Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rotations > General Surgery > Flashcards

General Surgery Flashcards

1
Q

middle aged adult + superficial unilateral hip pain that is exacerbated by external pressure to the upper lateral thigh

A

trochanteric bursitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how does trochanteric bursitis present?

A

hip pain when pressure is applied (as when sleeping) and with external rotation or resisted abduction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is trochanteric bursitis?

A

inflammation of the bursa surrounding the insertion of the gluteus medius onto the femur’s greater trochanter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what population does slipped capital femoral epiphysis affect?

A

obese male children during late childhood or early adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

WHat nerves supply the upper lateral thigh causing superficial referred pain?

A
  1. lateral femoral cutaneous

2. iliohypogastric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

By what mechanism does the following lower ICP?

Head elevation

A

increased venous outflow from the head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

By what mechanism does the following lower ICP?

Sedation

A

decreased metabolic demand and control of HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

By what mechanism does the following lower ICP?

Intravenous mannitol

A

Extraction of free water out of the brain tissue -> osmotic diuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

By what mechanism does the following lower ICP?

Hyperventilation

A

CO2 washout leading to cerebral vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cerebral blood flow increases via what mechanisms?

A
  1. Hypercapnia
  2. Increased metabolic demand
  3. Hypoxia through vasodilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

coag negative staph most commonly gains access to the blood via what??

A

indwelling femoral triple lumen catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

femoral catheter infections are more commonly caused by what?

A

enteric organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how soon after the onset of a new drug do you see drug fever?

A

one to two weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

drug fever is most commonly associated with what?

A
  1. Anticonvulsants

2. TMP-SMX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the most common presentation of intraductal papilloma?

A

a form of benign breast disease presents w intermittent bloody discharge from one nipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the common causes of paralytic ileus?

A
  1. Exaggerated intestinal rxn after abdominal surgery

2. Retroperitoneal hemorrhage associated with vertebral fracturs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does abdominal x-ray show in pts w paralytic ileus?

A
  • air fluid levels

- distended gas-filled loops of both the small and large intesines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the tx of choice for paralytic ileus?

A
  1. bowel rest
  2. supportive care
  3. tx of secondary cause of the ileus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the cause of nursemaid elbow?

A

subluxation of head of radius at the elbow joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the tx of nursemaid elbow?

A

Closed reduction:

  1. First extend and distract the elbow
  2. Supinate the forearm
  3. Hyperflex the elbow with your thumb over the radial head in order to feel the reduction as it occus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Kehr sign?

A

intraabdominal pathology causing peritonitis and irritation of the diaphragm
- irritation of the parietal peritoneum covering the undersurface of either hemidiaphragm can be referred to the ipsilateral shoulder bc the phrenic nerve originates from the C3-C5 spinal levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the only part of the bladder covered by peritoneum and thus can cause peritonitis?

A

bladder dome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which part of the bladder is most susceptible to rupture and why?

A
  • bladder dome

- the dome has a developmental hiatus where the urachus originates during embryonic life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the most common site of extraperitoneal bladder rupture?

A

bladder neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the gold standard for evaluating mesenteric ischemia?

A

mesenteric angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the typical presentation of mesenteric ischemia?

A

severe abdominal pain after eating and relatively normal abdominal exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is the respiratory quotient?

A

the steady state ratio of carbon dioxide produced to oxygen consumption per unit time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what does a RQ close to 1 indicate? 0.8? 0.7?

A

1= carbohydrates are the major nutrient being oxidized

  1. 8 = proteins
  2. 7 = fatty acids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how is RQ important in mechanically ventilated patients?

A
  • overfeeding, esp with carbs, causes excessive CO2 production and makes weaning from ventilation more challenging
  • this is important in pts w preexisting lung disease as well
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is the RQ in sepsis? why?

A

less than 1, bc sepsis is a hypermetabolic hypercatabolic state where both fat and protein are broken down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the presenting sx of severe CO poisoning after smoke inhalation?

A
  1. COnfusion -> COma
  2. Wheezes
  3. Seizure
  4. Heart failure or arrythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are the sx of moderate CO poisoning?

A
  1. HA
  2. Nausea
  3. Dyspnea
  4. Malaise
  5. Altered mentation
  6. Dizziness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

how does one diagnose CO poisoning?

A

confirmed clinically and by documenting elevated carboxyhemoglobin level (>3% nonsmokers, >15% smokers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

tx of CO poisoning?

A

100% oxygen w facemask

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

DRE finds a tender, fluctuant mass palpable only with the tip of the examining finger?

A

abscess in the rectovesical pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the sx of a anorectal abscess compared to a rectovesical abscess?

A 
Anorectal: perineal pain + fluctuant mass palpable on the perineum
- pain w ambulation and defecation
- urinary retention
Rectovesical: lower abdominal pain
- malaise, low grade fever
- tender pelvic mass on rectal exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

if pt has signs of PAD and ABI is normal, what should be the next step?

A

exercise testing with repeat ABI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

ABI of:
1-1.3
<0.4

A

1-1.3 = normal
50% occlusion in a major vessel
<0.4 = limb ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Presenting signs of a posterior shoulder dislocation versus anterior?

A

Posterior: flattening of anterior shoulder

  • prominent coracoid process
  • arm held adducted and internally rotated, cannot externally rotate

Anterior: most common,
- pt holds arm abducted and externally rotated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what does radiograph show w posterior dislocation of shoulder?

A
  1. Light bulb sign: Internal rotation of humeral head with circular appearance
  2. Rim sign: widened joint space >6mm
  3. Trough line sign: 2 parallel cortical bon lines on the medial aspect of the humerus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is a marjolin ulcer?

A

squamous cell carcinoma within burn wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what fibers are most often damaged in syringomyelia?

A
  1. spinothalamic tract (pain and temperature)

2. upper extremity motor fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what are the most common causes of syringomyelia?

A
  1. Arnold Chiari malformations

2. Previous spinal cord injuries: most often MVA w whiplash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is the most sensitive finding for blunt aortic injury on radiograph?

A

mediastinal widening (in the setting of MVA or falls >10ft)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

sx of compartment syndome?

A
  1. severe pain that is worsened on passive ROM
  2. Paresthesias
  3. Pallor
  4. Paresis
    all of the affected limb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

how do you diagnose compartment syndrome? tx?

A

use needle and pressure transducing catheter system
pressures >30mmHg may result in cessation of blood flow
- tx emergently by fasciotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what are postop measures used to decrease the risk of pneumonia?

A

all encourage lung expansion:

  1. Incentive spirometry* first line
  2. Deep breathing exercises
  3. CPAP
  4. Intermittent positive pressure breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what is the difference between pulmonary contusion and ARDS?

A

Pulmonary Contusion: within first 24hrs, unilateral

ARDS: 24-48 hours, bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what is the tx for mastitis?

A
  1. Analgesics
  2. Antibiotics: Dicloxacillin or cephalosporin
  3. Continued nursing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is Kehr sign?

A

Left shoulder pain referred from splenic hemorrhage irritating the phrenic nerve and diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what are the risk factors for nasopharyngeal carcinoma?

A
  1. EBV!!!!!!!! huge.
  2. Smoking
  3. Chronic nitrosamine consumption (diets rich in salted fish)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

acute pain and swelling of the midline sacrococcygeal skin and subcutaneous tissues

A

pilonidal cyst infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

pilonidal cysts are most prevalent in whom?

A

young males with a lot of body hair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

tx of pilonidal cysts?

A

drainage of abscesses and excision of sinus tracts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

perianal fistulae are generally located where?

A

within 3cm of the anal margin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

tx of duodenal hematoma?

A
  • most resolve spontaneously in 1-2 weeks so just nasogastric suction and parenteral nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

in what population do you normally see acalculous cholecystitis?

A

Pt’s chronically hospitalized in the ICU with any:

  1. Multiorgan failure
  2. severe trauma
  3. Surgery
  4. Burns
  5. Sepsis
  6. Prolonged parenteral nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is the suspected pathogenesis of acalculous cholecystitis?

A
  1. Cholestasis and gall bladder ischemia ->
  2. Secondary infection by enteric organisms ->
  3. Edema of the gall bladder serosa ->
  4. Necrosis of the gall bladder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

5 W’s of postop fever?

A
  1. Wound infection
  2. Wind (atelectasis)
  3. Water (UTI)
  4. Walking (DVT)
  5. Wonder drugs!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

most common cause of postop fever within 1 day of surgery?

A

atelectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the workup for postop fever?

A
  1. CBC
  2. Blood and urine cultures
  3. Urinalysis
  4. CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

how do you correct for low albumin in the setting of hypocalcemia?

A

Corrected Ca = 0.8 (normal albumin - observed albumin) + Observed Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

in acidosis, what happens to the ionized fraction of Ca?

A

increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

in alkalosis what happens to the ionized fraction of Ca?

A

decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what are some causes of hypocalcemia?

A
  1. Acute pancreatitis
  2. Necrotizing fasciitis (massive soft-tissue infections)
  3. Acute/chronic renal failure
  4. Pancreatic/small bowel fistulas
  5. Severe alkalosis (decrease in ionized fraction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what ECG changes does one observe in hypocalcemia?

A

prolonged QT interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what are some causes of hypercalcemia?

A
  1. Hyperparathyroidism
  2. Cancer: breast & multiple myeloma
  3. Drugs (thiazides)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what is the biggest danger of TPN?

A

infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q 
estimations of basal energy expenditure (BEE):
Nml Males:
Nml Females:
Nonstressed patient
Postsurgery
Trauma/sepsis/burns
Fever
A 
Nml Males: 25 kcal/kg/day
Nml Females: 22 kcal/kg/day
Nonstressed patient: BEE x 1.2
Postsurgery: BEE x 1.3-1.5
Trauma/sepsis/burns: BEE x 1.6-2.0
Fever: 12% increase per *C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q 
what is the RQ of:
Lipids-
protein-
carbs- 
balanced diet-
A

Lipids- 0.7
protein- 0.8
carbs- 1.0
balanced diet- 0.83

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what is the RQ?

A

ratio of carbon dioxide released to oxygen consumed per unit metabolism of a substrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what is the fuel for enterocytes? colonocytes? immune modulating agents?

A

Enterocytes: glutamine
Colonocytes: short chain fatty acids
Immune modulating: omega 3 fatty acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

causes of anion gap metabolic acidosis?

A 
MUDPILES
Methanol/metabolism errors
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron/Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what are the 4 major processes that cause anion gap metabolic acidosis?

A
  1. Ketoacidosis
  2. Lactic acidosis
  3. Renal failure
  4. Intoxication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what are the causes of normal anion gap metabolic acidosis?

A 
HARDUP
Hyperparathyroidism
Adrenal insufficiency/anhydrase inhibitors
Renal tubular acidosis
Diarrhea
Ureteroenteric fistula
Pancreatic fistulas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

how do you calculate the anion gap?

A

AG = Na - (Cl + HCO3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

what are the two mechanisms of metabolic alkalosis?

A
  1. Loss of H+ from kidneys or GI tract

2. Gain of HCO3: TPN, PRBCs, lactated ringers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the causes of respiratory alkalosis?

A 
MIS(HAP)3S
Mechanical overventilation
Increase in ICP
Sepsis
Hypoxia/hyperpyrexia/heart failure
Anxiety/ascites/asthma
Pregnancy/Pain/Pneumonia
Salicylates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Barium swallow = corkscrew shaped

A

diffuse esophageal spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

classic triad of achalasia?

A
  1. Dysphagia
  2. Regurgitation
  3. Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

tx of choice for achalasia?

A

Heller’s myotomy: esophagomyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what are the two false diverticula in the esophagus?

A
  1. Zenkers: pharyngoesophageal
  2. Epiphrenic
    = pulsion diverticula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

when would you tx asymptomatic zenkers diverticulum?

A

when it’s >2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

tx of zenkers diverticulum?

A
  1. Cervical pharyngocricoesphageal myotomy (incising the cricopharyngeus
    followed by:
    - Diverticulopexy: larger diverticula
    - Diverticulectomy: largest diverticula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

how do you differentiate between postop ileus and postop bowel obstruction?

A 
ileus = hypoactive or absent bowel sounds
obstruction = hyperactive tinkling sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what are the causes of postop ileus following bowel surgery?

A
  1. Increased splanchnic sympathetic tone following violation of the peritoneum
  2. Local release of inflammatory mediators
  3. Postop narcotic use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

poor glucose control can cause what bowel condition?

A

gastroparesis: characterized by early satiety, nausea, and postprandial vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what antibiotic is used as a promotility agent?

A

erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

what DA antagonist has promotility effect?

A

metoclopramide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what is morton neuroma?

A

not a neuroma- but is associated with pain between the 3rd and 4th toes on the plantar surface and a clicking sensation (Mulder sign) when simultaneously palpating this space and squeezing he joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what is tarsal tunnel syndrome?

A

compression of the tibial nerve as it passes through the ankle

  • caused by a fracture of the bones around the ankle
  • sx = burning, numbness, and aching of the distal plantar surface of the foot or toes (and sometimes calf)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

what is tenosynovitis?

A

inflammation of the tendon and its synovial sheath

  • seen in hands and wrist joints following a bite or puncture wounds
  • pain, esp w flexion and extension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what is tic douloureux?

A

trigeminal neuralgia- short bursts of excruciating, lancinating pain lasting from seconds to minutes in the distribution of the second and third branches of the trigeminal nerve.
- most likely external compression of the trigeminal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what is strabismus?

A

improper alignment of the eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

if you suspect a ruptured AAA in a pt, but theyre unstable for a CT scan, what can you do?

A

bedside ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

what abnormal lab values do you see in acute pancreatitis?

A
  1. Elevated amylase and lipase
  2. Elevated WBC
  3. Mild azotemia
  4. Hocalcemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

major thoracic trauma + tachypnea + paradoxical thoracic wall movements that correct with positive pressure mechanical ventilation

A

Flail chest!
= multiple contiguous ribs are fractured in two or more locations
= hypoxemia + hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

tx of flail chest?

A

pain control and supplemental O2

+ intubation with mechanical positive pressure in most pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

EKG shows absent P waves, irregular rhythm, and inverted T waves, what is it?

A 
A Fibb
(T wave inversions could also be due to her longstanding HTN)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what is Legg-Calve-Perthes disease? classic presentation?

A

idiopathic avascular necrosis of the femoral capital epiphysis

  • seen in boys 4-10 (5-7)
  • classically presents as hip, groin or knee pain + an antalgic gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

what is the tx of legg-calve parthes disease?

A

usually conservatively with observation and bracing

surgery when the femoral head is not well contained with the acetabulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

what pt population is SCFE most likely to present in?

A

obese adolescent male with complaints of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

How does osteosarcoma usually present on radiograph?

A

Codman’s triangle in metaphyses of long bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

How does Ewings sarcoma present on radiograph?

A

tumor seen within diaphyses of long bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Pt w recent cardiac surgery presents with fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge.

A

Acute mediastinitis!

- due to intraoperative wound contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what does CXR show in acute mediastinitis?

A

a widened mediastinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

tx of acute mediastinitis?

A

surgical debridement with immediate closure and prolonged antibiotic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

when does postoperative acute mediastinitis usually present?

A

within 14 days of the surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

when does postpericardiotomy syndrome present? tx?

A

a few weeks following a procedure with pericardium incision

tx: NSAIDs and pericardial puncture if tamponade occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what population is most prone to developing acute bacterial parotitis?

A
  1. Dehydrated post-operative patients

2. Elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

pt presents w flaccid paralysis after aortic surgery?

A

spinal cord ischemia- rare complication of vascular surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

what is the artery of adamkiewicz?

A

the most prominent thoracic radicular artery and arises from the aorta to supply the anterior spinal arteries in the T9-T12 region
- thus this artery is susceptible during thoracic surgery, causing spinal cord ischemia and flaccid paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

what are the risk factors for spinal cord infarction in a pt undergoing thoracic AA repair?

A
  1. Hypotension in the perioperative period
  2. Increased spinal canal pressure
  3. Aortic cross clamping or occlusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

how do pts w spinal cord ischemia usually present?

A
  1. Abruptly onset flaccid paralysis
  2. Bowel/bladder dysfxn
  3. Sexual dysfxn
  4. possible hypotension
  5. Loss of tendon reflexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what is the next step when spinal cord ischemia is suspected?

A
  1. Emergent MRI

2. supportive care and lumbar drains to reduce spinal pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what is the pressure threshold to perform escharotomy in burn victims w compartment syndrome?

A

25-40mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

what is the most commonly injured nerve in fracture of midshaft of the humerus?

A

radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what imaging modality is used to see uric acid stones?

A

CT scan! theyre radiolucent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

what is Volkmann’s ischemic contracture?

A

the final sequel of compartment syndrome in which the dead muscle has been replaced with fibrous tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

pt postop rhinoplasty develops whistling noise during respiration??

A

nasal septal perforation- usually from a septal perforation or a septal abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

what is the definition of oliguria in someone w/out preexisting intrinsiv kidney disease?

A

<6cc/kg

per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what are the steps in management of suspected prerenal azotemia?

A
  1. Change foley catheter

2. Careful fluid challenge (bolus IV fluids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

what is the most common bone in the body to be affected by stress fractures?

A

Tibia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

when do you typically see postop atelectasis at its worst?

A

second postop day and can last up to 5days!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

what are the common CXR radiographic findings in esophageal rupture?

A
  1. Pleural effusion (usually l sided)
  2. Pneumomediastinum
  3. Pneumothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what is the test of choice for diagnosing esophageal perforation/rupture?

A

water soluble esophagram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What are the signs for an AAA?

A
  1. Profound hypotension
  2. Abdominal or back pain
  3. Syncope
  4. Pulsatile mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What are the symptoms of fat embolism? (6)

A
  1. Severe respiratory distress
  2. Petechial rash
  3. Subconjunctival hemorrhage
  4. Tachycardia
  5. Tachypnea
  6. Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

How do you confirm diagnosis of fat embolism?

A
  1. presence of fat droplets in urine OR

2. Presence of intraarterial fat globules on fundoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

when do fat embolisms usually occur after fracture of long bone?

A

12-72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

what is hamman sign?

A

crunching sound on auscultation of the heart due to mediastinal emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

how do you treat complicated diverticulitis with abscess formation?

A

percutaneous abscess drainage under CT guidance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

define and list the triad of leriche syndrome?

A

(arterial occlusion at the bifurcation of the aorta into the common iliac arteries)

  1. bilateral hip, thigh and buttock claudication
  2. impotence
  3. symmetric atrophy of the bilateral lower extremities due to chronic ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

what nerve is responsible for knee extension and hip flexion?

A

femoral nerve!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

what nerve is at risk for injury in an anterior dislocation of the humeral head?

A

axillary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

what is and how do you manage a hydrocele?

A

a fluid collection within the processus or tunica vaginalis

- management = reassurance and observation, most spontaneously resolve by the age of 12months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

CXR shows widened mediastinum, large left sided hemothorax, deviation of the mediastinum to the R and disruption of the normal aortic contour

A

aortic injury secondary to rapid deceleration of the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

varicocele is dilation of what veins? pathophys?

A

dilatation of pampiniform plexus

  • incompetence of valves of these veins
  • occurs most frequently on the left side
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

what are the criteria for SIRS?

A
  1. Temp greater than 38.5C (101.3F) OR less than 35C (95F)
  2. Pulse greater than 90
  3. Respirations greater than 20
  4. WBC >12,000 OR >10% bands OR <4,000
    must have two of the 4 criteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

when is SIRS considered severe?

A 
when there is end organ damage:
1 Oliguria
2. Hypotension
3. Thrombocytopenia (plt <80,000)
4. Metabolic acidosis
5. Hypoxemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

what does SIRS look like in a burn pt?

A

also have a hypermetabolic response:

  1. Hyperglycemia
  2. Muscle wasting
  3. Protein loss
  4. Hyperthermia
  5. Increased energy expediture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

what is the greatest danger in massive hemoptysis?

A

Asphyxiation due to the airway flooding with blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

what is ludwig angina?

A

rapidly progressive bilateral cellulitis of the submandibular and sublingual spaces
- comes from infected 2nd or 3rd mandibular molar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

presenting symptoms of Ludwig angina? (4)

A
  1. Fever
  2. Dysphagia
  3. Odynophagia
  4. Drooling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

management of fracture of the scaphoid bone?

A

wrist immobilization for 6-10 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

young individual with a fleshy immobile mass on the midline hard palate

A

torus palatinus

surgically remove if symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

what is vanishing bile duct syndrome?

A

primary biliary cirrhosis: rare disease involving progressive destruction of the intrahepatic bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

what is the hallmark of primary biliary cirrhosis?

A

ductopenia (most common cause of it) other causes of ductopenia include failed liver transplant, hodgkins, sarcoid, CMV infxn, HIV and medication toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

how does one manage small nonbleeding esophageal varices?

A

prophylaxis with nonselective beta blockers (nadolol or propanolol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

how does one manage BLEEDING esophageal varices?

A

endoscopic sclerotherapy?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

what medication is used for actively bleeding esophageal varices?? mechanism?

A

Octreotide: analog of simvastatin

causes splanchnic vasoconstriction and reduced portal blood flow by inhibiting the release of glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

what should you be highly suspicious of in a pt with hx of chronic cirrhosis with ascites who develops abdominal discomfort or altered mental status?

A

Spontaneous bacterial peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

what are 6 classes of drugs that can cause pancreatitis?

A
  1. Diuretics: furosemide, thiazides
  2. Drugs for IBD: sulfasalazine, 5-ASA
  3. Immunosuppressive agents: azathioprine, L-asparaginase
  4. Dugs used by pt w hx of seizure or bipolar: valproic acid
  5. Dugs used by AIDS pts: didanosine, pentamidine
  6. Antibiotics: metronidazole, tetracycline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

what type of bilirubin is excreted in the urine?

A

conjugated (bc its water soluble and only loosely bound to albumin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What is rotor syndrome?

A
  • benign condition in which there is a defect in hepatic storage of conjugated bilirubin
  • increased conj bili on plasma and excreted in urine
  • LFTs are normal
  • no tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

what is the major cause of chronic diarrhea in HIV-infected patients with CD4 counts less than 180?

A

Cryptosporidium parvum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

what anitbody do you see in primary biliary cirrhosis?

A

anti-mitochondrial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

what is the tx of choice for primary biliary cirrhosis?

A

usodeoxycholic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

what viruses are associated with acute pancreatitis? (6)

A
  1. Mumps
  2. Hepatitis B
  3. HIV
  4. Coxsackievirus
  5. CMV
  6. HSV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

painless jaundice in a pt with conjugated hyperbilirubinemia and markedly elevated alk phosph

A

think intraabdominal malignancy obstructing biliary system (order a CT to confirm dx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

what are two history clinical clues that are characteristic of esophageal dysmotility seen in scleroderma?

A
  1. Sticking sensation in throat

2. dysphagia + heartburn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

what are the two manometric findings in scleroderma esophageal dysmotility?

A
  1. Absence of peristaltic waves in the lower 2/3 of the esophagus
  2. Significant decrease in the lower esophageal sphincter tone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What are 3 drugs that can cause SIADH?

A
  1. Cyclophosphamide
  2. Carbamazepine
  3. SSRIs like fluoxetine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

angiodysplasia is often seen in what two patient populations?

A
  1. Underlying aortic stenosis

2. End stage renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

PAS-positive material in the lamina propria of the small intestine

A

Whipple;s disease: t whippelii

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

treatment of diffuse esophageal spasm?

A
  1. Antispasmodics
  2. Dietary Modulation
  3. Psychiatric counseling
167
Q

first like therapy for H pylori associated PUD?

A
  1. Amoxicillin plus clarithromycin

2. PPI

168
Q

which medications may cause hyperkalemia? (3)

A

ACE inhibitors
Angiotensin receptor blockers
Spironolactone

169
Q

what is a common electrolyte abnormality found in cushings syndrome? how do you treat?

A

hypokalemia = corticosteroids will bind to aldosterone receptors in the kidney and cause renal potassium wasting
- tx: spironolactone (aldosterone antagonist)

170
Q

tx of IBD toxic megacolon?

A 
IV corticosteroids
IVF
Abx
bowel rest
- subtotal colectomy w/ end ileostomy if colitis doesnt resolve)
171
Q

what medications increase the risk for NASH?

A
  1. Corticosteroids
  2. Amiodarone
  3. Diltiazem
  4. Tamoxifen
  5. HAART
172
Q

Drug of choice for Primary biliary cirrhosis?

A

Ursodeoxycholic acid

173
Q

back pain + anemia + renal dysfunction + elevated ESR + hypercalcemia -> constipation

A

multiple myeloma

174
Q

what are the best screening markers for acute hepatitis B infection?

A

HBsAg

anti-HBc

175
Q

what electrolyte abnormality is most commonly found during or immediately after surgery in pts requiring multiple blood tansfusions?

A

hypocalcemia

176
Q

what does the EKG show in severe hypokalemia?

A

U waves

177
Q

what arrythmia occurs w hyperkalemia?

A

asystole

178
Q

what abnormal lab values can you see in SBO?

A

mild leukocytosis and modest increase in amylase

179
Q

what vitals and lab values indicate risk of impending strangulation in SBO?

A

fever, tachycardia, leukocytosis

metabolic acidosis

180
Q

what are the specific modalities used to stop variceal bleeding? (3)

A
  1. Vasoconstrictors: octreotide and vasopressin
  2. Endoscopic variceal ligation
  3. Variceal sclerotherapy
181
Q

first line treatment for bleeding pts with a coagulopathy?

A

FFP

182
Q

what are the two types of metabolic alkalosis? how do you differentiate between the two?

A
  1. Saline-resistant: has excess mineralcorticoid causing H and K and Na retention, kidneys then respond by excreting both Na and Cl = HIGH urine chloride
  2. Saline-responsive: LOW urine Cl (<20mEq/L) due to hypovolemia and hypochloremia
183
Q

what metabolic state is contraindicated for the use of hyperkalemia? why types of ppl are at high risk for this state?

A

succinylcholine

  1. Patients w crush or burn injuries more than 8 hours old (rhabdomyolysis)
  2. Demyelinating syndromes (Guillan barre)
  3. Tumor lysis syndrome
184
Q

what are common conditions associated with sudden onset A Fibb?

A
  1. Hypertensive heart disease
  2. Hyperthyroidism
  3. Drugs (Amphetamines, cocaine, theophylline)
  4. Post cardiac surgery
185
Q

steps in treating hyperkalemia?

A
  1. IV calcium gluconate
  2. Insulin and glucose (or beta 2 agonists)
  3. Sodium Bicarbonate
  4. Kayoxalate
186
Q

4 Causes of peptic strictures

A
  1. GERD
  2. Radiation
  3. Scleroderma
  4. Caustic ingestions
187
Q

How is the diagnosis of Wilson’s disease confirmed?

A
  1. Low serum ceruloplasmin
  2. Increased urinary copper excretion or Kayser-Fleischer rings
    * thus must perform measurement of serum ceruloplasmin levels and slit lamp examination
188
Q

what are 4 complications of acute pancreatitis?

A
  1. Pleural effusion
  2. ARDS
  3. Ileus
  4. Renal Failure
189
Q

why does hypomagnesemia cause refractory hypokalemia?

A

Mg is an important cofactor for potassium uptake and maintenance of intracellular potassium levels
*must correct Mg level in order to correct hypokalemia

190
Q

What two conditions cause hypomagnesemia?

A
  1. Chronic alcoholism

2. Intake of diuretics

191
Q

Hypoalbinemia can cause what electrolyte abnormality?

A

hypocalcemia bc ca is largely albumin nound

192
Q

what is another name for wilsons disease?

A

hepatolenticular degeneration

193
Q

Symptoms of Zinc deficiency?

A
  1. Alopecia
  2. Abnormal taste
  3. Bullous/pustulous lesions surrounding body orifices
  4. Impaired wound healing
194
Q

What deficiencies result from long term TPN use?

A

Zinc and Selenium (cardiomyopathy)

195
Q

How does end organ damage occur in acute severe pancreatitis?

A
  1. Local release of pancreatic enzymes enters the vascular system and increases permeability
  2. Large volumes of fluid migrate from the vascular system to the retroperitoneum
  3. Inflammatory mediators also enter the vascular system causing widespread vasodialtion, capillary leak, shock, and assoc end-organ damage
196
Q

what are major hereditary risk factors for pancreatic cancer?

A
  1. BRCA 1 & 2

2. Peutz-Jeghers syndrome

197
Q

What are the environmental factors that increase risk for pancreatic cancer?

A
  1. Smoking!!!!
  2. Chronic pancreatitis
  3. Obesity
198
Q

tx for hepatitis C?

A

Pegylated IFN + ribavirin

199
Q

Tx for hepatitis B?

A

Entecavir and tenofovir

200
Q

How does one calculate the anion gap?

A

AG = Na - (HCO3 + Cl)

201
Q

what is winters formula and how is it used?

A

PaCO2 = 1.5 (HCO3) +8

= calculating the PaCO2 required to compensate for a pt’s respiratory acidosis/alkalosis

202
Q

what are the main drugs known to cause esophagitis? 6

A
  1. Tetracyclines
  2. Aspirin & NSAIDs
  3. Alendronate
  4. Potassium Chloride
  5. Quinidine
  6. Iron
203
Q

hallmark = massive increase in the transaminases with modest accompanying elevations in total bilirubin and alk phosph

A

ischemic hepatic injury

204
Q

central versus nephrogenic DI

A

Central: decreased production of ADH from trauma, hemorrhage, infxn, tumors

Nephroenic: renal ADH resistance, from hypercalcemia, hypokalemia, renal dx and meds

205
Q

what medications are known to cause nephrogenic DI? 5

A
  1. Lithium
  2. Demeclocycline
  3. Foscarnet
  4. Cidofovir
  5. Amphotericin
206
Q

where does the bleeding come from in a mallory weiss tear?

A

tears in the submucosa of the distal esophagus and proximal stomach causes bleeding from submucosal arteries

207
Q

most common complication of PUD?

A

hemorrhage

208
Q

symptoms of VIPoma?

A
  1. Diarrhea
  2. Hypokalemia -> leg cramps
  3. Decrease in the amount of acid in the stomach
209
Q

dog + liver cyst

A

hydatis cyst

tx: surgical resection under coverage of albendazole

210
Q

young mom complains of pain along radial side of wrist, assoc with wrist flexion and thumb extension

A

Dequervians tenosynovitis

211
Q

ulnar fascial nodules felt in a scandenavian man

A

dupuytrens contracture

212
Q

an abscess in the pulp of the index finger- what is it and how do you fix?

A

Felon abscess

requires IMMEDIATE surgical decompression, can lead to necrosis of the tissue

213
Q

what is game keepers thumb? tx?

A

most commonly a skiing injury where thumb is jammed leading to ulnar collateral ligament injury
- tx: cast!!! can lead to arthritis

214
Q

what is jersey finger? tx?

A

when you make a fix the distal phalanx of the ring finger doesnt flex with the others
tx: splinting!

215
Q

what is mallot finger? tx?

A

cannot extend the distal phalanx

rx: splinting

216
Q

what is trigger finger? tx?

A

R middle finger is acutely flexed, woman unable to extend it when she tries she feels a painful snap
tx: steroid injections

217
Q

what is the most likely triggering event for MI during surgery?

A

hypotension

218
Q

what are the ABG findings in a massive pulmonary embolus?

A

hypoxemia and hypocapnea

219
Q

what kind of IV resuscitation do you give someone w delirium tremens?

A

5% alcohol and 5% dextrose

220
Q

acute water intoxication?

A

carefully infuse hypertonic saline and give mannitol

221
Q

pt not in shock but is oliguric- what two classical things do you think about? how do you diagnose?

A
  1. Acute renal failure
  2. Behind on fluids- thus measure urinary Na concentration, Na concentration of urine is >40 bc kidney unable to concentrate
    - can also calculate the FeNa (failure if >1, dehydrated if <1)
222
Q

what metabolic abnormality can perpetuate paralytic ileus?

A

hypokalemia

223
Q

what is ogilveys syndrome?

A

very common- massive colonic dilatation in elderly people who arent active and now postop = massive distention of the colon

224
Q

management of ogilveys syndrome?

A

colonoscopy- decopmresses the bowel, long rectal tube left in place

225
Q

what is the difference between anastomotic leak and a fistula?

A

anastomotic leak is assoc w fever!

226
Q

what would prevent a fistula from healing?

A 
FETID: 
Foreign body
Epithelialization
Tumor
Infection/irradiated
Distal obstruction
227
Q

hyperkalemia- 4 treatments!

A
  1. Calcium Gluconate
  2. Insulin + Glucose
  3. Kay-oxolate
  4. Sodium Bicarb
228
Q

Vigorous fluid replacement:
if alkalotic?
if acidic?

A 
Alkalotic = normal saline
Acidic = ringers lactate
229
Q

how do you diagnose boerhaaves syndrome?

A

gastrograffin swallow, but bad resolution so if this is negative just go ahead with the barium swallow

230
Q

what types of polyps can be left alone?

A

juvenile and peutz-jeghers

231
Q

when would you operate in crohns disease?

A
  • perforation
  • obstruction
  • bleeding
  • fistula formation
232
Q

what antibiotics are used to kill c diff?

A

metronidazole or vancomycin

233
Q

management of SCC of the anus?

A

neoadjuvant chemotherapy with radiation followed by resection (Nigrel protocol)

234
Q

what is the nigrel protocol?

A

neoadjuvant chemotherapy with radiation followed by resection of anal cancer

235
Q

if suspect stress ulcers, what workup?

A

endoscopy followed by angiogram to embolize vessels that are feeding the bleeding areas

236
Q

whats the difference between primary bacterial peritonitis and perforation peritonitis?

A

bacterial grows one organism where as perf grows multiple, sample fluid in abdomen from ascites

237
Q

very old person w abdominal pain, think of 2 conditions:

A
  1. Sigmoid Volvulus

2. Mesenteric ischemia

238
Q

Management of sigmoid volvulus?

A

proctosigmoidoscopic exam to untwist bowel, if recurs then sigmoid resection

239
Q

what is the blood marker for hepatocellular carcinoma?

A

AFP

240
Q

7 months pregnant suddenly bleeds into abdomen and goes into shock

A

visceral aneurysm

241
Q

cancer obstructing the biliary tract can be 1 of 3 cancers:

A
  1. Cancer of head of pancreas
  2. Cholangiocarcinoma: at head of common bile duct into lumen
  3. Adenocarcinoma growing into the ampulla of vader
242
Q

if suspect cancer in biliary tract and CT is nondiagnostic, what do you do next?

A

ERCP

243
Q

4 things seen on US to confirm diagnosis of pancreatitis?

A
  1. Presence of stones
  2. Pericystic fluid
  3. Gallbladder wall thickening
  4. Dilated duct
244
Q

difference between urinary amylase/lipase versus serum lipase?

A

serum: peaks within 12 hours and back to normal within 2 days
urinary: goes up around day 2-3 and peaks at day 4-5

245
Q

how do you diagnose hemorrhagic pancreatitis?

A

Hct <45

246
Q

what is the final pathway to death in a pt w hemorrhagic pancreatitis? what do we do to prevent

A

abscess! do daily CT scans, at the earliest indication of pus = drain it!

247
Q

pt had pancreatitis a few days ago and now has a fever?

A

abscess

248
Q

what are the 4 sequelae of pancreatic pseudocyst?

A
  1. Go away by itself: within 6 weeks
  2. Massive rupture
  3. Erode into major vessels so it bleeds
  4. Pancreatic juice becomes infected -> abscess -> sepsis -> death
249
Q

pancreatic pseudocysst is still there after 6 weeks, what do you do?

A

endoscopic internal cystogastroscopy

250
Q

severe necrolytic migatory dermatitis for several years + mild diabetes, thin

A

Glucagonoma

251
Q

4 instances of htn that surgery is the correction

A
  1. Hyperaldosteronism
  2. Pheochromocytoma
  3. Coarctation of the aorta
  4. Renal vascular HTN
252
Q

how do you diagnose hyperaldosteronism?

A

high aldosterone and low renin

253
Q

what could cause hyperaldosteronism?

A

Hyperplasia- manage medically

Adenoma- manage surgically

254
Q

workup of pheochromocytoma?

A

24hr urine collection for metenephrine and VMA

ct scan of adrenals

255
Q

diagnosis of Coarctation of the aorta?

A

spiral CT

256
Q

tx of renal vascular HTN?

A

dilation and stenting

257
Q

excessive salivation hours after birth, choking ata first feeding

A

esophageal atresia

258
Q

what are the associated malformations of TE fistula?

A 
VACTR
Vertebral anomalies
Anal anomalies
Cardiac anomalies
Tracheal esophageal anomalies
Renal and radial anomalies
259
Q

baby with large abdominal defect to the R of the umbilicus, normal cord that goes right to baby

A

gastroschisis

260
Q

baby with defect to the right of the umbilicus, umbilical cord goes to the sack and not the baby

A

omphalocele

261
Q

treatment of omphalocele?

A

Silo!- every day push bowel in a little bit more

262
Q

how do you diagnose malrotation?

A

barium enema from below

263
Q

double bubble sign + green vomiting = 1 of what 3 etiologies?

A
  1. Duodenal atresia
  2. Annular pancreas
  3. Malrotation
264
Q

premature baby + abdominal problems = almost always

A

necrotizing enterocolitis

265
Q

when do you go to the OR in an infant w necrotizing enterocolitis?

A

when shoes signs that bowel has died- abdominal wall erythema, air in biliary tree, or pneumoperitoneum

266
Q

how do you diagnose hypertrophic pyloric stenosis?

A

US not barium!

267
Q

tx of hypertrophic pyloric stenosis?

A

ranstid fiber myotomy

268
Q

how do you diagnose biliary atresia in an infant?

A

HIDA scan one week after phenobarb therapy (powerful choleretic- stimulates bile production)

269
Q

diagnosis of hirschbrungs? tx?

A

diagnosis = full thickness rectal mucosa biopsy

tx: take to surgery even if theyre one day old! remove part of colon that doesnt have innervation

270
Q

fixed split second heart sound + recurrent respiratory infections

A

ASD

271
Q

3month old with large pansystolic heart murmur at the L sternal boarder, + failure to thrive

A

VSD

272
Q

murmur that isnt usually heard on the day of birth but heard soon there after

A

VSD

273
Q

when wouldn’t you surgically repair a VSD?

A

when its the small variant thats found low in the muscle of the ventricle- these usually fix themselves

274
Q

when would you NOT use indomethacin to close a PDA?

A

when the baby has CHF bc indomethacin takes too long

275
Q

continuous machinery murmur in baby w bounding peripheral pulses

A

PDA

276
Q

5 R -> L shunts in babies

A
  1. Tetrology of Fallot
  2. Transposition of the great vessels
  3. Truncus arteriosus
  4. Total analogous pulm venous congestion
  5. Tricuspid atresia
277
Q

what is the age difference between tetrology of fallot and transposition of theg reat vessels?

A 
tetrology = 5-6yr old
transposition = few days old
278
Q

does aortic stenosis need a valve replacement or repair? what are the indications?

A

Replacement!!
Indications:
1. If pressure gradient >50mmHg across the valve
2. First signs of CHF: angina or syncope

279
Q

acute versus chronic aortic valve insufficiency?

A

Acute = medical EMERGENCY valve replacement due to endocarditis

280
Q

how do you manage mitral stenosis?

A

valve repair (w commisurotomy) versus replacement

281
Q

what is the tx of flail chest?

A

fluid restriction and use of diuretics (bc means theres underlying pulmonary contusion = very sensitive to fluid overload)

282
Q

absolute contraindication to surgery?

A

DKA (or sky high glucose) or diabetic coma

283
Q

measures of nutritional status (3) which are contraindications to surgery

A
  1. Albumin 20% of weight)

3. Transferrin <200

284
Q

Contraindications to surgery? 1 absolute and 3 others

A
  1. DKA (Absolute)
  2. Poor nutrition
  3. Severe liver failure (measure bili, PT, ammonia)
  4. Smoker (2 months before surgery)
285
Q

What is Goldman’s index? what is the most important factor of this?

A

tells you about a pts risk of surgery and weighs benefits

- Biggest predictor = CHF

286
Q

what is the biggest predictor of perioperative mortality?

A

EF! <35%

287
Q

what are the top three predictors of perioperative mortality?

A
  1. CHF (EF)
  2. MI within 6 months (EKG)
  3. Arrhythmia
  4. Old (>70yrs)
  5. Surgery is emergent
  6. Aortic Stenosis: listen for murmur
288
Q

what is the murmur of aortic stenosis?

A

late systolic crescendo-decrescendo murmur that radiates to the carotids, increases with squatting and decreases with preload

289
Q

what meds should you stop before surgery?

A
  1. Aspirin/warfarin
  2. NSAIDs
  3. Metformin (risk of lactic acidosis)
  4. Vitamin E
290
Q

why do we check BUN and creatinine before surgery?

A

uremia interferes with platelet function so increased risk of postop bleeding = uremic platelet dysfunction
- seen in BUN >100

291
Q

what does the coag panel show in uremic platelet dysfunction?

A

platelets are normal but a prolonged bleeding time

292
Q

what is pressure support vent setting and when is it important?

A

pt rules the rate but a boost of pressure is given (8-20)

- important for weaning from vent

293
Q

what is PEEP and when is it used?

A
  • pressure given at the end of cycle to keep alveoli open (5-20)
  • used in ARDS or CHF
294
Q

3 things that could cause HYPERvolemia and HYPOnatremia?

A
  1. CHF
  2. Nephrotic syndrome
  3. Cirrhosis
295
Q

HYPOvolemia and HYPOnatremia?2

A

Diuretics and Vomiting

296
Q

Normal volume status and hyponatremia? 3

A
  1. SIADH (CXR for lung ca)
  2. Addisons
  3. Hypothyroidism
297
Q

how do you treat normo/hypervolemic hypernatremia?

A

fluid restriction and diuretics and stop offfending cause

298
Q

how do you treat HYPOvolemic hyponatremia?

A

normal saline

299
Q

when do you use hypertonic saline?

A
  1. Symptomatic hyponatremia (seizures)

2. Na <110

300
Q

what is the appropriate rate of infusing Na?

A

0.5-1mEq/hr OR 12-24mEq/day

301
Q

how do you treat hypernatremia?

A

replace w D5W or hypotonic fluid

302
Q

electrolyte abnormality: prolonged QT interval

A

hypocalcemia

303
Q

electrolyte abnormality: shortened QT

A

hypercalcemia

304
Q

electrolyte abnormality: ST depression & U waves

A

hypokalemia

305
Q

how do you tx hypokalemia? rate?

A

give K but monitor renal fxn w Cr

max rate is 40mEq/hr

306
Q

electrolyte abnormality: peaked T waves, prolonged PR and QRS, sine waves

A

hyperkalemia

307
Q

tx of hyperkalemia? 4

A
  1. Give Ca-gluconate
  2. Insulin and glucose (or albuterol or b2 agonist)
  3. Kayexalate- poop out K
  4. Sodium Bicarb
308
Q

best maintenance fluid?

A

D5 in 1/2NS + KCl

309
Q

Risks of TPN?

A
  1. Acalculus cholecystitis
  2. Hyperglycemia
  3. Liver dysfunction
  4. Zinc deficiency
310
Q

hypercoagulable state that causes edema, HTN and foamy pee?

A

nephrotic syndrome (losing protein in urine aka losing clotting factors)

311
Q

clotting disorder in old people, what do you think of?

A

cancer

312
Q

whats special about anti-thrombin III deficiency?

A

CANNOT give them heparin! it wont work

313
Q

most common inheritable clotting disorder?

A

Factor V leiden

314
Q

young woman with multiple spontaneous abortions, what clotting disorder?

A

lupus anticoagulant

315
Q

post op, decreased platelets, increased clotting,

tx?

A

HIT (low platelets + clotting), occurs w/in 5-14 days of heparin
treat: agatroban, leparudin

316
Q

isolated decrease in platelets in young woman

A

ITP

317
Q

normal platelets but increased bleeding time and PTT

A

vonWillebrands!

318
Q

low platelets, increased PT, PTT, BT, low fibrinogen, high Ddimer, schistocytes

A

DIC!

319
Q

causes of DIC? 3

A
  1. gram negative sepsis
  2. disseminated carcinomatosis
  3. OB stuff
320
Q

topical burn med that doesnt penetrate eschar and can cause leukopenia?

A

Silver sulfasalazine

321
Q

topical burn med that penetrates eschar but hurts like hell?

A

mafenide

322
Q

what is a side effect of silver sulfasalazine?

A

leukopenia

323
Q

topical burn med that doesnt penetrate eschar and causes hypoK and hypoNa

A

silver nitrate

324
Q

what are the side effects of silver nitrate?

A

Hypokalemia & Hyponatremia

325
Q

best first step for electrical burn?

A

EKG- if abnormal then monitor on telemetry for 48hrs

326
Q

if see myoglobinuria in a burn patient, what do you think and what do you want to check?

A

Acute tubular necrosis

Check K! produced when cells break down

327
Q

if see cutaneous emphysema in stab wound to neck, what is first thing you do and how?

A

intubate! with a fiberoptic broncoscope

328
Q

indications to take someone w a hemothorax to the OR (2)

A
  1. > 1.5L from chest tube

2. Greater than 200cc/hr over the first 4 hours

329
Q

treatment for pulmonary contrusion?

A

good pulmonary toilet

330
Q

treatment of flail chest?

A

O2 and pain control via nerve block

331
Q

when do you suspect air embolism? 4 instances

A
  1. Lung trauma
  2. Vent use
  3. Removing central line
  4. Heart vessel surgery
332
Q

a patient has confusion, petechial rash in chest, axilla and neck and acute SOB after car accident

A

fat embolism

333
Q

EKG shows electrical alternans, and pulsus paradoxus

A

Pericardial tamponade

334
Q

workup of penetrating neck trauma: zone 3

A
  • above the angle of the mandible

- check aorta (aortigram) and triple endoscopy

335
Q

workup of penetrating neck trauma: zone 2

A

between angle of mandible and cricoid

- do 2D doppler to check vessels and exploratory surgery possibly

336
Q

workup of penetrating neck trauma: zone 1

A

below cricoid

- check aorta (aortography)

337
Q

handlebar sign makes you worry about what?

A

pancreatic rupture

338
Q

pt w epigastric pain, stable, blunt trauma to abdomen, and abdominal CT shows retroperitoneal fluid?

A

consider rupture of duodenum

339
Q

if do retrograde cystogram and see extraperitoneal extravasation of dye what do you do?

A

bed rest and foley

340
Q

if do retrograde cystogram and see intraperitoneal extravasation of dye what do you do?

A

go to OR emergently

341
Q

Ortho fractures that go to the OR? 4

A
  1. Depressed skull fracture
  2. Severely displaced or angulated fracture
  3. Any open fracture (bone sticking out)
  4. Femoral neck or intertrochanteric fracture
342
Q

boxers fracture?

A

4th or 5th metacarpal neck fracture

343
Q

POD1- high fever (104) and very ill appearing? tx?

A

necrotizing fasciitis

tx: OR! debride and IV PCN

344
Q

how does nec fasc spread?

A

in SubQ along scarpas fascia

345
Q

common bugs that cause nec fasc?

A

strep and clostridium

346
Q

POD1 high fever (>104) and muscle rigidity

A

malignant hyperthermia

caused by halothane or succinylcholine

347
Q

genetic defect leading to malignant hyperthermia? tx?

A

ryanodine receptor gene defect

tx: danrolene Na

348
Q

marjolins ulcer?

A

squamous cell carcinoma in a chronic ulcer

349
Q

surgical requirements for stage 3-4 pressure ulcers?

A

Albumin >3.5

Bacterial load <100k

350
Q

what is cause if thoracentesis from pleural effusion has a: low pleural glucose?

A

rheumatoid arthritis

351
Q

what is cause if thoracentesis from pleural effusion has a: high lymphocytes?

A

TB

352
Q

what is cause if thoracentesis from pleural effusion has blood?

A

cancer or PE

353
Q

Lights criteria for pleural effusion: determines whether or not its transudative

A

Transudative if:

- LDH <0.5

354
Q

indications for surgery in a lung abscess?

A
  1. Abx fail
  2. Abscess >6cm
  3. If empyema is present
355
Q

lung nodule: popcorn calcification

A

hamartoma (common and benign)

356
Q

most common lungcancer in nonsmokers?

A

adenocarcinoma- occurs in scars of old pneumonia

357
Q

where is adenocarcinoma of the lungs usually found and where does it met to?

A

found peripherally

- mets to liver, bone, brain, adrenals

358
Q

effusion from lung shows exudative with high hyaluronidase

A

adenocarcinoma of lung

359
Q

pt with kidney stones, constipation, malaise, low PTH and central lung mass?

A

squamous cell carcinoma: paraneoplastic syndrome (parathyroid related peptide)

360
Q

patient with shoulder pain, ptosis, constricted pupil and facial edema, smoker, central lung nodule

A

Superior sulcus syndrome from small cell carcinoma

361
Q

pt with ptosis better after 1 minute of upward gaze and central lung nodule

A

Lamber Eaton Syndrome from small cell carcinoma- abx to pre-syn Ca channel

362
Q

old smoker presenting with Na = 125, moist mucus membranes, no JVD

A

SIADH from small cell carcinoma= euvolemic hyponatremia

363
Q

CXR showing peripheral cavitation and CT showing distant mets

A

Large Cell Carcinoma

364
Q

3 criteria to diagnose ARDS?

A
  1. Bilateral fluffy infiltrates on CXR

2. PaO2/FiO2 <18 (r/o cardiac)

365
Q

Tx of ARDS?

A

PEEP

366
Q

best test to evaluate for Boerhaaves?

A

CXR and gastrograffin esopharam

367
Q

medical treatment for gastric varices?

A

octreotide or somatostatin

368
Q

tx of incidental varices see on endoscopy?

A

NOTHING do not prophylactically band asx varcies, give beta blockers

369
Q

what type of hiatal hernia needs surgery?

A

type 2= paraesophageal thats become strangulated/obstructed

370
Q

gastric varices are associated with what?

A

splenic vein thrombosis (after chronic pancreatitis)

371
Q

what is Dieulafoys?

A

vessel erodes into stomach leading to hematemisis

372
Q

best test to diagnose duodenal ulcers?

A

endoscopy with biopsy (CLO test)- bc it can also exclude cancer

373
Q

best test to diagnose SE SYndrome?

A

Secretin suppression test- see elevated gastrin still, (secretin is supposed to suppress it)

374
Q

tx of SMA syndrome?

A

restoring weight and nutrition

last resort: roux-en-y

375
Q

complications of pancreatitis?

A
  1. Pseudocyst
  2. Hemorrhage
  3. Abscess
  4. ARDS
376
Q

Complication of chronic pancreatitis?

A

can cause splenic vein thrombosis which leads to gastric varices

377
Q

Courvoisiers sign?

A

palpable nontender gallbladder, itching and jaundice

- obstructive symptoms from tumor in head of pancreas

378
Q

trousseau’s sign?

A

migratory thrombophlebitis associated with pancreatic cancer

379
Q

what is whipples triad?

A
  • used to diagnose insulinoma
    1. Symptoms: sweating, tremors, hunger,
    2. BGL<45
    3. Symptoms resolve with glucose administration
380
Q

characteristic rash in glucagonoma?

A

necrolytic migratory erythema

381
Q

symptoms of glucagonoma 3

A

hyperglycemia, diarrhea, weight loss

382
Q

type 1 choledochal cysts

A

fusiform dilation of the CBD

tx w xcision

383
Q

type 4 choledochal cysts?

A

Caroli’s disease: cysts are intrahepatic ducts

- needs liver transplant

384
Q

risk factors for cholangiocarcinoma?

A
  1. Primary sclerosing cholangitis (UC)

2. Liver flukes

385
Q

AST & ALT high s/p hemorrhage, surg, or sepsis

A

shock liver

386
Q

surgical procedure for portal HTN?complication?

A

TIPS

complication: encephalopathy (bc prevents clearance of ammonia)

387
Q

tx of hepatic encephalopathy?

A

lactulose

388
Q

when do you do surgery for a hepatic adenoma?

A

when its large or the pt wants to become pregnant

389
Q

liver bacterial abscess most commonly caused by what 3?

A
  1. E coli
  2. Enterococcus
  3. Bacteroides
390
Q

RUQ pain, profuse sweating, rigors, palpable liver

A

Entamoeba histolytica

tx: metronidazole

391
Q

Pt from mexico presents w RUQ pain and large liver cysts

A

Enchinococcus
mode of transmission: dog feces
lab findings: eosinophilia, + casoni skin test
tx: albendazole and surgery tor emove the ENTIRE cyst, rupture can cause anaphylaxis

392
Q

treatment of ITP?

A

steroids first

if relapse: splenectomy

393
Q

nutritional deficit in carcinoid syndrome?

A

Niacin: Pellagra (diarrhea, dementia, dermatitis)

tryptophan is used to make niacin and serotonin

394
Q

when do you do surgery in SBO?

A
  1. Peritoneal signs

2. No improvement in 48hours

395
Q

tx of ogilvies syndrom?

A

if >10cm, need decompression w NG tube and neostigmine (watch for bradycardia) or colonoscopic dcompression

396
Q

massively dilated cecum?

A

ogilvies

397
Q

what medications are given for IBD to induce remission? maintain remission?

A

Induce: Corticosteroids
Maintain: ASA and sulfasalzine

398
Q

Crohns disease- med given for any ulcer or abscess?

A

Metronidazole

399
Q

Meds given for SEVERE IBD?

A

Azathioprine
6MP
Methotrexate

400
Q

When is surgery indicated in a AAA?

A

if >5cm or growing >4mm/yr

401
Q

how does papillary thyroid cancer spread? follicular?

A

papillary: lymph
follicuar: blood

402
Q

what predisposes pt to thyroid lymphoma?

A

hashimotos thyroiditis

403
Q

when do you surgically excise an adrenal nodule?

A

if >6cm or functional

404
Q

Type of melanoma: best prognosis & most common

A

superficial spreading

405
Q

Type of melanoma: poorest prognosis

A

nodular

406
Q

Type of melanoma: palms, soles, mucous membranes in darker races

A

Acrolintiginous

407
Q

Type of melanoma: head and neck, good prognosis

A

Lentigo Maligna

408
Q

how and where does soft tissue sarcoma spread?

A

to lungs hematogenously

409
Q

what other disorder is umbilical hernia associated with?

A

congenital hypothyroidism

410
Q

what is the pathophys behind malrotation?

A

bowel doesnt rotate 270* ccw around SMA

411
Q

where dont you give epinephrine along w local anesthesia?

A

fingers
nose
penis
toes

412
Q

side effects of merperidine?

A

metabolite can lower seizure threshold esp in pt with renal failure
- used for general anesthesoa

413
Q

side effects of succinylcholine?

A
  • general anesthesia

- can cause malignant hyperthermia and hyperK (not for burn or crush vitcim)

414
Q

side efects of halothane?

A

can cause malignant hyperthermia (dantroline Na), liver toxicity
- general anesthesia

Rotations (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions