AMBOSS - Surgery

Question 1

Big mechanism of injury with mediastinal widening

Answer 1

Aortic injury

Question 2

Hemothorax treatment?

Answer 2

Chest tube

Question 3

Pneumobilia and s/sx of mechanical obstruction?

Answer 3

Cholecystoenteric fistula -> gallstone illeus

Question 4

Mechanical SBO without clear cause on imaging?

Answer 4

Ogilvie syndrome

Tx = neostigmine

Question 5

Blind loop syndrome

Answer 5

SIBO preventing absorption

H/o GI anatomy alteration (bypass etc) with s/sx malabsorption

Question 6

Treatment for anal fissure

Answer 6

Sitz bath (reduce sphincter tone, increase blood flow)
Nifidipine (increased blood flow for healing)

Question 7

First line tx for internal hemorroids

Answer 7

Docusate (to soften stool)
Topical/suppository lido if painful
If fails -> rubber band, infrared coag, sclerotherapy

Question 8

Glutamate dehydrogenase antigen tests for what?

Answer 8

C diff colitis

Also can do EIA for A/B tox, PCR, culture

Question 9

Hamman’s sign

Answer 9

Crunch with heartbeat (d/t mediastinal emphysema)

Question 10

Causes of postop hemorrhage

Answer 10

<24 hrs: Mechanical (slipped ligature, cessation of vasospasm) vs. hemostatic (undx’d coag dz)
<1 week: massive transfusion (dilution coag) vs. consumption coag
>1 week: surgical site infection, erosion of blood vessels

Question 11

Diagnosing Boerhaave syndrome

Answer 11

Initial: CXR
Confirm: Gastrografin swallow
Unstable/uncooperative: CT

Question 12

PBC marker and tx

Answer 12

AMA + (and ANA +)
1st line: Urodeoxycholic acid
Transplant if cirrhosis
Treat itching

Question 13

Treatment of pancreatic head vs. body/tail carcinoma?

Answer 13

Whipple (pancreaticoduodenectomy)

Left sided resection with splenectomy

Question 14

Double bubble on XR?

Answer 14

Duodenal atresia

Question 15

H/o chron’s dz presenting with SBO. Tx?

Answer 15

Bowel sparing resection (strictureplasty) d/t likely postop formation of adhesions

Question 16

Initial test for ZE (after ruling out h. pylori)

Answer 16

Fasting serum gastrin level

Question 17

Dx of suspected pyloric stenosis

Answer 17

Ultrasound showing elongated and thickened pylorus

Target sign on transverse view

Question 18

Lab findings in pyloric stenosis

Answer 18

Hypokalemic, hypochloridic metabolic alkalosis

Question 19

Dx steps of achalasia?

Answer 19

Barium swallow
Manometry
NEED EGD with bx to rule out cancer (pseudo-achalasia)

Question 20

Child with abd pain and concentric rings of bowel on US?

Answer 20

Intussusception (commonly caused by Meckle’s)

Question 21

Carpal tunnel syndrome management

Answer 21

Mild/mod: 1st line = volar splint or GC injection
Severe or refractory = decompression
S/Sx of severe = thenar atrophy

Question 22

Cushing triad

Answer 22

Hypertension, bradycardia, irregular respiration

Increased ICP -> Decreased brain perfusion -> increased sympathetic tone and HTN

Question 23

Intermetatarsal neuroma (aka Morton’s neuroma)

Answer 23

Pain and burning in downstream digits

Often in pt who wears narrow/high-heeled footwear

Question 24

Mulder’s sign

Answer 24

Pop or click + pain in patient with intermetatarsal neuroma

Question 25

Who gets SCFE?

Answer 25

Obese males, 10-16 years old PE: Flexed, ext rot hip (foot pointing at other) XR: sclerotic epiphysis, joint widening (or nml early) Surgical emergency, pinning

Question 26

Legg-Calves-Perthes disease

Answer 26

Avascular necrosis of femoral head, idiopathic | Usually around 6 years old

Question 27

Dx of developmental dysplasia of the hip

Answer 27

US NOT XR Hip is not yet calcified alpha angle <60

Question 28

DDH treatment

Answer 28

Pavic harness (rigid harness)

Question 29

Risk factors for DDH

Answer 29

Female | Breech presentation

Question 30

Severe disk herniation symtoms

Answer 30

Urinary retention Saddle anesthesia Bilateral sx's

Question 31

Lidocaine injection test

Answer 31

Used in impingement | Dx and Tx

Question 32

When is CRPP an option?

Answer 32

Generally with hand or distal radius fractures

Question 33

Study of choice for suspected posterior shoulder dislocation?

Answer 33

Axillary radiograph

Question 34

PE for posterior dislocation

Answer 34

Anterior flattening | Coracoid prominence

Question 35

What kind of fluid do you give burn patients?

Answer 35

Crystalloid

Question 36

Elbow fx vs. radial head sublux in a kiddo?

Answer 36

Inflammation vs. no-inflammation

Question 37

Osteosarc vs. Ewings

Answer 37

``` Ewing = kiddos, onion skin, diaphysis Osteosarc = teens, sunburst, metaphysis ```

Question 38

Palmar fibromatosis

Answer 38

Overproliferation of fibroblasts | Limit extension

Question 39

Breast CA treatment in pregnancy

Answer 39

Always resect Chemo after 1st tri NO Rads

Question 40

PDA treatment

Answer 40

Indomethacin (kill dem prostaglandins)

Question 41

Cutoff for US vs. mammo in breast CA?

Answer 41

30 years old

Question 42

Dx and tx for meconium ileus?

Answer 42

Gastrogaffin for both! Dx and osmotic pull

Question 43

Different treatment for types of male germ cell tumors?

Answer 43

``` NSGCT = Bleomycin, etoposide, cisplatin (increased AFP, ßhcg) SGCT = Rads ```