Card Set Information
4 y/o M afebrile, nL labs, limited internal rot. and abduction of hip. Dx?
Legg-Calve-Perthes disease, or idiopathic osteonecrosis of femoral head.
4-10, M predominance.
Benign bony growh located on midline suture of hard palate, secondary to both genetic and env. factors.
Common in young Fs, especially Asians.
What is an eschar
Eschar = Firm, necrotic tissue due to vascular limitation secondary to edema s/p burn.
Can cause compartment syndrome
S/p tonic-clonic seizure. Arm adducted and internally rotated. Inability to externally rotate.
Fat necrosis of the breast
Risk factors include
On biopsy shows macrophages and fat globules
Infection of submandibular and sublingual glands fron infected tooth. Can cause drooling and asphixiation. Fever, dysphagia, odynphagia, drooling.
SCC which arises within a burn wound. Can also occur from osteomyelitis, radiotherapy, venous ulcers.
1st and 2nd most common causes of hypotension with blunt abdominal trauma
(1) Splenic laceration
(2) Liver laceration
Bone pain, 10-20 y/o male,
Alk phos is elevated
Usuallye ffects areas of high growth.
Pain worst at night.
Pain typically begins after trauma.
Usually ICU patient
Probably due to cholestasis and gall bladder ischemia leading to infection.
Gallbladder wall thickening
How do you recogonize compartment syndrome
Key words to look for:
Soft tissue swelling
Treatment for diverticulitis
Uncomplicated: Outpatient bowel rest, oral Abx (metronidazole, cipro), observation.
Fluid collection < 3 cm = IV Abx, observation
Fluid collection > 3 cm = CT-guided drainage, than surgical drainage and debridement if no improvement by day 5.
Tetanus Immune globulin = Passive, temporary, immediate
Tetanus-diphtheria toxoid = Active, prolonged, delayed
Toxoid for anyone with severe wound w/ last dose > 5 years ago.
Toxoid for any with clean minor wounds w/last dose > 10 years ago
TIG injection for anyone w/ less than 3 vaccines or unknown immune status.
Scaphoid fracture buzz words
Pain on radial side of wrist
Pain in anatomic snuffbox
Decreased grip strength
Repeat X-Ray if initially negative
Diffuse Axonal Injury
Traumatic Deceleration Injury
Occurs at gray white matter junctions where density difference is greatest.
Minute punctate hemorrhages on CT
Acute Febrile Nonhemolytic Tranfusion Reaction
Immune mediated host antibodies that bind donor cells.
Activates complement and inflammatory cytokines.
Bilateral hip, thigh, buttock claudication
Symmetric atrophy of bilateral LE 2/2 ischemia
Arterial occlusion at bifurcation of aorta into common carotids.
Labeled Erthrocyte Scintiography
tagged RBC scan used to identify source of bleed in case of occult lower GI bleed
When do you delay appendectomy?
Usually have phlegmon w/walled off abscess.
Give IV Abx, Bowel rest
Delayed Appie a few weeks later.
What structures are at risk with a middle third clavicle fracture?
Brachial Plexus and Subclavian Artery
What to do with a scaphoid fracture?
: Open reduction and internal fixation
If no fracture shown, repeat in 10d.
Diarrhea from Carcinoid Tumor
Bad dumping syndrome following gastrectomy
dx study for suspected esophageal perforation?
Meniscus vs. MCL or LCL vs. ACL/PCL injury
Medial Meniscus (more commonly injured than lateral meniscus):
Popping sound and severe pain after twisting injury.
Positive McMurray's sign
: Palpable or audible snap while slowly extending the knee w/ tibial torsion.
ACL: Forceful hyperextension or deceleration injury. Anterior drawer test
PCL: "Dashboard injury" Posterior-directed force on tibia with knee flexed at 90*
MCL/LCL: Valgus/Varus stree test. MCL = Abduction; LCL= Adduction is rarely injured.
Subluxation of head of radius at elbow. Arm held in pronation at chest.
Supinate forearm and flex elbow to reduce.
Bladder versus urethra traumatic injury? Sign and diagnostic study?
Bladder Injury: Gross hematuria, retrograde cystogram w/ post-void films.
Urethra injury: Blood at the meatus, get retrograte urethogram.
Who get's oxalate stones?
People with fat malabsoprtion (e.g. Crohn's disease) becasuse Ca+2, which usually binds oxalate and prevents it from being reabsorbed, is used up binding fat, so you get more oxalate in body.
Other causes of acute pancreatitis
In addition to EtOH and cholelithiasis
PCWP, different values
Low suggests hypovolemia
High suggests alternative cause, such as myocardial contusion
What to do when you suspect PVD but have nL ABI
Try ABI pre/post exercise. Exercise can expose moderate ABI.
Contrast Aortic Injury/Rupture, Myocardial Contusion, Myocardial Rupture
Myocardial rupture = Immediate death
Myocardial contusion = Tachy with new arrthymias, sometimes sternal fracture
Aortic Injury/Rupture = Widened mediastinum, L hemothorax.
Extremity arterial thrombosis vs. arterial occlusion
Embolism = Acute pain, pulselessness, pallor
Thrombosis = Slow, progressive narrowing with insidious onset.
Caused by axial load (e.g. fall)
Can lead to anterior cord syndrome with loss of pain and temp., motor control.
Central Cord Syndrome
Greater motor loss in UE than LE
Bladder dysfunction & urinary retention
Variable sensory loss below level of injury.
Freq caused by hyperextension injury in elderly.
Mallory-Weiss Tear vs. Esophageal Rupture
Esophageal Rupture/Boerhaave Syndrome -> Instrumentation in esophagus or vomiting (w/ resistance) causes pneumomediastinum
Mallory-Weiss tear = Incomplete tear at GEJ. Presents as self-limiting hematopoesis because rupture is incomplete.
Carboxyhemoglobin level indicating need for incubation in burn patient
Key notes on varicocele
Will not transilluminate.
More common on the L
Dull or dragging discomfort.
What part of the bladder can cause leakage into peritoneum and pain on shoulder?
Nature of stress fractures
Do not result from discrete injuries such as falls/trauma. Instead secondary to repeated stress. Long distance runners most commonly effected, tibia and fibula most vulnerable.
Differentiating osteosarcoma and Ewing's Sarcoma
Both in young males
: Knee, sunburst pattern/Codman's triangle on X-ray. Risk factors: Paget's Disease; bone infarcts; radiation; familial retinoblastoma.
No systemic features.
Ewing's Sarcoma: Anaplastic small blue cell malignant tumor. Onion-skin appearance on bone. Diaphysis of long bones. 11;22 translocation.
Systemic features: fever; malaise; weight loss.
Paget's disease of Bone
Disordered bone remodeling in old people.
Increased osteoclast and osteoblast activity.
Results in structurally inferior woven bone throughout the body (which is bigger)
Bowing/fracture of long bones resulting in arthritis of hip, knee.
Frontal Bossing/ Increased hat size.
Hearing loss due to cochlear damage from enlargement of temporal bone.
Increase in Alk Phos and Phosphorus levels.
Recurrent skin infections around coccyx.
Can form sinus tracts.
Pilonidal cysts most common in young M, esp. w/lots of body hair.
Buzz word Nasopharyngeal Carcinoma
Common in runners.
Mechanically induced neuropathic degeneration
Neuropathic pain radiating from 3rd and 4th toe metatarsal heads.
Intraductal papilloma of the breast
Intermittent bloody discharge from one nipple,
nL u/s and mammo bc mass is typically right under nipple.
Anterior vs. Posterior Shoulder Dislocation
: Arm in Ext. rotation abducted (more common)
: Arm in internal rotation adducted
What can be damaged in supracondylar fracture of the humerus in children?
What other infectious cause can mimic appendicitis