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Surgery Shelf > Qbank and Pretest > Flashcards

Qbank and Pretest Flashcards

1
Q

What is indicated for circumferential full thickness burns of an extremity causing edema and decreased peripheral pulses?

A

Escharotomy

If this fails then fasciotomy

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2
Q

What are some signs of pulmonary contusion? What can make it worse?

A

Hypoxemia and patchy alveolar infiltrate

Made worse by IVF

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3
Q

When and why is surgery indicated in a newborn hydrocele?

A

If it lasts longer than 12 months (normally regresses on its own)
Indicated because of increased risk of indirect inguinal hernia

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4
Q

A patient has intense pain at the wound site, cloudy-gray discharge, decreased sensitivity at wound edges, fever, hypotension, and tachycardia- diagnosis?

A

Necrotizing surgical infection

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5
Q

What is the pathogenesis behind a varicocele? Presentation?

A

Swelling of the pampiniform plexus of veins
Dull, aching pain of testes
More common of L side

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6
Q

A patient who was pulled out of burning building appears normal on exam. Treatment?

A

Suspect acute CO poisoning–> treat with 100% O2

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7
Q

What triad consists of impotence, hip and thigh claudication, and symmetric atrophy of lower extremities?

A

Aortoiliac occlusion

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8
Q

What is the work up fo a suspected intraabdominal injury in a hemodynamically unstable patient?

A

FAST sonogram or diagnostic peritoneal lavage

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9
Q

What is the diagnosis of a patient who presents like a pneumothorax but DULLNESS to percurssion?

A

Hemothorax

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10
Q

A patient has paradoxical thoracic movements that correct with positive pressure mechanical ventilation- diagnosis and cause?

A

Flail chest caused by broken ribs

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11
Q

What part of tetanus vaccine causes passive immediate immunity?

A

TIG

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12
Q

What part of tetanus vaccine causes active delayed immunity

A

Td

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13
Q

What is associated with a burst fracture of the vertebrae and how does it present?

A

Anterior cord syndrome

Presents with total loss of motor function and bilateral loss of pain and temperature sensation below the lesion

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14
Q

First line treatment for stress fracture?

A

Rest and analgesics

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15
Q

What is the primary objective in management of rib fracture and why?

A

Pain relief–> allows proper ventilation to prevent pneumonia and atelectasis

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16
Q

A patient on coumadin needs emergent ex lap- what needs to be done?

A

FFP to reverse coumadin

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17
Q

A patient is recovering from AAA surgery and has thickening of bowel wall on CT- diagnosis? What will colonoscopy show?

A

Colonic ischemia due to interference of blood flow

Scope shows sharp transition zone from affected to unaffected area

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18
Q

A patient presents with delayed onset of hypotension, abdominal pain, and left shoulder pain following blunt abdominal trauma- diagnosis and work up?

A

Splenic injury

Get CT scan with IV contrast

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19
Q

What is the first sign of hypovolemia?

A

Tachycardia

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20
Q

A patient presents with JVD, decreased breath sounds, hypotension, and tracheal shift- diagnosis and treatment?

A

Tension pneumothorax

Tx: needle thoracostomy

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21
Q

After placing NG tube, X-ray shows NG tube coiled up in thoracic cavity- diagnosis?

A

Diaphragmatic hernia

More common on left side

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22
Q

What is the work up of penile fracture?

A

Urethral imaging to assess injury then surgery

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23
Q

What is the work up of a patient with massive hemoptysis?

A

First hemodynamically stabilize–> intubate to protect airway–> bronchoscopy to visualize and stabilize bleed

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24
Q

What should be suspected if a post-op patient has hypotension, hypoglycemia, abdominal pain, and N/V?

A

Pre-op steroid dependence

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25
Q

What is the course of care for a patient with a spinal cord injury?

A

Stabilize hemodynamically–> proper airway management–> urinary catheter placement

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26
Q

A trauma patient has symptoms of cholecystitis but NO stones- diagnosis? Risk factors

A

Acalculous cholecystitis

Risk factors- prolonged TPN, multiorgan failure, burns, sepsis, severe trauma

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27
Q

How to differentiate between Borhaave and Mallory-Weiss on physical exam?

A

Pneumomediastinum occurs in Borhaave- crepitus and retrosternal pain

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28
Q

A patient has numerous minute punctate hemorrhages with blurring of gray-white interface on CT scan of the head and physical exam findings are out of proportion- diagnosis?

A

Diffuse axonal injury

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29
Q

How to tell the difference between embolic occlusion and arterial thrombosis? DVT?

A

Embolic occlusion- pulseness and sudden severe pain
Arterial thrombosis- diminished pulses with progressive onset
DVT- does not affect pulse

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30
Q

Diagnosis of a congenital benign bony growth in the midline of hard palate

A

Torsus palatinus

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31
Q

An elderly patient has a fall and presents afterwards and is stable- what is the first part of the work up?

A

Cardiac tests to find etiology of the fall

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32
Q

Patient with suspected peripheral artery disease has normal ABI- next step?

A

Redo ABI after exercise

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33
Q

A patient post-op from cardiac surgery has acute mediastinitis- treatment?

A

Drain and debride then antibiotics- NOT antibiotics alone

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34
Q

A patient with blunt head trauma has worsening neurologic signs including CN III paralysis, ipsilateral hemiparesis- diagnosis?

A

uncal hernia due to epidural hematoma

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35
Q

After a blunt trauma, CXR shows deviated mediastinum with mass in lower left chest- work up and diagnosis?

A

Visceral perforation into diaphragm

Work up with barium swallow

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36
Q

What is the treat for a slipped capital femoral epiphysis in an obese adolescent? Why

A

Prompt surgery via pinning of slipped epiphysis

Without surgery, major risk of avascular necrosis of femoral head

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37
Q

What is the most common source of infection of submandibular and sublingual glands? What is the worried complication?

A

Teeth

Asphyxiation

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38
Q

Patient has hypotension and back pain following cardiac cath- diagnosis and work up?

A

get CT scan of abdomen

Probably retroperitoneal bleeding

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39
Q

What drugs can induce pancreatitis?

A

Furosemide, thiazide, sulfasalazine, azathioprine, valproic acid, AIDS, metronidazole, tetracycline

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40
Q

What is the most common cause of adrenal insufficiency in a patient from USA? Foreigner?

A

USA- autoimmune

World- TB

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41
Q

What causes ruptured submucosal veins @ GE junction?

A

Esophageal varices

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42
Q

What causes ruptured submucosal arteries in distal esophagus?

A

Mallory-Weiss tears

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43
Q

What are dyspepsia’s alarm symptoms?

A

Weight loss, dysphagia, persistent vomiting
Use upper endoscopy if alarm symptoms are present
If absent, use H. pylori serologic testing

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44
Q

What is the gold standard for acromegaly?

A

GH levels following glucose load

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45
Q

Patient presents in shock that WORSENS with fluid?

A

Myocardial contusion or other cause of myocardial shock

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46
Q

What should always follow central line placement?

A

CXR to confirm placement

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47
Q

How to manage non-bleeding varices?

A

Medically manage

Only use sclerotherapy if bleeding occurs

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48
Q

What is the intubation of choice with patients with cervical spine injury?

A

Orotracheal intubation

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49
Q

A patient has a widened mediastinum with a left sided hemothorax- diagnosis?

A

Aortic rupture

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50
Q

Abdominal pain radiating to the shoulder is caused by what?

A

Irritation to the diaphragm

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51
Q

A patient presents after trauma but is hemodynamically stable. He has abdominal bruises and a normal CT scan. A week later he is acutely worse- diagnosis?

A

Pancreatic abscess

Spleen injury would show up on CT scan

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52
Q

What is the management of an asymptomatic patient with head trauma?

A

Can be sent home if CT scan is normal

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53
Q

A patient has acute pain and swelling of midline coccyx- diagnosis and pathogenesis?

A

Pilonidal cyst due to hair follicle abscess

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54
Q

An elderly patient with hyperextension injuries has pronounced weakness in the upper extremities compared to the lower extremities- diagnosis?

A

Central cord syndrome

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55
Q

A burn victim has low oxygen- treatment?

A

Intubation

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56
Q

What is a marjolin ulcer?

A

Non-healing lesion after burn or trauma that increases in size- squamous cell cancer

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57
Q

A patient presents with a clavicle fracture- what is the first step in treatment?

A

Neurovascular workup

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58
Q

What is a common contributor to post-op ileus?

A

Morphine

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59
Q

What is the treatment for duodenal hematoma?

A

NG tube and TPN

If it does not resolve then surgery is indicated

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60
Q

In a patient with high bone turnover, what can prolonged immobIlization cause?

A

Hypercalcemia from activation of osteoclasts

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61
Q

How to differentiate follicular adenoma from carcinoma?

A

Invasion of tumor capsule and blood vessels

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62
Q

What is the best way to reduce decline in GFR in patient with diabetic nephropathy

A

Intensive blood pressure control

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63
Q

What agents can treat hyperkalemia?

A

Insulin, glucose, NaHCO3, beta-2 agonists

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64
Q

What is the first sign of hypocalcemia?

A

Hyperactive DTR

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65
Q

What effect does hypermagnesemia have on DTR?

A

DECREASED DTR

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66
Q

What are the ADH, renin and aldosterone levels in hypovolemic hyponatremia?

A

All decreased

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67
Q

What is the respiratory quotient- for carbs, protein, fatty acids?

A

Rate of CO2/O2 consumed

  1. 0 for carbs
  2. 8 for protein
  3. 7 for FA
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68
Q

What causes Trendelenburg sign?

A

Weakness in gluteus minimus and medius

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69
Q

A breast mass is fluctuant on physical exam- treatment?

A

Most likely an abscess so drainage

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70
Q

Needle crystals in urine indicate what?

A

Uric acid stones

Diagnose via CT of abdomen

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71
Q

What is Morton’s neuroma?

A

Mechanically induced degenerative neuropathy seen in runners

Presents with pain between 3rd and 4th toes reproducible by palpation

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72
Q

What is the leading diagnosis for a pulsatile mass below the inguinal ligament?

A

Femoral artery aneurysm

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73
Q

A patient with a small bowel obstruction has lactic acidosis- why?

A

Ischemia due to strangulated portion of bowel

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74
Q

What will a biopsy of IBD show?

A

Neutrophilic cryptitis

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75
Q

An patient with IBD is acutely ill- work up?

A

Abdominal X-ray

Do not give sigmoidoscopy if acutely ill

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76
Q

Suspected ZE syndrome should receive what work up?

A

Fasting serum gastrin levels

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77
Q

Why would a patient with a GI bleed have an elevated BUN/Cr ratio?

A

Mild volume depletion

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78
Q

What is the treatment for an acute anal fissure?

A

Local anesthesia and stool softeners

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79
Q

What is the treatment for chronic anal fissue?

A

Lateral sphincterotomy

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80
Q

What occurs following acute overdose of aspirin?

A

Acute erosive gastritis with upper GI bleed

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81
Q

What is the presentation of thyrotoxicosis? What causes hypertension in these patients?

A

Present with weight loss, irritability, tachycardia, and lid retraction
HTN caused by hyperdynamic circulation–> increased T3/T4 increases sensitivity to catecholamines

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82
Q

An older patient with unexplained constipation and elevated ESR could possibly have what?

A

Hypercalcemia due to multiple myeloma

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83
Q

What is the differential diagnosis for normotensive patient with hypokalemia and metabolic alkalosis?

A

Diuretic use
Surreptitious vomiting
Bartter syndrome- defective Na and Cl reabsorption in thick ascending limb
Gitelamn syndrome is defect in distal convoluted tubule

84
Q

Most common cause of thyrotoxicosis with reduced iodine uptake is?

A

Subacute thyroiditis

85
Q

How is metabolic alkalosis characterized?

A

Urine chloride levels
>20 is chloride resistant and has ECF volume expansion
<20 is chloride sensitive and has ECF volume contraction

86
Q

What are some causes of Cl resistant metabolic alkalosis? Does saline infusion correct it?

A

Hyperaldosteronism, Bartter syndrome

Na infusion does NOT help

87
Q

What are some causes of Cl sensitive metabolic alkalosis? Does saline infusion correct it?

A

Vomiting or diuretics abuse

Na infusion helps

88
Q

A patient has unexplained elevated CK and myopathy- what is the first test to be ordered?

A

Serum TSH- hypothyroidism can cause these symptoms

89
Q

When is succinylcholine contraindicated?

A

In hyperkalemia- causes life threatening arrhythmias

90
Q

What is the treatment for hypercalcemia?

A

Fluid resuscitation

91
Q

What is the presenting symptom in hypocalcemia caused by hypoalbuminemia?

A

NO SYMPTOMS- no change in ionized calcium levels

92
Q

An alcohol patient has refractory hypokalemia- why?

A

Hypomagnesemia can cause refractory hypokalemia as Mg is a cofactor for K uptake into cells

93
Q

Why would a patient with metabolic acidosis have a PaCO2 of 40?

A

Mixed acidosis

94
Q

A patient has hyponatremia and maximally diluted urine- diagnosis?

A

Primary polydipsia

95
Q

What is the best screening test for virulizing neoplasm?

A

Serum testosterone and DHEAS levels
Increased T and normal DHEAS indicate ovarian source
Increased DHEAS and normal T indicated adrenal source

96
Q

How does acidosis cause hypocalcemia?

A

Increased pH–> increased affinity of serum albumin to bind calcium–> decreased ionized calcium

97
Q

What is the treatment for acne?

A

Oral retinoids–>oral antibiotics–>topical retinoids

98
Q

A patient presents with vertigo, postural instability, vomiting, and nystagmus- diagnosis and treatment?

A

Meniere’s disease

Low salt diet, avoid alcohol and nicotine

99
Q

What is the most common thyroid nodule?

A

Colloid nodule

100
Q

What is the fastest way to correct for hyperkalemia?

A

Insulin and glucose

101
Q

A patient has symptoms of hyperthyroid but decreased uptake studies- what will be seen on biopsy?

A

Atrophy of follicles- this is exogenous thyroid hormone use

102
Q

A patient with cirrhosis has signs of infection- what is the first test to order?

A

Diagnostic paracentesis

103
Q

A patient with a normal colonoscopy two years ago now has a GI bleed- diagnosis?

A

Angiodysplasia

104
Q

Stepwise approach to treatment of ascites?

A

NA and H2O restriction–> spironolactone–> loop diuretics–> abdominal paracentesis

105
Q

How to treat hypernatremia?

A

Euvolemic or hypervolemic- 5% dextrose

Hypovolemic- normal saline

106
Q

A patient with a history of PUD surgery presents with abdominal pain, watery diarrhea and weight loss- diagnosis?

A

Possibly bacterial overgrowth following surgery

107
Q

What is the best initial screening test for adrenal insufficiency?

A

Cosyntropin- cortisol should increase after

108
Q

What is associated with aspirin exacerbated respiratory disease?

A

Nasal polyps

109
Q

What acid-base status does aldosterone deficiency cause?

A

Non-anion gap metabolic acidosis

110
Q

What is the most feared complication of retropharyngeal abscess?

A

Mediastinal involvement

111
Q

What could be the reason a patient with hyperthyroidism presents 3 days later acutely worse?

A

Radioactive iodine therapy caused release of thyroid hormone from dying cells

112
Q

If left untreated, what is a major concern with hyperthyroidism?

A

Bone loss

113
Q

A patient has a pancreatic mass with diarrhea, leg cramps and hypokalemia- diagnosis?

A

VIPoma

114
Q

What is a common cause of conductive hearing loss?

A

Osteosclerosis

115
Q

What causes a respiratory alkalosis during pregnancy?

A

Increased progesterone

116
Q

A patient with persistent diarrhea has biopsy showing dark brown discoloration of the colon with lymph follicles shining through as pale patches- diagnosis?

A

Melanosis coli with LAXATIVE ABUSE

117
Q

A patient who grinds his teeth at night has ear pain that is worse with chewing- diagnosis?

A

Temporomandibular joint dysfunction

118
Q

What is the most common neuropathy seen in diabetes?

A

Symmetric distal polyneuropathy

119
Q

Otoscopic exam finds granulation tissue in the external auditory canal- diagnosis and treatment?

A

Malignant otitis externa due to pseudomonas infection–> treat with ciprofloxacin

120
Q

What is the acid-base status of a patient in aspirin overdose?

A

Close to normal pH with decreased CO2 and decreased HCO3

121
Q

How can you differentiate between primary and secondary hypogonadism?

A

Primary has increased FSH and LH

Secondary has low FSH and LH-> check prolactin levels

122
Q

What is presbycusis?

A

Sensorineural hearing loss that occurs with age

123
Q

What is demeclocycline used to treat?

A

SIADH

124
Q

What is used to treat diabetes insipidus?

A

Desmopressin

125
Q

A patient has diarrhea, trouble remembering things, and a new malar rash- diagnosis?

A

Pellagra due to niacin deficiency

126
Q

What is the timeline of collagen deposit in wound healing?

A

Fibroblasts appear on day 3 to deposit type III collagen. Collagen content is maximum at 2-3 weeks and then type I collagen dominates

127
Q

What is the treatment for 3rd degree burns?

A

Excision of burns 3-7 days after injury
Topical Antibiotics
Split-thickness skin grafts at least 1 week after injury
Intubation and oxygen

128
Q

When should a cleft lip and palate be repaired?

A

Lip- first 3 months

Palate- 12-18 months w/ SPEECH therapy

129
Q

Which cytokines/ growth factors stimulate collagen synthesis?

A

TGF
TNF
IL-1

130
Q

Why cytokines/growth factors stimulate fibroblasts?

A

TGF, TNF, FGF, IL-1

131
Q

What happens to insulin levels during acute injury?

A

Slight decrease due to catecholamines followed by increase

132
Q

What diagnosis would show a “coiled spring” appearance of the 2nd and 3rd portion of the duodenum?

A

Hematoma- treat with NG tube and observation

133
Q

Which extremity fracture or dislocation is associated with the highest risk of vascular injury?

A

Knee dislocation

134
Q

Which gun shot patients are subject to ex lap?

A

Shot below T4

135
Q

What is the gold standard for diagnosing myocardial contusion?

A

First pass radionuclide angiography and echo- assess ventricular wall motion and EF

136
Q

What is the first part of the work up of penetrating injury to the rectum?

A

Flex sigmoidoscopy in the ER

137
Q

Why is surgery still indicated in vascular injury to extremity even if pulses are palpable?

A

Palpable pulses do not rule out arterial injury

138
Q

Why do K levels rise in shock?

A

Release from tissues
Decreased renal perfusion
Anaerobic metabolism

139
Q

What is the most common cause of death in patients with penetrating pancreatic injury?

A

Exsanguination from associated vascular injury

140
Q

A patient admitted with a MI has low T3 with normal T4 and TSH- what thyroid disease is present?

A

Sick euthyroid syndrome- normal reaction to acute illness

141
Q

A diabetic patient presents with a non-anion gap metabolic acidosis and hyperkalemia. Why do they have hyperkalemia?

A

Renal tubular acidosis

142
Q

What causes impotence in a pelvic fracture?

A

Parasympathetic nerve damage

Penile fracture is different- venogenic damage causes impotence

143
Q

What are some diagnostic tests for lactose intolerance?

A

Positive hydrogen breath test
Acidic stool pH
Increased stool osmotic gap

144
Q

What is the first test in a patient less than 50 years old who presents with minimal BRBPR and no risks for colon cancer?

A

Anoscopy/proctoscopy

145
Q

What is the treatment of choice for diabetic neuropathy?

A

Tricyclic antidepressants such as amitriptyline

146
Q

What is a lactotroph adenoma?

A

Prolactinoma

147
Q

A patient with a history of PUD presents with hypokalemic hypochloremic metabolic alkalosis and persistent vomiting- diagnosis and treatment?

A

Gastric outlet obstruction

Treat with stomach decompression, hydration with chloride and potassium replacement

148
Q

What drugs can cause esophagitis?

A

Tetracyclines, Aspirin, Alendronate, KCl

149
Q

What is an early sign of hypermagnesemia?

A

Loss of deep tendon reflexes

150
Q

How to treat acute severe hyponatremia following surgery?

A

Water restriction first

Hypertonic saline second

151
Q

Why are patients who lack ileum or jejunum at increased risk for Ca oxalate stones?

A

Excess free fatty acids binding Ca and allowing oxalate to be reabsorbed

152
Q

What could cause post-op tetany with normal calcium?

A

Hypomagnesemia

153
Q

A patient 4 weeks post op wants colostomy closed- what is the first part of the work up?

A

Make sure heart problems are under control

154
Q

What is the treatment for metabolic alkalosis with respiratory compensation when patient is hypovolemic?

A

Fix volume- normal saline should fix alkalosis if kidneys are normal

155
Q

What disturbance is seen with aspirin overdose?

A

Anion gap metabolic acidosis with respiratory alkalosis

156
Q

Why should a hernia repair be delayed?

A

Signs of heart failure

157
Q

A patient with recent MI has abdominal pain and blood in the stool- what is the first part of the work up?

A

Angiography- possible acute mesenteric ischemia

158
Q

What is the treatment for von Willebrand disease?

A

Cryoprecipitate

159
Q

What is the most worrisome complication intraoperatively and postoperatively in patient with polycythemia?

A

Hemorrhage

160
Q

Patient with abdominal trauma is given PRBC but develops coagulopathy- why?

A

Factor V and VIII deficiency

161
Q

What is the order in which the GI system regains function following surgery?

A

Small intestine–> stomach–> colon

162
Q

Patient on heparin begins to hemorrhage- how should the be treated?

A

Stop heparin, give protamine, insert vena cava filter

163
Q

What is a worry for a patient on long term steroids post op? What are some presenting signs?

A

Adrenal insufficiency

Look for mental status changes, hypoglycemia, hyperkalemia

164
Q

When can FFP be given for surgery in trauma?

A

On way to OR- 4-6 hour half life for FFP

165
Q

A post-op patient has serosanguinous fluid from the incision- what has happened?

A

Disruption of deep fascia- reclosure in the OR

166
Q

40 year old woman with 1-2 cystic mass- what is the next step in the management?

A

Aspiration of the mass

167
Q

Teenage girl has 1400g tumor in the breast with a firm lobulated whirled appearance- what is it?

A

Fibroadenoma

168
Q

Can a pregnant woman get chemotherapy?

A

Only in 3rd trimester

169
Q

What can Meckel’s diverticulitis present like?

A

Appendicitis

Cecal diverticulitis can present as appendicitis too!

170
Q

When is splenectomy indicated in asymptomatic ITP?

A

When platelet counts increase drastically after corticosteroid use

171
Q

What is the most common complication of an end colonostomy

A

Parastomal hernia

172
Q

A patient presents three weeks after surgery for perforated PUD with postprandial weakness, cramps, diarrhea, and sweating- diagnosis and treatment?

A

Dumping syndrome

Treatment is watchful waiting- should go away in 3 months

173
Q

A patient with benign gastric PUD fails 6 weeks of medical treatment- what is next step?

A

Bilroth 1

174
Q

An elderly patient with no PMH/PSH presents with SBO and aerobilia- diagnosis?

A

Biliary enteric fistula with gallstone ileus

175
Q

What is the treatment for Hirschsprung’s disease?

A

Colostomy decompression until nutritional status is adequate and bowel has returned to normal size–> then definitive repair

176
Q

What is the clinical course of pediatric umbilical hernia?

A

Should spontaneously resolve by age 4

Exception is massive enlargement or incarceration

177
Q

A 9 year old comes in with massive UGI bleed- diagnosis?

A

Bleeding esophageal varices due to infection via patent umbilical vein

178
Q

What is the work up of anal cancer?

A

CT scan of abdomen for metastasis

Transanal ultrasound to look for depth of invasion

179
Q

Is the pancreas necessary for protein digestion?

A

Yes, but still 95% of protein meal can be digested by brush border enzymes in absence of pancreas

180
Q

Where does carbohydrate absorption take place?

A

Almost all is absorbed by the end if the jejunum

181
Q

How is milk digested in the duodenum?

A

Everything but the fat

182
Q

What are 4 factors to assess when a patient in a trauma setting is in hypotensive shock?

A

HR- arrhythmias
Preload- decreased volume (hemorrhage), obstruction (tension pneumothorax, cardiac tamponade)
Contractility- CHF, myocardial contusion
SVR- massive vasodilation (sepsis, anaphylaxis, spinal trauma, anesthetics, ANS)

183
Q

What is the major presenting difference between tension pneumothorax and pericardial tamponade

A

THE LUNGS: tension pneumothorax has absent breath sounds and hyperresonance
Pericardial tamponade has normal lungs

184
Q

What is associated with hypocalcemia?

A

Prolonged QT interval
Hypomagnesemia
Hypoproteinemia

185
Q

What part of the GI tract has fluid most consistent with Lactate Ringers?

A

Small bowel and bile

186
Q

How can you counteract the effects of hyperkalemia on the myocardium without affecting serum levels of K?

A

Calcium gluconate

187
Q

What are 3 physiologic alterations seen in ARDS?

A

Decreased compliance
Decreased FRC
Hypoxemia

188
Q

What is true about metastatic potential of papillary thyroid cancer?

A

Commonly metastasizes to cervical lymph nodes

Not aggressive anywhere else and not aggressive invader

189
Q

What is the treatment for acalculous cholecystitis?

A

Percutaneous gallbladder drainage

190
Q

A child presents an hour after ingesting lye drain cleaner- treatment?

A

Antibiotics and steroids- help lessen chance of stricture formation

191
Q

What is the best test for establishing diagnosis and degree of myocardial dysfunction?

A

Radionuclide angiography- shows loss of compliance

192
Q

What is the treatment of thoracic outlet syndrome if conservative management fails?

A

decompression of brachial plexus

193
Q

What is the best test to see if TPN is providing adequate nutrition?

A

Albumin

194
Q

What is gastric outlet obstruction syndrome’s effect on the kidney and acid base status?

A

Increases Na-H exchange in distal tubule causing paradoxical aciduria
Gastric outlet obstruction is an alkalotic state due to vomiting/suction

195
Q

What is the physiologic effect of shivering?

A

Increased BMR–>increased O2 consumption–> increased CO2 production
Can lead to lactic acidemia

196
Q

What hiatal hernia needs surgery most urgently?

A

Type II- paraesophageal has highest risk of strangulation or obstruction

197
Q

What is the treatment for asymptomatic carotid artery stenosis of 60% or greater

A

Carotid endarterectomy

198
Q

What is subclavian steal syndrome?

A

Occlusion of the subclavian artery before the vertebral arter branches off causing intermittent claudication in a particular extremity (usually left)

199
Q

During an appendectomy a 4 cm carcinoid tumor is found- is further intervention needed?

A

Yes- right hemicolectomy should be performed

200
Q

What can a very high level of CEA signifiy?

A

Liver involvement

201
Q

PUD surgery- type 1 ulcer (on lesser curvature)

A

Antrectomy alone

202
Q

PUD surgery- elderly patient with bleeding duodenal ulcer

A

Vagotomy and pyloroplasty

Not worried about high recurrence rate

203
Q

PUD surgery- type III (pyloric) ulcer refractory to medical treatment

A

Antrectomy with vagotomy

204
Q

An elderly patient presents with vomiting, pain, distention and has grossly dilated loop of intestine shaped like an upside down U- diagnosis and treatment?

A

Sigmoid volvulus

Diagnose and treat with sigmoidoscopy

205
Q

What is the most common movement that tears a meniscus?

A

Flexion with rotation

206
Q

What is Volkmann’s ischemic contracture?

A

Supracondylar fracture of the humerus leading to compromise of blood supply and compartment syndrome

Surgery Shelf (2 decks)

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