NBME Surgery Flashcards
Normal liver span
<12cm
How much fluid does a burn victim need in the first 24 hours?
To calculate the fluid needed, you must know % of body surface area affected.
Formula: (% body surface) X 4 X kg
50% of fluids in 1st 8 hours
50% in next 16 hrs
Prophylaxis for burn wound care.
Infection prevention = topical:
- silver sulfadiazine
- mafenide
What is the initial treatment of Acute Pancreatitis?
Vigorous IV Fluids NPO Analgesics Nasogastric decompression if vomiting Most patients resolve in 3-5 days.
Value of K for Hyperkalemia?
Treatment?
Hyperkalemia when K>5.0
Tx = Dialysis
What lung neoplasms cause paraneoplastic effects and what are the associated key findings?
Squamous cell carcinoma = PTHrP = hypercalcemia
Small cell carcinoma = SIADH = hyponatremia
Small cell carcinoma = ACTH = more cortisol = Cushing syndrome (hypertension, weight gain, moon facies, abdominal striae, buffalo hump, hyperglycemia)
PT and PTT in DIC, HIT, ITP and TTP
DIC = Increased HIT = normal ITP = normal TTP = normal
Most important aspect of ventilation of a patient with Acute Respiratory Distress.
High PEEP
Next step in management:
After trauma patient is found to have a widened mediastinum.
Next step = spiral CT (CT angio / Aortic angio)
Epistaxis with no obvious source of bleeding and continues to bleed after packing. What is the bleeding artery?
Sphenopalatine artery
branch of maxillary artery
What do you see on urine analysis of urolithiasis?
Microscopic hematuria
Carotid bruit. Next step in management.
Carotid duplex ultrasonography
Pancreatic tumor associated with diarrhea.
VIPoma
Enterococcus is gram positive or negative?
Gram Positive
Pseudomonas is gram positive or negative?
Gram Negative
What type of hernia is associated with GERD?
Sliding hiatal hernia
NOT paraesophageal hernia
Best test to screen for breast cancer.
Best test to diagnose breast cancer.
Screen with mammogram
Diagnose with core needle biopsy.
Complex adnexal cyst. Next step in management.
Laporoscopic exploration
Mechanism of indomethacin
Cyclooxygenase inhibition
Midsystolic click. Dx?
Dx = Mitral valve prolapse
Associated with Marfans and Elher-Danlos
What are the antibodies to in Hashimoto vs Graves?
Hashimoto = anti-thyroid peroxidase (antimicrosomal) and anti-thyroid globulin Graves = anti-thryoid stimulatin immunoglobulin
What is toxic synovitis?
Synovial inflammation up to 4 weeks after URI or GI viral illness.
Hepatic mass with central scar on imaging. Dx? Next step?
Focal nodular hyperplasia. Treatment is not necessary.
Large bowel obstruction, but there is no mechanical obstruction. Dx? Tx?
Dx = Ogilvie syndrome
Tx = Gentle enema or nasogastric suction
if these fail then Sigmoid-guided placement of a rectal tube
What causes hypocalcemia in an alcoholic
The hypomagnesemia in an alcoholic causes decreased PTH and thus decreased calcium
Therapy for patient with pneumonia that has no spleen.
Ceftriaxon and vancomycin
Pregnant woman with tingling of index and middle fingers. Dx? Test to confirm diagnosis?
Dx = Carpal tunnel syndrome
Test to confirm diagnosis = nerve conduction study (electromyography)
Hidradenitis suppurativa. What glands are involved?
Apocrine glands
Most appropriate to predict patient’s risk for perioperative myocardial infarction before repair of AAA.
Radionucleotide scan with thallium and dipyridamole
How to evaluate adequate fluid resuscitation in a patient.
Urine output must be more than 30 mL/hr.
Adnexal mass – next step
Transvaginal Ultrasound
Drug used to keep Ductus Arteriosus open in Tetralogy of Fallot.
vs
Drug used to close Ductus Arteriosus
Open = Prostaglandin E1 Close = Indomethacin (NSAID)
Mechanism and side effect Ketorolac
Mechanism = Ketorolac is an NSAID, which inhibits synthesis of prostacyclin.
Side effect =
1) Renal ischemia. (prostaglandins vasodilate the afferent areteriole, so NSAID will cause arteriolar constriction)
2) Gastric ulcers (prostaglandins protect gastric mucose, so NSAID will cause removal of protective layer)
Heart sound: Opening snap
Mitral stenosis
Treatment for zero urine output
Place a foley or unkink the catheter
Low urine output after surgery = (how much?)
Treatment
< 0.5 mL/kg/hr
Tx = 500 mL 0.9% saline challenge
If improves = dehydration
If does NOT improve = Intrinsic renal damage
How to diagnose Sarcoidosis.
Sarcoidosis is a disease of noncaseating granulomas present in many organs. Most often involving the lungs.
Discover on X-ray: Bilateral mediastinal and hilar lymph nodes with diffuse interstitial disease bilaterally.
Minimum FEV1 to remain in patient to consider for pneumonectomy surgery
800 mL
“string sign” on barrium swallow
Crohn disease
How to diagnose physiologic jaundice?
High unconjugated billirubin
What to worry about in anesthesia of patients that are on chronic prednisone. How to treat?
Sudden hypotension, due to adrenal insufficiency.
Tx = hydrocortisone
Treatment of intussusseption.
Treatment of meconium ileus
Tx for intussusseption = Contrast enema
Tx for meconium ileus = Gastrografin enema
Diagnosis for Meckel diverticulum
Technetium scan
Subcutaneous emphysema in the upper chest and lower neck. Dx?
Traumatic rupture of trachea or lower bronchus.
How to control the symptoms of chronic pancreatitis?
Control steatorrhea = pancreatic enzymes
Hyperglycemia (diabetes) = Insulin
Major symptoms of pt with antithrombin III deficiency.
Increased thrombosis
Definitive diagnostic study for esophageal rupture.
Contrast esophogram
Treatment for esophageal rupture
IV fluids
NPO
Antibiotics
H2 blockers
Common cause of retinal artery occlusion
Carotid thrombosis
much check for carotid stenosis
Erythema and fullness between the gluteal folds. Fever. Diagnosis?
Pilonidal abscess
What other diagnsosis should you look out for if you find flail chest? Next steps in management?
Look out for pulmonary contusion.
Pulmonary contusion is sensitive to fluid overload, so restrict fluids and use diuretics.
Also look out for transection of aorta.
Cause of fever
during surgery
or
immediately after surgery
Wonder drugs = malignant hyperthermia = during surgery
Immediately after surgery = bacteremia
Causes of post op fever depending on POD (post-op-day). Next step.
POD 1 = Wind = Atelectasis = incenstive spirometry
POD 2 = Wind = Pneumonia = broad spectrum antibiotics
POD 3 = Water = UTI = take foley out
POD 5 = Walking = DVT/PE = Heparin bridge Warfarin
POD 7 = Wound = Cellulitis
POD 10-14 = Wound = Abcess = ultrasound/CT = antibiotics and incision drainage
