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Surg Flashcards

1
Q

hypoCa, hyperK, normal renal fx –> condition?

A

hypoPTH

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2
Q

pt w classic presentation of acute appendicitis –> next step?

A

appendectomy, NOT imaging

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3
Q

small (<2cm) pneumothorax –> next step?

A

observation & supplemental O2

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4
Q

UE –> muscle weak, sensory loss –> dx?

A

syringomyelia

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5
Q

syringomyelia: pathophys

A

spinal cord –> central canal –> CSF drainage disrupted –> cyst –> compress surrounding neural tissue

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6
Q

syringomyelia: 2 most common cause

A
  • Arnold-Chiari malformation

- prior spinal cord injury –> ie whiplash

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7
Q

syringomyelia: most commonly affected which spinal tracts?

A
  • spinothalamic tract (pain & temp)

- corticospinal tract (UE motor)

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8
Q

syringomyelia: PE findings

A
  • decreased strength, pain/temp in arms/hands or cape-like distribution
  • dorsal column fx preserved –> normal light touch, vibration, position sense
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9
Q

syringomyelia: how dx?

A

MRI

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10
Q

SBO + hemodynamic instability –> next step?

A

urgent surg exploration

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11
Q

SBO –> when require immed surg (3)?

A
  • clinical/hemodynamic instability
  • fail to improve after initial conservative measures
  • dev ssx of ischemia/necrosis
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12
Q

ileus –> classic XR finding?

A

small & large intestine –> gas-filled, uniformly distended w no transition pt

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13
Q

traumatic injury –> abd pain –> most likely dx?

A

paralytic ileus

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14
Q

ileus –> causes (4)

A
  • # 1 abd surg
  • retroperitoneal/abd hemorrhage/inflamm
  • intestinal ischemia
  • electrolyte abnormal
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15
Q

arm –> full thick burn –> circumferential –> eschar formation –> leads to what condition?

A

eschar –> restrict venous/lymph drain –> acute cmpt synd

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16
Q

acute cmpt synd –> clinical features

A
  • pain out of proportion to injury
  • pain increase w passive stretch
  • rapid & tense swell
  • paresthesia (early)
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17
Q

twisting injury w foot fixed –> what condition?

A

medial meniscus tear

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18
Q

meniscus tear –> clinical presentation

A
  • reduced knee extend
  • sensation of instability
  • effusion
  • palpable lock/catch when extend jt while under load
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19
Q

meniscus tear –> how confirm dx?

A

MRI or arthroscopy

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20
Q

meniscus tear –> tests?

A
  • Thessaly test

- McMurray test

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21
Q

what is Thessaly test? Positive test indicates?

A

stand on 1 leg –> flex knee 20deg –> int/ext rotate on flexed knee –> pain/click/catch –> meniscal tear

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22
Q

what is McMurray test? Positive test indicates?

A

hold knee in int/ext rotate –> passive knee flex/ext –> pain/click/catch –> meniscal tear

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23
Q

clavicle fx –> next step? why?

A

careful neurovasc exam –> r/o injury to brachial plexus, subclavian A

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24
Q

1 measure to prevent postop pulm comp

A

incentive spirometry –> promote lung expansion

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25
Q

what is Kehr’s sign

A

acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated

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26
Q

diffuse abd pain + guarding + pain in shoulder –> condition?

A

peritonitis

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27
Q

acute chem peritonitis –> what part of bladder ruptured?

A

dome

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28
Q

peritonsillar abscess –> tx

A

needle aspiration/I&D + abx

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29
Q

peritonsillar abscess –> clinical presentation

A
  • fever
  • pharyngeal pain
  • earache
  • trismus
  • muffled voice
  • swelling of peritonsillar tissues w uvula deviation
30
Q

varicocele –> clinical presentation

A
  • soft scrotal mass “bag of worms” –> decrease in supine, increase w stand/valsalva
  • subfertility
  • testicular atrophy
31
Q

meniscal tear –> tx?

A

mild ssx, older pt:

  • rest
  • modify activities

persistent ssx, impaired activity:
- surg

32
Q

postop fever –> blood cultures reveal coag-neg staph –> seen most often in what kind of pts?

A

pts w intravasc devices

33
Q

stress fracture –> RF (5)?

A
  • repetitive activies (running, gymnastics)
  • abrupt increase in physical activity
  • inadeq Ca, vitD
  • inadeq calories
  • female athlete triad: inadeq calories, hypo/amenorrhea, low bone density
34
Q

stress fracture –> tx?

A
  • reduce wt-bearing for 4-6wk

- if at high risk for malunion (anterior tibial cortex, 5th metatarsal) –> refer to ortho

35
Q

blunt trauma to chest –> pneumothorax –> chest tube –> persistent pneumothorax –> condition?

A

tracheobronchial rupture

36
Q

tracheobronchial rupture –> clinical findings

A
  • persistent pneumothorax despite chest tube placement
  • pneumomediastinum
  • subcut emphysema
37
Q

gunshot at 6th intercostal space –> pt unstable –> next step?

A

exploratory laparotomy

38
Q

penetrating wound below what level is considered to involve abd?

A

4th intercostal space (level of nipples)

39
Q

postop atelectasis –> when after postop?

A

postop day 2

40
Q

postop atelectasis –> RF (4)?

A
  • airway obstruction from retained airway secretions
  • decreased lung compliance
  • postop pain
  • meds that interfere w deep breathing
41
Q

postop atelectasis –> ABG results? why?

A

hypoxemia, hypocapnia, resp alk

lung collapse –> decrease lung vol –> V/Q mismatch –> hypoxemia –> tachypnea –> hypoCO2 & resp alk

42
Q

massive hemoptysis –> initial management?

A

estab adeq patent airway

43
Q

massive hemoptysis –> in what position should pt be placed?

A

lat position w bleeding lung in dependent position –> avoid blood collection in opp lung

44
Q

massive hemoptysis –> initial procedure of choice? why?

A

bronchoscopy

  • localize bleeding site
  • provide suction ability to improve visualization
  • other therapeutic interventions possible (balloon tamponade, electrocautery)
45
Q

severe burn –> wound infect & sepsis –> what org if soon after injury? If after 5days?

A

soon after burn –> G+

after 5day –> G-, fungus

46
Q

burn wound infect –> 1st sign?

A
  • change in burn wound appearance

- loss of skin graft

47
Q

burn wound infect –> dx?

A
  • quantitative wound culture

- bx for histopath

48
Q

young pt –> midline hard palate –> fleshy immobile mass –> condition?

A

torus palatinus

49
Q

torus palatinus –> tx?

A

asymptomatic: none

symptomatic, interfere w speech/eat: surg

50
Q

flail chest –> pathophys?

A

> 3 contiguous ribs fractured in >2 locations

51
Q

ischemic colitis –> CT findings?

A
  • thickened bowel wall

- pneumatosis coli

52
Q

ischemic colitis –> colonoscopy findings?

A
  • cyanotic mucosa

- hemorrhagic ulcerations

53
Q

hematuria –> indicates damage to what?

  • during initial part of voiding
  • at end of void
  • continuously thru void
A
  • initial: urethra
  • terminal: bladder, prostate
  • total: kidney, ureter
54
Q

ant shoulder dislocation –> cause?

A

glenohumeral jt –> forceful abduct & ext rot

55
Q

ant shoulder dislocation –> can damage what N? Leads to what signs?

A

Axillary:

  • deltoid: weak shoulder abduct
  • lat shoulder: sensory
56
Q

GI perforation –> next step?

A

exploratory laparotomy

57
Q

blunt abd trauma –> GI perforation –> pathophys?

A

blunt trauma –> damage mesenteric blood supply –> necrosis –> GI perforate

58
Q

blunt trauma to abd & chest –> tachycardia, hypotension –> condition?

A

splenic laceration

59
Q

splenic injury –> ssx?

A
  • abd pain
  • tachycardia
  • L shoulder pain
60
Q

blunt trauma to abd & chest –> what happens to:

  • preload
  • cardiac output
  • ejection fraction
A

massive internal hemorrhage –> hypovol shock:
decreased venous return –> decreased preload –> decrease cardiac output –> activate sympathetic –> increase SVR & HR –> increase ejection fraction

61
Q

ant spinal cord infarct –> potential comp of what procedure?

A

thoracic aortic aneurysm surg

62
Q

ant spinal cord synd –> ssx

A
  • spinal shock: bilat flaccid paralysis, loss of pain/temp
  • days-wks –> UMN: spastic, hyperreflex
  • normal vibrate, proprioception
63
Q

umbilical hernia –> assoc w?

A
  • black
  • premature
  • Beckwith-Wiedemann
  • hypothyroid
64
Q

pt w renal dz –> surg –> DVT –> tx? for how long?

A
  • unfractionated hep for acute

- warfarin for 3 mo

65
Q

pilonidal dz –> pathophys

A

intergluteal region –> hair follicle occlude –> edema, infect –> abscess –> rupture –> sinus tract –> sit, stand –> hair/debris into sinus tract –> recur infect

66
Q

pilonidal dz –> who?

A
  • 15-30yo M
  • obese
  • sedentary
  • deep gluteal cleft
67
Q

pilonidal dz –> presentation?

A

interglut region –> 4-5cm cephalad to anus –> painful, fluctuant mass –> mucoid/purulent/bloody discharge

68
Q

acute adrenal insuff –> etiology?

A
  • adrenal hemorrhage/infarct

- chronic adrenal insuff, glucocorticoid use –> acute illness/injury/surg

69
Q

acute adrenal insuff –> tx?

A
  • hydrocortisone, dexamethasone

- IVF

70
Q

acute adrenal insuff –> ssx

A
  • hypotension
  • vomit
  • abd pain
  • fever
71
Q

rhinoplasty –> whistling noise during respiration –> condition?

A

septal hematoma –> nasal septal perforation

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