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$$MS3 > Surgery > Flashcards

Surgery Flashcards

1
Q

What is Charcot’s triad and reynold’s pentad and what is its indication? tx?

A

RUQ pain/jaundice/fever
all 3 plus HoTN/AMS
Ascending cholangitis
ERCP with cipro + metro

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2
Q

Tx for follicular, medullary, papillary thyroid carcinoma?

A

Follicular/medullary - total thyroidectomy
Papillary - lobectomy
Follicular - I2 ablation

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3
Q

What electrolyte abnormalities would you see from mineralocorticoid deficiency?

A

Hyponatremia and hyperkalemia

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4
Q

Under what GCS score do you intubate? what does GCS evaluate?

A

8

Eye opening/motor/verbal

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5
Q

Management of abdominal gunshot wound?

A

Exploratory laparotomy

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6
Q

A patient who has a fake eye of missing toe from a cancer 20 years ago now have multiple masses in the liver, what is it?

A

Metastatic melanoma (metastasize 20+ years after the onset)

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7
Q

Management of Colle’s fracture?

A

Closed reduction and short arm cast

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8
Q

Difference seen on barium swallow in pt with achalasia vs. cancer?

A

Achalasia - massive dilation (bird’s beak)

Cancer - no massive dilation/just focal narrowing

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9
Q

What is the criteria for lumpectomy vs. mastectomy for breast cancer?

A

Size of 4cm
Under 4 - lumpectomy
Over 4 - mastectomy

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10
Q

Dx of mesenteric ischemia?

A

CT

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11
Q

What is cushing’s triad? and its management?

A

Increase ICP
Irregular breathing/HTN/bradycardia
Elevate head of the bed/give mannitol/hyperventilate/craniotomy

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12
Q

When do you do an endoscopy for GERD pt?

A

anyone with alarming symptoms such as dysphagia/bleeding/odynophagia
Or pt>50 with more than 5 years of GERD

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13
Q

What would you worry about a pt post brain surgery with AMS?

A

DI - hypernatremia

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14
Q

Elderly pt with hx of atherosclerosis/recent hypotension complains of sudden abdominal pain, what is it and what do you see on angiography?

A

non occlusive mesenteric ischemia from vasoconstriction

“string of sausages”

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15
Q

What would a penetrating trauma to the groin cause?

A

AV fistula causing venus HTN — edema and varicose veins

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16
Q

What test is used first for peripheral vascular disease? and how to interpret it?

A

ABI
normal 1 - 1.3
Under 1 - ischemia
Over 1.3 - calcified (DM or vasculitis)

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17
Q

What are afferent loop and dumping syndrome?

A

Post gastrojejunostomy
Dumping syndrome - too much food in small intestine too fast - nausea/vomiting/diarrhea/dizziness/fatigue tx - smaller meals and less fat
Afferent loop syndrome - mechanical obstruction of the afferent loop - abdominal pain 1-2 hours after eating, relieved by vomiting

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18
Q

Difference between incarcerated and strangulated bowel hernia

A

Incarcerated - just tender

Strangulated - tender/fever/elevated WBC - urgent surgery

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19
Q

What is the bacteria number in u/c for bacteriuria?

A

over 100,000

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20
Q

What score system is used to grade prostate cancer?

A

Gleason score

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21
Q

What does CVP measure and what is its normal range?

A

Venous filling pressure aka volume level

2- 6 mm Hg

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22
Q

What does contrast highlight?

A

Blood vessels

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23
Q

What causes nephrogenic DI?

A

Demeclocycline and Li+

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24
Q

Normal value of BUN/Cr, FENa and urine osm? what happens in intrarenal disease?

A 
BUN/Cr = 15
FENa <1%
Urine osm >500
BUN/Cr <15 (decrease reabsorption)
FENa >2% (decrease reabsorption) 
Urine osm <500 (can't concentrate)
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25
Q

What causes hypokalemia?

A

Loop/thiazide/Bartter’s syndrome

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26
Q

What electrolytes abnormalities does diarrhea and vomiting cause?

A

They both cause hypokalemia
Vomiting cause alkalosis
Diarrhea cause acidosis

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27
Q

Why does aldosterone cause alkalosis?

A

Aldosterone increase Na reabsorption and K/H+ secretion

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28
Q

Why does aortic regurg causes widen pulse pressure?

A

Pulse pressure = systolic - diastolic pressure
Aortic regurg - blood flows back into ventricles during diastole - increase ventricular volume thus systolic pressure - decrease aortic volume thus diastolic pressure

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29
Q

How does beta blocker increase K+?

A

It blocks renin

Prevent cellular uptake of potassium

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30
Q

What electrolyte abnormalities do VIPoma cause?

A

Hyperglycemia/hypercalcemia/hypokalemia

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31
Q

What other electrolyte is affected by low Mg?

A

Low Mg – low PTH— low Ca

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32
Q

When cant you do endocraft to fix AAA?

A

When the neck is <15mm

such as juxtarenal/suprarenal AAA

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33
Q

When cant you do endocraft to fix AAA?

A

When the neck is <15mm

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34
Q

Which IBD has nonceasating granuloma?

A

Crohn’s

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35
Q

Which use Mg2+ for acute asthma?

A

Inhibit smooth muscle contraction/ACh release

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36
Q

What are the 3 signs for appendicitis?

A

Rovsing/Psoas/obturator

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37
Q

Appendicitis is dx with contrast or noncontrast CT?

A

Contrast CT

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38
Q

What size of the carcinoid tumor that we dont care about?

A

<2 cm

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39
Q

Common etiology of big bowel obstruction?

A

Volvulus/diverticulitis

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40
Q

How to decompress sigmoid volvulus?

A

Sigmoidoscopy

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41
Q

Biliary air in liver with signs of SBO, what is it?

A

Gallstone ileus

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42
Q

What would be urine pH be with dehydrated patients?

A

Aciduria

Caused from aldosterone reabsorbs Na and excrete K and H+

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43
Q

A breast cancer mass is tend to feel rubbery or hard?

A

It is hard

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44
Q

Which biopsy method is preferred for breast cancer?

A

Core needle biopsy

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45
Q

What kind of adjuvant therapy should triple negative breast cancer pt receive?

A

Chemotherapy

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46
Q

What is Marjolin’s ulcer?

A

SSC of the skin with previous trauma or burn

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47
Q

What kind of feeding method is used for pt with a large burn or pancreatitis?

A

Enteral feeding vis either NG or NJ (nasojejunal) tubes

48
Q

What kind of feeding method is used for pt with a large burn?

A

Enteral feeding

49
Q

Frostbite limb with no pulse, what is happening?

A

Thrombosed arteries, need tPA

50
Q

You found a bulb at the carotid bifurcation, what could it be and what’s the tx?

A

Carotid body tumor

take it out

51
Q

What is acute peripancreatic fluid collection and when does it become pseudocyst?

A

Fluid around the pancreas in a sack (wait till it becomes pseudocyst)
If it’s over 4 weeks then it’s pseudocyst

52
Q

80% of stenosis at external carotid, what to do next?

A

Wait and see

External carotid stenosis does not cause stroke

53
Q

What should be the diet for CKD pt?

A

Restrict protein/K/Mg/Ph cuz kideny get filter them out thus lead to accumulation in blood stream

54
Q

What is ACE inhibitor’s effect on kidney and why is it used for CKD patients?

A

Decrease efferent arterial constriction/decrease GFR/lessen hyperfiltration/decrease protein filtration thus proteinuria

55
Q

Difference between stye and chalazion?

A

Stye is infection of a hair follicle and chalazion is blockage of sebaceous gland
Both can be tx with warm compresses to increase drainage

56
Q

Tx for CO and cynaide poisoning?

A

100% O2/cobolamine and thiosulfate

57
Q

Signs of diverticulitis with what else would make it a complicated one?

A

UTI - might be a fistula

58
Q

What could the pt do to alleviate the pain from pancreatitis?

A

lean forward

59
Q

Does the presence of gallstone enough to establish the dx as gallstone pancreatitis?

A

If there are no other factors then yes

60
Q

What is acute peripancreatic fluid collection and when does it become pseudocyst?

A

Fluid around the pancreas in a sack

If it’s over 4 weeks then it’s pseudocyst

61
Q

MRI findings of PML/Toxo/CNS lymphoma

A

PML - multiple non enhancing lesions
Toxo - multiple ring enhancing lesions
CNS lymphoma - solidary ring enhancing lesion

62
Q

Why hyperventilation decreases cerebral edema?

A

Hyperventilation – decrease PaCO2 — arterial vasoconstriction – decrease cerebral blood flow —- decrease cerebral edema

63
Q

The only STD ulcers that is painful? and the only STD ulcer associated LAD that is not painful?

A

Painful STD ulcers - HSV/chancroid

Nonpainful STD LAD - syphilis

64
Q

Why does rhabdomyolysis causes hypocalcemia?

A

Release phosphate — phosphate precipitates Ca — decrease Ca

65
Q

What does Prussian blue stain?

A

Iron

66
Q

When do you have target cells?

A

Post splenectomy/beta or alpha thal minor

67
Q

Tx for SIADH

A

ASX - water restriction/NS + loop/Li/demeclocycline

SX - hypertonic saline

68
Q

What’s in Lactated ringer that is not in NS? and why does surgeons prefer LR and medicine prefer NS?

A

LR has K that is not in NS
Large amount of NS infusion can cause acidosis but not LR
You use a lot of fluid in surgery thus you dont wanna give pt acidosis so LR is better
Medicine ppl dont wanna volume overload pt so they wont give large amount of fluid so LR is not needed (besides K in LR can worsen CKD or heart failure)

69
Q

What are the two condition with increased MCHC? and what should be giving to these pt?

A

Sickle cell/herediatry spherocytosis

Folate

70
Q

what are the three conditions that have spherocytes?

A

Herediatry spherocytosis/warm autoimmune hemolytic anemia/G6PD def

71
Q

What is the triad in PNH and what is the tx?

A

Anemia/pancyotpenia/venous thrombosis

Eculizumab - against factor C5

72
Q

Hypothyroidism causes?

A

Joint pain/increase lipid/macrocytic anemia

73
Q

Symptom and causes of central cord syndrome? prognosis?

A

Hyper extension of the neck
Loss of motor function and burning pain in upper extremities
Eventually recovery on its own

74
Q

What causes warm autoimmune hemolytic anemia? and what kind of hemolysis?

A

Cancer/drug/SLE

Extravascular

75
Q

Medical management of pul contusion

A

Use diuretics/fluid restrict

76
Q

What’s the cause of aortic rupture and what’s the dx?

A

Deceleration injury

Spiral CT aka CT angio

77
Q

What is the complications of HIT?

A

PE and DVT

78
Q

Why liver disease causes coagulopathy?

A

Decrease clotting factor/cholestasis decrease Vit K absorption/hyperslenishm (from portal HTN) - thrombocytopenia

79
Q

Adverse effect of heparin

A

Osteoporosis/alopecia

80
Q

Subtypes of Hodgkin’s and Non-Hodgkin’s lymphoma?

A

Hodgkin’s - ones like lymphocyte depleted

NHL - Burkitt’s/Mycosis fungoides

81
Q

What kind of bladder rupture can be fixed, intra or extraperitoneal?

A

Intraperitoneal

82
Q

What is alpha blocker’s role in kidney stone?

A

Relax the smooth muscle of distal ureter

83
Q

What mimics testicular torsion?

A

Appendages torsion

84
Q

What to do next with a young guy with ball mass?

A

Take it out, don’t bx

85
Q

Phimosis vs. paraphimosis?

A

Phimosis- can’t pull back foreskin - seen normally in young boys
Paraphimosis - foreskin pulled back too long - emergency - reduce it back

86
Q

What kind of inguinal hernia can be sliding hernia and what is the risk of repairing it?

A

Indirect inguinal hernia usually on the left side/colonic injury

87
Q

What is the MC type of hernia in men and women?

A

Indirect inguinal hernia

88
Q

What is femoral hernia associated with and where is it located?

A

Multiple births

Empty space in NAVEL (nerve, artery, vein, empty and lymphatics)

89
Q

What drug is associated with post op ileus?

A

Opioid

90
Q

What is Richter’s hernia?

A

Only one wall of bowel is strangulated or incarcerated

without associated symptoms

91
Q

When should we fix an infant’s umbilical hernia? and what size can it usually be healed by itself?

A

Delayed till 4 years old

If under 2cm then it usually heal on its own

92
Q

What causes ischemic orchitis and what is the tx?

A

Thrombosis of pampiniform plexus

Self limited

93
Q

What does the genital and femoral branch of genitofemoral nerve innervate and what about ilioinguinal?

A

Genital branch of genitofemoral - scrotum and cremastic reflex
Femoral branch - proximal medial thigh
Ilioinguinal - lower abd and medial thigh

94
Q

What is closed loop SBO?

A

A segment of bowel is obstructed both proximally and distally

95
Q

Management of postop NSTEMI?

A

Medical management

96
Q

What is dressler syndrome?

A

Post MI pericarditis

97
Q

What is the access hormone in pheo?

A

Epi/norepi

98
Q

Found a 8cm mass on adrenal gland, what to do next? and what if its 3cm?

A

Take it out
Any adrenal tumor that is over 6cm - take it out and don’t bx
3cm - check biochemical marker to see if the tumor is functional or not, if not observe

99
Q

see laryngeal cancer, think what other cancer?

A

Lung cancer

100
Q

What is the MC organism that causes otomycosis and what populations are most susceptible?

A

Aspergillus

Pt with hx of AML and DKA pts

101
Q

What can causes mastoiditis and what is the dx and tx?

A

Otitis media

CT/surgery

102
Q

Tx for acalculus cholecystitis

A

Abx and percutaneous cholecystectomy if critically ill

103
Q

What to do with pt with ASX gallstones?

A

Observe

104
Q

What is the complication of AAA repair and what is the dx?

A

Ligate IMA - ischemic colitis

Flexible sigmoidoscopy

105
Q

What is the screening for kids with FAP?

A

Sigmoidoscopy since the age of 10

106
Q

What does diffuse axonal injury results in?

A

Unconsciousness and then vegetative state

107
Q

MC site of PE?

A

Left common iliac vein

108
Q

Fever, painful, purple swollen leg, increased RR and HR, what is it?

A

Necrotizing fasciitis

109
Q

What kind of shock causes vasodilation?

A

Septic and anaphylactic

110
Q

Tx for ITP?

A

Steroid and then IVIG

111
Q

If pt is likely on Well’s criteria, can you give heparin before confirm the diagnosis?

A

Yes

112
Q

What are the 4 classes of wounds?

A

Class I - clean (not entering cavities)
Class II - clean contaminated (entering but do so surgically like c section)
Class III - contaminated - trauma
Class IV - dirty infected (like abscess, perforation)

113
Q

What area of bleeding can’t FAST detect?

A

Retroperitoneal

114
Q

Management of pancreatic injury with duct disruption

A

Surgery

115
Q

Management of blunt carotid injury?

A

Heparin only

116
Q

Hemodynamically stable GSW pt, what to do?

A

Get a CT first to assess

$$MS3 (8 decks)

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