Term
| what is a vericocele, where is the location |
|
Definition
dilation of pampinform plexus of testicle
more common on left becuse the vessel goes all the way up to the renal vein
(if on right is more likley a tumor)
90% unilateral |
|
|
Term
| how are varicoceles graded |
|
Definition
grade I: palpable with valsalva (feels like bag of worms)
grade II: palpable w/o valsalva
grade III: visible |
|
|
Term
| how do you treat a bile duct injury caused by laproscopic cholecystectomy |
|
Definition
| primary repair with T tube and drainage |
|
|
Term
|
Definition
| elevated DeMeester score on Bravo Probe or proved reflux esophagitis |
|
|
Term
| what are the 7 testicular neoplasms and their prevalence |
|
Definition
seminoma 35%
embryonal cell 20%
teratoma 5%
mixed cell 40%
lymphoma
leukemia
metastic |
|
|
Term
| what is the most common testicle tumor under 50yo |
|
Definition
| mixed cell: teratoma and embryoma |
|
|
Term
| what age does seminoma show up |
|
Definition
|
|
Term
| what age does embryonal cell testicular neoplasm show up |
|
Definition
|
|
Term
| what age does teratoma show up |
|
Definition
|
|
Term
| what is the most common testicular tumor >50yo |
|
Definition
|
|
Term
| who gets testicular leukemia most often |
|
Definition
|
|
Term
| 3 cancers that metastasize to the testicle |
|
Definition
|
|
Term
| origin of autonomic errection center |
|
Definition
|
|
Term
| what are the 5 nerve centers that innervate the penis |
|
Definition
autonomic errection center
cavernous nerves
somatic motor nerves
parasympathetic tumescence
sympathetic detumencence |
|
|
Term
| origin of the somatic motor nerves of the penis |
|
Definition
|
|
Term
| male sexual dysfunction prevalence |
|
Definition
|
|
Term
| 4 types of male sexual dysfunction |
|
Definition
impotence
premature ejaculation
retrograde ejaculation
retarded ejaculation |
|
|
Term
| 2 activities less exerting than intercourse and 2 that are more, and 1 that is same |
|
Definition
less: light housework, walking
same: gardening
more: golf, lifting |
|
|
Term
| how can you tell if sexual dysfunction is a psych issue or physiological |
|
Definition
| if they get nocturnal penile tumescence (errection) its psych |
|
|
Term
| contraindications to viagra 7 |
|
Definition
nitrates
recent MI, stroke, arrhythim in 6mo
resting BP <90/50
unstable angina
retinitis pigmentosa |
|
|
Term
|
Definition
| stone in collecting tubule that passes into calyces, renal pelvis, ureter due to supersaturated urine |
|
|
Term
| what is the number one cause of nephrolithiasis |
|
Definition
|
|
Term
| what is the 3rd most common affliction of urinary tract |
|
Definition
nephrolithiasis
240000-720000 have kidney stone each year |
|
|
Term
| what is the most important urinary stone type, how is it made |
|
Definition
oxalate/calcium caliculi: build up due to phosphoric acid in pop
supersaturation of urine with Ca and oxylate
stones form on tip of renal papillae as yellow plaque |
|
|
Term
| risk factors for calcium caliculi 4 |
|
Definition
low urine volume
hot temperature
increased Ca absorption from SI
hyperparathyroidism |
|
|
Term
| absorptive hypercalcuric nephrolithiasis: cause and TX |
|
Definition
increased Ca absorption in SI increases urinary Ca
TX limit Ca intake |
|
|
Term
| what are the only urinary stones that can be dissolved, how |
|
Definition
uric acid (non calcium caliculi)
stone forms from low urinary pH so raising pH >6 (alkaline therapy) cause dissolution |
|
|
Term
| if someone has non localized flank pain where is their urinary stone |
|
Definition
caliceal caliculi obstructs infundibulum
small caliculi are non obstructive but can still be symptomatic |
|
|
Term
| if someone has localzied flank pain where is their urinary stone |
|
Definition
|
|
Term
| if someone has sharp intermittent flank pain where is their urinary stone |
|
Definition
|
|
Term
| if someone has pain along inguinal canal to groin where is their urinary stone |
|
Definition
|
|
Term
| if someone has frequency, urgerncy, retention where is their urinary stone |
|
Definition
|
|
Term
|
Definition
ALL 3 needed
flank pain
fever and chills
bacteria |
|
|
Term
| 3 types of work up for UTI which is the best, why |
|
Definition
suprapubic aspiration: most accurate
straight cathed specimen: good results, best choice for most
bagged specimen: poor results, little benifit, unneeded expensive work up |
|
|
Term
|
Definition
| fever, irritability, dysuria, suprapubic pain |
|
|
Term
| non-specific signs of UTI 4 |
|
Definition
poor feeding
weight loss
vomiting
diarrhea |
|
|
Term
|
Definition
| fever and irritability with unidentified source |
|
|
Term
| 5 malignant tumors of the kidney, which is most common |
|
Definition
renal cell carcinoma 85%
metastic
lymphoma
onchocytoma
wilms |
|
|
Term
| 3 causes of bladder carcinoma, which is most common |
|
Definition
smoking #1 (just like kidney cancer)
occupational: dye, auto parts
infection/virus |
|
|
Term
|
Definition
|
|
Term
| clinical findings of prostate cancer 7 |
|
Definition
PSA >4 30% chance cancer
PSA rise of >1 per year
prostate nodule
asymptomatic
biopsy positive
gleason score positive
bone scan positive (at gleason 8-10 and PSA>10, later in disease) |
|
|
Term
| treatment of stress urinary incontinance 7 |
|
Definition
behavorial modification
pelvic floor exercises
medications
devices
bulking agents
surgery
artificial urinary sphincter |
|
|
Term
| 2 surgeries of stress urinary incontinence |
|
Definition
suspension: reinforce/strengthen existing structures
sling: use new structure to make support system (synthetic mesh can grow into urethre watch out) |
|
|
Term
| treatment of urge incontinence 3 |
|
Definition
behavior modification
medication
pelvic floor exercises |
|
|
Term
| most common obstructive urethral lesion in infants and newborns |
|
Definition
|
|
Term
| posterior urethral valve: cause, location, appearance |
|
Definition
congenital
distal prostetic urethra
mucosal folds that look like membranes |
|
|
Term
| posterior urethral valve: sighs |
|
Definition
obstruction (mild to severe)
palpable bladder distension
CR and BUN elevation (indicators of renal failure |
|
|
Term
|
Definition
urethral meatus on ventral side due to incomplete fusion of urethral folds often due to estrogen or progesterone given in pregnancy
causes hooded foreskin |
|
|
Term
| classifications of hypospadius 8 (in order from pepuce to testicle), which is most common |
|
Definition
glandular 50% LOTS!
subcoronarl LOTS!
distal penile
midshaft
proximal penile
penoscrotal
scrotal
perineal |
|
|
Term
| which hypospadius are considered anterior |
|
Definition
|
|
Term
| which hypospadius are considered middle |
|
Definition
distal penile
midshaft
proximal penile |
|
|
Term
| which hypospadius are considered posterior |
|
Definition
penoscrotal
scrotal
perineal |
|
|
Term
| interstitial cystitis: who gets it |
|
Definition
|
|
Term
| interstitial cystitis: morphological changes 4 |
|
Definition
bladder fibrosis
capacity 60mL
punctuate hemorrhagic area
hunners ulcer |
|
|
Term
| interstitial cystitis: 3 symptoms |
|
Definition
suprapubic pain
severe frequency
relieved upon voiding |
|
|
Term
| interstitial cystitis: why is there pain |
|
Definition
| when bladder fills it pushes on fibros |
|
|
Term
| interstitial cystitis; TX 3 |
|
Definition
oversistension
DMSO irrigation
elmiron oral |
|
|
Term
|
Definition
| bedwetting >3yo due to delayed maturation of nervous system |
|
|
Term
| ages common for enuresis and prevalence |
|
Definition
6yo 10%
14yo 5%
most gain control at 10yo |
|
|
Term
|
Definition
fluid restriction
voiding before bed
alarm clock
imipramine at HS
DDAVP andiduiretic |
|
|
Term
|
Definition
nocturia
uregency
frequency
UTI
incomplete bladder emptying (urinary retention)
overflow incontinence |
|
|
Term
|
Definition
bladder calciuli
UTI
renal failure
hematuria
loss of bladder function |
|
|
Term
| what is the DOC for BPH and the MOA |
|
Definition
a-adrenergic receptor antagonists
block a1 an a1 receptors |
|
|
Term
| where are a1 recetptors targeted in BPH treatment 2, how does antagonism cause effect |
|
Definition
prostate capsule and bladder neck
mediate muscle tone |
|
|
Term
| where are a2 recetptors targeted in BPH treatment, how does antagonism cause effect 3 |
|
Definition
outside urinary tract
cause SE: hypotension, dizziness, nasal secretion |
|
|
Term
|
Definition
|
|
Term
| what BPH drug has the least retrograde ejaculation |
|
Definition
| uroselective a1 antagonist alfuzosin |
|
|
Term
| when treating for BPH why is the PSA not accurate marker of progress |
|
Definition
| because it will decrease by half due to medicine |
|
|
Term
| what is the total body water of a premature infant, full term neonate, and averge adult |
|
Definition
preterm; 90%
full term: 80%
adult: 60% |
|
|
Term
| what percent of total body weight is total body water, intracellular fluid, extracellular fluid, plasma |
|
Definition
TBW 60%
ICF 40%
ECF 20%
plasma 4.3% |
|
|
Term
| what is the intracellular fluid composed of |
|
Definition
|
|
Term
| what is the extracellular fluid composed of |
|
Definition
interstitial fluid 75% ECF
plasma volume 25% ECF |
|
|
Term
| what are the 4 regions of the urethra |
|
Definition
penile or spongy
membranous
pre-prostatic
prostatic |
|
|
Term
| explain the 4-2-1 rule for fluid replacement |
|
Definition
4mL fluid/kg for 1st 10kg
2mL fluid/kg for 2nd 10kg
1mL fluid/kg for rest |
|
|
Term
| extrinsic clotting pathway: what triggers it, explain the pathway |
|
Definition
tissue factor released by trauma converts VII > VIIa
VIIa converts X > Xa
Xa converts prothrombin > thrombin
thronbin converts fibrinogen to fibrin |
|
|
Term
| how is the extrinsic clotting pathway monitored, what is normal |
|
Definition
PT normal 14sec
INR normal 1.0 |
|
|
Term
| what drug affects the extrinsic clotting pathway and how |
|
Definition
| warfarin stops vitamin K dependent clotting factors (II, IV, IX, X, protein C, protein S) |
|
|
Term
| how is warfarin activity monitored |
|
Definition
|
|
Term
|
Definition
|
|
Term
| indications for warfarin treatment 3 |
|
Definition
atrial fibrillation
DVT/PE
mechanical cardiac valve |
|
|
Term
| blood transfusion related injuries 6 |
|
Definition
ABO incompatability
transfusion related acute lung injury
sepsis from bacterial infection
massive transfusion complications
transfusion related circulatory overload
DIC - consumptive coagulopathy/hypercoaguability |
|
|
Term
| universal blood donor type |
|
Definition
|
|
Term
| ABO incontability: timing, what to monitor for 3 |
|
Definition
occurs immediatly up to 7d post transfusion
monitor urine output, K levels, coagulation (possible DIC) |
|
|
Term
| transfusion related acute lung injury: caue, timing, appearance and clinical signs |
|
Definition
frequent with PRBC but can occur with any blood product
usually begins 6h after transfusion
clinical signs like ARDS
causes noncardiogenic pulmonary edema |
|
|
Term
| transfusion related acute lung injury: treatment and prognosis |
|
Definition
supportive treatment
8% mortality |
|
|
Term
| what is transfusion related circulatory overload |
|
Definition
| too much fluid too fast and it leaks out of orifaces (esp lungs) |
|
|
Term
|
Definition
| sepsis, amniotic fluid embolism, trauma, transfusion |
|
|
Term
|
Definition
| anticoagulation (even though clotting factors exausted) |
|
|
Term
| 100kg male scheduled for CABG. calculate his blood volume |
|
Definition
100kg x 7% = 7L
100kg x 70mL/kg = 7000mL = 7L |
|
|
Term
| 50kg female patient that has no NPO for elective right knee arthroscopy. calculate TBW, ICF, ECF, blood volume |
|
Definition
TBW 60% 30L
ICF 40% 20L
ECF 20% 10L
BV 7% 3.5L |
|
|
Term
| 145lb female weight kg and hourly maintenance fluids |
|
Definition
145/2.2 = kg
then follow 4-2-1 rule |
|
|
Term
| 100kg male in exploratory laporotomy for 4h. NPO for 18h, EBL 100mL, loss 10mL/kg/hr. what are hourly maintenance fluids, fluids needed to replace EBL, fluids needed to replace insensible losses, total fluid while in OR |
|
Definition
140ml/h
1500ml crystalloid or 500ml colloid
4L
8.5L |
|
|
Term
| what is insensible evaporative loss |
|
Definition
| up to 20ml/kg/hr for large open abdominal surgery |
|
|
Term
|
Definition
blood replacement
3mL crystalloids per 1mL EBL
colloid 1mL per 1mL EBL |
|
|
Term
| 5 considerations for maintenance fluids |
|
Definition
NOP status
maintenance fluid
blood loss EBL
evaporative loss
insensible loss |
|
|
Term
|
Definition
cholelithiasis
cholecystitis
cholangitis
cirrhosis
hepatitis
fritz hugh curtis syndrome
leukemia
GERD
gastritis
PUD
esophagitis
gastroparesis
gastric outlet obstruction
gastric cancer
esophageal cancer
pneumonia
pulmonary emboli
bronchiectasis
nephrolithiasis
pyelonephritis
hydronephrosis
renal cancer
DKA
pancreatitis
pancreatitc cancer
addisons crisis
adrenal TB
lymphoma
budd chiari
CHF |
|
|
Term
| what areas can GERD causes pain |
|
Definition
epigastric
RUQ
nausea and emesis |
|
|
Term
|
Definition
diverticulitis
gastroenteritis
IBS
acute appendicitis
small bowel obst
meckel diverticulitis
mesenteric adenitis
IBD
large bowel obst
constipation
colonic volvulus
food poisoning
UTI
cystitis
urosepsis
uremia
nephrolithiasis
PID
uterine fibroid
ectopic pregnancy
adenomyositis
endometrosis
ovarian cystic disease
pelvic congestion syndrome
hernia
muscle strain
muscle spasm
myositis
abnormal aortic anrueysm
aortic dissection |
|
|
Term
| when do most congenital abnormalities of the limbs happen and why |
|
Definition
| 4-8wk because this is major time of limb growtn in embryogenesis between limb development and hand plate development |
|
|
Term
|
Definition
| interdigital cleft does not regress so fingers remain attached |
|
|
Term
| syndactyly: types and the difference |
|
Definition
simple: some regression, some finger differentation
complete: no regression, no finger differentation |
|
|
Term
| bradysyndactyly definition |
|
Definition
| small fingers without regression of web |
|
|
Term
| poland syndrome definition |
|
Definition
| absence of pectoral muscles, subclavicular depression, brachysyndactyly |
|
|
Term
| what is the biggest worry in a minor finger laceration |
|
Definition
digital arteries are lateral to digital nerve
if small laceration to digital artery causes pulsitile bleed means 90% chance cut digital artery too |
|
|
Term
| what is the most common injury of the hand and what diagnosis is it often associated with |
|
Definition
| nail bed laceration: associated with distal phalynx (tuft) fracture |
|
|
Term
| what layer of skin has nerves and vessels |
|
Definition
|
|
Term
| where on the hand are we more worried about digital nerve and artery laceration |
|
Definition
| more proximal than distal |
|
|
Term
| what 2 flexor tendons are on all fingers but thumb |
|
Definition
flexor digitorum superificialis
flexor digitorum profundus |
|
|
Term
| what 1 tendon is on the thumb |
|
Definition
|
|
Term
| what injury is worse than fracture in finger |
|
Definition
| flexor tendon injury because they dont heal fast and scar tissue causes stuffness |
|
|
Term
|
Definition
| refer to hand surgeon ASAP, requres surgery within 2wks because tendons snap back and shorten too much for repair |
|
|
Term
| which joint does flexor pollucus longus move if you isolate |
|
Definition
|
|
Term
| what joint does flexor digitorum superificialis move if you isolate |
|
Definition
|
|
Term
|
Definition
football player grabs jersey while other player is running and leads to avulsion of flexor digitorum profundus
DIP was forced in active flexion
can sometimes take some bone with it |
|
|
Term
|
Definition
| needs to be repaired within a week or tendon could regress too far (better prognosis if it ripped off bone because it cannot regress as much) |
|
|
Term
| what is most common closed tendon injury of finger |
|
Definition
| extensor tendon injury (mallet finger) |
|
|
Term
|
Definition
tucking in sheet, ball it tip of finger
extensor tendon at DIP is trying to stay extended but it is forced to bend |
|
|
Term
|
Definition
not emergency, extensor tendon connected by junction tendon, keep shaped and form scar tissue on straight finger
take to surgery if fits indications |
|
|
Term
| indications of mallet finger surgery |
|
Definition
avulsion fracture or sublexating
avulsion >30% joint involved
inability to get passive full extension
SWAN NECK DEFORMITY: hypertextension of PIP and flexion of DIP |
|
|
Term
| what is the most common finger dislocation |
|
Definition
| coach's finger/jammed finger/PIP joint |
|
|
Term
| coach's finger: appearance, diagnosis |
|
Definition
| volar plate injury (soft tissue) or avulsion fracture of middle phalanx due to DORSAL DISLOCATION, ALWAYS REQUEST 3 X-RAY VIEWS |
|
|
Term
| what is the most common metacarpal bone fracture |
|
Definition
|
|
Term
| pathogenesis of boxers fracture |
|
Definition
distal fragment displaces at volar angle due to action of interosseous muscle
neck of 5th metacarpal with dorsal angulation
can cause rotation, cross over, or hyperextension deformity |
|
|
Term
|
Definition
up to 40 deg angulation can have reduction (jhass reduction)
but greater needs fixation with wires |
|
|
Term
| explain jhass reduction maneuver |
|
Definition
make fist and pushh on head to proximal phalangeal joint
it pushes distal fracture segment back and other hand puts pressure on shaft of metacarpal
need to do ASAP weeks later wont work, follow with ulnar gutter splint |
|
|
Term
| carpal tunnel pathogenesis |
|
Definition
| compression neuropathy of median nerve due to repeated movment, wrist flexion, CONGENITAL NARROW TUNNEL, trauma, fluid, pregnancy, RA, cyst |
|
|
Term
|
Definition
infection causes fibrous bands that attach skin to bone (so when you hold stuff skin dosent move)
if not relieved causes necrosis, will need surgery and drainage, antibiotics not enough |
|
|
Term
| infectious pyogenic flexor tenosynovitis signs 4 |
|
Definition
kanavels signs:
finger partially flexed
pain with passive extension
flusiform or diffuse swelling on affected finger (sausage finger)
tenderness over course of affected tendon (even when not visible inflammed) |
|
|
Term
| what is the most common joint of osteoarthritis in the hand |
|
Definition
|
|
Term
| what is the most common autoimmune disorder of the upper extremity |
|
Definition
|
|
Term
| what are the most common hand tumors |
|
Definition
| benign ganglion cyst or benign lump |
|
|
Term
|
Definition
intermittent severe pain
point tenderness
cold intolerance
sublingual bluish discoloration on nail ridge
single or multiple lesions |
|
|
Term
| what is the most common malignant tumor of hand and nailbed |
|
Definition
|
|
Term
| SCC hand and nailbed: prognosis, age, signs |
|
Definition
agressive local infiltration 5-28% metastasis
60yo
subungal or perionchial wart like tumor, large ulceration, exophytic lesion |
|
|
Term
|
Definition
| percipitation of monosodium urate crystals in joint or tendon sheath causes acute inflammatory reaction, swelling, erythema, pain |
|
|
Term
| gouty tensosynovitis: signs |
|
Definition
| presents lik arthritis, infection, RA, neoplasm, digital triggering, CTS, tendon rupture |
|
|
Term
|
Definition
gouty tensonobitis
gout trophy
hyperuricemia
white chalk seeps through skin laceration |
|
|
Term
|
Definition
| skin compormise, contracture, ulceration, tendon rupture |
|
|
Term
|
Definition
NSAID DOC FOR TX OF FLARE
chlochicine and NSAID for flare
surgical debridement |
|
|
Term
| what is the most common source of emboli to the heart |
|
Definition
|
|
Term
|
Definition
| ischemia and necrosis in smoker (thromboangitis obliterans) |
|
|
Term
| hypodermal syndrome: cause |
|
Definition
| occlusion of ulnar artery in manual workers |
|
|
Term
| diagnosis of vascular diseases of the hand and arm |
|
Definition
always check heart
allens test: make fist, occlut both arteries, release one at a time (should fill in <5sec) |
|
|
Term
| signs of acute vascular disease of upper extremity |
|
Definition
acute finger tip necrosis
often in ICU patient |
|
|
Term
| definition of abdominal/visceral pain |
|
Definition
| sudden onset pain, tenderness, that will not go away on its own and usually needs emergency surgery |
|
|
Term
| how can you tell there has been a GI perforation 3 |
|
Definition
air on x-ray under diaphragm
rigid abdomen
emergent |
|
|
Term
| 4 causes of GI perforation |
|
Definition
gastrointestinal ulcer
gastrointestinal cancer
boerhaave syndrome
perforated diverticulum |
|
|
Term
| cholelithiasis: risk factors 8 |
|
Definition
more with age
women
native american
obesity
multiparity
rapid weight loss
oral contraceptives
TPN chrons |
|
|
Term
|
Definition
cholesterol
pigmented 20%
mixed 75% |
|
|
Term
| 2 types of pigmented cholelithiasis and where they are located |
|
Definition
black: from sterile bile within gallbladder
brown: from infected bile duct, soft |
|
|
Term
| cause of black cholelithiasis |
|
Definition
cirrhosis
hemolytic disease |
|
|
Term
| cause of brown cholelithiasis |
|
Definition
|
|
Term
| what labs indicate cholelithiasis |
|
Definition
ALP+GGT > AST+ALT
ALP is made in biliary epithelium and bone
GGT if elevated with ALP means biliary not bone
AST+ALT are made in hepatocytes and will be increased but not as much |
|
|
Term
| 6 ways to diagnose cholelithiasis |
|
Definition
x-ray
ultrasound
hida scan
CT scan
MCRP
ECRP |
|
|
Term
| effectiveness of x-ray in cholelithiasis diagnosis |
|
Definition
| only 10% of gallstones have enough Ca to see |
|
|
Term
| effectiveness of ultrasound in cholelithiasis diagnosis |
|
Definition
study of choice
95% sensitive and specific
reveals stones from 3mm
limited in aveluating choledocholithiasis |
|
|
Term
| MOA and interpertation of HIDA scan in cholelithiasis diagnosis |
|
Definition
inject techenium labeled imidodiacetic acid which goes into hepatocyte then is excreted in bile then duodenum
if GB does not fill in 1h (normal 30min) but the CBD and duodenum then it is acute cholecystitis
if marker shows in extra biliary location pt has biliary tree injury |
|
|
Term
| effectiveness of CT scan in cholelithiasis diagnosis |
|
Definition
low sensitivity for cholithiasis
expensive
detect level and etiology of biliary obstruction |
|
|
Term
| effectiveness of MCRP in cholelithiasis diagnosis |
|
Definition
expensive, non-invasive
evaluate for choledocholithiasis! |
|
|
Term
| MOA of ECRP in cholelithiasis diagnosis |
|
Definition
invasive, needs anesthetic
ampulla of vater is accessed endoscopically
contrast injected into biliary tree
stones if identified removed
biopsies and brushing sobtained |
|
|
Term
| tx of asymptomatic cholelithiasis |
|
Definition
| if stones found incidently 1-2% pt will get symptoms so prophylactic cholecystectomy not needed, wait until symptoms develop to do surgery |
|
|
Term
| signs of chronic cholecystitis |
|
Definition
biliary colic
no murphys sign (peritoneal irritation)
no infection: normal temp, WBC, liver function tests |
|
|
Term
| preferred diagnosis method of chronic cholecystitis |
|
Definition
|
|
Term
|
Definition
severe constant pain in RUQ that radiates into back
brought by spicy/fatty food, lasts hours, then resolves
due to contraction of GP against stone in CYSTIC DUCT |
|
|
Term
| cause of acute cholecystitis |
|
Definition
| sustained block of cystic duct causes progressive peritonitis |
|
|
Term
| sighs of acute cholecystitis 7 |
|
Definition
Psoas sign; epigastric RUQ pain radiating to back
nausea, emesis, fever, gaurding, rebound tenderness
murphys sign; arrested inspiration qith RUQ pressure due to peritoneal irritation |
|
|
Term
| acute cholecystitis lab signs 5 |
|
Definition
high leukocytes, left shift
elevated bilirubin, AST, ALT, ALP |
|
|
Term
| ultrasound findings in acute cholecystitis 3 |
|
Definition
| GB wall thick >3mm, pericholecystic fluid, distension |
|
|
Term
| HIDA scan findings in acute cholecyststis |
|
Definition
| GB not visualized until 4h |
|
|
Term
| treatment of acute cholecystitis |
|
Definition
symptoms <3d: antibioics, laproscopic cholecystectomy
symptoms >3d: antibiotics, analgesic, schedule for interval cholecystectomy in 4-6wk
(decreases complications) |
|
|
Term
| what is choledocholithiasis and cholangitis |
|
Definition
| infection of the common bile duct |
|
|
Term
| symptoms choledocholithiasis 2 |
|
Definition
intermittent jaundice
episodes of biliary colic |
|
|
Term
| symptoms acute cholangitis 4 |
|
Definition
charcots triad: RUQ pain, jaundice, fever
reynolds pentad later: mantal status change and hemodynamic instability |
|
|
Term
| how is choledocholithiasis and cholangitis diagnosed 5 |
|
Definition
liver enzymes
WBC
ultrasound
MCRP
ECRP |
|
|
Term
| changes in liver ensymes and WBC in choledocholithiasis and cholangitis 9 |
|
Definition
increased ALP, GGT, AST, ALT
direct and total bilirubin
amalyase, lipase
WBC left shift |
|
|
Term
| choledocholithiasis and cholangitis ultrasound signs |
|
Definition
| see if stone is causing obstruction because duct will be dilated (not helpful if no obstruction) |
|
|
Term
| choledocholithiasis and cholangitis MCRP signs |
|
Definition
| identify the biliary anatomy including site and origin of obstruction |
|
|
Term
| choledocholithiasis and cholangitis ECRP signs |
|
Definition
| same as MCRP but can remove stone |
|
|
Term
| choledocholithiasis and cholangitis management 3 |
|
Definition
if detected before elective removal: remove via ECRP before surgery or laproscopically at surgery (not as safe)
if removal of stones laproscopically at time of GB
if has cholangitis: emergent drainage of biliary tree, broad spectrum antibiotics, hydration, analgesia |
|
|
Term
| complications of cholangitis |
|
Definition
| pt typically develops ileus (no movement of intestine) after treatment so NG suction is needed |
|
|
Term
| choledocholithiasis and cholangitis prognosis |
|
Definition
15% pass stone through cystic duct into CBD and into duodenum without issue
rest get stuck causing significant morbidity |
|
|
Term
| gallstone pancreatitis: cause 2 |
|
Definition
|
|
Term
| gallstone pancreatitis: pathogenesis |
|
Definition
| passage of stone through cystic duct into CBD where it gets lodged in ampulla of vater causing ductal HTN and injury of pancreas a liver |
|
|
Term
| gallstone pancreatitis: diagnosis 6 |
|
Definition
increased amalyase, lipase, ALP
epigastric pain radiatinig into back
nausea and emesis |
|
|
Term
| gallstone pancreatitis: treatment |
|
Definition
volume rescusitation
antibiotics if severe
surgery done before leaving hospital
**if stone passes spontaneously and pt improves then they are taken for GB removal with or w/o cholangiogram and removal of stones
**if stone does not pass then pt is taken for ECRP with removal of stone and stent placement |
|
|
Term
|
Definition
erosion of large stone through GB into intestine causes cholecystoentric fistula
stone passes to most narrow point at terminal ileum |
|
|
Term
| gallstone ileus: symptoms |
|
Definition
| typical bowel obstruction complaints |
|
|
Term
| gallstone ileus: signs on x-ray |
|
Definition
SBO and AIR IN BILIARY TREE
GS in RLQ if stone has enough calcium |
|
|
Term
| gallstone ileus: treatment 2 |
|
Definition
healthy pt: remove stone via enterotomy/cholecystectomy and repair fistula
elderly/comorbid: remove stone with cholecystectomy, fistula repair |
|
|
Term
| cause of bile duct injury 2 |
|
Definition
>90% iratogenic as result of sirgery
75% occur in laproscopic cholecystectomy |
|
|
Term
| bile duct injury symptoms 3 |
|
Definition
post op pt with jaundice, abd pain
bilious output from surgical drain or sepsis |
|
|
Term
| bile duct injury prognosis |
|
Definition
minor leak from accessory duct will usually heal spontaneously with drainage of fluid and collection alone
cystic duct injury is usually treated with drainage and ECRP with stenting |
|
|
Term
| treatment of major bile duct injury with no significant loss of length discovered in operation |
|
Definition
| avulsion, devascularization, then primary repair |
|
|
Term
| treatment of major bile duct injury long length discovered in operation |
|
Definition
| slvulsion, devascularization, repair with biliary enteric anastamosis |
|
|
Term
| treatment of major bile duct injury post operation |
|
Definition
| reconstruction is delayed until anatomy has defined, bile leak controlled, sepsis resolved |
|
|
Term
| 2 tools used in major bile duct reapir and why |
|
Definition
clip: used when you clip the bile duct
choledochojyunstomy; drain common duct into jejunum |
|
|
Term
| 10 caues of acute abdomen hemorrhage |
|
Definition
solid organ trauma
leaking or ruptured arterial anrueysm
GI bleeding diverticulum
AV malformation of GI tract
intestinal ulceration
aortoduodenal fistula after aortic vascular grat
hemorrhagic pancreatitis
mallory weiss syndrome
spontaneous rupture of spleen |
|
|
Term
| what normally causes appendiciits |
|
Definition
always acute
fecalith causes obstruction of lumen |
|
|
Term
| treatment of bile duct injury if occurs in laproscopic cholecystectomy |
|
Definition
| do primary repair with T tubule and drain |
|
|
Term
| WHAT IS THE MOST COMMON HERNIA IN MEN AND WOMEN |
|
Definition
|
|
Term
| WHAT IS A SPIGELIAN HERNIA |
|
Definition
| OCCURS THROUGH SEMILUNAR LINE LATERAL TO RECTUS MUSCLE |
|
|
Term
| WHAT IS THE CAUSE OF ACUTE APPENDICITS |
|
Definition
| FECALITH CAUSES OBSTRUCTION OF LUMEN |
|
|
Term
|
Definition
| DEMEESTER SCORE ON BRAVE PROBE STUDY OR PROVEN REFLUX ESOPHAGITIS |
|
|
Term
| WHAT IS THE BEST METHOD OF DIAGNOSIS FOR GALLSTONE ILEUS |
|
Definition
|
|
Term
| HOW IS A DUODENAL ULCER PERFORATION TREATED |
|
Definition
| GRAMS PATCH WITH TRUNCAL VACOTOMY IF INDICATED |
|
|
Term
| what are the 4 areas of the stomach and their function |
|
Definition
cardia: most proximal portion adjacent to esophagus
fundus: accomodation (receptive relaxation, has gastric pacemaker which initiates motor activity)
body: storage and peristaltic grinding of food against closed pylorus
antrum: most distal portion, has pylorus (controls rate of gastric emptying and prevents duodenal reflux |
|
|
Term
| 5 parts of duodenum and their function |
|
Definition
duodenal bulb
descending (2nd): intense pacemaker, site of bile and pancreatic secretion entry into GI tract
transverse(3rd)
ascending (4th)
terminates into jejunum at ligament od treitz |
|
|
Term
| what causes peptic ulcer disease |
|
Definition
H, pylori and nsAIDS alter balance between protective and harmful elements of gastric enivornment leading to ulcers
tobacco and alcohol are risk factors |
|
|
Term
| signs of peptic ulcer disease 4 |
|
Definition
epigastric pain radiating into back
gnawing pain
associated with food intake
causes anorexia and weight loss |
|
|
Term
| signs of perforated ulcer and why |
|
Definition
| severe upper abdominal pain due to free air in peritoneal cavity |
|
|
Term
| repair of perforated ulcer in OR |
|
Definition
|
|
Term
| signs of gastric outlet obstruction 2 and cause |
|
Definition
| nausea, emesis, caused by scarring from ulcer |
|
|
Term
| tx of gastric outlet obstruction 4 |
|
Definition
NG decompression
parenteral nutrition
NPO
after recussitation take to OR for surgical resection |
|
|
Term
| tx of peptic ulcer disease |
|
Definition
surgery for bleeding, obstruction, perforation or malignancy
if refractive to antibiotics and acid supression do vagotomy and pyloroplasty |
|
|
Term
| what is vagotomy and pyloroplasty |
|
Definition
| stomach has vagal input transected leading to non relaxing pylorus then pyloroplasty is done |
|
|
Term
| signs and symptoms of acute pancreatitis 7 |
|
Definition
severe upper abdominal pain radiates into back
exacerbated by laying flat, improved with sitting or standing
nause and vomiting
upper abdominal tenderness
gaurding
rebound tenderness |
|
|
Term
| signs of herorrhagic pancreatitis 3 |
|
Definition
Grey-turner sign: bleed may track along retroperitoneal tissue causing ecchymosis of flank
cullen sign: umbilicus
fox sign: inguinal canal |
|
|
Term
| lab signs showing acute pancreatitis 12 |
|
Definition
leukocytosis
amaylase
lipase
if severe: LFT, BUN, CR, hypocalcemia, hyperglycemia
CT: preferred, sensitive to peripancreatic fluid, pancreatic edema, necrosis
ultrasound: consider to evaluate for gall stones |
|
|
Term
| who is appendicitis more comon in |
|
Definition
|
|
Term
| why do you always need to do all tests for appendicits and not just one |
|
Definition
| if lying in pelvis it is on obturator muscle but if in other positions obturator test wont show positive |
|
|
Term
| complications of appendicitis 4 |
|
Definition
carcinoid tumor of appendix
adenocarcinoma of cecum
perforation
abscess |
|
|
Term
| what is a strangulated hernia |
|
Definition
| herniated tissue has compressed its blood supply and the herniated tissue will most likely become necrotic |
|
|
Term
| what is the most common hernia in men and women |
|
Definition
|
|
Term
| indirect inguinal hernia cause |
|
Definition
bowel,omentum, or intraabdominal organ protrudes through deep inbuinal ring lateral to inferior epigastric vessels
congenital lesion related to patent processus vaginalis which predisposes to the hernia
anticedent event causes it (heavy lifting) |
|
|
Term
| what is a direct inguinal hernia |
|
Definition
protrudes directly through center og hesselbach's triangle medial into inferior epigastric vessels
acquired lesion and more common in older men |
|
|
Term
| what is a spigelian hernia |
|
Definition
| through semilunar line lateral to rectus muscle at junction with like of douglas |
|
|
Term
| what percent of body weight is solids |
|
Definition
|
|
Term
| what percent of average body weight is adipose |
|
Definition
|
|
Term
|
Definition
fluid overload
end stage renal patients
CHF patients |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| where are most cations found |
|
Definition
| 98% in the intracellular fluid |
|
|
Term
| 3 effects of hyperkalemia |
|
Definition
muscle
peaked T waves on EKG
CBIGK |
|
|
Term
|
Definition
weakness
leg cramps
U waves on EKG |
|
|
Term
| how much fluid is lost from the skin, lungs, urine/kidney, GI/intestines |
|
Definition
skin 600mL/d
lungs 400mL/d
urine/kidneys 1500mL/d
GI/intestines 100mL/d |
|
|
Term
| how is total blood volume determined |
|
Definition
| RBC volume 2% + plasma volume 5% = 7% |
|
|
Term
| how many does does the blood circulate through the body perminute |
|
Definition
|
|
Term
| how is the intrinsic coagulation pathway monitored, what is normal |
|
Definition
|
|
Term
|
Definition
strong acid indirectly binds antithrombin 3 (AT3)
accelerated AT3 interacton to neutralize factors II, IX, X, XI, XII, XIII |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| direct thrombin inhibitor |
|
|
Term
|
Definition
|
|
Term
|
Definition
citrate, phosphate, dextrose-adenine,
HCT 75% |
|
|
Term
| how does packed RBC affect the body |
|
Definition
| one unit PRBC increases Hb by 1g/dL or HCT by 30% |
|
|
Term
| normal lifespan of platelet, normal platelet count, level of platelets that causes spontaneous bleeding |
|
Definition
life 7-10d
level 140,000 - 400,000
bleeding <20,000 |
|
|
Term
| how does fresh frozen plasma affect the body |
|
Definition
due to liable clotting factors V and VIII
expires 24h after thawing |
|
|
Term
| why would you need a massive transfusion (replace whole blood in a few hours) |
|
Definition
P: platelets, potassium
A: ARDS, acid/base changes
T: temperature (hypothermia)
C: citrate intoxication, hypocalcemia
H: hepatitis, syphilis, HIV |
|
|
Term
| what is the most common hereditary bleeding disorder, what is wrong, how is it diagnosed |
|
Definition
von willibrand disease, unable to use vFW to make platelet plug
affects function of factor VIII
prolonged PTT |
|
|
Term
| what is a differential diagnosis |
|
Definition
| process of elimination in which you narrow down possible cause of your patient symptoms |
|
|
Term
| what is the differential diagnosis for abdominal pain 9 |
|
Definition
major anatomy
minor anatomy: msk, vascular, neurological, lymphatic, extra-abdominal
infectious
inflammatory
tumor: benign or malignant |
|
|
Term
|
Definition
| liver, gallbladder, stomach, kidney, pancreas, lung, vascular |
|
|
Term
|
Definition
| cholelithiasis, hepatitis, GERD, gastritis, PUD, pancreatitis, kidney stones, CHF, pneumonia |
|
|
Term
| anatomy of epigastric region 4 |
|
Definition
stomach
bowels
pancreas
lungs |
|
|
Term
|
Definition
GERD
gastritis, PUD
IBS
chrons disease
appendicitis
pancreatitis
diabetic ketoacidosis
pneumonia
diabetic ketoacidosis
pneumonia |
|
|
Term
|
Definition
| intestines, genitourinary tract, gynecologic, msk, vascular |
|
|
Term
|
Definition
cholelithiasis
cholecystitis
GERD
gastritis
PUD
bowel obstruction
food poisoning
IBS
IBD
hypo/hyperthyroidism
hypercalcemia
addisons disease
urosepsis
uremia
anorexia
bulemia
meningitis
vertigo |
|
|
Term
| most common viral infection causing diarrhea in adults |
|
Definition
|
|
Term
| most common viral infection cause diarrhea in kids |
|
Definition
|
|
Term
|
Definition
diverticulum
aortoenteric fistula
intussception
chrons disease |
|
|
Term
| 6 causes of colorectal bleed |
|
Definition
diverticulosis
AV malformation
hemorrhoids
fissures
chrons disease
ulcerative colitis |
|
|
Term
| BPH histological definition |
|
Definition
| histological definition that is non malignant enlargement of prostate due to increased cellular growth |
|
|
Term
|
Definition
|
|
Term
|
Definition
40s 8% men
50-60s 50% men
80s 90% men |
|
|
Term
|
Definition
presence of prostate growth factors and DTH contribute to development of BPH over time
studies show that imbalance in regulation of growth factorsand apoptosis is ultimate etiology
studies show genetic component for BPH and risk of developing symptoms in persons lifetime |
|
|
Term
| PROBLEMS ASSOCIATED WITH BPH 5 |
|
Definition
BLADDER CALCULI
UTI
RENAL FAILURE
HEMATURIA
LOSS OF BLADDER FUNCTION |
|
|
Term
| how do you get a direct inguinal hernia, what is the tx |
|
Definition
congenital located going down through inguinal internal ring
emergency surgery could become strandulated |
|
|
