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CanQB > Surgery > Flashcards

Surgery Flashcards

1
Q

T/F: Melanoma can be destructed by electrosurgical tech

A

F

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2
Q

What’s Charcot triad?

Used for?

A

Fever, jaundice, RUQ

Dx cholangitis

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3
Q

MCC of cholangitis

A

Gallstone impacts bile duct => cholestasis + G-ve bacteria

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4
Q

Labs in cholangitis

A

High bilirubin
High ALP
WBC
Fever

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5
Q

Acute cholecystitis

A

Cystic duct obstruction by gall stone

RUQ + fever + N/V
+ Murphy sign (arrest of inspiration during palpation)

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6
Q

T/F: post CABG depression increases risk of subsequent cardiac disease

A

T

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7
Q

Would Rx post-CABG depression improves risk of subsequent events?

A

No

Just improve depressive Sx

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8
Q

Who is at haigher risk of post-CABG depression

A

Rapidly progressive / acute disease before surgery

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9
Q

What correlates best with pre-op risk of bleeding?

A

Hx of bleeding

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10
Q

Signs of cardiogenic shock

A

Low BP, urine, refill
High HR, CVP
Narrow pulse pressure

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11
Q

Is DVT prophylaxis recommended for hip surgery?

A

Yes.

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12
Q

Nerve involved in thumb abduction + addiction

A

Abduction: interosseous of radial

Adductor: ulnar

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13
Q

Sx of carpal tunnel

A

Median nerve

Pain and numbness in dorsal thumb and index

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14
Q

What’s relation b/w insulin + anti-hyperglycemic and dupuytren’s contracture

A

Use of DM increase risk of contracture

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15
Q

Would steroid injections help dupuytren’s contracture

A

Multiple injections needed to regress disease if mild-moderate

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16
Q

When is surgery indicated in dupuytren’s contracture

A

Metacarpal joints contracture reaches 30 degrees

Associated with PIP joint at any degree

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17
Q

What levels of ALT indicates acute pancreatitis

A

3x normal limit

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18
Q

Local anesthetic lasts 2-4 hrs

A

Bupivacaine

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19
Q

Loading dose of unfractionated heparin

A
  1. Bonus dose 80U/kg in 6hr
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20
Q

Rx of torsades de pointes

A

Mg sulfate

Quinidine

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21
Q

Drugs contraindicated in torsades de pointes

A

Procainamide
Phenothiazide
Disopyramine
Tricyclics antidepressants

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22
Q

Tender breast lump
Cyclic changes
Young lady

Dx?

A

Fibrocystic changes

1st US = FNA

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23
Q

Post-op fever DDx

A

Wind 1, water 3, wound 5, walk 7

POD 1: atelectasis

POD 3: UTI

POD 5: wound infection

POD 7: DVT

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24
Q

How to reduce post-op resp complications

A

Incentive spirometer

Steroids in COPD only

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25
Q

IE in IV drug users affects which valve

A

IE affects mitral mainly

But in IV users affects tricuspid.

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26
Q

Calcification in lung nodule

  1. Central
  2. Concentric
  3. Popcorn
A
  1. Central = tuberculoma / histoplastoma
  2. Concentric = healed histoplasmosis
  3. Popcorn = hamartoma.
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27
Q

Lung nodule > 1 cm
No calcification
Tuberculin / histoplasmosis / coccidiomycosis
Was negative.

Rx infection or biopsy to r/o cancer?

A

Biopsy!
No calcification
Size > 1.5 cm

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28
Q

MCC of death in bariatric surgery?

A

PE > anastomatic leak

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29
Q

Maxillary fracture Sx

A

Can’t bite
Visual Sx
Nasal discharge
Raccoon eyes

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30
Q

Rx of carotid stenosis?

A

> 70% endarterectomy

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31
Q

Rx of compression fracture

A

Decrease activity
Vertebroplasty in 2 wks

No need for physical Rx

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32
Q

Female with RUQ mass
Otherwise healthy
On OCP

A

Hepatoceular adenocarcinoma

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33
Q

When is surgery indicated in hepatocellular carcinoma?

A

If lesion on surface of liver

Risk of bleeding + Ca transformation

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34
Q

Lisfranc fracture Sx

A 
Hx of twist and fall
In athletics 
Can't bear weight 
Mid-foot swelling + pain 
\+/- bruising on dorsum
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35
Q

Lisfranc vs middle cuneiform fracture

A

Cuneiform is due to direct blow to foot

Lisfranc due to twist injury

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36
Q

Rx anal fissure

A
  1. Conservative
    Stool softener
    Sitz baths
    Nitroglycerin oint
  2. Surgical (if medical failed)
    Sphincteromy
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37
Q

Foot drop is sign of?

A

Peroneal nerve palsy

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38
Q

Marker for GI cancer?

A

Caecinoembryonic antigen CEA

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39
Q 
Cancer antigens:
CA 125
CA 27-29
A-fetoprotein
PSA
A

CA 125: ovarian

CA 27-29: Breast

PSA: prostate

a-FP: hepatocellular carcinoma

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40
Q

MC site of venous ulcers

A

Medial malleolus

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41
Q

Origin of anorectal ulcer

A

Anal crypt

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42
Q

Rx of solitary brain met

A

Whole brain radiation + resection cancer

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43
Q

Asymptomatic hematuria Rx

A

Repeat sample in 1 wk

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44
Q

Bedside test for ACL tear of knee?

A

+ve Lachman test
“Forward subluxation of tibia”
Normal- Can’t subluxate
Abnormal- forward movement

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45
Q

Most reliable test for ACL tear of knee?

A

Lachman test

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46
Q

Bleeding after massive PRBC transfusion?

A

Dilutional thrombocytopenia

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47
Q

Lachman vs anterior drawer test?

A
  1. Lachman:
    Knee flexed at 30
    Femur stabilized
  2. Anterior drawer
    Knee at 90
    No femur stabilization
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48
Q

Rx of painful ingrown toenail?

A

If shows granulation or nail dystrophy = lateral matricectomy.

Mild - no granulation or dystrophy:
Abx
Cotton wick elevation

Recurrent - permanent nail ablation

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49
Q

Location of incision in ER tracheotomy? Why?

A

Above cricoid cartilage
Through cricothyroid membrane.

Below vocal cords
By-pass laryngeal obstruction

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50
Q

Preferred tracheotomy site in OR/controlled situation?

A

Below cricoid cartilage at isthmus + 3-4 tracheal rings

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51
Q

Absolute indication for tonsillectomy

A

Airway obstruction
Dysphagia
Sleep disorders
Cardiopulmonary complications.

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52
Q

Risks for plantar fasciitis

A

Obesity

Long standing

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53
Q

Plantar fasciitis Sx

A

Inferior heel pain on weight bearing

Pain: throbbing, searing or piercing

Pain in morning (first steps) or after inactivity.
Improves with walking.
Worse barefoot, on-toe walk, stairs.

Tenderness medial calcaneal tuberosity at plantar aponeurosis

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54
Q

Rx plantar fasciitis

A

NSAIDs

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55
Q

What causes pseudocyst in pancreatitis?

When do they appear?

Rx?

A

Pseudocysts lack true epithelium, they’re duct leakage.

Appear > 2 wks of episode.

Resolves with time if persists or gets infected/necrotic surgery

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56
Q

Is barbiturate addictive?

A

Yes

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57
Q

Barbiturates withdrawal Sx

A

Hallucinations

Seizures

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58
Q

Brachial neuritis Sx

A

AKA: neurologic amyotrophy.

M>F

Acute sever shoulder sharp pain esp. night.

Shoulder weakness

Not worsen by movement of shoulder

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59
Q

Dx brachial neuritis

A

EMG

Nerve conduction

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60
Q

Glioblastoma multiforme Sx

A

At 50 Yrs

Rapid !
Mass effect Sx: N/V, headache, visual

Dx: MRI/CT irregularly enhancing mass

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61
Q

Temporal Fracture classic

A

Battle sign (post auricular ecchymosis)

Ear bleeding (hemotympanum or blue tympanic membrane).

CSF otorrhea

+/- vertigo, CN7 palsy

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62
Q

Complications of gastric bypass (early + late)

A
  • Early:
    GI bleed
    Anastomotic leak
    SBO
- Late:
Hernia 
Stricture 
Stones 
Dumping syndrome

MC: anemia + B12 deficiency

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63
Q

What’s anisocoria

A

Unequal pupil size

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64
Q

Anisocoria + sever headache

A

Intracranial hemorrhage

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65
Q

Outpatient diverticulitis Rx

A

Cipro 500 BID
+
Metro 500 TID

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66
Q

Impatient diverticulitis Rx

A

Cefoxitin IV

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67
Q

Unilateral absence of vas deference associate w/

A

Ipsilateral renal agenesis

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68
Q

When to check sperm count after vasectomy

A

6 wks

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69
Q

Patellofemoral pain syndrome

A

AKA runner’s knee or anterior knee pain

Tenderness on medial retinaculum
Normal ROM
Normal tendon strength

Patellar deviation with knee flexion at 90

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70
Q

Rx of patellofemoral knee

A

Physical Rx

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71
Q

Lumbar radiculopathy Sx + Dx

A

Sever pain
Weak ankle jerk reflex
Spasm

Dx: MRI

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72
Q

CSF drainage

Raccoon eyes

A

Anterior cranial fossa fracture

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73
Q

Snake bite Rx

A

Minutes: venom extractors

2-6 hrs: Antivenin (CroFab > horse-serum)

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74
Q

Traumatic iritis Sx

A

Consensual photophobia

Decreased acuity

Conjunctival injection

Change in intraocular pressure

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75
Q

Corneal abrasion Sx

A 
Eye pain 
Foreign body sensation 
Pain w/ extraocular movement 
Excessive tearing 
\+ve fluorescent
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76
Q

Retinal detachment Sx

A

Flashing light (photopsia)

Shower of floaters

Vision loss (cloudy / curtain like)

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77
Q

What incision used in felon?

A

Longitudinal (superficial w/ foreign body or discharge)

Mid-lateral (deep w/o foreign body or discharge)

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78
Q

Fishmouth incision in felon

A

Contraindicated

Lead to unstable pulp

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79
Q

Assess motor function of median nerve

A

Thumb opposition

Thumb + 5th

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80
Q

Radial nerve injury Sx

A

Wrist drop

No thumb extension

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81
Q

Rx of boxers fracture

A

Ulnar gutter splint

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82
Q

Pre-op assessment in cataract surgery

A

Not needed in asymptomatic patients.

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83
Q

Thyroid nodules algorithm

A

All thyroid nodules = TSH + US

Nodule > 5mm + micocalcifications = FNA

Nodule > 5mm + no calcification = Repeat in 6-12 mo

Nodule > 1cm = FNA

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84
Q

Size of renal stones need admission

Needs surgical intervention

A

> 4 mm

Surgery for > 5 mm
Hasn’t passed in 2-4 wks

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85
Q

Aortic stenosis replacement indications

A

Aortic-valve gradient > 50

Valve area < 1 cm

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86
Q

Rotator cuff muscles

A

Infra + Supra spinatus

Subscapularis

Teres minor

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87
Q

Test Supraspinatus

Infraspinatus

Subscapularis

Teres minor

A

Abdication of shoulder

Lateral rotation

Medial rotation

Lateral rotation

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88
Q

Test infraspinatus

A

Lateral rotation

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89
Q

How long can NGT used?

A

< month

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90
Q

Side effects of NGT

A

Diarrhea esp. c. Diff

Stricture
Ulceration
Aspiration

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91
Q

Signs of moderate - sever ingrown toe nail

A

Swelling
Seropurulent discharge
Infection
Ulceration

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92
Q

Rx of sever ingrown toe nail

A

Abx
Partial nail avulsion and phenolization

Or

Surgical excision of matrix

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93
Q

What’s lateral epicondyltisi?

How is it Dx?

A

Tennis elbow
Pain with extension

Dx by history + PE

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94
Q

What’s varicocele?

A

Dilated veins of pampiniform plexus of scrotum

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95
Q

Varicocele Sx

A

Sub-fertile men
Left sided
Cause reversible testicular atrophy

-ve trans illumination

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96
Q

Radial nerve dermatome

A

Dorsum of hands

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97
Q

Acute back pain following trauma / lifting

A

Due to lumbosacral MS strain

Normal neuro

Rx NSAIDs + bedrest 3 days

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98
Q

MCC of fat embolism

A

Long bone fracture

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99
Q 
Diff eye surgeries 
LASIK
Radial keratotomy 
Photorefractive keratotomy 
Laser thermal keratoplasty
Intrastromal corneal ring
A
  1. LASIK:
    Refractive for myopia + hyperopia
    Corneal flap, ablation of corneal stroma w/ no sutures.
  2. RK:
    Radial incision to change corneal shape.
  3. PRK:
    No corneal flap needed
    Laser directly to cornea
  4. LTK:
    Shrink cornea + change shape
  5. ICR:
    Plastic ring into cornea to change shape
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100
Q

Rx of foot tendinopathy

A

NSIADs

Immobilize in cast boot for 2-3 weeks.

Steroids inj contraindicated

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101
Q

Tendinopathy of foot?

A

Can’t flex, invert or stabilize medial arch

Painful flat foot

Can’t heel raise.

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102
Q

What must be tested in rheumatoid arthritis before surgery,

A

Atlantoaxial subluxation.

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103
Q

Sign of Achilles rupture

A

Thompson test

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104
Q

Rx of open fracture

A

Sterile dressing
Tetanus
Abx (aminoglycoside + 2G cephalosporin)

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105
Q

Rx of sigmoid volvulus

A

Scope

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106
Q

Ulnar nerve sensation

A

5th finger
1/2 4th finger

Motor: thenar + hypothenar

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107
Q

Median nerve sensory

A

Thenar muscle (motor)

Palmar side of thumb, index, middle and 1/2 ring fingers.

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108
Q

Radial nerve sensory

A

Dorsolateral thumb, index, middle + 1/2 ring fingers

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109
Q

What’s Volkman’s ischemia

A

Ischemia from increased pressure by cast!

Iatrogenic compartment syndrome.

Worsening pain even at rest, not relieved by meds.

110
Q

Tibial nerve injury?

A

Loss of plantarflexion

Loss of toe flexion

Weak inversion

+ loss of sensation on posterior of leg and sole of foot

111
Q

Patient on Abx develops high INR?

112
Q

MCC of SBO

A

Adhesion > hernia > Ca

113
Q

MCC of post op lung abscess

A

Aspiration of oral secretions

114
Q

What’s a ranula?

A

Pseudocyst of Mucin collection from a ruptured salivary gland duct

Caused by trauma

Asymptomatic + Rx with surgical excision (marsupialization)

115
Q

When to stop BB in CHF/arryrhemia/HTN Before surgery?

A

Don’t stop.

Continue as scheduled

116
Q

What explains urinary Hg without RBC?

A

Myoglobinuria

117
Q

How does porphyria affect urine?

A

Makes urine burgundy in color

But no hemoglobin in urine

118
Q

How to judge adequacy of fluid replacement?

A

Urine output 1-2 ml/kg/hr

CVP 10-15

119
Q

What’s Parkland formula for burns?

Modified parkland?

A

4 x kg x BSA

1/2 in 8hr
1/2 in 16hr

Modified parkland:
Add 2000 ml to total for maintenance fluid.
4 x kg x BSA + 2000

120
Q

Indications for bariatric surgery?

A

BMI > 35 + Co-morbidities

BMI > 40 even w/o morbidities

With failure lose weight

Alcohol use is contraindication

121
Q

MC site of stress fracture in children?

122
Q

Sx of TMJ syndrome?

A 
Headache 
Tenderness of chewing ms 
Stuffiness in ear 
Disturbed sleep
Neck stiffness radiating to arm
123
Q

What causes foot drop?

No dorsiflexion

A

Common peroneal branch of sciatic nerve

124
Q

Rx of open (compound) lower leg fracture

A

Pain control

Irrigation

Sterile dressing

Tetanus prophylaxis

Abx (cephalosporin + aminoglycoside)

Closed > open reduction.

125
Q

Scaphoid fracture Sx, Rx

A

Snuffbox tenderness
Fall on stretched hands

Rx:

  1. XRay (repeat in 2wk in -ve)
  2. Immobilization (thumb splint) 2 wks
126
Q

Axillary nerve innervation

A

Teres minor
Deltoid
Sensation of glenohumeral joint and skin on deltoid.

127
Q

Axillary nerve injury

A

Dysfunction of deltoid muscle.

Can’t do forward elevation of shoulder (<30 degrees)

128
Q

Rx of prostate with < 5% low grade tumor?

A

Observation.

129
Q

How to asses for osteomyelitis in diabetic ulcer?

A

Look for palpable bone at base of ulcer.

130
Q

What’s Reynolds Pentad?

A

Septic shock from ascending cholangitis

  1. Shock
  2. RUQ pain
  3. Jaundice
  4. Fever
  5. Altered mental status
131
Q

Sign of rotator cuff injury

A

+ve impingement (Hawkin’s)

Flex arm at 90
Flex shoulder at 90
Internal rotation of arm
Pain = +ve.

132
Q

Dx anterior glenohumeral instability

A

+ve apprehension test

Abduct shoulder
Flex arm at 90
Externally rotate
Pain = +ve

133
Q

Complication of undescended testis?

A

Lifetime risk of testicular cancer w/ undescended testis 9.7x higher.

Esp. Seminoma

134
Q

Complication of cataract surgery

More in?
Prevented by?
Dx?
Rx?

A
  1. Cystoid macular edema:
    Breakdown of blood-retina barrier = fluid accumulation.

More in DM
Prevent with NSAIDs
Resolves spontaneously
Dx by fluorescein angiogram

135
Q

Rx of hydrocele

A

Observe in 1st year

Surgery after 1 year if not resolved

136
Q

Sx of orbital fracture

A 
Double vision 
Sunken eyeball 
Eye stuck downward 
Numbness on cheek / lip
Subcutaneous emphysema
137
Q

Dx orbital fracture?

Rx?

A

CT

Medical 
Surgical if:
Ophthalmos or enophthalmos
Diplopia 
Entrapment of nerve 
Fracture > 50% floor
138
Q

Rx of ankle sprain

A

Semi-rigid brace (air-cast)

139
Q

Predictors of increased post-op cardiac disease

A 
- Major:
Unstable MI, acute MI, recent MI
Sever valvular disease 
Decompensated HF
Supra-ventricular arrhythmia.
  • Moderate
    CHF
    DM
    CKD
  • Mild:
    Elderly
    Hx of stroke
    Uncontrolled HTN
140
Q

Dx anterior cruciate ligament?

A

Best: MRI

1st: anterior drawer test
Knees flexed 90 and leg pulled anteriorly.

141
Q

Indications for ORIF?

A
  1. Displaced intra-articular
  2. Displaced epiphyseal
  3. Avulsion fracture
  4. Non union

In ankle:
+ Talar > 10 degree

142
Q

Complication of mandibular fracture

A

Malocclusion of teeth

Numbness

143
Q

Rx of thrombosed external hemorrhoid

A

Excision under local

+ sitz baths

144
Q

MCC of cellulitis post-breast resection

A

Lymphadema from Axillary LN resection.

MC bug: non-GAS

145
Q

What’s hamate fracture?

A

Fracture of hamate (MC bone)
Due to direct blow by handle of tennis racket/golf club.

End of racket forced into the palm
Direct pressure on hypothenar

146
Q

Radial head subluxation ass with what fracture?

A

Pull of extended arm

nursemaid fracture

147
Q

Fall on hyper extended arms fractures? (3)

A

Lunate subluxation
Scaphoid fracture
Colle’s fracture.

148
Q

When to give pre-op Abx?

A

1hr prior to surgery

149
Q

Rx of hammer toe

A

Surgical correction

If can’t = weak pulses = costume made shoes

150
Q

1st step in hypovolemic shock?

A

Samples
IVF
Before FAST

151
Q

Facts on varicocele

A

Appear in teenage
Let > Rt
Dx clinically or US

152
Q

T/F: Rt sided varicocele needs referral to uro

A

T

Or child < 10

153
Q

What’s le Fort fracture?

A

Maxillary bone fracture

Classic in facial trauma

154
Q

What’s pallidotomy?

A

Thalamotomy and pallidotomy

For disabling tremor / dyskinesia

155
Q

Facial trauma + can’t breath

You’ve no tools?

A

Cricothyroid membrane opening via needle.

It’s between anterior cricoid + thyroid.

156
Q

LDL in aortic disease?

157
Q

Types of onychomycosis

A
  1. Proximal
  2. Distal
  3. White superficial
158
Q

Ottawa ankle and foot rules?

A
  1. Ankle X-ray:
    - Bone tenderness at posterior / tip lateral malleoulus
    - Bone tenderness at posterior / top of medial malleolus
    - can’t bear weight
  2. Foot X-ray:
    - Tenderness at base of 5th metatarsal
    - tenderness at navicular
    - Can’t bear weight
159
Q

When to repair aortic aneurysm?

160
Q

Prognosis of prostate Ca

Depends on?

A

Stage and Gleason grade

161
Q

Gameskeeper/skier’s thumb?

A

Avulsion of attachment of ulnar collateral ligament

Not associated with direct blow

162
Q

What finger fracture associated with direct blow?

A

Baseball finger / mallet finger.

163
Q

When does delirium termens starts?

A

2-10 days after alcohol

164
Q

Sx of delirium termens?

A 
Confusion 
Sleeplessness 
Nightmares 
Sweating 
Depression 
\+
Hallucinations esp. visual 
Illusions
165
Q 
Frozen shoulder
Age?
Cause?
Risks?
Sx?
A

Idiopathic
MEN 40-60
Risk: DM
Sx: shoulder stiffness, loss of active + passive ROM, pain esp. night.

166
Q

Frozen shoulder vs rotator tear?

A

Frozen = loss of ROM active + passive

Rotator cuff tear = loss of active, normal passive

167
Q

Medial collateral ligament tear Sx?

A

Pain and swelling on medial knee

Knee abduction > 5 mm = tear.

168
Q

Technetium-99 in lower GI bleed?

A

Not helpful

169
Q

Vaccination after splenectomy

A

Pneumococcal
Meningococcal
HiB

2 wks before surgery

170
Q

Tibialis stress

Tibilal posterior tendinitis

Pes anserine tendinitis

A

Tibialis stress = tenderness + pain w/ less activity.

Posterior tendinitis = pain extends to medial malleolus

Pos anserine = pain proximal to knee

171
Q

Rx of Achilles tendinopathy

A 
1. Conservative (3-6 mo)
Cryotherapy 
Heel lift 
Extracorporeal shock wave 
Deep friction massage 
Eccentric strength training
  1. Surgery only if medical fails.
172
Q

Role of NSAIDs in Achilles tendinopathy

A

No role? No inflammation

173
Q

Sx of lumbar lordosis

A

Pain with spine extension = walking downhill

174
Q

What’s central extensor slip?
Cause?
Rx?
Complication?

A

Tear of extensor slip tendon.

  • Passive flexion of PIP during active extension.
  • Dx: hold joint at 15-30 degree flexion, patient can’t actively extend finger, but passive flexion possible.
    And tenderness on dorsal middle phalanx.
  • Rx: split PIP in full extension 6 weeks.
  • complication: boutonnière
175
Q

What could follow aneurysmal subarachnoid hemorrhage? When?

A

Vasospasm
4-14 days
Dx: CT

176
Q

What’s Leriche Syndrome?

A

Triad of:
No femoral pulse
Pain w/ walking (claudication)
Impotence.

It’s atherosclerosis of GI arteries.

177
Q

P’s of compartment syndrome

A 
Pain 
Pallor 
Paresthesia
Pulselessness 
Paralysis
178
Q

Common scenario of anterior leg compartment syndrome

A

Compression during prolonged recumbency related to alcohol or drugs

179
Q

Complication of slipped capital femoral epiphysis

A

A vascular necrosis

180
Q

Contents of carpal tunnel?

A

Median nerve
Flexor policis longus
4 flexor digitorum profundus

181
Q

Risk of peri-op MI is highest in which surgeries?

A

Aortic and peripheral vascular

182
Q

MCC of anterior cruciate ligament tear?

A

Low-velocity non-contact injuries

Rotational injuries

Esp. Basketball, football, skiing.

183
Q

T/F: Anterior cruciate ligament more in females

184
Q

T/F: strength exercise prevent ACL tear

185
Q

Dx and Rx of non-displaced forearm fracture

A

Dx: fat pad sign

Rx: posterior splint 1-2 wks w/ repeat X-ray

186
Q

Effect of loss of one testis on fertility

187
Q

Patient with biliary colic and no stones on US?

A

Mostly biliary dyskinesia

Dx w/ nuclear scan

188
Q

Hoarseness after thyroidectomy?

A

Recurrent laryngeal nerve = vocal cord paralysis.

189
Q

Dx acute pancreatitis

A

Contrast CT

190
Q 
Which ones show on X-ray?
Glass 
Wood 
Plastic 
Urchin spine
A 
Glass > 2 mm
Urchin spine (has Ca)
191
Q

Most serious complication of supracondyl fracture

A

Compartment syndrome

192
Q

Hesselbach triangle

A

Transversalis fascia defect

Direct inguinal hernia

  • medial to inferior epigastric
  • lateral to rectus
  • superior to inguinal ligament
193
Q

Indirect inguinal hernia anatomy

A

In deep inguinal ring
Lateral to inferior epigastric
Descend into scrotal sca / labia majora

194
Q

Dx appendicitis

195
Q

T/F: stress fracture needs casting

196
Q

Rx of foot stress fracture in runners

A

Rest 4-8 wks start activity as tolerated.

197
Q

Different degrees of hemorrhoids and Rx

A
  • 1st degree:
    Bleed w/ defecation
    No prolapse
    Rx: diet (fiber), recurrent bleeding (sclerotherapy, coagulation, band)
  • 2nd degree:
    Prolapse w/ defecation + reduce spontaneously
    Rx: band ligation
  • 3rd degree:
    Prolapse need Manual reduction
    (Destroyed suspensory ligament)
    Rx: band ligation or resection.
  • 4th degree:
    Prolapse and can’t be reduced
    Rx: resection
198
Q

Sx of de quervain’s tenosynvitis? Rx?

A

Pain at thumb side of wrist.
Pain worse w/ movement
Pain w/ opening and closing thumb

Finkelstein’s test +ve

Rx: NSAISa early => steroids if constant Sx

199
Q

Rx of enlarging hematoma in wound sit?

A

Remove suture and ligate

200
Q

Elderly w/ mid-heel pain worse in evenings
Not better w/ NSAIDs
Normal PE + X-ray

A

Fat-pad atrophy

Fat-pad vs plantar fasciitis
Fat pad worse at night
Fasciitis worse in morning

201
Q

Prevention of decubitus ulcer

A

Alternate Rt + Lt 30 degrees oblique positions

Well tolerated by elderly

202
Q

Humeral shaft fracture palsy?

A

Radial nerve

203
Q

Supracondylar fracture at distal humerus injures what nerve?

A

Median nerve

204
Q

Fracture of humeral surgical neck injures what nerve?

A

Axillary nerve

205
Q

Glasgow Coma Scale?

A 
1. Eye
Spontaneous: 4
Speech: 3
Pain: 2
None: 1

2. Verbal:
Oriented: 5
Confused: 4
Inappropriate: 3
Incomprehensible: 2
None: 1

3. Motor:
Obeys command: 6
Localize pain: 5
Withdraw: 4
Flex: 3
Extend: 2
None: 1
206
Q

Overuse of forearm extensors syndrome?

A

Tennis elbow (lateral epicondylitis)

207
Q

Rx of massive / saddle shaped PE

A
  1. No trauma or contraindication: tPA

2. Trauma: embolectomy

208
Q

Patient w/ AFib for surgery.

Need for anticoagulant

A
  1. Lone Afib (no Hx thrombus)
    Stop warfarin 3-4 days pre-op
    Resume as indicated by surgeon.
  2. Afib w/ Hx of thrombus:
    Stop heparin 3-4 days pre-op
    Give prophylactic heparin post-op

In high risk (prosthetic valve): give therapeutic in INR below normal.

209
Q

Absolute contraindication to laparoscopy

A
  1. Coagulation abnormalities
  2. Shock
  3. High ICP
  4. Retinal detachment
210
Q

What’s malignant hyperthermia

A

Inherited myopathy in sarcoplasmic reticulum => high intercellular Ca => sustained contraction + hyper metabolic state.

211
Q

Trigger of malignant hyperthermia

A

Inhalation anesthetics (halothane)

Succinylcholine

212
Q

Sx of malignant hyperthermia

A

Fever
Tachycardia
Increases Ms tone + rigidity

213
Q

Rx of malignant hyperthermia

A

Dantrolene + cooling

214
Q

What’s Dressler’s syndrome?

A

Post-pericardiotomy syndrome

2 weeks after surgery = low grade fever + chest pain

215
Q

What’s osteitis pubis

A

Chronic lower abdominal pain + medial thigh w/ exercise.

216
Q

Dx of osteitis pubis

A

Lower abdominal + medial thigh pain w/ exercise

Tenderness on pubis

Widened pubis on X-ray

217
Q

What surgery has high risk of post-op DVT?

A

Neurosurgery

Orthopedics esp. hip replacement.

218
Q

Dx quada equine?

A

MRI w/ gadolinium

219
Q

What’s a jersey finger?

A

Tear of flexor digitorum profundus tendon of finger

Classically by catching finger in opponent’s clothes

220
Q

Rx of jersey finger?

A

Splint in slightly flexed position and refer to surgeon for tendon re-attachment

221
Q

MCC of bowel obstruction in elderly

A
  1. Adhesions

2. Groin hernia

222
Q

What Morton’s Neuroma

A

Tenderness in 3rd interspace between 3-4 toes.

No inflammation or redness.

223
Q

What’s the female athlete triad

A

Amenorrhea
Stress fracture
Eating disorder

224
Q

Essential findings in brain death (3)

A

Coma

Absence of brain stem reflexes

Apnea

225
Q

Dx brain death

A
  • R/o hypotension, hypothermia <32, drugs, brain stem encephalitis, encephalopathy, low PO4
  • GCS 3
  • No pupillary reflex
  • HR < 5 after atropine
  • No resp. w/ high CO2
  • +ve apnea test if no resp w/ PCO2 > 60 mmHg on 100 O2
226
Q

Initial Rx in coma

A

ABC (airway, IVF, viral signs)

Coma cocktail:
Dextrose D50W
Flumazenil
Naloxone 
Thiamine
227
Q

Dx rotator cuff

A

Painful abduction > 90

Weak external rotation (specific)

228
Q

Who gets more than ECG in pre-op evaluation

A
  1. Unstable MI
  2. Sever VHD
  3. Uncompensated CHF
  4. Significant arrhythmia
229
Q

Who gets ECG in pre-op

A 
Males > 45
Females > 55
DM
Chest pain 
NYHA 3
Cardiac disease
230
Q

SE of spironolactone in men?

A

Gynecomastia (Uni > bi)

231
Q

What’s contraindicated in anesthesia of penile surgery / circumcision?

A

Epinephrine

232
Q

What’s penumocephalus? What does it indicate?

A

Air in cranium

Skull fracture, trans-sphenoidal surgery, tumors in base of skull

233
Q

Serious complication of chronic calculous cholecystitis?

A

Gallbladder cancer

234
Q

Shoulder pain after gall bladder surgery

A

Referred pain (C3-5)

235
Q

Rx of buckle fracture of wrist

A

Removable splint

236
Q

Patient high risk for DVT post-op

A

SubQ enoxaparain 1-2hr before surgery + 24hr after.

237
Q

Bariatric surgery recommended BMI

A
  1. BMI > 40

2. BMI > 35 + comorbidity

238
Q

Effect of bariatric surgery on T2DM

A

Resolve disease in 75%

239
Q

Pain in spinal stenosis vs herniated disk

A

Stenosis = improves w/ setting

Disk = improves by standing

240
Q

Odds of having breast Ca? Die of breast ca?

A

1 in 8

1 in 30 dies of breast Ca

241
Q

Physical / mechanical prevention of DVT?

A

Compression stockings

242
Q

When do osgood-schlatter fracture resolve?

243
Q

Typical pain in Osgood-schlatter?

A

Confined to tibial tubercle.

244
Q

T/F: Osgood-schlatter not ass w/ trauma

245
Q

MC injured ligaments of knee

A

Medial CL

ACL

246
Q

When to refer varicocele to urology

A

If testicular volume 2ml less than normal

247
Q

Primary closure after animal bite?

A 
Face / scalp 
W/in 6hr of injury 
No devitalized tissue 
No fracture 
Immune competent
248
Q

Femoroacetabular impingement pain

A

Worsening anterolateral hip pain

Sharp moving from seated position

Pain w/ ROM exam

249
Q

Most sensitive test for femoroacetabular impingement

A

FADIR test

Pain w/ hip Flexion, adduction, internal rotation

250
Q

Rx of nursemaid’s elbow

A

Manual reduction w/ supination-flexion techniques

251
Q

Where’s CN XI?

Sx?

A

Posterior neck triangle

Innervates trapezius => dropped shoulder + can’t raise hand above head.

252
Q

Complication of scaphoid fracture / snuffbox?

A

A vascular necrosis

253
Q

Risk of post-op delirium in elderly?

254
Q

Rx of closed colle’s fracture

A

Slight flexion, full pronation, full ulnar deviation reduction

255
Q

What improves Ca Oxalate stones?

A

High Ca diet
Low Fat
High Mg
Citrate

256
Q

Imp risk of lung post-op?

257
Q

Ogilvie’s Syndrome?

A

Intestinal pseudo-obstruction with massive distention of colon or bowel after surgery.

No mechanical obstruction.

258
Q

Herb to be stopped week before surgery

A

Ginseng = hypoglycemia + anticoagulant

259
Q

When to start ROM exercise in ankle sprain

A

Early to maintain flexibility

260
Q

Rx of femoral neck + intratrochanteric fracture

A

Femoral neck: internal fix

Intratrochanteric: compression screw + side plate

261
Q

Diff dementia + delirium

A

Delirium = previously healthy + mental status fluctuates on successive visit.

262
Q

Surgery for rotator cuff injury

A

Young + Active

< 6wk of injury

263
Q

MCC of fistula-in-ano?

A

Rectal abscess

264
Q

Zanker’s diverticulum (cricopharyngeal)

A

Difficult swallow
Gurgling noise
Spitting food swallowed hrs ago
Bad smell

265
Q

Rx of choice in BCC

A

Mohs Surgery

266
Q

BCC cure rate w/ mohs surgery

267
Q

How to decrease pain from inj local anesthetic

A

Add Na HCO3
Warm solution
Small needle
Slow inj

268
Q

Proctalgia Fugax?

A

Episodes of sharp pain in rectum lasts minutes

Normal exam

269
Q

T/F: Achilles’ tendon rupture patient can’t do single leg toe raise

270
Q

Drug ass. w/ tendon rupture

CanQB (16 decks)

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