Nir Hus Q 18 21 iv


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Slides with topics that are covered and were tested in the recent Absite exams.
Nir Hus MD., PhD.

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Nir Hus Q 18 21 iv

  1. 1. Q: 18 - 21
  2. 2. Q18: Rx Acidosis In Normovolemic Shock <ul><li>Unlike other forms of shock, patients with septic shock are normovolemic with reasonable filling pressures. </li></ul><ul><li>The cardiac output is increased secondary to the hyperdynamic state induced by the sepsis. </li></ul><ul><li>The peripheral resistance is low and produces the paradoxical warm shock with pink dry extremities. </li></ul><ul><li>A low systemic vascular resistance is therefore most useful in establishing the diagnosis. </li></ul><ul><li>Most common is Gram Negative sepsis -- Hyperventilation, respiratory alkalosis, & AMS. </li></ul>
  3. 3. Q19: Rx Melanoma Thigh <ul><li>Superficial Spreading. </li></ul><ul><ul><li>More commonly found on the trunk, upper arms, and thighs. </li></ul></ul><ul><ul><li>Most common form of melanoma in white races. </li></ul></ul><ul><ul><li>It begins a small pigmented macule that is asymmetric, has irregular borders, and has color variations. </li></ul></ul><ul><ul><li>This type of melanoma remains in the flat phase for a shorter period of time than the lentigo maligna type before it penetrates into the deeper levels of the skin. </li></ul></ul>
  4. 4. Gender <ul><li>Women have a better prognosis likely due to the fact that they acquire melanoma in more favorable locations (extremities) </li></ul><ul><li>Women are less likely to have ulcerated lesions </li></ul>
  5. 5. Necessary resection margins for melanoma <ul><li>1cm… <1mm depth </li></ul><ul><li>2cm… 1-4mm depth </li></ul><ul><li>3cm… >4mm depth </li></ul>
  6. 6. TNM Classification
  7. 7. <ul><li>Lymph Nodes </li></ul><ul><ul><li>Remove all clinically positive lymph nodes </li></ul></ul><ul><ul><li>Any lesion of 4mm or higher in thickness – LND is controversial </li></ul></ul><ul><ul><li>Intermediate thickness (1-4mm) with no evidence of LN involvement – prophylactic LND is controversial </li></ul></ul><ul><ul><li>Sentinel lymphadenectomy is gaining wide acceptance as surgical modality for malignant melanoma </li></ul></ul><ul><ul><ul><li>Identifies the group of individual who may benefit from LND </li></ul></ul></ul>
  8. 8. Q20: Rx / Dx Cardiac Tamponade <ul><li>A 45-year old man is violently thrown against the steering wheel of his car during a high speed MVA. On arrival to the emergency department pt complains of chest pain and is visibly diaphoretic. His BP is 60/40 and RR=40. Which of the following would best allow you to delineate cardiac tamponade from tension pneumothorax as the cause of his hypotension? </li></ul><ul><ul><li>jugular venous pressure </li></ul></ul><ul><ul><li>breath sounds </li></ul></ul><ul><ul><li>pulse pressure </li></ul></ul><ul><ul><li>tachycardia </li></ul></ul>
  9. 9. Q20: Rx / Dx Cardiac Tamponade <ul><li>breath sounds </li></ul><ul><li>Both cardiac tamponade and tension pneumothorax can present as hypotension, respiratory distress,and tachycardia, however tension pneumothorax classicaly presents with absent breath sounds and hyperresonance to percussion on the affected hemithorax. </li></ul>
  10. 10. Q20: Rx / Dx Cardiac Tamponade <ul><li>Tamponade is almost invariably associated with widening of the mediastinal silhouette on the chest radiograph. </li></ul><ul><li>The association of rising atrial pressures, diminished cardiac output, and a widening mediastinum is sufficient to prompt surgical exploration. </li></ul><ul><li>Look for JVD, muffled heart sounds, and hypotension/decreased stroke volume (Beck's triad)‏ </li></ul>
  11. 11. Q21: Natural Anatom Constriction ESOP. <ul><li>Cricopharyngeus </li></ul><ul><li>Compression by the LEFT mainstem bronchus, and Aortic Arch </li></ul><ul><li>Diaphragm </li></ul>