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Surgery shelf > Kaplan > Flashcards

Kaplan Flashcards

1
Q

LMWH vs fractionated heparin binding

A

LMWH more specific binding potential than unfractionated heparin
LMWH more reliable effect on aPTT

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2
Q

SBO symptoms

A

suddent abdominal distention
vomiting, no gas
high pitched bowel sounds
diagnosed best with CT

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3
Q

Prostatic abscess

A

40-60 years old
aerobic gram neg bacilli and S. aureus
presentation is repeat UTI that seems to resolve with antibiotics
important diagnositc clue: fluctant mass on rectal exam, exam can be variable though
treat by evacuation by transurethra or perineal route

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4
Q

most accurate test for chronic pancreatitis

A

secretin stimulation test

should release a large volume of bicarb rich pancretic fluid in response to IV secretin

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5
Q

signs of urethral injury

A 
trauma to perineum/pelvic fracture
unable to void even though has the urge
when voiding no urine comes out
blood at the meatus
perineal, penile, scrotal hematoma
high riding prostate
boggy prostatic fossa
loss of prostatic attachments to the urogenital diaphragm or prostate hematoma
PERFORM: retrograde urethrogram, 14 french foley inject contrast, take xrays, advance if no trauma
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6
Q

lower abdominal u/s

A

confirms bladder distention

says nothing about the urethra

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7
Q

high grade gastric lymphoma treatment

A

chemo or radiation, usually chemo
need to assess depth of cancer to see if surgery is needed or not
if whole depth, risk of perforation during chemo so need surgery

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8
Q

low grade lymphomatoid transformation (MALToma) marginal zone lymphoma treatment

A

need to eradicate H. pylori

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9
Q

compartment pressure should be

A

30-40 mmHg

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10
Q

bone trauma without compartment syndrome

A

expanding hematoma with no distal pulses - we know the vasculature is compromised–> surgical exploration
assess vasculature if distal pulses are not intact with CT angio
if vasculature intact, can reduce the fracture

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11
Q

symptoms/treatment of incarcerted inguinal hernia

A 
mild but pain is present (rare with hernia)
erythema
low grade fever
tender mass
treat with emergent surgicall repair
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12
Q

complication of AAA repair

A

ischemic colitis (bloody diarrhea and leukocytosis), do a colonoscopy
Pathophys: IMA origin covered by graft, some patiets dont have good collateral from marginal artery of dummund from SMA –>ischemia of descending and sigmoid colon
Colonoscopy/flex sig: gold standard, cyanotic or shedding mucosa
Management: colonic resection with colostomy

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13
Q

active bloody bowel movements

A

nasogastric eval - for source before ligament of trietz

then tagged rbc study to see where blood is pooling if first eval is negative

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14
Q

most common reason for hypoxia in post op first night

A

atelectasis, get a CXR

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15
Q

painless jaundice

A

pancreatic cancer

get a CT, if negative ERCP/PTC to detect smaller malignancies

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16
Q

severe dehydration in alert patient

A

use 5% dextrose in 1/2NS

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17
Q

NS and 3% saline used for what

A

replace hyponatremia

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18
Q

Ringer’s lactate uses

A

hypovolemic shock
isotonic fluid loss
normal ion levels
composition and osmolatiry similar to that of plasma

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19
Q

when do you repair an umbilical hernia in a child

A 
if symptomatic (tender, vomiting, abdominal distention) when irreducible
if persists after 2 years
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20
Q

older man who smokes and drinks and has rotten teeth with neck mass

A

SCC with mets to node, need to biopsy with panendoscopy or FNA

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21
Q

reducing ICP, noninvasive

A

raising head of bed
sedation with propofol
hyperventilation to PaCO2 of 30-35
administration of mannitol

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22
Q

reducing ICP, invasive

A

burr hole decompression

craniotomy and evacuation

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23
Q

drugs that can exacerbate urinary retention, esp in BPH

A

antihistamines
decongestants
nasal drops
stimulation of alpha adrenergic receptors

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24
Q

classic place for bursitis to occur

A

where tendons or muscles pass over a bony prominence

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25
Q

carpal navicular bone fracture

A

often unrecognized
fall on outstretched hand
finding is pain with palpation over the anatomic snuff box

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26
Q

thin patient with blunt epigastric trauma, at risk for

A

pancreatic injury secondary to compressing pancreas against the spine
might see elevated amylase and lipase
can see with contrast in a thin patient

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27
Q

vascular injury signs that are an indication for immediate surgical exploration

A 
active hemorrhage
expanding hematoma
pulse deficit
bruit or thrill
distal ischemia (6Ps: paresthesia, poikilothermia, pulselessness, pallor, pain, paralysis)
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28
Q

vascular injury signs that are indication for imaging before possible surgery

A 
history of hemorrhage at scene
stable, nonexpanding hematoma
proximity to major vessel
anatomically related nerve deficit
ABI
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29
Q

ranson criteria

A 
age>55
wbc> 16000
glucose >200
AST> 250
LDH>350
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30
Q

bacteriuria definiion in a asymptomatic patient

A

> 100,000 CFU/mL

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31
Q

Approaches to BPH medications

A

tamsulosin-a blocker, can cause OrthoHTN
finasteride- 5a-reductase inhibitor, decreases DHEA and prostatic volume
dutasteride, both 5reductase enzyme inhibitor, marked DHEA suppression, no generic form

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32
Q

nissen fundoplication

A

surgical procedure for medication resistant GERD or hiatal hernia

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33
Q

epididymitis presentation

A 
fever
UTI with prostatitis
scrotal pain with flank pain
may have N/V
\+Prehn sign
treat with elevation and antibiotics
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34
Q

Prehn sign

A

scrotal pain relieved with elevation of the scrotal contents

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35
Q

Charcots triag

A

for cholangitis
jaundice
fever
abdominal pain

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36
Q

reynolds pentad

A 
for cholangitis
jaundice
fever
abdominal pain
shock
altered mental status
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37
Q

before getting surgery for carpal tunnel you must

A

do EMG and nerve conduction studies

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38
Q

medical treatment for hyperPTH

A

primary- estrogen/progesterone therapy beneficial in postmenopausal
Vitamin D in secondary hyperPTH

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39
Q

Medical treatment for DI

A

desmopressin (ADH analogue)

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40
Q

medical treatment for SIADH

A

demeclocyclin (ADH antagonist)

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41
Q

Management of placenta abruption

A

Deliver the fetus if there is hemodynamic instability

if still unstable after delivery, give fluids and red blood cells

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42
Q

pyloroplasty

A

widens the pyloris

used for gastroparesis, but not really anymore because of medical advancements

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43
Q

truncal vagotomy

A

cuts the anterior and posterior divisions of the vagus

used for PUD, but not really anymore since advancements of medication for PUD

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44
Q

CBC changes to acute massive blood loss

A

Hb/Hct don’t change much at the beginning because they are a concentration and blood loss is lost as a whole.
When you start equilabrating, Hb/Hct/WBC will decrease
BP is a better measurement to use for estimation of blood loss

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45
Q

unequivocal results for hip dislocation on newborn exam, next step

A

do ultrasound
babies dont have enough calcification for xrays
put in a pavlik abduction splint

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46
Q

hip fracture treatments

A

external fixation if unstabe
femoral neck - replace with prosthesis
interchocanter - ORIF, need anticoag after
shaft - rod fixation

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47
Q

malignant hyperthermia treatment

A

stop inhaled anesthetics
administer dantrolene
begin cooling protocol

48
Q

heller myotomy

A

done for achalasia

opens up a tight LES

49
Q

esophageal cancer treatment options

A

trans hiatal esophagectomy for symptomatic cancer above the cardia junction
transthoracic resection of the lower esophagus - early cancer or high grade dysplasia at the esophagogastric junction

50
Q

next steps in management for suspected kidney stones

A

xray then spiral ct without contrast

51
Q

indications for scope with gerd symptoms

A

alarm symptoms: new onset >45, dysphagia/odynophagia, bleeding
>50 with GERD for >5 years

52
Q

hemolytic vs nonhemolytics transfusion reactions

A 
both have fever
hemolytics is from a mistake (ABO incompatible)
nonhemolytics from reaction to wbc
most common reacion is nonhemolytic
most common deadly reaction is hemolytic
53
Q

morton neuoma

A

benign neuroma of third plantar interdigital nerve

54
Q

solutions for lack of erection

A

traumatic - pudendal artery revascularization
physcogenic - therapy
progressive vascular disease - medications
last resort - implantable penile prosthesis

55
Q

thoracic outlet syndrome causes

A

anterior scalene muscle - pinches vein inbetween muscle and clavical, relieved with surgery
cervical rib - relieve with surgery, usually young kid because a congenital problem
pancoast tumor - old smoker with associated horners
subclavian steal - cold tingling and muscle pain with posterior neuro problems
subclavian vein thrombosis - edema and venous engorement, complication of venous TOPS
arterial - absent pulses, limb ischemia
neurological - from brachial plexus impingment (paresthesia, muscular atrophy)

56
Q

bladder obstruction from BPH symptom relief

A

place catheter
if meet resistance
perform suprapubic tube placement

57
Q

most common cause of no UOP post surgery

A

kinked catheter

58
Q

treatment for diffuse esophageal spasm

A

CCB and lifestyle modification

59
Q

cystic testicular lesion

A

spermatocele versus epidiymal cyst
both benign and dont need follow up
if become symptomatic can remove surgically

60
Q

bruit and palpable thrill over area

A

could be an AV fistual from trauma, used for dialysis

61
Q

indications for immediate hemodialysis

A

Acidosis (severe)
Electrolytes (hyperkalemia)
intoxication with nephrotoxic substances (ethylene glycol)

62
Q

Two typical presentations for melanoma

A

primary tumor eye enucleation, then 20 years later with mets in liver

missing toe

63
Q

Two malignant tumors with eye enucleation

A

melanoma and retinoblastoma

64
Q

How to monitor melanomas clinically

A

monitor the tumor marker, tyrosinase

65
Q

sarcomas mets

A

to the lungs via bloodstream

66
Q

acalculous cholecystitis

A

fever, leuko, thickened gallbladder with pericholecystic fluid
no gallstones

stasis phenomena
US and HIDA similar to calculous cholecystitis

67
Q

Ogilvie syndrome

A

colonic pseudo obstruction
nonmechanical obstruction of large bowel (sym/para imbalance)
large bowel version on postop ileus
constipation or obstipation, distention
rule out obstructive carcinoma can give IV neostigmine (cholinesterase inhibitor and para agonist), need to admisinter slowely to avoid bronchospasm and brady

68
Q

painless neck mass differential

A

mets (80%) from lung or bowel, medial neck

lymphoma, less likely, lateral or axillary

69
Q

pickwickian syndrome

A

obesity hypoventilation syndrome

low oxygen an dhigh CO2

70
Q

indication for bariatric surgery

A 
motivated
BMI>40
BMI>35 with serious comorbidities
reasonable surgical risk
failure of previous weight loss regiments
71
Q

overflow incontinence from BPH treatment

A

alpha blocker - doxazosin, terazosin, tamsulosin

5a-reductase - finesteride

72
Q

stress incontinece therapy

A

alpha agonists, tighten sphincter

73
Q

bladder hyperactivity

A

oxybutynin and tolterodine (antispasmodics

74
Q

surgery with blood loss and decreasing UOP

A

give fluid challenge to see if UOP increases, if yes was dehydrated
can also draw CBC to see if need to be transfused

75
Q

new palsy after closed reduction

A

try to remanipulate the injury

76
Q

holstein lewis fracture

A

radial nerve palsy caused by humerus fracture in the middle third

77
Q

nonocclusive mesenteric ischemia (NOMI)

A

vasoconstriction of mesenteric vessels and hypoperfusion of vessels
usually has pre exisiting arterial atherosclerosis and has abdominal pain after hypoperfusion or vasoconstriction
see string of sausage sign, no cut offs

78
Q

acute pancreatitis

A

abdominal pain
N/V
Grey turner sign
common complication - abscess (2 weeks) and psudeocyst (6 weeks)

79
Q

grey turner sign

A

bruising along the flanks caused by SubQ tracking of digested blood around the abdomen from the inflamed pancreas

80
Q

short vs long arm cast

A

short arm -wrist immobilization

long arm - wrist and elbow

81
Q

ED
nocturnal erections
losing desire
losing ability to maintain

A
  1. if no then psychogenic
  2. check testosterone
  3. give PDI
82
Q

cardiogenic shock

A

use dobutamine

epi if not responding

83
Q

right vs left sided colon cancer

A

left - change in stool shape, blood coating stool

right - anemia, +FOBT, no changes in stool because larger colon diameter and thinner stool consistency

84
Q

chronic pancreatitis complication of spleen

A

rare - splenic vein thrombosis
splenic veins run along posterior surface of pancreas
inflammation causes thrombosis
gastric varices without concomitant esophageal varices (gastric veins drain into splenic veins)
treat with splenectomy

85
Q

nasal polyps in a child

A

think about cystic fibrosis

history of allergies in child

86
Q

purulent malodorous discharge from nose in child

A

foreign body rotting

can cause erosion and bleeding

87
Q

STI prostatitis

A

usually e coli or chlamydia
need to treat for 4-6 weeks
use floro or trimeth sulfa
ofloxacin has broad coverage for mixed infections

88
Q

wound dehiscence

A

clear pink fluid soaking through dressing
not red or inflammed
not distended
afebrile
tape wound, bind abdomen, avoid increases in intraabdominal pressure

89
Q

breast lump size delinaiton

A

4 cm mastectomy with axillary sampling

90
Q

SCC oropharynx risk factors

A

alcoholism
chronic tobacco use
HPV infection

91
Q

hirschsprung

A

get barium enema for diagnosis

then do biopsy of normal region

92
Q

pringle maneuver

A

clamping portal triad in hepatoduodenal ligament
hepatic arteries, portal veing
if still bleeding means hepatic veins or IVC

93
Q

visceral artery aneurysms

A

hepatic, splenic, rare finding
most found incidentally
most commonly in splenic and rupture during pregnancy
managed surgically and by transcatheter embolization
splenic aneurysms have signet ring sign on plain film
should be repaired in all child bearing aged women because of tendency to rupture

94
Q

Diagnostic test for colovesical fistula

A

CT scan

95
Q

tagged rbc scan vs technetium

A

tagged used for people actively bleeding

99m used for people who have bleed, or a kid who bled, concnern for meckles

96
Q

what makes diverticulitis complicated

A

perforation, abscess, fistula formation

needs surgical intervention

97
Q

treatment of osgood schlatter

A

conservative and hard cast if necessary

no surigcal intervention

98
Q

SCLC para

A

cushing disease
not operable
chemo and rad

99
Q

when to biopsy nodes in thyroid cancer

A

only when there are palpable nodes

100
Q

hypothyroid person who has surgeru not doing well, what do you give

A

steroids, adrenals have not been functioning well
cant just load T4 because adrenal cant just start working
need to give steroids then fix hypothyroid

101
Q

diagnose a PE

A

do a spiral CT

not VQ scan because less accurate

102
Q

GI bleed after 325 aspirin

A

still an underlying etiology, not just anticoaged

need to look for cancer with colonoscopy

103
Q

how to distinguish liver pyogenic vs amebic abscess on CT

A

you cant
do it clinically
pyogenic will be jaundice, septic, gallbladder disease
amebic will have travelled and is younger, treat with metronidazole then drain is doesnt get better

104
Q

congenital megaureter

A

dilated distal ureter without evidence of obstruction
especially considered when proximal ureter dilation, pelvocaliectasis, hydronephrosis are absent
path: aperistalsis of the distal ureter
some people are asym but some progress to hydroneph and nonfunctional kidney
affects males more then females
usually unilateral

105
Q

halitosis with a gastric ulcer

A

a fistula developed

106
Q

conscious vs deep sedation

A

use conscious when patient hasnt fasted and doesnt need to be asleep
can use benzos
conscious - need to have fasted and a major surgery

107
Q

ketamine side effects

A

hallucinations in 10-15%

can be used to replace prop

108
Q

anastrozole

A

aromatase inhibitor
for breast cancer in post menopausal women
can increase risk for fractures

109
Q

raloxifene

A

SERM
preventive agent
has less risk of fractures then anastrozole

110
Q

where to biopsy

A

at the interface of norma and abnormal

so pathologist can differentiate

111
Q

Choriocarcinoma

A

small cells with indistinct borders, scant cytoplasm, mitotic cells with necrosis
elevated AFP

112
Q

embryonal carcinoma

A

cytotrophoblastic and syncytiotrophoblastic
resemble chorionic villi
elevated bhCG

113
Q

seminoma

A

nests of large round clear cells with centrally placed cuclei and obvious nucleoli resembing primary spermatocytes
most common
tumor marker is placental alkaline phosphatase (PLAP)

114
Q

teratoma

A

tissue from 3 germ layers

115
Q

yolk sac carcinoma

A

papillary structures resembling glomeruli (schiller duval)

increased AFP

116
Q

causalgia

A

pain syndrome
severe pain with cold cyanotic extremity with no swelling and intact pulses
if pain disappears with sympathetic block, then diagnosis is made
treat with surgical sympathectomy

117
Q

diagnosing stenosis

A

ABI
pulse volume recordings
MRA or CTA
diagnostic angiogram

Surgery shelf (1 decks)

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