Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
64 Cards in this Set
- Front
- Back
Aortic dissection: what classifications need to be operated on.
|
Type A
or Type 1 and 2 Involving ascending arch |
|
Does aortic dissection cause hypertension or hypotension?
|
hypertension
|
|
What's the first line inv for suspected aortic dissection?
|
CT contrast b/c it's fast
Alternative 1st line is TOE MRI most accurate but slow.; |
|
Medical management
|
Pain relief (morphine/fentanyl)
Beta blockers (esmalol, metopralol. Aim for systolic 100-120 to reduce shear forces) If still hypertensive give sodium nitroprusside AFTER beta blocker to prevent reflex tachy which will increase shear forces) |
|
What is the 1 year risk of rupture of AAA between 6-7cm
|
25%
|
|
What is conservative rx for AAA
|
CVD risk factor control
HTN, lipids, diabetes etc. |
|
How does acute pancreatitis present?
|
Gradual or sudden severe, deep, constant epigastric or central abdominal pain (radiating to the back or both costal margins; relieved by sitting forward); vomiting; nausea; anorexia; tachycardia; fever; jaundice; shock; ileus; rigid abdomen ± local/generalised tenderness and periumbilical discolouration (Cullen’s sign) or discolourisation/bruising in the flanks (Grey Turner’s sign); may have absent bowel sounds
|
|
Which test most sensitive for pancreatitis?
|
lipase
|
|
Management for pancreatitis?
|
NBM controvesial for mild and severe pancreatitis
IVF resus with NS and morphine OR lots of NS until vital signs satisfactory and urine >30ml/hr Urinary ctheter, hourly obs INV: US or CT if fever developes ICU if septic, abcess or generalised peritonitis with multi organ failure |
|
When is ERCP indicated in pancreatitis?
|
if <48 hours and dx is uncertain or ongoing cholangitis and jaundice
DO NOT do in alcoholic pancreatitis |
|
Mx of acute pancreatitis
|
supportive
|
|
What is Cullen's sign?
|
bluish discoloration umbilicus
sign of pancreatitis with hemorrhage |
|
Difference between perforated peptic ulcer and early acute pancreatitis pain
|
perf peptic ulcer: guarding and rebound tenderness present
acute pancreatitis: guarding and rebound tenerness are NOT present because pancreas is retroperitoneal |
|
Which type of pancreatitis is associated with alcohol?
|
necrotizing
|
|
What happens to serum calcium in pancreatitis
|
goes down d/t fat saponification binding the calcium
|
|
Investigations
|
CXR may show gas under diaphragm
elevated amylase or lipase AXR shows no psoas shadow |
|
Do you give Abx in acute prancreatitis
|
only if there's proven infection
|
|
T/F: Perforation is a common complication of acute pancreatitis
|
False
|
|
What are structures are retroperitoneal
|
ACDC Rocker Kids Party Down (+AI)
Ascending Colon Descending Colon Rectum Kidneys Pancreas head Duodenum 2,3,4th Aorta, IVC |
|
T/F Hypocalcemia causes acute pancreatitis
|
False, hypercalcemia causes it!
|
|
T/F Antibiotics are not part of prophylaxis in acute pancreatitis
|
True
|
|
Management of necrotizing pancreatitis
|
wait 1-2 weeks til stable
resect necrosed parts |
|
How big does a pancreatic pseudocyst need to be before removal
|
>6 cm
|
|
Complication of AAA due to sacrificing the inferior mesenteric artery
|
ischemic colitis
|
|
List the 5 most common causes of life threatening altered LOC
|
1) SAH
2) Cardiac (MI, tamponade, arrhythmia, structural/valuvular abnormalities 3) Metabolic: Hypoglycaemia, adrenal crisis 4) Drup OD/alcohol intox 5) Status epilepticus |
|
What clinical signs differentiate a structural from metabolic cause of coma?
|
Structural:
1) extraoccular movements, and motor signs are usually asymmetric. 2) Pupils unequal/non-reactive 3) Focal or lateralising abnormalities present Metabolic 1) extraoccular movements and motor findings absent or symmetrical 2) equal and reactive pupils (=upper brainstem intact) 3) caloric unresponsiveness (=lower brainstem NOT intact) |
|
Most commonly affected side of ischemic colitis
|
left side of colon especially watershed areas, eg splenic flecture
|
|
Difference between mesenteric ischemia and ischemic colitis
|
mesenteric ischemia: abdo pain out of proportion to exam, early exam can often be unremarkable
ischemic colitis: bloody diarrhea, can have fever |
|
Which artery is usually involved in mesenteric ischemia?
|
superior mesenteric artery
|
|
Gold standard investigation in mesenteric ischemia
|
Mesenteric angiography
|
|
Blood results in mesenteric ischemia
|
metabolic acidosis
leukocytosis increase lactate increased LDH increased CK |
|
Management of mesenteric ischemia
|
resus and ABs
heparin early laparotomy if peritonitis/deterioration angioplasty and thrombectomy +/- stent resection of infarcted bowel |
|
Management of ischemic colitis
|
supportive - bowel rest, fluids
broad spectrum antibiotics surgery if infarcted bowel |
|
Mortality rate of mesenteric ischemia
|
>50%
|
|
Where is McBurney's point? What is it implicated in?
|
1/3 of distance from ASIS to umbilicus
appendicitis |
|
What is Murphy's sign? What is it implicated in?
|
push on right side under costal margin, patient winces when inspiring
cholecystitis, not cholangitis |
|
What is the most sensitive investigation in acute appendicitis?
|
CT with contrast most sensitive
U/S also done |
|
Antibiotics for acute appendicitis
|
Metronidazole PLUS
gentamicin OR cephalexin |
|
Clinical features of subarachnoid hemorrhage
|
abrupt, thunderclap headache, followed by meningism
1/3 pts will have senitnel bleed marked by abrupt headache days/weeks earlier with N&V transient diplopia that completely resolves |
|
Most common cause of subarachnoid hemorrhage
|
intracranial aneurysm
|
|
Investigations in subarachnoid hemorrhage
|
CT with contrast followed by non-contrast CT - look for blood in subarachnoid space
LP if negative CT to look for xanthochromia once confirmed on CT, angiography |
|
Management of subarachnoid hemorrhage
|
1. want to keep relatively hypervolemic and hypertensive to prevent vasospasm
2. nimodipine 3. neurosurgery to clip |
|
Cause of subdural hematoma
|
rupture of bridging veins and accumulation of blood between dura and arachnoid
|
|
Difference between acute and chronic subdural hematoma on CT
|
chronic = liquified clot = hypodense = darker
acute = hyperdense = whiter |
|
Which patients are prone to subdural hematoma?
|
alcoholics
elderly trauma patients |
|
Findings on CT of subdural hematoma
|
crescent shaped hyperdensity that does not cross the midline
|
|
Management of subdural hematoma
|
could resolve or
possible craniotomy with drain Toronto notes says drain if >1 cm |
|
What is a CN 3 palsy with pupillary involvement associated with?
|
berry aneurysms
|
|
Indications for craniotomy in acute/chronic subdural hemorrhage
|
clot thickness >10 mm
midline shift >5 mm GCS decreased >2 points from time of injury to hospital admission +/- fixed and dilated pupils |
|
Which artery is involved in epidural hematomas?
|
middle meningeal artery
|
|
Clinical features of epidural hematoma
|
talk and die
immediate LOC followed by lucid interval |
|
What does a CT show on epidural hematoma?
|
lens-shaped convex hyperdensity
|
|
Management of epidural hematoma
|
craniotomy
burr hole if in the bush |
|
How do you reverse warfarin? (used in intracerebral hemorrhage)
|
give FFP, vitamin K
prothrombinex |
|
Indications for neurosurgery in intracerebral hemorrhage
|
posterior fossa - neurosurgery good
supratentorial - neurosurgery same as medical management |
|
What does contrast in CT show...
|
blood brain barrier breakdown
|
|
Best way to diagnose basal skull fractures?
|
Clinically (poorly visualised on CT)
|
|
clinical signs of base of skull fracture?
|
battles sign (bruised mastoid process)
haemotympanum racoon eyes CSF rhinorrhea |
|
How do you grade brain injury
|
severe = GCS<8
Moderate =GCS 8-13 Mild = GCS14-15 |
|
How do you calculate cerebral perfusion pressures?
|
CPP = MAP - ICP
|
|
What CCP, MAP and ICP are you aiming for in severe head injury?
|
CCP > 60mmHg
MAP > 90mmHg ICP 20-25 |
|
what are the indications of mannitol
|
for control of raised ICP after severe head injury.
very useful in acute setting intermittent boluses more effective 0.5-1gm/kg |
|
How does mannitol affect ICP
|
rheological effects: in minitus, best response in low cerebral perfusion pressure
osmotic effects delayed for 15-30 min, lasts 90min-6hrs |
|
what are the disadvantages/complications of mannitol use for raised ICP
|
Acute renal failure (if serum osmolarity >320mOsm
raised ICP with prolonged infusion (may open BBB and diffuse into brain) complicates dx of diabetes insipidus |