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Surgery > OME - Spec Surg > Flashcards

OME - Spec Surg Flashcards

1
Q

INjury to the knee area, best imaging is what?

A

MRI

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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

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4
Q

Pt w/corneal abrasion, what is the 1st step?

Then do what?

A

Flush out irritant

Fluorescein dye test

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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

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7
Q

Pt w/testes in horizontal lie has what?

A

Testicular torsion

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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

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11
Q

How do you manage Increased ICP initially?

Ultimately have to do what?

A

Elevate HOB
give HyperT solutions
Hyperventilate

Craniotomy

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12
Q

Follicular thyroid cancer can be treated how?

A

Radioactive iodine

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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

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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

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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

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20
Q

What is the 1st test when suspecting testicular cancer?

Ultimately need to do what?

A

Trans-illumination

Orchiectomy

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21
Q

What test confirms orbital cellulitis?

What clinical sign do you see?

Treat how?

A

CT scan

EOM paralysis

Surgery

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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

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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

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25
Q

Teenage Pt that develops colicky pain after a binge drinking episode has what?

Diagnose how?

A

UPJ obstruction

US

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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)

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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

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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

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33
Q

Pt w/shiny skin or loss of hair w/decreased pulses and cool extremities has what?

A

PVD

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34
Q

Pt that has a jet black, smooth lesion on sun-exposed skin has what?

Diagnose how?

A

Melanoma

BIOPSY

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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

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37
Q

MC type of of congenital diaphragmatic hernia?

Other kind?

A

Posterior (Bochdalek)

Anterolateral (Morgagni)

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39
Q

How do you treat open-angle glaucoma?

A 
PG analogs (tafluprost)
Beta-blocker (timolol)
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40
Q

Fracture of the femoral head requires what?

Intertrochanteric fx?

Shaft fx?

What may easy the pt’s pain during transport?

A

Prosthesis

Plates

Shaft

Traction

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41
Q

What kind of glaucoma is caused by fluid being trapped in the anterior chamber?

Symptoms? Usually occur when?

A

Acute narrow angle glaucoma

Eye pain, HA, halos or corneal clouding
After being in the dark for awhile

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42
Q

What are the 3 classic features of aortic dissection?

A

Tearing chest pain radiating to the back
Asymmetric bp’s arm-to-arm
Widened mediastinum

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43
Q

What is Cushing’s Reflex?

What is most often causing it?

How to diagnose?

If midline shift give what?

A

HTN + Bradycardia

ICP from a brain mass

CT scan of head

Dexamethasone

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44
Q

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?

A

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

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45
Q

What presents w/an extremity becoming tense w/excruciating pain on passive flexion?

A

Compartment syndrome

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46
Q

What is a well-demarcated red papule in sun-exposed areas?

Metastasize?

A

SCC

It can

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49
Q

Treatment for Acute angle narrow glaucoma?

What is contraindicated?

A

A2 agonist, B-blocker, Acetazolamide

Atropine

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50
Q

How should BCC be diagnosed?

A

Full thickness biopsy of ulcer edge

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53
Q

How is Fibromuscular dysplasia managed?

A

1st w/angiography w/balloon dilation
Then stenting
If all fails go to surgery

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55
Q

If you have a PRLoma and develop apoplexy what is the only treatment?

Why?

A

IV Dexamethasone

For the corticosteroid effect to regain BP

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56
Q

What is an infectious obstruction of a hair follicle called?

A

Hordeolum

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59
Q

What is a Monteggia fracture?

A

Ulna breaks and radius dislocates (nightstick fracture)

MPU

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60
Q

How do you diagnose PVD?

Do what next?

What is done if an intervention is planned?

A

Ankle-Brachial index

US Doppler looking for pressure gradient drop

CT Angio

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62
Q

Pt that has macroscopic hematuria w/dysmprohic rbc casts has what?

Needs what?

A

Glomerular cause

Kidney Bx

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64
Q

What is Mallet finger?

Treatment?

A

Forceful flexion, CANNOT extend

Splint and NSAIDs

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66
Q

Pt fractures ankle but ambulatory, what to do?

If NON-ambulatory?

A

DO NOT image

Xray and surgery

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67
Q

Old pt that has painless U/L loss of vision w/out any other sxs, what happen?

What is pathognomonic?

Treatment?

A

Embolic occlusion of retinal a.

Cherry-red spots on fovea

Intra-arterial tPA
But also rebreathed CO2 and orbital pressure

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68
Q

When do you do an ORIF in setting of fracture?

Dx how?

A

If fracture is comminuted, angular, or open

Perpendicular X-rays

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72
Q

What causes cataracts?

Presents how?

PE shows what?

Treat how?

A

Age and DM

Progressive and chronic vision loss

White thing in ant chamber

Resection

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73
Q

SCC local lesions that have not invaded can be treated locally with what?

A

Imiquimod or radiotherapy

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74
Q

Is gastrochisis or omphalocele associated w/chromosomal abnormalities?

Which has worse prognosis?

A

Omphalocele (Beckwith-Wiedemann)

Same

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76
Q

What presents in kids w/bitemporal hemianopsia and has sella calcifications on Imaging?

A

Craniopharyngioma

77
Q

What is the only therapy that can relieve obstructing kidney stone quickly?

A

Percutaneous ureterostomy

79
Q

What position will arm be in the case of anterior dislocation of the shoulder?

MC injury after what?

What may be injured?

A

ABducted, ER “shake hand position”

Trauma to shoulder

Auxiliary nerve

80
Q

Baby that is blue at rest and pinks up with crying most likely has what?

Why?

What other unusual sign?

A

Choanal atresia

They are obligate NOSE breathers

Snores

81
Q

What is trigger finger?

What special sign?

Treatment?

A

Stenosis tenosynovitis - CANNOT extend finger

Loud pop

Splint and NSAIDs

82
Q

High-pitched blowing decrescendo murmur best heard in diastole at 4th ICS LSB is what?

Chronic condition manifests w/what?

A

AR

LVD, Wide Pulse pressure, water hammer pulse, pistol-shot pulse, Head Bobbing

83
Q

What are the anterior fossa tumors?

Who gets them?

A

Oligodendroglioma, GBM, Meningioma

Adults

84
Q

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?

A

Posterior urethral valves

Cath

Hydronephrosis, Renal dysfunction

Oligohydramnios

VCUG

85
Q

How do you diagnose secondary hyperaldosteronism?

A

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
Q

Dupuytren’s Contracture commonly seen in whom?

What is wrong?

Tx?

A

Alcoholic males and Scandinavians

Unable to extend the hand

Surgery

88
Q

How do you track AAA?

When do you go to surgery for AAA no matter what?

A

Serial US or CT scans

Pain or tenderness or Back pain

89
Q

Pt w/UTI, fever, chills, and low back pain w/tender prostate w/dirty UA has what?

Treatment?

A

Bacterial prostatitis

Long term fluoroquinolones

90
Q

Tib/fib fracture best treated how?

A

Nailing if open w/ORIF

91
Q

What is a Galezzi Fracture?

A

Radius breaks, ulna dislocates

Go LOW —> GDR

93
Q

Baby w/meconium ileus should be treated how?

A

Water-soluble contrast enema AKA gastrograffin enema

95
Q

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?

A

Acute limb ischemia

US or Arteriogram

Embolectomy, localized tPA, or heparin
6 hours

97
Q

Pt has virulent pud and diarrhea, what do they have?

First measure what?

Then do what?

Finally ID how?

A

Gastrinoma (ZE)

Serum gastrin

Secretin test

CT scan or SRS scintigraphy

98
Q

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?

A

MRI

Brain tumor - FND

100
Q

Baby w/HTN, claudication w/walking and obvious temp difference bw arms and legs suspect what?

Get what 1st?

Then what to def Dx?

A

Coarctation

BPs on arms and legs

Echo

103
Q

What are the posterior fossa brain tumors?

Who gets them?

A

Medulloblastoma, Ependymoma, Schwannoma

Kids

104
Q

Posterior dislocation of the shoulder occurs MC when?

Appears how?

A

Ext. m. Spasm - seizure or electricity

ADducted, IR

105
Q

Elderly pt w/osteoporosis FOOSH injury what happens?

Called what?

A

Radius displaced dorsally

Colles’ Fracture

106
Q

What is jersey finger?

Tx?

A

Hyperextension of finger
CanNOT flex
(Can’t fist pump)

Splint and NSAIDs

107
Q

What symptoms can RCC cause?

A

Anemia

Polycythemia

109
Q

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?

A

Eu or hyperthyroid

1 cm

Q6mo US
FNA

110
Q

Boot shaped heart on CXR is what?

Caused by what defect?

A

ToF

Endocardial cushion

112
Q

What is a Boxer’s fracture?

Tx?

A

Metacarpal fracture

Xray and cast

114
Q

Pt w/testes in normal ie and Tender cord has what?

Dx how?

treat how?

A

Acute epididymitis

US

< 35 Ceftri + Azithro
> 35 E.coli + Cipro

115
Q

What are the pituitary tumors of the brain? Who gets what?

A

Craniopharyngioma - kids
PRLoma - adults
Acromegaly - adults

118
Q

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?

A

Subarachnoid hemorrhage

CTA or MRA

LP looking for xanthochromia

119
Q

In CABG, the LAD is connected to what?

The others get what?

Pts will need to be on what medical therapy?

A

internal mammary artery

Great saphenous vein

BB, ACE-I, ASA, Statin

122
Q

Symptomatic PVD pts are managed with what medication?

A

Cilostazol

123
Q

ABI > 1.4 means what? Have to take what action?

1.0-1.4? ?

.9-1.0? ?

A

Calcified, Toe-Brachial Index

Normal, no action needed

Exercise ABI

124
Q

1st step to evaluate BPH?

Next?

Treat how?

If obstructive uropathy do what?

A

DRE - smooth, rubbery prostate

R/O Infection w/UA and UCx

Tamulosin and finasteride

In and out cath, maybe TURP

125
Q

Before replacing the valve in AS, what do you need to assess for?

With what?

A

CABG

Coronary angiography

126
Q

What do medulloblastomas and Ependymomas cause in kids?

A

HA and obstructive hydrocephalus

128
Q

What kind of PVD lesions can get a stent?

Everything else gets what?

A

In the femoral artery AND < 3cm

Bypass

129
Q

What is the MC cause of MR?

Treat how?

A

Infection or infarction (papillary m. Rupture > chordae tendonae rupture)

Replace valve or LV dilation

131
Q

Treatment for prostate cancer?

Meds?

A

Resection, radiation, brachytherapy

GnRH analogs - Leuprolide or
Anti-Androgen Flutamide

133
Q

Normal gas pattern in baby w/bilious vomiting most likely means what?

What imaging to confirm?

A

Malrotation

Contrast enema or upper GI series (better)

134
Q

What presents w/chronic, progressive central vision loss in a pt?

A

Macular degeneration

136
Q

What kind of thyroid nodule is suspicious for cancer?

Do what next?

If + do what?

A

Euthyroid pt

US guided FNA

Thyroidectomy

137
Q

What presents w/hematuria, flank pain, and a flank mass?

Diagnose how?

Treatment?

A

RCC

US then CT scan

Nephrectomy

138
Q

What are the complications of cleft lip/palate?

A

Feeding #1

OM, hearing and speech path

139
Q

What is a stye of the lacrimal duct?

A

Dacryocystitis

140
Q

Pearly or waxy lesion on the skin that is non-healing and bleeds easily is what?

Does it metastasize? Locally invade?

Diagnose how?

A

BCC

No, Yes invades

Excisional biopsy

142
Q

What are the early complications of SAH? What do you do?

Late?

A

Bleeding - give IV BB
Hydrocephalus - VP shunt/serial LP

Seizures - give antiepileptic
Vasospasm - give Nimodipine

144
Q

What is the 1st step in workup of aortic dissection?

Next?

Finally? If renal disease then do what?

A

R/O coronary disease w/EKG and troponin

Xray

CT angiogram, MRI/TEE

147
Q

To prevent vasospasm after acute infant in SAH, pt needs to be on what?

What else does the pt need to do?

A

CCB

Be on seizure prophylaxis

149
Q

Pt that has hematuria in the setting of trauma needs to get what?

What else will this imaging show?

A

Non-con CT

Kidney stones

154
Q

What is the pathology of intracranial hemorrhage?

F/u with what?

What is the #1 thing to do if pt has a brain bleed?

A

HTN

CT scan

Reverse anticoagulation

155
Q

When should you screen for AAA in men? How often?

With what?

A

Over 65 y/o and they smoked, screen only 1 time

US

158
Q

Pt w/INC insulin, INC C-peptide, and no sulfonurea has what?

A

Insulinoma

161
Q

When do you go to surgery for AAA?

A

If it is > 5.5cm or it is growing 0.5cm / 6mo

168
Q

What is a noninfectious obstruction of a gland, where the eyelid will be swollen and can shut, will heal on its own?

A

Chalazion aka stye

170
Q

Pt that has HTN and hypokalemia has what?

Get what test 1st? It will show what?

Next step do what?

Finally what?

A

Conn’s syndrome

Renin/Aldo level, will be > 20

CT to find tumor

Adrenal vein sampling to lateralize, then resect

174
Q

What is mild PVD?

Moderate?

Severe?

A

.8-.9

.4-.9

< .4

180
Q

If you see a TEF in child, what else should you look for?

A

VACTERL

182
Q

What causes a rumbling diastolic murmur w/opening snap?

A

MS

187
Q

Pt with gastrin level in the 1000’s has what?

100’s?

10’s?

A

Gastrinoma

on a PPI

Normal

188
Q

Bowel sounds over the lungs w/scaphoid ABD in a dyspneic baby means what?

Get what imaging?

Biggest problem is what?

A

Congenital Diaphragmatic Hernia

Babygram (XRAY)

Hypoplastic lung - requires intubation

189
Q

What is the 1st test to diagnose intussusception?

To treat?

A

US

Air enema

193
Q

What values indicates cardiogenic shock?

A

Cardiac index< 3 (Ventricular failure)

PCWP > 12 (too much fluid)

197
Q

1st step in evaluating a pt w/Cushing’s syndrome is what?

Next step is what?

A

24 hour urine cortisol OR overnight low-dose dexamethasone test

ACTH level

199
Q

What causes MS?

What is the treatment?

A

Rheumatic heart disease

Commissurotomy (balloon dilation)

200
Q

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?

A

Coarctation

CXR - rib notching

Arteriogram
CTA or MRA

202
Q

Pt that is hyperthyroid and has a hot nodule, what do you need to do?

A

NO biopsy needed

  • 1st get a TSH/Free T4
  • then RAIU needed if TSH shows hyperthyroid
203
Q

Fixed wide split S2 in kid is what?

Harsh systolic murmur at LLSB? Presents how?

A

ASD

VSD (MC), presents w/FTT or HF

207
Q

What causes secondary hyperaldosteronism?

A

B/L renal artery stenosis (old man, atherosclerotic disease)
OR
Fibromuscular dysplasia (young woman) —> stent

211
Q

Hirschsprung’s results bc of what?

A

Lack of inhibitory neurons, cannot relax

212
Q

What is the MC type of TEF?

What does it mean?

A

type C

Prox esophagus is BLIND and distal esophagus connects from trachea to stomach

Surgery (4 decks)

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