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uworld: surgery > Monday 9/5/16: Surgery Exam 3 > Flashcards

Monday 9/5/16: Surgery Exam 3 Flashcards

1
Q

What causes a medial collateral ligament tear?

A

Severe valgus stress (blow to the lateral knee) or twisting injury.

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2
Q

What are some examination findings of a medial collateral ligament tear?

A

Ecchymosis and joint line tenderness at the medial knee.

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3
Q

What is the valgus stress test?

A

Appreciable laxity when the leg is forced into abduction is helpful for diagnosis of a medial collateral ligament tear.

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4
Q

What is the most sensitive test for MCL tear?

A

MRI but is reserved for patients considered for surgical intervention.

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5
Q

How are patients with uncomplicated MCL tears treated?

A
  1. Nonoperatively
  2. Rest
  3. Ice
  4. Compression
  5. Elevation
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6
Q

How does injury to the anterior cruciate ligament present?

A

Tibia will show anterior rather than valgus laxity.

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7
Q

How do injuries to the lateral collateral ligament present?

A

High velocity traumas. Knee will have varus laxity.

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8
Q

How does medial meniscus injury present?

A

Shows a small joint effusion and crepitus, locking, or catching with range of motion.

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9
Q

What is patellar tendinitis or jumpers knee?

A

Chronic overuse injury characterized by anterior knee pain and tenderness. Stress testing of the ligaments are normal.

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10
Q

How do tibial plateau fractures present?

A

Contact sports, falls or MCV. But with fractures you are unable to bear weight on the knee.

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11
Q

What are clinical features of peritonsillar abscesses?

A
  1. Fever, earache
  2. Sore throat, difficulty swallowing
  3. Trismus
  4. Muffled “hot potato” voice
  5. Uvula deviation away from the enlarged tonsil.
  6. Pooling of saliva
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12
Q

What is a peritonsillar abscess

A

Acute bacterial infection of the region between the tonsil and the pharyngeal muscles.

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13
Q

What are the series of events for peritonsillar abscess ?

A
  1. Persistent tonsillitis/pharyngitis
  2. progresses to cellulitis/phlegmon
  3. Pus collecting into and abscess within a week of symptom onset
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14
Q

Who normally gets peritonsillar abscess ?

A

Older adolescents and young adults, drug or alcohol use increases risks.

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15
Q

What is the treatment for peritonsillar abscess ?

A

Needle aspiration or incision and drainage plus antibiotics to cover group A hemolytic strep and respiratory anaerobes.

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16
Q

How does epiglottis present?

A
  1. High-grade Fever
  2. Severe sore throat
  3. Odd phage that can progressively turn into airway obstruction
17
Q

How does tonsillitis present?

A

Tonsillar erythema and exudates
Tender anterior cervical nodes
Palatal petechia

18
Q

When do enlarged adenoids present?

A

Early childhood and regress with age

19
Q

What causes herpangina

A

Coxsackie A.

20
Q

How does herpangina present?

A
  1. Fever
  2. Sore throat
  3. Odynophagia
  4. Vesicles on the tonsils and soft palate
21
Q

How is infectious mononucleosis characterized?

A
  1. Fever
  2. Pharyngitis
  3. Posterior cervical lymphadenopathy
22
Q

When should tetanus-diphtheria toxoid be given?

A

Individuals with severe or dirty sounds who received a booster more than 5 years ago and those with minor clean wounds who received a booster more than 10 years ago

23
Q

When should tetanus immune globulin be given?

A

Any individual with severe or dirty wound AND an unclear or incomplete immunization history. Or in someone who is severely immunocompromised

24
Q

What type of protection does tetanus immune globulin provide?

A
  1. Passive
  2. Temporary
    3 immediate immunity
25
Q

How does acute pancreatitis present?

A
  1. Mid epigastric pain that radiates to the back
  2. Nausea and vomiting
  3. Elevated amylase and lipase
26
Q

What is the second most common cause of pancreatitis? And how can you determine that?

A

Gallstone pancreatitis if ALT>150 U/L

27
Q

What is the treatment for a resolved acute pancreatitis attack due to gallstones?

A

Early cholecystectomy

28
Q

What drugs cause drug induced pancreatitis?

A
  1. Thiazides
  2. ACE inhibitors

Not calcium channel blockers

29
Q

When is ERCP recommended in gallstone pancreatitis?

A

Patients with gallstone pancreatitis who have cholangitis, visible common bile duct dilation or obstruction or increasing liver enzymes

30
Q

When are HIDA scans used?

A

Evaluating cholecystitis in patients with intermediate ultrasound findings.

31
Q

How does a AAA present?

A
  1. Acute onset of severe back pain
  2. Syncope
  3. Hypotension
32
Q

What is the normal size of an abdominal aorta

A

1-3 cm

33
Q

How is a AAA different from a thoracic aortic aneurysm?

A

AAA involves all aortas layers and does not create an intimal flap or false lumen.

34
Q

AAA typical occur in what types of people?

A

Aged over 60.
Smokers
Men
People with a history of coronary artery disease

35
Q

How are AAA found?

A

Incidental ultrasound or CT

36
Q

What is a physical exam finding in a AAA

A

Pulsatile abdominal mass at or above the level of the umbilicus.

37
Q

Where can a AAA rupture into

A

Into the retroperitoneium and can create a aortocaval fistula with the IVC, leading to venous congestion in retroperitoneal structures (bladder)- the fragile vessels can break causing hematuria

38
Q

How do you treat AAA?

A

Emergently taken to the OR.

uworld: surgery (4 decks)

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