Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Step 2 > Surgery 3 > Flashcards

Surgery 3 Flashcards

1
Q

3 risk factors for emphysematous cholecystitis?

A

DM
Vascular compromise (obstruction or stenosis of the cystic artery)
Immunosuppression
Gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Presentation of emphysematous cholecystitis?

A

Fever, RUQ pain, N/V

Crepitus in abdominal wall adjacent to gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dx emphysematous cholecystitis?

A

Confirmed with imaging demonstrating air-fluid levels in gallbladder, gas in gallbladder wall, occasional pneumobilia (air in hepatobiliary system)

Cultures with gas-forming Clostridium, E. coli

Unconjugated hyperbilirubinemia, mildly elevated aminotransferases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Rx emphysematous cholecystitis?

A

Emergent cholecystectomy

Broad-spectrum IV ABX with Clostridium coverage (eg, amp-sulbactam)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does the presentation of acute cholangitis differ from emphysematous cholecystitis?

A

Both will have high fever and RUQ pain, but would expect jaundice and significant elevations in alk phos and conjugated bilirubin + imaging with bile duct dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is gallstone ileus?

A

Intestinal obstruction due to a gallstone that has passed through a biliary-enteric fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How are hip fractures classified?

A
  1. Anatomic location
  2. Fracture type

Intracapsular (eg, femoral neck and head) vs. extracapsular (eg, intertrochanteric, subtrochanteric)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which type of hip fracture has a higher change of avascular necrosis? Which type of hip fracture has a greater need for implant devices?

A

AVN - intracapsular fractures

Implant - extracapsular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In general, surgical repair should be done as soon as feasible to relieve pain, minimize complications, and reduce length of hospital stay. However, surgery may be delayed up to 72 hours in what situation?

A

To address unstable medical comorbidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Appearance of meningioma on MRI?

A

Extra-axial well-circumscribed or round homogenously enhancing dural-based mass

Usually calcified, can appear hyperdense on non-contrast head CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Presentation of meningiomas?

A

Benign primary brain tumors arising from meningothelial cells

More common in middle-age to elderly women

Significant neuro symptoms (mass effect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dx and Rx meningiomas?

A

Confirm dx intraoperatively

Rx of choice in symptomatic patients - complete resection (cure in most individuals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When should chemotherapy be considered for brain tumors?

A

Not first-line treatment for meningioma

May be coupled with surgical resection and radiation in patients with highly malignant primary brain tumors (glioblastoma multiforme, medulloblastoma, etc.); consider in patients with highly chemosensitive metastatic brain disease (testicular germ cell tumor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Appearance of brain mets on imaging?

A

Multipel ring-enhancing lesions at the gray-white junction (intra-axial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of esophageal perforation?

A

Spontaneous rupture (Boerhaave syndrome)
Instrumentation (endoscopcy, etc.)
Esophagitis (infectious, pills, caustic, etc.)
Esophageal ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Presentation of esophageal perforation?

A 
Chest and abdominal pain (retrosternal), systemic findings (eg, fever)
Subcutaneous emphysema in the neck
Hamman sign (crunching sound on chest auscultation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Dx esophageal perforation?

A

CXR or CT - wide mediastinum, pneumomediastinum, pneumothroax, air around paraspinal muscles, pleural effusion (late)

CT - esophageal wall thickening, mediastinal air fluid level

Water-soluble contrast esophagogram - leak at perforation site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of esophageal perforation?

A

ABX and supportive care for all patients (make patient NPO, IV PPIs, broad-spectrum ABX, nutrition, surgical drainage and debridement of infected or necrotic areas)

Surgical repair for significant leakage with systemic inflammation response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Presentation of Mallory-Weiss tear?

A

Incomplete mucosal tear at the gastroesophageal junction, usually due to protracted vomiting; it frequently presents with self-limited hematemesis without pneumomediastinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common complication of thyroidectomy and why?

A

Hypocalcemia 2/2 hypoparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Presentation of hypocalcemia?

A

Can be asymptomatic (found incidentally)
Non-specific symptoms (fatigue, anxiety, depression)
Involuntary contractions (tetany) involving the lips, face, and extremities ,and seizures
EKG with QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Persistent hypothyroidism can be seen post-thyroidectomy and can cause ___ without thyroid hormone supplementation.

A

Hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the sphincter of Oddi?

A

Muscular valve controlling the flow of bile and pancreatic juice into the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Sphincter of Oddi dysfunction can develop following any inflammatory process. It encompasses 2 separate physiologic entities - what are they?

A

Dyskinesia and stenosis of the sphincter of Oddi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Cause and presentation of sphincter of Oddi dysfunction?
Obstruction of flow through the sphincter may result in retention of bile, causing a functional biliary disorder that mimics a structural lesion Recurrent episodic pain in the RUQ or epigastric region with corresponding aminotransferase and alk phos elevations Visualization of a dilated common bile duct in the absence of stones Opioid analgesics may cause sphincter contraction and precipitate symptoms
26
Dx and Rx Sphincter of Oddi dysfunction?
Gold standard Dx - SOD manometry Rx of choice - sphincterotomy
27
What organisms are responsible for most deep infections following puncture wounds?
S. aureus P. aeruginosa (particularly prevalent after puncture wounds through the sole of a shoe as the warm, moist environment is quite hospitable to this microorganism
28
Radiographs are usually required to evaluate for underlying osteomyelitis when deep-penetrating injuries occur; however, bone changes consistent with osteomyelitis often take ___ weeks to form.
2+
29
Management of osteomyelitis following a puncture wound?
BCx Bone biopsy with culture Rx with IV ABX and surgical debridement
30
What is Peyronie disease and what is the pathophysiology?
Common condition affecting ~5% of men that arises due to repetitive blunt trauma to the penis during sexual intercourse with subsequent aberrant wound healing Characterized by the formation of fibrous plaques (2/2 TGF-1 upregulation) in the tunica albuginea, which reduces tissue elasticity and expansion during erections
31
Presentation of PYeronie disease?
Dorsal penile plaque Pain/curvature with erection Penile pain
32
Dx Peyronie disease?
Most diagnosed clinically, but U/S is sometimes necessary
33
Rx Peyronie disease?
Pain and deformity resolve spontaneously over 1-2 years in many people Those with ctive or progressive PD often require NSAIDs for pain, pentoxifylline to reduce fibrosis, and/or intralesional injections of collagenase Surgery in refractory cases
34
Presentation - clusters of small painless pink or skin-colored papules on the genitals?
Genital warts (condyloma acuminata)
35
Presentation - painless erythematous plaque on the penil shaft?
Bowen disease (cutaneous SqCC in situ), may progress to penile cancer
36
Presentation - painless genital ulcer?
Primary syphilis
37
Presentation of type 2 HIT?
Suspected with heparin exposure >5 days AND any of the following: Platelet count reduction >50% from baseline Arterial or venous thrombosis Necrotic skin lesions at heparin injection sites Acute systemic (anaphylactoid) reactions after heparin
38
Dx type 2 HIT?
Serotonin release assay (gold standard confirmatory test) Start treatment in suspected cases PRIOR to confirmation tests
39
Rx type 2 HIT?
Stop ALL heparin products Start a direct thrombin inhibitor (eg, argatroban) or fondaparinux (synthetic pentasaccharide)
40
What are the complications of HIT?
Venous and arterial thrombotic risk is significant (as high as 50% in untreated HIT) Thrombocytopenia (mild to moderate), minimal bleeding risk
41
When is warfarin the setting of HIT?
Anticoagulation maintenance, but only after the patient has received another anticoagulant and the platelet count is >150,000
42
Why is initial treatment with warfarin contraindicated in patients with HIT?
It rapidly lowers protein C levels, which may transiently increase the risk of thrombus
43
Discuss how TPN or prolonged fasting may lead to gallbladder stasis.
Presence of proteins and fatty acids in the duodenum acts as a stimulus for release of CCK, which in turn stimulates the contraction of the gallbladder; patients on TPN or prolonged fasting do not have this normal stimulus Small bowel resection also contributes due to decreased enterohepatic circulation of bile acids resulting in altered hepatic bile composition (supersaturated with cholesterol)
44
What is the mechanism for the development of cholesterol gallstones during pregnancy and in women taking OCs?
Estrogen-induced increase in cholesterol secretion | During pregnancy, progesterone also reduces bile acid secretion and slows gallbladder emptying
45
Initial medical and surgical management of perforated peptic ulcer?
NG suction, IV fluids, broad-spectrum ABX, IV PPIs Urgent ex lap
46
If CXR does not confirm suspected perforated viscus, what should be done?
CT scan of the abdomen with water-soluble oral contrast
47
Gold standard for evaluating mesenteric ischemia?
Mesenteric angiography
48
Diverticulosis is characterized by what pathologic features?
Herniation of the colonic mucosa/submucosa through the circular and longitudinal muscle layer due to elevated intraluminal pressure
49
Risk factors for diverticulosis?
Obesity, poor diet (lower fiber, high meat), and tobacco use
50
Common symptoms of compartment syndrome?
Pain out of proportion to injury Pain increased on passive stretch Rapidly increasing and tense swelling Paresthesia (early)
51
Uncommon symptoms of compartment syndrome?
Decreased sensation Motor weakness (within hours) Paralysis (late) Decreased distal pulses (uncommon)
52
Causes of compartment syndrome?
Most common following traumatic injuries or prolonged compression of an extremity Also occur following reperfusion of an acutely ischemic limb due to interstitial edema and possibly intracellular swelling
53
Dx compartment syndrome?
Measure compartment pressures with needle manometry Delta pressure (diastolic BP - compartment pressure) of 30 mm Hg or less is strongly suggestive
54
Definitive management of compartment syndrome
Urgent fasciotomy
55
Indications for urology consult in the setting of symptomatic ureteral stone?
1. Urosepsis 2. Acute renal failure 3. Complete obstruction 4. Stone 10+ mm 5. Uncontrolled pain 6. No stone passage in 4-6 weeks
56
Medical management of ureteral stones <10 mm?
Hydration Pain control (NSAIDs preferred over opioids) Antiemetics (metoclopramide, etc.) Alpha blockers (tamsulosin, etc.) can facilitate passage Strain the urine to recover the stone and confirm passage
57
Causes of Mallory-Weiss tear?
Sudden increas ein abdominal pressure (eg, forceful retching) Mucosal tear in the esophagus or stomach (sub-mucosal arterial or venous plexus bleeding) Risk factors - hiatal hernia, alcohol use
58
Clinical presentation of MW tear?
Vomiting, retching Hematemesis Epigastric pain
59
Dx Mallory-Weiss tear?
Longitudinal laceration on endoscopy
60
Rx MW tear?
Most heal spontaneously (90%) | Endoscopic therapy for persistent bleeding (electrocoagulation or local injection or epinephrine)
61
What is hidradenitis suppurativa?
Chronic inflammatory occlusion of folliculopilosebaceous units that prevents keratinocytes from properly shedding from the follicular epithelium; most common in intertriginous areas
62
Risk factors for hidradenitis suppurativa?
``` Family history of HS Smoking Obesity DM Mechanical stress on the skin ```
63
Presentation of HS?
Solitary, painful, inflamed nodules that can last for several days to months; may regress or progress to abscesses that open to the surface with purulent or serosanginuous drainage Chronic relapsing course
64
Complications of HS?
Sinus tracts, comedones, scarring (severe scarring can lead to dense, rope-like bands in the skin with strictures and lymphedema)
65
Dx HS?
Clinical
66
What type of lymph nodes are always suspicious for cancer?
Hard, unilateral, non-tender lymph nodes
67
What are two fo the most common solid organ injuries 2/2 blunt abdominal trauma?
Liver | Spleen
68
Common manifestations of hepatic laceration?
Hypotension Free intraperitoneal fluid RUQ pain and bruising R shoulder pain due to phrenic nerve irritation
69
Presentation of peritonsillar abscess (aka quinsy)?
Fever Pharyngeal pain/sore trhoat/difficulty swallowing Trismus Muffled "hot potato" oice Uvula deviation away from enlarged tonsil Saliva pooling Earache
70
Rx peritonsillar abscess?
Needle aspiration I&D ABX coverage of GAS and respiratory anaerobes
71
Why are cat bites much more likely to cause serious infection than dog or human bites? What bacteria are typically involved?
Cats have long, sharp teeth that can inoculate oral flora deep into skin, reaching soft-tissue structures; ``` Pasteurella multocida (GN coccobacilli) Anaerobic bacteria ```
72
Management of cat bites?
1. Copious irrigation and cleaning 2. Prophylactic amox/clav (amox - P. multocida, clav - oral anaerobes) 3. Tetanus booster as indicated 4. Avoid closure
73
Presentation of Zenker's diverticulum?
Most common in elderly patients, especially men Occurs in the posterior lower cervical esophagus near the cricopharyngeus muscle Dysphagia, regurgitation Halitosis 2/2 pooling of material in the diverticulum; if large, may e palpable
74
Patients with ZD are at risk for ___.
Aspiration pneumonia
75
Dx ZD?
Contrast esophagram
76
Rx ZD?
Surgical repair
77
Presentation of varicocele?
Soft scrotal mass (bag of worms) that decreases in supine positions and increases with standing/Valsalva maneuvers Subfertility Testicular atrophy
78
Why is the left testis frequently affected by varicocele?
Drainage of the L spermatic (gonadal) vein into the L renal vein, which is subject to compression between the superior mesenteric artery and aorta
79
Dx varicocele?
Clinically; U/S - retrograde venous flow, tortuous, anechoic tubules adjacent to testis, dilation of pampiniform plexus veins
80
Why can varicocele cause decreased fertility in males?
Mildly increased scrotal temperatures -> testicular atrophy, reduced sperm production, impaired spermatic motility
81
Rx varicocele?
Gonadal vein ligation or embolization (boys and young men with testicular atrophy) Scrotal support and NSAIDs (older men who do not desire additional children)
82
In the setting of suspected variceal hemorrhage, what are the next steps in management?
1. Place 2 large-bore IV catheters. 2. Volume resuscitation (crystalloid, pRBCs to maintain Hgb 7+) + IV octreotide + ABX + NPO 3. Urgent endoscopic therapy of esophageal varices.
83
What should be done following urgent endoscopic therapy of esophageal varices in the setting of: 1. No further bleeding 2. Continued bleeding 3. Early rebleeding
No further bleeding -> initiate second prophylaxis (beta blocker + endoscopic band ligation 1-2 weeks later) Continued bleeding -> balloon tamponade (temporary) -> TIPS or shunt surgery Early rebleeding -> repeat endoscopic therapy -> recurrent hemorrhage -> TIPS or shunt surgery
84
Who would get a contrast angiography rather than upper endoscopy in the setting of variceal bleeding?
Not stabilized sufficiently Upper endoscopy unsuccessful
85
Persistent pneumothorax and significant air leak following chest tube placement in a patient who has sustained blunt chest trauma suggests ___. Name 2 other associated findings.
Tracheobronchial rupture; pneumomediastinum, subQ emphysema
86
Most important initial diagnostic study in all stabilized patients following blunt chest trauma?
CXR
87
What is most commonly injured in tracheobronchial rupture?
R main bronchus
88
Dx and Rx tracheobronchial eprforation?
Confirm Dx with high-resolution CT, bronchoscopy, or surgical exploration; operative repair is indicated
89
___ classically causes tachycardia, new bundle branch blocks, or arrhythmia; sternal fracture is commonly associated.
Myocardial contusion
90
___ causes cardiac tamponade, which manifests with muffled heart sounds, hypotension, and distended neck veins.
Myocardial rupture

Step 2 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions