Surgery Shelf

Front 1

Mgmt
Gun shot wound below nipples

Back 1

Exploratory laparotomy

Front 2

Dx
Blunt abdominal trauma, negative CT.
1 week later presents with fever, chills, deep abdominal pain, shock.

Back 2

Retroperitoneal abscess or pseudocyst from pancreatic injury

(pancreas is over vertebrae so can get crushed against them)

Front 3

Dx
Hypotension, tachycardia, back pain, +/- ipsilateral neurologic deficit after catherization

Back 3

Retroperitoneal hemorrhage from local vascular hematoma (if cannulate above inguinal ligament)

Front 4

Dx study
Hypotension, tachycardia, back pain, +/- ipsilateral neurologic deficit after catherization

Back 4

CT of pelvis and abdomen

Front 5

Mgmt
Hypotension, tachycardia, back pain, +/- ipsilateral neurologic deficit after catherization

Back 5

1) Hemodynamic stability
2) If + neurologic deficits --> URGENT decompression of hematoma

Front 6

Dx
Severe acute midabdominal pain, vomiting, severe tenderness to palpation, absent bowel sounds, rigidity, rebound, heme positive stool, Afib

Back 6

Bowel infarction (acute mesenteric ischemia)

usually caused by emboli from heart

Front 7

Dx
Dorsal forefoot pain, female athlete triad, tender to palpation, swelling

Back 7

Stress fracture

Front 8

Dx
Pain between 3rd and 4th toes on plantar surface with clicking sensation (Mulder sign) when squeezing joints

Back 8

Morton neuroma

Front 9

Dx
Burning pain on plantar surface of foot worse with walking in runner

Back 9

Plantar fasciitis

Front 10

Dx
Burning, numbness of distal plantar surface of foot that can radiate to calf, hx of ankle fracture

Back 10

Tarsal tunnel syndrome

Front 11

Dx
Pain with flexion and extension, hx of puncture wound

Back 11

Tenosynovitis

Front 12

Dx
Drooping of the hemipelvis when standing on one leg

Back 12

Weakness of glut medius and minimus (superior gluteal n. problem)

Front 13

Dx
RLQ pain that used to be periumbilical, n/v/f, high whites

Back 13

Acute apendicitis

(periumbilical pain is distended appendix, RLQ is peritoneal irritation)

Front 14

Tx
Acute appendicitis

Back 14

Emergency Appendectomy

Front 15

Dx
Epigastric pain, fatigue, jaundice, anorexia, weight loss

Back 15

Pancreatic cancer

Front 16

Definition and Mgmt Acute Head Injury (Traumatic brain injury)
1) Mild
2) Moderate
3) Sever

Back 16

All) LOC and HA

1) Mild - GCS 13-15, normal exam, no fracture --> Head CT then discharge under care
2) Moderate - GCS 9-12 --> As above unless Neurologic deficit, seizure, prolonged LOC, or skull fracture --> Below
3) Severe - GCS 3-8 --> Head CT, admit, neuro exam q2hrs

Front 17

Dx
Acute onset painful, pulseless, paresthesia, paralysis in 1 leg.

Back 17

Embolic arterial occlusion

Front 18

Dx
Slow onset painful, pulseless, paresthesia, paralysis in 1 leg.

Back 18

Arterial thrombosis in extremity

Front 19

Dx
Painful leg, dull achy, warmth, swelling

Back 19

Venous thrombosis

Front 20

Mgmt
Abdominal trauma with suspected internal bleeding from organ s/p resuscitation efforts

Back 20

1) If hemodynamically stable --> CT
2) If not stable --> Exploratory laparotomy

Front 21

Dx
Whistling noise post nose job

Back 21

Nasal septal peforation due to septal hematoma

(nasal septum has low blood supply)

Front 22

Dx
Rhinorrhea, nasal pruritis, cough, edematous pale nasal mucosa

Back 22

Allergic rhinitis

Front 23

Dx
Painful nose, tenderness and erythema of nasal vestibule

Back 23

Rudolf nose aka Nasal furunculosis

(staph infection of nose hair follicle)

Front 24

Mgmt
Nasal polyp

Back 24

Remove only if symptomatic

Front 25

Dx
Cardiac arrest with initiation of mechanical ventilation in setting of trauma

Back 25

Positive vent pressure decreased blood return to heart --> Volume

Front 26

Dx
Needle shaped crystals on UA, constipation, RLQ pain, n/v

Back 26

Uric acid stones causing ileus from ureteral colic

Front 27

Dx study
Needle shaped crystals on UA, constipation, RLQ pain, n/v

Back 27

Abdominal CT or intravenous pyelography
for uric acid stones

Front 28

Dx
Fever, high whites, unilateral parotid inflammation (bug)

Back 28

Acute bacterial parotitis (staph most usually)

Front 29

Dx
Burst fracture of vertebra, paralysis, loss of pain and temp, proprioception intact

Back 29

Anterior cord sx,

Front 30

Dx study
Burst fracture of vertebra, paralysis, loss of pain and temp, proprioception intact

Back 30

Spine MRI

Front 31

Encapsulated organisms that cause trouble in splenectomy patients
(3)

Back 31

1) Strep pneumo
2) N. Meningitidis
3) H flu

Front 32

Dx
Chest trauma, tachypnea, respiratory distress despite fluid treatment, lung contusion

Back 32

Flail chest

Front 33

Dx
Recent abdominal aorta surgery, abdominal pain, TTP in RLQ, bloody diarrhea

Back 33

Bowel ischemia/infarction

(lose IMA with aortic graft placement)

Front 34

Dx study and Tx
Twisting knee injury, joint line tenderness, reduced ROM, popping or clicking

Back 34

Knee MRI and arthroscopic repair for
Meniscal tear

Front 35

Dx
Positive McMurrary (painful click with passive extension of knee

Back 35

Meniscal tear

Front 36

Mgmt
Localized chest wall pain, hypoventilation

Back 36

Analgesia for rib fracture

Front 37

Mgmt
Central line placed, absent breath sounds unilaterally

Back 37

Needle thoracostomy for iatrogenic pneumothorax

Front 38

Dx
Broken leg, dyspnea, confusion, non-palpable petechiae in upper body

Back 38

Fat embolism

Front 39

Dx study
Chest pain, epigastric pain, air in mediastinum, crunching sound on auscultation of the heart

Back 39

Contrast esophogram for
Esophageal perforation

(not endoscopy bc the air insufflation can worsen the perf)

Front 40

Mgmt
Blood in urethral meatus, no voiding at all, high riding prostate, scrotal hematoma

Back 40

Retrograde urethrogram for
Posterior urethral injury (in the pelvis)

Front 41

Dx
Blood in urethral meatus, no voiding at all, high riding prostate, scrotal hematoma

Back 41

Posterior urethral injury

Front 42

Dx
S/p thoracic surgery, fever, tachycardia, chest pain, high whites, wide mediastinum, purulent discharge from sternal drain

Back 42

Acute mediastinitis

Front 43

Tx
S/p thoracic surgery, fever, tachycardia, chest pain, high whites, wide mediastinum, purulent discharge from sternal drain

Back 43

Surgical debridement and Abx

Front 44

Mgmt
Hypoventilation after surgery in fat people

Back 44

Sit them upright to decrease pickwickian and increased FRC

Front 45

Mgmt
Facial burns, singing of eyebrows, oropharyngeal blistering, carbonaceous sputum, stridor, carboxyhemoglobin over 10%, or hx of confinment in burning building
(2)

Back 45

Intubation!

(all burn vitims get 100% oxygen on non-rebreather)

Front 46

Dx
Vertebral fracture, no stool or gas, abdominal distension, n/v, absent bowel sounds, air-fluid levels, gas filled loops in both small and large intestine

Back 46

Paralytic ileus

Front 47

Dx
Blunt chest trauma, persistent pneumothorax despite chest tube, subcutaneous emphysema

Back 47

Tracheobronchial perforation

Front 48

Dx
R shoulder pain, abdominal pain, after meals

Back 48

Biliary colic of the gallbladder

Front 49

Dx
N/v, abdominal pain, hypoglycemia, hypotension s/p surgery on steroids

Back 49

Acute adrenal insufficiency

Front 50

Tx
Anaphylactic shock

Back 50

IM Epi

Front 51

Mgmt
Lower GI bleeding
(2)

Back 51

1) Colonoscopy
2) If didn't locate then nothing if stopped bleeding or technetium scintigraphy is still bleeding

Front 52

SIRs criteria
(4)

Back 52

1) Temp over 101.3 or under 95
2) Pulse over 90
3) RR over 20
4) WBC over 12k or under 4k

Front 53

Dx
Fever, uriticaria, arthritis, and nephritis

Back 53

Serum sickness (protein rejection)

Front 54

Dx study
Trauma, LUQ abdominal pain, abdominal wall contusion, left lower chest tenderness, hypotension, left shoulder pain (kehr sign)

Back 54

Abdominal CT for
Splenic injury

Front 55

Dx
Trauma, LUQ abdominal pain, abdominal wall contusion, left lower chest tenderness, hypotension, left shoulder pain (kehr sign)

Back 55

Splenic injury

Front 56

Dx
Fever, dysphagia, odynophagia, drooling, submanidibular swelling

Back 56

Ludwig's angina (cellulitis of submandibular and sublingual spaces)

Strep usually!

Front 57

Dx
Lower GI bleed in elderly, painless, normal exam

Back 57

Diverticulosis

Front 58

Dx study
Acute onset abdominal pain, diffuse lower abdomen, female

Back 58

Pregnancy test

Front 59

Dx, Tx
Wound fails to heal after a prolonged period, and is growing

Back 59

Dx) Squamous cell carcinoma
Tx) Local excision

Front 60

Dx study
Wound fails to heal after a prolonged period, and is growing

Back 60

Skin biopsies for
Squamous cell carcinoma

Front 61

Mgmt
Apneic patient with possible cervical spinal lesion

Back 61

Orotracheal intubation with rapid sequence intubation

Front 62

Dx
Fever post-op day:
1-2:
3-5:
4-6:
5-7:
7+:

Back 62

1-2: PNA
3-5: UTI
4-6: DVT
5-7: Wound/line infxn
7+: Drug fever

Front 63

Dx
Pain in forefoot, worsened by walking, pain between 3rd and 4th toes when squeezed

Back 63

Morton neuroma

Front 64

Tx
Pain in forefoot, worsened by walking, pain between 3rd and 4th toes when squeezed

Back 64

Bilateral shoe inserts then surgery for
Morton neuroma

Front 65

Dx
Colicky/paroxysmal abdominal pain, hyperactive bowel sounds, n/v, abdominal distension, no stool or flatus

Back 65

SBO

Front 66

Mgmt
Colicky/paroxysmal abdominal pain, hyperactive bowel sounds, n/v, abdominal distension, no stool or flatus

Back 66

Laparatomy
for
SBO

Front 67

Dx
Early satiety, nausea, nonbilious vomiting, weight loss

Back 67

Gastric outlet obstruction

If acid ingestion --> pyloric stenosis

Front 68

Dx
Blunt chest trauma, deviated mediastinum and mass in left lower lobe

Back 68

Diaphragmatic perforation

Front 69

Dx study
Blunt chest trauma, deviated mediastinum and mass in left lower lobe

Back 69

Barium swallow
for
Diaphragmatic perforation

Front 70

Tx
Blunt chest trauma, deviated mediastinum and mass in left lower lobe

Back 70

Surgery
for
Diaphragmatic perforation

Front 71

Mgmt
Burn hx, seizure

Back 71

100% oxygen on non-rebreather
for
carbon monoxide poisoning

Front 72

Dx
Abdominal pain radiating to back, vomiting, distended bowel, hypodense enlargement on pancreas

Back 72

Pancreatitis with resultant ileus

Front 73

Tx
Acute pancreatitis
(3)

Back 73

1) IV fluids
2) NG suction
3) Analgesia

Front 74

Dx study
Abdominal pain radiating to back, vomiting, distended bowel, hypodense enlargement on pancreas

Back 74

Abdominal US
for
Gallstones that caused pancreatitis that caused ileus

Front 75

Dx
Chest trauma, hypoxia and respiratory distress hours later, chest pain, tachypnea, patchy irregular infiltrates onf CXR, worsened with IV fluid

Back 75

Pulmonary contusion

Front 76

Dx
Chest trauma, arrhythmia, hear failure, chest pain

Back 76

Myocardial contusion

Front 77

Dx
Trauma, anxiety, tachycardia, hypertension, widened mediastinum

Back 77

Aortic injury

Front 78

Dx study
Trauma, anxiety, tachycardia, hypertension, widened mediastinum
(2)

Back 78

1) CXR
2) if equivocal --> Chest CT
for
Aortic injury

Front 79

Dx
Pulled child's arm, holds it close

Back 79

Nursemaid's elbow

Front 80

Tx
Pulled child's arm, holds it close

Back 80

Elbow flexion and forearm supination

Front 81

Mgmt
Hypotension, abdominal pain, enlarged aortic silhouette

Back 81

Emergency abdominal surgery
for
Ruptured AAA

Front 82

Mgmt
Fall that causes broken bone

Back 82

Determine cause of fall to determine preoperative risk stratification

NOT to go straight to surgery

Front 83

Dx
Repeat vomiting, crepitus in suprasternal notch

Back 83

Esophageal perforation

Front 84

Dx
Acute RUQ pain, fever, high whites, following meals

Back 84

Acute cholecystitis

Front 85

Mgmt
Acute RUQ pain, fever, high whites, following meals
(2)

Back 85

1) Supportive care
2) Cholecystectomy within 72 hrs

Front 86

Dx
Unilateral, lateral hip pain worse when pressure on it

Back 86

Trochanteric bursitis

Front 87

Mgmt
Palpable clunk on hip exam in newborn

Back 87

US of hip
for
Developmental dysplasia of the hip

Front 88

Most damaged organs in MVC
(3)

Back 88

1) Spleen
2) Liver
3) Kidney

Pancreas and bowel less likely

Front 89

Dx
Crohn's disease, flank pain, hematuria

Back 89

Hyperoxularia due to crohn's disease causing kidney stones

Front 90

Dx
Diarrhea, rectal bleeding, tenesmus, incontinence, radiation hx

Back 90

Radiation proctitis

Front 91

Dx
Acute abdominal pain, thickening of bowel wall, blood in stool, sharp transition from affected to not affected on colonoscopy

Back 91

Bowel ischemia

Front 92

Dx
Intermittent bloody discharge, no masses noted on US

Back 92

Intraductal papilloma

Front 93

Dx
Young woman, lumpiness of breast

Back 93

Fibrocystic changes

Front 94

Dx
2 cm, firm, painles, mobile breast lump, young woman

Back 94

Fibroadenoma

Front 95

Mgmt
Newborn with cystic translucent mass in scrotum

Back 95

Nothing
for
Hydrocele

Front 96

Dx
Shock, elevated CWP worse with fluids, chest trauma

Back 96

Myocardial contusion

Front 97

Dx
Popping sensation in knee, immediate swelling

Back 97

Ligamentous tear

Front 98

Dx
Popping sensation in knee, next day swelling

Back 98

Meniscal tear

Front 99

Mgmt
Penile fracture
(2)

Back 99

1) Emergency urethrogram
2) Surgical repair of tunica albuginea

Front 100

Mgmt
Scaphoid fracture
1) Non-displaced
2) Displaced

Back 100

1) Non-displaced = wrist immobilization
2) Displaced = open reduction and fixation

Front 101

Mgmt
Solitary pulmonary lesion

Back 101

1) Chest CT

a) If benign features --> Serial CT scan monitoring
b) If malignant features --> Biopsy or PET scan

Front 102

Dx
LLQ pain, fever, high whites, colonic wall thickening

Back 102

Uncomplicated Diverticulitis

Front 103

Tx
LLQ pain, fever, high whites, colonic wall thickening

Back 103

1) Bowel rest
2) Abx

3) Hospitalize if elderly or have co-morbidities

Front 104

Dx
LLQ pain, fever, high whites, colonic wall thickening, fluid collection greater than 3 cm

Back 104

Complicated diverticulitis

Front 105

Tx
LLQ pain, fever, high whites, colonic wall thickening, fluid collection greater than 3 cm

Back 105

Percutaneous drainage under CT guidance

if fails, surgical drainage

Front 106

Dx
Child 4-10, hip +/- knee pain, antalgic gait, internal rotation and abduction of hip

Back 106

Legg-Calve-Perthes sx

Front 107

Dx
Obese child, hip +/- knee pain, antalgic gait

Back 107

SCFE

Front 108

Dx
Acute onset joint pain, swelling and warmth of joint, high whites

Back 108

Septic joint

Front 109

Tx
Circumferential burn with vascular compromise

Back 109

Escharotomy

Front 110

Mgmt
Penetrating chest trauma, stable vitals, hyperresonant chest field on one side

Back 110

CXR and Ches Tube placement
for
Non-tension Pneumothorax

Front 111

Mgmt
Penetrating chest trauma, hyperresonant chest field on one side, hypotension, severe respiratory distress

Back 111

Needle thoracentesis
for
Tension pneumothorax

Front 112

Dx
Chronic irritative voiding, dysuria, perineal discomfort, leukocytes in prostatic secretions without bacteruria, tender and boggy prostate of normal size

Back 112

Chronic nonbacterial prostatitis

Front 113

Tx
Chronic irritative voiding, dysuria, perineal discomfort, leukocytes in prostatic secretions without bacteruria, tender and boggy prostate of normal size

Back 113

Anti-inflammatories, sitz baths

Front 114

Dx
Perineal pain, dysuria, tenderness on DRE, fever

Back 114

Acute prostatis

Front 115

Dx
Chronic irritative voiding, dysuria, perineal discomfort, leukocytes in prostatic secretions with bacteruria, tender and boggy prostate of normal size

Back 115

Chronic bacterial prostatits

Front 116

Dx
Dysuria, perineal discomfort, no whites or bacteria in prostatic secretions

Back 116

Prostadynia

Front 117

Dx study
Painless swelling in testicle

Back 117

Ultrasound
for
Hydrocele

Front 118

Tx
Head trauma and Subdrual hematoma with symmetrical pupils and normal neurologic exam

Back 118

1) Hyperventilation
2) Diuretics
3) Fluid restriction

for
Increased ICP

Front 119

When to use steroids in head trauma

Back 119

Never!

Front 120

Dx study
GSW to abdomen

Back 120

Exploratory laparotomy
(always)

Front 121

Tx
Bleeding with multiple pRBCs administered

Back 121

FFP

Front 122

Tx
Broken rib pain causing hypoventilation

Back 122

Intercostal nerve block

(treats pain w/o affecting ventilation)

Front 123

Dx
Chest trauma, whiteout on CXR after normal initial CXR

Back 123

Pulmonary contusion

Front 124

Dx
Elderly, bilateral hydronephrosis

Back 124

Prostatic hyperplasia

Front 125

Dx
Elderly, urge urinary incontinence

Back 125

Detrussor overactivity

Front 126

Dx
Hypotension during vascular case

Back 126

Unclamping a tourniqueted vessel releases cytokines and waste products that cause hypotension

Front 127

Tx
Subdural hematoma with GCS of 8, increased ICP

Back 127

1) Intubation and hyperventilation

2) Mannitol helps but only 90 minutes later

3) Last resort is barbiturate coma after surgical decompression

Front 128

Dx
s/p surgery, palpitations, SOB, tachycardic, satting 90%

Back 128

PE

Front 129

Dx study
s/p surgery, palpitations, SOB, tachycardic, satting 90%

Back 129

Arterial blood gas
for
PE (whose A-a gradient is diagnostic)

Front 130

Mgmt
GSW to extremity after hemostasis

Back 130

1) Tetanus prophylaxis
2) Dopplers

Front 131

Concern in electrical burn

Back 131

Myoglobinemia

Front 132

Dx
Bladder cancer, papillary fronds, smoker

Back 132

Transitional cell tumor of bladder

Front 133

Hct to which patients should be tranfused if sx?

Back 133

30%

(BS non-evidence based)

Front 134

Dx
Liver cirrhosis, coma, portocaval shunt

Back 134

Hepatic encephalopathy

Front 135

Dx study
Liver cirrhosis, coma, portocaval shunt

Back 135

Ammonia levels

Front 136

Indicator patient is hypovolemic from prolonged surgery

Back 136

Serum BUN:Cr greater than 20

Front 137

Dx
Axillary node block, injures a nerve

Back 137

Ulnar nerve blocked accidentally

Front 138

Dx
Vague, epigastric pain, early satiety, large ill-defined mass weeks after abdominal trauma

Back 138

Pancreatic pseudocyst

Front 139

Tx
Vague, epigastric pain, early satiety, large ill-defined mass weeks after abdominal trauma

Back 139

Endoscopic anastamosis
i.e. Endoscopic cystogastrostomy

Front 140

Dx
1 week after surgery, left shoulder pain, LUQ tenderness, febrile, tachycardia, tachypnea, high whites

Back 140

Subphrenic abscess

Front 141

Dx
Chest trauma, hypotension, distended neck veins, muffled heart sounds

Back 141

Cardiac tamponade

Front 142

Tx
Chest trauma, hypotension, distended neck veins, muffled heart sounds

Back 142

Pericardiocentesis

Front 143

Dx
Vomiting, emesis, hyperactive abdomen, high pitched peristalsis with concurrent abdominal cramping

Back 143

Bowel obstruction

Front 144

Dx
Vomiting, emesis, hyperactive abdomen becomes silent, and pain becomes continous

Back 144

Bowel strangulation

Front 145

Mgmt
Upper neck trauma
with symptoms:
without symptoms:

Back 145

with: Arteriogram
without: observation

Front 146

Tx
Breast cancer with response to hormones

Back 146

1) Chemotx
2) Anastrozole (better than tamoxifen)

Front 147

Dx
Jaundice, occult blood in stool, high alk phos, dilated intra and extrahepatic ducts, distendend gallbladder without stones

Back 147

Ampullary carcinoma

Front 148

Dx study
Jaundice, occult blood in stool, high alk phos, dilated intra and extrahepatic ducts, distendend gallbladder without stones

Back 148

1) Colonoscopy
2) then Upper GI endoscopy
for
Either Colon ca or
Ampullary carcinoma

Front 149

Tx
Breast cancer
1) small
2) large or affects nipple or areola
3) large and affects pectoralis muscle

Back 149

1) Lumpectomy with radiation
2) Modified radical mastectomy with radiation
3) Radical mastectomy with radiation

Front 150

Dx
Dysphagia after carotid endarterectomy

Back 150

Sensory nerve damage of glossopharyngeal nerve

Front 151

Dx
S/p neck surgery, drooping of corner of mouth, swallowing not affected

Back 151

Injury to mandibular branch of facial nerve

Front 152

Dx
s/p neck surgery, tongue deviation

Back 152

Hypologlossal nerve injury

Front 153

Dx
Impotence after peroneal surgery

Back 153

Erectile nerve injury

Front 154

Dx
Fall, cracking sound, swelling behind ankle, pain with passive movement of hallus

Back 154

Posterior talar tubercle fracture

Front 155

Dx
Systolic murmur, on right sternum, low diastolic pressure

Back 155

Aortic regurg

Front 156

Tx
Systolic murmur, on right sternum, low diastolic pressure

Back 156

Valve replacement immediately

Front 157

Dx
MVC, hypotensive, tachy, low CVP, obtunded, widened mediastinum

Back 157

Ruptured thoracic aorta

Front 158

Dx study
MVC, hypotensive, tachy, low CVP, obtunded, widened mediastinum

Back 158

Spiral Chest CT

Front 159

Dx
Enlarged cardiac silhouette, low limb-lead voltages on EKG and variable QRS amplitudes

Back 159

Cardiac tamponade

Front 160

How much FEV1 is needed after surgery to survive?

Back 160

800 mL

Front 161

When to do pneumonectomy vs lobectomy?

Back 161

If central --> pneumonectomy
If distal --> lobectomy

Front 162

Dx
Sudden onset testicular pain, afebrile, no pyuria, high testis, cord above testis not tender

Back 162

Testicular torsion

Front 163

Mgmt
Sudden onset testicular pain, afebrile, no pyuria, high testis, cord above testis not tender

Back 163

Emergency surgery

Front 164

Dx
Scapular winging

Back 164

Long thoracic nerve injury

Front 165

Dx study
MVC with no neurologic sx

Back 165

C spine CT so that collar can be removed

Front 166

Normal values
CVP:
PA:
PCWP:

Back 166

CVP: 0-8
PA: 15-25/8-15
PCWP: 8-12

Front 167

Localize lesion:
Vibration and proprioception:
Pain and temperature:
Motor:

Back 167

Vibration and proprioception: Dorsal column
Pain and temperature: Spinothalamic (ventral)
Motor: Lateral and ventral corticospinal

Front 168

Dx
Severe deficits in UEs, spared LEs, cape distribution sensory loss with vibration and proprioception preserved everywhere

Back 168

Central cord syndrome

usually from whiplash

Front 169

Dx
Stereognosis, graphesthesia, two point discrimination all lost

Back 169

Posterior cord sx

Front 170

Dx
CP, febrile, chills, ill, crepitus in upper chest and lower neck

Back 170

Esophageal perforation

Front 171

Dx study
Severe flank pain, hematuria
(2)

Back 171

1) Abdominal plain film
2) If ambiguous Intravenous pyelography
for
Kidney stones

Front 172

Most common kidney stones
(4)

Back 172

1) Calcium phosphate
2) Calcium oxalate
3) Uric acid (radiolucent)
4) Cystine (radiolucent)

Front 173

Dx by urine pH
1) Alkaline urine
2) pH less than 5

Back 173

1) Alkaline = proteus infection
2) Acidic = Urate or cystine stones

Front 174

Dx
Fever, high whites, tender liver, elevated alk phos, mild jaundice, normal biliary tree, abscess in liver

Back 174

Dx) Amebic liver abscess
Tx) Long term metronidazole

Front 175

Dx
Liver abscess with thick walls and multiple septations

Back 175

Cystadenocarcinoma of liver

Front 176

Dx
Liver cyst with mother cyst containing daughter cysts around periphery

Back 176

Hydatid cysts

Front 177

Dx
Multiple liver cysts that enlarge over years, renal cysts

Back 177

Polycystic liver disease

Front 178

Dx
Multipel thin walled cystic structures in liver, no septations, asymptomatic and afebrile

Back 178

Simple liver cysts

Front 179

Dx
Gross hematuria, low grade fever and weight loss chronically, pyuria w/o bacteruria, cavitary lesions in kidney

Back 179

TB

Front 180

Dx
Frequent urination, gross hematuria, cyclophosphamide

Back 180

Hemorrhagic cystitis

Front 181

Dx
Hemangioblastomas of cerebellum and retina cysts of pancreas and kidney, renal cell carcinoma, hematuria

Back 181

Von Hippel Lindau sx

Front 182

Dx
Hematuria, hypertension, proteinuria less than 3g per day, edema

Back 182

Nephritic sx

Can be caused by strep infxn

Front 183

Dx
Hematuria and HTN, palpable enlarged kidneys on exam

Back 183

Autosomal dominant polycystic kidney disease

Front 184

Dx
Dysuria, frequency, suprapubic tenderness, hematuria

Back 184

Bacterial cystitis

Front 185

Dx
Hematuria, proteinuria, high serum IgA levels

Back 185

Berger disease

Front 186

Dx study
Bladder transitional cell carcinoma

Back 186

Urinary cytology and cystoscopy

Front 187

Mgmt
No stool in neonate ever, vomiting, abdominal distension, dilated small bowel loops, microcolon, no malrotation, no meconium ileus

Back 187

Diverting ileostomy and appendectomy
for
Hirschsprung's

Front 188

Dx, Dx study, Tx
Abdominal pain, hypotension, anemia, free blood in abdomen, birth control

Back 188

Dx) Ruptured hepatic adenoma
Dx study) CT
Tx) Surgery

Front 189

Dx
HTN, renal cysts, hematuria, +/- renal failure

Back 189

Adult polycystic kidney disease

Front 190

Dx study
HTN, renal cysts, hematuria, +/- renal failure

Back 190

1) Renal US for dx
2) Brain MRA for berry aneurysms

Front 191

Mgmt
Intubate a patient with brisk bleeding to face

Back 191

Cricothyroidotomy

Front 192

Mgmt
Testicular mass, painless, high suspicion for cancer

Back 192

Orchiectomy after serum markers

(no sampling as this spreads cancer)

Front 193

Dx
single upraclavicular mass, early satiety and epigastric discomfort

Back 193

Gastric cancer metastasis

Lymphoma should have B sx and more masses

Front 194

Dx study
Prostatic cancer screening

Back 194

DRE and PSA

Front 195

Dx by hematuria timing
1) Initial
2) Midstream
3) After prostatic milking

Back 195

1) Initial = Urethral ca (especially if elderly)
2) Midstream = Upper urinary tract
3) After prostatic milking = Prostatic disease

Front 196

Dx
Urethral discharge with gram negative diplococci

Back 196

Gonorrhea

Front 197

Mgmt
Clavicle fracture

Back 197

Immobilization by figure 8 device

Front 198

Dx
Halos around lights, eye pain, greenish steamy pupil

Back 198

Acute angle closure glaucoma

Front 199

Tx
Halos around lights, eye pain, greenish steamy pupil
(4)

Back 199

1) Carbonic anhydrase inhibitors
2) Beta blockers
3) Alpha 2 agonist
4) Definitive = Peripheral iridotomy

Front 200

Dx study
Fall from height onto feet after imaging of feet

Back 200

Xray of thoracic and lumbar spine

Front 201

Dx study
Blunt abdominal trauma, sx of bleeding, but hemodynamicallys table

Back 201

Abdominal CT

Front 202

Indications for
C-spine CT

Back 202

1) Head injury
2) Tender neck

Front 203

Dx study
Posterior dislocation of knee

Back 203

Arteriogram

Front 204

Dx study
Pelvic fracture and blood at meatus

Back 204

Retrograde urethrogram

Front 205

Mgmt
Food contents seeping out wound
(3)

Back 205

1) Nutrition
2) Fluids
3) Surgery if refractory

This is a fistula and needs only supportive care if no evidence of infection

Front 206

Tx
Pain in extremity, tightness, pain with passive extension

Back 206

Fasciotomy
for
Compartment sx

Front 207

Tx
Urinary retention after surgery

Back 207

1) Straight cath
2) Indewelling foley if need to straight cath 2-3 times

Front 208

Dx, Dx study, Tx (2)
Young woman, excruciating pain with bowel movements, blood streaks on toilet paper

Back 208

Dx) Anal fissure
Dx study) Exam under anesthesia
Tx) Stool softeners --> Lateral internal sphincterectomy

Front 209

Dx
Soiling of underwear only complaint

Back 209

Fistula in ano

Front 210

Sx of hemorrhoids
1) Internal
2) External

Back 210

1) Internal - bloody painless
2) External - painful, bloodless

Front 211

Dx
Fever, intense pain in perineum

Back 211

Perirectal abscess

Front 212

Tx
Sudden acute ischemia of LE

Back 212

Balloon tipped catherization

Front 213

Dx study
Carotid stenosis bruit
(2)

Back 213

1) Carotid duplex
2) If ambiguous arteriogram

Front 214

Dx study
HA of several weeks worse in morining, projectile vomiting, blurred vision

Back 214

Brain MRI
for
Brain tumor

Front 215

Dx study
Carotid bruit, visual defects and cerebellar defects

Back 215

Aortic arch arteriogram
for
Vertebral artery involvement in carotid disease

Front 216

Dx study
Brain surgery, inappropriate urine output

Back 216

Serum Na levels for posterior pituitary injury

Front 217

Dx study
Brain surgery, shock, hypoglycemia, hyperkalemia, high urine output

Back 217

ACTH levels

Front 218

Dx study
Smoker, drinker, bad dentition, unhealing ulcer, big neck lymph node, refractory hoarseness

Back 218

Panendoscopy and biopsy
for
Squamous cell tumor of mucosa of head and neck

Front 219

Dx
Smoker, drinker, bad dentition, unhealing ulcer, big neck lymph node, refractory hoarseness

Back 219

Squamous cell tumor of mucosa of head and neck

Front 220

Mgmt
High direct bili, high alk phos with barely high AST/ALT, no stone in common bile duct

Back 220

ERCP
for
Obstructive jaundice from bile stone

(can't see stone bc air in duodenum blocks)

Front 221

Dx
Obstructive jaundice, anemia, occult blood in
stool

Back 221

Ampullary carcinoma

Front 222

Dx study
High AST/ALT, normal akl phos non dilated hepatic tree

Back 222

Hep serology

Front 223

Dx study
Eczematoid lesion on areola, indurated

Back 223

Mammogram and punch biopsies
for
Paget's disease

Front 224

Dx
Eczematoid lesion on areola, indurated

Back 224

Paget's disease

Front 225

Dx
Afib, low pitched rumbling diastolic apical heart murmur

Back 225

Mitral stenosis

Front 226

Tx
Afib, low pitched rumbling diastolic apical heart murmur

Back 226

Mitral commissurotomy (repair pt's own valve not replace)

Front 227

Mgmt
Non small cell Lung cancer if high FEV1 and central or peripheral

Back 227

CT scan of chest and abdomen
to look for mets to see if cure possible

Front 228

Dx study
Sudden onset, tearing pericardial pain that radiates to back, HTN, unequal UE pulses

Back 228

Spiral CT or MRI angiogram
for
Dissecting aortic aneurysm

Front 229

Dx
Sudden onset, tearing pericardial pain that radiates to back, HTN, unequal UE pulses

Back 229

Dissecting aortic aneurysm

Front 230

Mgmt
Recent severe testicular pain, febrile, sweollen, cord tender
(2)

Back 230

1) US to rule out Torsion
2) Abx to treat epididymitis

Front 231

Tx
Painful testicle with swollen cheeks

Back 231

Antivirals for mumps

Front 232

Dx
Child, febrile, flank pain

Back 232

Vesicoureteral reflux

Front 233

Dx study
Testicular mass with mass on lung

Back 233

Orchiectomy for
Metastatic testicular cancer

Front 234

Dx
Posterior HA, visual changes, n/v, HA resolves but leaves neck stiffness

Back 234

Ruptured berry aneurysm

Front 235

Mgmt
Posterior HA, visual changes, n/v, HA resolves but leaves neck stiffness
(2)

Back 235

1) Head CT to diagnose berry aneursym rupture
2) Surgery

Front 236

Mgmt
GSW to extremity with normal pulses and no hematoma if near large vesslels

Back 236

Doppler studies
2nd line arteriogram

Front 237

Mgmt
GSW with hematoma or no pulses

Back 237

Surgical exploration

Front 238

Dx study
Cirrhosis and ascites, diffuse abdominal pain, febrile, high whites

Back 238

Culture of ascitic fluid
for
Spontaneous primary bacterial peritonitis

Front 239

Dx
Cirrhosis and ascites, diffuse abdominal pain, febrile, high whites

Back 239

Spontaneous primary bacterial peritonitis

Front 240

Dx
High alk phos, dilated biliary tree, thin walled distended gallbladder without stones, back pain

Back 240

Head of pancreas cancer

Front 241

Dx study
High alk phos, dilated biliary tree, thin walled distended gallbladder without stones, back pain

Back 241

CT scan of abdomen
for
Head of pancreas cancer

Front 242

Dx
Severe colicky abdominal pain, n/v, distended tympanic abdomen, high pitched bowel sounds, distended loops of small and large bowel, parrot's beak

Back 242

Sigmoid volvulus

Front 243

Tx
Severe colicky abdominal pain, n/v, distended tympanic abdomen, high pitched bowel sounds, distended loops of small and large bowel, parrot's beak

Back 243

Proctosigmoidoscopy
for
Sigmoid volvulus

Front 244

Tx
Burn, white, leathery, and anesthetic

Back 244

Immediate excision and grafting

Front 245

Mgmt
Head trauma with blurring of white gray interface, deep coma

Back 245

Decrease ICP

Front 246

Ddx
Postoperative CP with tachycardia and SOB

Back 246

1) 2-3 days: MI
2) 5-7 days: PE

Front 247

Ddx study
Postoperative CP with tachycardia and SOB

Back 247

1) 2-3 days: EKG for MI
2) 5-7 days: ABG for PE

Front 248

Dx
Rubbery, movable masses in young women

Back 248

Fibradenoma (possibly giant juvenile type)

Front 249

Mgmt
Pain in anatomic snuff box after fall if xray normal

Back 249

Immbolization

if displaced, then surgery

Front 250

Dx
Child, multiple air fluid levels

Back 250

Intestinal atresia

Front 251

Dx study
PE postoperative

Back 251

Spiral CT

(VQ scan not good if atelactatic post-op or if infiltrates on CXR)

Front 252

Dx study
Hematuria, vague dysuria, smoker
(2)

Back 252

1) IVP
2) Cystosocpy bc IVP will miss early bladder cancer

Front 253

Dx
Chest trauma, hypoxemia, infiltrates on CXR

Back 253

Pulmonary contusion

Front 254

Dx
S/p surgery, pRBC transfusion, chills, febrile within a few hours after surgery

Back 254

Acute febrile non hemolytic reaction

Front 255

What does compartment syndrome become?

Back 255

Volkman's ischemic contracture

Front 256

Tx
Volkman's ischemic contracture

Back 256

Fasciotomy

Front 257

Dx
Pelvic injury, with L shoulder pain

Back 257

Dome of bladder injury

(only place where peritoneum touches bladder where if broken leaks urine into peritoneum to irritate diaphragm)

Front 258

Dx
Chest trauma, widened mediastinum, L hemothorax

Back 258

Aortic rupture

Front 259

Dx
Critically ill pt, gallbladder distension with thickened walls, pericholecystic fluid

Back 259

Acalculous cholecystitis

Front 260

Tx
Copyright (c) USMLEWorld, LLC., Please do not save, print, cut, copy or paste anything while a test is active.

Back 260

Percutaneous cholecystostomy with subsequent cholecystectomy when stable
for
Acalculus cholecystitis

Front 261

Dx
Highpitched hyperactive bowel sounds with air fluid levels

Back 261

Bowel obstruction

Front 262

Dx
Chest trauma, tachypnea, paradoxical chest wall movement resolves with mechanical ventilation

Back 262

Flail chest

Front 263

Dx
Hemoptysis, pneumomediastinum, pneumothorax refractory to chest tube placement

Back 263

Tracheobronchial injury

Front 264

Tx
DVT for 3 days

Back 264

Heparin

(bridge to warfarin)
(also, no role for streoptokinase or plasminogen in anything but stroke and MI)

Front 265

Tx
To prevent bleeding in OR for hemophilia A

Back 265

Vasopressin

Front 266

Tx
Rebound tenderness, free air in perotoneum, INR 2.1

Back 266

Fresh Frozen Plasma
to reverse warfarin given emergent laparotomy

Front 267

Mgmt - airway
Conscious, normal voice

Back 267

No airway mgmt

OTT with hyperventilation (unconscious people cannot protect airway and hypervent to decrease ICP)

Front 268

Mgmt - airway
Conscious, normal voice, hematoma in neck

Back 268

Orotracheal intubation with RSI preferred, blind nasotracheal intubation 2nd line

Front 269

Mgmt - airway
Conscious, normal voice, air emphysema in neck and upper chest

Back 269

OTT with RSI and bronchoscopy

Front 270

Mgmt - airway
Unconscious, gurgly voice

Back 270

OTT with hyperventilation

(unconscious people cannot protect airway and hypervent to decrease ICP)

Front 271

Mgmt - airway
Pt lost consciousness, noisy labored breathing, neck pain and concern for neck trauma
(2)

Back 271

1) OTT with neck immobilization
(do not move neck, but don't wait for c-spine films either)
2) Nasotracheal tube if facial injuries do not preclude

Front 272

Mgmt - airway
1) Conscious but bleeding briskly in facial orifices, gurgling voice
2) What if unconscious?

Back 272

Cricothyroidotomy for both

(not emergency tracheostomy)

Front 273

Mgmt
Penetrating abdominal trauma

Back 273

In this order:
1) 2 large gauge IV catheters
2) Foley
3) IV Abx
4) Ex lap
5) Fluid and blood product resuscitation

Front 274

Mgmt
Blunt abdominal trauma

Back 274

Fluid resuscitation before OR
(bc OR not mandatory and can be avoided if after resuscitation hemodynamically stable)

Front 275

Mgmt
Arterial bleed in extremity

Back 275

Gloved finger pressure or pressure dressing

NOT tourniquet

Front 276

Mgmt
Exsanguination and cannot get IV line

Back 276

Intraosseous cannulation

Front 277

Dx
Chest trauma, hypotensive, pale, cold, shivering, tachycardic, distended neck veins, bilateral breath sounds

Back 277

Pericardial tamponade
(absolutely, clinical diagnosis.)

Front 278

Mgmt
Chest trauma, hypotensive, pale, cold, shivering, tachycardic, distended neck veins, bilateral breath sounds
(3)

Back 278

1) Pericardiocentesis
2) If positive --> thoracotomy
3) If brutal trauma then consider straight to OR

for
Cardiac tamponade

Front 279

Dx
Chest trauma, diaphoretic, cold, shivering, hypotensive, respiratory distress, deviated trachea, no breath sounds unilaterally

Back 279

Tension pneumothorax

Front 280

Tx
Chest trauma, diaphoretic, cold, shivering, hypotensive, respiratory distress, deviated trachea, no breath sounds unilaterally

Back 280

Immediate pleurocentesis
for
Tension pneumothorax

DO NOT go to xray to confirm, clinical diagnosis

Front 281

Only 3 causes of shock in trauma

Back 281

1) Hemorrhage
2) Tension thorax
3) Pericardial tamponade

Front 282

Mgmt
Cold, diaphoretic, CP, hypotensive, distended neck veins

Back 282

1) EKG
2) Trops
3) Cath lab
4) Thrombolytics (if offered)
for
Cardiogenic shock

Front 283

Dx
Cold, diaphoretic, CP, hypotensive, distended neck veins

Back 283

Cardiogenic shock

Front 284

Dx
Hypotensive, tachy, warm and flushed, VCP low, no infection or fever
s/p spinal anethesia, or allergic reaction

Back 284

Vasomotor shock

Front 285

Tx
Hypotensive, tachy, warm and flushed, VCP low, no infection or fever
s/p spinal anethesia, or allergic reaction

Back 285

1) Vasoconstrictors
2) Volume replacement

Front 286

Mgmt
Penetrating trauma to any body part

Back 286

Remove in OR not ED

Front 287

Skull fracture repair mgmt if conscious
1) Closed linear skull fracture
2) Open skull fracture
3) Non-linear skull fracture

Back 287

1) Nothing
2) Close skin in ED
3) Surgical repair

Front 288

Mgmt
Skull trauma with LOC
(3)

Back 288

1) Head CT
2) Neuro exam

Front 289

Mgmt
Skull trauam with LOC, but now conscious, no neurologic sx and normal head CT

Back 289

Discharge if family willing to awaken intermittently to check for coma

Front 290

Dx
Head trauma, currently in coma, raccoon eyes, leaking fluid from nose or ear

Back 290

Basal skull fracture

Front 291

Mgmt
Head trauma, currently in coma, raccoon eyes, leaking fluid from nose or ear

Back 291

1) Head CT
2) C-spine imaging
for
Basal skull fracture

(don't do anything about basal skull fracture, not even abx)

Front 292

Dx
Head trauam, LOC --> regained --> now in coma, 1 pupil fixed and dilated, hemiparesis

Back 292

Epidural hematoma

Front 293

Dx study
Head trauam, LOC --> regained --> now in coma, 1 pupil fixed and dilated, hemiparesis

Back 293

Head CT
for
Epidural hematoma

Front 294

Tx
Head trauam, LOC --> regained --> now in coma, 1 pupil fixed and dilated, hemiparesis

Back 294

Craniotomy
for
Epidural hematoma

Front 295

Mgmt
MVC, deep coma, 1 fixed dilated pupil, contralateral hemiparesis
If no lateralizing signs, and no midline shift?

Back 295

Lateralizing) Emergency craniotomy
for
Either epidrual or subdural hematoma

Non-lateralizing) Decrease ICP NOT craniotomy

Front 296

Dx
MVC, deep coma, bilateral fixed dilated pupils, diffuse blurring of the gray white mass interface and multiple small punctate hemorrhages

Back 296

Diffuse axonal injury

Front 297

Mgmt
MVC, deep coma, bilateral fixed dilated pupils, diffuse blurring of the gray white mass interface and multiple small punctate hemorrhages
(6)

Back 297

1) Decrease ICP
a. Head elevation
b. Hyperventilation
c. Mannitol
d. Furosemide
e. Hypothermia
f. Sedation

for Brain perfusion preservation in diffuse axonal injury

Front 298

Dx
3-4 week hx of rapid cognitive deterioration, psychomotor retardation, hypersomnia, hx of trauma a few weeks ago

Back 298

Chronic subdural hematoma

Front 299

Dx study
3-4 week hx of rapid cognitive deterioration, psychomotor retardation, hypersomnia, hx of trauma a few weeks ago

Back 299

Head CT
for
Chronic subdural hematoma

Front 300

Tx
3-4 week hx of rapid cognitive deterioration, psychomotor retardation, hypersomnia, hx of trauma a few weeks ago

Back 300

Craniotomy
for
Chronic subdural hematoma

Front 301

Mgmt
Hypotension, tachy, fractures of extremities, dilated pupils, coma

Back 301

Look for source of bleeding, canNOT be in head

Front 302

Mgmt
Penetrating neck trauma, unstable

Back 302

Surgical exploration

Front 303

Mgmt
Penetrating neck trauma zone II (mid neck), stable

Back 303

Surgical exploration irrespective of stability

Can consider observation if stab wound

Mandible to cricoid

Front 304

Mgmt
Penetrating neck trauma to upper neck (zone III), stable

Back 304

Angiography
for diagnosis and therapy (embolization)

Mandible to base of skull

Front 305

Mgmt
Penetrating neck trauma to lower neck (zone I)

Back 305

1) Angiography first
2) Soluble contrast esophogram
3) Esophagoscopy
4) Bronchoscopy

All done even if pt asymptomatic.

Below cricoid

Front 306

Dx
MVC, loss of motor and pain/temp on both sides distal to injury with preservation of sense and position

Back 306

Anterior cord sx

Front 307

Dx
MVC, paralysis and burning pain in UEs, normal motor in LEs

Back 307

Central cord sx

Front 308

Mgmt
MVC, loss of motor and pain/temp on both sides distal to injury with preservation of sense and position

Back 308

1) Spine MRI
2) Corticosteroids
for
Anterior cord sx

Front 309

Mgmt
MVC, paralysis and burning pain in UEs, normal motor in LEs

Back 309

1) Spine MRI
2) Corticosteroids
for
Central cord sx

Front 310

Mgmt
Elderly, chest trauma, fractured rib

Back 310

Local nerve block

to prevent hypoventilation --> PNA

Front 311

Dx, Dx study, Mgmt
Chest stab, moderate SOB, stable vitals, no breath sounds on 1 side, hyperresonant

Back 311

Dx) Plain pneumothorax
Dx study) CXR
Mgmt) Chest tube high in pleural cavity

Front 312

Dx, Dx study, Mgmt
Chest stab, moderate SOB, stable vitals, no breath sounds on 1 side, dull to percussion

Back 312

Dx) Hemothorax
Dx study) CXR
Mgmt) Chest tube low in pleural cavity

Front 313

Dx, Mgmt
Chest stabbed, moderated SOB, no breath sounds on 1 side, hyperresonant at apex, dull at base, air fluid level on CXR

Back 313

Dx) Hemopneumothorax
Mgmt) Chest tube at base

Front 314

Mgmt
PT with claudication but normal ABIs

Back 314

Repeat ABI after exercise
for
Mild Periperal arterial disease

(apparently don't do CT angiography)

Front 315

Dx
Acute pain and swelling of midline sacrococcygeal skin

Back 315

Pilonidal cyst

Front 316

Tx
Acute pain and swelling of midline sacrococcygeal skin

Back 316

I&D of abscess and excision of sinus tracts

Front 317

Mgmt
Trauma, hypotension, tachy refractory to fluid resuscitation, head and abdominal trauma, GCS depressed

Back 317

Ex lap
for
Occult hemorrhage

Front 318

Mgmt
s/p surgery, slightly hypotensive, slightly tachy, BUN/Cr 36, foley in place

Back 318

1) Change Foley to check for clog
2) Fluid bolus for PreRenal azotemia

If Bun/Cr > 20 (normal is 10)

Front 319

What FENa says about renal disease

Back 319

FENa less than 1 = intrinsic renal disease
FENa greater than 1 = extrinsic renal disease

Front 320

Tx
Hairline stress fracture of 2nd metatarsal
(2)

Back 320

Rest and analgesia

Front 321

Dx study
Foot pain, normal xray

Back 321

Foot MRI

Front 322

Tx
Fracture of 5th metatarsal or any displaced metatarsal

Back 322

Surgical reduction

Front 323

What causes diabetic ulcers?
(3)

Back 323

1) Neuropathy
2) Microvascular insufficiency
3) Relative immunosuppression

Front 324

Dx
Ulcers on legs, lower extremity edema, stasis dermatitis

Back 324

Venous insufficiency

Front 325

Dx
Abdominal pain, vomiting, nausea, bloating distended abdomen

Back 325

SBO due to adhesions (usually)

Front 326

Dx
Tymapnic abdomen, abdominal pain, AST/ALT ratio >2

Back 326

Alcoholic hepatitis

Front 327

Dx
Bilateral hip, thigh and buttock with walking, impotence, and atrophy of LEs

Back 327

Leriche sx (arterial occlusion of the bifurcation of the aorta)

Front 328

Dx
Hypoexmia, respiratory alkalosis, trinagular opacity on CXR, afebrile, no whites

Back 328

Atelectasis

Front 329

Tx
Duodenal hematoma causing bowel obstruction
(2)

Back 329

Nasogastric suction and parenteral nutrition

Front 330

Dx, Mgmt (3)
Hard, red, tender area in breast of breastfeeding mother

Back 330

Dx) Mastitis
Mgmt) Antibiotics, analgesics, and continue breast feeding

Front 331

Tx
Breast abscess
(2)

Back 331

1) Stop breastfeeding
2) I&D

Front 332

Dx
Fever, RLQ pain worsened with deep palpation, no rebound or guarding, high whites, furuncles

Back 332

Abdominal abscess

Front 333

Dx study
Fever, RLQ pain worsened with deep palpation, no rebound or guarding, high whites, furuncles

Back 333

Abdominal CT
for
Abdominal abscess

Front 334

Dx
Acute bdominal pain radiating to perineum or groin, n/v, afebrile, cannot sit still on exam table from pain

Back 334

Kidney stones

Front 335

Dx study
Acute bdominal pain radiating to perineum or groin, n/v, afebrile, cannot sit still on exam table from pain

Back 335

Abdominal CT
for
Kidney stones

Front 336

Tx
Variceal bleeding
1) Still bleeding)
2) Stopped bleeding)
3) Still bleeding after endoscopy)

Back 336

1) Still bleeding) Sclerotherapy or banding
2) Stopped bleeding) Medical management with propranolol
3) Still bleeding after endoscopy) Portosystemic shunt

Front 337

Tx
Sucking chest wound

Back 337

One way gauze dressing, then Chest tube once in hospital

Front 338

Mgmt
Flail chest, respiratory distress

Back 338

Mechanical ventilation with bilateral chest tubes

Front 339

Tx
Lung contusion

Back 339

1) Fluid restriction using colloid
2) Diuretics
3) Mechanical ventilation usually

Front 340

Mgmt
Chest truama, pneumothorax, tenderness over ribs, respiratory distress, cyanotic
(2)

Back 340

1) Needle to release tension pneumo
2) THEN CXR to rule out widened mediastinum

Front 341

Mgmt
Chest trauma, bruising over chest, gritty and tenders over sternum

Back 341

This is sternal fracture, c/f MI and aortic injury so:
1) EKG
and
2) Trops
to diagnose/treat myocardial contusion/infarction
3) Spiral CT to rule out aortic rupture

Front 342

Dx, Dx study, Tx
MVC, moderate respiratory distress, no breath sounds on L, percussion unremarkable, multiple air fluid levels on CXR

Back 342

Dx) Traumatic diaphragm rupture
Dx study) None needed. NG tube curling can confirm though.
Mgmt) surgical repair

Front 343

Dx, Dx study, Tx
MVC, multiple extremity fractures, fracture of 1st rib, scapula or sternum (a hard to break bone), and widened mediastinum

Back 343

Dx) Aortic rupture
Dx study) Spiral CT --> Aortogram if CT negative
Mgmt) Emergency surgical repair

Front 344

Dx, Dx study, Mgmt
MVC, pneumothorax, progressive subcutaneous emphysema all over upper chest and lower neck,

Back 344

Dx) Rupture of trachea or bronchus
Dx study) CXR
Mgmt) Bronchoscopy to determine extent of damage, THEN surgical repair

Front 345

Dx
Erythematous and edematous breast, remote hx of mastitis, afebrile, lymphadenopathy, non-bloody discharge from nipple

Back 345

Inflammatory breast carcinoma

Front 346

Mgmt
Erythematous and edematous breast, remote hx of mastitis, afebrile, lymphadenopathy, non-bloody discharge from nipple

Back 346

Biopsy for histology and treat accordingly
for
Inflammatory breast carcinoma

Front 347

Dx study
DM, cigarettes, HTN, HLD, claudication

Back 347

ABI doppler

Front 348

Medical mgmt
Claudication
(3)

Back 348

1) ASA
2) Statin
3) Cilostazol

Front 349

Dx
Child, hip and knee pain, adducted and internally rotated hip, externally rotates with hip flexion

Back 349

SCFE

Front 350

Dx study
Child, hip and knee pain, adducted and internally rotated hip, externally rotates with hip flexion

Back 350

Frog leg Xray
for
SCFE

Front 351

Tx
Child, hip and knee pain, adducted and internally rotated hip, externally rotates with hip flexion

Back 351

Surgical pinning of femoral head
for
SCFE

Front 352

Dx
Male adolescent, dull aching and fullness of scrotum, transillumination negative, swelling increases with valsalva

Back 352

Varicocele

Front 353

Dx
Hard, bony mass on hard palate

Back 353

Torus palatinus (benign congenital bony growth)

Front 354

Dx
POD #3, discomfort upper abdomen, breathing comfortably, satting 90% down from 98%, tachypneic, pO2 low, pCO2 high

Back 354

Atelectasis

Front 355

Dx
POD#0, dyspnea, cough, wheeze, hypoxemia, tachypnea

Back 355

Aspiration

Front 356

Dx
s/p surgery, COPD pt, hypoxemia, wheezing, dyspnea

Back 356

Bronchospasm

Front 357

Dx
s/p surgery, hypoxemia, rapid shallow breathing, orthopnea, respiratory failure

Back 357

Bilateral diaphragmatic paralysis

Front 358

Dx
S/p thoracic vessel surgery of aorta, flaccid paraplegia and loss of pain sensation with intact proprioception

Back 358

Spinal cord ischemia from damage to anterior spinal arteries

Front 359

Algorithm for palpable breast mass in woman
IRRESPECTIVE of physical exam findings

Back 359

Less than 30 --> Ultrasound
1) If simple cyst --> Needle aspiration
2) If complex cyst or solid mass --> Image guided core biopsy

Older than 30 --> Mammogram and Us
If suspicion for malignancy --> core biopsy

Front 360

Components of GCS score
(3)

Back 360

1) Eye opening/contact
2) Motor response
3) Verbal response

Front 361

Etio
Nasal polyp cancer

Back 361

EBV infection

Front 362

Dx
Abdominal pain 10 days ago and now, fever, high whites, painful defecation and diarrhea, tender boggy fluctuant mass on DRE at tip of finger

Back 362

Pelvic abscess from appendicitis

Front 363

Tx
Abdominal pain 10 days ago and now, fever, high whites, painful defecation and diarrhea, tender boggy fluctuant mass on DRE at tip of finger

Back 363

Drainage of
Pelvic abscess from appendicitis

Front 364

Dx
Extremity pain 6 hrs after embolectomy procedure, normal pulses, red swollen extremity, pain with passive extension

Back 364

Reperfusion injury leading to compartment sx

Front 365

Dx
Sudden onset severe epigastric pain that spreads to whole abdomen, CXR shows free air in peritoneum

Back 365

Gastic perforation

Front 366

Algorithm for Tetanus
Unimmunized:
More than 10 years ago:
Less than 10 years ago:

Back 366

Unimmunized:
1) Minor or clean wound --> Td only
2) Dirty wound --> Td and TIG

More than 10 years ago:
1) Minor or clean wound --> Td only
2) Dirty wound --> Td and TIG

Less than 10 years ago:
1) Minor or clean wound --> Nothing
2) Dirty wound --> Td if last booster more than 5 years ago

Front 367

Dx
High Respiratory quotient:
Low Respiratory quotient:

Back 367

High Respiratory quotient: High carb diet
Low Respiratory quotient: Low carb diet

Front 368

Dx
Chest trauma, hypotensive, tachy, venous distension, refractory to fluids, CXR shows normal cardiac silhouette and no tension pneumothorax

Back 368

Cardiac tamponade

Front 369

Tx
Anterior spinal cord sx from trauma, after airway and hemodynamic stability

Back 369

Place foley to check urinary retention and prevent bladder distension damage

Front 370

Dx
Pulsatile mass in groin, anterior thigh pain

Back 370

Femoral artery aneurysm

Front 371

Amputation in field mgmt

Back 371

Place with saline moistened gauze on ice

Front 372

Dx
Supracondylar fracture, pain and paresthesia of arm

Back 372

Brachial artery injury

Front 373

Dx
Midshaft fracture of humerus, inability to extend wrist

Back 373

Radial nerve injury

Front 374

Mgmt
s/p Central venous catheter placement

Back 374

CXR to confirm location and lack of complications

Front 375

Dx
Medial knee pain following trauma, snapping painful sensation with extension

Back 375

Medial meniscal tear

Front 376

Dx
High alk phos with normal Ca and Vit D, bone pain, afebrile, hearing loss

Back 376

Paget's disease

Front 377

Mgmt
Suspected child abuse
(3)

Back 377

1) Admit for safety
2) Skeletal survey
3) Notify child services

Front 378

Dx
Child with antaglic gait, limited ROM at hip, hip pain, collapsed femoral head

Back 378

Legg Calve Perthes sx

Front 379

Tx
Fixed palpable mass in breast, spiculated with coarse calcifications, foamy macrophages and fat lobules on biopsy

Back 379

Nothing (benign)
for
Fat necrosis of breast

Front 380

Dx
Adolescent, bone pain, high alk phos, periosteal inflammation (codman's triangle), sunburst pattern

Back 380

Osteosarcoma

Front 381

Dx
Adolescent, bone pain, long bones, onion skin pattern

Back 381

Ewing's sarcoma

Front 382

Dx
Hemoptysis, dense opacity in lung

Back 382

TB

Front 383

Mgmt
Hemoptysis, dense opacity in lung
If stable -->
If unstable-->

Back 383

If stable --> Sputum sample for TB dx
If unstable--> Flexible bronchoscopy for bleeding control

Front 384

Tx
Massive hemoptysis with unstable vitals
(3)

Back 384

1) Intubate
2) Hemodynamic stability
3) Flexible bronchoscopy

Front 385

Mgmt
Displaced clavicular fracture, bruit

Back 385

1) Arteriogram for vascular injury
2) Neuroexam for brachial plexus injury

Front 386

Tx
s/p surgery, painful wound, desensitized edges, gray cloudy discharge, febrile, subcutaneous crepitus

Back 386

Emergent surgical exploration
for
Necrotizing surgical wound

Front 387

Dx study for all
Soft tissue injuries of the knee

Back 387

MRI

Front 388

Dx, Dx study (2)
Shoulder held adducted and internally rotated, s/p tonic clonic seizure

Back 388

Dx) Posterior shoulder dislocation
Dx study) Axillary or scapular plain film

Front 389

Dx
Should dislocation held abducted and externally rotated, shoulder numbness

Back 389

Anterior shoulder dislocation
+
Axillary nerve damage

Front 390

Dx
s/p partial gastrectomy, postprandial abdominal cramps, weakness, lightheadedness, diaphoresis

Back 390

Dumping sx

Front 391

Tx
s/p partial gastrectomy, postprandial abdominal cramps, weakness, lightheadedness, diaphoresis

Back 391

1st) Diet modification
2nd) Octreotide
3rd) Reconstructive surgery

Front 392

Dx, Tx
Acute severe back pain, gross hematuria, SOB, no CP, hypotension, tachycardia, ST depressions

Back 392

Dx) Ruptured AAA
Tx) Emergency surgery

Front 393

Dx
Chest trauma, intubated and mechanically ventilated, chest tubed placed, sudden cardiac arrest

Back 393

Air embolism

(injury to pulmonary vasculate into left heart)

Front 394

Tx
Chest trauma, intubated and mechanically ventilated, chest tubed placed, sudden cardiac arrest
(3)

Back 394

1) Cardiac massage
2) Trendelenburg
3) Thoracotomy
for
Air embolism

Front 395

Dx
Sudden death from opened central catheter line or hissing sound during thoracotomy

Back 395

Air embolism

Front 396

Dx, Tx
Severe blunt trauma, becomes disoriented, petechial rashes in axillae and neck, fever, tachycardia, respiratory distress and hypoxemia develop

Back 396

Dx) Fat embolism
Tx) Respiratory support

Front 397

Mgmt
All penetrating abdominal trauma
(4)

Back 397

1) Foley catheter
2) Two large gauge IVs
3) Broad spectrum abx
4) Exploratory laparotomy

(as long as goes through peritoneum)

Front 398

Tx
Penetrating abdominal trauma, clean entrance and exit wounds to colon

Back 398

Primary repair

Front 399

Mgmt
Penetrating abdominal wound to nipple line or right below
(3)

Back 399

1) CXR
2) Chest tube if needed
3) Exploratory laparatomy

Front 400

Mgmt
Penetrating abdominal trauma which does not enter peritoneum

Back 400

Digital exam, if not in peritoneum --> Nothing

Front 401

Dx, Tx
Blunt trauma, tender abdomen, guarding and rebound in all quadrants

Back 401

Dx) Acute abdomen from burst viscus organ
Tx) Exploratory laparotomy
(all trauma with acute abdomen gets surgery)

Front 402

Dx, Dx study, Tx
Blunt trauma, CXR normal, hypotension, tachycardia, dropping hct, cvp is low

Back 402

Dx) Intrabdominal hemorrhage
Dx study) FAST, if negative or inadequate --> Peritoneal lavage
Tx) Exploratory laparotomy

Front 403

Dx study
Blunt abdominal trauma, stable

Back 403

Serial CT scans

Front 404

Tx
Ruptured spleen

Back 404

1) All efforts to repair spleen before splenectomy which will require pneumovax

Front 405

Tx
Trauma, blood oozing from all raw surfaces

Back 405

FFP and Platelets

Front 406

Tx
In OR: significant coagulopathy, hypothermia, and refractory acidosis

Back 406

Pack all bleeding surfaces and close temporarily with towel clips

Front 407

TX
POD#1, tense distended abdomen, retention sutures are cutting, hypoxia, renal failure

Back 407

Open suture for later closure
for
Abdominal compartment syndrome

Front 408

Dx study
Pelvic fracture, stable, stable pelvic hematoma

Back 408

1) Physical exam
2) Foley catheter
to rule out injury to rectum, bladder, or genitals

Front 409

Tx
Pelvic fracture, hemodynamically unstable

Back 409

Arteriographic embolization
or
Fixation

Front 410

Tx
Penetrating urologic injury, blood in urine

Back 410

Surgical repair

Front 411

Dx, Dx study
1) Pelvic trauma with blood at the meatus
2) Pelvic trauma with at meatus, scrotal hematoma, high riding prostate, urge to urinate but cannot

Back 411

1) Bladder or urethral injury
2) Posterior urethral injury
Dx study for both is Retrograde urethrogram

Front 412

Tx
Pelvic trauma, blood at meatus, scrotal hematoma, urethrogram shows anterior urethral injury

Back 412

Immediate surgical repair (posterior is delayed 6 months)

Front 413

Mgmt
Pelvic trauma, no blood at meatus or hematoma, resistance on foley insertion

Back 413

Remove foley, do retrograde urethrogram

Front 414

Dx, Dx study (2)
Pelvic trauma, no blood at meatus, foley produces blood in urine

Back 414

Dx) Bladder injury
Dx study) Retrograde cystogram
IF NEGATIVE --> Still need another film after film empty to check for leaks at trigone

Front 415

Dx, Dx study, Tx
Pelvic fracture, foley reveals blood in urine, retrograde cystogram is normal

Back 415

Dx) Kidney injury
Dx study) Abdominal CT scan
Tx) Surgery only if exsanguinating or renal pedicle avulsed, otherwise nothing

Front 416

Dx
Renal trauma, six weeks later acute SOB and flank bruit

Back 416

Arteriovenous fistula at renal pedicle causing heart failure

Front 417

Dx study
Microscopic hematuria after trauma
in adults)
in children)

Back 417

In adults = Nothing
In children = Ultrasound or IVP

Front 418

Dx, Dx study, Tx
Trauma to scrotum, scrotal hematoma, no blood in urine

Back 418

Dx) Scrotal hematoma
Dx study) Ultrasound to rule out testicle rupture
Tx) Surgery if ruptured, o/w nothing

Front 419

Tx
Penis fracture

Back 419

Urgent surgical repair

Front 420

Tx
Extremity wound:
1) Wound lateral to femur
2) Wound medial to femur, normal pulses, no hematoma
3) Wound medial to femur, expanding hematoma

Back 420

1) Wound cleaning and tetanus prophylaxis
2) Arteriogram + 1)
3) Surgical exploration + 1)

Front 421

Tx
Extremity wound, shattered bone, nerve palsy, and expanding hematoma

Back 421

In this ORDER:
1) Fracture stabilization
2) Vascular repair
3) Nerve repair

Front 422

Tx
High velocity bullet wound

Back 422

Surgical debridement for cone of destruction

Front 423

Tx
Crushing injury to extremity with normal pulses
(3+1)

Back 423

1) Fluid, diuretics and alkalinzation to prevent myoglobinemia
2) Fasciotomy for compartment sx

Front 424

Tx
Alkaline burn

Back 424

30 minutes of tap water irrigation

Front 425

Tx
Electrical burn
(2)

What to watch out for? (2)

Back 425

Tx
1) IV fluids, diuretics (mannitol), and alkalinization of urine for myoglobinemia
2) Surgical debridement

Watch out for:
1) Posterior shoulder dislocation
2) Compression fracture of vertebral bodies

Front 426

Dx study (2), Tx (2)
Burn patient, with soot in oropharynx

Back 426

Dx study)
1) Carboxyhemoglobin level
2) Bronchoscopy
Tx)
1) 100% Oxygen
2) Possible need for intubation
2)

Front 427

Tx
Boiling water burns, not extensive

Back 427

Silver sulfadiazine

Front 428

Fluid resuscitation in burn victims
(2)

Back 428

1) 4 mL of LR for each kg per % burned per day + 2L of D5NS
1/2 in 1st 8 hrs
2) Or titrate to .5-1 ml/kg/hr of UOP

Front 429

Burns
1) Leathery, white, anesthic
2) Moist, blisters, painful

Back 429

1) 3rd Degree
2) 2nd Degree

Front 430

Burn Tx
(4)

Back 430

1) Silver sulfadiazine
2) Triple antibiotic ointment near eyes
3) Analgesia
4) NG suction

Front 431

Tx
Less extensive area but 3rd degree burn

Back 431

Early excision and grafting

Front 432

Tx
1) Provoked domestic animal bite
2) Wild animal bite

Back 432

1)Wound cleaning, tetanus prophylaxis, observe animal
2) Check animal brains for rabies + 1)

Front 433

Tx
Bat bite

Back 433

Rabies immunoglobulin and rabies vaccine

Front 434

Tx
1) Snake bite, asymptomatic
2) Snake bite, edema, pain, and ecchymotic discoloration at bite site (3)

Back 434

1) Nothing, not envenomated
2) Antivenin (lots of vials!), Type and crossmatch, coags, LFTs

Front 435

Tx
Bee sting, hypotensive, wheezing
(2)

Back 435

1) Epinephrine
2) Remove stingers

Front 436

Dx, Tx
Spider bite, hourglass mark, n/v/ muscle cramps

Back 436

Dx) Black widow
Tx) IV Ca gluconate + muscle relaxants

Front 437

Dx, Tx
Spider bite, ulcer at site with necrotic center and halo of erythema

Back 437

Dx) Brown recluse
Tx) Dabsone, delayed excision and skin grafting

Front 438

Mgmt
Human bite to hand

Back 438

Surgical exploration

Front 439

Dx, Dx study, Tx
Newborn with uneven gluteal folds, easily dislocated hip with clunk or snapping

Back 439

Dx) Developmental dysplasia of hip
Dx study) Ultrasound NOT xray
Tx) Abduction splinting with harness

Front 440

Dx, Dx study, Tx
6 yo with limping, decreased hip ROM, antalgic gait, passive motion of hip is guarded

Back 440

Dx) Legg Calve Perthes
Dx study) Plain film
Tx) Casting and crutches

Front 441

Dx, Dx study, Tx
Adolescent, antalgic gait, hip pain, foot internally rotated, as hip is flexed leg externally roates

Back 441

Dx )SCFE
Dx study) Plain film
Tx) Pinning of the femoral head

Front 442

Dx, Dx study, Tx
Child with hip pain, refuses to move it from flexed, externally rotated, and slightly abducted location

Back 442

Dx) Septic joint
Dx study) Aspiration
Tx) Open arthrotomy for drainage

Front 443

Dx, Dx study, Tx
Child with fever, persistent severe localized bone pain

Back 443

Dx) Hematogenous osteomyelitis
Dx study) Bone scan
Tx) Abx

Front 444

Tx
Bowlegged
<3)
3+)

Back 444

<3) Normal --> Nothing
3+) Blount disease (medial proximal growth plate problem) --> Surgery

Front 445

Tx
Knock-kneed

Back 445

Nothing

Front 446

Dx, Tx
Tibial tubercle tenderness

Back 446

Dx) Osgood-Schlatter
Tx) Immobilization in extension

Front 447

Dx, Tx (2)
Newborn with feet turned inward, plantar flexion at ankle, inversion of foot, adduction of forefoot, and internal rotation of tibia

Back 447

Dx) Talipes equinovarus
Tx) Serial casting --> Surgery if refractory

Front 448

Mgmt
Scoliosis

Back 448

If significant prior to puberty then needs surgery, if less so then bracing

Front 449

Tx
Growth plate fracture
1) Divides the growth plate in two
2) Doens't

Back 449

1) Open reduction and internal fixation
2) Closed reduction is sufficient

Front 450

Mgmt
Woman breaks bone for no good reason
(3)

Back 450

1) xray of bone
2) Whole body scan for mets
3) Primary in women --> Breast
in men --> Lung

Front 451

Dx
Anemia with multiple lytic bone lesions

Back 451

Multiple myeloma

Front 452

Dx study
Soft tissue tumor in muscle, firm, fixed to surrounding structures

Back 452

MRI for sarcoma

Front 453

Dx study
Rules of orthopedic imaging from trauma
(2)

Back 453

1) Always get orthogonal views
2) Include joint, 1 above, and 1 below

Front 454

Dx, Tx
Dinner fork deformity of wrist,

Back 454

Dx) Colles fracture
Tx) Closed reduction and cast

Concern for: Reflex sympathetic dystrophy and carpal tunnel

Front 455

1) Dx, Tx
Trauma to forearm, anterior dislocation of radial head and diaphyseal fracture of proximal ulna

2) Dx, Tx
Forearm trauma, fracture of distal third of radius and dorsal dislocation of distal radioulnar joint

Back 455

1)
Dx) Monteggia fracture (nightstick fracture)
Tx) Closed reduction of radial head, open reduction and internal fixation of ulnar fracture

2)
Dx) Galeazzi fracture
Tx) Open reduction and fixation of radius, casting of forearm in suppination

Front 456

Tx
Anatomic snuff box pain, on plain film:
Non-displaced)
Displaced)

Back 456

Non-displaced) Thumb splint
Displaced) Open reduction and internal fixation

Front 457

Tx
Metacarpal fracture
Mild -->
Severe -->

Back 457

Mild --> Closed reduction with splint for mild
Severe -->
Plate fixation for severe

Front 458

Tx
1) Elderly fall, hip pain, displaced fracture of femoral neck
2) Elderly fall, hip pain, intertrochanteric fracture

Back 458

1) Hip replacement (vascular supply compromised for repair)
2) Open reduction and pinning

Front 459

Tx
Closed fracture of femoral shaft

Back 459

Intramedullary femoral rod fixation

Front 460

Tx
Femur fractures, shock

Back 460

1) Fixation
2) Fluid resuscitation

Front 461

Dx
Femoral fractures, then develops fever, scleral petechiae, hypoxemia

Back 461

Dx) Fat embolism

Front 462

Tx
Knee ligament tears
If 1 ligament -->
If multiple ligaments -->

Back 462

If 1 ligament --> hinged cast
If multiple ligaments --> surgery

Front 463

Tx
ACL tear
GORFs -->
Atheltes -->

Back 463

GORFs --> Immobilization rehab
Atheltes --> Surgery

Front 464

Tx
Stress fracture

Back 464

1) Cast or crutches
2) Repeat xray in 2 weeks

Front 465

Tx
Fracture of shafts of tibia and fibula
(2)

Back 465

If can reduce --> cast
If can't reduce --> Medullary rod

Front 466

Tx
Loud pop, can still plantar flex ankle, obvious defect in achille's tendon

Back 466

GORFs --> Cast
Athletes --> Surgery

Front 467

Tx
Displaced fractures of both malleoli

Back 467

ORIF

Front 468

Dx, Tx
Severe pain in forearm after falling asleep on it, tender to palpation and passive motion, pulses normal

Back 468

Compartment sx

Front 469

Tx
Pain from cast

Back 469

Remove cast (NEVER analgesia)

Front 470

Tx
ALL compound fractures

Back 470

ALL OPEN FRACTURES go to OR for cleaning and reduction

Front 471

Dx, Dx study, Tx
MVC, one extremity lower than other, adducted and internally rotated

Back 471

Dx) Posterior hip dislocation
Dx study) Plain film
Tx) Emergency reduction (to save vascular supply)

Front 472

Dx, Tx (3)
Swollen, dusky foot, gas crepitus

Back 472

Dx) Gas gangrene
Tx)
1) Surgical debridement
2) IV PCN
3) Hyperbaric oxygen

Front 473

Mgmt
Trauma to upper arm
1) Was never able to extend at wrist -->
2) Lost ability to extend at wrist -->

Back 473

1) Was never able to extend at wrist --> Split
2) Lost ability to extend at wrist --> Surgery for entrapment

Front 474

Dx study
Fall, broken calcanei

Back 474

Spinal xray

Front 475

Tx
Numbness and tingling in hand over median nerve
(2)

Back 475

1) Splint + NSAIDs
2) If surgery --> need pre EMG

Front 476

Dx, Tx
One finger acutely flexed and unable to extend, snap if forced passively

Back 476

Dx) Trigger finger
Tx) Steroid injection, surgery if refractory

Front 477

Dx, Tx
Pain with thumb in fist

Back 477

Dx) De Quervian sx
Tx) Splint, NSAIDs

Front 478

Dx, Tx
Contracted hand with palmar fascial nodules

Back 478

dx) Depuytren's contracture
Tx) Surgery

Front 479

Dx, Tx
Abscess in tip of finger

Back 479

Dx) Felon
Tx) Immediate drainage

Front 480

Dx, Tx
Laxity of thumb after extending trauma

Back 480

Dx) Gamekeeper's thumb
Tx) Casting

Front 481

Dx,Tx
1) Cannot flex one finger
2) Cannot extend one finger

Back 481

1) Jersey finger --> cast
2) Mallet finger --> cast

Front 482

Dx, Dx study, Tx
Back gave out, now electrical shock down leg exacerbated by straight leg test

Back 482

Dx) Lumbar disc herniation
Dx study) MRI
Tx) Bed rest

Front 483

Dx, Tx
Acute back pain, electric pain down leg, distended bladder, flaccid rectal sphincter, saddle anesthesia

Back 483

Dx) Cauda equina sx
Tx) Emergent Surgery

Front 484

Dx, Tx
Chronic back pain and stiffness getting progressively worse, morning stiffness improves with activity, 30 something male

Back 484

Dx) Ankylosing spondylitis
Tx) NSAIDs, PT

Front 485

Dx
Elderly man, back pain, weight loss, pain worse at night, no alleviating factors

Back 485

Metastatic cancer to bone

Front 486

Dx, Dx study
PAD, toe is blue, no peripheral pulses at extremity

Back 486

Dx) Ischemic ulcer
Dx study) Doppler ABI --> Arteriogram

Front 487

Dx
Sharp heel pain whenever foot strikes ground, worse in morning, xray shows bony spur near pain

Back 487

Plantar fasciitis

Front 488

Dx, Dx study, Tx
Acute swelling, redness, and exquisite pain at big toe

Back 488

Dx) Gout
Dx study) Joint aspiration
Tx) Acutely --> Indomethacin and colchicine
Chronic --> Allopurinol

Front 489

EF cutoff for non-cardiac surgery

Other softer contraindications
(4)

Back 489

35%

et al
1) MI w/in 6 months --> wait
2) Afib
3) PVCs
4) High CVP --> treat CHF

Front 490

Pre-op
Jugular venous distension
(4)

Back 490

1) CCBs
2) Beta blockers
3) Digitalis
4) Diuretics
for
Congestive heart failure before surgery

Front 491

Pre-op
Severe progressive angina

Back 491

Coronary revascularization prior to surgery

Front 492

Pre-op
Smoker
(2)

Back 492

1) Smoking cessation for 8 weeks
2) Respiratory therapy

Front 493

Pre-op
Hepatic risk factors which contraindicate surgery
(3)

Back 493

1) Bili over 2
2) Albumin under 3
3) PT above 16

Front 494

Dx, Tx
Pre-op, 20 lb weight loss, albumin low, transferrin low

Back 494

Dx) Nutritional depletion
Tx) 4-7 days of nutritional support before surgery

Front 495

Dx
After induction, hyperthermia, metabolic acidosis, hypercalcemia

Back 495

Dx) Malignant hyperthermia
Tx) IV Dantrolene

Front 496

Dx
Immediately after completion of invasive procedure pt spikes high fever, and chills

Back 496

Bacteremia

Front 497

Dx, Dx study
POD#2, severe retrosternal pain, SOB, tachycardia

Back 497

Dx) MI
Dx study) EKG and Trops

Front 498

Dx, Dx study, Tx
POD#7, CP, SOB, diaphoretic, tachycardic, distended neck veins

Back 498

Dx) PE
Dx study) ABG --> Spiral CT if unclear
Tx) Heparin (if already anticoagulated then IVC filter)

Front 499

Tx
Aspiration during intubation
(2)

Back 499

1) Lavage with bronchoscopy
2) Bronchodilators

Front 500

Dx
TB hx, intra-op becomes difficult to bag patient, CVP rises and BP falls

Back 500

Intra-op pneumothorax

Front 501

Dx study
Acute onset disorientation

Back 501

ABG
for
Hypoxemia

Front 502

Dx, Tx
s/p surgery, bilateral pulmonary infilitrates, hypoxemia, no evidence of CHF

Back 502

Dx) ARDS
Tx) PEEP with permissible hypercapnia

Front 503

Tx
Hyponatremic disorientation

Back 503

Hypertonic saline

Front 504

Dx, Tx
Brain surgery, profound UOP without appropriate intake

Back 504

Dx) Hypernatremia
Tx) D5W or 1/4NS

Front 505

Dx
Cirrhotic patient goes into coma after portocaval shunt

Back 505

Hyperammonia

Front 506

Dx study
Low UOP s/p surgery

Back 506

Urine Na

If Dehydrated = Urine Na will be low like 10-20 and FENa < 1
If Renal failure = Urine Na will be 40+ and FENa > 1

Front 507

Dx, Tx
s/p abdominal surgery, abdominal distension without pain, obstipation, dilated loops of bowel without air fluid levels

Back 507

Dx) Paralytic ileus
Tx) NGO and NPO till peristalsis

Front 508

Dx, Mgmt
Elderly s/p abdominal surgery, abdomen grossly distended and tense but not tender, occasional bowel sounds, very distended colon on xray with few distended loops of small bowel

Back 508

Dx) Ogilvie
Mgmt) Colonoscopy

Front 509

Dx, Tx
Salmon colored fluid leaking from laparotomy site

Back 509

Dx) Dehiscence
Tx) Tape wound, bind abdomen

Front 510

Tx
Surgical Wound opens and abdomen spills out

Back 510

Wrap in warm moist gauze and OR

Front 511

Dx, Dx study, Tx
POD#7, surgical wound is red, hot, tender, and boggy

Back 511

Dx) Wound infection
Dx study) US
Tx) Surgery

Front 512

Dx, Tx
S/p surgery, draining feces, small volume, patient afebrile

Back 512

Dx) Fecal fistula (would be febrile if draining inside)
Tx) No therapy

Front 513

Dx, Tx
s/p surgery, draining large volume of green fluid from surgical wound

Back 513

1) If fever --> acute abdomen --> Ex lap
2) If no fever --> high output fistula --> high volume TEN

Front 514

Tx
Asymptomatic euvolemic serum Na 122

Back 514

Fluid restriction
for
SIADH

Front 515

Tx
Hypovolemic hyponatremia

Back 515

LR or NS

Front 516

Tx
DKA, fluid resuscitated but now, hypokalemic

Back 516

10-20 mEq/L of K

Front 517

Tx
Hyperkalemia
(4)

Back 517

1) Ca Gluconate
2) Insulin and dextrose
3) Kayexalate
4) Hemodialysis

Front 518

Tx
1) Metabolic acidosis from shock, high AG
2) Metabolic acidosis from GI losses, normal AG

Back 518

1) LR NOT NS (bc don't want hyperchloremic acidosis)
2) Bicarb

Front 519

Tx
Metabolic acidosis from vomiting
(2)

Back 519

1) NS
2) K

Front 520

Dx, Dx study, Tx
Burning retrosternal pain when lying in bed

Back 520

Dx) GERD
Dx study) Endoscopy and biopsies
Tx) PPIs

Front 521

Tx
GERD with progression, endoscopy shows Barret's esophagus

Back 521

1st) Medical management
2nd) If continued sx --> Fundoplication

Front 522

Mgmt
GERD with esophagitis, recommended surgery

Back 522

1) pH monitoring
2) Mamometry studies
3) Endoscopy with biopsies
Basically every esophagus study to plan the surgery.

Front 523

Dx, Dx study
Difficulty swallowing, liquids worse than solids, now sits up straight to help swallowing, occasionally vomits undigested food

Back 523

Dx) Achalasia
Dx study) Barium swallow

Front 524

Dx (2), Dx study (3)
Smoker drinker, progressive dysphagia from solids to liquids, foods "stick" in throat, weight loss

Back 524

Dx) Ca of esophagus
If drinker --> SCC
If reflux --> Adenocarcinoma

Dx study) All in this order
1) Ba swallow
2) Endoscopy
3) CT scan

Front 525

Dx, Dx study, Tx
Frequent vomiting progresses to hematemesis

Back 525

Dx) Mallory weiss tear
Dx study) Endoscopy
Tx) Nothing or photocoagulation

Front 526

Dx, Dx study, Tx
Frequent vomiting, now severe wrenching epigastric pain, diaphoretic, fever, high whites

Back 526

Dx) Boerhaave sx (esophageal perforation)
Dx study) Gastrografin swallow
Tx) Emergency surgery

Front 527

Dx study, Tx
Esophageal perf from endoscopy

Back 527

Dx study) Gastrografin study
Tx) Surgery

Front 528

Dx, Dx study (2), Tx
Elderly, massive weight loss, anorexia, vague epigastric discomfort

Back 528

Dx) Ca of stomach
Dx study) Endoscopy biopsies --> CT scan
Tx) Surgery

Front 529

Dx, Tx
Colicky abdominal pain, vomiting, abdominal distension, no flatus, high pitched loud bowel sounds that coincide with colicky pain, Xray shows distended loops of small bowel with air fluid levels
THEN --> develops fever, high whites, abdominal tenderness and rebound tenderness

Back 529

Dx) Mechanical SBO from adhesions
Tx) NG suction

THEN
Dx) Strangulated obstruction (compression of mesenteric blood supply)
Tx) Emergency surgery

Front 530

Dx, Tx
SBO, hernia that can't be reduced

Back 530

Dx) Incarcerate hernia
Tx) Surgery

Front 531

Dx, Dx study
Protracted diarrhea, face flushing, expiratory wheezing, prominent jugular venous pulse

Back 531

Dx) Carcinoid sx
Dx study) 5-hydroxy indolacetic acid

Front 532

Dx, Dx study, Tx
Anorexia, vague periumbilical pain that then localizes sharply to RLQ, rebound and guarding, high whites

Back 532

Dx) Acute appendicitis
Dx study) Abdominal CT
Tx) Appendectomy

Front 533

Dx, Dx study, Tx
59 yo M faining at work, 4+ occult blood in stool, anemic

Back 533

Dx) Right colon Ca
Dx study) Colonoscopy and biopsies
Tx) Blood transfusions and right hemicolectomy

Front 534

Dx, Dx study, Tx
Bloody bowel movements on and off for weeks, constipation with narrow caliber stool

Back 534

Dx) Left colon Ca
Dx study) Endoscopy and biopsies (can start with proctosigmoidoscopy before full endoscopy)
Tx) Surgery

Front 535

Polyp mgmt
Which are malignant? --> excised
Which are benign?

Back 535

Malignant = FAV
Familial polyposis
Adenomatous polyp
Villous adenoma

Benign = JHP
Juvenile
Hyperplastic
Peutz jegher

Front 536

Dx, Tx
UC, tender abdomen, xray shows massively distedned transverse colon and gas within colonic wall

Back 536

Dx) Toxic megacolon
Tx) Surgery

Front 537

Dx, Dx study, Tx
Abx, now watery diarrhea, crampy abdominal pain, fever, whites

Back 537

Dx) Pseudomembranous colitis from C diff
Dx study) C diff stool toxin
Tx) Stop abx, start metronidazole

Front 538

Dx, Mgmt (3)
Itching, painful anus with blood on tissue paper

Back 538

Dx) External hemorrhoids
Mgmt) Proctosigmoidoscopic exam to rule out anal cancer
1. DRE
2. Anoscopy
3. Flex sig

Front 539

Dx, Dx study
Unhealing anal fistulas

Back 539

Dx) Crohn's disease
Dx study) Biopsies to rule out cancer

Front 540

Dx, Dx study, Tx
Exquisite perianal pain, BM very painful, chills and fever, hot tender red fluctuant mass in perineum

Back 540

Dx) Ischiorectal abscess
Dx study) Exam under anesthesia (to rule out cancer)
Tx) Incision and drainage

Front 541

Dx, Dx study, Tx
Perianal discomfort, fecal staining, palpable cords on ass

Back 541

Dx) Fistula in ano
Dx study) Proctosigmoidoscopy
Tx) Fistulotomy

Front 542

Dx, Dx study, Tx
HIV Pt, fungating mass in anus, rock hard enlarged lymph nodes in groin, weight loss, looks ill

Back 542

Dx) SCC of anus
Dx study) Biopsy
Tx) Chemo and radiation

Front 543

Mgmt
Upper GI bleeding

Back 543

Endoscopy

Front 544

Mgmt
BRBPR, currently bleeding
(1+3+1)

Back 544

1) NG tube aspiartion of stomach
If blood --> Endoscopy

If green with no blood --> Distal GI bleed
1) Target red cell scan
2) Arteriogram if heavy
3) t/c colonoscopy if very light

If white with no blood --> NOT currently bleeding and non-diagnostic, so
1) Upper and lower endoscopies

Front 545

Dx, Dx study
Child with large bloody bowel movement

Back 545

Dx) Meckel's diverticulum
Dx study) Radiolabeled techntium scan

Front 546

Dx, Dx study, Tx
ICU Pt, recently started massive hematemesis

Back 546

Dx) Stress ulcer
Dx study) Endoscopy
Tx) Laser endoscopy --> embolization if refractory

Front 547

Dx, Mgmt
Acute onset abdominal pain that is severe generalized and constant, diaphoretic, shallow breathing, abdomen is rigid very tender with guarding and rebound

Back 547

Dx) Acute abdomen
Mgmt) Ex lap

Front 548

Dx, Dx study, Tx
Cirrhotic Pt with ascites, p/w acute generalized abdominal pain, guarding and equivocal rebound, fever, whites

Back 548

Dx) Primary peritonitis
Dx study) Cx ascitic fluid
Tx) Abx

Front 549

Dx, Mgmt
Acute excruciating abdominal pain, rigid abdomen, motionless, no bowel sounds, air under diaphragm on xray

Back 549

Dx) Acute abdomen with perforated viscus
Mgmt) Emergency laparotomy

Front 550

Dx, Dx study (2), Tx (3)
Alcoholic, severe acute epigastric pain after alcohol, constant radiates to back, n/v

Back 550

Dx) Acute pancreatitis
Dx study) Amylase and lipase, CT scan
Tx) NPO, NG suction, IV fluids

Front 551

Dx, Dx study (2), Tx
Acute severe RUQ pain, colicky at first radiating to right shoulder with nv, now constant with guarding and rebound, fever, whites

Back 551

Dx) Acute cholecystitis
Dx study) Ultrasound
if equivocal --> HIDA scan
Tx) Surgery within 72 hrs

Front 552

Dx, Dx study (2)
Right flank colicky pain of sudden onset radiating to inner thigh and scrotum, microscopic hematuria

Back 552

Dx) Ureteral colic
Dx study)
1) Abdominal plain film
2) Ultrasound

Front 553

Dx, Dx study, Tx (2)
3 prior episodes of LLQ pain, now pain again, constant
LLQ, tenderness, vaguely palpable mass, no whites or fever

Back 553

Dx) Acute diverticulitis
Dx study) CT scan
Tx)
If single attack = Abx
If recurrent = sigmoid resection

Front 554

Dx, Tx
Severe abdominal distensionvwith tympany, n/v, colicky abdominal pain, obstipation, distended loops of small bowel on xray, parrot's beak gas shadow in RUQ tapering towards LLQ

Back 554

Dx) Volvulus of the sigmoid
Tx) Proctosigmoidoscopy to relieve obstruction

Front 555

Dx, Tx
Afib, acute abdomen

Back 555

Dx) Embolic mesenteric ischemia
Tx) t/c Embolectomy if very early (but it's usually dead)

Front 556

Dx, Dx study, Tx
Vague RUQ pain, weight loss

Alpha Fetoprotein elevated =
CEA elevated =

Back 556

Alpha Fetoprotein elevated = Primary hepatoma
CEA elevated = Metastatic from colon

Dx study) CT with contrast
Tx) Surgical resection

Front 557

Tx
Liver abscess in cholangitis

Back 557

Percutanous drainage

Front 558

Dx
High bili, mostly unconjugated

Back 558

Hemolytic jaundice

Front 559

DX, Dx study
Travel abroad, now malaise, weakness, anorexia, billi is 12, indirect 7, direct 5, alk phos mildly elevated, AST/ALTs very high

Back 559

Dx) Hepatocellular jaundice
Dx study) Serologies for hepatitis

Front 560

Dx, Dx study
Bili 22, direct 16, indirect 6, minimally elevated transaminases, alk phos progressively increased to 6x normal

Back 560

Dx) Obstructive jaundice
Dx study) RUQ US

Front 561

Dx, Dx study, Tx
Bili 22, direct 16, indirect 6, minimally elevated transaminases, alk phos progressively increased to 6x normal, colicky abdominal pain

Back 561

Dx) Obstructive jaundice from stones
Dx study) RUQ US
Tx) ERCP then cholecystectomy

Front 562

Dx, Dx study
Bili 22, direct 16, indirect 6, minimally elevated transaminases, alk phos progressively increased to 6x normal, on US dilated intra/extrahepatic ducts, very distended thin-walled gallbladder

Back 562

Dx) Malignant obstructive jaundice (i.e. tumor), distended gallbladder is bad: stones caused thick walls
Dx study) CT t/c ERCP

Front 563

Dx, Tx
Bili 22, direct 16, indirect 6, minimally elevated transaminases, alk phos progressively increased to 6x normal, on US dilated intra/extrahepatic ducts, very distended thin-walled gallbladder, CT normal, ERCP shows narrowing of distal common duct

Back 563

Dx) Cholangiocarcinoma
Tx) Whipple (pancreatoduodenectomy)

Front 564

Dx, Tx
Bili 22, direct 16, indirect 6, minimally elevated transaminases, alk phos progressively increased to 6x normal, on US dilated intra/extrahepatic ducts, very distended thin-walled gallbladder, CT normal, positive blood in stool

Back 564

Dx) Ampullary carcinoma
Tx) Endoscopy

Front 565

Dx, Dx study
Bili 22, direct 16, indirect 6, minimally elevated transaminases, alk phos progressively increased to 8x normal, on US dilated intra/extrahepatic ducts, very distended thin-walled gallbladder, CT normal, ERCP shows narrowing of distal common duct, weight loss

Back 565

Dx) Cancer of head of pancreas
Dx study) CT then possibly ERCP (both ducts will be blocked)

Front 566

Dx, Dx study, Tx
Repeated episodes of RUQ pain by fatty good, radiates to right shoulder, occasional n/v

Back 566

Dx) Gallstones with biliary colic (NOT acute cholecystitis)
Dx study) RUQ US
Tx) Elective cholecystectomy

Front 567

Dx, Tx (2)
Severe RUQ pain of 3 days, colicky now constant, tenderness to deep palpation, very high fever, high whites, high bili, alk phos 2000 or 20x normal

Back 567

Dx) Acute ascending cholangitis
Tx)
1) Abx
2) ERCP to decompress; 2nd line is PTC

Front 568

Dx study, Tx (1+2)
Hx of obstructive cholangitis and biliary pancreatitis that is resolving

Back 568

Dx study) RUQ US
Tx) Elective cholecystectomy
or
If worsens ERCP and sphincterectomy

Front 569

Dx, Tx
Alcoholic with epigastric pain radiating to back, amylase 1200, normal Hct

Back 569

Dx) Acute Edematous pancreatitis
Tx) NPO, NG suction, IV fluids

Front 570

Dx
Alcoholic with epigastric pain radiating to back, high amylase, low hct, whites, metabolic acidosis, low pO2, low Ca

Back 570

Dx) Hemorrhagic pancreatitis
Dx study) Serial CT scans

Front 571

Dx, Dx study, Tx
ICU Pt being treated for hemorrhagic pancreatitis, week later develops high fever and whites

Back 571

Dx) Pancreatic abscess
Dx study) CT scan
Tx) Drainage

Front 572

Dx, Dx study, Tx
Hx of acute pancreatitis or abdominal trauma, now epigastric mass with vague upper abdominal pain

Back 572

Dx) Pancreatic pseudocyst (not lined by epithelium)
Dx study) CT scan
Tx) Observation, if refractory --> drainage

Front 573

Dx, Dx study, Tx (2)
Alcoholic, constant epigastric pain of many years, calcifications in upper abdomen on xray

Back 573

Dx) Chronic pancreatitis
Dx study) ERCP
Tx) Stop drinking, pancreatic enzyme replacement

Front 574

Mgmt
Umbilical hernia in small child

Back 574

No operation if under 2 yo

Front 575

Mgmt
Asymptomatic inguinal hernia
Reducible -->
Incarcerated -->

Back 575

Reducible --> Elective repair to prevent strangulation
Incarcerated --> If old incarcerated,
If NEW --> urgent surgical repair

Front 576

Dx, Dx study, Tx
Firm, rubbery mass, mobile in young woman

Back 576

Dx) Fibroadenoma
Dx study) Ultrasound
Tx) Excision is optional

Front 577

Dx, Tx
Firm, mobile, rubbery mass in adolescent that has grown quite large

Back 577

Dx) Giant juvenile fibroadenoma
Tx) If deforming breast --> surgery

Front 578

Dx, Dx study, Tx
Mexican immigrant, very slow growing breast mass, rubbery, movable, no axillary lymph node enlargement

Back 578

Dx) Cystosarcoma phyllodes
Dx study) Core biospy
Tx) Margin free resection (can become malignant)

Front 579

Dx, Dx study, Tx (3)
10 yr hx of breast pain related to menstrual cycle, with multiple lumps on both breasts, now a firm round 2 cm mass persists for 6 weeks

Back 579

Dx) Fibrocystic disease
Dx study) If over 30 --> Mammogram
Tx) Aspirate cyst
If clear and cures --> nothing
If bloody --> cytology
If recurs --> Needle biopsy

Front 580

Dx
Bloody discharge from nipple on and off for several months, no palpable masses

Back 580

Dx) Intraductal papilloma
Dx study) Mammogram (mammogram everything that isn't palpable)
Tx) Surgical resection

Front 581

Dx
Lactating mother, cracked nipple with red, hot, tender mass in breast, fever, whites

Back 581

Dx) Breast abscess
Tx) Incision and drainage

NB) If non-lactating breast abscess = breast cancer

Front 582

Mgmt
50 yo woman, firm mass in breast

Back 582

In this order
1) Core biopsy
2) If equivocal --> excisional biopsy

Front 583

Mgmt
Firm ill defined mass in pregnant woman's breast

Back 583

1) Mammogram
2) Biopsies

(don't need to terminate pregnancy)

Front 584

Dx. Dx study
Right breast mass with ill defined borders, movable form best wall but not within breast, orange peel appearance, nipple retraction

Back 584

Dx) Breast Ca
Dx study) Mammogram --> Core biopsy --> Excisional biopsy till definitive answer

Front 585

Dx, Dx study
Red swollen breast, no fever, no whites, orange peel skin

Back 585

Dx) Breast Ca
Dx study) Can do punch biopsy

Front 586

Dx
Breast trauma, notices 3 cm hard mass, deep in breast

Back 586

Breast Ca
(trauma just brings attention to otherwise occult process)

Front 587

Dx, Dx study (2)
Hard mass in axillary lymph node

Back 587

Dx) Breast Ca
Dx study) Mammogram + Node biopsy

Front 588

Dx study
Microcalcifications on routine mammogram

Back 588

Stereotactic guided core biopsy

Front 589

Tx (3)
Small infiltrating ductal carcinoma Ca far from nipple

Back 589

1) Lumpectomy
2) Axillary node dissection
3) Radiation

Front 590

Tx
Infiltratin ductal carcinoma under nipple

Back 590

Modified radical mastectomy (included node dissection, not need for radiation)

Front 591

Prognosis
Lobular breast cancer
Inflammatory breast cancer

Back 591

Lobular breast cancer --> Likely bilateral
Inflammatory breast cancer --> Terrible prognosis

Front 592

Mgmt
Ductal carcinoma in situ

Back 592

1 quadrant --> Lumpectomy with radiation
Multicentric --> Simple total mastectomy

Front 593

Tx
Infiltrating ductal carcinoma in pregnancy

Back 593

1) Lumpectomy
2) No radiation during pregnancy
3) Chemo but not till after 1st trimester

Front 594

Tx
Fungating, ulcerated, breast cancer

Back 594

Palliation with chemotherapy

Front 595

Tx (3)
Breast cancer with metastatic spread into lymph nodes

Back 595

1) Lumpectomy
2) Radiation
3) Chemotherapy for metastases

Front 596

Tx
Metastatic to the nodes breast cancer that is hormone receptive

Back 596

1) Lumpectomy with radiation
2) Tamoxifen instead of chemotherapy

Front 597

Mgmt (2)
Severe constant HA in breast cancer survivor

Back 597

1) CT brain scan
2) High dose steroids

Front 598

Dx study, Tx
Breast cancer survivor, back pain over spine

Back 598

1) Bone scan
2) Xrays if positive

Tx
1. Local radiation
2. Orthopedic supports

Front 599

Dx study
Asymptomatic single mass on thyroid

Back 599

FNA

Front 600

Mgmt
Indeterminate thyroid FNA

Back 600

Surgery

Front 601

Dx, Dx study, Tx (2)
Thyroid mass, hyperthyroid

Back 601

Dx) Hot adenoma
Dx study) TSH and T4.
Tx) Beta blockers then surgery

Front 602

Dx, Dx study, Tx
Lateral aberrant thyroid tissue from neck

Back 602

Dx) Metastatic follicular carcinoma of thyroid
Dx study) Thyroid scan
Tx) Surgery

Front 603

Dx, Dx study (2), Tx
High Ca with low phosphorous on labs

Back 603

Dx) Parathyroid adenoma
Dx study) PTH and sestambi scan
Tx) Surgery

Front 604

Dx study mgmt for Cushing's

Back 604

1) Low dose dexamethasone --> Normal (fat woman)
2) High dose dexamethasone --> Pituitary adenoma
3) High dose resistant --> Adrenal adenoma

Front 605

Dx, Dx study, Tx
Virulent peptic ulcer disease, watery diarrhea, resistant to PPI

Back 605

Dx) Zollinger ellison (Gastrinoma)
Dx study) Serum gastrin + CT of pancreas
Tx) Removal of pancreatic tumor

Front 606

Dx,
High insulin
Low c-peptide =
High c-peptide =

Back 606

Low c-peptide = psychiatric
High c-peptide = insulinoma
Dx study) CT of pancreas

Front 607

Dx, Dx study, Tx
Severe, migratory necrolytic dermatitis, thin frame, mild stomatitis and mild diabetes

Back 607

Dx) Glucagonoma
DX study) Glucagon levels + CT of pancreas
Tx) Surgery

Front 608

Dx, Dx study (2), Tx (2)
HTN, highish Na, low K

Back 608

Dx) Hyperaldosteronism
Dx study) Aldosterone (hi) and renin (low) levels
THEN
IF responds to lying down --> hyperplasia --> Aldactone
IF doesn't respond to posture --> Adenoma --> Surgery

Front 609

Dx, Dx study, Tx
HTN, severe pounding HA, palpitations, perspiration, and paollor

Back 609

Dx) Pheochromocytoma
Dx study) VMA
Tx) Surgery

Front 610

Dx, Dx study (2), Tx
HTN in both arms but neither legs

Back 610

Dx) Coarctation of aorta
Dx study) CXR for scalloped ribs --> CT or MRI angiogram
Tx) Surgery

Front 611

Dx, Dx study, Tx
HTN, refractory to meds, bruit over abdomen

Back 611

Dx) Renovascular HTN
Tx) Stenting

Front 612

Dx, Dx study (2), Tx
Neontate, excessive salivation, NG tube coils up on itself

Back 612

Dx) Tracheoesophageal fistula
Dx study) (to rule out VACTER)
1. Echo
2. US of kidneys
Tx) Surgery

Front 613

Dx study
Neonate imperforate anus

Back 613

1) CXR
2) Echo
3) Renal US
4) Look for genital or perineal fistulas
to rule out VACTER

Front 614

Dx, Tx (4)
Neonate, tachypnea, cyanotic, grunting, scaphoid abdomen, hypoxia and acidosis

Back 614

Dx) Congenital diaphragmatic hernia
Tx)
1. Wait 48 hrs for lungs to mature
2. Intubate
3. Suction
4. Then surgery

Front 615

Tx
1) Gastroschisis
2) Omphalocele

Back 615

For both:
1. TPN (bowel won't work for a month)
2. Silo housing to return bowel to abdomen

Front 616

Dx, Tx
Neonate, moist medallion bathed in urine on abdomen

Back 616

Dx) Extrophy of urinary bladder
Tx) Emergency surgery

Front 617

Dx, Dx study, Tx
Neonate, green vomit, baby has Down sx, double bubble on xray i.e. large air fluid level

Back 617

Dx) Duodenal atresia or annular pancreas
Dx study) Look for other malformations (e.g. Contrast enema)
Tx) Surgery

Front 618

Dx, Dx study, Tx
Neonate, green vomit, double bubble, air in the distal bowel beyond duodenum in non-distended loops

Back 618

Dx) Incomplete obstruction from duodenal atresia or annual pancreas, but more likely malrotation
Dx study) Contrast enema
Tx) If incomplete obstruction --> Eventual surgery
If malrotation --> SUPER emergency

Front 619

Dx
Neonate, green vomit, does not pass meconium, abdominal distension, xray shows multiple air fluid levels and distended loops of bowel

Back 619

Dx) Intestinal atresia

Front 620

Dx, Tx (multiple)
Premie with feeding intolerance, abdominal distension, dropping plt count, treated with indomethacin

Back 620

Dx) Necrotizing enterocolitis
Tx)
1. If no air in bowel wall --> NPO, abx, TEN
2. If air in bowel wall, biliary tree, or peritoneum --> Surgery

Front 621

Dx, Dx study, Tx
3 day old, feeding intolerance and bilious vomiting, multiple dilated loops of small bowel and a ground glass appearance of lower abdomen, Fhx of CF

Back 621

Dx) Meconium ileus
Dx study and Tx) Gastrografin enema (not CF tests!)
--> Surgery if above unsuccessful

Front 622

When can malrotation present?

Back 622

Up to 1st few weeks of life

Front 623

Dx, Dx study, Tx (2)
3 week old, projectile vomiting, peristaltic waves, olive sized mass

Back 623

Dx) Pyloric stenosis
Dx study) Electrolytes
Tx)
1. Correct electrolytes
2. Pyloromyotomy

Front 624

Dx, Dx study, Tx
8 week old, progressive jaundice, high bili 2/3 conjugated, 1/3 unconjugated, sweat test normal, neg hep panel

Back 624

Dx) Biliary atresia
Dx study) HIDA scan after 1 week of phenobarbital
Tx) Surgical derivation

Front 625

Dx, Dx study (2)
Child, chronic constipation, abdominal distension, dilated loops of bowel throughout abdomen, rectal exam followed by massive bowel movement

Back 625

Dx) Hirschsprung's
Dx study)
1. Barium enema
2. Full thickness biopsy is definite

Front 626

Dx, Dx study, Tx
9 month old child, colicky abdominal pain, vague mass on right side, currant jelly stools

Back 626

Dx) Intussusception
Dx study and Tx) Barium enema or air enema

Front 627

Dx, Tx
Acantholysis (separation of epidermal cells), fragile blisters, immunoflourescence to antibodies in epidermis

Back 627

Dx) Pemphigus vulgaris
Tx) Steroid

Front 628

Dx
Deep blisters, abs at the dermo-epidermal junction

Back 628

Bullous pemphigoid

Front 629

Dx, Tx
Blisters and erosions of skin in photodistribution, hyperpigmentation in other areas, preceeded by alcohol estrogen or ion intake

Back 629

Dx) Porphyria cutanea tarda
Tx) Chloroquinolone or phlebotomy

Front 630

Dx
Wheals within half hour, no longer than 24 hrs

Back 630

Type I Uriticaria Hypersensitivity (IgE)

Front 631

Dx
Measle like rash, 3-4 days after exposure

Back 631

Type IV Morbiliform Hypersensitivity (Lymphocytes)

Front 632

Dx
Target like lesions on palms and soles

Back 632

Erythema multiforme

Front 633

Dx, Tx
Hemorrhagic crusts over mucus membranes

Back 633

Dx) Steven Johnson's
Tx) Steroids and IVF

Front 634

Dx
1) Full thickness skin sloughs off, usually drug related,
2) Granular layer skin sloughing (more superficial)

Back 634

Dx
1 = Toxic epidermal necrolysis
2 = Staphylococcal scalded skin sx

Front 635

Dx
Interdigital space blisters of feet, KOH preparation shows dermatophytes

Back 635

Dx) Tinea pedis

Front 636

Dx, Dx study
Red round, scaly border head

Back 636

Dx) Tinea capitis
Dx study) KOH prep

Front 637

Tx (3)
HPV

Back 637

1) Cautery
2) Podophyllin
3) Cryotherapy

Front 638

Tx
Cellulitis

Back 638

Abx for staph or strep

Front 639

Tx
Necrotizing fasciitis

Back 639

1) Abx for strep and mixed infxn
2) Surgical debridement

Front 640

Dx study
Syphilis in HIV pt

Back 640

Spinal tap for tertiary syphilis

Front 641

Dx. Dx study
Itchy bumps with linear burrows

Back 641

Dx) Scabies
Dx study) Microscopy of scrapings

Front 642

Dx, Dx study
Fever, mental status changes, petechial rash with slate gray center

Back 642

Dx) Meningococcemia
Dx study) Spinal tap

Front 643

Dx
Crusty, greasy stuck on appearance of skin lesion

Back 643

Seborrheic keratosis

Front 644

Dx
Crusty red patch

Back 644

Actinic keratosis (premalignant)

Front 645

SCC =
BCC =

Back 645

SCC = rarely metastasize
BCC = pearly bumpy crust and telangiectasia

Front 646

Dx
Silvery scale on red skin

Back 646

Psoriasis

Front 647

Dx
Dry skin, fissured, crusted inflammed

Back 647

Asteatotic dermatitis

Front 648

Dx
Fhx, skin lesions on flexors

Back 648

Atopic dermatitis

Front 649

Dx
Redness, scaling in nasolabial folds and scalp

Back 649

Seborrheic dermatitis

Front 650

Dx
Herald patch, VDRL negative, salmon colored discrete scaly patches on trunk and proximal extremities

Back 650

Pityriasis Rosea

Front 651

Decubitus ulcer stages
I:
II:
II:
IV:

Back 651

I: Nonblanchable redness
II: Epidermal
II: Full skin on fascia
IV: To bone or muscle

Front 652

Dx
Childhood but persistent hemangioma, deeper dermal vessels

Back 652

Cavernous hemangioma

Front 653

Dx
Tear of middle meningeal artery

Back 653

Epidural hematoma and fracture of temporal bone

Front 654

Dx
Moth eaten appearance of long bones and frontal bossing

Back 654

Paget's disease

Front 655

Vessel:
Epidural
Subdural

Back 655

Epidural - middle meningeal artery - Convex
Subdural - bridging veins - concave

Front 656

Dx
on Head CT dark linear lesion with cortical atrophy

Back 656

Chronic subdural hematoma

Front 657

Dx
On head CT white dots

Back 657

Intracerebral hemorrhage

Front 658

Dx
Dense lesion in cerebello pontine angle

Back 658

Acoustic schwannoma

Front 659

Dx
Displacement of vertebral body alignment

Back 659

Fracture of cervical spine

Front 660

Dx
Poor bone density, fish mouth apearance of superior and inferior surfaces of vertebral bodies

Back 660

Osteoperosis with collapsed vertebral body

Front 661

Dx
Dislocation of shoulder anteriorly

Back 661

Damage to axillary nerve

Front 662

Dx
Fracture of the shaft of humerus

Back 662

Danger to radial nerve

Front 663

Dx
Supracondylar fracture of the humerus, positive fat pad sign

Back 663

Danger to median nerve and brachial artery

Front 664

Dx
Soap bubble appearance of bone, easily broken bone, reactive periosteal bone

Back 664

Giant cell tumor

Front 665

Dx
Narrowing of joint spaces, osteophyte formation, subchondral sclerosis and bone cysts

Back 665

Osteoarthritis

Front 666

Dx
RF positive, periarticular osteoperosis, marginal erosions, synovial cyst formation, bilaterally symmetric

Back 666

Rheumatoid arthritis

Front 667

Dx
RF negative, loss of joint space, interdigitating bony erosions, pencil in cup deformity

Back 667

Psoriatic arthritis

Front 668

Nerves and vessles in danger from dislocation
Anterior Hip:
Posterior Hip:
Knee:

Back 668

Anterior Hip: Obturator nerve
Posterior Hip: Sciatic nerve and femoral head vessels
Knee: Popliteal artery

Front 669

Neck of femur fractures
1) Elderly, avascular necrosis common
2) Young people, no avascular necrosis

Back 669

1) Intracapsular
2) Extracapsular

Front 670

Dx
Bilateral hilar lymphadenopathy

Back 670

Sarcoidosis

Front 671

Dx
Severe hemoptsis, fungus ball in lung

Back 671

Aspergillosis

Front 672

Dx
Bronchiectasis with tram lines

Back 672

CF

Front 673

Dx
Boot shaped heart

Back 673

Tetralogy of Fallot

Front 674

Dx
Kerley B lines

Back 674

Congestive heart failure

Front 675

Esophageal strictures
Smooth =
Irregular =

Back 675

Smooth = Benign (GERD)
Irregular = Malignant

Front 676

Dx
Step ladder pattern air-fluid levels

Back 676

Small bowel obstruction

Front 677

Dx
Skip lesions of GI tract, cobblestoning of mucosa, string sign

Back 677

Crohn's disease

Front 678

Dx
Continuous lesions in large bowel, superficial ulcerations, pseudopolyps

Back 678

Ulcerative colitis

Front 679

Dx
Apple core appearance of colon

Back 679

Colon cancer

Front 680

Dx
Mushroom heads

Back 680

Diverticulitis

Front 681

Dx
Blood and thunder retina

Back 681

Central retinal vein occlusion

Front 682

Dx
Cherry red spot on retina

Back 682

Central retinal artery occlusion

Front 683

Dx
Blurry vision over months

Back 683

Open angle glaucoma

Front 684

Dx
Sudden onset of unilateral eye pain, n/v, colored halos around lights, mid dilated and fixed pupil, large optic cup to optic disc ratio

Back 684

Acute closed angle glaucoma

Front 685

Dx
Blurry vision especially around lights +
1) yellow brown pupil and improved near vision
2) Spoke opacities in pupil

Back 685

1) Nuclear cataract
2) Cortical cataract

Front 686

Dx, Dx study, Tx
Young child with occasional stridor, respiratory distress, and crowing respiration (hyperextended position when breathing), and difficulty swallowing

Back 686

Dx) Vascular ring
Dx study) Barium swallow then trach
Tx) Surgery

Front 687

Mgmt
Asymptomatic congenital heart defect, needs dental work

Back 687

Abx prophylaxis

Front 688

Dx, Dx study, Tx
Pulmonary flow systolic murmur, fixed split S2, hx of frequent URIs

Back 688

Dx) Atrial septal defect
Dx) Echo
Tx) Surgery

Front 689

Dx, Dx study, Tx
Failure to thrive, loud pansystolic heart murmur at left sternal border, pulmonary vascular markings

Back 689

Dx) Ventricular septal defect
Dx study) Echo
Tx) Surgery

Front 690

Mgmt
2 month old baby with VSD low in septum

Back 690

Nothing, will close spontaneously

Front 691

Dx, Dx study, Tx (2)
Child with trouble feeding and pulmonary congestion, bounding peripheral pulses, machinery like heart murmur, heart failure

Back 691

Dx) Patent ductus arteriosus
Dx study) Echo
Tx) Indomethacin --> If heart failure also needs surgery

Front 692

Dx, Dx study
Child, cyanotic spells relieved by squatting, systolic ejection murmur, small heart, pulmonary vascular markings, RVH on EKG

Back 692

Dx) Tetralogy of Fallot
Dx study) Echo

Front 693

Dx
Child with cyanosis
From birth =
After birth =

Back 693

From birth = Transposition of great arteries
After birth = Tetralogy of Fallot

Front 694

Dx, Dx study, Tx (1+4)
Angina, syncopal episodes, harsh midsystolic murmur on right

Back 694

Dx) Aortic stenosis
Dx study) Echo
Tx)
1. If asymptomatic --> nothing
2. If gradient more than 50 mm, CHF, angina, or syncope --> Valve replacement

Front 695

Dx, Tx
Wide pulse pressure, high pitched, diastolic murmur, LVH

Back 695

Dx) Aortic regurg
Tx) Valve repair

Front 696

Dx
Loud diastolic murmur on right out of the blue!

Back 696

Aortic regurg from endocarditis

Front 697

Dx, Dx study, Tx
DOE, orthopnea, cough, hemoptysis, afib, low pitched rumbling diastolic apical heart murmur

Back 697

Dx) Mitral stenosis
Dx study) Echo
Tx) Elective surgery

Front 698

Dx, Dx study, Tx
Hx of prolapse, DOE, afib, orthopnea, high pitched holosystolic murmur that radiates to axilla and back

Back 698

Dx) Mitral regurg
Dx study) Echo
Tx) Valve surgery

Front 699

Mgmt
Progressive unstable angina

Back 699

Catherization to determine suitability for coronary revascularization

Front 700

Tx
Progressive angina, three vessel disease with good distals

Back 700

CABG

Front 701

Dx, Tx
DOE, hepatomegaly, ascites, square root sign and equal pressures throughout heart chambers during diastole

Back 701

Dx) Constrictive pericarditis
Tx) Surgery

Front 702

Mgmt
Coin lesion in lung in young man

Back 702

Serial xrays

Front 703

Mgmt
Coin lesion when over 50, previous xray normal

Back 703

1) Sputum cytology
2) Chest and upper abdomen CT
3) Biopsy mass
a) By bronchoscopy if central
b) Percutaneously if peripheral

Front 704

Mgmt
Coin lesion, good pulmonary function, no evidence of metastasis with normal cytology, bronchoscopy and biopsy

Back 704

1) Thoracotomy and wedge resection

Front 705

Tx
Squamous cell cancer of lung, not surgical candidate by FEV1

Back 705

Chemotherapy and radiation

Front 706

Tx
Squamous cell cancer of lung, central hilar mass, FEV1 2200

Back 706

Pneumonectomy

Front 707

Tx
Small cell carcinoma of lung

Back 707

Radiation and chemotherapy

(not surgical, so don't bother with nodes either)

Front 708

Dx, Dx study, Tx
Claudication of arm, transitory vertigo, blurred vision, speech dysarhria

Back 708

Subclavian steal sx
Dx Study) Angiogram
(shows retrograde flow in vertebral artery when exercising arm)
Tx) Surgical bypass

Front 709

Dx, Dx study, Tx
Pulsatile abdominal mass, asymptomatic

Back 709

Dx) AAA
Dx study) Ultrasound
Tx) Elective surgical repair

Front 710

Dx, Mgmt
Vague epigastric and upper back pain, abdominal pulsatile mass

Back 710

Dx) LEAKING AAA
Mgmt) Vascular consult stat

Front 711

Dx, Tx
Sudden excruciating back pain, diaphoretic, hypotension, abdominal pulsatile mass

Back 711

Dx) Ruptured AAA
Tx) Immediate surgery

Front 712

Mgmt
Claudication, otherwise healthy

Back 712

Nothing (vascular disease has unpredictable course)
Not even studies!

Front 713

Mgmt
Claudicant that has trouble doing his job

Back 713

1) Doppler studies
2) If significant gradient on 1) do arteriogram
3) THEN bypass or stenting

Front 714

Mgmt
Claudicant, rest pain, hairless

Back 714

Doppler studies and arteriogram 1st

Front 715

Dx, Dx study, Tx (2)
Sudden pale, cold, pulseless leg, grossly irregular pulse at radius

Back 715

Dx) Embolization to leg
Dx study) Doppler
Tx)
1) If complete --> Fogarty embolectomy +/- fasciotomy if several hours later
2) If incomplete --> TPA

Front 716

Dx, Dx study, Tx (2)
Sudden tearing chest pain that radiates to back, bp 220/110, unequal pulses in extremities, widened mediastinum

Back 716

Dx) Dissecting aneurysm of thoracic aorta
Dx study) Spiral CT
Tx)
1. If ascending aorta --> Emergency surgery
2. If descening aorta --> Medical management in ICU

Front 717

Dx, Dx study, Tx
Indolent, raised waxy skin mass, growing over 3 years, without enlarged lymph nodes

Back 717

Dx) Basal cell carcinoma
Dx study) Full thickness biopsy
Tx) Surgical excision

Front 718

Dx, Dx study, Tx
Non-healing, indolent punched out ulcer on skin, without enlarged lymph nodes

Back 718

Dx) Basal cell carcinoma
Dx study) Full thickness biopsy
Tx) Surgical excision

Front 719

Dx, Dx study, Tx
1.5 cm ulcer on lower lip for 8 months

Back 719

Dx) SCC
Dx study) Biospy
Tx) Surgical resection with 1cm margins
or
Radiation therapy

Front 720

Dx, Dx study, Tx
Assymetrical pigmented lesion, 1.8 cm, irregular

Back 720

Dx) Melanoma
Dx study) Full thickness biopsy
Tx)
1. Superficial melanoma (under 1mm) --> Margin free local excision
2. Deep melanoma --> Wide 2-3 cm local excision

Front 721

Dx, Dx study, Tx
Mole has changed recently

Back 721

Treat as melanoma
Dx) Melanoma
Dx study) Full thickness biopsy
Tx)
1. Superficial melanoma (under 1mm) --> Margin free local excision
2. Deep melanoma --> Wide 2-3 cm local excision

Front 722

Dx, Tx
Multiple liver mets, no primary tumor, toe or eye missing for melanoma

Back 722

Dx) Malignant melanoma
Tx) Surgical resection

Front 723

Tx
1) Childhood strabismus
2) Childhood cataracts

Back 723

Surgical correction to prevent ambylopia for both

Front 724

Dx, Tx (3)
Severe frontal headache, pupils fixed in mid-dilation, halos around lights

Back 724

Dx) Acute angle closure glaucoma
Tx) Diamox, pilocarpine or mannitol

Front 725

Dx, Dx study, Tx
Swollen red hot tender eyelids of 1 eye, fever, whites, pupil is fixed and dilated with limited EOM

Back 725

Dx) Orbital cellulitis
Dx study) CT scan
Tx) Surgical drainage

Front 726

Dx, Tx
Flashes of light at night when eyes closed, floaters during day, cloud at top of visual field

Back 726

Dx) Retinal detachment (1-2 floaters normal)
Tx) Emergent spot weld of retina

Front 727

Dx, Tx
Sudden loss of vision in 1 eye, no other problems

Back 727

Dx) Embolic occlusion of retinal artery
Tx) Press one eye and breathe into bag on way to OR

Front 728

Dx
After heavy dinners blurry vision

Back 728

Dx) The sugar

Front 729

Dx, Tx
Midline maass in neck at hyoid bone, seems connected to tongue, there for years but now infected

Back 729

Dx) Thyroglossal duct cyst
Tx) Surgery to remove mass and tract

Front 730

Dx, Tx
Fluctuant round mass on side of neck near sternocleidomastoid, cystic on CT

Back 730

Dx) Brachial cleft cyst
Tx) Surgical removal

Front 731

Dx, Dx study, Tx
Child with mushy fluid filled mass at base of neck of many years, supraclavicular and goes deep into chest

Back 731

Cystic hygroma
Dx study) CT to determine deepness
Tx) Surgical removal

Front 732

Mgmt
Enlarged lymph node in neck, jugular chain, 1.5 cm, tender, noticed yesterday

Back 732

Return in 3 weeks

Front 733

Mgmt
Enlarged lymph node, jugular chain, 2 cm, firm, not tender, 6 week hx, low grade fever and night sweats, enlarged lymph nodes in axilla as well

Back 733

Dx) Lymphoma
Dx study) FNA of available nodes

Front 734

Dx, Dx study
Elderly, hard 4 cm mass in supraclavicular are, movable, not tender, 3 month hx, weight loss,

Back 734

Dx) Malignant met to supraclavicular node from tumor below the neck
Dx study) Look for primary tumor which, both need biopsy

Front 735

Dx, Dx study, Tx
Smoker and drinker, rotten teeth, 4 cm mass in neck, 6 month hx, growing

Back 735

Dx) Metastatic SCC to jugular chain node, primary in mucosa of mouth or larynx
Dx study) Panendoscopy (i.e. mouth, pharynx, larynx, esophagus, trachea, bronch) NEVER BIOPSY
Tx) Surgery, chemo, and radiation

Front 736

Dx
HIV, hoarseness OR painless ulcer in mouth OR unilateral unremitting ear ache

Back 736

SCC of ENT mucosa

Front 737

Dx, Dx study
Unilateral sensory hearing loss

Back 737

Dx) Acoustic neuroma
Dx study) MRI

Front 738

Dx, Dx study
Gradual, unilateral nerve paralysis of facial nerve

Back 738

Dx) Neoplasm
Dx study) MRI

Front 739

Dx, Dx study
Firm mass in front of one ear, 4 month hx, deep to skin, painless, normal nerve functioning

Back 739

Dx) Pleomorphic adenoma (mixed tumor) of parotid gland
Dx study) FNA in OR (not in office!)

Front 740

Dx
Deep rock hard mass in cheek, painful, gradual loss of facial nerve

Back 740

Parotid cancer

Front 741

Dx
Unilateral earache, foul smelling rhinorrhea

Back 741

Foreign body

Front 742

Dx, Tx
Recent tooth extraction, now red hot tender fluctuant mass on lower side of face, mass pushes up on floor of mouth, febrile

Back 742

Dx) Ludwig's angina
Tx) Incision and drainage and maintain airway

Front 743

Dx, Tx
Sudden facial paralysis

Back 743

Dx) Bell's palsy
Tx) Antivirals +/- steroids

Front 744

Mgmt
Loss of facial nerve functioning after trauma but not immediately

Back 744

Nothing
it's from edema which will resolve

Front 745

Dx, Dx study, Tx (2)
Chronic sinusitis, now with double vision

Back 745

Dx) Cavernous sinus thrombosis
Dx study) Head CT
Tx) Abx, I&D

Front 746

Tx
Nosepicker has nosebleed

Back 746

Tx) Phenylephrine and pressure

Front 747

Dx, Tx
Adolescent with posterior nosebleed

Back 747

Dx) Nasopharyngeal angiofibroma
Tx) Surgery

Front 748

Tx
Nosebleed, bp 220/115

Back 748

1) Posterior packing +/- ligation
2) BP control

Front 749

Dx
Transient hand weakness, blurred vision, and confusion frequently. no HA, resolve spontaneously

Back 749

Dx) Carotid stenosis
Dx study) Duplex --> Arteriogram if no stenosis looking for plaque
Tx) CAE if over 50-70% stenosis if symptomatic

Front 750

Dx study
Frequent transient vertigo, diplopia, blurred vision, no HA, and resolve spontaneously

Back 750

Duplex scanning --> aortic arch study if not found
for
Transient ischemic attacks to brain involving vertebral artery

Front 751

Dx, Dx study
Very severe HA of sudden onset then lapses into coma

Back 751

Hemorrhagic stroke
Dx study) Head Ct

Front 752

Dx, Dx study, Tx
Sever HA, resolved, again now with nucchal rigidity

Back 752

Dx) Subarchnoid hemorrhage
Dx study) Head CT --> Angiogram for clipping

Front 753

Dx, Dx study, Tx
Persistent HAs, worse in mornings, projectile vomiting now, blurry vision

Back 753

Dx) Brain tumor
Dx study) MRI
Tx) Lower ICP until surgery

Front 754

Dx,
Months of HAs, vomiting, blurry vision, papilledema, bp now 190/110 and bradycardia

Back 754

Dx) Brain tumor with neurologic sequelae and cushing's triad

Front 755

Dx
Explosive HA over one eye, optic nerve atrophy, papilledema, anosomia

Back 755

Frontal lobe tumor

Front 756

Dx
Short boy with bitemporal hemianopsia, calcified lesion in sella

Back 756

Craniopharyngioma

Front 757

Dx, Dx study (3+1), Tx (2)
Amenorrhea and galactorrhea, no sex

Back 757

Dx) Prolactinoma
Dx study)
1. Beta, TSH, and Prolactin
2. Brain MRI
Tx) Bromocriptine --> Surgery if fails or if desire pregnancy

Front 758

Dx, Dx study, Tx
Huge face and hands, HAs

Back 758

Dx) Acromegaly
Dx study) Somatomedin levels, brain MRI
Tx) Surgery or radiation

Front 759

Dx, Dx study, Tx
Beautiful girls turns fat, pimply, with humps

Back 759

Dx) Cushing's
Dx study) Dexamethasone protocol
Tx) If pituitary --> surgery

Front 760

Dx
Tanned, bitemporal hemianopsia

Back 760

Dx) Nelson sx (microadenoma)
Dx study) MRI
Tx) Transsphenoidal surgery

Front 761

Dx, Dx study, Tx
Amenorrhea, and severe HAs, now with excruciating HA, stupor, and hypotenstion

Back 761

Dx) Pituitary apoplexy
Tx) Steroid replacement urgently
Dx study) MRI to determine damage

Front 762

Dx, Dx study, Tx
Severe generalized HAs, worse in mornings, projectile, vomiting, lost upper gaze, sunset eyes

Back 762

Dx) Tumor of pineal gland (Parinaud sx)
Dx study) MRI
Tx) Surgery

Front 763

Dx, Dx study, Tx
Child with severe morning HAs, knee chest position, truncal ataxia

Back 763

Dx) Tumor of posterior fossa (most peds subtentorial)
Dx study) MRI
Tx) Surgery

Front 764

Dx, Dx study, Tx
Severe HAs, seizures, projectile vomiting, low grade fever, recent otitis media and mastoiditis

Back 764

Dx) Brain abscess
Dx study) CT
Tx) Resect abscess

Front 765

Dx, Dx study, Tx
Severe back pain for 2 weeks, then acutely falls, paralyzed below waist, hx of breast cancer

Back 765

Dx) Breast met to spine bone
Dx study) MRI for spine
Tx) Surgery is compressed, nothing if resected

Front 766

Dx, Dx study, Tx (2)
Months of back pain, sudden onset severe pain with heavy lifting, electric shock down leg, straight leg positive

Back 766

Dx) Disc herniation
Dx study) MRI
Tx)
1. Bed rest
2. Surgery if sphincter loss or progressive weakness

Front 767

Dx, Dx study, Tx
Leg pain with walking, relieved by rest and bending, no pain with exercise if hunched over, normal pulses

Back 767

Dx) Neurogenic claudication
Dx study) MRI
Tx) Surgical decompression of cauda equina

Front 768

Dx, Tx
Paraplegic develops sudden pounding HA, perspiration, and bradycardia, massively HTN

Back 768

Dx) Autonomic dysreflexia
Tx) Alpha adrenergic blockers +/- CCBs

Front 769

Dx, Dx study, Tx
Severe sharp lightning pain in face from palpation

Back 769

Dx) Tic douloureux (trigeminal neuralgia)
Dx study) MRI for rule out
Tx) Anticonvulsants

Front 770

Dx, Dx study, Tx
After crushing injury, constant pain, cold cyanotic and moist

Back 770

Dx) Causalgia (reflex sympathetic dystrophy)
Dx study) Sympathetic block
Tx) Surgical sympathectomy

Front 771

Dx, Mgmt
Adolescent with sever testicular pain, high riding, horizontal lie, non-tender cord, no fever pyuria or mumps,

Back 771

Dx) Testicular torsion
Tx) Emergency surgery (NO Dx testing)

Front 772

Dx, Dx study, Tx
24 yo with testicular pain, fever, pyuria, swollen, cord very tender

Back 772

Dx) Acute epididymitis
Dx study) Ultrasound to rule out torsion
Tx) Abx

Front 773

Dx, Tx (2)
Ureteral stones, fever, flank pain

Back 773

Dx) Obstruction and infection of urinary tract
Tx)
1. Abx
2. Ureteral stent or percutaneous nephrosotomy

Front 774

Dx, Dx study, Tx
Woman with frequent painful urination of bad smell, fever, n/v, flank pain

Back 774

Dx) Pyelonephritis
Dx study) US
Tx) IV abx bc FLANK PAIN
o/w just regular abx in woman

Front 775

Dx, Tx
Chills, fever, dysuria, frequency, low back pain, exquisitely tender prostate

Back 775

Dx) Acute bacterial prostatitis
Tx) Iv Abx (NO Dx studies)

Front 776

Dx study
Urgency, frequency, dysuria that is cloudy, mild fever, prostate is not warm, boggy or tender

Back 776

Dx study) IVP
for
Something that aint prostatitis

Front 777

Dx, Dx study, Tx
Neonate who hasn't peed

Back 777

Dx) Posterior urethral valves
Dx study) Voiding cystourethrogram
Tx) Surgery

Front 778

Dx, Tx
Urethra on underside of penis

Back 778

Dx) Hypospadias
Tx) Foreskin reconstruction

Front 779

Dx, Mgmt
Minor trauma in child, microhematuria

Back 779

Dx) Congential urologic problem
Dx study) US first

Front 780

Dx, Dx study, Tx
Boy with dysuria, frequency, low abdominal and perineal pain, flank pain, fever, chills

Back 780

Dx) UTI in male
Dx study) IVP and cystogram
Tx) Abx now and possibly prophylactically

Front 781

Dx, Dx study (2), Tx
Girl with incessant wetting herself

Back 781

Dx) Low implantation of ureter (below sphincter)
Dx study)
1st) PE (if can see then go to surgery)
2nd) if not, IVP
Tx) Surgery

Front 782

Dx
Colicky flank pain after adolescent drinks beer

Back 782

Dx) Ureteropelvic junction obstruction
Dx study) Ultrasound
Tx) Surgery

Front 783

Dx, Dx study, Tx
Ten days after liver transplant, gamma glutamyltransferase and alk phos and bili go up, no biliary obstruction or thrombosis on US

Back 783

Dx) Acute rejection
Dx study) Biopsy
Tx) Steroid boluses

Front 784

Dx, Mgmt
Years after transplant organ function loss

Back 784

Chronic rejection
Mgmt) Biopsy to rule out late acute rejection (no cure)

Front 785

Dx
Within minutes of transplant thrombosis

Back 785

Hyperacute rejection
(now prevented with cross matching blood)

Front 786

Dx, Dx study
Bubbles of air when man urinates

Back 786

Dx) Bladder bowel fistula from diverticulitis
Dx study) CT scan

Front 787

Dx, Tx
1) Sudden onset impotence after trauma of perineum
2) Sudden onset impotence after surgery to rectum

Back 787

1) Vascular injury --> Vascular reconstruction
2) Nerve injury --> Prosthetic device

Front 788

Dx, Tx
Atherosclerosis, gradual impotence, no nocturnal erection

Back 788

Dx) Organic impotence
Tx) Viagra

Front 789

Mgmt
Ureteral colic, mild pain, mild n/v, small stone near bladder

Back 789

Analgesia and fluids
(bc stone is small and close to passing)

Front 790

Mgmt
7 mm stone in ureteropelvic junction

Back 790

Lithotripsy

Front 791

Dx, Tx
Cannot void for 12 hrs, distended bladder, enlarged prostate

Back 791

Dx) Acute urinary retention
Tx)
1. Foley for 3 days
2. 5-alpha reductase inhibitors

Front 792

Dx, Tx
Fed dribbles of urine frequently, distended bladder

Back 792

Dx) Urinary overflow incontinence
Tx) Foley

Front 793

Tx
Stress incontinence

Back 793

Surgical repair of pelvic floor

Front 794

Dx study
Painless gross hematuria that is total

Back 794

Dx study) IVP
for
Cancer of kidneys or bladder

Front 795

Dx study
Hematuria, flank pain, flank mass that is solid not cystic, hypercalcemia

Back 795

IVP or CT
for
Renal cancer

Front 796

Dx, Dx study, Tx
Rock hard nodule in prostate, increased PSA

Back 796

Dx) Prostate cancer
Dx study) Transrectal biopsy
Tx) Surgery

Front 797

Tx
Sever diffuse bone after prostate cancer

Back 797

Orchiectomy or flutamide or luteinizing hormone agonists
for
palliation of mets from prostate cancer

Front 798

When to stop treating asymptomatic prostate cancer

Back 798

After 75

Front 799

Tx
Painless hard testicular mass, in testicle not epididymis by US

Back 799

Orchiectomy
(DO NOT do biopsy)

Front 800

Tx
Low PaO2 on vent

Back 800

1) Increase FIO2
2) Increase recruitment

Front 801

Tx
To adjust PCO2

Back 801

Tidal volume better than respiratory rate
(bc bigger change outside deadspace)

Front 802

Non gap acidoses
(3)

Back 802

1) Diarrhea
2) Diuretics
3) Rental tubular acidoses

Front 803

Ddx
Alkalemia with Cl under 20
(3)

Back 803

1) vomiting or Nasogastric suction
2) Antacids
3) Diuretics

Front 804

Ddx
Alkalemia, Cl over 20

Back 804

1) Conn's
2) Barter's
3) Gittleman's

Front 805

Ddx
Hypervolemic, hypernatremia
(3)

Back 805

1) CHF
2) Nephrotic
3) Chirrosis

Front 806

Ddx
Hypovolemic hyponatremia
(2)

Back 806

1) Diuretics
2) Vomiting

Front 807

Ddx
Euvolemic, hyponatremia

Back 807

1) SIADH
2) Addison's
3) Hypothyroid

Front 808

Complication of water resuscitation to hypernatremia

Back 808

Cerebral edema

Front 809

Dx
Chovostek or trossueau, prolonged QT

Back 809

Hypocalcemia

Front 810

Dx, Dx study
Bones, stones, groans, psycho, shortened QT

Back 810

Hypercalcemia
Dx study) EKG

Front 811

Dx
Paralysis, ileus, ST depression, U waves

Back 811

Hypokalemia

Front 812

Dx, Tx
Peaked T waves, prolonged PR and QRS, sine waves

Back 812

Hyperkalemia
Tx)
1. Ca glucconate
2. Insulin glucose
3. Kayexalate
4. Albuterol and bicarb
5. Dialysis

Front 813

Dx
Confusion, headache, cherry red skin

Back 813

CO poisoning

Front 814

Dx
Hypercoagulable
1) old person
2) Edema, HTN, foamy pee
3) Young person
4) ATIII def
5) Low platelets

Back 814

Old) Cancer
Foamy pee) Nephrotic sx
Young) Factor V Leiden
ATIII def) Heparin useless
Low platelets) HITT --> Ergatroban

Front 815

Bleeding
1) Isolated decrease in platelets
2) Normal platelets, bleeding time and PTT high
3) Low plts, hi PT PTT BT low fibriongen, high Ddimer, schistocytes

Back 815

1) Idiopathic thrombocytopenic purpura
2) von willebrand
3) DIC

Front 816

Abx for Burns

Back 816

1) TOPICAL not IV or PO

Front 817

Dx
Burn, leukopenia caused by drug which doesn't cross eschar

Back 817

Silver sulfadiazine

Front 818

Tx
Penetrates eschars, but is painful

Back 818

Mafenide

Front 819

Dx
Doesn't penetrate eschar, causes hypokalemia and hyponatremia

Back 819

Silver nitrate

Front 820

1st step
Eletrical brun

Back 820

EKG for arrythmia
if abnormal --> Tele

Front 821

Tx
Neck trauma, subq emphysema

Back 821

Intubate with bronch

Front 822

Tx
s/p intubation no breath sounds on left

Back 822

Pull ETT tube back from R mainstem bronchus

Front 823

Tx
Flail chest

Back 823

Local nerve block

Front 824

Mgmt
GSW to abdomen

Back 824

Ex lap with tetanus

Front 825

Mgmt
Penetrating abdominal trauma but stable

Back 825

FAST
If positive --> OR
If negative --> DPL
If positive --> Or
If negative --> medical mgmt

Front 826

Mgmt
Stable blunt abdominal trauma

Back 826

Abdominal CT

Front 827

Dx
Handlebar bruising and pain, trauma

Back 827

Pancreatic rupture

Front 828

Dx, Dx study
Blunt abdominal trauma, retroperitoneal fluid

Back 828

CT abdomen
Dx = duodenal rupture

Front 829

Mgmt
Pelvic trauma, shock

Back 829

FAST and DPL (not ex lap bc can't do repair anyway)

Front 830

Dx study
Pelvic trauma, blood at meatus

Back 830

1st Retrograde urethrogram
if negative --> Retrograde cystogram

Front 831

Tx
Bladder bleeding into itself
Bladder bleeding into peritoneum

Back 831

Intra = Foley and rest
Peritoneal = surgery

Front 832

Ortho tickets to the OR
(5)

Back 832

1) Depressed skull fx
2) Displaced fx
3) Angulated fx
4) Any open fx
5) Femoral neck or intratrochanteric fx

Front 833

Dx
Punched a wall

Back 833

Metacarpal fx, may need wire

Front 834

Nec fasc bugs

Back 834

Strep or clostridium

Front 835

Etio Malignant hyperthermia

Back 835

Defect in ryandodine receptor

Front 836

Dx, Tx
Pain at incision site, edema, induration, no drainage

Back 836

Cellulitis
Abx

Front 837

Dx, Tx
Pain at incision site, edema, induration, drainage

Back 837

Wound infection
Tx) Open and repack (NO Abx)

Front 838

Dx, Tx (2)
Salmon colored fluid from wound

Back 838

Dehiscence
Tx)
Surgery
IV abx

Front 839

Dx, Tx
Unexplained fever post op

Back 839

Abdominal abscess
Tx) Drainage

Front 840

Dx, Tx
S/p gyn surgery, fever no cause

Back 840

Thrombophlebitis
Tx) Heparin + Abx

Front 841

Dx study
for Pressure ulcer

Back 841

DO NOT Cx!
CBC and Bcx to check for spreading infection

Front 842

Ddx
Transudative pleural effusion
(3)

Back 842

CHF
Nephrosis
Cirrhosis

Front 843

Dx
Transudative pleural effusion, low gluocse

Back 843

Rheumatoid arthritis

Front 844

Dx
Transudative pleural effusion, high lymphs

Back 844

TB

Front 845

Dx
Transudative pleural effuison, bloody

Back 845

Cancer

Front 846

Light's criteria for TRANSUDATIVE
(2)

Back 846

1) LDH <200
2) Protein effusion/serum <0.5

Front 847

Indications to treat pneumo (3)
How?

Back 847

1) Recurrent
2) Bilateral
3) Incomplete lung expasion

Tx) VATS with talc plexy

Front 848

Dx, Tx (2)
Lung air fluid level

Back 848

Lung abscess
Tx) Abx
If abx fail or if empyema --> Drain

Front 849

Dx, Mgmt
Lung nodule, concentric calcification

Back 849

Old granuloma (benign)
Mgmt) Q2 month CXR

Front 850

Dx
Lung cancer non smoker, mets in adrenals, high hyalaruinase in pleural fluid

Back 850

Adenocarcinoma
Mets to adrenals

Front 851

Dx
Lung cancer, kidney stones, constipation, low PTH

Back 851

SCC of lung
Paraneoplastic making parathyroid hormone causing hypercalcemia

Front 852

Dx
Pancoast tumor

Back 852

Small cell lung cancer

Front 853

Dx
Ptosis improves with upward gaze

Back 853

Small cell lung cancer with lambert eaton sx

Front 854

Dx
Smoker with hyponatremic edema

Back 854

Small cell cancer with SIADH paraneoplasm

Front 855

Dx
CXR shows peripheral cavitation with distant mets

Back 855

Large cell lung cancer

Front 856

Ddx
ARDS
(5)

Dx criteria (3)

Tx

Back 856

1) Sepsis
2) Aspiration
3) Trauma
4) Low perfusion
5) Pancreatitis

Dx criteria
1) Pa)2/FiO2 < 200
2) Bilateral inflitrates
3) PCWP < 18

Tx = Low pressure PEEP

Front 857

Dx
SEM cres/decrs, louder with squatting, softer with valsalva

Back 857

Aortic stenosis

Front 858

Dx
SEM louder with valsalva

Back 858

HOCM

Front 859

Dx
Late SEM with click, louder with valsalva

Back 859

Mitral valve prolapse

Front 860

Dx
Holosystolic murmur radiates to axilla

Back 860

Mitral regurg

Front 861

Dx
Holosystolic murmur with late diastolic rumble

Back 861

VSD

Front 862

Dx
Continuous machine like murmur

Back 862

PDA

Front 863

Dx
Wide fixed splite S2

Back 863

ASD

Front 864

Dx
Rumbling diastolic murmur with opening snap, LAE and Afib

Back 864

Mitral stenosis

Front 865

Dx
Blowing diastolic murmur with widened pulse pressure

Back 865

Aortic regurg

Front 866

Dx,Tx
Bad breath and food stuck in throat

Back 866

Zenker's diverticulum
Tx) Surgery

Front 867

Dx, Tx
Dysphagia to liquids and solids, swallow study shows bird beak

Back 867

Achalasia
Tx = CCBs

Front 868

Dx, Tx
Dysphagia of hot and cold liquids, diffuse indentations on swallow study

Back 868

Diffuse esophageal spasm
Tx = CCBs

Front 869

Dx study
GERD

Back 869

24 pH monitoring
Endoscopy if danger signs

Front 870

GERD Tx
(4+4)

Back 870

1) Behavior
2) Antacids
3) H2 blockers
4) PPI

Surgery if
1) Stricture
2) Barretts
3) Incompetent sphincter
4) Refractory to meds

Front 871

Dx, dx study, tx
Hematemesis with cirrhosis
(4+1)

Back 871

Dx) gastric varices
Tx immediate)
1. ABCs
2. NG lavage
3. Octreotide
4. Balloon tamponade if unstable to transport

Definitive tx
1. Endoscopic sclerotherpay or banding

DO NOT prophylactically surgery, just Beta block

Front 872

Dx study
Esophageal cancer

Back 872

1st barium swallow
2nd endoscopy
3rd staging CT

Front 873

Tx
Sliding hiatal hernia, GERD

Back 873

Treat sx

Front 874

Tx
GERD, type hiatal hernia = paraesophageal

Back 874

Surgery

Front 875

Indications for Gastric ulcer sx

Back 875

No improvement in 12 weeks of medical tx

Front 876

Dx
Gastric cancer, look for?
(5)

Back 876

1. Ovarian cancer (krukenberg)
2. Mets on DRE (blummer's)
3. L supraclavicular fossa (virchow's)
4. Lymphoma (HIV)
5. MALt lymphoma

Front 877

Dx
Foamy pee, protein in urine, enlarged ruggae

Back 877

Mentrier's

Front 878

Dx study, Tx
Ulcer improves with eating

Back 878

Duondeal ulcer
study) fecal occult blood test
Tx) PPI, Abx x2

Front 879

Dx, Dx study, etc, Tx
Ulcer refractory to therapy

Back 879

ZES
Dx study) Secretin test challenge (gastrin will stay high in ZES)
Etc) MEN I (Pituitary and parathyroid screening as well)
Tx) Surgery of tumor

Front 880

Dx, Tx
Bilious vomiting and post prandial pain, recent intential weight loss

Back 880

SMA syndromem (duodenum compressed by SMA)
Tx) Restore weight or roux-en-y

Front 881

Dx study
MEG pain radiating to back

Back 881

Dx ) Pancreatitis
Dx study) CT

Front 882

Pancreatitis complications
(4)

Back 882

1) Pseudocyst
2) Hemorrhage
3) Abscess
4) ARDS (from third spacing)

Front 883

Chronic pancreatitis complication

Back 883

Splenic vein thrombosis --> Gastric varices

Front 884

Dx
Large, nontender GB, itching and juandice

Back 884

Courvoiseir's sign = adenocarcinoma of pancreas (ie. cancer) in head of pancreas

Front 885

Dx
MEG and bad absorption in intestine

Back 885

chronic pancreatitis

Front 886

Dx
Troussau's sign i.e. migratory thrombophlebitis in different vessels

Back 886

pancreatic cancer

Front 887

Dx study
Pancreatic cancer

Back 887

Endoscopic ultrasounds + FNA

Front 888

When is pancreatic cancer a surgical candidate?
(2)

Back 888

1) No mets
2) No extension in blood vessels

Front 889

Dx
Sweats, shaking, hunger, low BG, high insulin, high c-peptde

Back 889

1) Insulinoma

Front 890

Dx
Necrolytic migratory erythema, hyperglycemia, diarrhea, weight loss

Back 890

Glucagonoma

Front 891

Dx
Malabsorption, steatorrhea

Back 891

Stomatastatinoma or chronic pancreatitis

Front 892

Dx, Tx
Watery diarrhea, hypokalemia, dehydration, flushign

Back 892

VIPoma
Tx) Octreotide

Front 893

Dx
RUQ pain, fever, after fatty food

Back 893

Dx) Acute cholecystitis

Front 894

Dx, Tx
RUQ pain, high bili and alk phos

Back 894

Common bile duct stone
Tx) Cholycystectomy +/-ERCP to remove stone

Front 895

Dx, Tx
RUQ pain, fever, jaundice, hypotension, altered mental status

Back 895

Ascending cholangitis
Tx) Abx, ERCP to remove stone

Front 896

Tx
Type I choledochal cyst, dilation of CBD from fusiform cyst

Back 896

Removal of cyst

Front 897

Tx
Type IV choledochal cyst, cysts in intrahepatic ducts

Back 897

Liver transplant

Front 898

Tx
Cholangiocarcinoma

Back 898

Surgery +/- radiation

Front 899

Dx
AST = 2x ALT

Back 899

Alcoholic hepatitis

Front 900

Dx
AST and ALT high but ALT more so

Back 900

Hepatitis

Front 901

Dx
AST and ALT high s/pt shock

Back 901

Shock liver

Front 902

Tx
Portal HTN

Back 902

Beta blocker

Front 903

Tumor marker for
hepatocellular carcinoma

Tx)

Back 903

AFP

Tx) Can surgery 1 mass, radation for multiple

Front 904

Dx, Dx study, Tx
OCP liver bleeding

Back 904

Dx) Hepatic adenoma
Dx study) US or MRI
Tx) Stop OCPs, resect if large

Front 905

Dx
Benign liver tumor, didn't rupture

Back 905

Focal Nodular hyperplasia

Front 906

Dx
RUQ pain, palpable liver, profuse sweating and rigors

Back 906

Amoebic abscess
Tx) Flagyl

Front 907

Tx
Liver bacterial abscess

Back 907

Drainage and IV ABx

Front 908

Dx, Dx study, Tx
Mexico, RUQ and large liver cysts, eosinophilia

Back 908

Dx) Enchinococcus (from dog feces)
Dx study) Casoni skin test
Tx) Albendazole and remove cyst with surgery

Front 909

Tx
High plts after splenectomy

Back 909

ASA

Front 910

Vaccines s/p splenectomy
(3)

Back 910

1) Pneumo
2) H flu
3) Nisseriae meningitis
4) prophylactic PCN

Front 911

Dx, Tx (2)
Isolated thrombocytopenia, megakaryocytes in marrow, no splenomegaly

Back 911

Dx) Idiopathic thrombocytopenia
Tx) Steroids
If refractory --> splenectomy

Front 912

Dx, Tx
Hemolytic anemia, spherocytes on smear

Back 912

Dx) Hereditary sphercocytosis
Tx) Splenectomy

Front 913

Dx
Left lower rib fracture and intra abdominal hemorrhage

Back 913

Splenic rupture

Front 914

Indications for appendectomy

Back 914

Any clinical suspicion of appendicitis

Front 915

Tx
Burst appendix

Back 915

1) Drain
2) Abx
3) Appendectomy after stabilization

Front 916

Dx
Flushing, diarrhea, wheezing
What to look for?
Tx?

Back 916

Carcinoid syndrome
(usually tumor in appendix releasing serotonin)

Look for = diarrhea, dementia, dermatitis bc of niacin deficiency

Tx) If big at base of appendix or with nodes --> hemicolectomy
IF not--> appendectomy

Front 917

Surgical indications for
SBO

Back 917

1) peritoneal signs
2) increased whites
3) no improvement in 48 hrs

Front 918

Tx
Cecal or sigmoid volvulus

Back 918

If not strangulated --> decompression
If strangulated --> Surgery and colostomy

Front 919

Tx, Dx study
Ogilvie's = cecum massively dilated

Back 919

1) Decompress with NG
2) Neostigmine (can cause brady)
OR
3) Colonscopic decompression

Dx study) check for low K exacerbating it

Front 920

Inner tube or coffee bean sign =
Parrot's or bird's beak on colon =

Back 920

Inner tube or coffee bean sign = sigmoid volvulus
Parrot's or bird's beak on colon = cecal volvulus

Front 921

Dx, TX
Child, flank mass, hematuria, HTN

Back 921

Dx) Wilm's tumor
Tx) Surgical resection, check other kidney

Front 922

Dx, Dx study, Tx
Child, abdominal mass, fever, FTT, proptosis, ataxia, HTN

Back 922

Dx) Neuroblastoma
Dx study) Urine catecholamines
Tx) Chemo + Radiation

Front 923

Tx
Inguinal hernia in child

Back 923

Surgery as long as not premie

Front 924

Dx, Tx
Intermittent painless rectal bleeding, intestinal obsturction, child

Back 924

Meckel's
Tx) Diverticular resection and enterotomy

Front 925

Tx (2)
Child with midgut volvulus

Back 925

1) Surgery immediately
2) Appendectomy prophylactically

Front 926

Tx
Infant cannot swallow

Back 926

Tracehoesophageal malformation
Tx) Surgery after decompression of pouch

Front 927

Tx
Congenital lobar emphysema

Back 927

Resect affected lung lobe

Front 928

Dx, Tx
Child presenting with cystic infection in neck

Back 928

Dx) Thyroglosal duct cyst
Tx) Excision of cyst

Excise all pediatric neck cysts!

Front 929

Tetralology of Fallot

Back 929

1) VSD
2) Pulmonary stenosis
3) Overriding aorta
4) RVH

Front 930

Tx
Patent ductus arteriosus

Back 930

1) Indomethacin
2) If refractory to indomethacin --> surgery

Front 931

Tx
VSD

Back 931

1) Medically manage CHF
2) If can't --> surgery or if never closes after 2 years

Front 932

Tx
Eisenmenger sx

Back 932

Heart + Lung transplant

Front 933

Tx
ASD

Back 933

Treat if sx with patch

Front 934

Tx
Melanoma

Back 934

1) If less than 1 mm --> 1 cm margins
2) 1-4 mm --> Check nodes
If (-) --> 1 cm margins
If (+) --> Chemo + 1 cm margins + vaccine + interferon