Master the board step 3

Master the Boards: USMLE Step 3
Postoperative
Complication Features Management
Fever
Pulmonary embolus
(PE) (Day 7)
Aspiration
Intraoperative
tension
pneumothorax
Postoperative
confusion
Acute respiratory
distress syndrome
(ARDS)
Delirium tremens
(Days 2–3)
Tachycardia, shortness of breath, hypoxia,
increased A-a gradient
Shortness of breath, hypoxia, infiltrate on
x-ray
Positive-pressure breathing; patient becomes
progressively more difficult to “bag”
BP steadily declines, and CVP steadily rises
Suspect hypoxia first
Consider sepsis
Bilateral pulmonary infiltrates and hypoxia,
with no evidence of CHF
Tachycardia, hyperthermia, hypertension,
altered mental status
CTA (CT angiogram)
Anticoagulate with heparin
IVC filter if recurrent PE
Lavage and remove gastric contents
Bronchodilators and respiratory support
Steroids do not help
Insert needle to decompress and place chest
tube later
Check blood gases
Get blood cultures and CBC
Positive end-expiratory pressure (PEEP)
Give benzodiazepines (barbiturates are
second-line agents because of lower
therapeutic range); watch for seizures and
rhabdomyolysis
Pediatric Surgery
Conditions That Need Surgery at Birth
Congenital anomalies constitute the conditions that need surgery at birth. On
the Step 3 exam, the most important first step before surgery is to rule out
other associated congenital conditions. In any of the following presentations,
look for other associated elements of the VACTER (vertebral, anal, cardiac,
tracheal, esophageal, renal, and radial) constellation:
··
Look at anus for imperforation.
··
Check the x-ray for vertebral and radial anomalies.
··
Do echocardiogram looking for cardiac anomalies.
··
Do sonogram looking for renal anomalies.
Esophageal Atresia
Excessive salivation is noted shortly after birth, or choking spells are noticed
when first feeding is attempted.
332