Med Surg Final Review/Final Exam Review (2023) With Complete Solution 2023-

Med Surg Final Review/Final Exam Review (2023) With Complete Solution 2023-24

1.      If I push the endotracheal tube too far, where will it go? Right lung  so we will have absent breath sound in the left lung. Right bronchus intubation

2.      TIPS (Transjugular Intrahepatic Portosystemic Shunt): in Portal hypertension to decrease the gastric varices bleeding by decreasing the portal venous pressure

a.      This procedure reduces the portal venous pressure and decompresses the varices, thus controlling bleeding

3.      Difference between embolic and thrombotic stroke: how do you explain it to a patient in a way that they understand?

a.      Ischemic Stroke:

i.       Inadequate blood flow to the brain from partial or complete occlusion of an artery  causes ischemia distal to the occlusion

ii.      80% of all stroked are ischemic strokes  usually thrombolytic should work

iii.       It can be thrombotic or embolic

iv.      Atherosclerosis, a hardening and thickening of arteries, is the major cause of ischemic stroke. It can lead to thrombus formation and contribute to emboli.

v.      Thrombotic stroke: clot formation there

vi.       Embolic stroke: it means it came from somewhere else

1.      Thrombotic and embolic are almost the same except that embolic means the blood clot came from somewhere else in the body  you had clot in your carotid and it went to your brain

b.      Thrombotic stroke:

i.       Thrombosis occurs in relation to injury to a blood vessel wall and formation of a blood clot.

ii.      Result of thrombosis or narrowing of the blood vessel

iii.       Most common cause of stroke

iv.      Lacunar strokes are typically asymptomatic  lacunar infarcts can be seen in MRI

1.      When we do the MRI in 60-70 years old patient we may see minor infarcts  it means the patient had lacunar strokes but it was totally asymptomatic

c.       Embolic Stroke:

i.       Occurs when an embolus lodges in and occludes a cerebral artery

ii.      Second most common cause of stroke

iii.       Rapid occurrence of severe clinical symptoms (loss of consciousness or neurologic deficits)

iv.      Onset is usually sudden and may or may not be related to activity

v.      Patient usually remains conscious, although he may have a headache

vi.       Basically patient has big clot that immediately starts to travel to the brain  symptoms: dysarthria, weakness