OME - Spec Surg Flashcards
1
Q
INjury to the knee area, best imaging is what?
A
MRI
3
Q
Bovine valves last how long? Need anticoagulation?
Mechanical valves?
A
< 10 years
10-20 years, YES Warfarin goal INR 2.5-3.5
4
Q
Pt w/corneal abrasion, what is the 1st step?
Then do what?
A
Flush out irritant
Fluorescein dye test
5
Q
What kind of macular degeneration shows blood and fluid?
What kind shows pigment changes?
How are they treated?
A
Wet, laser
Dry, supportive care
7
Q
Pt w/testes in horizontal lie has what?
A
Testicular torsion
10
Q
What causes DeQuervian’s Tenosynovitis?
What happens?
Dx with what test?
Tx?
A
Prolonged extension of the thumb - cradle baby, lift heavy weights overhead)
Thumb hurts
Finale stein
Splint and NSAIDs
11
Q
How do you manage Increased ICP initially?
Ultimately have to do what?
A
Elevate HOB
give HyperT solutions
Hyperventilate
Craniotomy
12
Q
Follicular thyroid cancer can be treated how?
A
Radioactive iodine
14
Q
If you find VMA elevated in a pt w/pheochromocytoma sx, what do you do next?
Confirm with what?
Finally what?
A
Localize w/CT (better) or MRI
MIBG scan or Adrenal vein sampling
Resect but give phenoxybenzamine 1st
15
Q
What is a felon?
Occurs when?
What other sx will they have?
A
Abscess in pulp of the fingertip
Following penetrating injury
Fever
17
Q
Pt w/bladder cancer, what is the treatment?
When do you remove the bladder?
A
Transurethral resection + BCG or Cisplatin
Invasion of muscular layer, or TONS of recurrences
20
Q
What is the 1st test when suspecting testicular cancer?
Ultimately need to do what?
A
Trans-illumination
Orchiectomy
21
Q
What test confirms orbital cellulitis?
What clinical sign do you see?
Treat how?
A
CT scan
EOM paralysis
Surgery
22
Q
Pt has migratory necrolytic dermatitis and some diabetes mellitus, what do they have?
Do what 1st? Then what?
A
Glucagonoma
Glucoagon level, then CT
23
Q
CTS Treatment starts with what?
If it fails what next?
Ultimately what treatment, but what do you need to get 1st to confirm Dx?
A
Splinting and NSAIDs
Intraarticular steroids
surgery, EMG
25
Q
Teenage Pt that develops colicky pain after a binge drinking episode has what?
Diagnose how?
A
UPJ obstruction
US
27
Q
Pt that complains of floaters, or a veil/cloud on top of their visual picture has what?
Treat how?
How does it happen?
A
Retinal detachment
Laser
Marfan, HTN or MAJOR trauma (MVA)
28
Q
If you suscept Hirschsprung’s what is the 1st step in imaging?
Next?
For confirmation?
A
KUB shows dilated colon and normal distal colon
Contrast enema
Suction biopsy
29
Q
Child that has synovial inflammation up to 4 weeks after a URI or GI illness w/no fever or leukocytosis has what?
Dx how?
Treat how?
A
Transient synovitis
XRay - normal
Supportively
33
Q
Pt w/shiny skin or loss of hair w/decreased pulses and cool extremities has what?
A
PVD
34
Q
Pt that has a jet black, smooth lesion on sun-exposed skin has what?
Diagnose how?
A
Melanoma
BIOPSY
35
Q
What presents w/colicky flank pain and hematuria?
Workup starts how?
Then what?
Treatment?
A
Kidney stone
UA and UCx
CT scan
Hydration and analgesics if <0.5cm, lithotripsy if < 1.5cm, Nephrostomy if septic
37
Q
MC type of of congenital diaphragmatic hernia?
Other kind?
A
Posterior (Bochdalek)
Anterolateral (Morgagni)
39
Q
How do you treat open-angle glaucoma?
A
PG analogs (tafluprost) Beta-blocker (timolol)
40
Fracture of the femoral head requires what?
Intertrochanteric fx?
Shaft fx?
What may easy the pt’s pain during transport?
Prosthesis
Plates
Shaft
Traction
41
What kind of glaucoma is caused by fluid being trapped in the anterior chamber?
Symptoms? Usually occur when?
Acute narrow angle glaucoma
Eye pain, HA, halos or corneal clouding
After being in the dark for awhile
42
What are the 3 classic features of aortic dissection?
Tearing chest pain radiating to the back
Asymmetric bp’s arm-to-arm
Widened mediastinum
43
What is Cushing’s Reflex?
What is most often causing it?
How to diagnose?
If midline shift give what?
HTN + Bradycardia
ICP from a brain mass
CT scan of head
Dexamethasone
44
In Cushing’s eval, if the ACTH level is elevated, what does that mean? Need to do what?
If it is decreased what does it mean? Need to do what?
Extra-adrenal, perform a high-dose dexamethasone suppression test then confirm with an MRI or CT (could be in lungs, pancreas, etc)
Adrenal, get CT/MRI of adrenals
45
What presents w/an extremity becoming tense w/excruciating pain on passive flexion?
Compartment syndrome
46
What is a well-demarcated red papule in sun-exposed areas?
Metastasize?
SCC
It can
49
Treatment for Acute angle narrow glaucoma?
What is contraindicated?
A2 agonist, B-blocker, Acetazolamide
Atropine
50
How should BCC be diagnosed?
Full thickness biopsy of ulcer edge
53
How is Fibromuscular dysplasia managed?
1st w/angiography w/balloon dilation
Then stenting
If all fails go to surgery
55
If you have a PRLoma and develop apoplexy what is the only treatment?
Why?
IV Dexamethasone
For the corticosteroid effect to regain BP
56
What is an infectious obstruction of a hair follicle called?
Hordeolum
59
What is a Monteggia fracture?
Ulna breaks and radius dislocates (nightstick fracture)
MPU
60
How do you diagnose PVD?
Do what next?
What is done if an intervention is planned?
Ankle-Brachial index
US Doppler looking for pressure gradient drop
CT Angio
62
Pt that has macroscopic hematuria w/dysmprohic rbc casts has what?
Needs what?
Glomerular cause
Kidney Bx
64
What is Mallet finger?
Treatment?
Forceful flexion, CANNOT extend
Splint and NSAIDs
66
Pt fractures ankle but ambulatory, what to do?
If NON-ambulatory?
DO NOT image
Xray and surgery
67
Old pt that has painless U/L loss of vision w/out any other sxs, what happen?
What is pathognomonic?
Treatment?
Embolic occlusion of retinal a.
Cherry-red spots on fovea
Intra-arterial tPA
But also rebreathed CO2 and orbital pressure
68
When do you do an ORIF in setting of fracture?
Dx how?
If fracture is comminuted, angular, or open
Perpendicular X-rays
72
What causes cataracts?
Presents how?
PE shows what?
Treat how?
Age and DM
Progressive and chronic vision loss
White thing in ant chamber
Resection
73
SCC local lesions that have not invaded can be treated locally with what?
Imiquimod or radiotherapy
74
Is gastrochisis or omphalocele associated w/chromosomal abnormalities?
Which has worse prognosis?
Omphalocele (Beckwith-Wiedemann)
Same
76
What presents in kids w/bitemporal hemianopsia and has sella calcifications on Imaging?
Craniopharyngioma
77
What is the only therapy that can relieve obstructing kidney stone quickly?
Percutaneous ureterostomy
79
What position will arm be in the case of anterior dislocation of the shoulder?
MC injury after what?
What may be injured?
ABducted, ER “shake hand position”
Trauma to shoulder
Auxiliary nerve
80
Baby that is blue at rest and pinks up with crying most likely has what?
Why?
What other unusual sign?
Choanal atresia
They are obligate NOSE breathers
Snores
81
What is trigger finger?
What special sign?
Treatment?
Stenosis tenosynovitis - CANNOT extend finger
Loud pop
Splint and NSAIDs
82
High-pitched blowing decrescendo murmur best heard in diastole at 4th ICS LSB is what?
Chronic condition manifests w/what?
AR
LVD, Wide Pulse pressure, water hammer pulse, pistol-shot pulse, Head Bobbing
83
What are the anterior fossa tumors?
Who gets them?
Oligodendroglioma, GBM, Meningioma
Adults
84
Newborn male w/low or no urine output + a palpable bladder has what?
Treat how?
If untreated can lead to what?
May be a PMHx of what?
Confirm Dx how?
Posterior urethral valves
Cath
Hydronephrosis, Renal dysfunction
Oligohydramnios
VCUG
85
How do you diagnose secondary hyperaldosteronism?
Start w/Aldo:renin ratio that approaches 1
Then US w/Doppler
Def Dx w/Angiogram but only do that if an intervention is planned
86
Dupuytren’s Contracture commonly seen in whom?
What is wrong?
Tx?
Alcoholic males and Scandinavians
Unable to extend the hand
Surgery
88
How do you track AAA?
When do you go to surgery for AAA no matter what?
Serial US or CT scans
Pain or tenderness or Back pain
89
Pt w/UTI, fever, chills, and low back pain w/tender prostate w/dirty UA has what?
Treatment?
Bacterial prostatitis
Long term fluoroquinolones
90
Tib/fib fracture best treated how?
Nailing if open w/ORIF
91
What is a Galezzi Fracture?
Radius breaks, ulna dislocates
Go LOW —> GDR
93
Baby w/meconium ileus should be treated how?
Water-soluble contrast enema AKA gastrograffin enema
95
Pt w/sudden onset of an extremity that is painful, pale, pulseless, w/paresthesias, paralysis and poikilothermia has what?
Diagnose how?
Treatment? W/in how much time?
Acute limb ischemia
US or Arteriogram
Embolectomy, localized tPA, or heparin
6 hours
97
Pt has virulent pud and diarrhea, what do they have?
First measure what?
Then do what?
Finally ID how?
Gastrinoma (ZE)
Serum gastrin
Secretin test
CT scan or SRS scintigraphy
98
Pt that complains of HA that are worse in the morning w/signs of papilledema, projectile vomiting should get what?
What is going on? What is tell-tale sign for what is going on?
MRI
Brain tumor - FND
100
Baby w/HTN, claudication w/walking and obvious temp difference bw arms and legs suspect what?
Get what 1st?
Then what to def Dx?
Coarctation
BPs on arms and legs
Echo
103
What are the posterior fossa brain tumors?
Who gets them?
Medulloblastoma, Ependymoma, Schwannoma
Kids
104
Posterior dislocation of the shoulder occurs MC when?
Appears how?
Ext. m. Spasm - seizure or electricity
ADducted, IR
105
Elderly pt w/osteoporosis FOOSH injury what happens?
Called what?
Radius displaced dorsally
Colles’ Fracture
106
What is jersey finger?
Tx?
Hyperextension of finger
CanNOT flex
(Can’t fist pump)
Splint and NSAIDs
107
What symptoms can RCC cause?
Anemia
| Polycythemia
109
What makes a high risk for a thyroid nodule?
What is the cutoff in size when seen on US?
If smaller than cutoff size do what?
If larger?
Eu or hyperthyroid
1 cm
Q6mo US
FNA
110
Boot shaped heart on CXR is what?
Caused by what defect?
ToF
Endocardial cushion
112
What is a Boxer’s fracture?
Tx?
Metacarpal fracture
Xray and cast
114
Pt w/testes in normal ie and Tender cord has what?
Dx how?
treat how?
Acute epididymitis
US
< 35 Ceftri + Azithro
> 35 E.coli + Cipro
115
What are the pituitary tumors of the brain? Who gets what?
Craniopharyngioma - kids
PRLoma - adults
Acromegaly - adults
118
What is diagnosed w/a CT scan Non-con that shows blood outside the parenchyma and bw the gyri?
What is the best test for this?
If - but still have suspicion do what?
Subarachnoid hemorrhage
CTA or MRA
LP looking for xanthochromia
119
In CABG, the LAD is connected to what?
The others get what?
Pts will need to be on what medical therapy?
internal mammary artery
Great saphenous vein
BB, ACE-I, ASA, Statin
122
Symptomatic PVD pts are managed with what medication?
Cilostazol
123
ABI > 1.4 means what? Have to take what action?
1.0-1.4? ?
.9-1.0? ?
Calcified, Toe-Brachial Index
Normal, no action needed
Exercise ABI
124
1st step to evaluate BPH?
Next?
Treat how?
If obstructive uropathy do what?
DRE - smooth, rubbery prostate
R/O Infection w/UA and UCx
Tamulosin and finasteride
In and out cath, maybe TURP
125
Before replacing the valve in AS, what do you need to assess for?
With what?
CABG
Coronary angiography
126
What do medulloblastomas and Ependymomas cause in kids?
HA and obstructive hydrocephalus
128
What kind of PVD lesions can get a stent?
Everything else gets what?
In the femoral artery AND < 3cm
Bypass
129
What is the MC cause of MR?
Treat how?
Infection or infarction (papillary m. Rupture > chordae tendonae rupture)
Replace valve or LV dilation
131
Treatment for prostate cancer?
Meds?
Resection, radiation, brachytherapy
GnRH analogs - Leuprolide or
Anti-Androgen Flutamide
133
Normal gas pattern in baby w/bilious vomiting most likely means what?
What imaging to confirm?
Malrotation
Contrast enema or upper GI series (better)
134
What presents w/chronic, progressive central vision loss in a pt?
Macular degeneration
136
What kind of thyroid nodule is suspicious for cancer?
Do what next?
If + do what?
Euthyroid pt
US guided FNA
Thyroidectomy
137
What presents w/hematuria, flank pain, and a flank mass?
Diagnose how?
Treatment?
RCC
US then CT scan
Nephrectomy
138
What are the complications of cleft lip/palate?
Feeding #1
| OM, hearing and speech path
139
What is a stye of the lacrimal duct?
Dacryocystitis
140
Pearly or waxy lesion on the skin that is non-healing and bleeds easily is what?
Does it metastasize? Locally invade?
Diagnose how?
BCC
No, Yes invades
Excisional biopsy
142
What are the early complications of SAH? What do you do?
Late?
Bleeding - give IV BB
Hydrocephalus - VP shunt/serial LP
Seizures - give antiepileptic
Vasospasm - give Nimodipine
144
What is the 1st step in workup of aortic dissection?
Next?
Finally? If renal disease then do what?
R/O coronary disease w/EKG and troponin
Xray
CT angiogram, MRI/TEE
147
To prevent vasospasm after acute infant in SAH, pt needs to be on what?
What else does the pt need to do?
CCB
Be on seizure prophylaxis
149
Pt that has hematuria in the setting of trauma needs to get what?
What else will this imaging show?
Non-con CT
Kidney stones
154
What is the pathology of intracranial hemorrhage?
F/u with what?
What is the #1 thing to do if pt has a brain bleed?
HTN
CT scan
Reverse anticoagulation
155
When should you screen for AAA in men? How often?
With what?
Over 65 y/o and they smoked, screen only 1 time
US
158
Pt w/INC insulin, INC C-peptide, and no sulfonurea has what?
Insulinoma
161
When do you go to surgery for AAA?
If it is > 5.5cm or it is growing 0.5cm / 6mo
168
What is a noninfectious obstruction of a gland, where the eyelid will be swollen and can shut, will heal on its own?
Chalazion aka stye
170
Pt that has HTN and hypokalemia has what?
Get what test 1st? It will show what?
Next step do what?
Finally what?
Conn’s syndrome
Renin/Aldo level, will be > 20
CT to find tumor
Adrenal vein sampling to lateralize, then resect
174
What is mild PVD?
Moderate?
Severe?
.8-.9
.4-.9
< .4
180
If you see a TEF in child, what else should you look for?
VACTERL
182
What causes a rumbling diastolic murmur w/opening snap?
MS
187
Pt with gastrin level in the 1000’s has what?
100’s?
10’s?
Gastrinoma
on a PPI
Normal
188
Bowel sounds over the lungs w/scaphoid ABD in a dyspneic baby means what?
Get what imaging?
Biggest problem is what?
Congenital Diaphragmatic Hernia
Babygram (XRAY)
Hypoplastic lung - requires intubation
189
What is the 1st test to diagnose intussusception?
To treat?
US
Air enema
193
What values indicates cardiogenic shock?
Cardiac index< 3 (Ventricular failure)
| PCWP > 12 (too much fluid)
197
1st step in evaluating a pt w/Cushing’s syndrome is what?
Next step is what?
24 hour urine cortisol OR overnight low-dose dexamethasone test
ACTH level
199
What causes MS?
What is the treatment?
Rheumatic heart disease
Commissurotomy (balloon dilation)
200
Torso HTN, leg HoTN and claudication in a young adult is what?
What is the 1st test to get?
What is the best test?
But what is sufficient?
Coarctation
CXR - rib notching
Arteriogram
CTA or MRA
202
Pt that is hyperthyroid and has a hot nodule, what do you need to do?
NO biopsy needed
- 1st get a TSH/Free T4
- then RAIU needed if TSH shows hyperthyroid
203
Fixed wide split S2 in kid is what?
Harsh systolic murmur at LLSB? Presents how?
ASD
VSD (MC), presents w/FTT or HF
207
What causes secondary hyperaldosteronism?
B/L renal artery stenosis (old man, atherosclerotic disease)
OR
Fibromuscular dysplasia (young woman) —> stent
211
Hirschsprung’s results bc of what?
Lack of inhibitory neurons, cannot relax
212
What is the MC type of TEF?
What does it mean?
type C
Prox esophagus is BLIND and distal esophagus connects from trachea to stomach
