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Surgery > Pestana Q's > Flashcards

Pestana Q's Flashcards

1
Q

Airway management if patient is talking

A

Does not need to be secured

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2
Q

EMS should do what when patient is in shock and close to a trauma center

A

Take them right away

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3
Q

What type of shock is anaphylaxis

A

Vasomotor

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4
Q

Best tx of subdural hematoma

A

Monitor intracranial pressure
Elevate Head
Hyperventilate
Do no diurese to the point of lowering systemic pressure

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5
Q

Best treatment for rib fracture

A

Stop the pain so the patient can breath

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6
Q

White out on lungs days after chest wall trauma

A

Pulmonary contusion

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7
Q

If bleeding during trauma surgery, what do you give

A

10 units PRBC

10 units FFP and platelets

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8
Q

First test for urethral trauma

A

Retrograde urethrogram

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9
Q

Treatment of bullet to extremities if not near vessels

A

Tetanus prophylaxis and cleaning of wound

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10
Q

Treatment of clavicle fracture

A

figure of eight device or sling

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11
Q

Intertrochanteric fracture of right hip tx

A

ORIF and post op anticoagulation

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12
Q

Exam sign for compartment syndrome

A

Excruciating pain when toes are passively extended

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13
Q

Severe nutritional depletion shown by? Tx for operation to be possible

A

Loss of 20% body weight over past few months
Serum albumin below 3
Anergy to skin antigens
Serum Transferrin less than 200
Tx: 7-10 days of preoperative nutritional support

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14
Q

3 problems of an externally draining abdominal fistula

A

Fluid and electrolyte loss
Nutritional depletion
Erosion and digstion of belly wall

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15
Q

Treatment for metabolic alkalosis after vomiting

A

Normal saline and KCL

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16
Q

Symptoms of internal vs external hemorrhoids

A

External hurts

Internal bleeds

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17
Q

Best tx for small breast ca in 2nd trimester of pregnancy

A

Surgery, defer the rest

can do chemo

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18
Q

Best first test for a movable lump in the neck

A

FNA

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19
Q

First test in young woman with HTN and hypokalemia

A

Serum renin aldosterone

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20
Q

Most common type of esophageal atresia

A

Blind pouch in upper esophagus and fistula b/w lower esophagus and tracheobronchial tree

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21
Q

Meconium ileus x-ray apperance and diagnostic test

A

x-ray: multiple dilated loops of small bowel and ground glass appearance
dx: Gastrografin enema (also treats by drawing in fluid and dissolving the pelvis)

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22
Q

Vascular ring symptoms in newborns

A

stridor, respiratory distress, crowning respiration (where baby assumes a hyperextended position)

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23
Q

FEV1 to make lung cancer operatable

A

800 mL (per lung)

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24
Q

Tx for complete distal artery occlusion

A

Embolectomy with fogerty catheter

add fasciotomy if several hours passed before revascularization

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25
Q

Skin cancer that is raised and waxy

A

Basal cell

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26
Q

Strabismus in an older child indicates

A

Exaggerated convergence caused by refraction difficulties, fixed by corrective lenses

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27
Q

Workup of SCC of oral mucosa

A

Triple endoscopy
Seen in old men who smoke and drink and have rotten teeth
Often first sign is metastatic node in the neck

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28
Q

What is ludwig angina

A

Abscess in the floor of the mouth (threat to airway)

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29
Q

Preferred tx for chronic mitral stenosis

A

Surgical commisuratomy or ballon valvuloplasty

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30
Q

Best test to confirm aortic dissection

A

Spiral CT

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31
Q

Cavernous sinus thrombosis symptoms

A

Diplopia (from EOM paralysis) in patients with sinusitis

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32
Q

Acute epididymitis presentation and management

A

Fever, pyuria, swollen testis (but testis in normal position)
Do US to rule out torsion and give Ab

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33
Q

Colicky pain after a young guy drinking his first beers

A

Ureteropelvic junction obstruction

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34
Q

best dx for skin cancer

A

full thickness biopsy at the edge of the lesion

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35
Q

Branchial cleft cyst description

A

Anterior edge of SCM muscle

Sometimes has a opening and blind tract in the skin overlying them

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36
Q

Cystic hygroma features

A

large, mushy, ill defined mass as the base of the neck that occupies the entire supraclavicular area
CT before removing to be sure no mediastinal invasion

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37
Q

What type of chemo for testicular cancer

A

Platinum based

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38
Q

When is acute rejection seen

A

5 days - 3 months

Technical problems more common

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39
Q

What is it when a testicle is in the canal at birth, but can easily be pulled to where it belongs

A

Overactive cremasteric muscle, not an undescended testicle

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40
Q

When does blunt trauma to the abdomen require and exploratory lap

A

When signs of peritoneal irritation (acute abdomen) devlop

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41
Q

How are penetrating urethral injuries explored

A

Surgery

42
Q

RUQ mass that moves up and down in a baby most likely?

A

Malignant liver tumor

Afp will be elevated

43
Q

Deep unmovable RUQ mass in baby likely

A

Wilms tumor or neuroblastoma

CT to figure out

44
Q

Easiest way to biopsy breast mass

A

Mamographically or monographically guided multiple core biopsies

45
Q

Genu varum normal ages

A

Bowlegs - up to age 3

46
Q

Genu valbus normal ages

A

knock knee- up to 8

47
Q

Dinner fork fracture

A

Colles fracture - fall on outstretched hand in older women, fracture of the distal radius

48
Q

What happens when femur is driven backwards (hitting dash in car wreck)

A

Posterior dislocation of the hip

Leg internal rotated

49
Q

What can palmar fascial nodules be felt in

A

Dupuytren contracture

50
Q

Two clinical findings used to predict operative mortality in those with liver disease

A
  1. Encephalopathy

2. Ascites

51
Q

3 lab findings used to predict operative mortality in pt’s with liver dz

A

Albumin, INR, Bili

52
Q

Child class mortalities

A

A: 10%
B. 30%
C: 80%

53
Q

Tx of pyogenic liver abscess? likely 2/2?

A

Percutaneous drainage

Likely 2/2 gall bladder disease

54
Q

When are umbilical hernias normal in children

A

When they are 2-5 years old

55
Q

Test if mammogram is indeterminate

A

Radiographically guided core biopsy

56
Q

What must follow lumpectomy for breast cancer

A

Radiotherapy

57
Q

When to biopsy vs resect lymph nodes in breast cancer removal

A

If not palpable, sentinel node biopsy

If palpable, resection

58
Q

Test for persistant headache or bone pain in women who recently had breast cancer

A

MRI to look for mets

59
Q

3 possible things that can be seen in a newborn with bilious vomiting and a “double bubble”

A
  1. Duodenal atresia
  2. Annular pancreas
  3. Malrotation (also will se a normal gas pattern distal)
60
Q

Bilious vomiting and multiple air-fluid levels throughout abdomen in newborn

A

Intestinal atresia

61
Q

Subdural hematoma + retinal hemorrhages in baby

A

Shaken baby (child abuse)

62
Q

Chronic constrictive pericarditis presentation

A

DOE, hepatomegaly, ascites

Square root sign (equalization of pressures b/w heart chambers)

63
Q

Excruciating back pain in a patient with a large AAA means

A

Aneurysm is already leaking

64
Q

First manifestation of squamous cell of oral mucosa

A

Metastatic neck nodes

65
Q

What should never be done on squamous cell carcinoma of the oral mucosa? what do you do instead

A

Never do open biopsy - will interfere with surgical approach of the tumor
FNA instead

66
Q

Two year old with any unilateral ENT signs

A

foreign body

67
Q

Brain vs inner ear dizziness

A

Brain: unsteadiness but room stable

Inner ear: room is spinning

68
Q

Bradycardia and Hypertension from brain mass caused by

A

Cushing reflex

69
Q

Signs of brain tumor with shorter timeline likely? Best test

A

Think brain abscess

Use CT head (works as well as MRI and cheaper)

70
Q

Most common reason for a newborn boy to not urinate during the first day of life

A

Posterior urethral valves

71
Q

What establishes prostate Ca diagnosis

A

transrectal needle biopsy

72
Q

Most common tool to take out large ureteral stones? Who can’t get it

A

Extracoporeal shock wave lithotripsy (ESWL)

Can’t do on pregnant woman, heavy bleeders, and cm large stones

73
Q

Who gets chronic subdural hematomas? why?

A

Very old and severe alcoholics

Shrunken brain is rattled around the head by minor trauma, tearing venous sinuses

74
Q

What do you do if abdominal compartment syndrome develops during ex lap

A

Place a temporary cover over the abdominal contents

75
Q

High riding prostate means

A

Urethral injury

76
Q

How do you diagnose a bladder injury

A

Retrograde cystogram, including post void films

77
Q

Imaging for suspected posterior shoulder dislocation

A

Axillary or scapular lateral views

78
Q

When can femoral shaft fractures cause shock

A

If bilateral and comminuted

79
Q

What is needed for displaced ankle fractures

A

Open reduction and internal fixation

80
Q

Most common herniated disk areas

A

L4-S1

81
Q

Worst single predictive finding for cardiac risk before surgery

A

Jugular venous distension

82
Q

Watch out for development of what in malignant hypothermia

A

Myoglobinuria

83
Q

Zero urinary output usually caused by

A

mechanical problem, rather than a biological one

84
Q

Best fluid for severe dehydration

A

D5 1/2 NS

85
Q

What should be added to Nissen procedure if severe dysplastic changes are seen

A

radiofrequency ablation

86
Q

Medical Tx for rectal fissure

A

Dialtezam

87
Q

Blood per rectum in child likely? what test

A

Likely Mekel’s

Start workup with technetium scan, looking for ectopic gastric mucosa

88
Q

First test after US shows dilated gall bladder? Next?

A

CT abdomen for pancreatic cancer

If neg, ERCP to look for bile duct or ampulla cancer

89
Q

When does a pancreatic abscess develop

A

Fever and leukocytosis 10 days after pancreatitis onset

90
Q

Real problem with congenital diaphragmatic hernia? Tx

A

Hypoplastic lung (will still have fetal type circulation)
Wait 3-4 days to allow maturation
Extracorporeal membrane oxygenation

91
Q

What is necrotizing entercolitis

A

Seen in premature infants when they’re first fed
Rapidly dropping platelet count (sign of sepsis in babies)
Surg if abdominal wall erythema and air in portal vein seen

92
Q

Only way to rule out bladder cancer

A

Cytoscopy

93
Q

RCC odd features

A

hypercalcemia, erythrocytosis, elevated liver enzymes

94
Q

Acute rejection tx

A

Anti-thymocyte serum and steroid bolus

95
Q

Sudden chills and fever spike in renal stone indicates? tx?

A

Indicates obstruction and infection

Place nephrostomy tube or uretal stent

96
Q

Venous stasis ulcer description and tx

A

Indurated and hyper pigmented skin over medial malleolus that isn’t painful
Duplex scan for workup, then physical support to keep the veins empty

97
Q

What is Ogilvie syndrome

A

Paralytic ileum of colon seen after surgery in senile elderly
Fluid and electrolyte revelation, then colonoscopy to suck out air and place long rectal tube

98
Q

First step in workup for disabling intermittent claudication

A

doppler studies to look for ABI

If bad do CT angio or MRI angio

99
Q

What should be suspected in adult with “mild” generalized acute abodomen

A

Primary peritonitis

cultures of peritoneal fluid will only show a single organism

100
Q

Scalloping of ribs seen in

A

Coarctation of the aorta

101
Q

Diagnostic test for Hirschsprung’s

A

Full thickness biopsy of rectal mucosa

102
Q

Two most common brain tumors in children

A
  1. Medulloblastoma (cerebellar syndromes)

2. Ependymoma (knee chest position to open flow of CSF)

Surgery (8 decks)

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