Term
| T/F Apocrine metaplasia on breast biopsy histology raises your risk of breast cancer. |
|
Definition
|
|
Term
| T/F Adenosis on breast biopsy histology raises your risk of breast cancer. |
|
Definition
|
|
Term
| T/F Squamous metaplasia on breast biopsy histology raises your risk of breast cancer.. |
|
Definition
|
|
Term
| T/F Mild hyperplasia on breast biopsy histology raises your risk of breast cancer. |
|
Definition
|
|
Term
| T/F Moderate hyperplasia on breast biopsy histology raises your risk of breast cancer. |
|
Definition
|
|
Term
| T/f Papillomatosis on breast biopsy histology raises your risk of breast cancer. |
|
Definition
|
|
Term
| T/F Ductal ectasia on breast biopsy histology raises your risk of breast cancer. |
|
Definition
|
|
Term
| By how much does moderate or severe hyperplasia increase breast cancer risk? |
|
Definition
|
|
Term
| By how much does papillomatosis increse the risk for breast cancer? |
|
Definition
|
|
Term
| By how much does atypical hyperplasia increase your risk of breast cancer? |
|
Definition
| 5x; 10x if you have a family history of breast cancer |
|
|
Term
| By how much does lobular carcinoma in situ increase your risk of breast cancer? |
|
Definition
|
|
Term
| Invasive lobular carcinoma presents as... |
|
Definition
| focal thickening resembling fibrocystic change instead of a dominant breast mass |
|
|
Term
| What are the best ways to detect invasive lobular carcinoma? |
|
Definition
| physical exam, MRI, U/S (often negative on mammography) |
|
|
Term
| If a patient has atypical ductal hyperplasia on core needle biopsy, ___% of patients have ductal CIS on excisional biopsy. |
|
Definition
|
|
Term
| What is the false negative rate of screening mammography? |
|
Definition
|
|
Term
| What is the false positive rate of mammography? |
|
Definition
|
|
Term
| What percent of patients undergoing biopsies for mammographic abnormalities are found to have carcinoma? |
|
Definition
|
|
Term
| When is ultrasound useful to evaluate breast masses? |
|
Definition
| in low risk patients with a palpable abnormality and a negative mammogram |
|
|
Term
| What are the characteristics of a benign appearing cyst on U/S? |
|
Definition
| absence of septation and absence of a solid component |
|
|
Term
| What is teh tamoxifen chemoprevention dosing? |
|
Definition
|
|
Term
| What is the sensitivity and specificity of MRI for breast cancer? |
|
Definition
| 90-95% sensitive, 45% specific |
|
|
Term
| Having a mother or sister with breast cancer increases your risk by... |
|
Definition
|
|
Term
| What is your increased risk of breast cancer if you have a first degree relative who gets breast cancer before menopause? |
|
Definition
|
|
Term
| What is your increased risk of breast cancer if a first degree relative had bilateral breast cancer? |
|
Definition
| 4.0-5.4 if postmenopausal; 9.0 for premenopausal |
|
|
Term
| What percent of breast cancers are due to BRCA genes? |
|
Definition
|
|
Term
| Having a BRCA gene increases your risk of breast cancer by... |
|
Definition
|
|
Term
| Treatment options for benign breast lesions depends on what factors? |
|
Definition
| risk factors, pt concerns about cosmesis vs. cancer, ability to continue close breast surveillance |
|
|
Term
| When should patients with family history of breast cancer start getting screening mammographies? |
|
Definition
| 5-10 years prior to the earliest familial case |
|
|
Term
| T/F Lobular carcinoma in situ is considered a marker for subsequent breastcancer and not an early stage of existing breast cancer. |
|
Definition
| true; increases your risk of invasive lobular or invasive ductal 10x |
|
|
Term
| T/F Prophylactic breast radiation has been shown to reduce subsequent breast cancerrisk. |
|
Definition
|
|
Term
| What is the primary purpose of mammography? |
|
Definition
| to detect nonpalpable breast masses |
|
|
Term
| What are the categories of the Glasgow Coma scale? |
|
Definition
| eye opening, best motor response, verbal response |
|
|
Term
| What are the eye opening categories of the GCS? |
|
Definition
| 4=spontaneous, 3= to speech, 2= to pain, 1= none |
|
|
Term
| What are the motor response categories of the GCS? |
|
Definition
| 6= obeys commands, 5= localizes pain, 4= withdraws to pain, 3= decorticate posture, 2= decerebrate posture, 1= no response |
|
|
Term
| What are the verbal response values for the GCS? |
|
Definition
| 5= oriented, 4= confused conversation, 3= inappropriate words, 2= incomprehensible sounds, 1= none |
|
|
Term
| What is decorticate posturing? |
|
Definition
|
|
Term
| What is decerebrate posturing? |
|
Definition
|
|
Term
| For a patient with a severe head injury, the most important management principle is... |
|
Definition
| avoidance of secondary brain injury by maintaining blood pressure and getting an airway |
|
|
Term
| What is the Monro-Kellie doctrine? |
|
Definition
| volume of blood, brain and cerebrospina lfuid within the nonexpansile cranium must remain constant for intracranial pressure to remain constant |
|
|
Term
| How do you manage a patient with a severe head injury? |
|
Definition
| ABCs, intubate and maintain blood pressure, then hyperventillate and give mannitol |
|
|
Term
| Why do you hyperventillate pts with head injuries? |
|
Definition
| cerebral vasoconstriction, reducing the volume of blood in the cranium and allowing room for the intracranial mass lesion |
|
|
Term
| What is the dose of IV mannitol for head injury? |
|
Definition
|
|
Term
| When is Mannitol contraindicated for head injury? |
|
Definition
| hypovolemia because it can lead to shock |
|
|
Term
| How common are epidural hematomas? |
|
Definition
| 0.5% of all head injuries and 9% of severe head injuries |
|
|
Term
| Which has a worse prognosis epidural orsubdural hematoma? |
|
Definition
| subdural is worse because of coexisting brain injury |
|
|
Term
|
Definition
| transient loss of consciousness associated with no CT abnormalities |
|
|
Term
| GCS of a mild head injury= |
|
Definition
|
|
Term
| GCS ofa moderate head injury= |
|
Definition
|
|
Term
| GCS of a severe head injury? |
|
Definition
|
|
Term
|
Definition
| a hole drilled through the skull, usuallyon the side of the larger pupil to decompress an intracranial mass lesion; used when you have adequate training and no access to neurosurgery |
|
|
Term
| dilation of a pupil with a sluggish response to light is an early sign of... |
|
Definition
|
|
Term
| Does temporal herniation occur on the same side or the opposite side as a blown pupil? |
|
Definition
|
|
Term
| When is surgical decompression indicated for head injury? |
|
Definition
| if there is midline shift or focal hemorrhage |
|
|
Term
| Initial neurologic assessment of a person with a head injury should include... |
|
Definition
| GCS and pupillary reflextesting |
|
|
Term
| What are the most important indicators of outcome in head injured patients? |
|
Definition
| initial GCS in the ED and age |
|
|
Term
| How much fluids should you give someone with a thermal injury? |
|
Definition
|
|
Term
| Why do pts in fires get upper airway burns? |
|
Definition
| the upper airway is burned as it cools hot gases from a fire |
|
|
Term
| What indicates upperairway burns in a pt with thermal injury? |
|
Definition
| facial and upper torso burns and carbonaceous sputum |
|
|
Term
| What is a sign that a burn victim probably needs intubation? |
|
Definition
| dry, red or blistered oropharynx |
|
|
Term
| Complications of smoke inhalation= |
|
Definition
| tracheobronchitis and edema fro mexposure to the incomplete combustion of carbon particles and other toxic fumes |
|
|
Term
| A carboxyhemoglobin level of greater than ___ may indicate significant CNS dysfunction that may also be permanent. |
|
Definition
|
|
Term
| A carboxyhemoglobin level of greater than ___ may portend coma and death. |
|
Definition
|
|
Term
| What is the half life of CO? |
|
Definition
| 250 min on room air; 40-60 min with 100% O2 |
|
|
Term
| What is the burn size associated with a systemic response? |
|
Definition
|
|
Term
| When can a burn pt be resuscitated with oral fluids? |
|
Definition
|
|
Term
| Why should you use LR instead of NS to resuscitate burn pt? |
|
Definition
| avoid hyperchloremic metabolic acidosis |
|
|
Term
| What is the parkland formula for resuscitating burn pt? |
|
Definition
| for adults and children over 10 kg, the total 24 hr volume is calculated using 4 mL/kg/% burn. Half of this amount is given in the first 8 hours and the remainder in the next 16 hours |
|
|
Term
| How much fluid do you give to children under 10 kg with burns? |
|
Definition
| 2-3 mL/kg/% burn divided similarly over the next 24 hrs; they should also recieve maintenance fluids that includes 5% dextrose |
|
|
Term
| When do you use colloid fluids for burns? |
|
Definition
| avoided in the first 12 to 18 hrs because of increased capillary permeability, but can beused subsequently if resuscitation is not being achieved withthe crystalloid regimen |
|
|
Term
| What thermal injury complications lead to larger fluid requirements than initially calculated? |
|
Definition
| inhalational inuries, extensive and/or deep burns, and delayed resuscitation |
|
|
Term
| What UOP should a patient have if they are recieving adequate resuscitation? |
|
Definition
| adults= 0.5 mL/kg/h of UOP; children 0.5-1 mL/kg/h; infants= 1-2 mL/kg/h |
|
|
Term
| In what clinical situation is excess UOP desired? |
|
Definition
|
|
Term
| How big is approx 1% of a patients body surface? |
|
Definition
|
|
Term
| What is the rule of nines for adults? |
|
Definition
| front of head and neck= 4.5%; back of head and neck= 4.5; Front of torso= 18, Back of torso= 18; front of one arm= 4.5%, back of one arm= 4.5%; front of one leg= 9%; back of one leg= 9% |
|
|
Term
| What is the rule of nines for kids? |
|
Definition
| front of head with neck= 9%; back of head with neck = 9%; front of torso= 18%, back of torso= 18%; front of one arm= 4.5%; back of one arm= 4.5%; front of one leg= 7%; back of one leg= 7% |
|
|
Term
| When calculating the total percentage of burn involvement in a patientwith serious burns, which depth of burns do you count? |
|
Definition
| first degree are not counted |
|
|
Term
| What type of burns often don't seem as severe at first? |
|
Definition
|
|
Term
| What are fourth degree burns? |
|
Definition
| extend through skin and subcutaneous fat, even involving deep structures |
|
|
Term
| After establishing ABCs and stabalizing burn pts, what is the next step? |
|
Definition
| preventing against hypothermia and infection; do NOT use steroids!! |
|
|
Term
| What medication is contraindicated in burns? |
|
Definition
| steroids should not be used for any burn greater than 10% TBSA because it can predispose to infection |
|
|
Term
| What prophylactic IV antibiotics should be given to patients with burns to prevent infection? |
|
Definition
| none because they select for resistant organisms |
|
|
Term
| What medicines should be used topically for extensive burns? |
|
Definition
| silver sulfadiazine, sulfamylon (mafenide), silver nitrate, pigskin |
|
|
Term
| What are the pros and cons of using silver sulfadiazine? |
|
Definition
| does not penetrate eschar and so is not helpful in an infected burn; can rarely cause leukopenia, requiring cessation of use; pts allergic to sulfa are usually not affected by SS because the silver molecule is attached to the antigenic portion of the sulfadiazine molecule;however if this cream is chosen it is prudent to try a test patch for patients with sulfa allergy; A rash or pain will ensue if they are truly allergic to SS |
|
|
Term
| What are the pros and cons of using sulfamylon (mafenide)? |
|
Definition
| pain on application; can cause severe systemic metabolic acidosis because it inhibits carbonic anhydrase; penetrates the eschar so useful for full-thickness infected burns and for unexcised burns with colonization |
|
|
Term
| What are the pros and cons of using silver nitrate? |
|
Definition
| does not penetrate the eschar and turns the burn area black, usage can result in severe leaching of sodium and chloride, which can lead to profound hyponatremia and hypochloremia, particularly when used on large areas on children |
|
|
Term
| When is it good to use pigskin for burns? |
|
Definition
|
|
Term
| What are the pros and cons of using pigskin? |
|
Definition
| can encourage epithelialization in partial thickness burns |
|
|
Term
| What are neurologic complications of burns? |
|
Definition
| transient delirium commonly occurs, but an altered mental status requires evaluation to identify other etiologies such as anoxia and metabolic abnormalities |
|
|
Term
| What are the cardiovascular complications with burns? |
|
Definition
| venous thrombosis, suppurative thrombophlebitis-> bacteremia, which maycause endocarditis along with the local venous abscess |
|
|
Term
| What are some pulmonary complications of burns? |
|
Definition
| pneumonia, respiratory failure requiring mechanical ventillation |
|
|
Term
| What are some GI complications of burns? |
|
Definition
| stomach and duodenal ulcers, pancreatitis, acalculous cholecystitis, hepatic dysfunction (decrease in splanchnic flow) |
|
|
Term
| Why is it good to start feeding burn patients early with a feeding tube? |
|
Definition
| prevent GI complications by increasing splanchnic flow; decrease nosocomial pneumonias by inhibiting bacterial overgrowth |
|
|
Term
| What are some renal complications of burns? |
|
Definition
| ATN because of poor perfusion or myoglobinuria |
|
|
Term
| Burn patients at risk for eye injury (like in an explosion) should be evaluated by... |
|
Definition
| flourescein in the ED looking for corneal abrasions (treated with antibiotic lubrication); early examination is important before edema makes the exam difficult |
|
|
Term
| What is a first degree burn? |
|
Definition
| burn of the epidermis that causes erythema and pain and then heals in 3-4 days |
|
|
Term
| WHat is the treatment for a first degree burn? |
|
Definition
|
|
Term
| What is a second degree burn? |
|
Definition
| through epidermis and into dermis that looks pink/red and weepy with swelling and blisters; very painful |
|
|
Term
| What is the course of second degree burns? |
|
Definition
| superficial dermal heal within 3 weeks without scarring or functional impairment; deep dermal heal in 3-8 weeks but with severe scarring and loss of function |
|
|
Term
| What is the treatment for second degree burns? |
|
Definition
| excise and graft deep dermal burns |
|
|
Term
| What's another name for second degree burns? |
|
Definition
|
|
Term
| What is a third degree burn? |
|
Definition
| goes all the way through the dermis and is white or dark, leathery, waxy, painless |
|
|
Term
| What's another name for a third degree burn? |
|
Definition
|
|
Term
| What is the course of third degree burns? |
|
Definition
| burns can heal only by epithelial migration from periphery and contraction; unless they are tiny (cigarrette burn size), they will need grafting |
|
|
Term
| When should a burn pt be moved to a burn center? |
|
Definition
| <10 or >50 with full thickness burn of >10%; any age with TBSA>20%; partial or full-thickness burn involving face, eyes, ears, hands, genitalia, perineum, and over joints; burn injury complicated by chemical, electrical, or other forms of significant trauma; any pt requiring special social, emotional, and long-term rehab support |
|
|
Term
| When should a skin graft be performed on pts with burns? |
|
Definition
| autologous skin grafts should be performed as early as possible to prevent sepsis and get the best functional recovery |
|
|
Term
| What should you do if there is not enough autologous skin to do a skin graft on a burn? |
|
Definition
| temporary coverage of burn wounds with cadaveric skin and porcine skin; then staged burn wound excision and skin graft coverage |
|
|
Term
| Should aspirin be given to pts with claudication? |
|
Definition
| prob; does not improve claudication but will reduce the risk of myocardial infarction, strokes, and the progression of claudication symptoms; clopidogrel is more effective than aspirin in preventing CV ischemic events but is associated with increased cost and bleeding complications |
|
|
Term
| What meds should be considered in pts with claudication due to atherosclerosis? |
|
Definition
| aspirin vs. clopidogrel, statin |
|
|
Term
|
Definition
| lower extremity peripheral vascular occlusive disease |
|
|
Term
|
Definition
| no symptoms or signs; ABIs between 0.8 and 1.0; treatment= lifestyle and risk factors |
|
|
Term
|
Definition
| claudication, decreased or absent distal pulses; ABI between .41 and .8; treatment is Stage I plus potential intervention |
|
|
Term
| What is stage III LEPVOD? |
|
Definition
| rest pain, absent or diminished distal pluses plus elevation pallor; ABI between 0.2 and 0.4; tx= probable bypass |
|
|
Term
|
Definition
| ulcreation, absent pulses, elevation pallor, distal skin breakdown; ABI less than 0.2; tx probable bypass with woundcare |
|
|
Term
|
Definition
| minor gangrene, absent pulses, elevation pallor, distal skin breakdown, distal gangrene; ABI less than 0.2; bypass plus wound care plus possible minor amputation |
|
|
Term
|
Definition
| major gangrene; absent pulses, elevation pallor, distal skin breakdown, gangrene proximal to forefoot; ABI <0.2 or unobtainable; tx= bypas plus possible minor or major amputation |
|
|
Term
| How can diabetes alter the clinical presentation of PVD? |
|
Definition
| neuropathy can confound an impression of ischemic rest pain; increased susceptibility to infection |
|
|
Term
| For claudication, angioplasty techniques work best for what kinds of lesions? |
|
Definition
| short, focal, concentric, noncalcified atherosclerotic stenosis |
|
|
Term
| What is the 5 year patency of arterial bypass for LE claudication? |
|
Definition
| at aortoiliac level= 90%; at distal femoral-tibial bypass= 65% |
|
|
Term
| T/F When tissue loss is noted in pt with PVD, there is usually multilevel disease. |
|
Definition
|
|
Term
| How can you differentiate between rest pain due to PVD and diabetic neuropathy of the lower extremities? |
|
Definition
| rest pain is better called metatarsalgia and should be over the metatarsals unlike diabetic neuropathy |
|
|
Term
|
Definition
| focused abdominal sonography for trauma |
|
|
Term
| When a diagnostic laparoscopy is performed on a trauma pt, what should be done when perforation of a hollow viscus is suspected? |
|
Definition
|
|
Term
| What should be performed on primary survey of a stab wound to abdomen? |
|
Definition
| listen to breath sounds, evaluate circulation for cool skinor capillary refill longer than 2 sec (signs of shock), look for distended neck veins or muffled heart tones, pupillary response, response to verbal stimuli, remove close, upright chest radiograph, |
|
|
Term
| If a trauma pt has a normal initial CXR, should you rule out pneumothorax? |
|
Definition
| no; repeat CXR in 4-6 hrs to r/o delayed pneumothorax |
|
|
Term
|
Definition
| sensitivity for pericardial blood is as high as 100%; sensitivity in detecting abdominal injury approximates only 50% |
|
|
Term
| What findings on abdominal stab wound are indications for celiotomy? |
|
Definition
| rigidity, guarding, or significant tenderness distant from the stab wounds |
|
|
Term
| The practice of performing celiotomy on every pt with abdominal trauma has been replaced by what kind of therapy? |
|
Definition
| admission to hospital for serial abdominal exams, local exploration of the wound followed by diagnostic peritoneal lavage (DPL) and abdominal CT or exploratory laparoscopy |
|
|
Term
| How long should pts with stab wounds to the abdomen be observed? |
|
Definition
|
|
Term
| What is local wound exploration of a stab wound? |
|
Definition
| a sterile field is preped around the stab wound and the area is infiltrated with a local anesthetic; the stab wound is enlarged to permit adequate exploration, and teh tract of the wound is followed. If the anterior abdominal fascia has penetrated, further evaluation is indicated |
|
|
Term
| What is diagnostic peritoneal lavage? |
|
Definition
| catheter placed into abdomen using the seldinger technique; catheter is aspirated after placement to look for evidence of gross blood or fecal contents |
|
|
Term
| What happens if the DPL is negative? |
|
Definition
| 1 L of warm saline is instilled into the abdomen and then removed by gravity |
|
|
Term
| What are the criteria for positive DPL in pts with blunt abdomenal trauma? |
|
Definition
| gross aspiration of 10 mL of blood, aspiration of fecal contents,, or the presence of more than 100,000/mm3 of RBCs or 500/mm3 WBC in the lavage fluid |
|
|
Term
| What's different about the criteria for blunt abdomenal trauma vs. sharp trauma? |
|
Definition
| sharp abdominal trauma has a different RBC count which has not be standardized (anywhere from 1,000 to 100,000/mm3) |
|
|
Term
| DPL is not sensitive for what kinds of injuries? |
|
Definition
| those to the diaphragm or retroperitoneal structures |
|
|
Term
| What kind of contrast is given for CT scans post trauma? |
|
Definition
|
|
Term
| On a CT for trauma to the abdomen, what are signs of injury? |
|
Definition
| peritoneal penetration, free intraperitoneal fluid or air, intraperitoneal extravasation of contrast material, or injury to an intraperitoneal hollow organ |
|
|
Term
| Diagnostic laparoscopy is useful in diagnosing what kinds of injuries? |
|
Definition
| peritoneal penetration, solid organ injury and diaphragm injury; not sensitive for detecting hollow viscus injury |
|
|
