Master the board step 3

Master the Boards: USMLE Step 3
Steroids are good for
cerebral edema secondary
to tumors and abscesses,
but they have no role in
head trauma patients.
Management
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First-line measures are the following:
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Head elevation
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Hyperventilation
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Avoid fluid overload
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Second-line measures are the following:
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Mannitol: Use very cautiously; it can reduce cerebral perfusion.
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Sedation and/or hypothermia: These lower oxygen demand.
Basic Science Correlate
Mannitol is filtered by the glomeruli but not reabsorbed from the renal
tubule. The result is decreased water and Na+ reabsorption, which
subsequently leads to decreased extracellular fluid volume.
Caution! Do not overdo the treatment for elevated intracranial pressure.
Lowering ICP is not the ultimate goal; preserving brain perfusion is. Systemic
hypotension or excessive cerebral vasoconstriction may be counterproductive.
General Surgery
Acute Abdomen
The 4 main causes of an acute abdomen are these:
1. Perforation
2. Obstruction
3. Inflammatory/infection
4. Ischemia
The most important question to ask yourself when presented a case of an acute
abdomen is when to operate and when to treat medically.
Primary peritonitis is
spontaneous inflammation
in children with nephrosis
or an adult with ascites
and mild abdominal pain
(even if there is fever and
leukocytosis).
When is surgery the answer?
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Peritonitis (excluding primary peritonitis)
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Abdominal pain/tenderness plus signs of sepsis
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Acute intestinal ischemia
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Pneumoperitoneum
In all of the above cases, make sure pancreatitis is first ruled out.
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