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Step 2 > Surgery > Flashcards

Surgery Flashcards

1
Q

SIRS criteria

A

systemic inflammatory response syndrome

  1. temp < 36 or > 38
  2. HR > 90
  3. tachypnea (>20) or PCO2 < 32
  4. WBC < 4000 or > 1200
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2
Q

sirs vs sepsis, etc

A

sirs = 2 criteria
sepsis = + source
severe sepsis = + organ dysfunction
septic shock = + hypotension

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3
Q

dx avascular necrosis

A

MRI

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4
Q

causes of avascular necrosis

A

corticosteroids, EtOH abuse, SLE, gout, sickle cell, gaucher,

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5
Q

acute abdomen next step

A

exploratory lap

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6
Q

colonic dilation + toxic labs

A

toxic megacolon…duh

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7
Q

dilation of colon POD 3-5

A

Ogilvie syndrome (acute colonic pseudo-obstruction)

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8
Q

ogilvie syndrome: tx

A
  1. bowel rest (24 - 48 hr)
  2. neostigmine
  3. colonoscopic decompression
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9
Q

something “stuck” in throat, cant swallow next step

A

emergent endoscopy

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10
Q

scrotal mass next step

A

ultrasound

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11
Q

solid scrotal mass next step

A

excisional bx

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12
Q

double bubble sign

A

duodenal atresia

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13
Q

hoarseness, throat clearing, post laryngeal erythema, vocal fold edema

A

laryngopharyngeal reflux (LPR)

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14
Q

LPR: tx

A

behavior mod, PPI (lansoprazole)

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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)

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16
Q

MCC bacterial prostatitis

A

E. coli

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17
Q

bacterial prostatitis: tx

A

bactrim or cipro

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18
Q

DVT prophylaxis in CKD pts

A

unfractionated heparin (usually LMWH)

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19
Q

new onset increased ICP w/o infection signs

A

brain tumor

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20
Q

thrombocytopenia + increased D-dimer

A

DIC

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21
Q

anterior uveitis + back pain

A

ankylosing spondylitis

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22
Q

single heart sound

A

tricuspid atresia

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23
Q

uncomplicated vertebral compression fx: tx

A

acetaminophen

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24
Q

unilateral sensorineural hearing loss next step

A

MRI (r/o acoustic neuroma)

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25
Q

diarrhea in HIV (CD4<50)

A

CMV colitis

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26
Q

“hot potato voice” – WTF?

A

muffled - think peritonsillar abscess

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27
Q

peritonsillar abscess - what do you see?

A

inflamed, medially displaced tonsil
uvula deviate to other side
muffled voice

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28
Q

rib fracture –> trouble breathing –> tx?

A

intercostal nerve block

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29
Q

dilated colon + nausea/constipation/distension

A

acute intestinal pseudo-obstruction (ogilvie)

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30
Q

pearly skin lesion w/ telangiectasias

A

basal cell carcinoma

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31
Q

afib with rapid ventricular response: tx

A
  1. diltiazem/verapamil or beta blocker
  2. amiodarone
    hemo unstable –> cardioversion
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32
Q

anal fissure tx

A

sitz baths
stool softeners
topical nitroglycerin

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33
Q

leg claudication – where/what artery?

A 
hip/butt --> aortoiliac artery
thigh (+lower) --> common femoral 
upper 2/3 calf --> superficial femoral
lower 2/3 calf --> popliteal
feet --> tibial
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34
Q

lynch syndrome (HNPCC) CA worries

A

colorectal (duh)

endometrial

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35
Q

intussusception tx

A

air enema

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36
Q

test for zollinger-ellison

A
  1. fasting serum gastrin concentration

2. CT to find tumor

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37
Q

bone = periosteal elevation, concentric bony layers in tumor, mottled appearance

A

Ewing’s sarcoma

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38
Q

when do you get subphrenic abscesses

A

1-3 wks post splenectomy or gastrectomy

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39
Q

appendicitis in preggers: dx

A

graded compression u/s

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40
Q

odynophagia

A

painful swallowing

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41
Q

dysphagia w/ solids and liquids q/o odynaphagia

A

achalasia

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42
Q

achalasia dx

A

barium swallow

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43
Q

hemothorax post trauma management

A

resp distress –> ET tube
hemo stable –> tube thoracostomy
hemo unstable –> open thoracotomy

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44
Q

crescent brain bleed + midline shift

A

subdural hematoma

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45
Q

complication 12-48 hrs s/p MI w/ dyspnea + new murmur

A

think MR (TEE, blowing sys murmur, S4)

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46
Q

complication 2 - 7 days s/p MI w/ hTN and pulselessness

A

free wall rupture (or pseudoaneurysm)

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47
Q

complication 3-5 days s/p MI w/ hTN, tachy, and palpable thrill

A

ventricular septal rupture

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48
Q

DVT tx in preggo

A

LMWH

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49
Q

PDA tx

A

indomethacin

surgery if PDA too large or pt < 6 kg

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50
Q

pancreatic calcification on xray

A

chronic pancreatitis

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51
Q

complications of chronic pancreatitis

A

DM, bile duct/duodenal obstruction, pseudocysts, ascites, pleural effs, splenic vein thrombosis, adenocarcinoma

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52
Q

coronary stent vs bypass

A

stent for 1 or 2 vessels; 3 –> bypass

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53
Q

post prandial abdominal pain w/ DM pt

A

chronic mesenteric ischemia

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54
Q

melanoma: breslow tumor thickness : margin

A

< 1 mm : 1 cm
>= 1.5 and <4 mm : 2 cm
>= 4 mm : 3 cm

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55
Q

carotid stenosis management

A

> 70% occlusion w/o sx: CEA
60 w/ sx: CEA
60 w/ sx + major health issues: stents (no good for surg)

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56
Q

hepatic encephalopathy management

A
  1. treat underlying if possible
  2. lactulose
  3. rifaximin if lactulose doesn’t work in 48 hrs (or cant tolerate)
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57
Q

primary biliary cholangitis pathology

A

autoimmune –> destroy intrahepatic bile ducts –> cholestasis

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58
Q

primary biliary cholangitis tx

A

ursodeoxycholic acid

ESLD –> liver transplant

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59
Q

epidural hematoma tx

A

craniotomy w/ clot evacuation

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60
Q

when to do bariatric surgery

A

BMI >40

BMI >35 w/ comorbid condition

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61
Q

when to screen for AAA

A

men who ever smoked: once btwn 65 and 75

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62
Q

when to screen for lung CA

A

30+ pack years

55 - 79

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63
Q

JVD, hTN, decreased breath sounds

A

tension pneumothorax

64
Q

mgmt for drinking strong acid/base

A

endoscopy

65
Q

nephrolithiasis dx

A

non-contrast helical CT

U/S for preggos

66
Q

go to appendicitis tx

A
  1. antibiotics (broad - zosyn?)

2. lap appy

67
Q

head/neck pain + Horner synd

A

carotid artery dissection

68
Q

carotid artery dissection – series of events

A 
carotid dissects (trauma, spontaneous)
symp fibers messed up --> Horner syndrome
endothelial damage --> clotting --> CVA (usually in middle cerebral artery)
69
Q

carotid artery dissection dx

A

MRA

70
Q

person 50+ falls on outstretched hand – what breaks?

A

distal radius (Colle’s frx) –> ant forearm bulge, “dinner fork deformity”

71
Q

what do you break in a street fight?

A

5th metacarpal (dorsum tenderness)

72
Q

dx for adenocarcinoma of ampulla of vater

A

ERCP

73
Q

thyroid storm tx

A 
fluids
hydrocortisone
propranalol
PTU 
iodine 1 hr later
74
Q

pheochromocytoma tx

A

phenoxybenzamine
then propranalol
then surgery to remove tumor

75
Q

urethral trauma management

A
  1. retrograde urethrogram
  2. then cystoscopy or laparotomy to fix
  3. (if cant go to surgery right away insert a suprapubic cath)
76
Q

rhabdo management

A

give fluids, fix electrolytes

77
Q

non healing penis ulcer post tx

A

suspect carcinoma in situ (bx that ish)

78
Q

tx for entamoeba histolytica

A

metronidazole

79
Q

EKG: regular rate tachy, narrow QRS, no P wave (obstructed by QRS)

A

atrioventricular nodal reentrant tachycardia (AVNRT)

MC paroxysmal supraventricular tachycardia

80
Q

AVNRT management

A

unstable pt –> synchronized electric cardioversion
stable –> cardiac massage then medical caridoversion (adenosine)
meds dont work/prevent recurrence –> radiofrequency ablation

81
Q

post prandial pain for months w/ “food fear”

A

chronic mesenteric ischemia

82
Q

skin lesion: erythematous nodule w/ central ulceration that bleeds

A

squamous cell carcinoma

83
Q

ischemic priapism management

A

fluids, O2, pain control

then aspiration and irrigation of corpora cavernosa

84
Q

hit head, lucid, then coma

A

epidural hematomas

85
Q

MC vessel injured in epidural hematoma

A

middle meningeal artery

86
Q

vessels injured in subdural hematoma

A 
bridging veins (MC)
cortical arteries
87
Q

flushing + diarrhea + RUQ pain

A

carcinoid syndrome

88
Q

liver path: soft yellow lesion w/ homogenous interior

A

hepatic adenoma

89
Q

liver path: pedunculated surface w/ brown, sponge-like interior

A

hepatic hemangioma

90
Q

liver path: macrovesicular steatosis w/ areas of lobular inflammation

A

non-alcoholic fatty liver dz

91
Q

liver path: exterior fibrous capsule w/ interior areas of necrosis

A

hepatocellular carcinoma

92
Q

liver path:firm tan lesion w/ fibrous septa and central stellate scar

A

focal nodular hyperplasia

93
Q

trauma pt with signs of internal bleeding management

A

unstable –> laparotomy
stable –> FAST scan
U/S is equivocal/unavailable –> diagnostic peritoneal lavage

94
Q

bugs to look out for in splenectomy pt

A

strep pneumo
H flu
neisseria meningitidis

95
Q

when do you put in ear tubes?

A

3+ episodes in 6 months

4+ episodes in 12

96
Q

when to repair a AAA

A

> 5.5 cm w/o sx
grows 0.5 mc in 6 mo
any symptomatic AAA

97
Q

signs of symptomatic AAA

A

abdominal or back pain

thromboembolism

98
Q

foreign body tx

A

rigid bronchoscopy

99
Q

traumatic bladder rupture: dx

A

retrograde cystography

100
Q

signs of scaphoid frx

A

decreased grip strength

tenderness to snuffbox

101
Q

signs of lunate frx

A

dorsum tenderness

102
Q

signs of trapezium frx

A

pain when pinching (thumb to #2)

tenderness at thenar eminence

103
Q

signs of triquetrum frx

A

tenderness at ulnar border

104
Q

signs of pisiform frx

A

pain and swelling at ulnar/palmar suface

105
Q

tetralogy of fallot

A
  1. overriding aorta
  2. pulmonary stenosis
  3. VSD
  4. ventricular hypertrophy
106
Q

hyperparathyroidism –> how to investigate?

A

sestamibi scan best way to find parathyroid adenomas (MCC primary hyperparathyroidism)

107
Q

thyroid nodule workup

A
  1. serum TSH
  2. U/S if abnormal
  3. FNA
  4. total thyroidectomy if malignant
108
Q

ankylosing spondylitis tx

A
  1. NSAIDs
  2. etanercept (TNF alpha inhibitor)
  3. sulfasalazine
  4. surgery
109
Q

open vs closed angle glaucoma

A 
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
Q

trismus

A

inability to open your mouth (lock jaw)

111
Q

ludwig’s angina pathophysiology

A

cellulitis of submandibular space

112
Q

ludwig’s angina sx

A

fever, fatigue, drooling, trismus, elevated tongue, dysphagia

113
Q

ludwig’s angina organism

A

MCC by strep viridans form dental infection

114
Q

lateral gaze palsy, vision changes, HA, post sinusitis

A

cavernous sinus thrombosis

115
Q

HTN, HA, pulsatile tinnitus, epigastric bruits

A

fibromuscular dysplasia

116
Q

string of beads renal artery

A

fibromuscular dysplasia

117
Q

reynaud’s, hand deformities, dysphagia

A

scleroderma

118
Q

new onset ascites management

A

paracentesis

119
Q

abdominal pain, ascites, fever, AMS

A

bacterial peritonitis

120
Q

mouth pain, tongue swelling, palpable structure in floor of mouth

A

sialolithiasis (submandibular salivary gland stones)

121
Q

diverticulitis imaging

A

CT - diverticula, focal inflammation and fat stranding

122
Q

diverticulitis tx

A

liquid diet and antibiotics

123
Q

charcot’s triad

A

fever, jaundice, RUQ pain (for ascending cholangitis)

124
Q

reynold’s pentad

A

charcots (fever jaundice, RUQ pain) + hTN and AMS

shows suppurative cholangitis

125
Q

lung abscess tx

A
  1. IV clindamycin

2. if not working metronidazole/penicillin

126
Q

fingers affected by carpal tunnel

A

1, 2, 3, half of 4

127
Q

temporal arteritis 1st step

A

steroids (then biopsy)

128
Q

staph aureus endocarditis tx

A

IV vanco

129
Q

winged scapula nerve

A

long thoracic

130
Q

mastectomy nerve damage

A

long thoracic

131
Q

becks triad

A

hTN, JVD, muffled heart sounds (cardiac tamponade)

132
Q

cardiac tamponade tx

A

pericardiocentesis

133
Q

bladder cancer dx

A

cystoscopy

134
Q

tx for delirium till you know whats up

A

haloperidol

135
Q

liver: peripherally-enhancing lesion

A

hepatic abscess

136
Q

bacterial sinusitis tx

A

amoxicillin-clavulanate

137
Q

acromegaly tx

A
  1. transsphenoidal surgery

2. octreotide if cant

138
Q

sausage like mass in a baby belly

A

intussusception

139
Q

abdominal compartment syndrome

A

new organ dysfunction caused by increased intraabdominal pressure
(happens with rapid fluid resuscitation)

140
Q

abdominal compartment syndrome dx

A

bladder pressure > 12 mmHg

141
Q

corkscrew appearance on barium esophagram

A

diffuse esophageal spasm

142
Q

high riding or absent prostate

A

posterior urethral injury

143
Q

blood at meatus, inability to void, pelvic ecchymoses

A

urethral injury

144
Q

gastroparesis dx

A

scintigraphic emptying study

barium follow thru if not available

145
Q

spinal epidural abscesses dx

A

MRI

146
Q

lesion @ distal femur with sunburst appearance

A

osteosarcoma

147
Q

slipped capital femoral epiphysis dx

A

plain film in frog leg

148
Q

slipped capital femoral epiphysis tx

A

surgical stabalization

149
Q

fat 12 yo boy with limp/hip pain

A

SCFE

150
Q

hepatocellular CA – when to resect?

A
  1. preserved hepatic fxn (not cirrhosis)
  2. 1 tumor < 5 cm
  3. 3 or less < 3 cm
  4. no mets
151
Q

fat 4 - 10 yo boys with antalgic limp

A

legg-calve-perthes (avascular necrosis)

152
Q

painless rectal bleeding in infant

A

meckel’s diverticulum

153
Q

intussusception dx

A

US

154
Q

meckel’s diverticulum dx

A

technetium-99m pertechnetate scan

155
Q

meckel’s tx

A

surgical resection

156
Q

suspected aortic rupture management

A

stable –> CT scan

unstable –> thoracotomy

Step 2 (7 decks)

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