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STEP2: SURGERY > NBME > Flashcards

NBME Flashcards

1
Q

What is the landmark of the ETT tip placement?

A

4-6cm ABOVE tracheal CARINA (level of clavicular heads, ridge of cartilage dividing two bronchi)

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2
Q

What is the landmark of the CENTRAL LINE tip placement?

A

Tip placed above RIGHT ATRIUM in SVC

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3
Q

What is the landmark of the SWAN-GANZ CATHETER tip placement?

A

Tip placed WITHIN R. or L. MAIN PULMONARY ARTERIES

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4
Q

What is the landmark of a NASOGASTRIC TUBE placement?

A

PROXIMAL to gastric PYLORUS

DISTAL to ESOPHAGOGASTRIC junction

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5
Q

What is the artery of bleeding that does not stop despite anterior nasal packing?

A

SPHENOPALATINE ARTERY

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6
Q

When ABG level shows DECREASED PaO2, what are the two possible options of switching parameters?

A

1) INCREASE FiO2

2) INCREASE PEEP

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7
Q

When should you INCREASE TIDAL VOLUME during intubation?

A

HIGH PaCO2

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8
Q

What is normal postvoid residual volume?

A

<50mL = normal

<100 is acceptable

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9
Q

SPINAL CORD COMPRESSION

A

SYMMETRIC LE weakness + SENSORY LOSS + Loss of rectal tone + EARLY LMN (hyporeflexia) /LATER UMN (hyper-reflexia) + URINARY RETENTION** Bladder flaccidity

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10
Q

CAUDA EQUINA (LMN) SYNDROME

A

ASYMMETRIC severe radicular pain + SADDLE HYPO/ANESTHESIA + HYPO/AREFLEXIA + LATE onset bowel/bladder dysfn

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11
Q

CONUS MEDULLARIS SYNDROME

A

SYMMETRIC LE WEAKNESS + Sudden onset severe back pain + LMN/UMN SX (Hyper-reflexia) + EARLY onset bowel/bladder dysfn

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12
Q

DIFFUSE Mucosal inflammation + Nuclear inclusion bodies resulting in need for total abdominal colectomy with ileostomy for perforated cecum = WHAT VIRAL INFECTION?

A

CMV COLITIS

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13
Q

PANCREATIC TUMOR resulting in CHRONIC WATERY DIARRHEA + Resulting dehydration/hypokalemia/achlorydria + Vasodilation (FLUSHING/HYPOTENSION) + Hypercalcemia/ Hyperglycemia = ?

A

VIPoma

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14
Q

What is the difference between HYDROCELE and TESTICULAR CANCER?

A

HYDROCELE - Can be transilluminated

TESTICULAR Ca/ VARICOCELE - NOT transilluminated

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15
Q

SPERMATOCELE vs HYDROCELE

A

SPERMATOCELE = epididymal, painless fluid-filled cyst along head of EPIDIDYMUS ABOVE testes

HYDROCELE = fluid filling scrotal sac

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16
Q

Trauma resulting in ECCHYMOSES, TENDERNESS OVER R. ILIAC CREST (Flank pain), ABRASIONS ON R. FLANK is indicative of __? What is the next step in diagnosis?

A

UNILATERAL KIDNEY TRAUMA

Next step = CT ABDOMEN W/ CONTRAST (can give contrast to a pt with a single kidney and normal Cr)

17
Q

OSTEOLYSIS (OSTEOPENIA) -> BONY DISRUPTION -> DEFORMITY (Decreased sensation to proprioception, pain, and light touch) most commonly in the ANKLE

A

CHARCOT DISEASE - Lack of joint sensation

18
Q

LEIOMYOMA vs LEIOMYOSARCOMA

A

LEIOMYOMA - PRE-MENOPAUSAL, benign, multiple pelvic masses

LEIOMYOSAROCMA - POST-MENOPAUSAL, malignant, single pelvis mass

19
Q

CT scan: ASCITES (fluid wave) + MULTIPLE PELVIC MASSES + OMENTAL THICKENING = What malignant dx?

A

OVARIAN ADENOCARCINOMA

20
Q

What are the major indications for URGENT PRE-OP DIALYSIS before an elective surgery? Why is the pt dialyzed?

A

HYPERKALEMIA (>5.5) + VOLUME OVERLOAD

Pt dialyzed due to INCREASED RISK OF BLEEDING with UREMIA (Inhibits both PLT adhesion and aggregation)

21
Q

PAIN OUT OF PROPORTION to PASSIVE EXTENSION + normal capillary refill time/normal sensation/normal peripheral pulses = ?
What’s the treatment?

A

COMPARTMENT SYNDROME

Tx = FASCIOTOMY (SURGICAL DECOMPRESSION)

22
Q

CORE NEEDLE BX = NEEDLE-LOCALIZED OPEN BX for breast ca

A

CORE NEEDLE = NEEDLE LOCALIZED OPEN BX WITH MAMMOGRAPHIC GUIDANCE

23
Q

3 Factors that allow closure of PATENT DUCTUS ARTERIOSUS

A

1) INCREASED O2 tension
2) DECREASED PGE2
3) INCREASED NE release -> Vasoconstriction -> Closure of PDA

24
Q

What are indications of SURGICAL RESECTION of an ovarian cyst?

A

1) COMPLEX CYST
2) 5-8CM SIMPLE CYST that is SYMPTOMATIC
3) OVARIAN CYST that has INCREASED IN SIZE

25
Q

What type of ovarian cyst is NOT surgically resected?

A

PRE-MENOPAUSAL <8cm SIMPLE CYST, normal CA-125, Asx

26
Q

When a pt presents with NORMAL AG, HYPERCHLOREMIC METABOLIC ACIDOSIS, what are the two possible etiologies of this?

A

BICARBONATE LOSS FROM GI TRACT

OR

BICARBONATE LOSS FROM KIDNEY

27
Q

Radioactive Iodine uptake:
DIFFUSE UPTAKE -
FOCAL, NODULAR UPTAKE -

A

DIFFUSE - Hyperthyroidism: GRAVE’S, TSH-secreting pituitary adenoma// Hypothyroidism: Hashimoto’s, I2 deficiency

NODULAR - Hyperthyroidism: Toxic thyroid adenoma// Hypothyroidism: Thyroid adenoma, cancer, cyst

28
Q

DURATION of nerve blockade anesthesia is dependent on which factor? What are the 3 classes?

A

LIPID SOLUBILITY

SHORT ACTING (C-cut it short): Chloroprocaine (45-90min)
INTERMEDIATE (LM): Lidocaine, mepivacaine (90-180min)
LONG ACTING (BR): Bupivacaine, levobupivacaine, ropivacaine (4-18hrs)
29
Q

What mediates CACHEXIA in malignancy (temporal wasting, scaphoid abdomen, BMI <18)?

A

INCREASED TNF-a (nicknamed cachexin), IFN gamma, IL-6

30
Q

CENTRAL RETINAL ARTERY OCCLUSION (CRAO) vs CENTRAL RETINAL VEIN OCCLUSION (CRVO)

A

CRAO - Retina = grossly SWOLLEN/PALE with prominent fovea + Cherry red spots + PALLOR OF OPTIC DISC + MACULAR EDEMA + THIN ARTERIOLES + SAUSAGE-LIKE NARROWING OF RETINAL VEINS

CRVO - SPLOTCHES of HEMORRHAGES on SWOLLEN DISC + COTTON WOOL SPOTS DIFFUSELY

31
Q

EXCESSIVE NERVOUS/SWEATINg + TREMORS + TACHYCARDIA + HUNGER (sx of hypoglycemia) WORSENED by FASTING = what tumor of pancreas?

A

INSULINOMA

32
Q

Which tumor of pancreas has the pentad: DIABETES + WEIGHT LOSS + CHOLELITHIASIS + DIARRHEA/STEATORRHEA + ACHLORYDRIA/HYPOCHLORHYDRIA

A

SOMATOSTATINOMA

33
Q

What is a CELIOTOMY?

A

CELIOTOMY = LAPAROTOMY (INCISION OF ABDOMEN)

34
Q

What is the finding that best indicates ADEQUATE RESUSCITATION in a trauma pt?

A

URINE OUTPUT 30-40mL/hr

35
Q

What is the GCS minimum for requiring INTUBATION?

A

GCS<8 - impending INTUBATION

STEP2: SURGERY (1 decks)

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