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92 Cards in this Set

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breast cyst work up
- aspirate --> grossly blood fluid --> mammogram and excision
- aspirate --> nonbloody --> residual mass --> mammogram and excision

- if no residual mass --> f/u with U/S if cyst returns or not:
- cyst returns --> mammogram and excision
- cyst doesn't come back --> routine screening
old man with rectal mucosa protruding w/ bluish discoloration
- rectal prolapse with strangulation, emergency surgery
25 year old with sudden pulseless left leg
- emboli originating from cardiac source: a fib, MI, ventricular dysfx, endocarditis, valvular disease, atrial myxoma, prosthetic aortic valve
atrial myxoma
- primary cardiac tumors found in left atrium -- diastolic murmur at apex
- sx: rapidly worsening heart failure in young individuals, new onset afib
- prompt surgical excision
bicuspid aortic valve
- leads to aortic stenosis
venous vs arterial emboli
- arterial: emobli from heart
- venous: clotting disease
pain out of proportion to the extent of their injury?
- compartment syndrome
most life threatening complication of compartment syndrome?
- rhabdo, not gangrene
kid with blood stools and positive technetium-99?
- meckel's diverticulum
when do you see inussusception?
- before 2 years of age
early stages of compartment syndrome
- pain with passive movement, later you have absence of pulses
pt s/p mono with persistant LAD
- if >4weeks since infx (or any persistant LAD) then get biopsy b/c may be lymphoma
morbidity from breast implants?
- contracture causing pain
- rupture
- no systemic, immune disease
- small increase in anaplastic T cell lymphoma
s/p clavicle fracture, when can they return to sports?
- 4-6 weeks
pt with obvious PVD, but normal ABI?
- do ABI after treadmill exercise
symptomatic tx of PVD
- cilostazol: PDI- inhibits plt aggregation and acts as arterial vasodilator, improves max walking distance, take in combo with asa and clopidogril is fine
desmoid tumors
- associated with gardner
- benign tumor
- abdominal mass, high rate of recurrence
dermatofibroma
- proliferation after trauma
epidermoid cyst
- keratin lodged in dermis, resolve spontanesously
- associated with Gardern's
pyogenic granuloma
- capillary proliferation after trauma, seen in pregnant women
afib in pts s/p CABG
- common, resolves spontaneously 6-8 wks
risk of morphine in AKI
- morphine builds up --> decreases resp rate --> give O2--> further decreases resp rate b/c get rid of drive to breathe
evaluation of pancreatic mass found on CT?
- EUS guided cyst aspiration
- not ERCP: more complications, less sensitive, used for therapeutic procedure to choledocolithiasis
calcified gallbladder wall with gallstones?
- porcelain gallbladder
- elective cholecystectomy
- don't do nothing because high risk of cancer
tenderness along medial knee? lateral knees? anterior drawer? posterior drawer?
- MCL injury
- Lateral collateral ligament
- ACL
- PCL
3 month old with bulge in groin
- indirect inguinal hernia: failure of processus vaginalis to obliterate --> elective repair ASAP
pt w/ cauda equina, next step?
- MRI, then BCx, Abx, CT guided drainage, followed by surgical decompression
- only give high dose glucocorticoids if neurologic sx (and not if from epidural abscess e.g. hx of epidrual inj)
fat embolism
- pt s/p orthopedic trauma --> 24-48hrs develops resp distress, fever, tachy, petechiae, AMS
- prevent w/ early immobilization and operative fixation
- heparin doesn't decrease risk
nuchal rigidity and CN III palsy
- CN III palsy: ptosis, anisocoria
- posterior communicating artery aneurysm
most common cause of death in steering wheel injury
- aortic rupture
grossly displaced clavicle fracture vs minimally displaced
- open reduction internal fixation
- conservative ice, analgesics, sling
how to store amputated finger
- wrap in saline moistened sterile guaze and seal in sterile plastic bag
- place in ice and saline container (not ice only b/c of frost bite)
patient falls out outstretched hand, which fx?
- scaphoid fx
- get xray, if neg, get MRI - must get diffinitive dx to prevent unnecessary splinting
- if untreated then complicated by nonunion
scrotal trauma (kid kicked in balls --> scrotal hematoma)
- must do surgical exploration
animal bite
- debride
- xray
- if face- suture (good vascular supply = decreased infx)
- if hand: leave open b/c high risk infx
elevated PSA
- check again in 2-4 weeks, if still high then further investigate
- if low then elevated PSA secondary to inflammation for many reasons
which knee injury associated with popping?
- ACL
which knee injury associated with MVA dashboard injury?
- PCL
- same as if athlete falls on flexed knee
uilateral painless scrotal mass?
- negative transillumination means solid mass
- next step is U/S to ddx solid vs cystic also intra vs extra-testicular
- if U/S suspicious then do CT w/ CXR for mets
- testicular cancer
testicular tumor markers
- beta hCG and AFP elevated in non-seminomas
- only hCG in pure seminomas
- tx: radical inguinal orchiectomy with lymph node dissection for staging
hip fracture is old demented nonambulatory patient
- recommend pain control
- surgery is high risk and only benefits those who walk
left hypoglossal nerve injury in CEA?
- tongue deviates to left side (side of injury)
HypoCa2+ sx vs HyperCa2+ sx
- hypo (seen in s/p parathyroidectomy): perioral numbness, muscle cramps, carpopedal spasm, +Chvostek sign, +Trousseu's sign; severe: AMS, seizures
- hyper: nausea, vomiting, constipation, polyurai, pleuritis, AMS if severe
hungry bone syndrome
- in s/p parathyroidectomy: hypoCa2+ due to relative hypoparathyroidism
- ** happens 2-4 days after surgery
- **HY
anal abscess s/p I+D
- need close follow up b/c 50% will develop chronic fistual
most frequent complication of transurethral resection of prostate?
- retrograde ejaculation, not erectile dysfx
midline neck mass that moves with protrusion of tongue
- thyroglossal duct
- may have the only functional thyroid tissue
- do imaging to see if any other thyroid tissue (CT scan) and do preoperative thyroid function testing
complication of untreated varicocele?
- testicular atrophy b/c of rise of temperature --> seminiferous tubules to atrophy
- doesn't not cause impotence
right vs left varicocele?
- if right sided then must do CT b/c of anatomy stuff...
- if both sides then also do CT (not US)
- left sided, common, ok
- if varicocele doesn't disappear in supine position, also do CT
which test to check for testicular torsion?
- cremasteric reflex: stroke upper inner thigh and testis should elevate if normal
- ddx testicular torsion (no reflex) from epididymititis (normal)
- pain relief w/ scrotum elevation is Prehn sign and is + in epididymitis and absent in torsion but is not a reliable test
- can also do doppler U/S
Kleinfelter features
- what malignancy w/ higher incidence?
- sparse hair, gynecomastia, long legs
- breast cancer
diarrhea s/p cholecystectomy?
- rx cholestyramine, not recommend dietary changes
subphrenic abscess
- develops 14-21 days after abdominal surgery
- get abd U/S to dx
strongest risk factor for male breast cancer?
- klinefelter (XXY)
sphincter sparing rectal cancer surgery
- node positive proximal cancer
treatment of dumping syndrome
- high protein, low carb diet
- low fiber will control diarrhea, but no the other sx of dumping syndrome
most common cause of epididymitis?
- Chlamydia
orchitis
- mumps infection
- sudden onset fevers, severe scrotal pain and swelling
abx for dog bites
- augmentin
when to give tetanus toxoid
- tetanus toxoid if dirty wound and received booster >5 years ago
- tetanus toxoid if clean wound and received booster >10 years ago
- if dirty wound and unclear of insufficient immunization history: give toxoid and immune globulin
asystole
- chest compression
- epinephrine
ACS
- asystole: epi followed by atropine
- defib for vfib, pulses vtach
- undiff and regular wide-complex tach: amiodarone
Assessment of blunt cardiac injury
1. CXR: fx, PTX, hemothorax, widened mediastinum, aortic injury --> if (+) then FAST, CT scan or TTE/TEE
2. if (-) then do EKG --> if negative then no further work up; if + then do TTE, TEE, FAST, etc
complications in pregnant woman from ruptured appendix?
- peritonitis, fetal death, abscess formation and pylephlebitis (infectious thrombosis of portal veins (not tubo-ovarian abscess)
femoral nerve injury
- can't extend knee against resistance
- sensory loss over medial of thigh, medial shin, arch of foot
- decreased knee jerk
sciatic nerve injury
- affects lower leg musculature, hamstrings
- preserved sensation ove knee, normal knee jerks
obturator nerve injury
- weak leg adduction and sensory loss over small area of medial thigh
peroneal nerve injury
- acute foot drop
- sensory loss over dorsum of foot and lateral shin
- injury at knee
acute cholangitis tx
- BCx and abx (amp and gent or monotherapy w/ imipenem or levo or piperacillin-tazobactam, or CTX+metronidazole)
- if cholangitis is controlled then do ERCP
- if not controlled do emergent ERCP for biliary drainage for decompression
- cholecystectomy is for acute or chronic CHOLECYSTITIS, but even so ERCP should be tried first
abdominal pain w/ met acidosis
- MESENTERIC ISCHEMIA
- negative imaging
- exam doesn't match severity of pain
acute cholecystitis- when to put T tube
- high risk surgical pts (advanced pulm, CV pts)
tx of pulmonary contusion
- if stable, then just supportive
- if really bad then may need intubation
- thoracentesis if resp compromise from hemo or PTX
work up palpable breast mass?
- <30: U/S --> if simple then needle aspirate if pt wants; if complex or sold then image guided core biopsy
- if >30 then mammogram/U/S --> if suspicious then core biopsy
earliest sign of hypovolemia?
- tachycardia
PEx in patellar tendon tear?
- can't maintain extended knee against gravity if complete tear
- ortho surgery
positive click on McMurray's maneuver?
- medial meniscal tear
BMI >35 on orlistat, losing minimal weight?
- bariatric surgery
bariatric surgery guidelines?
- BMI >40 and failed previous weight loss
- BMI >35 with obesity related comorbidities
SBO with air in distal colon?
- means not a complete obstruction
- can admit and observe
inability to void secondary to BPH
- urethral cath
- suprapubic only by urologist if urethral cath is unsuccessful or evidence of urethral or pelvic trauma
O'Donohue's unhappy triad
- most recognized knee injury complex
- if ACL and MCL injury look for medial meniscus injury
ddx anterior chest traumas
- PTX/hemothorax: hypotension, unilateral decreased breath sounds
- cardiac tamponade: hypotension, distended neck veings
- cardiac contusion: hemodynamic instability if massive, normal breathing
- flail chest: tachypnea, shallow breaths, tachy, peripheral cyanosis
tx of mild gallstone symptoms?
- ursodeoxycholic acid
- SE: diarrhea
which med to stop prior to hold on morning of surgery?
- diuretics--> hypovolemia/hypotension
- otherwise CCB, alpha agonist, statins, ACE-I, BB can be taken on day of surgery b/c of possible W/D sx causing HTN
Cushing's triad
- intracranial hypertension
- bradycardia, hypertension, respiratory depression
loss of cremasteric reflex
- secondary to DM (Erectile dysfunction) (preserved ambulation)
- loss of L1-L2 but would also see abnormal hip flexion and adduction (difficult ambulation)
nerves that control sphincter tone
- S2-S4
tx of renal stones
-5mm and less: pass spontanesously
- <10mm and proximal ureteral calculi: shockwave
- >10mm prox: flexible ureteroscopy w/ laser lithrotripsy
- if all fails then perQ approach
grab a knife-- what's damaged?
- tendons run anterior surface
- arteries, nerves and veins run on the side
undescended testis
- earliest surgery is 6months
- risk of cancer is still higher s/p orchiopexy
- risk of torsion if you don't do the surgery
complication of IV nutrition?
- hyperglycemia: most serious
- hypophos: resp weakness, hemolysis, impaired O2 release
common cause of sudden hyperglycemia in ICU?
- sepsis