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142 Cards in this Set
- Front
- Back
What are the risk factors for pulmonary complications in the sx pt?
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*known pulmonary dz
*abnormal PFTs *Smoking *increased OR time *Age >60 *Obesity *Upper abd or thoracic sx |
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_______ has the highest M&M of all pulmonary complications post-op.
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PNA
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What is the variable presentation of C. diff colitis?
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May range from mild diarrhea & discomfort to severe pain, tenderness, fever, & inc WBC.
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_______ is the MCC of fever w/in 24 hrs of sx.
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Atelectasis
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ASA should be avoided ____ days preoperatively to allow for what?
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*10
*to allow return fxn of platelets, allow them to regenerate |
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Re: diabetic meds and surgery, should po hypoglycemics be avoided or given on the day of sx? Insulin?
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*Avoid po on day of sx
*Give 1/2 the usual dose of insulin on am of sx. |
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What are the steps of wound healing?
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*Coagulation
*Inflammation *Collagen synthesis *Angiogenesis (granulation) *Epithelialization *Contraction |
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______ are essential for wound healing.
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Macrophages
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Epithelialization of surgical wounds closed primarily is usually complete by ___-____ hours.
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24-48
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What are the 5 W's of post-op fever?
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Wound- infection
Wind- atelectasis, PNA Water- UTI Walk- DVT Wonder drugs- direct s/e or those w/compromising immunity, respiration or perfusion. |
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What are the 4 classic signs of wound infections?
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Rubor- erythema, redness
Dolor- pain Calor- heat, warmth Tumor- swelling, edema |
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What are the 3 poor operative techniques that may lead to wound failure?
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*suture material w/ inadequate tensile strength
*inadequate # of sutures *too small bite size |
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Hypertrophic scar and keloid formation are more common in which population?
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African-Americans
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What is the MCC of free air under the diaphragm?
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perforated peptic ulcer (90% of the time)
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What is the quality of pain of a perforated ulcer?
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Severe & sudden in nature.
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______ sign is seen in cholecystitis.
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Murphy's
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_____ sign is pain referred to the left shoulder due to irritation of the left hemidiaphragm. It is often seen w/ ________.
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*Kehr
*splenic rupture |
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What are the surgical causes of abdominal pain?
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*perforated duodenal ulcer
*cholecystitis *hepatic abscess *retrocecal appendicitis |
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_______ is still the MC surgical emergency in the pregnant woman.
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Appendicitis
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What is the pain of pancreatitis described as? Where does the pain radiate?
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*Boring
*To the back |
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With cervical spine precautions or any trauma, what should you do first?
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Always clear the airway first!
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What are the S&S of a PTX?
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*dyspnea
*decreased breath sounds on same side *hyper-resonance on same side *usually asymptomatic, may have chest pain |
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What is Kehr's sign? When does it increase?
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*pain radiating to left shoulder or neck secondary to splenic rupture
*inc when pt is in Trendelenburg position or w/LUQ palpation due to diaphragmatic irritation. |
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The most frequently injured solid organ associated with penetrating trauma is the ______.
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Liver
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The most frequently injured solid organ(s) associated w/blunt trauma is/are _______.
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spleen, liver
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What is the Grade V Laceration on the renal injury scale?
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Completely shattered kidney
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If the skin is warm, it is ______ shock. If it is cold & clammy, it is ______ or ______. Shock w/bradycardia is ______ unless proven otherwise.
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*distributive
*hypovolemic, cardiogenic *neurogenic |
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The MCC in the surgical or trauma pt is ______ shock.
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hemorrhagic
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Of the vital organs, the first "casualty" of hypovolemic or cardiogenic shock is the ______.
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kidneys --> blood is shunted away from the constricted renal arteries.
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What is the MCC of distributive shock? What are the other two causes?
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*Septic shock
*Neurogenic *Anaphylactic |
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What are the physical findings of anaphylactic shock?
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*urticaria & angioedema; esp around the lips
*laryngeal edema (stridor), wheezing |
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What is intracellular fluid (ICF) mostly found? Is it higher in males or females?
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*skeletal muscle mass
*higher in males |
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What is the MC fluid disorder?
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Volume deficit (dehydration)
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What are the causes of losses that mimic ECF?
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*Hemorrhage
*GI fluid-- V/D, NG suction, etc *Post-op fluid sequestration (3rd) *Intra-abd & retroperitoneal inflammation (pancreatitis, etc) *Systemic inflammation response syndrome (SIRS), burns, sepsis, pancreatitis |
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What are the losses that are principally water?
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*Fever
*Osmotic diuresis *Diabetes insipidus *Prolonged H2O deprivation *Inadequate input during procedure |
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What is the goal of fluid replacement?
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To replace the deficit in most pts over the next 24 hrs.
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What is the definition of hypernatremia?
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Sodium >145 mEq/L; always associated w/hyperosmolarity
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What are the causes of hypernatremia?
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*Loss of H2O --> (dehydration):
-DI, diuretics, sweating, GI loss *Inc Na due to excess mineral-corticoid activity: ie. Cushing's, RAS, etc. |
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What is the definition of hypercalcemia? What are some of the causes?
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*Ca >15 mg/dL
*Hyperparathyroidism *CA (esp breast & multiple myeloma) *Drugs (thiazides) |
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What do esophageal motility disorders result from?
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abnormalities in the propulsive pump action of the esophagus or relaxation of the LES
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______ is the failure of the lower portion of the esophagus to relax during swallowing. The resulting dysphagia is due to which 3 mechanisms?
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*Achalasia
1- Complete absence of peristalsis in the esophageal body 2- Incomplete/impaired relaxation of the LES 3- Inc resting tone of the LES |
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What are the S&S of achalasia?
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*dysphagia for both solids & liquids
*regurgitation of food *severe halitosis (due to decomposition of stagnant food w/in the esophagus) |
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What is the classic triad of achalasia?
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*dysphagia
*regurgitation *weight loss |
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What is the pathophysiology of GERD?
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LES resistance w/reflux of acidic gastric contents into the esophagus.
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What are some meds for the tx of GERD? What is the procedure of choice for surgical repair?
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*antacids, H2-blockers, PPIs
*Nissen fundoplication |
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More than 90% of esophageal carcinomas are ______ and ______.
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*squamous cell
*adenocarcinoma |
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What are the functions of parietal cells (oxyntic)?
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1- secrete HCl, accounting for the acidic pH of the stomach
2- secrete IF for absorption of vit B12 in the terminal ileum |
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What is the fxn of chief (peptic) cells?
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To secrete pepsinogen, a proenzyme activated by gastric HCl to form pepsin, which digests protein.
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What type of cells are found in the antrum of the stomach? What is their function?
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*G cells
*Secrete gastrin, which stimulates gastric acid secretion, pepsin secretion, & mucosal growth of the GI tract (trophic action). |
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Which environmental factors cause PUD?
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*H. pylori
*NSAIDs *Smoking |
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What are the causes of duodenal ulcers?
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*H. pylori
*NSAIDs/steroids *Zollinger-Ellison (ZE) syndrome |
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ZE accounts for 0.1-1% of pts w/_____, but over 90% of pts w/ZE have ______.
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*ulcer
*PUD |
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What is a sign of posterior duodenal perforation? Anterior duodenal perforation? Which is more common?
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*Posterior --? Bleeding from the Back, involving gastroduodenal artery
*Anterior-- Free Air from Ant duodenal perf. *MC is ANTERIOR! |
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What are the S&S of gastric ulcers?
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*Burning, gnawing epigastric pain that occurs w/anything in the stomach; worse after eating
*Anorexia/wt loss *Vomiting *Associated w/ blood type A |
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What is the risk of ulcers rebleeding in-hospital? Which type of ulcers are more likely to rebleed?
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*1/3
*Gastric ulcers are 3x more likely to rebleed than duodenal ulcers. |
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What is the MC type of malignant gastric tumors?
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Adenocarcinoma --> comprises 95% of malignant gastric CA.
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What are the tx options of Gastric Volvulus?
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*Sx repair of accompanying hernia
*Gastropexy-- fixes stomach to anterior abd wall *Gastric resection if there is necrosis. |
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What is the ligament of Treitz?
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Where the duodenum ends and jejunum begins
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Re: peristalsis, intestinal contractions occur at a rate of _____.
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1-2 cm/sec
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What is the MCC of a SBO?
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adhesions from prior surgery
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If a pt w/a SBO is stable or has a partial SBO, what does the management trial consist of?
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*NPO
*NG suction *IV hydration *Foley *Monitor electrolytes |
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What is the definition of Crohn's disease?
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Inflammatory bowel dz characterized by transmural inflammation involving any part of the GI tract, from mouth to anus, of unknown etiology. Discontinuous, results in skip lesions, often leads to fibrosis, obstruction & fistulae formation.
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Describe the typical hx of Crohn's disease.
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Prolonged diarrhea w/abd pain, weight loss, and fever w/ or w/o gross bleeding.
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A 70 y/o male w/a hx of PVD and hyperlipidemia presents to the ER w/severe, diffuse abd pain. BP is 170/100 & HR is 90 bpm. Supine AXR shows free air in the abd & w/in the wall of the small intestine. Most likely dx?
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small bowel infarction
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What is diverticular disease?
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Herniation of the mucosa thru the muscular layers of the bowel wall at sites where arterioles penetrate, forming small outpouchings or diverticula
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What is the classic S&S of diverticulosis? (Absent in diverticulitis)
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*Massive, painless lower GI bleeding.
*But 80% of pts are asymptomatic |
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What is the test of choice for suspected diverticulitis and what does it show?
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*CT scan
*Periocolonic inflammation w/ or w/o abscess formation. |
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What is the Tx of a large bowel obstruction?
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1- correct F&E abnormalities
2- NGT for decompression 3- Broad-spectrum IV ABX (i.e. cefoxitin) 4- Relieve obstruction sx |
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What are the 3 MCCs of obstruction of the large bowel?
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1- adenocarcinoma (65%)
2- scarring secondary to diverticulitis (20%) 3- volvulus (5%) |
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What is the definition of a volvulus of the colon and where is the MC location?
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*rotation of a segment of intestine about its mesenteric axis
*characteristically occurs in the sigmoid (75%) or cecum (25%). |
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What is the MC S&S of colorectal polyps?
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Asymptomatic
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Microcytic anemia in an elderly male or postmenopausal woman is ______ until proven otherwise.
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Colon CA
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What is the old system used for staging Colon CA?
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Dukes system:
*A- limited to wall *B- thru wall of bowel but not to lymph nodes *C- Mets to regional lymph nodes *D- distant mets |
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What is the tx of pilonidal cyst?
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I&D under local anesthesia w/removal of involved hairs.
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In young pts, what is the MCC of luminal obstruction of the appendix? Older pts?
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*Young --> lymphoid tissue hyperplasia
*Older --> fecalith |
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What is McBurney's point and what is it a +test of?
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*tenderness at 1/3 the distance from ASIS to umbilicus
*appendicitis |
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What is a very sensitive test in the dx of appendicitis?
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abdominal CT w/contrast
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How do elderly pts tend to present w/ appendicitis? They have a higher risk of _____ than in younger pts.
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*present atypically, leading to delay in dx; present later in the course & w/less pain, may present as SBO; delayed leukocytosis
*inc risk of perf & inc mortality than in younger pts |
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What is the MC condition requiring major abd sx?
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abdominal wall hernias
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What is the ratio prevalence between males & females developing hernias?
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male to female ratio is 7:1
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What is the MC hernia in males and females?
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indirect inguinal hernia
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How would you differentiate between a hydrocele and a hernia?
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transilluminate --> hernias will not light up
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What is an indirect inguinal hernia? They are b/l ____% of the time?
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*Herniation through the internal inguinal ring traveling to the external ring.
*33% (1/3) |
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Re: pediatric umbilical hernias, sx repair is indicated if which 3 conditions are met?
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1- the defect is >2 cm
2- child is >3-5 y/o 3- protrusion is disfiguring & disturbing to the child or parents |
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How does the liver get it's O2 supply? Where does the majority of its blood supply come from?
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*50% L&R hepatic arteries
*50% portal vein *75% portal vein *25% hepatic arteries |
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What should be the first test performed in all pts w/a suspicion of gallstones?
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u/s
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Jaundice is yellowing of the skin & sclera due to an elevation in total bilirubin > ______.
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2.5
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What are the S&S of obstructive jaundice?
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*yellow skin & sclera
*pruritis *may have hepatomegaly tenderness of RUQ, or signs of cirrhosis *dark urine *clay-colored stools *anorexia, nausea |
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In obstructive jaundice, the _____ level rises more quickly than the bilirubin level. Also, when obstruction is relieved, the _____ level falls more quickly than the bilirubin level.
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*Alkaline phosphatase (ALP)
*ALP |
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In the US, most hepatic abscesses (80%) are of ______ origin.
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bacterial
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What are some pyogenic risk factors for hepatic abscesses? Amebic risk factors?
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Pyogenic --> usually secondary to bacterial sepsis or biliary or portal vein infxn; can also occur from a perforated infected gallbladder cholangitis, diverticulitis, liver CA, or liver mets. Amebic --> pts from Central America, homosexual men, institutional pts and ETOH.
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80-90% of pts w/hepatocellular carcinoma have underlying ________. What is the most predominant type? (in the US)
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*cirrhosis
*ETOH cirrhosis |
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The MCC of portal HTN in the US is ______. The MCC outside North America is ______.
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*cirrhosis from ETOH
*schistosomiasis |
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What are the S&S of portal HTN?
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*ascites
*jaundice *splenomegaly *palmar erythema *spider angiomata *truncal obesity w/wasting of extremities *asterixis (flapping tremor) *hepatic encephalopathy |
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______ is the MC clinical finding in portal HTN.
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splenomegaly
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What are the Tx options for ascites?
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*decrease Na intake
*K+ sparing diuretic *abd paracentesis |
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85% of stones in the gallbladder are composed of primarily _______.
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cholesterol
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What is Charcot's triad?
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*jaundice
*RUQ pain *fever |
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Where is the MC site of obstruction in gallstone ileus?
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ileocecal valve
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_______ is an uncommon tumor that may occur anywhere along the intrahepatic or extrahepatic biliary tree. It is MC located at _______. Nearly all are ______.
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*cholangiocarcinoma
*@ the bifurcation of the R&L hepatic ducts (60-80% of cases) *adenocarcinomas |
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What are the 3 MC causes of acute pancreatitis in the US?
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*ETOH abuse (40-50%)
*Gallstones (40%) *Idiopathic (10%) |
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What are the two lab studies that should be ordered on a pt w/suspected pancreatitis?
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*lipase --> only found in gastric & intestinal mucosa & liver, in add to the pancreas --> more SPECIFIC
*amylase --> also found in salivary glands, sm bowel, ovaries, testes & skeletal muscle, so is not a specific marker for pancreatitis. |
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Which pain med should be avoided in acute pancreatitis? Why? Which should be used instead?
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*morphine
*possible spasm of the sphincter of Oddi *meperidine (Demerol) |
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What is the MCC of chronic pancreatitis? ______ are not a common cause of chronic pancreatitis.
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*ETOH abuse (70%)
*Gallstones |
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Which two things are associated w/chronic pancreatitis that may be seen on imaging?
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*pancreatic calcifications
*stones |
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Tumors of the pancreatic tail are usually unresectable b/c they are asymptomatic during growth & thus present @ a later stage. Why do tumors @ the head of the pancreas present earlier?
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b/c they cause biliary obstruction
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A 40 y/o male c/o chronic epigastric pain shortly following meals & notices needing increasing doses of his anti-ulcer med. What is the most likely dx?
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Gastrinoma
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What is a gastrinoma? It is aka ______. 90% are located where?
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*Neoplasm associated w/overproduction of gastrin
*Zollinger-Ellison syndrome *"gastrinoma triangle" |
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All protein hormones are produced in locations starting w/ P...
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*parathyroid
*pancreas *pituitary |
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What are the causes of hyperthyroidism? (6)
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*Graves' dz
*Toxic Nodular Goiter *Toxic thyroid adenoma *Subacute thyroiditis *Functional metastatic thyroid CA *Struma ovarii (abn thyroid tissue in ovary) |
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What are the causes of hypothyroidism?
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*Autoimmune thyroiditis
*Iatrogenic: s/p thyroidectomy, s/p radioablation, secondary to antithyroid meds *Iodine deficiency |
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What is the Tx if a pt presents in myxedema coma?
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Thyroxine po or IV emergently
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What are the 3 main bacteria that cause acute thyroiditis?
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*Strep pyogenes
*Staph aureus *Pneumococcus pneumoniae |
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______ is the MC type of thyroid CA, but ______ has the worst prognosis.
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*Papillary
*Anaplastic |
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What are the common S&S of hyperparathyroidism?
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*"Stones, bones, groans, & moans."
*kidney stones *bone pain, fxs *N/V/C, muscle pain, etc *lethargy, confusion, depression, paranoia |
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What is Cushing's syndrome? Name some causes.
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*excessive cortisol production
*iatrogenic administration of corticosteroids *pituitary tumor that secretes ACTH *ectopic ACTH secretion by tumor elsewhere *adrenal tumor that secretes cortisol |
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What is the MCC of Cushing's syndrome?
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iatrogenic administration of corticosteroids
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What is the MCC of ectopic ACTH production? 2nd MCC?
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*small cell lung CA (aka oat cell carcinoma)
*carcinoid tumors |
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What are some conditions associated w/rupture of the spleen?
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*malaria
*mono *blunt LUQ trauma *splenic abscess |
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The ______ is the MC injured organ in blunt abdominal trauma.
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spleen
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______ is the MC reason for splenectomy.
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trauma
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Which vaccine will be needed for pts undergoing splenectomy? When may it be given?
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*Pneumococcal
*May be given on the day of hospital d/c |
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When is it ideal to perform self breast exams?
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*@ the same time each month (one week after menstrual period)
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The smallest breast mass palpable on physical exam is ______.
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1 cm
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The MCC of a persistent breast mass after trauma is ______.
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fat necrosis
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______ is the development of female-like breast tissue in males. At least ___ cm of excess subareolar breast-tissue is required to make the dx.
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*gynecomastia
*2 |
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What are the side effects of hormonal therapy such as Tamoxifen?
|
Those that stimulate menopause:
*hot-flashes *irregular menses *thromboembolism *inc risk for endometrial CA due to selective hormone agonist action |
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What is the MCC of burn injuries? ___% may be treated as outpatient.
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*scalding
*80% |
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Incidence of burns is higher during ______. 75% of burn-related deaths can be attributed to ______.
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*winter months
*house fires |
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The risk of infection of burned tissue is increased b/c _______. The neoeschar and lack of vascularity limit _______.
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*the wound is protein rich & moist, and is thus a good culture medium
*ABX delivery |
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An increase in fluid requirements is necessary in which type of burn injuries?
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*high-voltage electrical
*inhalation *delayed resuscitation *intoxicated at time of injury |
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The MC compartment requiring fasciotomy is the ______ compartment.
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anterior tibial
|
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Burn pts are very prone to which type of infections?
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*PNA
*catheter-related infections |
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Carbon monoxide is a colorless, tasteless, odorless gas and has an affinity for Hgb ____x that of O2.
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200
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Which type of skull fx carries a much greater risk of underlying brain injury & complications, such as meningitis and post-traumatic seizures?
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depressed
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Recovery of cerebral concussion is often complete; however, residual effects such as ______ may last for some time.
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headache
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A 19 y/o male w/a head injury has LOC followed by a brief lucid interval. He presents to the ED in a coma, w/an ipsilateral fixed & dilated pupil and contra-lateral hemiparesis. What is the most likely dx?
|
Epidural hematoma
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______ is a collection of blood between the dura and the skull w/the majority associated w/tearing of the middle meningeal artery from an overlying temporal bone fx.
|
Epidural hematoma
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Describe a subdural hematoma.
|
Collection of blood below the dura and over the brain. Results from tearing of the bridging veins, usually secondary to an acceleration-decel mechanism.
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Diffuse patterns of coronary vessel obstruction, as can occur in diabetes, may not be amenable to ______.
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CABG
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_______ is the dx method of choice for peripherally located lung nodules. Most are _____ guided.
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*Transthoracic needle bx (TNB)
*CT |
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What is the MC site for acute osteomyelitis?
|
*the metaphyseal end of a single long bone (esp around the knee)
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