Question Main

Id
Division

SubDivision

Notes

Acute Limb Ischemia:

1. Sx = The 6Ps are Pain, Pallor, Paresthesias, Pulselessness,
Poikilothermia and (later) paralysis

4507

Medicine Cardiovascular System

2. Dx = clinical
3. Tx = Clot Busters
4. Other = Acute arterial occlusion can be from embolus, arterial
thrombosis, or trauma to the artery. Emboli come from the heart, with
LE being affected more often.
AcuteMediastinitis:

2337

Surgery

Cardiovascular System

1. Sx = 2 weeks Following a cardiac Surgery, fever chest pain,

leukocytosis. sternal wound drainage and purulent discharge.
2. Dx = Chest X ray shows mediastinal widening.
3. Tx = drainage, surgical debridement, and ABX therapy.
VenoousHypertension

3455

Surgery

Cardiovascular System

1. Sx = Edema, stasis dermatitis, and venous ulcerations

2. Dx =
3. Tx =

AAA rupture
3551

Surgery

Cardiovascular System

1. Sx = Acute onset back pain and profound hypotension

2. Dx = presumptive diagnosis with clinical signs.
3. Emergent surgery

VenousValve Incompetence:
4025

Surgery

Cardiovascular System

1. Sx = unilateral lower extremity dema that worsens when the leg is

dependent.
- improves with elevation.
2. Dx = Doppler exam will show no evidence of thrombosis.
3. Tx =

Peripheral Artery Aneurysm:

4241

Surgery

Cardiovascular System

1. Sx = Pulsatile mass that can compress adjacent sturctures.

2. Dx = Clinical, US
3. Tx = surgery. HTN control.

Peripheral Arterial Diseae:

4494

Surgery

Cardiovascular System

1. Sx = In a patient w/ multi risk factors for atherosclerosis +

intermittent claudication.
2. Dx = ABI to confirm presence of peripheral arterial disease
3. Tx = conservative initially, quit smoking and exercise to develop
collateralcirculation.
Retroperitoneal Bleeding:

1. Sx = Sudden onset of hypotension, tachycardia, flat neck veins and

back pain.
4501

Surgery

Cardiovascular System

2. Dx = non-contrast CT scan of abdomen and pelvis or abdominal

ultrasound.
3. Tx = supporitve, with intensive monitoring, rest, and IV fluids or
bloodtransfusion.
- Surgical repair is rarely required.
Aortoiliac Occlusion

4508

Surgery

Cardiovascular System

1. Sx = Triad of bilateral hip, thigh, and buttock claudication +

impotence and systemic atrophy of the biltateral lower extremities (b/c
chronic ischemia)
2. Dx = soft or absent pulses bilaterally from the groin. Vascular
examination
3. Tx =

Myocardial Contusion:

4541

Surgery

Cardiovascular System

1. Sx = Shock following MVC, slightly elevated PCWP, with blood

pressure that doesn't change.
- sign of elevated intracardiac filling pressures second to left
ventricular dysfunction.
2. Dx = Echocardiogram in patients with blunt chest trauma na disngs
of acute heart failure or shock
3. Tx =

Compartment Syndrome:
1. Sx = pain out of proportion to injury. Pain increases with passive
stretch. Rapidly increasing and tense sweling. paresthesia.
4608

Surgery

Cardiovascular System

2. Dx = measure intracoparment pressures. Compartment pressure

greater than 30mmHG indicates significant CS. delta pressure
(diastolic - compartment) of 20-30 indicates significant CS.
3. Tx = fasciotomy.
4. Other = the overall cause of symptoms found in cases of
compartment syndrome is soft tissue swelling.

Aortic Injury:
4696

Surgery

Cardiovascular System

1. Sx = MVC or fall of greater than 10 feet. anxiety, tachycardia and

hypertension.
2. Dx = CXR shows mediastinal widening and possible deviation of
trachea. CT and angiography if you need more info.
3. Tx = Surgery.

Squamous Cell Carcinoma

1. Sx = patient with severe burn and extenstive scar formation.
Chronic NON-Healing wound. Esp. associated with UV sun exposure.
3456

Surgery

Dermatology

2. Dx = Biopsy
3. Tx = Removal.
4. Other = Marjolin ulcer = SCC that arises within a burn wound.
- SCC that arises in chronic wounds tends to be more aggressive.
Gram Negative Sepsis Following burn:

4550

Surgery

Dermatology

1. Sx = patient w/ recent history of burn over 20+ % body surface.

Progressive confusion, lethargy, reduced urine output.
- Change in appearance of a burn, Systemic findings (^ temp, HR,
RR, and decreased BP)
2. Dx = Wound culture >10^5 bacteria/g of tissue. Also need biopsy
for histopathology to determine invasion depth.
3. Tx = broad spectrum antibiotics. Tailored after culture results come
back
4. Gram (+) first, then Gram (-)

4550

Surgery

Dermatology

Gram NegativeSepsis:
- Following a Burn, may be associated with change in wound
appearance, hypothermia, and thrombocytopenia.
Retropharyngeal Abcess:

1. Sx = neck pain, odynophagia, and fever following penetrating

trauma to the posterior pharynx.
2846

Surgery

Ear, Nose & Throat (ENT)

2. Dx = nuchal rigidity and bulging of the pharyngeal wall on

examination. lateral radiographs show increased thickness of the
pre-vertebral soft tissues w/ an air fluid level.
3. Tx = Surgical intervention
4. increased risk of developing acute necrotiing mediastinitis

Peritonsilar Abscess
1. Sx = Fever, sore throat, difficulty swallowing, trismus, muffled voice
nd Uvula deviation away from enlarged tonsil.
2847

Surgery

Ear, Nose & Throat (ENT)

2. Dx =
3. Tx = needle aspiration or incison and drainage plus antibiotic
theray to cover Grup A hemolytic streptococci and respiratory
anaerobes
TorusPalatinus:

3427

Surgery

Ear, Nose & Throat (ENT)

1. Sx = young pt. with fleshy immobile mass on midline hard palate

2. Dx = clinical
3. Tx = no medical or surgical therapy unless patient gets symptoms
or mass starts to affect speech or eating.

3428

Surgery

Ear, Nose & Throat (ENT)

Nasal septal perforation

1. Sx = whistling through nose following rhinoplasty

NasoPharyngeal Carcinoma:

1. Sx = Asian or Mediterranian pt. with neck swelling and espestaxis

but no history of trama. (might be smoker)
3500

Surgery

Ear, Nose & Throat (ENT)

2. Dx = Undifferentiated Carcinoma seen on biopsy

3. Tx = chemo, radiation, resection
4. Other = Strong association with EBV. also w/ smoking,
nitrosamines.
Acute Adrenal Insufficiency:

4077

Surgery

Endocrine, Diabetes &

Metabolism

1. Sx = Hypotension, Shock, N/V, Weakness, Fever. In a patient with

glucocorticoid use (chronic) or with expected autoimmune syndrome
(other autoimmunediseases)
2. Dx =
3. Tx = IV hydrocortisone or dexamethasone.

Hypocalcemia from Primary Hypoparathyroidism:

1. Sx = pins and needeles sensations around mouth and feet. muscle
cramps by end of day.
4254

Surgery

Endocrine, Diabetes &

Metabolism

2. Dx = hypocalcemia and hyperphosphatemia in the presence of

normal kidney function.
3. Tx = depending on cause
4. Other = caues include post surgical, autoimmune, and defecive
calcium sensing receptor.

Ovarian Cyst Rupture:

12160

Surgery

FemaleReproductive
System & Breast

1. Sx = acute abdomen due to hemoperitoneum. sudden onset. might

immediately follow sex or strenous activity.
2. Dx = Pelvic free fluid on US. Point in menstrual cycle where
ovarian cyst would be large
3. Tx = sugery if patient is hemodynamically unstable.
SmallBowelObstruction:

2322

Surgery

Gastrointestinal & Nutrition

1. Sx = Colicky Abdominal pain, vomitting, inability to pass flatus or

stood, abdmonial distention, tenderness.
2. Dx = CXR
3. Tx = Surgery

Umbillical Hernia:
1. Sx = Black kid w/ buldge in umbilical region covered by skin
2476

Surgery

Gastrointestinal & Nutrition

2. Dx = clinical. buldge protrudes w/ straining or crying. defect in

linea alba covered by skin.
3. Tx = usually reducible, w/ spontaneous closure by age 5. Surgery
otherwise.
Acute Mesenteric Ischemia:

2822

Surgery

Gastrointestinal & Nutrition

1. Sx = Rapid onset peri-ubillical pain. Pain out of proportion to

examination findings.
2. Dx = leukocytosis, elevated amylase and phosphate levels, and
metabolic acidosis on labs. CT for diagnosis. angiography if resutls
are unclear.
3. Tx = supportive, resection if necrosis occurs.
Pancreatic Pseudocyst:

2897

Surgery

Gastrointestinal & Nutrition

1. Sx = history of alcoholism, recent episode of panreatitis, N/V,

abdominal distention
2. Dx = roun well circumscribed encapsulated fluid collection on CT
3. tx = Endoscopic drainage if the patient has symptoms. expectant
management (NPO) if they're asymptomatic

Gallstone Ileus:
1. Sx = Episodes of N/V. Pneumobilia (air in biliary tree). Hyperactive
bowelsounds.
2903

Surgery

Gastrointestinal & Nutrition

2. Dx = Abdominal CT (shows gallbladder wall thickening,

pneumobilia, and obstructive stone).
3. Tx = Surgical removal of stone and cholesystectomy (same time or
later)
4. Other = Gallstone passes through a biliary-enteric fistula into the
small bowel. Tumbling obstruction as it moves. diffuse abdominal pain
and vomiting before lodging in th ileum days later.
Acute upper Gi Bleeding:

2922

Surgery

Gastrointestinal & Nutrition

1. 1st step is to recussitate fluids. (2 large bore IV needles or a

central line should be placed.
2. 2nd step is to control the bleeding itself. might give
vasoconstrictors, octreotide or somatistatin.
Gallstonepancreatitis:

2933

Surgery

Gastrointestinal & Nutrition

1. Sx = pancreatitis symptoms (midepigastric pain radiating towards

back, elevated amylase)
2. Dx = ultrasound shows thickened gallbladder wall and gallstoens.
(ALT >150 is 95% sensitive for gallstone pancreatitis)
3. Tx = Supportive treatment until acute pancreatitis is resolved,
(including NPO) and cholecystecomy to follow.
Emphysematous Cholecystitis

2940

Surgery

Gastrointestinal & Nutrition

1. Sx = a diabetic, vascular, or otherwise compromised patient with

fever, RUQ pain, N/V and crepitus in the abdominal wall near
gallbladder
2. Dx = Air fluid levels in gallbladder, gas in gallbladder wall, and
culutres of gas forming clostridium or e. coli.
3. Tx = emergent cholecystectomy. broad spectrum antibiotics with
clostridiumcoverage(ampicillin-sublactam)
Sphincter of Oddi Dysfunction:

2973

Surgery

Gastrointestinal & Nutrition

1.Sx = Post-Cholesystectomy pain, with normal ERCP (rules out CBD

stones)
2. Dx = Elevated biliary sphincter pressure. RUQ pain and elecation of
liver enzymes during attack.
3. Tx = ERCP with sphinctertotomy.

Gilbertsyndrome:
1. Sx = Mild episodes of jaundice provoked by stress in males.
2983

Surgery

Gastrointestinal & Nutrition

2. Dx = Unconjugated hyperbilirubinemia on repeat testing, normal

CBC, AST, ALT and alk phos.
3. Tx = supportive if necessary.
4. Other = Most common inherited disorder of bilirubin
glucoronidation.
Paralytic Ileus:

3179

Surgery

Gastrointestinal & Nutrition

1. Sx = abdominal pain following a traumatic injury. absent bowel

sounds.
2. Dx = X-ray revealing gas filled loops of both small and large
intestines + gastric dilatation. NO TRANSITION POINT
3. Tx = Conservative. bowel rest, supportive care, treatment of
secondary causes.
Psoas Abcess:

3181

Surgery

Gastrointestinal & Nutrition

1. Sx = subacute fever and lower abdominal or flank pain radiating to

groin
2. Dx = Positive Psoas sign (abdominal pain with hip extension. CT
scans to confirm
3. tx = drainage with antibiotics.
ComplicatedDiverticulitis:

1. Sx = following initial presentation with acute diverticulitis. (pain,

fever, leukocytosis)
3182

Surgery

Gastrointestinal & Nutrition

2. Dx = Inflammatory changes on CT.

3. Tx = CT guided perc. drainage for more than 3cm of fluid. Surgical
drainage and debridebment if symptoms persist more than 5 days
4. Other = Complicated diverticulitis is any diverticulitis that's
assocaited with an abcess, perforation, obstrution, or fistula formation.
B.A.T. Splenic Injury:

3358

Surgery

Gastrointestinal & Nutrition

1. Sx = following MVC or similar trauma. delayed onset of

hypotension, LUQ pain, abdominal wall contusiion and left rib fracture
2. Dx = CT scan with contrast in stable patients will show splenic injury
w/ good accuracy.
3. Tx = IV fluids and Urgent laparotomy for patient w/ unstable vitals or
CT images that warrant it.

DuodenalhematomafollowingBAT

3851

Surgery

Gastrointestinal & Nutrition

1. Sx = kid with blunt abdominal trauma, when blunt force rapidly

compresses duodenem against the vertebral column. Pt. has failure to
pass gastric contents past the obstructing hematomy (day or 2 after
injury)
2. Dx = Abdominal Ct
3. Tx = parenteral nutrition and NG tube should be enough, but perc.
drainage and surgery if not.
Ischemic Colitis:

1. Sx = pain, tenderness, diarrhea and lactic acidosis in a patient

who's 60+ and has had either a vascular procedure or an MI.
3877

Surgery

Gastrointestinal & Nutrition

2. Dx = CT scan shows thick bowel wall and double halo sign.

Colonoscopy shows mucosal pallor or cyanosis, petechia,
hemorrhage.
3. Tx = Supportive Care, IV fluis, bowel rest, Abx, and Colon resection
if the bowl is infarcted or they become clinically unstable.
Anal Fissures:

4111

Surgery

Gastrointestinal & Nutrition

1. Sx = Pain with bowel movements, bright red blood on stool surface

or toilet paper, most commonly at posterior anal midline, might have
skin tag.
2. Dx = Clinical
Tx = High fiber, adequate fluids, stool softeners, sitz baths, topical
anestheticsanvasodilators.

4111

Surgery

Gastrointestinal & Nutrition

Anal Fissure Treatment:

- Do medical management first and then Surgical intervention if the
fissures are refractory to medical management.
Appendicial Abcess:

1. Sx = delayed presentation of appendicitis. signs of peritionitis.

fever, leukocytosis.
4251

Surgery

Gastrointestinal & Nutrition

2. Dx = Anterior abdominal palpation might not be telling, maneuvers

that assess deep abdominal spaces (psoas sign) will help more.
3. tx = appendectomy
4. other = pt. who comes in with appendicitis symptoms 5+ days after
onset are likely to have perforation and abcess formation. treat with
fluids, abx, bowel rest. + appendectomy
Perforated viscus:

4462

Surgery

Gastrointestinal & Nutrition

1. Sx = Acute onset, severe constant epigastric pain in a patietn wit

history of peptic ulcer symptoms.
2. Dx = Chest X ray shows intraperitoneal free air.
3. Tx = Urgen exploratory lapartomy.

Pancreatic Injury with BAT

4555

Surgery

Gastrointestinal & Nutrition

1. Sx = fever, chills, deep abdominal pain (signs of retroperitoneal

abcess).
2. Dx = serial Ct scans, (immediate CT might not show injury. amylase
valuesaren'thelpful
3. Tx = immediate placement of perc. drainage cath, culture of the
fluid and surgical debridement.
Pancreatic Cancer

4558

Surgery

Gastrointestinal & Nutrition

1. Sx = Systemic symptoms + weight loss. Abdominal/back pain.

Jaundice, unexplained migratory superficial thrombophlebitis and
hepatomegaly.
2. Dx = Abdominal US if jaundiced, CT scan if no jaundice

4558

Surgery

Gastrointestinal & Nutrition

You'd gain weight with a duodenal ulcer rather than lose it. You
essentially have pain with a duodenal ulcer whenever there's no food
to act as a buffer for acid secretion
Warfarin Reversal:

4601

Surgery

Gastrointestinal & Nutrition

1. The reversal of warfarin must be rapidly achieved in cases wehre

emergent surgery is required.
- May be acheived pre-operatively by infusion of fresh frozen plasma.
Pilonidal Disease:

4640

Surgery

Gastrointestinal & Nutrition

1. Sx = Acute pain and swelling of the midline sacrococcygeal skin

and subq issues. Young males with lots of body hair.
2. dx = clinical
3. tx = drainage of abscesses and excision of sinus tracts
Perforated Viscus:

12142

Surgery

Gastrointestinal & Nutrition

1. Sx = Sudden onset acute abdominal pain, fever, ^HR, and

peritonitis. History of PUD as cause.
2. Dx = Guarding and Rigidity on P.E. Postive Stool Guiac, Upright
CXR shows Free inttraperitoneal ari.
3. Tx = Laparotomy
GCS Scale

1. Eye Opening
- from 1 to 4
- none, pain, verbal stimuli, then spontaneous
3213

Surgery

GeneralPrinciples

2. Verbal Response
- from 1 to 5
- none, then sounds, then words, then appropriate words, then
disoriented, then oriented.
3. Motor Response
- from 1 to 6
- none, to etention, to flexion, to withdraws to pain, to localizes, to
obeys

Cervical Spine Trauma management:

3227

Surgery

GeneralPrinciples

1. Pre-hospital: spinal immobilization, helmet removal and airway

oxygenation
2. ER : orotracheal intubation unless theres facial trauma, cervical
stabilization unless it interferes with intubation, CT of entire cervical
spine, monitoring for neurogenic shock from spinal cord injury.
Catheter Associated infection

3464

Surgery

GeneralPrinciples

1. Sx = Post-operative fever (1 wk). Subacute. Infection signs (rather

than contamination) shown with fever, hyptoension, leukocttosis,
redness at the catheter entry site, and culture growht in both aerobic
and anaerobic bottles.
- seeing growth of the organism in more than 2 bottles is another sign
of infection over contamination
2. Dx = Blood culture samples
3. Tx = Antibiotics.

Tracheobronchial Rupture:

3503

Surgery

GeneralPrinciples

1. Sx = Trauma w/ rapid de-acceleration. Forceful impact.

Pneumothorax persistent despite chest tube placement.
2. Dx = Chest X ray with High resolution CT scan to confirm. Sub-Q
emphysema. Pneumomediastinum. (usually the right main bronchus is
injured in these cases)
3. Tx = Surgery.

Hypovolemic Shock
4207

Surgery

GeneralPrinciples

1. Tachycardia and peripheral vascular constriction are the first

physiological changes when hemorrhage occurs.
- These repsonses act to maintain the blood pressure within normal
limits until severe blood loss has occured.
Ruptured Abdominal Aortic Aneurysm:

4212

Surgery

GeneralPrinciples

1. Sx = Older man with smoking and HTN history, severe ad sudden

abdominal pain, weak, drowsy, pale.
2. Dx = ruptured aorta seen on CT. (blood collection in adventitia).
Hypotension, tender abdomen. Bedside ultrasound in unstable patient.
3. Tx = Surgical repair.

4500

Surgery

GeneralPrinciples

UnstablepatientwithHemoperitoneum
1. Always require an emergency lapartomy.

Bladder Injury:
1. Sx = Abdominal pain that results to the shoulder (Kehr sign).
4557

Surgery

GeneralPrinciples

2. Dx = Chemical peritonitis.
3. Tx = surgery
4. The dome of the bladder is the only part that's coverd by
peritoneum, meaning it's the only way you'd get leakage of urine into
theperitoneum.
Deep Venous Thrombosis:

4493

Surgery

Hematology & Oncology

1. Sx = LE pain, swlling, and difficulty bearing weight, with edema and

painwithmovement.
2. Dx = Clinical symptoms following surgery
3. Tx = 3 months of anticoagulation for provoked DVT. Stable patient
can begin within 2 days of surgery. If they're gonna take warfarin
you've got to bridge with heparin.
Tetanusvaccinations:

3325

Medicine Infectious Diseases

1. patient with signficant puncture wound who hasn't gottent tetanus

within 5 years should be vaccinated.
2. tetanus immune globulin for a patient who hasn't ever had a full
immunization set or doesn't know
Necrotizing Fasciitis

1. Sx = History of minor trauma. Patient with erythema of the overlying

skin, swelling and edema. Key = Pain out of proportion to examination
findings.
2749

Surgery

Infectious Diseases

2. Dx = Systemic signs = fever and hypotension. Culture reveals

microbiology. Clinical diagnosis
3. Tx = Surgical debridement and broad spectrum antibiotics.
4. other = Group A strep is commonly cultured, though it's often
polymicrobial.
Necrotizing Surgical Site infection:

4102

Surgery

Infectious Diseases

1. Sx = post surgery pain, red, edematous lesion spreading beyond

surgical site. Systemic signs. Paresthesia and anesthesia at endges
of wound. Dishwater drainage. Subq gas or crepitus
2. Dx = clinical. suspicious in patient w/ diabetes
3. Tx = surgical exploration, glycemic control, antibioitics

Transfusion Reaction:
1. Sx = fever following surgery within 6 hous.
2. Dx = clinical
4526

Surgery

Infectious Diseases

3. Tx = stop the transfusion, rule out other serious cases of fever, give
antipyretic
4. Other = small amounts of leukocyte may remain in the red cell
concentrate (RBC packs). During blood storage, the leukocytes
release cytokines that can cause fevers, chills and malaise in patient
who receives the RBC pack.
Post-operative Parotitis:

4544

Surgery

Infectious Diseases

1. Sx = Dehydrated post op patient with painful swelling of the parotid

gland that's aggravated by chewing.
2. Dx = PE findings show tender, swollen and red gland. purulent
saliva from the parotid duct. Staph aureus usually found on culture
3. Tx = adequate fluid hydration, oral hydration abx
Prosthetic Joint Infection

1. Sx = Early onset will have wound drainage with redness, swelling

and fever. Delayed will have joint pain with implant loosening or sinus
tract formtion.
9111

Surgery

Infectious Diseases

2. Dx = clinical.
3. Tx = removalof implant. Might keep it and do debridement if it's
early onset.
4. Early onset = Staph A, gram neg. and Anaerobes
Late onset = Coag negative staph, Propionobacterium, enterococci.
Varicocele:

4525

Surgery

MaleReproductiveSystem

1. Sx = soft scrotal mass (bag of worms). Decreases in supine

position. increases with valsalva. Subfertility and testicular atrophy
2. Dx = Ultrasound (shows retrograde venous flow, tortous tubules and
dilation of Panpinaform plexus
3. Tx = Gonadal vein ligation (if younger), scrotal support and
NSAIDS (if older and don't want kids)
Ways to Decrease ICP

1. Head elevation = increase benous outflow from brain

3226

Surgery

Nervous System

2. Sedation = decrase metabolic demand and control HTN

3. IV mannitol = Extract free water (osmotic diuresis)
4. Hyperventilation = CO2 washout produces cerebral vasoconstriction
5. Removal of CSF = Reduce CSF vol/pressure

Epidural Hematoma:
3297

Surgery

Nervous System

1. Sx = Brief period of unconsciousness followed by lucid interval.

Signs of ICP (nausea, vomitting, headache
2. Dx = Lens Shaped hyperdensity on head CT. (does NOT cross
suture lines)
3. Tx = Surgical evacuation for symptomatic patients.
Anterior Spinal cord syndrome:

4204

Surgery

Nervous System

1. Sx = abrupt onset of bilateral flaccid paralysis and loss of pain and

temp sensation below the level of the injury. UMN signs develop later
2. Dx = Clinical. Vibration and propioception preserved
3. Tx =

Rotator Cuff Tear:

4605

Surgery

Nervous System

1. Sx = patient with shoulder injury, especially following fall onto

outstreched hands.
2. Dx = Positive Drop Arm Sign (can't lower the arm smoothly, drops
from 90degrees)
Syringomyelia:

4698

Surgery

Nervous System

1. Sx = History of Spinal Cord Injury or Arnold Chiari malformation,

moderate wasting of small muscles, impairedpain and temp sensation
on the Upper Extremities. gradual progression
2. Dx = MRI + clinical signs.
3. Tx = surgery to remove pressure on syrinx.
4. Other = Damage involves crossing fibers of the spinothalamic tract,
pain and temp, and UE motor fibers (b/c they're all medially located)
Meningioma:

11997

Surgery

Nervous System

1. Sx = of increased ICP. found in middle aged elderly woman.

2. Dx = extra-axial well circumscribed round homogeneously
enhancing dural based mass on MRI. Hyperdense on CT
3. Tx = Surgical removal (they're benign)
Lactic Acidosis following septic shock

2812
3216

Surgery
Surgery

Pulmonary & Critical Care

Pulmonary & Critical Care

1. Tx = Antibiotics and IV normal saline with or without vasopressor

therapy
- key is to maintain the intravascular pressure

Needle Throroacostomyfor Tension pneumothorax

Pulmonary Contusion:
1. Sx = less than 24 hours after BAT. ^^ HR, RR, and hypoxia
4145

Surgery

Pulmonary & Critical Care

2. Dx = Rales, decreased breath sounds. CT scan or CXR shows

alveolar infiltrate that's not restricted by anatomical borders.
3. Tx = pain control, pulmonary hygeine and Supplemental oxygen or
ventilatory support
Primaryspontaneouspneumothorax

4538

Surgery

Pulmonary & Critical Care

1. Sx = foundin patients w/ no history of lung disease. tall skinny

dudes in their 20s
2. Dx = CXR
3. Tx = supplmental oxygen. observation
Hypovolemic Shock:

4540

Surgery

Pulmonary & Critical Care

1. Sx= hypotension, ^HR, flat neck veins, confusion, cold extremities

and dec. response to IV fluids.
2. Dx = clinical,
3. Tx = replenish fluids and find source of blood loss.

4551

Surgery

Pulmonary & Critical Care

PEEP will increase thoracic pressure, which will decrease venous

return and therefore devrease ventricular preload. As such, it's
important that a patient is hydrated while undergoing PEEP because
they otherwise might experience ischemia.
Flail Chest

4561

Surgery

Pulmonary & Critical Care

1. Sx = trauma patient with fractured ribs who has paradoxical chest

wall mostion with respiration.
2. DX = Rib fractures with or without contustion and hemothorax seen
on CXR
3. Tx = Pain control, supplementa oxygen, PPV with or without chest
tube in cases of respiratory failure.
Thermal injury - Airway injury

4597

Surgery

Pulmonary & Critical Care

1. Sx = clinical indicators of thermal inhalation injury include burns on

the face, singing eyebrows, oropharyngeal inflammation/blistering,
carbon deposits, carbon filled sputus, strido and a
Carboxyhemoglobin of 10+%
3. Tx = early intubation to prevent upper airway obstruction by edema.

4695

Surgery

Pulmonary & Critical Care

Post op Atelectasis:

- Due to impaired cough and shallow breathing post-op

PostOpAtelectasis:
1. Sx = Tachypnic patietn with no chest pain following surgery.
Chronic cough, history of asthma and smoking. decreased breath
sounds
4931

Surgery

Pulmonary & Critical Care

2. Dx = opacity seen on chest x ray.

3. Tx = incentrive spirometry. supportive care
4. other = patient will have low CO2 because they're hyperventilating
to compensate for the partially collapsed lung. their pH will be slightly
high for said reason, and their PO2 will still be a little low (cause
collapsed lung)
Hemoptysis

1. establish adequate airway

4937

Surgery

Pulmonary & Critical Care

2. maintain ventilationa nd gas exchange

3. ensure hemodynamic stability
4. place patient in lateral position
5. bronchoscopy procedure to identify site and attempt early therapy
Urethral Injury

3348

Surgery

Renal, Urinary Systems &

Electrolytes

1. Sx = perineal tenderness, normal prostate, bleeding from the

urethra.
2. Dx = High riding prostate or urethral exam. blood at the urethral
meatus.scrotalhematoma.
3.

Pre-Renal Azotemia
4607

Surgery

Renal, Urinary Systems &

Electrolytes

1. Sx = Post-op patient with oliguria.

2. Dx = BUN/creatinine ratio > 20/1. FE(na) <1 (meaning the kidneys
are functioning properly and excreting very little sodium)
3. Tx = IV fluid challenge will either mange hypovolemia, or diagnose
renal failure due to another cause.
Hematuria Types

4751

Surgery

Renal, Urinary Systems &

Electrolytes

1. Initial hematuria = urethral damage

2. Terminal hematuria = blader or prostatic damage
3. Total hematuria = kidney or ureter damage

RotatorCuff impingement
3168

Surgery

Rheumatology/Orthopedics
& Sports

1. Sx = pain w. abduction, external rotation, subacromial tederness,

normal range of motion with positive impingement tests.
2. Dx = subacute pain on abduction with history that involved
repeititiveshouldermotion.
3. Tx = rest.

FatEmbolism:
3302

Surgery

Rheumatology/Orthopedics
& Sports

1. Sx = 12-72 hr after open fracture of long bones. Dyspnea,

petechiae, ^HR, ^RR, fever. CNS dysfunction (confusion to stupor)
2. Dx = Fat droplets in urine. intra-arterial fat globules on fundoscopy.
Bilateral pulmonary infiltrates on X-Ray (after clinical findings)
3. Tx = Supportive

Compartment Syndrome:
3463

Surgery

Rheumatology/Orthopedics
& Sports

1. Sx = Severe pain, pain w/ passibe motion, and paresthesia

2. Dx = Compartment presrue measurement
3. Tx = Surgical Fasciotomy.

Supracondylar Fractures of the humerus:

1. Sx = 2nd to a fall on an outstretched hand. most common fracture
of the pediatric population.
3556

Surgery

Rheumatology/Orthopedics 2. Dx =
& Sports
3. Tx = Analgesia and immobilization. Orthopedic consultation if
fracture is displaced.
4. Other = most common complication = entrapment of the brachial
artery or median nerve.
Claviuclar Fractures Warranting Angiogram:

3557

Surgery

Rheumatology/Orthopedics
& Sports

1. Sx = Bruising around the clavicle following trauma. Gap in mid

clavicle
2. Dx = Auscultation to look for bruit. Neuro-exam to look for brachial
plexus injury. Angiogram to rule out injury to underlying vessel.
3. Tx = Brace, rest, ice. (Open reduction & fixation for distal 3rd)
Stress Fracture:

3566

Surgery

Rheumatology/Orthopedics
& Sports

1. Sx = ballet dncers, basketball and soccer players, military recruits.

Either activility related or metabolic in cause.
2. Dx = X ray (often in tibia (major weight bearing bone in leg) Pain at
a specific area that increases with running or jumping.
3. Tx = rest and healing.

MCL tear
1. Sx = History of blow to the lateral knee or twisting injury.
Ecchymosis and joint line tenderness at medial knee.

3569

Surgery

Rheumatology/Orthopedics
2. Dx = positive valgus stress test (laxity with abduction). MRI is the
& Sports
most sensitive (really only for a person being considered for surgery)
3. tx = RICE (rest, ice, compression and elevation) and analgesics or
surgery.
Meniscal Tears

4250

Surgery

1. Sx = Younger pagients with rotational force on planted foot or older

patients just b/c of degeneration of meniscal cartlidge.
- popping sensation. catching, locking, reduced range of motion, slow
Rheumatology/Orthopedics
onset joint effusion.
& Sports
2. Dx = MRI

3. Tx = rest and activity modification for mid=ld symptoms. Surgery

for persistent symptoms and impaired activity.
Trochanteric Bursitis:
4546

Surgery

Rheumatology/Orthopedics 1. Sx = hip pain when pressure is applied (sleep) and with external
& Sports
rotation or resisted abduction
2. Dx =

Pre-patellar bursiitis:
11976

Surgery

Rheumatology/Orthopedics
& Sports

1. Sx = Anterior knee pain, tenderness, erythema and localized

swelling in occumpations that require a lot of kneeling.
2. Dx = clinical. confirmed with aspiration of bursal fluid for cell count
andgram stain.
3. Tx = drainage and systemic antibioitcs.