USMLE STEP 2 CK NOTES - Surgery

M.Team
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USMLE STEP 2 CK NOTES - Surgery

Postby M.Team » Sat Jul 16, 2016 9:38 am

((Retroperitoneal abscess))

Fever, chills and deep abdominal pain

Pancreatic injuries may be missed by CT scan during the first six hours following trauma

Blunt abdominal trauma can compress the neck and/or body of the pancreas against the vertebral column over which it lies  serial CT

Enlargement of the gland, parenchymal disruption, areas of diminished contrast perfusion and peri-pancreatic fluid collections

If blunt traumatic pancreatic injury is undetected initially, devitalized tissue or a pseudocyst resulting from such injury can become secondarily infected

Treatment is by immediate placement of a percutaneous drainage catheter, culture of the drained fluid, and ultimately surgical debridement
Complications: retroperitoneal abscess or pseudocyst

[Spleen is the most commonly injured organ following blunt abdominal trauma --> CT]
[Gastric perforation --> penetrating injury --> x-ray (air under diaphragm) --> immediate surgery]
[Small bowel injury is less likely after blunt (as opposed to penetrating) trauma, one exception is the duodenum which is almost entirely retroperitoneal --> vulnerable to crush injury where it overlies the vertebral bodies (duodenal hematoma and obstruction)]
[Mycotic (infected) aortic aneurysm --> abdominal pain, fever, and chills but not after trauma --> most common causes of infective aortic aneurysms are Staphylococci and Salmonella]

M.Team
Site Admin
Posts: 35
Joined: Wed Jul 06, 2016 3:43 pm
Contact:

Re: USMLE STEP 2 CK NOTES - Surgery

Postby M.Team » Sat Jul 16, 2016 9:38 am

((CO poisoning))
Confusion, wheezes and a seizure, syncope, heart failure or arrhythmias

Tasteless, colorless and odorless gas
Carbon monoxide has over 200 times higher affinity for hemoglobin than oxygen

Shifting the hemoglobin-oxygen dissociation curve to the left

S&S:
Early symptoms of carbon monoxide poisoning are typically neurological and include agitation, confusion and somnolence
Mild to moderate --> Headache, nausea, dyspnea, malaise, altered mentation and dizziness
Severe --> seizure, coma, syncope, heart failure, or arrhythmias
Bright cherry lips

Labs:
Elevated carboxyhemoglobin level (> 3% in nonsmokers and >15% in smokers)

Pulse oximetry is unreliable and may appear normal since it cannot differentiate carboxyhemoglobin from oxyhemoglobin

Treatment:
100% oxygen via non-rebreather facemask (decrease half life from 5 to 1-2 hours)
Hyperbaric oxygen can be used in severe cases not responsive to facemask-administered oxygen


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