22 FEB 2017 2019 SURG

Question 1

what are the hallmark CT findings in pulmonary contusion?

Answer 1

patchy, irregular, nonlobular alveolar infiltrates not restricted by anatomical boundaries

Question 2

what are the typical lab findings in acute mesenteric ischemia?

Answer 2

• leukocytosis
• elevated Hb
• elevated amylase
• metabolic acidosis

Question 3

what is the most common infectious agent in bacterial parotitis?

Answer 3

staph aureus

Question 4

what an be done pre- and post-operatively to prevent bacterial parotitis?

Answer 4

adequate fluid hydration and oral hygiene

Question 5

mechanical bowel obstruction (eg from adhesions) causes (hyper / hypo) active bowel sounds, whereas prolonged postop ileus caused (hyper / hypo) active bowel sounds

Answer 5

• MBO: hyperactive

- prolonged postop ileus: hypoactive

Question 6

unlike prolonged postop ileus, mechanical bowel obstruction (eg adhesions) will show __________ on x ray

Answer 6

air fluid levels

Question 7

• what is the MOA of metoclopramide?

- what is the MOA of ondansetron?

Answer 7

• metoclopramide: DA antagonist - prokinetic agent

- ondansetron: serotonin receptor antagonist (can cause constipation)

Question 8

what therapy can be used to temporarily fix flail chest? how does it work?

Answer 8

• mechanical positive pressure ventilation (MPPV)
• corrects paradoxical motion of flail segment by replacing normal negative intrapleural pressure with positive intrapleural pressure and forcing the segment to move outward with the rest of the rib cage during inspiration

Question 9

what are the most common organisms responsible for prosthetic joint infection within 3 months?

Answer 9

• staph aureus
• gram negative rods
• anaerobes

Question 10

what are the most common organisms responsible for prosthetic joint infection within 3-12 months?

Answer 10

• coagulase negative staph
• propionibacterium spp
• enterococci

Question 11

what are the most common organisms responsible for prosthetic joint infection after 12 months?

Answer 11

• staph aureus
• gram negative rods
• beta hemolytic strep

Question 12

what is the most potent regulator of cerebral blood flow?

Answer 12

paCO2

Question 13

what are causes of postop fever within 2 hours?

Answer 13

• prior trauma / infection
• blood products
• malignant hyperthermia

Question 14

what are causes of postop fever within 24hr - 7d?

Answer 14

• nosocomial infections
• SSI
• noninfectious (MI, PE, DVT)

Question 15

what are causes of postop fever after 1 month?

Answer 15

• viral infections

- SSI

Question 16

why is mechanical positive pressure ventilation (MPPV) contraindicated in hypovolemic shock?

Answer 16

• causes an acute increase in intrathoracic pressure, which, in a severly hypovolemic patient with low central venous pressure, can collapse venous capacitance vessels and cut off venous return
• sudden loss of right ventricular preload can cause acute circulatory failure and sudden cardiac death

Question 17

which has a greater risk of avascular necrosis: intraacpsular or extracapsular femoral fractures?

Answer 17

intracapsular

Question 18

which have a greater need for implanted devices: intracapsular or extracapsular femoral fractures?

Answer 18

extracapsular

Question 19

what is Cushing’s reflex? what does it indicate?

Answer 19

• HTN
• bradycardia
• respiratory depression
• indicates increased ICP

Question 20

what compartment pressure indicates significant compartment syndrome?

Answer 20

equal to or over 30 mm Hg

Question 21

what imaging test is used for penile fracture?

Answer 21

retrograde urethrogram

Question 22

patients with suspected prerenal AKI should be treated with what kind of fluid?

Answer 22

IV isotonic fluid (NS) - to restore renal perfusion

Question 23

what are the 4 Ts for anterior mediastinal tumors?

Answer 23

• thymoma
• teratoma (includes other germ cell tumors)
• thyroid neoplasm
• terrible lymphoma

Question 24

seminomas may show an elevation in what hormone?

Answer 24

B-HCG (AFP is essentially always normal)

Question 25

nonseminomatous germ cell tumors have an elevation in what hormone?

Answer 25

AFP (many also do have an increase in B-HCG)