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129 Cards in this Set
- Front
- Back
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Most burns and wounds heal by which intention?
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secondary intention
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What shoud you think of if you see fever after surgery and it's within the day?
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something within the surgical encounter--trauma of the surgery
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What shoud you think of if you see fever after surgery and it's 2 days after?
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think atelectasis
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What shoud you think of if you see fever after surgery more than 2 days?
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UTI or Pneumonia
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What shoud you think of if you see fever after surgery is more than 5 days
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Wound infection
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Post op pt. develops delirium and is disoriented and pulling the lines, what should you think?
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Restrain the pt. and may have to administer haloperidol
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When does wound dehisicice usually occur? What is a complication?
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about after 5 days
complication is incisional hernia |
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Which hernia has the highest risk of strangulation?
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Femoral
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Whcih is more common indirect or direct hernia?
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Indirect--Inguinal ring---young
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What are the places of indirect and direct, more in young or old, and which is most common?
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Indirect is in inguinal ring--more likely seen in young and most likely right sided. Increased risk of strangulation
Direct is Hasselbach's traingle, more likely seen in older men, and can be on either side...more acquired |
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Pt. had flex sig. and a polyp is seen, what is the next step in management?
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Do colonoscopy
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Pt. had FOBT that is positive, what is next step in management?
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Do colonoscopy
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If you find adenoma that is >1cm or high grade and villous what is the next step in management?
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Colonoscopy every 3 years
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If you find adenoma less than 1 cm or 1-2 polyps what is the next step in management?
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Colonoscopy every 5 years
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If you find h that is hyperplastic polyp 1cm what is the next step in management?
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normal f/u
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If you find malignant polyp that is completely removed with clear marginswhat is the next step in management?
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F/u in 3 months and then colonoscopy in 3 years
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If you find malignant polyp that is completely removed adn margins are not clear what is the next step in management?
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colectomy
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What is the most impt. modifieable risk factor of colon cancer?--red meat, alcohol, or smoking
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Red meat or High fat diet
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What is the most impt.
non-modifiable risk factor of colon cancer? |
Family hx
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Pt. is asking if they should go on aspirin for the prevention of colon ca.
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NO---shoudl not be used to prevent the risk, but if they are on it already...it does reduce the risk
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What labs will you order for f/u of Colon ca?
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Fobt, LFT, CEA every 3 mo. for 3-5 years
Colonoscopy q year for 3 years |
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What should you order if you are following colon ca. and see LFT and CEA increasing?
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Abd CT and CXR
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When do you start screening for endometrial Ca in a woman?
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If pt has HNPCC or PCOS
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How do you confirm HNPCC?
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genetic testing
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When do you start screening in HNPCC? What if pt. is 40 y.o?
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age 25 or 10 yrs. earlier from when you diagnosed family member every 2 years.
If 40 then screen every year |
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What do you think of whenyou see hyper-pigmented mucocutaneous macule on the lips and buccal mucosa with polyps?
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PeutzJagher sydrome
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What do you think of when you see stellate lesion on CT/MRI?
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Focal nodular hyperplasia
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What do you think of when you see cold defect on scinticgraphy and normal LFT?
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Liver cell adenoma
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When is orchidopexy done?
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12-18 months
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What is contraindicated in hypospadias?
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circumcision
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When can repair be done in hypospadias?
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6mo to 3 years
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What is the treatment for hydrocele for a pt.?
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surgery
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When can surgery be performed on an infant with hydrocele?
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1 year
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pt. comes for infertility work-up and found to have a bag of worms, and on ultrasound shows extrascrotal mass. Pt. will show low sperm count, low sperm motility, and low sperm concentration; what is the treatment?
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Varicocelectomy (ligation of varicocele)
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A young man had a testicular torsion on the rt. side, pt. went for surgery, do you do surgery on the right side, left, side or both side?
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Both sides---b/c the risk of having torsion on the other side is also increased
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What do you suspect if you see signs of torsion and you see a blue dot sign?
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Torsion of the appendix of the Testis
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What are the common causes of epidydimitis in young men?
Older men? |
Young--Chlamydia or Gono
Older--E.coli or Pseudomonas |
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Pt. developed Gono epididymitis, how do you diagnose?
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G-stain
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What is the next line in treatment of a Pt. developed Gono epididymitis? or who is chlamydia epididymitis?
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Treat with Ceftriaxone and tell partner.
Chlamydia Treat with Doxy and tell the partner |
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What do you think of with a male of 25 y/o with testicular swelling and painless nodule?
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testicular cancer
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Do you do biopsy in a testes?
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NO
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What is the treatment of testicular ca?
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surgery
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What is important to follow in non-seminoma?
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alpha feto prot. and Bhcg are elevated
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What is the treatment of non-seminoma?
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orchiectomy
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how do you f/u in testicular cancer?
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f/u in monthly for 2 years, and then every 2 months in the 3rd year
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What is the common cause of erectile dysfunction organic or psychogenic?
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Organic...more ppl have DM and obesity
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What is C/I to phosphodiesterase inhibitor?
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nitrates
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Pt. has taken a phosphodiesterase inhib and develops chest pain...when can you give nitrate?
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viagra and levitra after 24 hrs
use nitrates in cialis after 48 hrs |
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what do you suspect if a depressed pt. c/o of loss of sexual desire
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SSRI side effect
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What can be a treatment of premature ejaculation?
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SSRI
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Should you cath a pt. that was admitted for acute prostatitis?
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NO! do a percutaneous suprapubic cath
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What is the complication of doing a prostatic massage in acute prostatis
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bleeding
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What is the treatment for BPH with immediate relief?
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terazosin or doxazocin
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What is the treatment for BPH with high blood pressure?
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Terazosin or Doxazocin
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What is the treatment for BPH with orthostatic hypotension?
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Tamsulosin and Alfuzosin
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What is the treatment for BPH with intent of decreasing prostate size?
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5 alph-reductase inhib--Finasteride and Dutasteride
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What is the complication of TURP?
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hyponatremia, bleeding, retrograde ejaculaton, impotence
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What is a LHRH, give example?
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Leuprolide
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What is the most common used strategy for ablation of androgen?
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Orchiectomy---take out testes
LHRH agonist--Leuprolide |
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What should you do if you see prostate cancer and spinal compression?
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ureteral obstruction and DIC with use of Corticosteroid and then followed by ketoconazole
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what can cause malignant hyperthermia?
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succinyl choline and halothane
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What drug can treat malignant hyperthermia but not neuroleptic syndrom?
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Dantrolene
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What can cause dissociative amnesia? What does that mean?
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Ketamine;
they are awake, but they can't feel the pain |
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What is neroleptic malignant syndrome caused by?
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Neuroleptic---antipsychotic
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Some anesthetics which you can anesth. and prolong it?
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Sevoflurane, desflurane, isoflurane....and you can titrate it
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What should you think of when you see respiratory difficulty, hoarse voice, and low O2 with inspriatory stridor and intubation....what should you think of ? What can you give?
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Laryngospasm and laryngeal edema
treat with Nebulized racemic-epi |
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what is the common complication of spinal anestheisa? What is the treatment?
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HA
Blood Patch |
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What is a better monitor of hypotension in shock? What must you order?
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Urine output is a better indicator to monitor shock than blood pressure.
Order a FOLEY |
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What should you do if you see a man with abdominal gun shot who is conscious with low BP and increased pulse. Pt. is diaphoretic, cold, thristy, and anxious. No JVD, normal BS and no tracheal deviation...what are you thinking and what should you do?
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Hypovolemic shock
Give IV saline or Ringer's and do Surgical exploration |
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You have a pt. with a GSW, bleeding profusely from the groin, low BP, and a conscious pt. with visible loss?
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Apply direct local pressue adn control the bleeding.
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3 y/o hypovolemic shock and peripheral IV lines are unsuccessful, with life threatening hypovolemia and failure to have peripheral access in kids < 6yr. of age. What do you do?
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Intraosseous cannulation in the proximal tibia or distal femur
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Waht is the treatment of high ICP?
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head elevation
O2 MANNITOL |
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What will a CT scan show of a Subdural Hematoma?
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Concave
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What if you see white fluid on CT scan of head? (new or old blood)
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New blood
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What is the difference btwn subdural hematoma vs. epidural?
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Epi is convex adn limited by suture lines
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What if you see a pt. with confusion and amnesia with or without LOC, and amnesia involves the loss of memory surronding the traumatic event...what are you thinking?
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TBI
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What must you do with any pt. with a concussion?
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CT scan
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when can you return to play after a tbi and there is some confusion and no amnesia and no LOC?
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20 min
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when can you return to play after a tbi and there is some confusion with LOC?
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Go to ER and may need CT
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when can you return to play after a tbi and there is some confusion <15 min and no amnesia and LOC?
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RETURN 1 week after full recovery
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when can you return to play after a tbi and there is some confusionmore than 15 min and no amnesia and 1 min LOC?
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Return in 2 weeks
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when can you return to play after a tbi and there is some confusion more than 24 hoursnand no amnesia and 1 min LOC?
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return in ONE MONTH
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What is the treatment for an epidural hematoma?
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Prompt surgery
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Pt. has a knife embedded in the head, what should you do?
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REmove the object in the ER
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Blunt trauma to the head, profuse bleeding from the scalp, with low BP and neurologically intact, what should you do?
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Direct pressure to control bleeding
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Blunt traum of the head, communuted fx or depressed fx, scalp lac..what should you do?
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Go to OR
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Pt. after MVA with ecchymosis around the eyes or back fo the ear or clear fluid coming from the nose or ear and pt is unconscious...what should you do?
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Fracture base of the skull...must do a CT head
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A pt. is a baseball player was hit by a bat, had LOC for a brief period but gained consciousness adn started playing, few hours later he is found with LOC with a dilated and fixed pupil with hemiparesis...what do you do?
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Craniotomy for blood evac.
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75 y.o man fell from a horse, didn't lose consciousness, couple of weeks after the accident, pt. is confused and sleeping all day, not able to take care of self contrary to his personality...what shoudl you think of ? What should you do?
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SDH
Do a CT head and see a cresent shaped hematoma |
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What do you suspect if you see tracheal deviation away from the affected side, and resonance to percussio? How do you confirm the diagnosis? Waht must you do to treat? What must you do after treatment?
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tension PTX
Needle thoracostomy Place a chest tube with water sealed drain You must check chest tube insertion with a CXR after treatment. |
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A 27 y/o man with a GSW is in hypovolemic shock Neck vein distended without resp. prob and breath sounds are normal, what is the diagnosis? What is the treatment?
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Cardiac Tamponade
Pericardiocentesis ro Thoracotomy |
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What should you think of when you see falling arterial pressure and rising venous pressure with a small and quiet heart. You also see JVD and hyptotension, what are you thinking?
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Cardiac tamponade
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If you see JvD and hypotension and pulsu paradoxus what should you think of?
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Hemoparicardium
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what shoudl you do if you see Hemopericardium?
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Pericardiocentesis or Thoracotomy
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What are you thinking if you see hypotension, unilateral decreased breat sounds, and dullness on percussion with XRaY with white out. Now what shoud you do?
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Massive Hemothorax
You should put a tube thoracostomy |
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What do you think of when you see widening of the mediastinum?
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AO Rupture
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How can you confirm AO rupture in a stable pt.?
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CT or MRI
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How can you confirm AO rupture in a unstable pt?
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TEE
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What is the gold starndad to dx AO Rupture?
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Angiography
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A pt. has a fractured rib and oxygen sat is low and airway is clear, what should you do next?
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Manage breathing as you have managed his airway already...so give pain medication.
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What is the most likely cause of death in abdominal trauma?
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Hemorrhage or sepsis
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What is the goal of evaluating a blunt trauma?
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FAST--focused assessment with U/S
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What if you have an unstable pt. with a +FAST do?
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ex lap
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What if you have a stable Pt. with a +FAST what should you do?
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Peritoneal Lavage, CT scan and diagnostic Lap
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What should you think of when you see Left UQ pain and left shoulder pain?
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splenic injury
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If a pt. who has a splenic injury, how long should they wait till they go back to sports?
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3-6 weeks for contact sport
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What is the commonest organ that is injured in abdomen
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spleen
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What are the complications of an upper humerus fracture?
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Adhesive Capsulitis, avascular necrosis, axillary nerve injury
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When can you return to sports after a shaft of humerus fx?
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12 weeks
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What is the complication of supracondylar fracture?
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Volkmann's ischemic contracture
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What do you do if you have a fx. of the radius ((Galeazzi)?
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surgical fixation without any need of immobilization
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What is the likely cause of a Colle's fx?
What do you see on Xray? What do you do for a non-displaced frx? What about a displaced fx? |
falling on an outstretched hand.
NOn-displaced--cast immobilization Displaced--percut. pinning or open reduction |
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What is a complication of not splinting the scaphoid frx. in time?
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avascular necrosis
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What is the most sensitive test of compartment syndrome? What is a late sign?
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Limited PROM of the digits
Late= los of pulse |
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An old lady had a fall 3 days ago, and now with resp. difficulty and low Oxygen sat. and ecchymosis in neck and chest, what is most likely diagnosis?
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Fat embolism
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An old lady had a fall 3 days ago, and now with resp. difficulty and low Oxygen sat. and ecchymosis in neck and chest, what should you do?
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If resp. distress...intubate the pt.
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What should you do if you have a fx. of the shaft of the femur?
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skeletal traction ori IMNR
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What do you susupect when you have medial joint line tenderness, a locking sensation and when the pt. is lying supine with hip and knee joint fully flexed, with one hand on the affected knee, nad the other on the same foot and as the foot is externally rotated the examiner extends the patient's knee. The presence of the SNAP suggests?
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Medial meniscus injury
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Describe the McMurray's test
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lying supine with hip and knee joint fully flexed, with one hand on the affected knee, nad the other on the same foot and as the foot is externally rotated the examiner extends the patient's knee. The presence of the SNAP
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What test would you do if there was a sudden pivot in the knee while running, and there is a swollen knee with excessive pain? What are you looking for?
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Lachman's test
ACL injury |
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Describe the Lachman's test?
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knee place in 20 degree position and the examiner tries to push the tibia anteriorly, if there is anterior translation of the tibia and lack of a firm end point, it is an ACL tear
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If a pt c/o pain and tells you that the knee is unstable and may "give out" a positive sign on the drawer test...what tests should you do?
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Xray to r/o any fracture or bone tear
MRI to diagnose ligamental injury |
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Female pt. with pain in her knee area that says knee is giving way or buckling and pain is worse when squatting or prolonged sitting or going down the stairr...pt. is obese...what are you thinking?
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Patellofemoral pain syndrome (runner's knee)
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What is the treatment of Patellofemoral pain?
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rest, ice, quad strengthening, evaluation of footwear
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pain at tibial turburcle and pain going up and down the stairs, what should you think?
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Stress fracture
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What should you suggest with stress fracture?
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Rest and don't overdo it
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What should you think if you see a 14 y/o boy that is over wt. with groin pain and pain during movement. You find tenderness in groin or medial side of knee. what do you do if you see slipped capital femoral epiphysis and ice cram scoop falling off cone
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surgical managment and wt. loss
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What if you find a 9 y/o who presents with hip pain and a limp, with decreased ROM, what should you do?
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Long term limit of activites with fair/poor prognosis.
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What is the Parkland formula?
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4ml X % BSA X Body wt.---give 1/2 in first 8 hours and remaining in the next 16 hours
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