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147 Cards in this Set
- Front
- Back
Basal Skull Fx Work Up
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CT if in coma
C-Spine Injury! nothing to do about fx |
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A man involved in a high-speed, head-on automobile collision is in coma. He has never had any lateralizing signs, and CT scan shows a small crescent- shaped hematoma, but there is no deviation of the midline structures.
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Another subdural hematoma, but without lateralizing signs and evidence of displacement of the midline structures, surgery has little to offer. Management will probably be directed at controlling ICP
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Penetrating wounds anywhere in the neck w/ unstable patient
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immediate ex lap
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Zone I of the neck
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Thoracic Inlet to Cricoid Cartilage
Subclavian vessels, brachiocephalic veins, common carotid arteries, aortic arch, and jugular veins, trachea, esophagus, lung apices, cervical spine, spinal cord, and cervical nerve roots. |
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Zone II of the neck
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Cricoid cartilage to the angle of the mandible.
Carotid and vertebral arteries, jugular veins, pharynx, larynx, trachea, esophagus, and cervical spine and spinal cord. |
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Zone III of the neck
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A angle of the mandible and the base of the skull.
salivary and parotid glands, esophagus, trachea, vertebral bodies, carotid arteries, jugular veins, and major nerves (including cranial nerves IX-XII), traverse this zone |
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Flail Chest. Next Step
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1. R/O other injuries - abdominal and aortic rupture (CXR)
2. Pulmonary Contusion real problem. Monitor w/ ABG & support if needed - w/ b/l chest tubes if tubed (even in OR) 3. Don't need to stabalize flail portion |
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Pulonary Contusion Managment
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1. Fluid restriction (using colloid), diuretics
2. Respiratory support. intubation, mechanical ventilation, and PEEP PRN |
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Aortic Rupture Next Step
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1. CXR w/ wide mediastinum
2. Spiral CT 3. Aortogram if equivical |
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Air Embolism Managment
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1. Cardiac Massage
2. Trendelenburg 3. Thoractomy |
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Posterior Urethral Injuries
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Repair in 6 months
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Anterior Urethral Injuries
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Immediate Repair
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Scrotal Hematoma Next Step
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U/S for ruptured testicle
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Crush Injury things to think about (2)
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1. Rhabdo - diuresis, alkalinize
2. Compartment Syndrome - fasciotomy |
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Brown Recluse Spider
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dabsone
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Osteomyalities
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BONE SCAN. x-rays take weeks to show. then abx
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Varum (bow legs) after age 3
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Blouts
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Posterior Dislocation of Shoulder X-rays to order
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axillary view or scapular lateral.
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Hip Fracture
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DVT/PE! Anticoagulate after surgery
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Posterior Dislocation of the Hip
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emergency because avascular necrosis
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Carpul Tunnel Next Steps
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1. wrist xrays to r/o other things
2. splints & antiinflammatories |
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De Quervain tenosynovitis
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splints & antiinflammatories
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Dupuytren contracture
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contracted hand that can no longer be extended, Palmar fascia1 nodules
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Felon
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infection in pulp of finger. like a compartment syndrome
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Gamekeepers Thumb
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ulnar collateral ligament of the thumb. cast
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When she makes a fist now, the distal phalanx of her ring finger does not flex with the others.
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jersey finger (to the flexor),Splinting
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Mallot Finger
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Injury to extensor tendon. can't extend distal phalanx.
splint |
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Gout
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Acute - indomethacin and colchicine.
Chronic- allopurinol or probenecid. |
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Post - op Confusion Next Steps
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1. Hypoxia - ABG
2. Metabolic 3. DTs esp if 3-5 dys out |
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ARDS next steps
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PEEP, allowing significant
hypercapnia, to minimize barotrauma. R/O sepsis |
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Low UO post op
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Urinary Na -
Dehydrated < 10-20 mEq Kidney Damage > 40 meq or FeNa in renal failure >1 |
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SCC of anus
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Biopsy & Nigro Protocol
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LGI Bleed
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> 2mL/min (1 U every 4 hours) angiogram
<0.5 ml/min colonoscopy Tagged RBC in between |
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LGI Bleed w/o
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1. r/o UGI Bleed w/ NGT
2. Hemorrhoids 3. RBC study if offered |
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Old melena no longer bleeding
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NGT unhelpful do upper and lower endoscopies (most likely upper)
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Chronic Pancreatitis if forced to pick test
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ERCP
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Ductal Carcinoma in situ on breast biopsy
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No axillary sampling
lumpectomy + XRT or simple total mastectomy if multicentric lesions |
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Positive SLN or axilary dissection
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Chemotherapy if young
Hormonal if old |
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Hot thyroid adenoma
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Confirm hyperthyroidism by measuring free thyroxine (T4) or thyrotropin (TSH).Confirm source of the excessive hormone with radioactive iodine scan. Do surgery after beta-blocking.
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High Ca / Low PO4 on test
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1. PTH
2. sestamibi |
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Hyperaldosteronism
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1. Renin: Aldo
Hyperplasia - appropriate response to postural changes (not surgical - aldactone) Adenoma - no response to postural changes (Ct or MRI then surgery) |
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Coartation of Aorta W/U
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Chest XRAY - scalloping of ribs
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HTN 2/2 fibromuscular dysplasia rx
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w/up with duplex or aortogram
since usually young balloon dilation with stenting or surgery |
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Malrotation Presentation
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DOuble bubble wtih normal gas pattern distal
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Malrotation W/up
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contrast enema or upper GI study (more reliable)
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NEC
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stop all feedings
broad abx IVF and nutrition Surgery if - abd erythema, pneumobilia, pneumoperitoneum |
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Biliary Atresia W/up
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HIDA scan after 1 week of phenobarb
surgery |
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Orbital Cellulitis w/up
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CT scan to assess exten with drainage
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Sistrunk Operation
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Thyroglossal duct cyst. Remove mass and track with medial segment of hyoid and some of tongue cecum
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Unilateral Hearing Loss (adult)
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Sensioneural assume aoustic neuroma and look for tumor w/ MRI
(if kid think foreign body) |
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Bell's
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antivirals ?immediatly +/- steriods
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A 72-year-old, hypertensive man, on aspirin for arthritis, has a copious nosebleed. His blood pressure is 220 over 115 when seen in the ER. He says he began swallowing blood before it began to come out through the front of his nose.
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epistaxis secondary to hypertension
Medical treatment to lower the blood pressure, but getting the ENT people there right away should also be part of the equation. Posterior packing is needed, emergency arterial ligation may be required. |
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A 57-year-old man seeks help for "dizziness." On further questioning he explains that he gets light-headed and unsteady, but the room is not spinning around.
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Neurologic, probably vascular occlusive- but not inner ear. Direct your manage- ment and workup in that direction.
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Prolactinoma
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r/o pregnancy and hypothyroid
measure PrL MRI Bromocriptine or surgery if want baby or non responsive |
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Acromegaly
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Somatomedin C/IGF1 determination (production stimulated by GH)
MRI surgery or radiation |
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Pituitary Aproplexy Rx
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Steroid Replacement
MRI or CT |
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A business executive who has been a T6 paraplegic for many years is held at a business meeting for several hours beyond the time when he would normally have done his in-and-out self catheterization of the urinary bladder. He develops a pounding headache, profuse perspiration, and bradycardia. His blood pressure is 220 over 120.
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autonomic dysreflexia. Obviously his bladder needs to be emptied, but he also needs alpha-adrenergic blocking agents and may benefit from calcium-channel blockers (such as nifedipine).
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Trigeminal Neuralgia
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r/o organic lesions with MRI
Rx with anticonvulsants |
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UTI in a guy work up
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DO NOT start with cystoscopy
start w/ IVP or US |
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IVP
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don't do if renal function
first test for blood in pee |
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Bladder Cancer
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IVP then cystoscopy
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Contraindications to shock wave lithotripsy
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pregnancy, bleeding issues, too big stones (cm)
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Electrical Burns things to watch for
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myoglobinuria
compartment syndrome demylinating dx and cateracts resperatory infections (after capillary damage) |
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Duodenal Hematoma
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Coiled spring on upper GI
treat with observation. drain if in there for another reason or obstructed > 2wks |
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Transfusion Reaction
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stop transfusion
alkanize urine fluids and mannitol |
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Transudate
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pressure filtration with NORMAL capillary permeability
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Exudate
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inflammatory leaking b/c increased cap permealibity (exudata ~water)
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Cardiogenic Shock
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dobutamine
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Neurogenic Shock
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IVF then dopamine or phenylephrine
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Septic Shock
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ealry abx
norepi |
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Black Widow Spider
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N/V, cramps
Ca glutamate +/- muscle relaxants |
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Brown Recluse Spider
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skin ulcer w/ necrosis
Dapsone +/- surgerical excision |
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loss of ileum can lead to
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increased oxalate (hyperabsorbed by colon)
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von willibrand's treatment
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CRYO to give back vWF
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refeeding syndrome lytes
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low PO4, Mg, K (insulin causes shift into cells)
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Acute adrenal insufficiency
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low glucose, K
change in MS, fever, CV collapse rx - dex! |
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Partial Gastrectomy + Billroth 2 nutrition changes
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low Ca
steatorrhea low B12 low Fe |
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Descending aortic dissection
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b blocker + nitroprusside
surgery if end organ failure |
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chylothorax
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low fat diet + drainage. if >500cc /day OR for ligation
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Pheo blockade order
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alpha first (1-3 wks preop) then beta
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vWD work up
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PTT MAYBE prolonged
increased bleeding time w/ nl platelet count decreased ristocetin induced platelet aggregation |
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vWD treatment
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DDAVP and F8 concentration
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Low pitched Diastolic Rumble
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Mitral Stenosis
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harsh crescendo-decresendo systolic @ right 2 IC space
loader with squatting softer w/ val salva parvus et tardus |
Aortic Stenosis
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Diastolic decrescendo @ lft sternal border
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Aortic Regurg
also waterhammer pulse and wide pulse pressure |
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Holosystolic at apex radiates to axilla w/ LAE
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mitral regurg
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midsystolic or late systolic clicks or murmur increased with valsalva and handgrip, softer with squatting
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mitral prolapse
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Anterior Mediastinal Mass
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thymoma
lymphoma teratoma |
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Middle Mediastinal Mass
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bronchogenic cyst
pericardial cyst |
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Posterior Mediastinal Mass
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neurogenic tumor
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anti mitochrondrial antibodies
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Primary biliary cirrhosis
fatigue and puritis treat with urso |
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toxic megacolon rx
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high dose roids and IV Abx
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malignant hyperthermia rx
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dantrolene& Ca if high K
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Paget's Disease of bone
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high Alk Phos
think arthritis, hearing loss, kidney stones, vision loss |
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Femoral n.
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knee extension and hip flexion
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Tibeal n.
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knee flextion, planter flextion, digis
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Obturator n.
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adduction thigh
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Fibular/Common Peraneal n.
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divides into superficial and deep peroneal n.
ant and lateral leg muscles |
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Watery Diarrhea
Dehydration Hypokalemia Achlorhydia |
VIPoma = Verner-Morrison Syn
rx octreotide then surgery |
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Human Bite
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washout by orthO!
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Low Ca EKG
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long QT
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MEN 1 gene
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RENIN
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MEN 2 gene
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Ret
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Elderly Clotting
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Cancer
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Edema HTN Foamy Pee
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Nephrotic Syndrome
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Young person clotting w/ FHx
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Factor V Leiden
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Antithrombin 3 Deficiency
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Heparin not work
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Post - op
Low platelets and clots |
HIT
Rx - Lepirudin (direct thrombin inhibitor) or argatroban (direct thrombin inhibitor) |
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Isolated platelet drop
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ITP
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NOrmal plates w/ increased bleeding time & PTT
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vWD
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Low platelets, increased PT,PTT, BT, and D-dimers. Can see schistocytes
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DIC
Gram - sepsis, carcinomatosis, OB stuff |
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Silver Sulfadiazine
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doesn't penetrate eschar
leukopenia |
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Mafenide
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penetrates eschar
hurts |
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Silver Nitrate
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Doesn't penetrate eschar
hypoK hypoNa |
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Electrical Burn 1st STEP
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EKG
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Handlebar Sign
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Pancreatic Rupture
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Malignant Hyperthermia
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Dantrolene
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Random causes of post-op fever to watch for
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Thyrotoxicosis
Thrombophlebitis Adrenal Insufficiency Lymphangitis Sepsis |
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Transudative Pleural Effusion Causes
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CHF
Nephrotic Cirrhotic |
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Pleural Effusion w/ low glu
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RA
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Pleural Effusion w/ high lymphocytes
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TB
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Pleural Effusion w/ blood
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Malignant or Pulmonary Embolus
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Exudative Pleural Effusion Causes
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parapneumonic, cancer
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Transudative Effusion If...(light's)
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LDH<200
LDF effusion:serum <0.6 Protein effusion:serum<0.5 |
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Lung Abscess
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2/2 aspiration
1. PCN or clinda surgery if abx fail, abscess >6cm, empyema |
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Paraneoplastic Syn from Lung CA
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SCC
PTH-rp --> low PO4 high Ca |
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Pt w/ ptosis better after 1 min of upward gaze
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Lambert Eaton from small cell CA
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SIADH
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small cell
rx fluid restiction |
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Peripheral cavitation and distant mets
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LARGE cell CA
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ARDS
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PaO2/FiO2 < 200
Bilateral infiltrates on CXR PCWP <18 |
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HOCM
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systolic louder w/ valsalva softer w/ squatting or handgrip
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ASD
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wide fixed and split S2
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Mitral Stenosis
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rumbiling diastolic w/ opening snap
LAE and Afib |
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Aortic Regurg
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blowing diastolic w/ wide pulse pressure
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aymptomatic varices
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b blocker
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ZE Syndrome w/up
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Secretin stim test (inapropp high gastrin)
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AST = 2x ALT
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EtOH Hepatitis
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AST>ALT in high 1000s
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viral hepatitis
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AST and ALT high s/p hemorrhage, surgery or sepsis
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shock liver
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Post splenectomy thrombocytosis > 1mil Rx?
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ASA
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perfed appy bugs to cover
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E Coli
Bacteroides |
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SBO First Test
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CXR for free air
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Diverticulitis W/UP
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CT for abscess
NO Barium Enema and NO scope do colonoscopy 4-6 wks later surgery if old, multiple episodes |
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Rectal Cancer
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upper/mid 1/3 - LAR
lower 1/3 - APR |
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Laryngeal Cancer
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Kids - laryngeal papilloma
Adults - SCC |
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Neonate not passing meconium dx (2!)
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Meconium ileus
HIRSCHSPRUNG's |
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Occlusive Mesenteric Ischemia Rx
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heparin
glucagon intraarterial papavarine laporotomy to remove clot |