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49 Cards in this Set
- Front
- Back
USMLE 2_Musculoskeletal_
What are the most common locations fro compartment syndrome? |
Anterior lower leg and anterior distal forearm 2' to trauma
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USMLE 2_Musculoskeletal_
Pt presents with pain out of proportion to physical findings. Pain with PASSIVE motion of toes and fingers. Dnx? Treatment? |
Compartment Syndrome. 6 P's:
Pain Pulselessnes Parasthesias Poikilothermia Paralysis Pallor Tnx-immediate fsciotomy to Down Pressure and Up Perfusion |
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USMLE 2_Musculoskeletal_
PREGRNANT or MIDDLE-AGED woman who overuses her wrist flexors with aching thenar area of the hand. Dnx? |
Carpal syndrome.
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USMLE 2_Musculoskeletal_
What other conditions make pt be at risk for having a compartment syndrome? When are symptoms worse? |
DM
THYROID dysfunction Symptoms are worse at night. |
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USMLE 2_Musculoskeletal_
Signs or maneuvers to dnx carpal tunnel syndrome |
TINNEL sign (tapping) and PHALEN's maneuver (flex wrists for 60 seconds to reproduce the signs).
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USMLE 2_Musculoskeletal_
Tnx of carpal tunnel? |
Splint for the wrist- place it in a neutral position.
NSAID's Corticosteroids Sx only if sensory loss and thenar weakness are present. |
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USMLE 2_Musculoskeletal_
Most common types of bursitis. |
Superficial bursae:
1.Olecranon 2.Prepatellar 3.Infrapatellar |
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USMLE 2_Musculoskeletal_
Mechanism of bursitis. Treatment of bursitis. |
Overuse (repetitive use). Trauma. Systemic inflammatory dz. Infection.
Treat conservatively: NSSAID's for inflammation, elevation. Corticoids ONLY if no infection. Antibiotics is infection is present->septic?->7-10days of abix. |
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USMLE 2_Musculoskeletal_
Most common locations of tendonitis- an inflammatory condition of overuse? Other risk factors? |
Achilles tendon.
ITB-Iliotibial band. Patellar tendon. SE of Rx-tosufloxacin (TFLX), gatifloxacin (GFLX), levofloxacin (LVFX), ciprofloxacin (CPFX), prulifloxacin (PUFX) |
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USMLE 2_Musculoskeletal_
Tnx of tendonitis. |
NSAID's, ice for the FIRST 24-48 hours. Splinting.
Lidocaine and Corticosteroids if the rest fails. NEVER inject the Achilles tendon |
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Case 36_HyperPARAthyroidism_
What kind of lab values are found? |
HYPERcalcemia -s a hallmark. Also PTH stands for Phosphorus Trashing Hormone. Cl is nL to high. Classic ratio of Chloride to Phosphorus is 33:1
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Case 36_HyperPARAthyroidism_
What is the most common metabolic complication of the condition? |
KIDNEY stones
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Case 36_HyperPARAthyroidism_
What type of phsyc complications can hyperPARAthyroidism can cause? |
Depression
Psychosis Coma |
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Case 36_HyperPARAthyroidism_
What are the two most common causes of hypercalcemia? |
hyperPARAthyroidism and malignancy
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Case 27_Liver Tumor_
What is the gold standard test for Hepatocellular Carcinoma (HCC)? |
Laparascopic ultrasound. Also used for Adenoma and Adenocarcenoma when combined with biopsy.
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Case 27_Liver Tumor_
What is a high sensitivity and specificity test for HemANGIOMA (no specific s&s other than fullness after eating small amounts, gnawing pain in the RUQ)? |
ANGIOgraphy
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Case 27_Liver Tumor_
Define and contrast Benign tumor vs Malignant |
Benign does not spread hematogenously or via lymphatics. Malignant-does. 1' liver tumor may be benign, while 2'-always malignant (result of the mets: from GI, breast)
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Case 27_Liver Tumor_
What is the most common benign liver tumor? How is it confirmed? |
HEMANGIOMA. Angiography. NEVER biopsy!
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Case 27_Liver Tumor_
When is liver transplantation has no role in treatment? |
When tumor is 2'. It metastasized from some other place. I.e. with a new liver it'll happen again. What's the point..
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Case 27_Liver Tumor_
What is the gold standard test for Hepatocellular Carcinoma (HCC)? |
Laparascopic ultrasound. Also used for Adenoma and Adenocarcenoma when combined with biopsy.
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Case 27_Liver Tumor_
What is a high sensitivity and specificity test for HemANGIOMA (no specific s&s other than fullness after eating small amounts, gnawing pain in the RUQ)? |
ANGIOgraphy
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Case 27_Liver Tumor_
Define and contrast Benign tumor vs Malignant |
Benign does not spread hematogenously or via lymphatics. Malignant-does. 1' liver tumor may be benign, while 2'-always malignant (result of the mets: from GI, breast)
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Case 27_Liver Tumor_
What is the most common BENIGN liver tumor? How is it confirmed? |
HEMANGIOMA. Angiography. NEVER biopsy!
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Case 27_Liver Tumor_
When is liver transplantation has no role in treatment? |
When tumor is 2'. It metastasized from some other place. I.e. with a new liver it'll happen again. What's the point..
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Case 27_Liver Tumor_
What type of liver tumor is associated with oral contraceptives? Has to be rescected b/c malignant potential or hemorrhage. |
Focal Nodular Hyperplasia. Evaluate with HEMANGIOGRAPHY.
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Case 27_Liver Tumor_
Which tumor should not be biopsied? |
Hemangioma. Risk of hemorrhage.
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Case 52_Lumbar Prolapsed Nucleus Pulposus_
What is the best imaging diagnostic test? |
MRI or meylography
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Case 52_Lumbar Prolapsed Nucleus Pulposus_
Mechanical backache vs Entrapment neuropathy. Mechanism or injury. |
Minor trauma producing ligamentous or muscular injury vs Prolapsed intervertebral disk that applies pressure on an adjacent nerve in lumbosacral plexus (or a sacral nerve bundle like in cauda eqina)
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Case 52_Lumbar Prolapsed Nucleus Pulposus_
What level of disk herniation is most common? |
L4-5 and L5-S1. Lying flat relieves pain.
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Case 52_Lumbar Prolapsed Nucleus Pulposus_
What is a characteristic symptom with cauda equina? |
Bladder and bowel control difficulties, numbness. URGENT medical/surgical care required to avoid permanent damage.
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Case_53_Neonatal Jaundice (Persistent)_
When jaundice is persistent past 7 days of life, pathology may be implicated. I.e. beyond 2 wks-> PATHOLOGIC. Presence of what type of bilirubin indicates possibility of biliary atreasia? |
If CONJUGATED hyperbilirubinemia is present, that means that liver is mature to conjugate and hemolysis is not likely to be the reason of jaundice. Biliary atresia becomes a part of differential dnz
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Case_53_Neonatal Jaundice (Persistent)_
When has surgical correction to be done for biliary atresia? |
The latest is 12 wks (84 days) of age. I.e. if pnt is older than that-> look for a liver transplant as the next step in treatment.
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Case_53_Neonatal Jaundice (Persistent)_
What is important in preoperative management of the pt? |
Check coagulation abnormalities and correct with vit K and Fresh Frozen Plasma if necessary.
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Case_53_Neonatal Jaundice (Persistent)_
What is the name of the procedure to treat biliary atresia in newborns under 12 wks of age? What's the complication and its management? |
Kasai procedure or Kasai portoenterostomy. Complication- COLANGITIS (scarring, inflammation, blockage of bile ducts). Treat with abix and cortecosteroids to fight infection and suppress inflammation which can cause more damage/scarring/obstruction.
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Case 48_Obesity (Morbid)_
What are the criteria for Sx alteration of GI system? |
BMI >35kg/m2 with comorbidities or BMI >40kg/m2 w/out comorbidities.
Imperial calculation LbsX704/inchesXinches or Metric kg/m2 |
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Case 48_Obesity (Morbid)_
Most common complication post-Sx restrictive procedure? |
Leakage from the attachment of stomach to the intestine-> leukocytosis, fever, L shoulder pain on post-op day 3-5.
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Case 48_Obesity (Morbid)_
Common late sequelae from gastric restrictive procedures? |
Anemia
Vitamin deficiency Osteoporosis |
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Case 42_Testicular Cancer_
What is the most common presentation of testicular CA? |
Painless scrotal mass (non-tender heavy sensation in the scrotum)
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Case 42_Testicular Cancer_
What are the tumor markers? |
beta-hCG and Alfa fetal protein.
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Case 42_Testicular Cancer_
What is the major division of the CA? |
seminoma (90%) and nonseminomatous germ cell tumors
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Case 42_Testicular Cancer_
What is the Sx procedure to prevent the spread? |
CA progresses up the lymphatic drainage. RETROPERITONEAL lymphadenectomy around vena cava and aorta (they follow spermatic cord into retroperitoneum). Do Sx before radiation, b/c the nodes will "petrify" and become impossible to remove.
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Case 42_Testicular Cancer_
When do you do radical inguinal orchiectomy? |
When the lesion within the scrotum is confirmed as a solid mass
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Case 48_Obesity (Morbid)_
What are the criteria for Sx alteration of GI system? |
BMI >35kg/m2 with comorbidities or BMI >40kg/m2 w/out comorbidities.
Imperial calculation LbsX704/inchesXinches or Metric kg/m2 |
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Case 48_Obesity (Morbid)_
Most common complication post-Sx restrictive procedure? |
Leakage from the attachment of stomach to the intestine-> leukocytosis, fever, L shoulder pain on post-op day 3-5.
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Case 48_Obesity (Morbid)_
Common late sequelae from gastric restrictive procedures? |
Anemia
Vitamin deficiency Osteoporosis |
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Case_53_Neonatal Jaundice (Persistent)_
When jaundice is persistent past 7 days of life, pathology may be implicated. I.e. beyond 2 wks-> PATHOLOGIC. Presence of what type of bilirubin indicates possibility of biliary atreasia? |
If CONJUGATED hyperbilirubinemia is present, that means that liver is mature to conjugate and hemolysis is not likely to be the reason of jaundice. Biliary atresia becomes a part of differential dnz
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Case_53_Neonatal Jaundice (Persistent)_
When has surgical correction to be done for biliary atresia? |
The latest is 12 wks (84 days) of age. I.e. if pnt is older than that-> look for a liver transplant as the next step in treatment.
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Case_53_Neonatal Jaundice (Persistent)_
What is important in preoperative management of the pt? |
Check coagulation abnormalities and correct with vit K and Fresh Frozen Plasma if necessary.
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Case_53_Neonatal Jaundice (Persistent)_
What is the name of the procedure to treat biliary atresia in newborns under 12 wks of age? What's the complication and its management? |
Kasai procedure or Kasai portoenterostomy. Complication- COLANGITIS (scarring, inflammation, blockage of bile ducts). Treat with abix and cortecosteroids to fight infection and suppress inflammation which can cause more damage/scarring/obstruction.
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