Term
Pyogenic liver abscess:
1. Common means of bacterial invasion in the liver
2. predisposing conditions
3. most common cause in US?
4. common organisms
5. common organisms in immunocompromised?
6. s/s?
7. labs/imaging?
8. tx |
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Definition
1. Common means of bacterial invasion in the liver: common bile duct, portal vein, hepatic artery, direct extension of an infectious process, trauma to abd wall, appendicitis, diverticulitis
2. predisposing conditions: malignancy, DM, IBD, cirrhosis, liver transplant
3. most common in US: cholangitis
4. common organisms: e. coli, klebsiella, proteus, enterobacter aerogenes, strep milleri
5. in immunocompromised: candida, TB, actinomycoses
6. s/s: fever (may be swinging fever), pain in RUQ or epigastrium, jaundice, tenderness
7. Labs: leukocytosis w/ left shift, abnormal LFTs, pos blood culture. imaging: elevated R diaphragm on CXR, intrahepatic defect on US/CT/MRI
8. Tx: hospitalization, IV 3rd gen cephalosporin + flagyl, needle aspiraiton if >5 cm, treat underlying infection |
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Term
Venous insufficency in lower extremities:
1. cause.
2. s/s
3. ddx
4. prevention
5. tx |
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Definition
1. caused by ineffective valves (post-thrombotic syndrome) or dilated veins which created high hydrostatic pressure
2. s/s: edema (initial sx), thin/shiny/pigmented skin - brawny skin pigmentation, itching, dull pain when standing, ulcerations just above ankle or on medial or anterior shin, varicosities
3. Ddx with b/l swelling: CHF, CKD, liver dz.
with unilateral swelling: lymphedema, arterial insufficiency (absent pulses)
4. prevention: anticoagulation or thrombolysis of acute DVT to minimize valve damage, compression stockings
5. compression stockings, frequent position changes, leg elevation, pneumatic compression, sclerotherapy on affected veins,
For ulcer: get rid of edema! Unna boot |
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Term
Intermittent Claudication
1. This is a sx of ____
2. sx?
3. common arteries
4. labs/imaging
5. tx |
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Definition
1. sx of peripheral artery disease
2. sx: cramping pain or tiredness in calf with exercise, reduced popliteal/pedal pulses, foot pain relieved by dependency, loss of hair, thinning of skin, muscle atrophy, ulceration of tips of toes
3. superficial femoral artery - causes sx at 2-4 blocks
concommitant dz with profunda femoris or popliteal artery - causes sx earlier
4. labs: reduced ABI. imaging: angiography, CTA, MRA to show location of obstruction
5. tx: smoking cessation, weight loss, walking, phosphodiesterase inhibitors (cilostazol)
Bypass surgery for severe disease
Endovascular surgery for lesions <10 cm - stenting, ballooning, thrombendarterectomy |
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Term
Venous thromboembolism
1. prothrombotic states
2. PE - sx, echo, labs, imaging, tx
3. DVT: sx, labs, imaging, tx |
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Definition
1. factor V leiden def, prothrombin gene mutation, hyperhomocysteinemia, cancer, HTN, COPD, long flights, air pollution, obesity, smoking, eating lots of red meat, oral contraceptives, pregnancy, HRT, surgery, trauma
2. PE sx: "the great masquerader". sudden onset dyspnea, pleuritic CP, cough, hemoptysis, syncope, tachycardia, crackles, wheezes, fever, pleural rub, leg swelling, systemic arterial hypotnesion, widespread thromboembolism
echo: RV hypokinesis
labs: d-dimer (can r/o PE but cannot confirm dx), elevated cardiac enzymres (troponin, BNP)
CXR: pleural effusion, westermark's sign (focal oligemia/loss of blood flow), hampton's hump (wedge-shaped density above the diaphargm), palla's sign (enlarged right pulmonary artery)
CT w/ contrast - GOLD STANDARD FOR DX
IV gamma-emitting radionuclide scan or V/Q scan are 2nd line for dx
Tx: Heparin until PTT 2-3 times the upper limit of normal Or Lovenox (enoxaparin) OR warfarin until INR 2-3.
Duration: Postop or postpartum: 3-6 mos, isolated DVT: 6-12 weeks
DVT:
sx: DX OF PE IS PRESUMPTIVE DX OF DVT, localized tender ness along deep venous system, unilateral leg swelling, calf swelling 3 cm> than asymptomatic side, unilateral pitting edema, collateral superficial vein dilation
Labs: d-dimer
Duplex US: loss of "wink sign" (inability to compress veins), possibly visualization of clot
Tx: same as PE
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Term
Cancer of ascending colon
1. sx
2. labs/imaging
3. tx
4. prognosis: |
|
Definition
1. sx: often asymptomatic until quite large bc stool in ascending colon is watery and can move around it. may have chronic, intermittent bleeding, fatigue, iron-def anemia, angina, palpitations
2. colonoscopy is gold standard, barium enema, Ct colonography, Ct of abd/pelvis, US to check for liver mets
Labs: LFT, CEA (carcinoembryonic antigen) - poor prognosis if >5 ng/ml
3. Tx: resection is tx of choice, regional lymph node dissection
chemo (5-FU or folfox [5-FU, leucovorin, oxaliplatin)
Stage 1: just surgery
stage 2 (node-negative): +/- chemo
stage 3 (node-positive): chemo
stage 4 (metastatic): non-resectable usually, median survival of 6 mos
4. prognosis
stage 1: 90-100% 5 year survival
Stage 2: 80% 5 year survival
stage 3: 30-50% 5 year survival
stage 4: 6 mos survival w/o tx
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Term
Large Bowel Obstruction
1. 3 most common causes
2. sx
3. PE findings
4. imaging
5. complications
6. tx |
|
Definition
1. colon cancer, diverticulitis, volvulus
2. sx: constipation, colicky pain, lumbar pain, n/v, abd distention/tenderness
3. PE: abd distention and tympany, peristaltic waves, high-pitched tinkles, rushes, gargles, localized peritoneal signs
4. imaging: CT scan with rectal contrast
Abd XR: distended colon "picture frame" of abd cavity
5. complications: bowel perforation, ischemic colitis
6. tx: surgery - resection of necrotic bowel and decompression of the obstructed segment, stent placement, colostomy, |
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Term
Small bowel obstruction
MOST COMMON SURGICAL DISORDER OF THE SMALL INTESTINE
1. causes
2. sx
3. Pe findings
4. Labs/imaging
5. tx |
|
Definition
1. causes: adhesion (#1), neoplasm, external hernia, intussusception, foriegn body, gallstone, IBD, stricture, CF, hematoma
2. sx: vomiting (may be feculent), abd discomfort, colicky pain, distention, constipation, rushes
3. PE findings: dehydration, mild fever, abd distention, visible peristalsis, mild tenderness, rushes, tinkles, hernia
4. labs: may be normal, hemoconcentration, leukocytosis, abd electrolytes, elevated amylase
CT: highly accurate
Abd XR: ladder-like pattern of dilated small bowel with air-fluid levels
6. tx: expectant if continued passage of stool/flatus, surgery
preop: NG decompression, fluids, abx if strangulation is possible
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Term
Ileus
1. common causes
2. sx
3. labs/imaging
4. tx |
|
Definition
1. post op, post-GI condition (pancreatitis, peritonitis, etc), opioids, anticholinergics
2. sx: mild, diffuse, continuous abd discomfort, n/v, distention, diminished/absent bowel sounds
3. labs: electrolytes, appropriate labs for underlying condition
4. abd XR: distended gas-filled loops, air-fluid levels, CT to exclude mechanical obstruction
5. tx: NPO w/ gradual return of diet as bowel fxn returns, NG suction, IV fluids, alvimopan - opioid receptor antagonist |
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Term
Pneumothorax:
Types:
1. occurs in the absence of an underlying lung disease. affects mainly tall, thin boys
2. complication of preexisting pulmonary disease (asthma, COPD, pneumonia, menstruation, sarcoid, TB)
3. results from penetrating trauama
4. results as a complication from procedures
5. results in the setting of penetrating trauma, lung infection, cardiopulmonary resuscitation, positive pressure ventilation
ssx?
labs?
imaging? |
|
Definition
1. primary spontaneous
2. secondary spontaneous
3. traumatic
4. iatrogenic
5. tension
sx: CP on affected side, dyspnea, tachycardia, diminished breath sounds, decreased fremitus, decreased chest motion, hypotension, tracheal shift
ABG: hypoxemia, alkalosis
EKG: QRS and T wave changes - may mimic MI
CXR: visible pleural line, air-fluid level, deep sulcus sign on supine film, contralateral mediastinal shift
Tx:
- reliable pt wtih small ptx - observation
- aspiration for large/progressive primary ptx
- chest tube for large/secondary/tension pneumo
- other: stop smoking, avoid future exposure to high/low pressure conditions (scuba diving, high altitudes) |
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Term
Ulcerative colitis
Facts:
1. 3 types?
2. more common in what population?
3. increased risk of?
sx?
labs
imaging
tx |
|
Definition
1. proctosigmoiditis (1/3), left-sided colitis (1/3), extensive colitis (1/3)
2. nonsmokers and pts who've had appy <20 y/o
3. colon cancer
sx: characterized by flare-ups and remissions. blood diarrhea is hallmark. lower abd cramps, fecal urgency, anemia, low serum albumin, negative stool cultures
labs: hematocrit (<30 is severe), ESR (>30 is severe), albumin (<3 is severe)
proctosigmoidoscopy is gold standard
abd xr: colonic dilation
barium enema may precipitate toxic megacolon in pts wtih severe disease
Tx:
- mild-moderate: limit caffeine and gas-producing veggies, anti-diarrheals for mild, chronic sx (loperamide, opium tincture, diphenoxylate with atropine)
- distal colitis: topical mesalamine (best) or corticosteroids. oral aminosalicylates
- disease above sigmoid: 5-ASA agents (mesalamine, balsalazide, sulfasalazine), corticosteroids,
- severe disease: 7-10 days of corticosteroids, infliximab or cyclosporine, surgery
- fulminant colitis/toxic megacolon: pts are quite ill and appear toxic. toxic megacolon (colonic dilation >6 cm on xray) broad spectum abx, NG suction, frequent position changes, repeat xray, surgery if failure to improve in 48-72 hours |
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Term
| infection or abscess of the soft tissue on the terminal joint of finger |
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Definition
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Term
Causes of RLQ pain:
1. • Quality/Frequency – Steadily worsening; migrates to RLQ
• Radiation and Assoc. SX – Groin; Occasionally back; N/V, anorexia, fever, abdominal guarding and rebound tenderness
• Clinical clues – Migration and progression. No prior similar episodes.
• Tests – CBC (leukocytosis), UA; CT scan (gold standard) or U.S. (esp for preg pts.)
2. • Quality/Frequency – Steadily worsening; migrates to RLQ
• Radiation and Assoc. SX – Groin; Occasionally back; N/V, anorexia, fever, abdominal guarding and rebound tenderness
• Clinical clues – Migration and progression. No prior similar episodes.
• Tests – CBC (leukocytosis), UA; CT scan (gold standard) or U.S. (esp for preg pts.)
3. • Quality/Frequency – Crampy diffused/ waves
• Radiation and Assoc. SX – N/V; anorexia
• Clinical clues – Abdominal distention, inability to pass stool or flatus; prior surgery causes 75% of cases.
• Tests – X-ray; air fluid levels and bowel distention. Barium enema, CT scan. |
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Definition
1. appy
2. diverticulitis
3. cecal volvulus |
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Term
Cirrhosis:
facts:
1. __ leading cause of death in the US
2. most common causes?
3. pathogenics?
sx?
labs
imaging
Complications
tx |
|
Definition
1. 12th
2. hep C, B, and alcohol
3. injury --> fibrosis --> nodular regeneration
sx: may have no sx until late, enlarged liver, hard liver, splenomegaly, fever, hematemesis, weakness, fatigue, distrubred sleep, cramping, weight loss, anorexia, n/v, abd pain, amenorrhea, loss of libido, sterility, gynecomastia, spider nevi, palmar erythema, dupuytren contractures, glossitis, cheilosis, jaundice, ascites, pleural effusion, peripheral edema, ecchymosis, encephalopathy, asterixis, tremor, dysarthria, delirium, coma, dilated abd veins
labs: macrocytic anemia, folate def, hemolysis, hypersplenism (low WBC count), GI bleed, high wbc if infection, thrombocytopenia, long P
LFTs: elevated AST and alk phos, progressive elevation of bilirubin, low albumin, increased gamma globulin
elevated cardiac enzymes, cirrhotic cardiomyopathy, prolonged QT
increased risk of DM
US: assesses liver size, hepatic nodules, ascites, cancer
US with doppler: patency of splenic, portal, and hepatic veins
EGD: varices
Liver biopsy
Complications: upper GI bleed from varices, gastropathy, ulcer, liver failure, cancer, systemic infection, osteoporosis (12-55% of patients)
tx: ALCOHOL ABSTINENCE, protein restriction (60-80 g/day) if encephalopathy, HAV/HBV/pneumonia vaccines
- ascites: 2000 mg/day sodium restriction, paracentesis, diuretics (spironolactone + furosemide)
- TIPS (transjugular intrahepatic portosystemic shunt) procedure for refractory ascites and varices. 20-30% get hep encephalopathy after TIPS |
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Term
Causes of ascites
1. serum ascites albumin gradient >1.1
2. elevated ascitic adenosine deaminase
3. chylous (rich in trigs) |
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Definition
1. portal htn
2. TB peritonitis
3. cirrhosis, TB, cancer, trauma |
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Term
Complications of ascites/cirrhosis:
1. Complication of TIPS procedure
2. complication causing abd pain, increasing ascites, fever, progressive encephalopathy. ascitic fluid = WBC 500 cells/mcl with high percentage of PMNs. LEUKOCYTE ESTERASE in ascitic fluid. Need IV abx.
3. azotemia (Cr >1.5) w/o kidney disease, renal failure, oliguria, hyponatremia, low urinary sodium. tx with IV albumin + vasoconstrictor
4. a state of disordered CNS fxn resulting from failure of th liver to detox noxious agents of gut origin bc of hepatic dysfunction and portosystemic shunting. sx range from day-night reversal to coma. may have asterixis. Ammonia is most readily recognizable toxin. tx with lactuolose or oral abx to control overgrowth of intestinal flora.
5. due to GI bleed or alcoholism.
6. due to loss of vit-K-dependent factors (prothrombin). treated with vitamin K or FFP.
7. Due to pulmonary restriction and atelectasis caused by massive ascites. TRIAD: chronic liver disease, increased alveolar-arterial gradient, intrapulmonary vscular dilation resulting R to L pulmonary shunt. Needs liver transplant. |
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Definition
1. hepatic encephalopathy
2. spontaneous bacterial peritonitis
3. hepatorenal syndrome
4. hepatic encephalopathy
5. anemia
6. coagulopathy
7. hepatopulmonary syndrome |
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Term
Liver transplant:
1. indications
2. absolute contraindications
3. relative contraindications |
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Definition
Indications:
- irreversible, progressive chronic liver disease with worsening function, rising bilirubin, decreasing albumin, worsening coagulopathy, refractory ascites, recurrent variceal bleeding, worsening encephalopathy.
- acute hepatic failure
- metabolic diseases of the liver
Contraindications:
- malignancy, advanced cardiopulmonary disease (except hepatopulmonary disease), and sepsis
relative contraindicaitons:
>70 y/o, morbid obese, portal and mesenteric vein trhombosis, active alcohol/drug use, severe malnutrition, lack of pt understanding |
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Term
| Common postop thyroidectomy complications |
|
Definition
bleeding
laryngeal edema
damage to recurrent laryngeal nerve w/ voice paralysis
hypoparathyroidism - check Ca levels postop
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Term
What disease?
Sx: severe headache, perspiration, palpitations, anxiety, sense of doom, vasomotor changes, hypertension, facial flushing, postural tachycardia and hypotension, elevation of basal body temp, retinal hemorrhage
Labs: hypermetabolism
normal thyroid hormone
hyperglycemia
leukocytosis
elevated ESR
Tests?
tx
prognosis |
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Definition
Pheochromocytoma: catecholamine-producing tumor of adrenals
Most sensitive test: fracitonated free metanephrines
- urine catecholamines, metanephrines, and creatinine
CT/MRI for finding tumors in adrenals
tx:
- removal of tumors -- Tx of choice
- need team approach: enocrinologist, anesthesiologist, and surgeon
- CCB, alpha blockers... NOT beta blockers
Risk of surgery: postop shock - tx with IV saline + NE
Malignancy is more common in larger pheo's and paragangliomas = 5 year survival rate of 44%. Need Iodine nuclear med therapy
25% regain HTN after surgery
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Term
1. Definition: tumor arising from ____. They are a rare cause of ____.
2. "Rule of Tens"
3. associated wtih what endocrine disorder?
4. Congenital disease that is associated with malignant, extra-adrenal, bilateral pheo that presents at an early age. These tumors secrete NE.
5. complications? |
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Definition
1. adrenal medulla, HTN
2. rule of tens: 10% of cases are not associated with HTN, 10% are extra-adrenal, 10% in kids, 10% have pos fam hx, 10% involve both adrenal glands, 10% have mets
3. multiple endocrine neoplasia (MEN)
4. Von Hippel-Lindau Disease (VHL)
5. Complications: those of HTN, cardiomyopathy, heart failure, sudden death, ARDS, HTN emergency |
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Term
Post op Fever:
1. occurs in about __% of pts with major surgery
2. factors associated with infectious origin?
3. fever w/in first 48 hours is most likely?
4. Fever on each postop day |
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Definition
1. 40%
2. preop trauma, ASA class 2 or above, fever onset after 2nd post op day, initial temp >101.5, WBC >10K, serum BUN >15
3. atelectasis
4. day 1: atelectasis, day 3-4: UTI, phlebitis day 4-5: pneumonia, wound infection, day 5-7: DVT, intra-abd abscess
5. wind, water, wound, wonder drug, walk, womb |
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Term
Post Op Wound Infections:
clean-contaminated and contaminated vs. clean wound infection rates |
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Definition
| 1. any sort of contamination: 6-15% infection, clean: 1-3% infection |
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Term
Screening for lung cancer in smokers/former smokers
1. recommendation?
2. a new test that is very sensitive for finding lung cancers |
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Definition
1. currently no recommendation for screening
2. LDCT: low-dose CT |
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Term
Pleural effusions:
- 5 pathological processes account for most pleural effusions:
`1. Increased production of fluid in the setting of normal capillaries due to increased hydrostatic pressure or decreased oncotic pressure =____
2. increased production of fluid due to abnormal capillary permeability = ____
3. decreased lymphatic clearance of fluid from pleural space = ____
4. infection in pleural space. purulent pleural fluid. lots of white cells in fluid.
5. bleeding in pleural space |
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Definition
1. transudates
2. exudates
3. exudates
4. empyema
5. hemothorax |
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Term
what disease?
Sx: dyspnea, cough, respirophasic CP
PE: dullness to percussion of chest, diminished breath sounds
Tx? |
|
Definition
pleural effusion
tx: thoracentesis, chest tube, systemic tx to treat underlying cause
- pleurodesis: irritant is placed into pleural space following chest tube drainage and lung reexpansion in order to form adhesions between visceral and parietal pleura to obliterate pleural space (doxycycline, talc)
- tube thoracostomy: when pleural glucose is <60 or pH is <7.2 |
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Term
pleural effusion classification:
1. a pleural effusion is classified as ___ if it has one or more: ratio of pleural protein to serum protein >0.5, ratio of pleural LD to serum LD >0.6. Most common causes of this type of effusion?
2. a pleural effusion is classified as ___ if it has these labs: glucose=serum glucose, pH 7.4-7.55, <1000 WBC with predominance of PMNs. Common causes?
- how much pleural fluid must there be to be visible on lateral and frontal XR? on CT? |
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Definition
1. exudate - pneumonia or cancer
2. transudate - CHF, cirrhosis, atelectasis, hypoalbuminemia
- lateral: 75-100 ml, frontal: 175-200 ml, CT: 10 ml |
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Term
Spleen Stuff:
1. characterized by diffuse enlargement and amplification of the normal splenic fxn resulting in pancytopenia. commonly caused by neoplasia, bone marrow disorder, or metabolic disorder
2. 7 other indications for splenectomy
3. what condition has the highest incidence for splenectomy?
5. what prophylactic vaccines should be given?
6. contraindications to lap splenectomy?
7. hematologic complications of splenectomy?
8. Complications following splenectomy |
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Definition
1. hypersplenism
2. autoimmune disorders (antibodies against platelets, erythrocytes, or neutrophils), trauma, vascular disease, cysts/abscesses/tumors, diagnostic procedures, iatrogenic (spleen injured during surgery), incidental splenectomy (tumor, vascular involvement, excision of hilum lymph nodes)
3. ITP
5. against encapsulated organisms - h. flu, s. pneumonia, N. meningitidis
6. portal htn, severe comorbidities
7.
- RBC: counts do not change but cytoplasmic inclusions may appear (howell-jolley bodies, siderocytes)
- WBC: granulocytosis initially, lymphocytosis and monocytosis later
- Platelets: thrombocytosis (400-500K)
8.
- thromboembolic events (portal thrombosis) - fever, abd pain, diarrhea, abn liver fxn --> needs anticoagulation
- increased risk of infection, often due to encapsulated bacteria
- DIC |
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Term
Chronic wounds:
1. ___ fails in a chronic wound. most often, it fails in the ___ phase.
2. phases of wound healing
3. things that play a significant role |
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Definition
1. wound healing, inflammatory phase
2. coagulation --> inflammation --> fibroplasia --> matrix deposition --> angiogenesis --> epithelialization --> collagen maturation --> wound contraction
3. inflmmatory phase: lactate, macrophages
fibroplasia/matrix synthesis: fibroblasts, which secrete collagen and proteoglycans |
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Term
Late complications of PUD surgery that occurs because the stomach's ability to regulate the rate of its emptying is impaired.
sx: cardiovascular (sweating, palpitaitons, weakness, dyspnea, flushing, syncope) and GI (N/V/D, cramping, belching)
tx? |
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Definition
Dumping syndrome
tx: low carb, high fat and protein diet. Fluids only between meals |
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Term
Most common in 20-45 y/o
Sx: epigastric pain (aching/burning/gnawing).
- Characteristic daily cycle: no pain in AM, begins 2 hours after breakfast, is releived by noon meal, recurs in afternoon. Food, milk, and antacids give temporary relief
PE: localized epigastric tenderness to right of midline
tests?
treatment? |
|
Definition
Duodenal ulcer
workup: Gastrin >200 pg/ml
basal gastric acid output and maximal acid output are both higher in ulcer pts
May see ulcer on upper GI series
Treatment:
- H2 blockers (ranitidine, cimetidine) or PPI (omeprazole)
Surgery:
- vagotomy + antrectomy --> biliroth I reconstruction
- Subtotal gastrectomy --> biliroth II reconstruction
- Total gastrectomy
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Term
|
Definition
Triple therapy: PPI + amoxicillin + clarithromycin - all BID for 14 days
Quadruple therapy: PPI + bismuth + TCN + Flagyl |
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Term
Peptic Ulcers:
1. can occur in what 5 places?
2. Due to waht chemical?
3. Why would it happen in the jejunum?
4. Why would it happen in the ileum?
5. complications of all ulcers? |
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Definition
1. esophagus, duodenum, stomach, jejunum, ileum
2. gastric acid
3. gastrojejunostomy
4. meckel's diverticulum
5. bleeding, perf, obstruction |
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Term
Incidence peaks ages 40-60 y/o
sx: epigastric pain relieved by food or antacids
- pain usually begins within 30 min of eating
achlorhydria (pH>6) indicates malignancy
workup - gastroscopy. What indicates malignancy?
treatment? |
|
Definition
Gastric ulcer
"rolled up edges" or "meniscus sign" on gastroscopy --> malignancy
tx:
- omeprazole or H2 blockers
- stop ulcerative agents (NSAIDs, alcohol)
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Term
Sx: sudden, severe upper abd pain - the onset of which can be recalled precisely. Peritonitis. shoulder pain. may have n/v.
PE: very distressed pt with knees drawn up and shallow breathing, involuntary gauarding, tympany over RUQ, epigastric pain not as dramatic as expected
labs: leukocytosis and rise in amylase
xray: free subdiaphragmatic air
treatment? |
|
Definition
perforated peptic ulcer
tx: NG tube decompression, IV abx (cefazolin or cefoxitin)
Surgery: suture closure of perf with omentum |
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Term
Sx: severe diarrhea, steatorrhea, ulcer sx, hemorrhage, perforation, obstruction
Labs: hypergastrinemia (usually exceeding 500 pg/ml)
CT/MRI: pancreatic tumor
somatostatin-receptor scintography
Upper GI series: ulcer in duodenal bulb
definition of this disease?
test?
tx? |
|
Definition
Zollinger-Ellison Syndrome
- gastric acid hypersecretion by gastrinoma
test: secretin provocation test - rise in gastrin >150 pg/ml within 15 min of administration of secretin
tx: H2 blockers QID or PPI BID
surgery: resection via exploratory laparotomy is ideal |
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Term
Peritonitis:
1. common causes of mild, moderate, and severe peritonitis
2. ____ - results from bacterial contamination originating from within the viscera or from external sources. most often follows disruption of hollow viscus.
3. sx?
4. ____ is highly predictive of serious intraperitoneal sepsis
5. workup
6. treatment - including names of abx |
|
Definition
1. mild: appy, perforated ulcer, salpingitis - <10% mortality
- moderate: diverticulitis, small bowel perf, gangrenous cholecystitis, trauma - <20% mortality
- Severe: large bowel perf, ischemic small bowel, necrotizing pancreatitis, postop - 20-80% mortality
2. secondary peritonitis
3. sx: abdominal pain, tenderness, guarding, rigidity, diaphoresis, distention, free peritoneal air, diminished bowel sounds, fever, chills, rigors, tachycardia, tachypnea, restlessness, dehydration, oliguria, disorientation, shock
4. unexplained shock
5. paracentesis or diagnostic lavage: >200 WBC is indicative of peritonitis
labs: CBC, T&C, ABG, electrolytes, blood clotting profile, liver and renal function test, blood culture
6. treatment: fluid and electrolyte replacement, control of sepsis, systemic ABX - 3rd gen cephalosporin, bactrim, aztreonam, ampicillin-sulbactam, ticarcillin-clavulanic acid, imipenim-cilastin, flagyl, clindamycin. usually need abx for 10-14 days.
Surgery: remove infected material and lavage copiously
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Term
Postop fluid management:
1. daily fluid, sodium, potassium, and glucose requirements
2. maintenance fluids per hour
3. maintenance fluids per day
4. fluid increase in febrile pt |
|
Definition
1. fluid: 2000-2500 ml/day, NA: 75 meq/day, K: 40-60 meq/day, glucose: 100 g/day
2. maintenance fluids per hour: 4:2:1 rule
40 ml for first 10 kg
20 ml for 2nd 10 kg
1 ml for each kg over 20 kg
3. maintenance fluids per day: 1000:500:20 rule
1000 ml for first 10 kg
500 ml for next 10 kg
20 ml for each kg above 20 kg
4. fluids in fever: for each degree >100F, requirement increases by 2 ml/kg/day |
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Term
Sx: deep seated abd pain, back pain, hepatomegaly, palpable mass, cholangitis, pruritis, weight loss, sudden onset DM, pain aggravated by lying down
Courvoisier sign: palpable nontender gallbladder in a jaundiced pt suggests neoplastic obstruction of common duct
labs: elevated alk phos and bilirubin.
tests?
complications?
tx?
prognosis? |
|
Definition
pancreatic cancer
CT: shows pancreatic mass in 95% and extension beyond pancreas in 90%
ERCP if CT is neg and suspect cancer
tests for pancreatic function:
- secretin or CCK
- pancreolauryl test for exocrin fxn
- PABA excretion test
- fecal fat balance test
compliations: splenomegaly, portal HTN, varices
tx: pancreatic resection (WHIPPLE PROCEDURE)- can only be done if hepatic artery near the origin of the gastroduodenal artery, the SMA, the liver, and regional lymph nodes are free of tumor
prognosis:
- palliative therapy: 7 mos
- after whipple: 18 mos
- 10% 5 year survival |
|
|
Term
Types of pancreatic cancer:
1. arises from beta cells and produces sx of hypoglycemia. WHIPPLE TRIAD: hypoglycemia produced by fasting, blood glucose <50 at times of sx, relief of sx by IV glucose. tx?
2. migratory necrolytic dermatitis, weight loss, stomatitis, hypoaminoacidemia, DM. PROMINENT RASH IN DM. arises from alpha cells in pancreas. tx?
3. DM, diarrhea, malabsorption, dilation of GB. caused by an islet cell tumor. |
|
Definition
1. insulinoma. tx: diazoxide, stretozocin, surgery
2. glucagonoma. tx: TPN, somatostatin, streptozocin, dacarbzine
3. somatostatinoma |
|
|
Term
| Tests for pancreatic function: |
|
Definition
|
|
Term
Breast cancer
1. risk factors
2. incidence
3. recommendations for testing
4. sx
5. tumor frequnecy by quadrant
6. diagnosis
7. diagnosis of breast mass by decreasing order of frequency
8. treatment |
|
Definition
1. risk factors: delayed childbearing, family hx, BRCA 1 or 2, personal hx
2. incidence: 1/8 american women
3. breast exam by dr: every 2-3 years age 20-40, every year age >40
- mammogram - every year at 40 y/o
4. most common sx: single painless lump. others: skin/nipple retraction, axillary lymphadenopathy, breast enlargment, erythema, edema, pain, fixation to skin or chest wwall
5. upper outer: 45%, nipple: 25%, upper inner: 15%, lower outer: 10%, lower inner: 5%
6. open biopsy is most reliable. US differentiates cystic from solid mass
7. fibrocystic dz of breast, fibroadenoma, intraductal papilloma, lipoma, fat necrosis
8. For stage I, II, III: surgical resection + adjuvant radiation or systemic therapy
lumpectomy + lymph node dissection for early stages
Targeted therapy:
- trastuzumab (herceptin): monoclonal abx for HER2
- Bevacizumab (Avastin): monoclonal antibody against vascular endothelial growth factor (VEGF)
- Tamoxifen or Diethylstillbesterol (DES): hormonal therapy - decreases recurrence by 25% in pts with ER-positive tumors |
|
|
Term
Types of breast cancer:
1. characterized by small erosions of nipple epithelium
2. most malignant form. rapidly growing, painful mass with warmth, erythema, and edema to skin |
|
Definition
1. paget's
2. inflammatory |
|
|
Term
Soft tissue wounds:
1. treatment for each: contusion, abrasion, gravel/dirt, hematoma, puncture wound
2. facial wounds can be closed up to __ hours after they've occurred. other woudns should not be closed >__ hours after wound.
3. indications for abx
4. improtant structures to avoid when fixing a facial |
|
Definition
contusion: ice, rest, elevation
abrasion: cleaned and sterile dressing until scab forms
gravel/dirt: must be cleaned out within 24 hours
hematoma: ice + pressure until stable, then evacuation
Puncture wounds: irrigation + abx + observation. tetanus vaccine
2. facial 24 hrs, others not after 8-12 hours
3. indications for abx: delayed presentation, known contamination, immunocompromised, very young or old, hands/lower legs, pts in whom bacteremia would have serious consequences (prosthetic heart valves, orthopedics)
4. lacrimal duct, parotid duct, branches of facial nerve |
|
|
Term
Colon polyps:
1. types
2. prevalence: __% at 60 y/o
3. features associated with increased risk of CRC: size > ___, __ histology, ____, >(#) polyps
4. best test? |
|
Definition
1. adenomatous: villous, tubulovillous, tubular, hyperplastic. Inflammatory
2. 60% at 60 y/o
3. Size >1cm, villous histology, high grade dysplasia, >3 polyps.
4. colonoscopy
|
|
|
Term
Drugs that should be discontinued 5-7 days prior to surgery
Drugs that should be discontinued 2 weeks before surgery
Drugs that should be discontinued the day of surgery |
|
Definition
1. aspirin, plavix, warfarin, coumadin, herbal supplements, NSAIDs
2. MAOIs
3.diuretics, anti-hyperlipidemics, vitamins, morning insulin (50-80% of usual dose), short-acting insulin, oral hypoglycemics, renal drugs
|
|
|
Term
Burns:
1. home fires are responsible for __% of burns each year but __% of deaths due to smoke inhalation
2. Rule of 9's
3. why are complications more common in kids and elderly?
4. burns to what 4 body parts have worst prognosis?
5. greatest risk of fluid/protein loss in first __-__ hrs
6. muscle wasting can be up to __/day due to doubling of metabolism
7. why might a burn pt need prophylactic antacids? |
|
Definition
1. 5%, 50%
2. each arm = 9%, head = 9%, anterior and posterior trunk = 18% each, each leg = 18%, perineum = 1%
3. kids: body surface relative to weight is much greater than adults; immature kidneys, liver, and immune system; kids are prone to seizures
elderly: multiple comorbidities
4.hands, feet, face, perineum
5. 6-8 hrs
6. 1 lb
7.gastroduodenal curling ulcers
8. |
|
|
Term
| Explain first, second, and third degree burns |
|
Definition
First degree: pain, erythema, minor microscopic damage
protective fxns of skin are intact, edema is minimal, systemic manifestations are rare. Pain resolves in 48-72 hours with skin peeling.
Mechanism: brief scalding or sun burn
Second degree "partial thickness": all of epidermis and some of dermis
pain, blister, red with layer of white nonviable dermis
heal in 10-14 days with minimal scarring
Deeper burns take 4-8 weeks with only a fragile epithelial covering that arises from residual uninjured epithelium. heals with hypertrophic scarring. may convert to 3rd degree by bacteria. may need skin graft
Third Degree "full thickness": white, dry, waxy. may appear unburned. OR brown, dark red, or black. lack of sensation, capillary refill, and normal texture. may feel leathery. all dermis is destroyed, leaving no chance for re-epithelialization. |
|
|
Term
Three zones of burned tissue:
1. ____ (necrosis with irreversible cell death, no blood flow),
2. ____ (environmental insults cause wound to become necrotic)
3. ____ (usual inflammatory response) |
|
Definition
1. coagulation
2. wound conversion
3. hyperemia |
|
|
Term
Burn treatment: acute and post-resuscitaiton
Parkland formula
Wound dressings
Only use topical abx when? names of abx?
When to use open dressings?
How often to change occlusive dressings? |
|
Definition
Acute: like any other trauma -
airway, ABGs, carboxyhemoglobin, administer 100% O2, urinary catheter if burn exceed 20% of body, peripheral IV, LR according to parkland formula, wound debridement, IV narcotics, tetanus shot, overhead radiant heater to avoid hypothermia
Post-resuscitation: decrease catecholamine response and provide enoguh calories to offset hypermetabolism
pulmonary toilet if smoke inhalation, 30 cal/kg and 1.5 g/kg protein, Vit A/E/C/zinc, low-dose heparin, maintenance fluids, early mobilization to avoid contracture
parkland formula: 4 ml/kg/% body burned/day. half delivered over first 8 hours
wound dressings:
- 2nd degree: abx ointment, occlusive dressing
- 3rd degree: skin substitute
- only use topical abx on deep 2nd or 3rd degree burns that are likely to get infected bc they retard wound healing
- abx: silver sulfadiazine or silver release
- open (exposure) dressings on face/head
- closed must be changed 2x/day |
|
|
Term
DIC:
1. Causes?
2. sx
3. characteristic labs
4. tx - when heparin? replacement therapy? |
|
Definition
1. causes: serious illness (sepsis), severe tissue injury (burns, head trauma), obstetric complications, cancer, blood transfusion reaction
2. sx: bleeding and trhombosis due to coagulation and fibrinolysis, spontaneous bleeding, digital ischemia, gangrene, renal cortical necrosis, hemorrhagic adrenal infarct, microangiopathic hemolytic anemia
3. characteristic labs: hypofibrinogenemia, elevated fibrin degredation products (D-dimer), thrombocytopenia, prolonged PT, low antithrombin III, prolonged PTT
4. tx: should be aimed at underlying disorder. heparin for serious clinical consequences and a cause that is not easily reversible.
- HEPARIN if acral cyanosis
- FFP must be given with heparin if antithrombin III is <50%
- replacement therapy while treating underlying illness: platelet transfusion to maintain platelets at 30-50K, fibrinogen to be maintained at >150, FFP for coagulation factor deficiency
- EACA 1 g IV/hr |
|
|
Term
Sx: pain and bleeding wiht defecation. pain subsides over a few hours after defecation. blood may be noted on toilet paper.
Rectal exam: tight sphincter. may see proximal hypertrophied anal papilla
tx?
frequent location?
workup? |
|
Definition
anal fissure
workup: anoscopy, sigmoidoscopy, bx if non-healing, anal manometry
tx: stool softeners, bulking agents, sitz baths -->heal 90%
- botulinum toxin
- topical nitro ointment
surgery: lateral internal sphincterotomy |
|
|
Term
Abdominal pain:
1. most common cause of nonspecific abd pain?
2. other common causes?
3. alarm signs
4. Pain aggravated by movement or cough is most likely?
5. palpable LLQ mass is most liekly?
6. hyperactive bowel sounds is most liekly?
7. reduced BS?
8. involuntary RLQ guarding?
9. midepigastric or duodenal sweep pain?
10. rushes, high pitched tinkles, sudden onset colicky pain, vomiting, obstipation?
11. lower abd tenderness + increased bowel sounds and cervical motion tenderness?
12. classic triad: abd tenderness + palpable mass LLQ + fever?
13. costovertebral angle tenderness + ileus? |
|
Definition
1. gastroenteritis
2. gastritis, PUD, GERD, IBS, dysmenorrhea, salpingitis, appy, chole, cholelithiasis, SBO, mesenteric adenitis, diverticulitis, pancreatitis, ureterolithiasis, increacerated hernia, gas entrapment, ischemic bowel
3. alarm signs: weight loss, GI bleed, anemia, fever, frequent nocturnal sx, onset >50 y/o
4. movement/cough = appy or PUD
5.LLQ mass: diverticular disease
6. hyperactive bs: SBO
7. reduced BS: perforation
8. RLQ guarding: appy
9. epigastric/duodenal sweep: PUD
10. rushes & high-pitched, tickling peristalsis - obstruction
1.. increased BS + cervical motion: salpingitis
12. trid abd pain, palpable LLQ mass, fever: diverticulitis
13. costovertebral: ureterolithiasis |
|
|
Term
Sx: diarrhea, abd pain, weight loss,
if perianal: larger indolent ulcers, violaceous perianal skin, fistulas
may have extraintestinal involvement: uveitis, episcleritis, erythema nodosum, pyoderma gangrenosum, peripheral arthritis, amyloidosis, DVT, sclerosing cholangitis
Colonoscopy: cobblestoning
XRAY: string sign and skip lesions, often sparing of rectum
tx? |
|
Definition
crohn's disease
tx: steroids for acute attacks
maintenance tx:
- oral 5-aminosalicylates (sulfalazine or mesalamine)
- immunosuppressants (azathioprine, mercaptopurine, infliximab) |
|
|
Term
Crohn's Disease:
1. Can spare the ___ in 50%
2. ___ mucosal inflamation and granuloma formation
3. can affect entire GI tract from mouth to anus
4. three general features?
5. complications |
|
Definition
1. rectum
2. transmural
4. regional enteritis, granulomatous colitis, transmural colitis
5. 4-20x cancer risk of general population, increased risk for lymphoma, leukemia, and toxic megacolon |
|
|
Term
Ranson's Critera:
At presentaiton:
1. Age >__
2. WBC >__
3. Glucose >__
4. LDH >__
5. AST >__
After 24 hrs:
1. Hematocrit <__
2. BUN >__
3. Ca <__
4. PO2 <__
5. Base deficit >__
6. Fluid sequestration >__ |
|
Definition
At presentaiton:
1. Age >55
2. WBC >16K
3. Glucose >200
4. LDH >350
5. AST >250
After 24 hrs:
1. Hematocrit fall >10%
2. BUN increase >8
3. Ca <8
4. PO2 <60
5. Base deficit >4
6. Fluid sequestration >600
|
|
|
Term
Types of hernias:
1. only part of bowel becomes incarcerated or strangulated in the fascial defect. at risk for perforation/peritontiis
2. combo direct and indirect on the same side
3. hernia through the linea semilunaris
4. happens when obliteration of processus vaginalis fails to occur. hernia sac passes through internal inguinal ring through transversalis fascia. lateral to inferior epigastrics.
5. due to defect in transversalis fascia through hasselbach's triangle. medial to inferior epigastrics.
6. indirect hernia in which the wall of a viscus forms a portion of the hernia sac. commonly involve cecum and colon.
7. descends femoral canal beneath inguinal ligament
8. protrudes through linea alba above the umbilicus |
|
Definition
1. richter
2. pantaloon
3. spigelian
4. indirect inguinal
5. direct inguinal
6. sliding inguinal
7. femoral
8. epigastric
9. |
|
|
Term
Abdominal wall nerves:
1. innervates suprapubic skin.
2. most frequently injured during anterior open inguinal repair. innervates the base of penis or mons pubis, scrotum/labia, and medial thigh
3. subject to injury during laproscopic hernia repairs. innervates scrotum and anteromedial thigh and lateral thigh.
4. large nerve can be injured in lap or femoral hernia repairs |
|
Definition
1. iliohyogastric
2. ilioinguinal
3.genitofemoral
4. femoral |
|
|
Term
| components of Hesselbach's triangle |
|
Definition
inguinal ligament
inferior epigastrics
lateral border of rectus |
|
|
Term
Postop bleeding complications:
1. wound edges become raised and discolored. needs evacuation
2. serous sanguinous discharge POD 5-8. popping sensation with coughing. fever, v/d, abd pain, skin inflammation
3. rapidly evolving, life threatening condition w/in first 24 hrs after surgery. sx of hypovolemia: hypotension, decreased urine, peripheral vasoconstriction, increase in abd girth |
|
Definition
1. hematoma
2. dehiscence
3. hemoperitoneum |
|
|
Term
Nipple discharge:
most common causes in non-lactating breast (3)
Causes:
1. spontaneous, unilateral, serous or serous-sanguineous discharge from a single duct. may be able to feel duct at edge of areola. benign
2. in pre-menopausal women: spontaneous multiple duct discharge. unilateral or bilateral. most noticeable just before menstruation. green or brownish discharge.
3. milky discharge from multiple ducts in the non-lactating breast. work up: serum prolactin and TSH.
4. clear, serous, or milky discharge from a single duct or multiple ducts. more evident just before menses.
5. purulent discharge |
|
Definition
duct ectasia, intraductal papilloma, carcinoma
1. intraductal papilloma
2. fibrocystic
3. hyperprolactinemia
4. oral contraceptives or estrogen
5. subareolar abscess
|
|
|
Term
Breast cancer in men:
1. incidence is __% that of women.
2. sx?
3. tx?
4. mets commonly to?
5. prognosis? |
|
Definition
1. 1%
2. painless lump. sometimes: nipple dischare, retraction, erosion, ulceration. commonly preceded by gynecomastia.
3. tx: mastectomy, radiation, tamoxifen!, castration, estrogens (NOT androgens)
4. mets to bone.
5. stage I: 58% 5 year, 38% 10 year
stage II: 38% 5 year, 10% 10 year
All stages: 36% 5 year, 17% 10 year |
|
|
Term
Shock:
1. 6 general causes
2. decompensated vs. compensated shock |
|
Definition
1. depletion of vascular volume, compression of great vessels, intrinsic heart failure, loss of autonomic control, severe untreated systemic inflammation, severe but partially compensated systemic inflammation
2. decompensated: BP or cardiac output is inadequate for peripheral perfusion
compensated: perfusion is adequate but only at the expense of excessive demands on the heart |
|
|
Term
sx: postural hypotension is first sign
difficulty establishing IV access, cold/pale skin, increased capillary refill, collapsed neck veins, oliguria (<0.5 ml/kg/hr), decreased hematocrit, third, supine hypotension, metabolic acedemia with compensated rapid resp rate, altered mental status
cause?
compensatory responses?
tx?
modalities to avoid? |
|
Definition
hypovolemic shock: inadequate circulating blood volume
causes: bleeding, protracted v/d, sequestration of fluid in gut, loss of plasma in burned tissue
compensatory responses: constriction of peripheral/visceral veins and arterioles, improved cardiac contractility and HR, increased sodium and water reabsoprtion through RAA system
tx: ABCs
- stop bleeding
- fluids: 14 g needle with 3L crystalloid fluids (NS or LR)
- blood: when loss exceeds 1.5L or 30% of blood volume (O- is universal)
avoid: colloid fluids, vasopressors, trendelenberg position, pneumoatic antishock garments to suppress bleeding |
|
|
Term
Shock with EKG changes due to an underlying cardiac condition. may have CP, third heart sound, rales, ST elevation, enlarged heart, pulm edema, JVD, edema, hepatomegaly.
could be due to ruptured AAA
tx: bradycardia, tachy, vfib, chf, coronary stenosis, |
|
Definition
cardiogenic shock
tx:
- bradycardia: 0.5 mg atropine at 2 min intervals
- vfib: synchronized cardioversion
- stable tachy: establish euvolemia, may need CCB or BB
- CHF: diuretics
- stenosis: vasoconstrictors
other:
- vasodilators (nitroprusside, nitroglycerin) for long term control
- inotropes (dobutamine or milrinone) to increase CO
- chronotropes (dopamine) to increase HR
|
|
|
Term
Shock caused by failure of autonomic nervous system
causes: regional/general anesthetics, spinal cord injury, autonomic blocking agents
Sx: hypotension, warm/flushed skin in denervated area. may have increased HR.
tx? |
|
Definition
neurogenic shock
tx: trendelenburg
IV lfuids
vasoconstrictors (NE) if HR is too rapid, vasodilators (dopamine) if HR is too slow |
|
|
Term
shock caused by bowel perf, intestinal necrosis, abscess, gangrene, soft tissue infection, ischemia, massive burns.
due to cytokinemia
sx: oliguira, hypotension, Ams, metabolic acidemia, signs of adrenergic discharge, ischemia on EKG, hyper or hypothermia
BASICALLY LOOKS LIKE A COMBO OF OTHER SHOCKS
tx? |
|
Definition
low output inflammatory shock
tx: IV fluids, abx, correction of underlying problem, admission to ICU, vasoconstrictors, inotropes with swan-ganz catheter
successful recovery puts pt in high-output state |
|
|
Term
Animal bites
1. infection rates - dogs, cats, humans
2. common microbes?
3. tx?
4. prophylactic abx? cat bites, hand bites |
|
Definition
1. dogs: 5%, cats: 30-50%, humans: 15-30%
2. most are polymicrobial - avg of 4 microbes per bite. pasteurella (anaerobe) is most common
3. tx:
- cleaning, irrigation, and debridement
- suture if needed and NOT infected
4. prophylactic abx:
- all cat bites: dicloxacillin 0.5 g QUID for 3-5 days
- any hand bite: penicillin V 0.5 g QID for 3-5 days
- any immunocompromised pt should have abx
- pasteurella: penicillin or TCN for 2-3 weeks
- human bites: unasyn, zosyn (b-lactam and b-lactamase inhibitor), or a 2nd gen ceph for anaerobes
- clindamycin + fluoroquinolone for penn allergy
|
|
|
Term
How mcuh local anesthetic can a 70 kg adult safely receive?
contraindications for lidocaine and epi? |
|
Definition
28 ml of 1% lidocaine and 49 ml of 1% lido w/ epi
contraindications:
lidocaine: severely unstable BP, allergy, liver disease
epi: fingers, nose, toes, penis, pinna, digital block - can cause necrosis due to loss of blood supply |
|
|
Term
sx: hypertension in arms but low/normal BP in legs. exaggerated by exercise. absent/weak femoral pulses, delay in pulse from brachial to femoral.
EKG: LV hypertrophy
CXR: rib notching
tx? |
|
Definition
coarctation of aorta - narrowing of aortic arch just distal to origin of L subclavian
tx:should tx anyone with gradient >20 mmHg between arms and legs
- procedure of choice: percutaneous stenting
- resection of coarctation site: 1-4% mortality rate
- balloon angioplasty
Prognosis: most pts die before age 50 |
|
|
Term
liver laceration:
__% can be medically managed
__ maneuver to clamp hepatic pedicel |
|
Definition
|
|
Term
Basilar skull fx:
1. involve which bones?
2. sx
3. tx
4. complications |
|
Definition
1. sphenoid, temporal, occipital bone, clivus
2. battle sign (retroauricular ecchymosis), racoon eyes (bilateral periorbital ecchymosis), hemotympanum
3. tx: conservative if cranial nerve injury is r/o
4. complications: epidural hematoma if ruptures middle meningeal artery |
|
|
Term
common malignant tumor of the bone caused by a bone marrow plasma cell disorder. commonly affects pts 50-80 y/o. commonly affects vertebrae or long bones
sx: bone pain, pathologic fx, anemia
labs: bence-jones proteins
xray: "punched out" lytic lesions
tx? |
|
Definition
multiple myeloma
tx: chemo, radiation, bone marrow transplant
|
|
|
Term
small blue cell tumor w/ characteristic t(11:22) chromosomal translocation. commonly occurs in kids >5 y/o and young adults.
common locations: pelvis, knee, proximal humerus, femur diaphysis
sx: pain, fever, elevated inflammatory markers, leukocytosis
xray: destructive (lytic) diametaphyseal lesions
- classic "onion skin" appearance - mulitple layers of reactive periosteum
tx? |
|
Definition
ewing's sarcoma
tx: chemo, radiation, surgery |
|
|
Term
results form malignant cartilaginous cells with peak incidence in 5-6th decades
common locations: knee, shoulder, pelvis, spine
xray: cortical thickening and stippling consistent with cartilage deposition
tx? |
|
Definition
chondrosarcoma
surgical resection |
|
|
Term
Sx: RLQ pain, tenderness, fever, leukocytosis
xray: localized air-fluid levels, ileus, increased RLQ soft tissue, calculus, altered psoas shadow, abnormal R flank stripe
CT: periappendiceal fat stranding, phlegmon
complications:
1. usually due to delayed medical care. increased fever, pain, peritonitis, tubal infertility.
2. palpable RLQ mass. needs US-guided aspiration
3. due to perf of a gangrenous organ. peritoneal signs, adynamic ileus
4. suppurative thrombophlebitis of portal drainage system - characterized by SHAKING CHILLS
tx? |
|
Definition
appy
1. perforation
2. appendiceal abscess
3. peritonitis
4. pyelphlebitis
tx: lap appy |
|
|
Term
Blunt abd trauma:
1. due to ____
2. commonly injured organs?
3. seat belt sign -- look for injury to what organs?
4. evaluation
5. when to go to surgery/ |
|
Definition
1. rapid decelration (MVA)
2. non-compliant organs - liver, spleen, pancreas, kidneys. SPLEEN IS MOST COMMON
3. seat belt sign - pancreas and small bowel
4. evaluation: FAST exam
5. surgery if unstable + pos FAST exam |
|
|
Term
penetration abd trauma:
1. sx?
2. when to take to surgery? |
|
Definition
1. sx: shock if major vessels/organs penetrated. increased intraabd pressure, sepsis, leukocytosis, fever, peritonitis, hypovolemia
2. give fluids. if pt doesn't respond, has peritonitis, or hypovolemia, do CXR and take to surgery. also if depth of wound is unknown. all GSW should be taken to surgery |
|
|
Term
Workup for abdominal trauam:
1. 4 areas examined in FAST exam?
2. when would DPL indicate bowel injury? |
|
Definition
1. RUQ, LUQ, subxiphoid, pelvis
2. WBC, particulate matter, amylase, or bacteria in lavage fluid
|
|
|
Term
Splenic injuries:
MOST COMMONLY INJURED ORGAN IN BLUNT TRAUMA
treatment? |
|
Definition
1. close monitoring in ICU
2. artery injury: angiographic embolization
3. splenectomy/surgery if unstable -- need vaccines for encapsualted organisms (h. flu, n. meningitidis, pneumococcus)
4. emergent celiotomy
5. salvage procedures: splenorrhaphy, partial resection |
|
|
Term
suspect this with upper abd injury and elevated amylase
xray/CT: distended duodenal C-loop
tx? |
|
Definition
pancreatic injury
CT is best study
tx: drainage/resection |
|
|
Term
What kind of head injury:
caused by direct impact
classic presentation: knocked out, wake up, unconsious again
tear of middle meningeal artery
CT: football-shaped blood
tx? |
|
Definition
|
|
Term
what kind of head injury?
common in elderly and alcoholics
tear of tethered bridgeing veins
deceleration injuries
CT: blood follows contour of head
poor prognosis if AMS at time of presentaiton |
|
Definition
|
|
Term
Spinal cord injuries:
1. greater neuro deficit in upper extremities. due to hyperextension which causes buckling of ligamentum flavum
2. hemisection of spinal cord - causes motor paralysis and contralateral sensory loss distal to lesion
3. due to flexion injuries. paralysis and hypalgesia below injury. fine touch and proprioception intact
4. injury below L2. perineal or bilateral leg pain, bowel/bladder dysfunction, perianal anesthesia, diminished rectal sphincter tone, lower extremity weakness |
|
Definition
1. central cord syndrome
2. brown-sequard syndrome
3. anterior cord syndrome
4. cauda equina |
|
|
