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Surgery UWorld > Surgery 1 > Flashcards

Surgery 1 Flashcards

1
Q

Varicocele vs. Hydrocele

A

Dilation of pampiniform plexus - left side (rt angle)
- bag of worms, worse standing, better supine
Accumulation of fluid btwn parietal & visceral layers of tunica vaginalis
- transillumination

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2
Q

Appendicitis > 5 days after onset…

A

Perforation w/ abscess formation

  • may be contained abscess…
  • IV hydration, abx, bowel rest + interval appendectomy
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3
Q

Blunt Abdomen Trauma

- hemodynamically stable

A 
Alert? 
 - No = serial abd exams +/- CT
 - Yes = FAST
    Fast +  CT of abdomen
    Fast -   serial abd exams +/- CT
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4
Q

Highly specific and sensitive test for PAD in symptomatic patients?

A

Ankle-brachial index

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5
Q

Blunt abdominal trauma…interval…ULQ pain + left shoulder pain + hypotensive + tachycardia

A

Splenic injury w/ delayed symptoms

- if stable, get abd CT w/ contrast

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6
Q

Hypotension after surgery…bloody diarrhea…where injury?

A

Splenic flexure
- watershed areas damaged (splenic + rectosigmoid)
Do colonoscopy to confirm

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7
Q

Symptomatic epidural hematoma patients?

A

Emergent neurosurgical hematoma evacuation

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8
Q

Multiple rib fractures + respiratory distress

A

Flail chest

  • retracts during inspiration
  • bulges out during expiration
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9
Q

Blunt abdominal trauma

How know if splenic laceration?

A

Free intraperitoneal fluid

- hypotension after BAT suggests solid organ or vascular injury

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10
Q

Rapid deceleration trauma to chest?

A

Aortic injury

  • widened mediastinum
  • left-sided hemothorax
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11
Q

Pain and changes in lung compliance after surgery…

A

Atelectasis

  • impaired cough and shallow breathing
  • get low O2 due to mucus plug + lung bases not getting O2 due to shallow breathing
  • then get compensatory increase in RR and then decreased PCO2
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12
Q

Significant body area burns get…

A

Hypovolemic shock

  • give adequate fluid resuscitation
  • worry about bacterial infection
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13
Q

Sudden-onset, severe, poorly localized mid abdominal pain (periumbilical) w/ N/V
Heart Stuff

A

Mesenteric Ischemia

  • cardiac embolic events (a-fib, valve disease)
  • pain out of proportion to exam findings
  • elevated lactate = metabolic acidosis
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14
Q

Left sided bowel in lung field

A

Diaphragmatic rupture

  • do CT scan of chest & abdomen
  • Shift of mediastinum to other side
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15
Q

Abrasion wound; pain + red
No sensation to light touch
CT scan shows ?

A

Necrotizing fasciitis
- gas in subQ tissue
- pain out of proportion to exam + swell + erythema
- tissue necrosis + crepitus + purulent drainage
- radiographic evidence of gas in deep tissues
RAPID progression

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16
Q

GSW, obtunded mental state + hypotension

- if peritonitis, evisceration of organ or unstable

A

FAST

- if equivocal = get immediate laparotomy

17
Q

Hyperextension injury to hand
- mild tenderness in snuffbox
- pain w/ radial deviation
X-ray does NOT reveal a fracture

A

Place thumb spica cast and repeat XRAY in 7-10 days

  • scaphoid fracture - blood supply
  • CT/MRI would give immediate diagnosis
18
Q

4 Steps to pt w/ hemodynamically unstable victim of motor vehicle accident w/ suspected blunt abdominal trauma

A
  1. Cervical spine immobilization
  2. IV hydration
  3. FAST
  4. If blood in peritoneal cavity = urgent laparotomy
19
Q

Septic Shock, metabolic acidosis, treat?

A

Correct underlying cause + restore tissue perfusion

  • IV normal saline (0.9%) - NOT D5
  • dopamine/pressors only after IV fluids fail
20
Q

Pain radiate to groin + extension of hip increases pain flexion decreases pain

A

Psoas sign + psoas abscess
CT of and/pelvis to confirm
Treat w/ drainage + broad-spectrum abx

21
Q

Femoral vs. Common peroneal vs. Tibial nerve?

A

Femoral - medial thigh & lower leg
Common Peroneal - anterior & lateral leg
Tibial - posterior thigh & leg + plantar flexion of foot

22
Q

AAA rupture can cause…

A

Profound hypotension
Abd/back pain + syncope
Injure bladder = hematuria

23
Q

Suspected tension pneumothorax?

A

Subclavian catheter

Treat w/ needle thoracotomy in hemodynamically unstable patients

24
Q

Cardiac cath can cause?

A

Retroperitoneal hematoma - get CT of abd/pelvis without contrast…surgical repair almost NEVER needed

25
Q

Diaphragm injury

A

Surgical repair + exploration of abdomen look for other traumatic injuries

26
Q

Diverticulitis w/ abscess

A

Do CT-guided percutaneous drainage

- rim-enhancing perisigmoid fluid collection

27
Q

Pulmonary contusion vs. ARDS

A

Pulm contusion = w/in 24 hours of injury

ARDS: 24-48 hours after trauma + BILATERAL lung involvement

28
Q

Surgical repair AAA w/ postop bloody diarrhea + pain
Thickening of colon (at rectosigmoid junct)
Ulcerations seen via colonoscopy
Colon above and below lesions is normal
Management?

A

Ischemic colitis: pt > 60yo w/ Renal/Heart dx
- supportive care: IV, bowel rest + IV abx
- possible colon resection
- bowel infarct / perforation / gangrene
- clinical deterioration
Older b/c often have extensive CV disease
Pneumatosis in bowel wall!

29
Q

Gallbladder wall thickening
Pericholecystic fluid
Dx + treatment?

A

Acalculous cholecystitis

Abs followed by percutaneous cholecystostomy

30
Q

Tenderness medial knee at joint line
Internal rotation = locking sensation + pain
Normal Xray

A

Medial meniscus tear

- do valgus stress test: stabilize thigh, push on medial leg…laxity = MCL injury

31
Q

Internally & externally rotate knee

Pain, clicking, catching

A

Meniscal tear

32
Q

Hemorrhagic Shock

A

Signs of Class I: pt loses

33
Q

Early vs. Late Wound Prosthetic Joint Infection

3 mos) (3-12 mos

A

Staph aureus & Pseudomonas – early

Staph epidermis + enterococci – late

Neisseria g. in septic arthritis

34
Q

Occupations requiring kneeling

  • concrete
  • carpet laying
  • plumbing
A

Housemaid’s knee = Prepatellar bursitis
- infection common w/ Staph aureus

No infection? Modify activity + NSAIDs
Infection = drainage + abx

35
Q

Unilateral LE edema worse when leg is dependent

- better when leg elevated

A

Venous valvular incompetence

  • blood pools
      • get increased capillary hydrostatic pressure
          • fluid leaves capillaries into interstitial tissue
36
Q

Thyroidectomy – leads to what lab value?

A

Hypocalcemia

  • can get tetany, muscle cramps, poor sleep
  • get QT prolongation
37
Q

Gas in gallbladder wall

A

Emphysematous cholecystitis

  • life-threatening form of acute cholecystitis
    • infection by gas-forming bacteria
      • Clostridium
      • E. coli strains
38
Q

Rust-colored discharge in Bra of 42yo F
No family hx breast CA, no fever
No fluid expressed from nipples

A

Intraductal papilloma

Surgery UWorld (1 decks)

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