Surg Flashcards
hypoCa, hyperK, normal renal fx –> condition?
hypoPTH
pt w classic presentation of acute appendicitis –> next step?
appendectomy, NOT imaging
small (<2cm) pneumothorax –> next step?
observation & supplemental O2
UE –> muscle weak, sensory loss –> dx?
syringomyelia
syringomyelia: pathophys
spinal cord –> central canal –> CSF drainage disrupted –> cyst –> compress surrounding neural tissue
syringomyelia: 2 most common cause
- Arnold-Chiari malformation
- prior spinal cord injury –> ie whiplash
syringomyelia: most commonly affected which spinal tracts?
- spinothalamic tract (pain & temp)
- corticospinal tract (UE motor)
syringomyelia: PE findings
- decreased strength, pain/temp in arms/hands or cape-like distribution
- dorsal column fx preserved –> normal light touch, vibration, position sense
syringomyelia: how dx?
MRI
SBO + hemodynamic instability –> next step?
urgent surg exploration
SBO –> when require immed surg (3)?
- clinical/hemodynamic instability
- fail to improve after initial conservative measures
- dev ssx of ischemia/necrosis
ileus –> classic XR finding?
small & large intestine –> gas-filled, uniformly distended w no transition pt
traumatic injury –> abd pain –> most likely dx?
paralytic ileus
ileus –> causes (4)
- # 1 abd surg
- retroperitoneal/abd hemorrhage/inflamm
- intestinal ischemia
- electrolyte abnormal
arm –> full thick burn –> circumferential –> eschar formation –> leads to what condition?
eschar –> restrict venous/lymph drain –> acute cmpt synd
acute cmpt synd –> clinical features
- pain out of proportion to injury
- pain increase w passive stretch
- rapid & tense swell
- paresthesia (early)
twisting injury w foot fixed –> what condition?
medial meniscus tear
meniscus tear –> clinical presentation
- reduced knee extend
- sensation of instability
- effusion
- palpable lock/catch when extend jt while under load
meniscus tear –> how confirm dx?
MRI or arthroscopy
meniscus tear –> tests?
- Thessaly test
- McMurray test
what is Thessaly test? Positive test indicates?
stand on 1 leg –> flex knee 20deg –> int/ext rotate on flexed knee –> pain/click/catch –> meniscal tear
what is McMurray test? Positive test indicates?
hold knee in int/ext rotate –> passive knee flex/ext –> pain/click/catch –> meniscal tear
clavicle fx –> next step? why?
careful neurovasc exam –> r/o injury to brachial plexus, subclavian A
1 measure to prevent postop pulm comp
incentive spirometry –> promote lung expansion
what is Kehr’s sign
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
diffuse abd pain + guarding + pain in shoulder –> condition?
peritonitis
acute chem peritonitis –> what part of bladder ruptured?
dome
peritonsillar abscess –> tx
needle aspiration/I&D + abx
peritonsillar abscess –> clinical presentation
- fever
- pharyngeal pain
- earache
- trismus
- muffled voice
- swelling of peritonsillar tissues w uvula deviation
varicocele –> clinical presentation
- soft scrotal mass “bag of worms” –> decrease in supine, increase w stand/valsalva
- subfertility
- testicular atrophy
meniscal tear –> tx?
mild ssx, older pt:
- rest
- modify activities
persistent ssx, impaired activity:
- surg
postop fever –> blood cultures reveal coag-neg staph –> seen most often in what kind of pts?
pts w intravasc devices
stress fracture –> RF (5)?
- repetitive activies (running, gymnastics)
- abrupt increase in physical activity
- inadeq Ca, vitD
- inadeq calories
- female athlete triad: inadeq calories, hypo/amenorrhea, low bone density
stress fracture –> tx?
- reduce wt-bearing for 4-6wk
- if at high risk for malunion (anterior tibial cortex, 5th metatarsal) –> refer to ortho
blunt trauma to chest –> pneumothorax –> chest tube –> persistent pneumothorax –> condition?
tracheobronchial rupture
tracheobronchial rupture –> clinical findings
- persistent pneumothorax despite chest tube placement
- pneumomediastinum
- subcut emphysema
gunshot at 6th intercostal space –> pt unstable –> next step?
exploratory laparotomy
penetrating wound below what level is considered to involve abd?
4th intercostal space (level of nipples)
postop atelectasis –> when after postop?
postop day 2
postop atelectasis –> RF (4)?
- airway obstruction from retained airway secretions
- decreased lung compliance
- postop pain
- meds that interfere w deep breathing
postop atelectasis –> ABG results? why?
hypoxemia, hypocapnia, resp alk
lung collapse –> decrease lung vol –> V/Q mismatch –> hypoxemia –> tachypnea –> hypoCO2 & resp alk
massive hemoptysis –> initial management?
estab adeq patent airway
massive hemoptysis –> in what position should pt be placed?
lat position w bleeding lung in dependent position –> avoid blood collection in opp lung
massive hemoptysis –> initial procedure of choice? why?
bronchoscopy
- localize bleeding site
- provide suction ability to improve visualization
- other therapeutic interventions possible (balloon tamponade, electrocautery)
severe burn –> wound infect & sepsis –> what org if soon after injury? If after 5days?
soon after burn –> G+
after 5day –> G-, fungus
burn wound infect –> 1st sign?
- change in burn wound appearance
- loss of skin graft
burn wound infect –> dx?
- quantitative wound culture
- bx for histopath
young pt –> midline hard palate –> fleshy immobile mass –> condition?
torus palatinus
torus palatinus –> tx?
asymptomatic: none
symptomatic, interfere w speech/eat: surg
flail chest –> pathophys?
> 3 contiguous ribs fractured in >2 locations
ischemic colitis –> CT findings?
- thickened bowel wall
- pneumatosis coli
ischemic colitis –> colonoscopy findings?
- cyanotic mucosa
- hemorrhagic ulcerations
hematuria –> indicates damage to what?
- during initial part of voiding
- at end of void
- continuously thru void
- initial: urethra
- terminal: bladder, prostate
- total: kidney, ureter
ant shoulder dislocation –> cause?
glenohumeral jt –> forceful abduct & ext rot
ant shoulder dislocation –> can damage what N? Leads to what signs?
Axillary:
- deltoid: weak shoulder abduct
- lat shoulder: sensory
GI perforation –> next step?
exploratory laparotomy
blunt abd trauma –> GI perforation –> pathophys?
blunt trauma –> damage mesenteric blood supply –> necrosis –> GI perforate
blunt trauma to abd & chest –> tachycardia, hypotension –> condition?
splenic laceration
splenic injury –> ssx?
- abd pain
- tachycardia
- L shoulder pain
blunt trauma to abd & chest –> what happens to:
- preload
- cardiac output
- ejection fraction
massive internal hemorrhage –> hypovol shock:
decreased venous return –> decreased preload –> decrease cardiac output –> activate sympathetic –> increase SVR & HR –> increase ejection fraction
ant spinal cord infarct –> potential comp of what procedure?
thoracic aortic aneurysm surg
ant spinal cord synd –> ssx
- spinal shock: bilat flaccid paralysis, loss of pain/temp
- days-wks –> UMN: spastic, hyperreflex
- normal vibrate, proprioception
umbilical hernia –> assoc w?
- black
- premature
- Beckwith-Wiedemann
- hypothyroid
pt w renal dz –> surg –> DVT –> tx? for how long?
- unfractionated hep for acute
- warfarin for 3 mo
pilonidal dz –> pathophys
intergluteal region –> hair follicle occlude –> edema, infect –> abscess –> rupture –> sinus tract –> sit, stand –> hair/debris into sinus tract –> recur infect
pilonidal dz –> who?
- 15-30yo M
- obese
- sedentary
- deep gluteal cleft
pilonidal dz –> presentation?
interglut region –> 4-5cm cephalad to anus –> painful, fluctuant mass –> mucoid/purulent/bloody discharge
acute adrenal insuff –> etiology?
- adrenal hemorrhage/infarct
- chronic adrenal insuff, glucocorticoid use –> acute illness/injury/surg
acute adrenal insuff –> tx?
- hydrocortisone, dexamethasone
- IVF
acute adrenal insuff –> ssx
- hypotension
- vomit
- abd pain
- fever
rhinoplasty –> whistling noise during respiration –> condition?
septal hematoma –> nasal septal perforation
