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x Surgery M3 > From USMLE CK2 > Flashcards

From USMLE CK2 Flashcards

1
Q

Bowel ischemia: physical presentation?

A

rapid onset of severe, periumbilical pain, perhaps nausea

pain out of proportion to exam findings

HTN, tachy, decr bowel sounds.

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2
Q

bowel ischemia - lab findings?

A

leukocytosis

elevated serum lactate, amylase, phospnate

metabolic acidosis due to incr serum lactate

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3
Q

bowel ischemia: tx?

A

resuscitate

broad spectrum abx

NG tube decompression

surgery

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4
Q

acalculus cholecystitis: seen in what patients?

A

severely ill/ in ICU already

septic, mult organ failure, trauma, burns

likely due to cholestasis and GB ischemia

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5
Q

acalculus cholecystitis: how to dx?

A

s/s are vague

high suspicion in pts who are really ill

confirm with imaging - GB wall thickening, some pericholecystic fluid. looks like gallstone dz without the stones

CT: air-fluid levels, distention

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6
Q

acalculus cholecystitis: tx?

A

abx

immediate cholecystostomy (stoma/drain GB)

eventual CCY when possible for pt.

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7
Q

Encapsulated bacteria: what are they?

What vaccines do we give to asplenic pts?

A

SHiNE SKiS

Strep pneumo, H. Inf, N. Meningitidis, E Coli, salmonella, Klebsiella, Group B Strep

Asplenics are not able to opsonize/clear via spleen. Vaccinate for Strep pneumo, H Inf, N Meningitidis

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8
Q

Basal Cell Carcinoma: appearance? location? metastasize? margins?

A

Appearance: Raised waxy lesion, or nonhealing ulcer

Location: Upper part of face

Does not met - will invade

Margins: 1mm

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9
Q

Squamous Cell Carcinoma

A

Appearance: nonhealing ulcer

Location: Lower lip, lower part of face

Will metastasize

Margins: 0.5 to 2cm

Dissect nodes. May do radiation

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10
Q

Metastatic Malignant Melanoma: where will it met to? what is preferred chemo?

A

Will metastasize to anywhere. Weird cancer.

Interferon is preferred adjuvant systemic therapy

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11
Q

Melanoma: what margins are required?

A

Lesion <1mm: only local excision

Lesion 1-4mm: 2-3cm margins, aggressive node dissection

Lesion >4mm: really bad prognosis

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12
Q

Abdominal aortic aneurysm: what size is ok to watch? what size to we do elective repair on?

A

Ok to watch if 4cm or smaller.

Do elective repair if 5cm + (chance of rupture is high).

Also if it grows 1cm+ per year, do repair.

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13
Q

Abdominal aortic aneurysm: how are they usually treated now?

A

with endovascular stents

placed percutaneously.

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14
Q

Tender abdominal aortic aneurysm: what is prognosis?

A

will rupture in a day or two - immediate repair!

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15
Q

What parameters define severe nutritional depletion?

A
  • loss of 20% body weight over a few months
  • serum albumin under 3
  • anergy to skin antigens
  • serum transferrin level less than 200 mg/dL

(or combination of the above)

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16
Q

Pt with severe nutritional depletion needs surgery - what needs to be done?

A
  • this pt has very high operative risk
  • do preoperative nutritional support (4-5 days is helpful, 7-10 days is optimal)
17
Q

Acute angle closure glaucoma: presentation?

A

very severe eye pain or frontal headache

typically in evening, when pupils have been dilated for a few hours.

pt may be seeing halos. Eye feels hard as a rock on PE.

18
Q

Acute angle closure glaucoma: treatment?

A

Emergency!

get opthalmology. in meantime, give systemic carbonic anhydrase inhibitors, and give topical beta blockers and a2-selective adrenergic agonists.

can also give mannitol and pilocarpine.

19
Q

Retinal detachment: presentation?

A

emergency

pt sees flashes of light and floaters.

floaters corresponds with extent of detachment

20
Q

Retinal detachment: treatment?

A

laser spot welding to protect the remaining retina

21
Q

what medication class is associated with medication-induced hearing loss?

A

loop diuretics

ie furosemide

usually requires high doses to be ototoxic, but pts with renal failure can have ototoxicity at lower doses.

22
Q

Lisinopril: class?

side effects?

A

ACE inhibitor

SEs: cough, hyperkalemia, angioedema

23
Q

aspirin: side effects?

A

tinnitus

at high doses can cause hearing loss

24
Q

define vertigo

A

sensation of severe spinning, along with nausea

may be central or peripheral in cause.

25
Q

Meniere’s disease: define

A

inner ear problem from distension of endolymph compartment. episodes of vertigo (room spinning, nausea), feeling of fullness in ear.

tx = low salt diet.

26
Q

what category of antibiotic is ototoxic? what are they used for?

A

aminoglycosides

streptomycin. against gram-neg aerobes and anaerobic bacilli (ie TB)

27
Q

Charcot’s Triad?

A

fever, jaundice, RUQ pain

indicates ascending cholangitis

28
Q

Reynold’s Pentad?

A

fever, jaundice, RUQ pain, confusion, hypotension

indicates suppurative cholangitis (ascending cholangitis that is now infected)

x Surgery M3 (4 decks)

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