Surgery Flashcards
1
Q
SIRS criteria
A
systemic inflammatory response syndrome
- temp < 36 or > 38
- HR > 90
- tachypnea (>20) or PCO2 < 32
- WBC < 4000 or > 1200
2
Q
sirs vs sepsis, etc
A
sirs = 2 criteria
sepsis = + source
severe sepsis = + organ dysfunction
septic shock = + hypotension
3
Q
dx avascular necrosis
A
MRI
4
Q
causes of avascular necrosis
A
corticosteroids, EtOH abuse, SLE, gout, sickle cell, gaucher,
5
Q
acute abdomen next step
A
exploratory lap
6
Q
colonic dilation + toxic labs
A
toxic megacolon…duh
7
Q
dilation of colon POD 3-5
A
Ogilvie syndrome (acute colonic pseudo-obstruction)
8
Q
ogilvie syndrome: tx
A
- bowel rest (24 - 48 hr)
- neostigmine
- colonoscopic decompression
9
Q
something “stuck” in throat, cant swallow next step
A
emergent endoscopy
10
Q
scrotal mass next step
A
ultrasound
11
Q
solid scrotal mass next step
A
excisional bx
12
Q
double bubble sign
A
duodenal atresia
13
Q
hoarseness, throat clearing, post laryngeal erythema, vocal fold edema
A
laryngopharyngeal reflux (LPR)
14
Q
LPR: tx
A
behavior mod, PPI (lansoprazole)
15
Q
when do you do a skeletal survey?
A
children < 2: physical abuse suspected
children < 5: weird fractures
older kids: suspect in unreliable (intellectually impaired)
16
Q
MCC bacterial prostatitis
A
E. coli
17
Q
bacterial prostatitis: tx
A
bactrim or cipro
18
Q
DVT prophylaxis in CKD pts
A
unfractionated heparin (usually LMWH)
19
Q
new onset increased ICP w/o infection signs
A
brain tumor
20
Q
thrombocytopenia + increased D-dimer
A
DIC
21
Q
anterior uveitis + back pain
A
ankylosing spondylitis
22
Q
single heart sound
A
tricuspid atresia
23
Q
uncomplicated vertebral compression fx: tx
A
acetaminophen
24
Q
unilateral sensorineural hearing loss next step
A
MRI (r/o acoustic neuroma)
25
diarrhea in HIV (CD4<50)
CMV colitis
26
"hot potato voice" -- WTF?
muffled - think peritonsillar abscess
27
peritonsillar abscess - what do you see?
inflamed, medially displaced tonsil
uvula deviate to other side
muffled voice
28
rib fracture --> trouble breathing --> tx?
intercostal nerve block
29
dilated colon + nausea/constipation/distension
acute intestinal pseudo-obstruction (ogilvie)
30
pearly skin lesion w/ telangiectasias
basal cell carcinoma
31
afib with rapid ventricular response: tx
1. diltiazem/verapamil or beta blocker
2. amiodarone
hemo unstable --> cardioversion
32
anal fissure tx
sitz baths
stool softeners
topical nitroglycerin
33
leg claudication -- where/what artery?
```
hip/butt --> aortoiliac artery
thigh (+lower) --> common femoral
upper 2/3 calf --> superficial femoral
lower 2/3 calf --> popliteal
feet --> tibial
```
34
lynch syndrome (HNPCC) CA worries
colorectal (duh)
| endometrial
35
intussusception tx
air enema
36
test for zollinger-ellison
1. fasting serum gastrin concentration
| 2. CT to find tumor
37
bone = periosteal elevation, concentric bony layers in tumor, mottled appearance
Ewing's sarcoma
38
when do you get subphrenic abscesses
1-3 wks post splenectomy or gastrectomy
39
appendicitis in preggers: dx
graded compression u/s
40
odynophagia
painful swallowing
41
dysphagia w/ solids and liquids q/o odynaphagia
achalasia
42
achalasia dx
barium swallow
43
hemothorax post trauma management
resp distress --> ET tube
hemo stable --> tube thoracostomy
hemo unstable --> open thoracotomy
44
crescent brain bleed + midline shift
subdural hematoma
45
complication 12-48 hrs s/p MI w/ dyspnea + new murmur
think MR (TEE, blowing sys murmur, S4)
46
complication 2 - 7 days s/p MI w/ hTN and pulselessness
free wall rupture (or pseudoaneurysm)
47
complication 3-5 days s/p MI w/ hTN, tachy, and palpable thrill
ventricular septal rupture
48
DVT tx in preggo
LMWH
49
PDA tx
indomethacin
| surgery if PDA too large or pt < 6 kg
50
pancreatic calcification on xray
chronic pancreatitis
51
complications of chronic pancreatitis
DM, bile duct/duodenal obstruction, pseudocysts, ascites, pleural effs, splenic vein thrombosis, adenocarcinoma
52
coronary stent vs bypass
stent for 1 or 2 vessels; 3 --> bypass
53
post prandial abdominal pain w/ DM pt
chronic mesenteric ischemia
54
melanoma: breslow tumor thickness : margin
< 1 mm : 1 cm
>= 1.5 and <4 mm : 2 cm
>= 4 mm : 3 cm
55
carotid stenosis management
> 70% occlusion w/o sx: CEA
> 60 w/ sx: CEA
> 60 w/ sx + major health issues: stents (no good for surg)
56
hepatic encephalopathy management
1. treat underlying if possible
2. lactulose
3. rifaximin if lactulose doesn't work in 48 hrs (or cant tolerate)
57
primary biliary cholangitis pathology
autoimmune --> destroy intrahepatic bile ducts --> cholestasis
58
primary biliary cholangitis tx
ursodeoxycholic acid
| ESLD --> liver transplant
59
epidural hematoma tx
craniotomy w/ clot evacuation
60
when to do bariatric surgery
BMI >40
| BMI >35 w/ comorbid condition
61
when to screen for AAA
men who ever smoked: once btwn 65 and 75
62
when to screen for lung CA
30+ pack years
| 55 - 79
63
JVD, hTN, decreased breath sounds
tension pneumothorax
64
mgmt for drinking strong acid/base
endoscopy
65
nephrolithiasis dx
non-contrast helical CT
| U/S for preggos
66
go to appendicitis tx
1. antibiotics (broad - zosyn?)
| 2. lap appy
67
head/neck pain + Horner synd
carotid artery dissection
68
carotid artery dissection -- series of events
```
carotid dissects (trauma, spontaneous)
symp fibers messed up --> Horner syndrome
endothelial damage --> clotting --> CVA (usually in middle cerebral artery)
```
69
carotid artery dissection dx
MRA
70
person 50+ falls on outstretched hand -- what breaks?
distal radius (Colle's frx) --> ant forearm bulge, "dinner fork deformity"
71
what do you break in a street fight?
5th metacarpal (dorsum tenderness)
72
dx for adenocarcinoma of ampulla of vater
ERCP
73
thyroid storm tx
```
fluids
hydrocortisone
propranalol
PTU
iodine 1 hr later
```
74
pheochromocytoma tx
phenoxybenzamine
then propranalol
then surgery to remove tumor
75
urethral trauma management
1. retrograde urethrogram
2. then cystoscopy or laparotomy to fix
3. (if cant go to surgery right away insert a suprapubic cath)
76
rhabdo management
give fluids, fix electrolytes
77
non healing penis ulcer post tx
suspect carcinoma in situ (bx that ish)
78
tx for entamoeba histolytica
metronidazole
79
EKG: regular rate tachy, narrow QRS, no P wave (obstructed by QRS)
atrioventricular nodal reentrant tachycardia (AVNRT)
| MC paroxysmal supraventricular tachycardia
80
AVNRT management
unstable pt --> synchronized electric cardioversion
stable --> cardiac massage then medical caridoversion (adenosine)
meds dont work/prevent recurrence --> radiofrequency ablation
81
post prandial pain for months w/ "food fear"
chronic mesenteric ischemia
82
skin lesion: erythematous nodule w/ central ulceration that bleeds
squamous cell carcinoma
83
ischemic priapism management
fluids, O2, pain control
| then aspiration and irrigation of corpora cavernosa
84
hit head, lucid, then coma
epidural hematomas
85
MC vessel injured in epidural hematoma
middle meningeal artery
86
vessels injured in subdural hematoma
```
bridging veins (MC)
cortical arteries
```
87
flushing + diarrhea + RUQ pain
carcinoid syndrome
88
liver path: soft yellow lesion w/ homogenous interior
hepatic adenoma
89
liver path: pedunculated surface w/ brown, sponge-like interior
hepatic hemangioma
90
liver path: macrovesicular steatosis w/ areas of lobular inflammation
non-alcoholic fatty liver dz
91
liver path: exterior fibrous capsule w/ interior areas of necrosis
hepatocellular carcinoma
92
liver path:firm tan lesion w/ fibrous septa and central stellate scar
focal nodular hyperplasia
93
trauma pt with signs of internal bleeding management
unstable --> laparotomy
stable --> FAST scan
U/S is equivocal/unavailable --> diagnostic peritoneal lavage
94
bugs to look out for in splenectomy pt
strep pneumo
H flu
neisseria meningitidis
95
when do you put in ear tubes?
3+ episodes in 6 months
| 4+ episodes in 12
96
when to repair a AAA
> 5.5 cm w/o sx
grows 0.5 mc in 6 mo
any symptomatic AAA
97
signs of symptomatic AAA
abdominal or back pain
| thromboembolism
98
foreign body tx
rigid bronchoscopy
99
traumatic bladder rupture: dx
retrograde cystography
100
signs of scaphoid frx
decreased grip strength
| tenderness to snuffbox
101
signs of lunate frx
dorsum tenderness
102
signs of trapezium frx
pain when pinching (thumb to #2)
| tenderness at thenar eminence
103
signs of triquetrum frx
tenderness at ulnar border
104
signs of pisiform frx
pain and swelling at ulnar/palmar suface
105
tetralogy of fallot
1. overriding aorta
2. pulmonary stenosis
3. VSD
4. ventricular hypertrophy
106
hyperparathyroidism --> how to investigate?
sestamibi scan best way to find parathyroid adenomas (MCC primary hyperparathyroidism)
107
thyroid nodule workup
1. serum TSH
2. U/S if abnormal
3. FNA
4. total thyroidectomy if malignant
108
ankylosing spondylitis tx
1. NSAIDs
2. etanercept (TNF alpha inhibitor)
3. sulfasalazine
4. surgery
109
open vs closed angle glaucoma
```
open = slow. peripheral vision loss then central
closed = acute. red eyes + vision changes (halos). cloudy cornea, fixed mid position pupil, firm globe. + HA/n/v
```
110
trismus
inability to open your mouth (lock jaw)
111
ludwig's angina pathophysiology
cellulitis of submandibular space
112
ludwig's angina sx
fever, fatigue, drooling, trismus, elevated tongue, dysphagia
113
ludwig's angina organism
MCC by strep viridans form dental infection
114
lateral gaze palsy, vision changes, HA, post sinusitis
cavernous sinus thrombosis
115
HTN, HA, pulsatile tinnitus, epigastric bruits
fibromuscular dysplasia
116
string of beads renal artery
fibromuscular dysplasia
117
reynaud's, hand deformities, dysphagia
scleroderma
118
new onset ascites management
paracentesis
119
abdominal pain, ascites, fever, AMS
bacterial peritonitis
120
mouth pain, tongue swelling, palpable structure in floor of mouth
sialolithiasis (submandibular salivary gland stones)
121
diverticulitis imaging
CT - diverticula, focal inflammation and fat stranding
122
diverticulitis tx
liquid diet and antibiotics
123
charcot's triad
fever, jaundice, RUQ pain (for ascending cholangitis)
124
reynold's pentad
charcots (fever jaundice, RUQ pain) + hTN and AMS
| shows suppurative cholangitis
125
lung abscess tx
1. IV clindamycin
| 2. if not working metronidazole/penicillin
126
fingers affected by carpal tunnel
1, 2, 3, half of 4
127
temporal arteritis 1st step
steroids (then biopsy)
128
staph aureus endocarditis tx
IV vanco
129
winged scapula nerve
long thoracic
130
mastectomy nerve damage
long thoracic
131
becks triad
hTN, JVD, muffled heart sounds (cardiac tamponade)
132
cardiac tamponade tx
pericardiocentesis
133
bladder cancer dx
cystoscopy
134
tx for delirium till you know whats up
haloperidol
135
liver: peripherally-enhancing lesion
hepatic abscess
136
bacterial sinusitis tx
amoxicillin-clavulanate
137
acromegaly tx
1. transsphenoidal surgery
| 2. octreotide if cant
138
sausage like mass in a baby belly
intussusception
139
abdominal compartment syndrome
new organ dysfunction caused by increased intraabdominal pressure
(happens with rapid fluid resuscitation)
140
abdominal compartment syndrome dx
bladder pressure > 12 mmHg
141
corkscrew appearance on barium esophagram
diffuse esophageal spasm
142
high riding or absent prostate
posterior urethral injury
143
blood at meatus, inability to void, pelvic ecchymoses
urethral injury
144
gastroparesis dx
scintigraphic emptying study
| barium follow thru if not available
145
spinal epidural abscesses dx
MRI
146
lesion @ distal femur with sunburst appearance
osteosarcoma
147
slipped capital femoral epiphysis dx
plain film in frog leg
148
slipped capital femoral epiphysis tx
surgical stabalization
149
fat 12 yo boy with limp/hip pain
SCFE
150
hepatocellular CA -- when to resect?
1. preserved hepatic fxn (not cirrhosis)
2. 1 tumor < 5 cm
3. 3 or less < 3 cm
4. no mets
151
fat 4 - 10 yo boys with antalgic limp
legg-calve-perthes (avascular necrosis)
152
painless rectal bleeding in infant
meckel's diverticulum
153
intussusception dx
US
154
meckel's diverticulum dx
technetium-99m pertechnetate scan
155
meckel's tx
surgical resection
156
suspected aortic rupture management
stable --> CT scan
| unstable --> thoracotomy
