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STEP 2 > Surg/Sports/ENT > Flashcards

Surg/Sports/ENT Flashcards

1
Q

what does FAST stand for?

A

focused assessment with sonography for trauma, used to assess for intraperitoneal hemorrhage in patients with blunt abdominal trauma; HD stable patients with positive findings may undergo subsequent testing (abdominal CT); HD unstable patients - Xlap

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2
Q

anterior drawer vs Lachman test

A

test ACL injury

anterior drawer - patient supine with knee flexed; grip proximal tibia with both hands and pull

Lachman - place knee at 30 degree flexion, stabilize distal femur with 1 hand and pull proximal tibia with the other

laxity = positive test

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3
Q

Thessaly vs McMurray test

A

test meniscal tear

Thessaly - patient stands on 1 leg with knee flexed 20 degrees; patient then internally and externally rotates on flexed knee

McMurray - passive knee flexion and extension while holding the knee in internal or external rotation

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4
Q

culprits in emphysematous cholecystitis

A

Clostridium perfringers (must cover with ampicillin-sulbactam) and some E. coli strains

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5
Q

Fitx-Hugh Curtis syndrome

A

perihepatitis in the setting of PID, imaging shows inflammation of hepatic capsule

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6
Q

torus palatines

A

young individual with benign bony growth located on the midline suture of the hard palate, no tx required unless sx’tic

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7
Q

old man w acute onset severe back pain, syncope, hypoTN, and hematuria

A

AAA rupture –> venous congestion in retroperitoneum –> venous congestion –> rupture of bladder veins –> hematuria

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8
Q

acalculous cholecystitis is most often seen in …

A

severely ill patients in the ICU with multi organ failure, severe trauma, surgery, burns, sepsis, prolonger parenteral nutrition; likely d/t cholestasis and gallbladder ischemia leading to secondary infection by enteric organism and resultant edema/necrosis; tx immediately with abx followed by percutaneous cholecystostomy and then cholecystectomy once patient is stable

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9
Q

mesenteric ischemia usually presents with

A

sudden periumbilical pain out of proportion to exam findings in patients with older age, A fib, and CVD

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10
Q

tx of anal fissures

A

dietary modifications, soon softener, sitz bath, topical anesthetics (topical lidocaine) and vasodilators (nifedipine)

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11
Q

adhesive capsulitis

A

fibrosis and contracture of glenohumeral joint capsule –> frozen shoulder; decreased passive and active ROM; stiffness > pain

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12
Q

female athlete triad

A

low caloric intake, hypo/amenorrhea, low bone destiny –> risk factors for stress fractures

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13
Q

retropharyngeal abscess progression

A

presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx (e.g. swelling fish bone). Infection within the retropharyngeal space can drain into the superior mediastinum. Infection through the alar fiascos into the danger space can transmit into the posterior mediastinum and result in acute necrotizing mediastinitis

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14
Q

Ludwig angina

A

rapidly progressive bilateral cellulitis of the submandibular and sublingual spaces, most often arising from an infected mandibular molar

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15
Q

3 criteria for x lap in patient w abdominal trauma (blunt or penetrating)

A

1) HD instability
2) peritonitis
3) evisceration

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16
Q

hypocalcemia ECG finding

A

QT prolongation

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17
Q

psoas abscess presentation

A

subacute fever, abdominal/flank pain radiating to the groin, anorexia/wt loss, psoas sign (pain with hip extension)

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18
Q

blunt abdominal trauma timing

A

may take several days to present, i.e. patients may not initially show evidence of mesenteric vessel injury and should be considered for longer period of obs/monitoring

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19
Q

vascular complication of cardiac catheterization

A

retroperitoneal hematoma - i.e. bleeding from arterial access site - occurs within 12 Horus of catheterization; presents with sudden HD instability and flank/back pain

other complications: arterial dissection, acute thrombosis, pseudoaneurysm, AV fistula formation

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20
Q

stress fracture radiologic finding

A

x-ray may be initially normal but can show hairline lucency or periosteal thickening

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21
Q

tx of metatarsal fx

A

fx of metatarsal 2-4 are managed conservatively as the surrounding metatarsal act and splits and nonunion is uncommon

22
Q

postgrastrectomy complication, presents with GI and vasomotor sxs after meals (nausea, diarrhea, cramps, palpitations, diaphoresis); caused by loss of normal action of the pyloric sphincter d/t injury or surgical bypass –> rapid emptying of hypertonic gastric contents into small intestine –> causes shifts in intravascular space to small intestine; managed with dietary modification (eating freq smaller meals with increased fiber/protein rather than simple sugars)

A

dumping syndrome

23
Q

patients with revised cardiac risk index (RCRI) >/= 2 must receive what to reduce cardiac mortality during surgery?

A

preoperative beta blockage

24
Q

number one limiting factor prior to surgery is

A

history of CVD; patients must be medically optimized prior to surgery

25
Q

prior to surgery, patient with hx of cardiac disease, regardless of age, needs

A

an ECG, stress testing, and an Echo

if patient is under 35 and has no CVD hx, only ECG

26
Q

shock occurs when

A

tissues in the body do not receive enough O2 and nutrients to allow cell function; you’ll see tachycardia and hypoTN but also

brain - confusion 
kidney - increased BUN:Cr ration 
liver - high enzymes 
heart - chest pain and SOB 
blood - increased lactic acid
27
Q

CO =
SV =
TPR =
BP =

A 
CO = SV x HR 
SV = EDV - ESV 
TPR = MAP - MVP* 
BP = CO x TPR

*mean venous pressure

28
Q

Kehr sign

A

pain in the left shoulder –> splenic rupture

29
Q

Hamman sign

A

crunching heard upon palpation of the thorax d/t subcutaneous emphysema

30
Q

Boerhaave syndrome diagnostic test

A

Gastrografin esophagogram showing leakage

Gastrografin = diatrizoate meglumine and diatrizoate sodium solution

31
Q

the most common cause of esophageal perforation is

A

iatrogenic

32
Q

mgmt of gastric perforation

A

make patient NPO, place NG tube, IVFs and broad spectrum abx’s –> surgery

33
Q

most common complication after diverticulitis

A

abscess formation

34
Q

right-sided (cecal) diverticulitis

A

often misdiagnosed as appendicitis; tx medically (abx’s)

35
Q

acute pancreatitis dx

A

CT best, amylase most sensitive, lipase most specific

36
Q

biliary colic caused by

A

contraction of the gallbladder against stone –> increases in intra-gallbladder pressure –> pain

37
Q

tx of acute cholangitis

A

remember Charcot’s triad and Reynold’s pentad; U/S shows dilated CBD (MRCP more accurate)

give abx’s then decompress CBD
if patient HD stable –> ERCP
HD unstable –> PTC (percutaneous transhepatic cholangiogram)

later - elective cholecystectomy

38
Q

small bowel obstruction vs ileus

A

small bowel obstruction - hx of surgery; dissension and increased bowel sounds; small bowel dilation

ileus - recent surgery / metabolic or pharmacological causes; reduced/absent bowel sounds; small and large bowel dilation

39
Q

trigger finger

A

acutely flexed and painful finger, caused by stenosis of tendon sheath; tx with steroid injections

40
Q

Dupuytren contracture

A

men >40, palmar fascia becomes contracted and hand cannot be fully extended open, tx surgically

41
Q

special tx of fat embolism

A

requires oxygen to keep PO2 over 95%

42
Q

herniated disk disease

A

lifting injury, electric pain shooting down dermatomal distribution, + straight leg raise

43
Q

management of AAA by size

A

3-4 cm - US every 2-3 years
4-5.4 cm - US every 6-12 months
>5.5 cm - repair

44
Q

the most common ECG finding for PE

A

nonspecific ST segment changes (NOT S1-Q3-T3)

45
Q

dx of PE in patient who has allergy to IV contrast

A

V/Q scan

46
Q

ischemia-reperfusio syndrome

A

repercussion of limb following arterio-ocussive ischemia for 4-6 h –> edema –> compartment syndrome (occurs when pressure within a muscular fascial compartment rises above 30 mmHg)

47
Q

5 causes of hypoPTHism

A

1) post surgical
2) autoimmune
3) congenital (DiGeorge)
4) defective calcium-sensing receptor on PTH glands
5) infiltrative disease (hemochromatosis, Wilson, radiation)

48
Q

mgmt of c spine injury

A

initial stabilization of the c spine, unless there is significant facial trauma, orotracheal intubation with rapid-sequence intubation is the preferred method of establishing airway in apnea patient with cervical spine injury

49
Q

labs in acute mesenteric ischemia

A

leukocytosis, elevated Hb (d/t hemoconcentration), elevated amylase, and metabolic acidosis (d/t lactate)

50
Q

sxs of opioid withdrawal

A

GI sxs with increased bowel sounds, flu-like sxs, signs of sympathetic nervous system activation (mydriasis, agitation, anxiety)

51
Q

colicky RUQ pain in patient with previous cholecystectomy, elevated enzymes, worsened by opioid analgesics

A

sphincter of Oddi dysfunction

STEP 2 (15 decks)

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