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9 Surgery > NBME Surgery > Flashcards

NBME Surgery Flashcards

1
Q

Normal liver span

A

<12cm

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2
Q

How much fluid does a burn victim need in the first 24 hours?

A

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

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3
Q

Prophylaxis for burn wound care.

A

Infection prevention = topical:

  • silver sulfadiazine
  • mafenide
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4
Q

What is the initial treatment of Acute Pancreatitis?

A 
Vigorous IV Fluids
NPO
Analgesics
Nasogastric decompression if vomiting
Most patients resolve in 3-5 days.
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5
Q

Value of K for Hyperkalemia?

Treatment?

A

Hyperkalemia when K>5.0

Tx = Dialysis

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6
Q

What lung neoplasms cause paraneoplastic effects and what are the associated key findings?

A

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)

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7
Q

PT and PTT in DIC, HIT, ITP and TTP

A 
DIC = Increased
HIT = normal
ITP = normal
TTP = normal
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8
Q

Most important aspect of ventilation of a patient with Acute Respiratory Distress.

A

High PEEP

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9
Q

Next step in management:

After trauma patient is found to have a widened mediastinum.

A

Next step = spiral CT (CT angio / Aortic angio)

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10
Q

Epistaxis with no obvious source of bleeding and continues to bleed after packing. What is the bleeding artery?

A

Sphenopalatine artery

branch of maxillary artery

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11
Q

What do you see on urine analysis of urolithiasis?

A

Microscopic hematuria

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12
Q

Carotid bruit. Next step in management.

A

Carotid duplex ultrasonography

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13
Q

Pancreatic tumor associated with diarrhea.

A

VIPoma

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14
Q

Enterococcus is gram positive or negative?

A

Gram Positive

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15
Q

Pseudomonas is gram positive or negative?

A

Gram Negative

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16
Q

What type of hernia is associated with GERD?

A

Sliding hiatal hernia

NOT paraesophageal hernia

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17
Q

Best test to screen for breast cancer.

Best test to diagnose breast cancer.

A

Screen with mammogram

Diagnose with core needle biopsy.

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18
Q

Complex adnexal cyst. Next step in management.

A

Laporoscopic exploration

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19
Q

Mechanism of indomethacin

A

Cyclooxygenase inhibition

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20
Q

Midsystolic click. Dx?

A

Dx = Mitral valve prolapse

Associated with Marfans and Elher-Danlos

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21
Q

What are the antibodies to in Hashimoto vs Graves?

A 
Hashimoto = anti-thyroid peroxidase (antimicrosomal) and anti-thyroid globulin
Graves = anti-thryoid stimulatin immunoglobulin
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22
Q

What is toxic synovitis?

A

Synovial inflammation up to 4 weeks after URI or GI viral illness.

23
Q

Hepatic mass with central scar on imaging. Dx? Next step?

A

Focal nodular hyperplasia. Treatment is not necessary.

24
Q

Large bowel obstruction, but there is no mechanical obstruction. Dx? Tx?

A

Dx = Ogilvie syndrome
Tx = Gentle enema or nasogastric suction
if these fail then Sigmoid-guided placement of a rectal tube

25
Q

What causes hypocalcemia in an alcoholic

A

The hypomagnesemia in an alcoholic causes decreased PTH and thus decreased calcium

26
Q

Therapy for patient with pneumonia that has no spleen.

A

Ceftriaxon and vancomycin

27
Q

Pregnant woman with tingling of index and middle fingers. Dx? Test to confirm diagnosis?

A

Dx = Carpal tunnel syndrome

Test to confirm diagnosis = nerve conduction study (electromyography)

28
Q

Hidradenitis suppurativa. What glands are involved?

A

Apocrine glands

29
Q

Most appropriate to predict patient’s risk for perioperative myocardial infarction before repair of AAA.

A

Radionucleotide scan with thallium and dipyridamole

30
Q

How to evaluate adequate fluid resuscitation in a patient.

A

Urine output must be more than 30 mL/hr.

31
Q

Adnexal mass – next step

A

Transvaginal Ultrasound

32
Q

Drug used to keep Ductus Arteriosus open in Tetralogy of Fallot.
vs
Drug used to close Ductus Arteriosus

A 
Open = Prostaglandin E1
Close = Indomethacin (NSAID)
33
Q

Mechanism and side effect Ketorolac

A

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)

34
Q

Heart sound: Opening snap

A

Mitral stenosis

35
Q

Treatment for zero urine output

A

Place a foley or unkink the catheter

36
Q

Low urine output after surgery = (how much?)

Treatment

A

< 0.5 mL/kg/hr
Tx = 500 mL 0.9% saline challenge
If improves = dehydration
If does NOT improve = Intrinsic renal damage

37
Q

How to diagnose Sarcoidosis.

A

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.

38
Q

Minimum FEV1 to remain in patient to consider for pneumonectomy surgery

A

800 mL

39
Q

“string sign” on barrium swallow

A

Crohn disease

40
Q

How to diagnose physiologic jaundice?

A

High unconjugated billirubin

41
Q

What to worry about in anesthesia of patients that are on chronic prednisone. How to treat?

A

Sudden hypotension, due to adrenal insufficiency.

Tx = hydrocortisone

42
Q

Treatment of intussusseption.

Treatment of meconium ileus

A

Tx for intussusseption = Contrast enema

Tx for meconium ileus = Gastrografin enema

43
Q

Diagnosis for Meckel diverticulum

A

Technetium scan

44
Q

Subcutaneous emphysema in the upper chest and lower neck. Dx?

A

Traumatic rupture of trachea or lower bronchus.

45
Q

How to control the symptoms of chronic pancreatitis?

A

Control steatorrhea = pancreatic enzymes

Hyperglycemia (diabetes) = Insulin

46
Q

Major symptoms of pt with antithrombin III deficiency.

A

Increased thrombosis

47
Q

Definitive diagnostic study for esophageal rupture.

A

Contrast esophogram

48
Q

Treatment for esophageal rupture

A

IV fluids
NPO
Antibiotics
H2 blockers

49
Q

Common cause of retinal artery occlusion

A

Carotid thrombosis

much check for carotid stenosis

50
Q

Erythema and fullness between the gluteal folds. Fever. Diagnosis?

A

Pilonidal abscess

51
Q

What other diagnsosis should you look out for if you find flail chest? Next steps in management?

A

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.

52
Q

Cause of fever
during surgery
or
immediately after surgery

A

Wonder drugs = malignant hyperthermia = during surgery

Immediately after surgery = bacteremia

53
Q

Causes of post op fever depending on POD (post-op-day). Next step.

A

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

9 Surgery (3 decks)

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