diffuse low back pain and exq tender prostate on DRE TX: IV abx NO MORE DRE OF PROSTATE MASSAGE CAN LEAD TO SEPSIS!!!!!!! |
|
|
Priaprism |
MCC papverine Tx: Emergency injection of alpha agonist, phenylephrine epinephrine or terbutaline into corpora and change meds to prostaglandin E 1 |
|
|
Newborn hasnt urinated |
check for meatul stenosis -Dx posterior urethral valves -dx with voiding cystourethrogram for dx -tx endoscopic fulguration or resxn for tx |
|
|
low implanatation of one ureter |
IVP and surgical repair |
|
|
Ureteropelvix jxn obstruction |
16yo male binge drinks, colicky flank pain US and repair |
|
|
Total hematuria w/up |
Ddx: Renal cell Ca or Transitional cell CA of bladder -IVP -then cystoscopy |
|
|
hematuria, flank pain, flank mass |
LAO HYPERCALCEMIA, ERYTHROCYTOSIS AND INCREASED LIVER ENZYKES -Renal Cell Ca, clear cell hypernephroma -IVP then CT Scan |
|
|
Painless gross total hematuria - neg febrile - neg culture |
Bladder Ca 1st IVP 2nd Cystoscopy or both
|
|
|
Prostate CA |
rock hard prostate nodul -transrectal needle bx eventual surgical rsxn |
|
|
h/o radical prosatectomy widespread bone mets |
palliative 1) orchiectomy 2) LHRH agonists 3) antiandrogens 9flutamide) |
|
|
testicular CA |
painelss hard mass TX: radical orchiectomy by inguinal route lymph node dissection in some cases platinum based chemo Sr markers for f/ip need to be drawn b4 orchiectomy (alpha feto protein and b hcg) |
|
|
test with and without mets tx |
very responsive to chemo always do chem |
|
|
big boggy prostate |
BPH -indwelling cath for 3 days -alpha blocker -porstatuc rsxn |
|
|
UTI in men |
cult, ivp or US |
|
|
pneumothuria |
fisual b/w bowel and bladder work up: CT scan, proc/sig eventual surf |
