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Step 2 CK > Surgery > Flashcards

Surgery Flashcards

1
Q

management of BAT: unstable and stable

A

unstable: ABC than FAST; + fast laparotom, inconclusiv do DPL than if positive laparotomy; negative fast or dpl look for extraabdominal hemorrhage, + stabilize with splint or angio, - stabilize and abdominal CT
stable: ABC than abdominal CT

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2
Q

penetrating trauma management?

A

abc, than on warfarin infuse ffp than laparotomy otherwise abc and than laparotomy

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3
Q

duodenal hematoma management

A

resolve on own in 1-2 weeks and NG suction/parenterall nutrition with intervention. Surgery if conservative fails.

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4
Q

hemorrhagic shock tx regimen that differs from norm?

A

fluids before mechanical ventilation to prevent circulatory collapse

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5
Q

symptoms of acute arterial occlusion and tx?

A

5 p (pain, pallor, poikilotherma, paresthesia, pulsenessnes and paralysis). IV heparin

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6
Q

mcc rapid deceleration chest trauma?

A

aortic rupture

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7
Q

pt comes in and has right sided pneumothorax that does not get better with chest tube placement?

A

bronchial rupture

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8
Q

best initial/most accurate bronchial rupture?

A

cxr initial. high res CT/bronchoscopy/surgery

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9
Q

management of hypotension refractory to fluids after trauma?

A

ongoing occult blood loss with surgical exploratory laparotomy to stop further hemorrhage

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10
Q

management of pneumoa

A

small-less than 2 cm and stable-observe
large-chest tube or needle aspiration
clinically unstable or tension pneumo-urgent needle decompression, then chest tube placement (tube thoracostomy)

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11
Q

management of trauma to neck?

A

think cervical spine and immobilization cervical spine before ABC. then OROTRACHEAL intubation

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12
Q

Lowering ICP interventions?

A

Pharmacologic: IV mannitol, sedation to decrease metabolic demand
Respiratory: Hyperventilation
Physical: head elevation, removal of CSF

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13
Q

ddx anterior mediastinal mass?

A

thymoma, teratoma, thyroid neoplasm, and terrible lymphoma

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14
Q

sign of gastric outlet obstruction?

A

succussion splash (placing stethoscope over abdomen and rocking patient back and forth at hips with retained gastric material greater than 3 hours after a meal)

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15
Q

preferred imaging for diagnosis of acute mestenteric ischemia?

A

1) CT and if inconclusive mesenteric angio

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16
Q

management of acute mesenteric ischemia vs ischemic colitis?

A

both pretty similar: iv fluids, ng decompresstion, antibiotics, and bowel resection for infarct or perf

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17
Q

diagnosis and test confirming for diaphragmatic rupture?

A

ng tube in chest, and ct chest confirms diagnosis

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18
Q

management of complicated diverticulitis?

A

fluid collection less than 3 cm: IV abx and observation. fluid collection greater than 3 cm: CT guided percutaneous drainage

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19
Q

management of diverticulitis normally?

A

IV fluids, NPO, and abx (IV or oral)

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20
Q

physical exam for SBO vs ileus?

A

sbo-hyperactive bowel and no large bowel dilation

ileus-hypoactive bowel and large bowel dilation

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21
Q

patient comes in with air under diaphragm (perforated peptic ulcer or other viscus organ) management?

A

surgical emergency

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22
Q

tx anal fissure?

A

high fiber diet, adequate fluid, sitz bath, stool softener, nifedipine and nitroglycerin

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23
Q

SIRS criteria (must meet 2 of 4)

A

fever greater than 101.4 or less than 95, wbc greater than 12k or less than 4000, rr greater than 20 or pco2 less than 32, pulse greater than 90

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24
Q

tx psoas abscess?

A

surgical drainage and broad spectrum abx

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25
Q

tx and complication of retropharyngeal abscess?

A

drainage and iv broad spectrum. if mediaspinal spread which is complication can cause necrotizing mediasinitis by spreading to posterior mediastinum. tx. debridement of mediastinum

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26
Q

tx retroperitoneal abscess?

A

percutaneous drainage catheter, culture of drained fluid, and surgical debridement

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27
Q

tx of retroperitoneal hematoma?

A

hemorrhage and hematoma within 12 hours of cath. iv fluids, bed rest, and blood transfusion if necessary (supportive)

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28
Q

causative organism prosthetic joint and timeline?

A

less than 3 months: s aureus, gram neg rods, anaerobe

greater than 3 months: s epidermidis, propionibacterium, enterococci

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29
Q

What is tetanus pphx?

A

generally always tetanus toxoid containing vaccine only!!

if unimmunized, uncertain, or less than 3 tetanus toxoid doses you give both vaccine and TIG

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30
Q

humerus midshaft fracture nerves injured?

A

radial nerve most common (wrist drop), ulner nerve also commonly (claw hand)

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31
Q

cause and complication of supracondylar humerus fracture?

A

falling on outstretched hand. brachial artery most likely injured (leading to loss of brachial and radial pulses), median nerve injury), median nerve injury, cubitus varus deformity and compartment syndrome secondary to ischemia

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32
Q

complication of undiagnosed compartment syndrome in supracondylar humerus fracture?

A

volkmann contracture

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33
Q

most common locations of nondisplaced hairline (stress) fracture?

A

second metatarsal or tibia

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34
Q

complication and management of hip fracture

A

femoral neck/head-greater risk of avascular necrosis
extracapsular-greater need for implant devices (eg nails, rods)
SURGERY

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35
Q

Best initial test for urethral injuries?

A

Retrograde urethrogram

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36
Q

Cause of urethral injuries?

A

anterior-straddle injuries or instrumentation

posterior-pelvic fracture

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37
Q

major difference besides cause of anterior vs posterior urethral injuries?

A

anterior-may not complain of problems with voiding
posterior-pelvic hematoma can cause high riding prostate and can have sensation of inability to void even with urge present

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38
Q

obturator nerve damage cause of injury, level, and presentation?

A

pelvic surgery, L2-L4, medial thigh decreased sensation and loss of adduction

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39
Q

femoral nerve damage cause of injury, level, and presentation?

A

pelvic fracture, L2-L4, loss of hip flexion and thigh extension

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40
Q

tibial nerve damage cause of injury, level, and presentation?

A

Knee trauma or baker cyst (proximal) and tarsal tunnel syndrome (distal). L4-S3. Inability to curl toes and loss of sensation on sole of foot. proximal lesions also lose standing on TIPtoes (tibial inverts and plantarflexes)

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41
Q

common peroneal nerve damage cause of injury, level, and presentation?

A

trauma or compression of lateral aspect of leg. fibular neck fracture. L4-S2. loss of PED (plantar everts and dorsiflexes) leading to foot dropPED. loss of dorsum sensation.

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42
Q

nerve block during child birth?

A

s2-s4 pudendal nerve.

43
Q

nerve that tibial and fibular originate from?

A

sciatic

44
Q

superior gluteal damage cause of injury, level, and presentation?

A

iatrogenic secondary to IM medial gluteus injection. superior gluteal innervates medius and minimus. L4-S1. trandelenberg gait with pelvic drop contralateral to side of injury and ipsilateral to standing

45
Q

inferior gluteal damage cause of injury, level, and presentation?

A

posterior hip dislocation L5-S1, difficulty rising from seat, climbing stairs, and loss of hip extension. inferior gluteal innervates maximus

46
Q

mcc edema?

A

valvular incompetence that worsens throughout day and becomes better at night

47
Q

most common location of venous stasis dermatitis?

A

medial leg below knee and above medial malleolus

48
Q

What maneuver can prevent postoperative atelectasis?

A

sitting upright increases frc by 20-35%

49
Q

acid base of atelectasis?

A

initial resp acidosis and than resp alkalosis to compensate for hypoxemia

50
Q

location of needle thoracostomy and chest tube placement?

A

midclavicular 2nd intercostol space. midaxillary 5th intercostal space.

51
Q

cause and management of dumping syndrome?

A

postgastrectomy with rapid emptying of hypertonic gastric contents with loss of pyloric sphincter action manifesting 15-30 mins after a meal. management with frequent small meals, replace simple sugars with complex carbs, incorporate high-fiber and protein-rich foods

52
Q

anterior spinal cord syndrome cause and symptoms?

A

taa repair with asa artery ischemia. flaccid paralysis below lesion and bilateral loss of pain and temp below level of injury. vibration and propioception preserved.

53
Q

most common organs involved BAT?

A

liver or spleen

54
Q

definition massive hemoptysis and intervention?

A

greater than 600 mL or 100 ml/hour and intervention with bronchoscopy to have better visualization of site and if necessary balloon tamponade or electroacutery. if this doesnt control bleeding, can do thoracotomy

55
Q

rotator cuff tendinopathy vs tear?

A

severe pain with abduction from repetitive movements above head due to impingement of tendon between humeral head and acromion vs more weakness with abduction after a fall

56
Q

persistent pain with decreased range of motion in multiple planes?

A

adhesive capsulitis

57
Q

audible pop and bulge over the anterior arm?

A

biceps tendon rupture

58
Q

most common injured humerus fracture midshaft?

A

radial and ulnar nerve

59
Q

most common injured supracondylar humerus fracture?

A

brachial artery and median nerve.

60
Q

best test ischemic colitis?

A

CT with contrast. angio is most accurate

61
Q

penetrating abdominal trauma next best step?

A

IMMEDIATE LAP

62
Q

diaphragmatic hernia suspicion CXR best next test?

A

ct chest and abdomen.

63
Q

management of mi and chf in perioperative evaluation for surger?

A

recent mi must defer surgery for 6 months and stress patient at that interval. chf medical managment with ACE, B-blocker and spironolactone

64
Q

perioperative testing for patients with hx of cardiac disease or without history of cardiac disease?

A

no hx: only ekg

hx cardiac disease: ekg, stress test, and echo

65
Q

periop testing for known lung disease of hx smoking?

A

pft

66
Q

c-spine injury management of airway?

A

orotrach intubation with flex bronch

67
Q

three types of distributive shock and how to differentiate them?

A

neurogenic, septic, anaphylactic. neurogenic has decreased CO and septic and anaphylactic has increased CO. septic no change pcwp and anaphylactic has decreased pcwp

68
Q

cullen sign PE and cause?

A

bruising around umbilicus. hemorrhagic pancreatitis and aaa rupture

69
Q

grey turner sign PE and cause?

A

flank bruising. retroperiotoneal hemorrhage

70
Q

kehr sign PE and cause?

A

pain in the left shoulder secondary to subdiaphragmatic peritonitis. splenic rupture, bladder injuries, bowel, bile, or pancreatic secretions

71
Q

balance sign and cause?

A

dull percussion on left and shifting dullness to right. splenic rupture

72
Q

seatbelt sign and cause?

A

bruising where seatbelt in deceleration injury

73
Q

atelectasis vs tension pneumo on cxr?

A

atelectasis pulls trachea toward involved lung and tension pneumo pushes trachea away

74
Q

most common location for infarction in the bowel?

A

watershed at splenic or hepatic flexure, and rectosigmoid (ima)

75
Q

what is hamman sign?

A

crunching heard on palpation of the thorax due to subcutaneous emphysema

76
Q

most common location boerhaave vs mallory weiss?

A

boerhaave left posterolateral aspect of distal esophagus. mallory weiss at GEJ

77
Q

diagnosis of boerhaave or mallory weiss?

A

gastrografin esophagram

78
Q

gastric perforation best initial and most accurate?

A

cxr showing free air and ct most accurate

79
Q

managment of rlq pain fever, leukocytosis and anorexia for greater than 5 days.

A

complicated appendicitis with abscess formation is diagnosis. if stable, bowel rest and iv abx with abscess drainage. return in 6-8 weeks for appendectomy

80
Q

managment acalculous cholecystitis?

A

abx followed by percutaneous cholecystostomy with later lap chole

81
Q

drug used to alleviate obstruction from stool impaction int patients on chronic opioids?

A

methylnaltrexone

82
Q

hallmark lab sign of sbo?

A

elevated lactate with marked acidosis

83
Q

best initial/most accurate fecal incontinence testing and tx?

A

flex sig/anoscopy. anorectal manometry most accurate. tx is stool bulking agent, exercises via biofeedback, or injection of dextranomer/hyaluronic acid to decrease incontinence

84
Q

when do you do closed reduction?

A

mild fracture without displacement

85
Q

when do you do open reduction and internal fixation?

A

severe fractures with displacement or misalignment of bone pieces

86
Q

when do you do open fractures?

A

skin must be closed and bone must be set in operative room with debridement

87
Q

presentation of anterior shoulder dislocation and concern?

A

arm held to side with externally rotated forearm must rule out axillary artery or nerve injury. supinated

88
Q

presentation of posterior shoulder dislocation?

A

arm is medially rotated and held to side. pronated

89
Q

pain in index finger that is found to be flexed while others extended. and when pulled free, loud popping sound and pain subsides treatment.

A

trigger finger. tx with steroid injection

90
Q

presentation, tests to confirm, and tx of fat embolism?

A

confusion, petechial rash, and dyspnea within 5 days of fracture (after 12-72 hours). Po2 less than 60 and cxr with infiltrates. keep po2 above 95% and intubation if necessary

91
Q

definition compartment syndrome?

A

compression of nerves, blood vessels, and muscles inside a closed space

92
Q

unhappy triad?

A

acl/mcl/medial or lateral meniscus

93
Q

managment of AAA testing?

A

3-4 cm-u/s every 2-3 yrs
4-5.4 cm-us or ct every year
greater than 5.5 and asymptomatic: surgical repair

94
Q

testing for aortic dissection in unstable vs stable?

A

unstable-TEE, stable-MRA

95
Q

tx of pneumonia postoperative?

A

vanco and pip tazo (HAP)

96
Q

post op fever causes and days?

A

Wind (1-2), water (3-5), walking (5-7), wound (7), weird (8-15 by drug fever or deep abscess with ct scan needed)

97
Q

postop confusion workup and causes?

A

abg, cxr, cbc. septic or hypoxic patient. if hypoxic and no cxr changes, think pe. cxr changes think pneumonia. if septic with abnormal cbc, think bacteriemia or uti and tx with empiric.

98
Q

postop patient with severe hypoxia tachypnea and accessory muscle use with cxr showing bilateral pul infiltrates without JVD dx and tx?

A

adult respiratory distress syndrome. tx with PEEP

99
Q

forced hyperextension of neck in rear end collision

A

central cord syndrome

100
Q

burst fractures of vertebral bodies

A

anterior cord syndrome

101
Q

tx of black widow vs brown recluse spider

A

iv cal gluconate vs dapsone

102
Q

tx of prolonged surgery with numerous blood given and DIC develops?

A

FFP/ platelets. if also hypothermia and acidosis need to stop surgery and pack abdomen

103
Q

compartment syndrome formal diagnosis?

A

pressure in compartment greater than 30, of change in pressure DBP-compartment is less than 20-30

104
Q

scaphoid fracture managment?

A

intitial x-ray negative means repeat 7-10 days and immobilize. initial x-ray showing small radiolucent means nondisplaced less than 2 mm and no angulation and than means 4-6 months of wrist immobilization

Step 2 CK (16 decks)

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