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63 Cards in this Set

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alcoholic with sever epigastric px and calcifications in retropt? tx?
chronic pcitis
tx = stop alcohol, replace pancr enzymes
further invest with ERCP for possiblel surgery
1 day post surgical fever due to? tx?
atelectasis
tx = try to cough, breath deep, monitor with ausc, xray
3rd day post - surg fever? tx?
uti, to urinalysis, u culture,
tx with ab's
any thyroid mass, tx?
probably benign if soft, but do FNA
young, male, single nodule, history of radiation to the neck, solid mass on sonogram and cold nodule on scan.
prob thyroid cxr...still do FNA...will need surg
tx for hot nodule?
surgery (or radioablation before?)
tx for lateral appearing l/n containing "normal thyroid tissue" on pathology?
=metastatic follic thyroid carc. tx = radio scan to define it, then, surg
persistent hypercalcemia in asx pt? tx?
think hyperPTH due to PTH adenoma

tx: PTH determination and sistimibi scan to localize the adenoma. Surgery will follow.
CUSHING'S mngment?
r/o csteroid therapy;
do am / pm cortisol levels as well as dexamethasone supression test. if +, remove microadenoma from pit via trans nasal, transsphenoidal route surgery
tx for inoperable glucagonoma?
if can't do surgery, give
somatostatin to help symptomatically and streptozocin is the indicated chemotherapeutic agent.
diff in tx b/w hyperaldosteronism causing HTN that fluctuates with lying down, standing, vs doesnt fluctuate?
fluctuating = adrenal hyperplasia
non = adrenal adenoma - needs surgery
tx for cong diaph hernia in newby?
. It is better to wait 36 to 48 hours to do surgery to allow transition from fetal circulation to newborn circulation. Meanwhile the trick is to keep the kid alive with endotracheal intubation, hyperventilation (careful not to blow up the other lung), sedation and NG suction.
OTHER condition presenting exactly same as duod atresia?
annular pancreas
and midgut volvulus (but onset anytime, not nec immediately after birth)
newby with green vomit plus double bubble plus air distal to the duodenum?tx?
MALROTATION!!
Do a contrast enema, and if not diagnostic order a water-soluble 9gastrographin) upper GI study.
tx for NEC?
Stop all feedings, broad spectrum antibiotics, IV fluids/nutrition. Surgical intervention if they develop abdominal wall erythema, air in the biliary tree or pneumoperitoneum.
management for meconium ileus?
Gastrografin enema may be both diagnostic and therapeutic, so it is the obvious first choice. If unsuccessful, surgery may be needed.
tx for pyl stenosis?
Ramsted Pyloromyotomy.
management for biliary atresia?
HIDA scan, percutaneous liver biopsy and exploratory laparotomy
tx for intussusception?
Barium enema is both diagnostic and therapeutic in most cases. It should be your first choice. If reduction is not achieved radiologically, exploratory laparotomy and manual reduction will be needed.
meckel's vs gastrinoma test?
meckels = technetium scan
gastrinoma = octreotide scan
tx for enlarged l/n in alcoholic smoker 70y/o
Don’t biopsy the node! FNA is OK, but the best answer is to do a triple endoscopy (examination under anesthesia of the mouth, pharynx, larynx, esophagus and tracheobronchial tree).
tx for any suspected sq cell carc of head and neck?
triple endoscopy to find and biopsy the primary tumor and to look for synchronous second primaries.
suspected parotid gland tumor...dx?
parotid glands are never biopsied in the office or under local anesthesia. ...referral to a head and neck surgeon for formal superficial parotidectomy.
dbl vision in pt with recurrent sinusitis?
URGENT! orbital cellulitis or cavernous sinus thrombosis
tx = hosp, high dose IV AB's, drainage, and CT for guidance
epistaxis in 18 y/o with no hx of nose-picking?
Either septal perforation from cocaine abuse, or posterior juvenile nasopharyngeal angiofibroma.
when is surgery indicated for aortic stenosis?
gradient >50mmHg OR angina, syncope, CHF sx
tx for acute aortic insuff due to acute endocarditis ie in drug user?
Emergency valve replacement, and antibiotics for a long time.
tx for elderly man with lung cancer and FEV1 of 1100? of 2000?
since surg pneumonectomy will take out a large portion of the lung, consider FEV to be halved after surgery (unless % of FEV for that lung is given). at least 800 FEV is required for survival after surg; thus for FEV1 of 1100, only 550 will remain = don't do surgery - do chemo/rad therapy. for FEV2000, go ahead with surgery
explorative tests before pneumonectomy?
CT scan and mediastinoscopy
tx for small cell carcinoma of lung?
chemotherapy and rad...NOT surgery
neurologic sx in pt with arm px upon exertion? dx? tx?
subclav steal syndrome
dx = angiography showing retrograde vertebral art flow and/or subclav narrowing
tx = vasc surgery
how to do aortogram for ao dissection?
the forces that dissected the vessel plus the force of the dye injection could further shear the aorta, thus study is done with beta blockers or IV nitrates to lower blood pressure.
sub arach hemorrhage tx?
surgery to clip the bleeding aneurysm
Measures to decrease intracraneal pressure while awaiting surgery for brain tumor?
include mannitol, hyperventilation, and high dose steroids (decadron).
6y/o with headaches and ataxia, for months?
cerebellar tumor
Signs and symptoms suggestive of brain tumor that develop in a couple of weeks with fever and an obvious source on infection ...? tx?
brain abscess!!
do CT
tx = neurosurgery / resection
acute management of ANY spinal injury?
high dose corticosteroids to minimize the permanent damage
m/c lumbar disc compressions? tx?
L4-L5 or L5-S1
MRI
bed rest
surg only if does not resolve, or sphincter dysfunction
leg pain on exercise with straight back, not on exercise with hunched ie cycling?
neurogenic claudication...tx = surg decompression of cauda equina
tx of Tic doloreaux (trigeminal neuralgia)
anti cholinergics
management of scoliosis in kid?
Baseline X-Rays are needed to monitor progression. (At the onset of menses skeletal maturity is about 80%
WORKUP for pathological, acute bone snap/fracture in elderly?
TUMOR! X-Rays to diagnose this particular broken bone, whole body bone scans to identify other mets, and start looking for the primary. In women, breast. In men, prostate. In heavy smokers, lung…and so on
tx for posterior knee dislocation?
MUST check popliteal: pulses, arteriogram, and prompt reduction of knee

...actually this is tx for post and anterior dislocation, as both tend to affect popliteal
tx for tenderneess of tibia after long hike/march with normal xray?
= stress fracture; won't show up on xray until 2 weeks later.
need to cast leg and repeat xray in 2 wks
tx for gas gangrene after rusty nail trauma to foot?
Tons of IV penicillin and immediate surgical debridement of dead tissue, followed by a trip to the nearest hyperbaric chamber for hyperbaric O2 treatment.
mngment for venous stasis ulcer?
unna boot, support stalking, and/or varicose vein surgery
how to diff b/w test torsion and epididymitis?
Use US
tx of ureteral obstruction AND infection?
in septic pt: dont do stone extraction surg which may be hazardous; do decompression by ureteral stent or percutaneous nephrostomy
included test for any pyelonephritis?
US to r/o obstruction too
tx for priaprism?
IMMEDIATE inj of alpha agonist (phenylephrine, epinephrine or terbutaline) into the corpora
tx of hematuria in kid after minor trauma ie on playground injury?
Hematuria from the trivial trauma in kids means congenital anomaly of some sort.
Management: start with sonogram. IVP may be needed later
pyelonephritis sx in young boy?
this means congenital anomaly of some sort, since boys rarely get pyelonephritis or even uti's
Management: start with sonogram. IVP may be needed later
colicky flank px in young boy who drank a lot? NSIM?
ureretopelvic jxn obstruction
do US and/or IVP or retrograde cysturethrogram
then surgical repair
gross hematuria in elderly pt w/o renal failure?
think CXR!!!
do US or IVP first, then cystoscopy
NSIM for flank mass in elderly with abnormal lft's, epo, etc?
suspect cxr; do CT or ivp FIRST
NSIM for bladder cxr suspected due to bleeding?
IVP first, then cystoscopy
NSIM for rock hard mass in prostate?
needle bx, then surg resection if cxr
palliation in post cxr/-prostatectomy pt with now widespread bone px with bone mets? how long will it last?
palliation via bilat orchiectomy, but his will only last 2-3 yrs.
also may give LHRH agonist or antiandrogens ie flutamide
when is ASX prostate cxr treated
never after age 75 b/c most men at this age get it, but die of something else
post surgical day 2, pt with problem with incontinence? tx?
acute overflow incont...
give bladder catheter
best option for tx of 8 mm ureteral stone?
shock-wave-lithrotripsy
A 33 year old man has urgency, frequency, and burning pain with urination. The urine is cloudy and malodorous. He has mild fever.
think prostatitis over UTi b/c uti's not so common in this age men. if prostate is normal on exam, then think uti but need to check via IVP or US for other causative etiology ie obstruction, etc.
elderly man with pneumaturia, what test immediately?
CT to check for colon/sigmoid cancer causing fistula

eventually, surgery