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349 Cards in this Set
- Front
- Back
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What is the pref. method of securing the AW?
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Orotracheal intubation
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What do you do if there is trauma to the cervical spine and you need to intubate?
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Do orotracheal intubation with manual cervical immob
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What should you do to do orotrach intub in a pt. with cervacal spine trauma?
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Flexible bronchoscope
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What if you have extensive facial trauma and bleeding into the airway and need an airway?
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Do a cricothyroidotomy-best ans
OR Percut Traceostomy |
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What should you do if you suspect blood in the airway?L
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Listen for gurgling sounds
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What do you order on CCS if you see pulse ox <90
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Increase oxygen and flow rate
ABG Determine cause of hypoxia |
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What are 3 reasons why a pt. my have circulatory disturbances?
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Hypovol Shock
Pericardial tamponade Tension PTX |
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What is the most common type of shock?
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Hypovoemic
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What are you thinking if you see a pale, cold, shivering pt. with sweating, hypotension, and tachy?
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Hypovol shock
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What is a common finding in Tension PTX and pericardial tamponade?
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Distended neck veins or a High Central venous pressure
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What will you find on CXR for pericardial tamponade?
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Enlarged heart on CXR
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What is the best treatment for pericardial tamponade?
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pericardiocentesis tap or window
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What will you see on EKG with pericardial tamponade?
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Electrical alterans (different QRS shapes)
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Waht will you find on PE?
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pulsus paradoxus ---decrease in BP by 10mmHg with inspiration
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What will you think of if you see tracheal deviation, respiratory distress, and absent breath sounds?
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Tension PTX
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What is the treatment for Tension PTX?
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Insert needle (thorocosmy) and then place a CHEST TUBE
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What should you do after you place a chest tube for PTX?
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check it with a cxr
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Are intracranial bleeds the cause of hypotensive shock?q
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NO
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What do you do if a 22 y/o male arrives in the ER with GSW in the abdomen and is sweating, pale, cold, shivering, anxious, and asks for a blanket, what is the next step in management?
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IVF
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What should you do if you see a visible site of bleeding and hypotension?
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Control the site of bleeding if it only one or 2 sites...if it is multiple...resuscitate
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What should you do when you have abdominal trauma and you see an visible site of bleeding?
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Direct local pressure
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What if you have a visible sight of bleeding and you control it, what should you do next?
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IVF
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What are the orders to put if you have to do an Ex LAP?
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IVF
Bloodtype and cross match PT/PTT Iv access npo IV antibiotics Foley |
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What is the first step in management for a pt. with a blunt trauma?
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Fluid resusitation
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Where can you give fluid resuscitation in a child <6y/o
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Interosseous cannulation in proximal tibia
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What do you think of if you see hypotension and tachy in a pt. that is WARM and FLUSHED (not pale and cold)?
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Vasomotor shock
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What are you thinking if you see hypotension after taking PCN?
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PCN allergy
VASOmotor shock |
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What are you thinking if pt. is warm and flushed with hypotension after spinal anesthesis?
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VASOmotor shock
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What are you thinking if you see warm and flushed with hypotension after a bee sting?
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VASOmotor shock
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What is the first step in management in vasomotor shock?
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Vasoconstrictors and fluids
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What would you do if you see a communited depressed skull fx after trauma?
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Surgery (craniotomy)
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What would you do if you see a communited depressed skull fx after trauma and pt. is asymptomatic?
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Surgery (craniotomy)
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What should yo give to a pt. with and open skull fx?
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Tetanus Toxiod and Prophy Abx
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What are you thinking if you see a pt. iwth bruising around both eyes?
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Basal skull fx
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What are you thinking if you see a pt. with bruising behind the ears?
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Basal skull fx
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What are you thinking if you see clear fluid dripping from teh ear or nose and has a head trauma/
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CSF leak and basal skull fx
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What radiograph will show a basal skull fx?
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CT head AND neck
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What should you do if you see CSF leak form ears or nose?
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nothing it will resolve on its own
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Are prophylactic ABx needed for CSF leaks?
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NO
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What might you see 2-3 days after a basal skull fx?
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Facial palsy
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What do you do if you see facila nerve palsy after 2-3 days from a basal skull Fx?
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give steroids
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Why do you see facial nerve palsy after a basal skull fx?
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neuropraxia
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What are you thinking if you see a head trauma with SUDDEN LOC and then a period where pt. wakes up immediately and appears normal (honeymoon) but then deteriorates?
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Epidural Hematoma
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What is the finding on CT with epidural hematomoas?
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lens shaped hematoma
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What is the mangement in epidural hematomas?
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Emerg Craniotomy
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What is the prognosis of epidural hematomas if the pt. is not treated
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POOR--fatal in hours
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What are you thinking if you see a pt. with trauma and weeks later complain of headache, personality changes, memory loss, confusion, dementia
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Subdural Hematoma
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What will you find on CT for a subdural hematoma?
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semilunar, crescent shaped
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What is the management of subdural hematomas?
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Conservative done with steroids
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When do you do a craniotomy in a subdural hematoma?
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if there are lateralizing signs and midline displacement
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What are you thinking if you see a deeply unconscious pt. that had an accel/decel injruy to the head?
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DAI
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What is the prognosis with DAI?
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POOR
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Can surgery help DAI?
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no
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What is the best therapy for DAI?
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prevent further injury from increased ICP
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What are you thinking if you see briefly depressed consciousness after a head traum, with some improvement and then progressively worsens and you see a dilation of one pupil and decreased responsiveness to light
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Increased ICP
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What should you do if you suspect Increased ICP?
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Get head CT
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What will you find on head CT with a pt. with increased ICP
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midline shift or dilated ventricles
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What are the orders for CCS for an ICP pt?
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Head elevation
Hypervent Avoid Fluid overload mannitol and furosemide sedation/and or hypthermia |
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Why woudl you order sedation and/or hypothermia for a ICP pt?
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llowers oxygen demand
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IN a ICP pt. what is the main goal...lowering pressure or maintaining brain perfusion?
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Maintaining brain perfusion
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What are the four main causes of an acute abdomen?
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Perforation
Obstruction Inflam/Infx Ischemia |
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If you see peritonitis...do you operatere or do medical treatment/
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surgery
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If you see abd pain/tenderness with signs fo sepsis do you operatere or do medical treatment/
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surgery
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If you see intestinal ischemia...do you operatere or do medical treatment/
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surgery
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If you see pneumoperitoneum...do you operatere or do medical treatment/
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surgery
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What are you thinking if you see a pt. with spont. inflammation in kids with nephrosis ?
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Primary peritonitis
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What if you see a spont. inflammation in adults with ascities and mild abdominal pain (with fever and Incr. WBC)
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Primary peritonitis
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Do you treat Primary peritonitis medically or surgically?
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medically
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Do you treat pancreatitis medically or surgically?
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medically
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Do you treat cholangitis medically or surgically?
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medically
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Do you treat urinary stones medically or surgically?
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Medically
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What are things that can mimic an acute abdomen?
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Lower lobe pneum--look for infiltrate on CXR
MI---look for EKG changes PE--suspect this in any immobilized pt. Ruptured ovarian cyst |
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What are the nonsurgical casuse of an actue abdomen?
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MI, acute pericarditis
Lower love pneum, pulm infarct Hepatitis, GERD DKA, adrenal insuff Pyelonephriatis, acute salphingitis Sickle cell crisis Acute porphyria |
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What are you thinking if you see a pt. with acute abdominal pain that sudden, severe, constant, and generalized and pain is excruciating with ANY movement?
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GI perforation
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What are you thinking if you see lower abdominal pain and FEVER in elderly pt?
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Diverticulitis
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What are you thinking if you see epigastric pain that wakes you up at nigh and is referred to the scapula?
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Perf. peptic ulcer
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What are the MOST common causes of GI perf?
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perf. peptic ulcer,
Diverticulitis CHRons |
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How do you diagnose a pt. with a GI perf?
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Supine and ERect X-ray
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What are you looking for on a SUPINE and ERECT Ab xray when you suspect a GI perf?
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Free air under the diaphram
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What should you order if you see free air under the diaphram on a pt. with a perf. ?
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IV fluids
Iv Access NPO IV abx= flagyl and gent OR IV-cefoxitin or cefotetan Pepare for surgery |
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What do you suspect if you see pain in the chest or upper abdomen, with dysphagia or odynophagia and subcut. emphysema after an endoscopy?
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Esopha perf
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What do you recommend if you see esoph perf; what is the first study?
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Gastrograffin contrast esophagram
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Do you do a BARIUM swallow if you see pain in the chest or upper abdomen, with dysphagia or odynophagia and subcut. emphysema after an endoscopy?
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NO
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What should you think if you see a pt. with SEVERE colicky pain, no flatus or feces, Nausea, vomiting with a pt. with a prior surgery?
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Obstruction
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What should you think if you see a pt. with SEVERE colicky pain, no flatus or feces, Nausea, vomiting in an old pt. with wt. loss, anemia, or black stool?
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Obstruction
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What should you think if you see a pt. with SEVERE colicky pain, no flatus or feces, Nausea, vomiting and recurrent lower abdominal pain?
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obstrucion from diverticulits
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What should you think if you see a pt. with SEVERE colicky pain, no flatus or feces, Nausea, vomiting with h/o hernia
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Obstruction from incarcerated hernia
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What should you think if you see a pt. with SEVERE colicky pain, no flatus or feces, Nausea, vomiting and sudden abdominal pian in elderly pt?
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Obstruction from volvulus
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What do you suspect if you see a pt. trying to get comfortable What should you think if you see a pt. with SEVERE colicky pain, no flatus or feces, Nausea, vomiting
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obstruction
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What is labs should you get if you suspect a pt. with obstruction?
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CBC and lactate
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What do you think if you see dialated loops of bowel, and no gas in the rectum on Supine and ERect Abd Xray?
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Obstrution
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What do you think of if you see birds beak on Abd Xray?
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Volvulus
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what is the treatment orders if you suspect an obstruction?
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NPO
IV access IVF NG suction Gastrograffin contrast study Surgery consult Emerg Surgery |
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what is the treatment orders if you suspect an obstruction due to volvulus?
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Proctosigmoidoscopy with a rigid instrument
Leave rectal tube in place Sigmoid resection for recurrent cases |
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What abdominal hernias should not get elective repair
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umbilical hernia in pt. <2yr and esophageal sliding hernia
or strangulated hernia |
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What if you see hernia with fever, high WBC, constant pain and signs of peritoneal irritation, what should you do
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Emerg surgery
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What are the 4 hepatic risk factors to assess before surgery?
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PT >16
albumin < 3 BR > 2 encephalopathy |
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What do you do if you see EF< 35% should you do surgery?
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No noncardiac surgery
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What do you do if you see JVD should you do surgery?
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Stabilize ACEI, B-blockers, digitalis, and diuretics
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What do you do if you see Recent M Ishould you do surgery?
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Defer surgery for 6 months after the MI
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What do you do if you see progressive angina should you do surgery?
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Do a cardiac cath to eval for possible coronary revascularization
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What do you do if you see smoking with FEV1 <1.5 should you do surgery?
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Order PFT to eval FEV
If FEV1 is abnormal get an ABG Stop smoking 8 weeks before surgery |
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What do you do if you see BR>2.0 should you do know before surgery?
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40% mortality
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What do you do if you see BR > 2.0, PT > 16, and Serum albumin <3.0 what should you know before surgery?
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80-85% mortality risk
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What level of BR, serum albumin, PT, should be for hepatic risk factors?
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BR >2
Serum albumin <3.0 PT >16 |
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What do you do if you see loss of 20% of the body wt. over several months should you do surgery?
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Provide 5-10 days fo nutritional supplement via gut before surgery
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What do you do if you see fever in post op day 1? What are you thinking
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CXR--atelectasis
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What do you do if you see fever in post op day 3? What are you thinking
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U/A--UTI
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What do you do if you see fever in post op day 5? What are you thinking
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Doppler of LE--thrombophlebitis
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What do you do if you see fever in post op day 7? What are you thinking
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Complete PE and CT scan--wound infection
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What are you suspecting if yo see a pt. that was given halothane or succinylcholine and got temp > 104; what should you do?
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Malig Hyperthemia
Tx: with IV dantrolene 100% oxygen Correct acidosis and put cooling blankets on |
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What should you look for if you see a pt. with malig hyperthermia after treatment?
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myoglobinuria
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What are you suspecting if yo see a pt. that had temp(104) after using a scope for example in the urinary track? What should you do?
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Bacteremia
3 X blood cultrures Empiric ABx |
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What are you thinking if you see temp 101-103 on post op day 1 and what do you recommend?
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Atelecasis
incentive spirometry |
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What are you thinking if you see temp 101-103 on post op day 3 and what do you recommend?
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Pneumonia
CXR---Infiltrate Sputum culture Abx--for HAP treatment |
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What are you thinking if you see temp 101-103 on post op day 5 and what do you recommend?
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DVT
Doppler U/S of deep veins of leg/pelvis Tx Anticoag |
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What are you thinking if you see temp 101-103 on post op day 7 and what do you recommend?
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Wound infection
Tx. Abx if only cellulitis I & D if abscess is present |
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What are you thinking if you see temp 101-103 on post op day 15 what do you recommend for
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for deep abscesses (subphrenic, pelvic or subhepatic
Dx: CT scan of body TX: Percut radio guided drainage |
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What are you thinking if you see hypotension while intraoperative and you suspect an MI, what should you do?
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DON"T give Thrombolytics
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Can you give thrombolytics in a post op setting for perioperative MI/
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NO
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What do you do if you have a fever on Day 7 and SOB?
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PE
order CT Angio anticoag with heparin IVC filter if PE recurrent |
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What do you do if you have a pt. with aspiration?
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Lavace and remove gastric contents
Bronchodialtors and resp suport Steroids don't help |
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What if you see positivie pressure breathing, and pt. becomes harder to "bag"
BP steadily declines, and CVP increases? |
PTX
Insert needle to decompress Chest tube placement |
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What if you post op see confusion, what should you order first ?
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Hypoxia, order ABG
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What if you rule out hypoxia for post-op confusion what should you order next?
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Blood cultures and CBC for Sepsis
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Waht hould you do and what are you thinking if you see bilateral pulm infiltrates and hypoxia with no evid of CHF
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ARDS
Tx: PEEP |
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What do you do and treat post of if you see tachycardia, hyperthemia HTN, and alt mental status?
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Del. Tremens
Tx. Benzo---watch for sz and rhabdo |
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What is the most effective method of decreasing the risk of HIV vertical transmission to a fetus?
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AZT monotherapy
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What does the transmission rate reduce to if you use AZT monotherapy?
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25 to 8 percent
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When is triple therapy in HIV most effective in an HIV mom?
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most effective in HIV load >1000
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When is HIV monotherapy with AZT sufficient?
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with HIV load less than 1000
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What is the major rounte of vertical transmission in HIV?
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contact with teh infected genital secretions at the time of vaginal delivery
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What is the vertical transmission rate without treatment?
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25-30 percent
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what is the most effective treatment in a pt. with low CD4 and high RNA viral loads >1000?
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C-section
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Why should you not test a neonate for HIV after delivery?
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B/c neonate will bbetest positive from the transplacental passive IgG passage
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What will a neonate show on an HIV test after being born?
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positive HIV test
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What is the best method to test a neonate for HIV status?
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HIV RNA pcr
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If a mom is already on HAART meds, what should she do if she gets pregnant?
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Cont. the meds
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If a preg. woman just finds out she is HIV positive and viral load is low, what can she do?
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Start monotherapy AZT
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If a preg woman finds out she is HIV positive and has a high >1000 vrial load, what should she do?
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start HARRT triple therapy at 14 weeks
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What drug is a must for HIV in preg?
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AZT
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How can you prevent and treat for HIV in preg?
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Give triple therapy at 14 weeks and include AZT
Give IV intraparturm AZT Give PO AZT to the infant for 6 weeks after delivery |
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How do you treat/prvent in a neonate for HIV?
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PO AZT for 6 weeks after delivery
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What should you do after 6 weeks of PO AZT treatment in a neonate for HIV?
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Give 6 weeks of Bactrim treatment for PCP
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What should be the route of delievery of a preg pt. with a viral load > 1000?
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Planned C-section
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What should be the route of delievery of a preg pt. with a viral load < 1000?
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Vaginal delivery or
Planned C-section |
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Should a mom breastfeed if HIV postivive?
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NO
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Should invasive procedures be performed on a pt. with HIV?
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NO, don't do artificial ROM or a fetal scalp electrode
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Is there immunity if there has been a prevously treated syphyllis case?
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NO
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Can you assume that a preg pt. is protected if she has been previously treated for her syphyllis?
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NO
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Can a syphillis reinction occur over and over again?
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YES
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How does transplacental infection result from in syphyllis?
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primary and secondary infection
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What is teh risk of transmission in syphyllis transplacental infection?
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60 percent risk
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What has the lowest risk of transplacental transmission, primary, secondary, or tertiary syphyllis?
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tertiary
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When is this syphillis finding fournd, early (1st trimester) or late aquired (after 2 years old).....saddle nose?
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LATE
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When is this syphillis finding fournd, early (1st trimester) or late aquired (after 2 years old).....non-immune hydrops fetalis?
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Early
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When is this syphillis finding fournd, early (1st trimester) or late aquired (after 2 years old).....hutchinson teeth
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LATe
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When is this syphillis finding fournd, early (1st trimester) or late aquired (after 2 years old).....maculopapular ro vesicular peripheral rash?
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EArly
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When is this syphillis finding fournd, early (1st trimester) or late aquired (after 2 years old).....mulberry molars
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LATE
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When is this syphillis finding fournd, early (1st trimester) or late aquired (after 2 years old).....anemai, thrombocytopenia, HSP
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EARly
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When is this syphillis finding fournd, early (1st trimester) or late aquired (after 2 years old).....saber shins
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LATE
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When is this syphillis finding fournd, early (1st trimester) or late aquired (after 2 years old).....perinatal moratlity rates...50 percent?
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Early
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Deafness (CN 8 palsy)
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Late
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What should be done in the first trimester for syphyllis?
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VDRLL or RPR screening
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How should you confirm for syphyllis?
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FTA-Abs or MHA-TP test
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How do you confirm and most accurate test syphillis when a painless genital ulcer is involved?
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Darkfireld microscopy
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Does a C-section prevent vertical transmission of syphyillis?
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NO
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What is the treatment of sypyllis?
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Benazathine PCN IM one time
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What should you give a PCN allergic pt. in the treatment of syphyllis?
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oral desensitization followed by a full dose Benzathine PCN
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Is FTA-Abs a confirmatiory or screening test?
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Confirmatory
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Is MHT-TP a confimatory or screening test?
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Confirmatory
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How does a neonate get Hep B?
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primary infection or
ingestion of infected genital secretions during vag delivery |
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when does the primary infection of HepB occur first or thrid trimester?
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first trimester
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What is the risk of getting chronic HEP B once the neonate is infected?
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80 percent
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What is the risk of getting chronic HEP B once an ADULT is infected?
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10 PERCent
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What HepB (suface, core, or env) determines infectivity?
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hep B--envelope
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What HEpB determines acute infection?
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hep B c antibody
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If a mom has HIV, can she breast feed?
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NO
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If a mom takes MXT, can she breast feed?
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no--cytotoxic drug
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If a mom takes cyclosporine can she breast feed?
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No--cytotoxic drug
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If a mom takes a substance abusive drug excetp (cigs or alcohol) can she breast feed?
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NO
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If a mom has ACTIV TB can she breast feed?
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NO
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If a mom has HTLV-1 can she breast feed?
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NO
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If a mom has HEP B and neonate is NOT immunized can she breast feed?
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NO
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If a mom has HSV and there is a lesion on the breast can she breast feed?
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NO
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What condition in the infant should the mom not breast feed?
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Galactosemia
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Do you have to do a C-section in a pt. with HEp B?
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NO
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What can you give to immunize and prevent Hep B if the mom is HBsAg negative?
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Give active immunization during preg
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Can you give active Hep B immunization during preg?
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YES
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What passive immunization should be started in a pt. to prevent Hep B?
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After pt. is exposed to Hep B give HBIG to the mother
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What is the treatment for Hepatitis Bin the neonate ?
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hepatitis immunization and HBIG in the neonate
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What can you treat Chronic HEP B with?
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LAmivudine or Interferon
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What are the 4 main causes of an acute abdomen?
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Perf
obstruction Inflamm/Infection Ischemia |
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Should you treat medically or with surgery for peritonitis?
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Surgery
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Should you treat medically or with surgery for pneumoperitoneum/
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surgery
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Should you treat medically or with surgery for PRIMARY PERITONITIS
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MEDICALLY
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Should you treat medically or with surgery for acute intestinal ischema?
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surgery
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Should you treat medically or with surgery for pancreatitis?
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medically
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Should you treat medically or with surgery for chalangitis
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medically
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Should you treat medically or with surgery for abdominal pain and signs of sepsis
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surgery
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what is primary peritonitis?
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spontateous inflam in children with nephrosis or an adult with ascites and mild abdominal pain (even if there is fever and high WBC)
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What do you do if you see urinaryh stones on Xray Should you treat medically or with surgery for ?
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medically
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What should you look for to r/o an acute abdomen if you are thinking lower lobe pneumonia?
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infiltrate on CXR
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What should you look for to r/o an acute abdomen if you are thinking MI?
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EKG changes
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What should you look for to r/o an acute abdomen if you are thinking pulmonary emboli?
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look for an immobilized patient
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At birth why should you look at the anus?
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For imperforation
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At birth why should you look at teh Xray?
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Vertebral and radial anomalies
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At birth why should you look the Echo?
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cardiac anomalies
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At birth why should you look at the sonogram?
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renal anomalies
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What are you thinking if you see excessive salivation after birth and choking spells with FIRST FEED
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Esoph Atresia
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What should you do if you think a pt. has esoph atresia?
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Confirm with NG
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What are you thinking if you see the NGT coiled in the upper chset on XRay?
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Esoph atresia
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How should you treat an esoph atresia?
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Surgery
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What if you can't do surgery for an esoph atresia right away, what should you do?
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Gastostomy to protect lungs from acid reflux
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What if you don't see flatus or stool in the anus and anus is absent, what are you thinking?
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Imperforated Anus
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At birth why should you look at the anus?
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For imperforation
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At birth why should you look at teh Xray?
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Vertebral and radial anomalies
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At birth why should you look the Echo?
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cardiac anomalies
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At birth why should you look at the sonogram?
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renal anomalies
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What are you thinking if you see excessive salivation after birth and choking spells with FIRST FEED
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Esoph Atresia
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What should you do if you think a pt. has esoph atresia?
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Confirm with NG
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What are you thinking if you see the NGT coiled in the upper chset on XRay?
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Esoph atresia
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How should you treat an esoph atresia?
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Surgery
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What if you can't do surgery for an esoph atresia right away, what should you do?
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Gastostomy to protect lungs from acid reflux
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What if you don't see flatus or stool in the anus and anus is absent, what are you thinking?
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Imperforated Anus
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What should you do if you find a imperforated anus?
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Look for a fistula near by to vagina or perineum
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If a imperf anus is present, what should you do?
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Delay repair until further grwoth, but before toilet training
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If a imperf. anus is not present, what should you do?
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Colostomy to find high rectal pouches
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What do you do if you see DYSPNEA at birth, and loops of bowel in the left chest on XRAY...what are you thinking?
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Congenital Diaphragmatic hernia---perfom an endotrach intubation, low pressure vent, sedation, and NGT suction...delay for 3-4 days for lungs to mature
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What do you see is the primary abn. in congenital diaphragmatic hernia?
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Hypoplastic lung with fetal type circulation
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What are you thinking if you see the umbilical cord is normal and the defect is to the right of the cord, with no protective membrane and bowl looks angry and matted?
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Gastroschisis
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What are you thinking if you see umbilical cord goes into the defect with a thin membrane over normal looking bowel?
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Omphalocele
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How do you treat a small gastroschiis or omphalocele?
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Close small defects primarily
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How do you treat a large gastroschiis or omphalocele?
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Silo to protect the bowel and manual replacement of the bowel daily until complete closure (1 week); in the meantime, give parenteral nutrition (bowel will not work in gastroschisis)
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What do you do if you see exstrophy of the urinary bladder?
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abdominal wall defect over teh pubis
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What shoud you do if you see exstrophy of the urinary bladder?
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Transfer the patient to a specialized center with srugeical repair in the first 1-2 days of life...don't delay surgery
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What are you thinking if you see double bubble?
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1.Duodenal atresia
2. Annular pancreas and malrotaion |
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What are you thinking if you see green vomiting and double bubble sign in a newborn?
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annular pancreas
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What are you thinking if you see green vomiting and multiple air-fluid levels throughout the abdomen?
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Intestinal atresia
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What are the conditions that need surgery at birth?
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esoph atresia
imperf anus congenital diaphragmatic hernia Gastroschisis Omphalocele Extrophy of the urinary bladder Intestinal atresia |
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What are you thinking if you see an abdominal wall defect over the pubis?
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Exstrophy of the urinary bladder
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What should you do if you have exstrophy of the urinary bladder?
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Transfer the pt. wo a specialized center that offers surgical repair in 1-2 days of life, don't delay surgery
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What are the conditions that require surgery in first 2 months of life?
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Nec Enterocolitis
Meconium Ileus hypertrophy pyloric stenosis bilirary Atresia Hirschrung Ds (aganglionc megacolon) |
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What are you thinking if you see FEEDING Intol in PREMATURE infants when first fed?
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Necrot. Enterocolits
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What will you find in necrot. enterocolitis on physical exam and in CBC?
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Distended abdomen
Rapidly dropping platelet count |
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What should you do if you see NEC?
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Stop all feeds
RX: broad-spec ABx Deliever IVF and nutrition Do surgery if there are signs of necrosis or perf (abd. wall redness, portal vein gas, or gas in the bowel wall) |
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What are you thinking and how will you treat feeding of intol and BILIOUS vomiting in a baby with CYSTIC Fibrosis?
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Meconium ileus
Treat with Gastrografin enema |
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What are you thinking if you see multiple dialated loops of small bowel adn a ground glass appearance in the lower abdoment?
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meconium ileus
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How will you treat meconium ileus?
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Gastrografin enema
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How will you diagnose meconium ileus?
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Gastrografin enema
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What will you find on gastrografin enema when diagnosing meconium Ileus?
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microcolon and inspissated pellets of meconium in the terminal ileum
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What will you find on gastrografin enema with treating meconium ileus?
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gastrografin drawsfluid in and dissolves teh pellets
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What are you thinking if you see NONBilious Projectile vomiting after each feeding at 3 weeks of age?
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Hypertrophic Pyloric stenosis
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What are you thinking i fyou see a gastric peristaltic wave and a palpable olive size mass in the RUQ
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Hypertrophic pyloric stenosis
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What should you diagnose pyloric stenosis with?
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U/S
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How do you treat hypertrophic pyloric stenosis?
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Correct dehydration and assoc hypochloremic, hypokalemic, metabolic alkalosis and then a
Ramstedt pyloromyotomy |
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What are you thinking if you see a baby with persisten progressively increasing Jaundice (conjugated) IN A 6-8 week old?
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Biliary Atresia
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How do you diagnose Biliary atresia?
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Conduct serologies and sweat test to r/o other problems
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What should you order after week of phenobarbital?
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HIDA scan
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What do you give phenobarb in Biliary atresia?
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powerful choleretic
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What if no bile reaches the duodenum even with phenobarb stim, what should you do?
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surgical exploration
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What is the most important clue in diagnosis of Hirschspring Ds Aganglionic megacolon)
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Chronic constipation
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what are you thinking if you do a rectal exam and an explosive expulsion of stool and flatus with relief of the abdominal distention occurs?
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Hirschprung
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How do you diagnose Hirschsprung Ds?
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full-thickness biopsy of the rectal mucosa
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What are you thinking if you have a surgical condition that is later in infancy and not in first 2 months or newborn?
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Intussusception, and Meckel
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What are you thinking if you see a 6-12 month old chubby, healthy-lookingkid with Breif COLICKY episodess of abdominal pain taht makes them "double up and squat"?
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intussusception
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What are you thinking if you see a vague mass on the Rt. side of the abdomen?
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Intussusception
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What are you thinking if you see an empty RLQ wiht colicky abdom pain?
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Intussusception
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What ar eyou thinking if you see colicky abdom pain with currant jelly stools?
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Intussusception
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What should you do if you suspect intussusception?
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Barium or air enema
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What should you do if enema for intussusception fails to achieve reduction?
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Surgery
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What should you do if you suspect a lower GI bleed in a ped. child?
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Meckel Divertic
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What should you do to diagnose a Meckel?
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Radioisotope scan
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What are you looking for in a radioisotope scan in Meckel Diverticulum?
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Gastric mucousa in the lower abdomen
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What should you order if you suspect a frx?
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2 views at 90 degrees to one another and ALWAYS include the joints above and below the broken bone
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Should you only order the area that a pt. complains of if there is a fracture involved?
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NO, always order XRAYs in the line of force
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What surgery is acceptable for fractures that are not badly displaced or angulated?
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Closed resduction
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What surgery is acceptable if the answer is a frcture severely displaced or angulated or can't be aligned?
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ORIF
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How should open fractures be managed?
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cleaning in the OR and reduction within 6 hours from the time of injury
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What should always be done if there are facial injuries?
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Perform cervical spine films
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What are you thinking if you see an adducted arm and externally rotated forearm with numbness over the deltoid
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Anterior shoulder dislocation
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What should you order if you don't see an anterior shoulder dislocation on a PA/lateral film and suspect anterior dislocation?
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Axillary/Scapular Xray of the shoulder
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What dislocation should be suspected if you see a pt. with a recent sz. or electrical burn and shourlder injury or pain?
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Post. shoulder dislocation
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What should you be thinking if you see a deep penetrating or dirty wound that later becomes tender, swollen with gas crepitus?
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Gas gangrene
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What are you thinking if you see the arm held close to the body and the forearm internally rotated?
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Posterior dislocation
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what are you thinking if you see the most common shoulder dislocation and the arm held close to the body but externally rotated forearm and assoc. numbness over the deltoid muscle?
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Anterior dislocation
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Why would there be numbness over teh deltoid muscle in an anterior dislocation?
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axillary nerve stretch
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What is the best choice for the management of a clavicular fx?
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Figure 8 sling
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What is the best choice for the management of a colles's fx?
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Closed reduction and casting
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What type of fx are you thinking if you see a elderly woman who falls on an outstretched hand?
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Colles fx
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What are you thinking if you see a dinner-fork deformity with a painful wrist?
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Colle's fx
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How would you treat a dinner fork deformity iwth a painful wrist?
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Closed reduction and casting
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What are you suspecting if you see a adiaphyseal frx and dispaced dislocation of the nearby joint if it is a direct blow to the ulnar?
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Monteggia fx
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What are you suspecting if you see a adiaphyseal frx and dispaced dislocation of the nearby joint if it is a direct blow to the radius?
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Galeazzi fx
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How do you treat a diaphyseal fx and a displaced dislocatin of a nearby joint?
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ORIF for the diaphyseal fx
Closed reduction for the dislocated joint |
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What do you think it is if you fall on an outstretched hand with pain in the anatomical snuff box?
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Scaphoid fx
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How long does it take for a scaphoid fx to be seen on Xray?
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more than 3 weeks
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What do you do to help prevent nonunion?
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Thumb spica cast
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What are you thinking if you see a pt. with an externally rotated and shortened leg?
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Hip fx
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what type of hip fractures are a high risk group of avascular necrosis?
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Femoral neck fractures
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How are femoral neck frx best treated?
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Femoral head replacement
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How are intertrachanteric fx. treated?
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open reduction and pinning
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How are femoral shaft fractures treated?
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Intermedullary rod fixation
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What are you thinking if you have a woman wake up in the middle of night with an acutely flexed finger and a "snap" when u forceably extend the finger?
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Trigger finger
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What are you thinking when you see a young mom carrying baby with flexed wrist and extended thumb to stabilize the baby's head?
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DeQuervains tenosynovitis
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What is the best intial therapy for trigger finger or DeQuervains tenosynovitis?
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Steroid injection
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What do you call it if there is contracture of the palm with palmar fascial nodules?
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Dupuytrens contracture
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What is the only treatment for dupuytrens contracture?
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Surgery
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What are you thinking if you see a head-on car collision where the knees hit the dashboard
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Post. dislocation of the hip
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What should you do if you see a posterior hip dislocation?
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Ortho emergency
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What are you thinking if you see a internally rotated leg, and what must you do to treat?
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Emergency reduction to avoid avascular necrosis
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What are you thinking if you see direct blow to the opposite side of the joint?
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Medial/Lateral collateral ligament injury
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What should you do if you see an isolated medial/lateral collateral ligament injury?
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Casting
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What should you do if you see multiple ligaments injured?
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Surgery repair
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What do you do if you see swelling pain and anterior or posterior drawer sign?
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Anterior cruciate ligament or
posterior cruciate ligament |
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How should you treat a young athlete with an anterior or posterior drawer sign?
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Arthroscopic repair
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How do you treat older patients with Anterior or posterior cruciate ligament injury?
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Immob and rehab
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What do you do if you see prolong swelling and pain with locking during ambulation?
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Meniscal injury
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How do you treat with catching and locking during ambulation/
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Arthroscopic repair
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What are you thinking if you see history of forced marches with negative Xray?
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Tibial stress injury
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How do you treat a tibial stress injury/
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Cast first
No weight bearing and Repeat films in 2 weeks |
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What if you see a middle-aged man that "overdoes it" at tennis/basketball or a pt. that has a h/o fluoroquinolones, complaining of a sudden "pop" and limp
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Rupture of achilles Tendon
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What should you treat a rupture of Achilles Tendon with?
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casting in the equinus position or surgical repair
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What if you see prolonged ischemia, reperfusion, crushing injuries, or other types of trauma where there is pain and the affected area feels tight and tender to palpation; what are you thinking?
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Compartment syndrome
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What if you see excruciating pain with passive extension?
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Compartment syndrome
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How will the pulses be in compartment syndrome?
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they will be normal
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What is the first step in compartment syndrome?
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emergency fasciotmoy
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What are you thinking if you see injury to the distal humerus obliquely?
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Radial nerver complication
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What will happend if you see a radial nerve injury?
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Unable to dorsiflex or extend the wrist
Function is regained after reduction |
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What is the next step in management for a radial Nerve complication?
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surgery is indicated if paralysis persists after reduction
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What happens if there is decreased distal pulses and posterior dislocation of the knee?
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popliteal artery injury
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What should you do if you see a popliteal artery injury?
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Doppler studies or arteriogram
Do prophylactic fasciotomy if reduction is delayed |
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What are you thinking if you see months of back pain with SUDDEN onset of SEVERE bck pain that came on when moving a t.v. The pain is an electrical shock that shoots down his leg, which is worse wehn he coughs or strains and relief by flexing his legs. Straight leg raising is painful...what ARE YOu thinking?
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Lumbar disc herniation
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What is the treatment for lumbar disc herniation?
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Ibuprofen and brief bed rest
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What are you thinking if you see back pain with bowl bladder incon, flaccid anal sphincter, and saddle anesthesia, what do you hink?
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Cauda equina syndrome
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What are you thinking if you see bamboo spine with pain and morning stiffness with improvemtn with activity?
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Anky Spondy
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What should you do for treatment for anky spondy?
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Anti-inflam agent and Physical therapy
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What are you thinking if you see an older pt. with progressive and constant back pain that is worse at night and no relief with rest?
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mets
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What will you see on x-ray with hypercalcemia and elevated alk. phos?
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Lytic lesions
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What will you order in mets if you want to see early disease in malig?
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Bone scan is most sensitive
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What is the diagnostic test of choice if there are any neuro symptoms, and will show the greatest amount of detail?
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MRI
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What are the blastic mets lesions?
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Prostate and Breast
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What are the lytic mets lesions?
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Lung, renal, breast, thyroid
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What if you see an older, obese pt. with SHARP heel pain every time their foot strikes the ground?
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Plantar fascitis
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When is the pain worse in plantar fascitis?
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worse in the morning
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Where is the tenderness in plantar fascitis?
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over a bony spur
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what should you do for treatment for a bony spur?
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Symptomatic treatment with resolution in 12-18 months
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What is the diagnosis if you have inflammation of the common digital nerve at the 3rd interspace btwn 3rd and 4th toes?
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morton neuroma
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Morton neuroma is palpable and there is a very tender spot there, and how can you manage it?
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analgesics and the correct footwear
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