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DIT Step 2 > Surgery > Flashcards

Surgery Flashcards

1
Q

-ectomy

A

remove

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2
Q

-orraphy

A

repair

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3
Q

-otomy

A

incision

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4
Q

-ostomy

A

surgical creation of an opening between 2 organs OR organ and skin

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5
Q

-plasty

A

restructure/shaping/formation

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6
Q

MC breast cancer

A

invasive ductal carcinoma

IDC

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7
Q

serous or bloody nipple discharge

A

intraductal papilloma

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8
Q

MC breast mass in 35-50 yo F

A

fibrocystic change

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9
Q

MC breast mass in teen and young women

A

fibroadenoma

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10
Q

breast mass accompanied by redness, pain, heat

A

inflammatory carcinoma

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11
Q

Si/Sx SBO

A 
abd pain
abd distension
vague abd discomfort
obstipation
N/V
high pitched bowel sounds
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12
Q

findings of SBO on upright AXR

A

air-fluid levels

distension of bowel

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13
Q

management and definitive tx of SBO

A

NPO
NG tube to suction
IVF
Foley (bladder decompression)

surgical decompression = laparotomy and lysis of adhesions

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14
Q

indications for repair of AAA to prevent future rupture?

A

> = 5.5 cm in M
= 5.9 cm in F
1 cm/yr
0.5 cm/6 mo interval

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15
Q

Sx AAA non-ruptured

A

abdominal tenderness
pain in abdomen and back
pulsating abdominal mass

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16
Q

Ddx female RLQ pain x 1 day

A 
appendicitis
ectopic pregnancy
ovarian torsion
constipation
PID
misplaced IUD
GE
UTI --> pyelo
perforated PUD
Crohn dz
pancreatitis intussusception
volvulus
diverticulitis
tumor
Mecke's diverticulum
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17
Q

MC conditions assoc with post-operation fever

A 
WIND - pna, atelectasis (1-3)
WATER - uti (4)
WALKING - pe, dvt (4-7)
WOUND - incision inf (7-9)
WONDERDRUGS - abx, etc. (any)
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18
Q

Boxer’s fx

A

5th metacarpal neck fx

from punching a wall = direct trauma to clenched fist

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19
Q

Boxer’s fx tx

A

initially: splinting (ulnar gutter splint)

closed reduction for severely angulated 4th/5th MC fx

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20
Q

interventions to decrease ICP

A 
Elevate head to 30* (reverse trandelenberg)
sedation/paralysis
intubate and hyperventilate
(PCO2 goal: 25-30 mmHg)
mannitol
ventriculostomy 
(take out extra CSF)
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21
Q

What is AMI and how present?

A

sudden onset intestinal hypoperfusion from occlusive arterial embolus (esp SMA)

  • pain out of proportion (acute)
  • vomiting
  • diarrhea
  • hx of afib or heart dz
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22
Q

Criteria to clear a possible cervical spinal injury in stable adult pt with head and neck trauma

A
  • must be ALERT (GCS)
  • must be WITHOUT NECK PAIN
  • must NOT be INTOXICATED
  • must NOT have DISTRACTING INJURY (knee hurts>neck)
  • must NOT have ABNL NEURO FINDINGS
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23
Q

Primary trauma survey (ATLS)

A

ABCDE

A: Airway - C-spine stabilization
B: Breathing - oxygenation and ventilation
C: Circulation - hemorrhage, access, heart working, shock
D: Disability - neuro, CNS/PNS
E: Exposure and Environment - undress, injuries, prevent hypothermia

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24
Q

Secondary trauma survey (ATLS)

A

history

detailed physical exam

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25
Murphy's sign
cholecystitis
26
Reynold's pentad
ascending cholangitis ``` fever jaundice RUQ pain hypotension AMS ```
27
Psoas sign
retrograde appendicitis
28
Obturator sign
appendicitis on obturator internus (internal rotation = ankle out_
29
Kehr's sign
referred pain to LEFT shoulder from blood under left hemidiaphragm splenic rupture
30
Grey-Turner's sign
pancreatitis ecchymosis on flank
31
Cullen's sign
cUL UmbiLicus pancreatitis periumbilical ecchymosis
32
McBurney's sign
appendicitis pain radiates from umbilicus to 2/3 to right ASIS
33
Rovsing's sign
appendicitis right sided abdominal pain on left sided percussion/palpation
34
MC injured knee ligament
MCL | medial collateral ligament
35
Positive Lachman test
ACL tear Flex knee @ 30*, stabilize femur, pull tibia forward, + if tibia does not resist and comes forward
36
Positive McMurray test
Meniscus tear Flex knee, rotate tibia, presure on either side of knee, + if pain or clicking
37
Common dashboard knee injury in MVA
PCL | posterior collateral ligament
38
Ranson criteria for determining prognosis of acute pancreatitis, at admission
@ admission = GA LAW - Glucose > 200 - AST > 250 - LDH > 350 - Age > 60 - WBC > 16
39
Ranson criteria for determining prognosis of acute pancreatitis, in first 48 h
Calvin and HOBBS - sCa2+ < 8 - HCT decreased > 10% - PO2 < 60 mmHg - BUN increase > 5 - Base deficit > 4 - Sequestration of fluid > 6L
40
Associated mortality per Ranson criteria score
0 - 2 = 0 - 3% mortality 3 - 5 = 11 - 15% mortality 6 - 11 = > 40% mortality
41
When estimating TBSA for burns, what is the rule of 9s?
``` head - 9 neck - 1 front trunk - 9 back trunk - 9 right arm - 18 left arm - 18 right leg - 18 left leg - 18 ```
42
classic presentation of acute appendicitis
``` periumbilical pain migrates to McBurney's point N/V decrased appetite Rovsing sign Psoas sign Obturator sign Peritonieal irritation (guarding, rebound tenderness) ```
43
Tx appendicitis
surgical appendectomy pain med abx
44
classic si/sx of carotid artery stenosis
bruit (not sp/sn) hx of TIA/stroke amurosis fugax
45
major RF breast cancer
``` female increased age prior breast cancer 1st degree relative with breast cancer genetics/BRCA 1/2 obesity EtOH use increased estrogen exposure: - nulliparity - children later in life >30 - early menarche <13 - late menopause ```
46
MC type of breast cancer
invasive ductal carcinoma | 75% of all breast cancer
47
Hx afib, now with severe periumbilical abdominal pain x 12 h -->
AMI = MI/CVA of the gut!
48
RF acute mesenteric ischemia (AMI)
``` afib/arrhythmias CAD/atherosclerosis hx TIA/stroke increased age severe cardiac valve dz recent MI intra abd cancer ```
49
imaging test of choice to diagnose AMI
CT angiography
50
treatment of AMI
IMMEDIATE OR - embolectomy - resection of necrotic bowel
51
incisional hernia
post-op hernia
52
epigastric hernia
above umbilicus, through linea alba
53
umbilical hernia
through umbilical ring
54
femoral hernia
through femoral ring | medial to femoral vessels
55
Hesselbach hernia
under inguinal ligament | lateral to femoral vessels
56
Bochdalek hernia
hernia of stomach through posterior diaphragm
57
Morgagni hernia
hernia of stomach through anterior diaphragm
58
indirect inguinal hernia
travels through ing canal | palpate @ superficial inguinal ring
59
direct inguinal hernia
palpate @ superficial inguinal ring
60
hiatal hernia
through diaphragmatic defect at GE junction/@ esophageal hiatus
61
ventral hernia
incisional hernia in ventral abdominal wall
62
gastrostomy
surgical connection of stomach to skin for feeding (G-tube) | + percutaneous PEG tube placement
63
ileostomy
small bowel opened and attached to skin for stool output
64
colostomy
colon bowel opened and attached to skin for stool output
65
laparoscopy
visualization of peritoneal cavity using laparoscope
66
laparotomy (celiotomy)
incision into abdominal cavity
67
what is intussusception?
telescoping of bowel intro a downstream section of bowel causing an obstruction
68
intussusception MC in which population?
toddlers < 2 yo
69
treatment intussusception
preferred air or barium enema to surgical reduction
70
MC benign cardiac tumor in adults and where
left atrial myxoma
71
features of compartment syndrome
6 Ps - pain - pallor - parathesias - poikilothermia - paralysis - pulselessness
72
MC cause of compartment syndrome
fractures
73
Tx compartment syndrome
immediate fasciotomy to relieve compartment pressure, increase tissue perfusion, prevent permanent neurovascular damage
74
diagnostic test of choice for acute cholecystitis
RUQ US
75
MC location gallstones in acute cholecystitis
cystic duct
76
sign assoc with acute chole
Murphy's sign
77
zone 1 of the neck
clavicle to cricoid cartilage ``` great vessels aortic arch trachea esophagus lung apices c-spine spinal cord CN roots ```
78
zone 2 of neck
cricoid cartilage to angle of mandible ``` carotid A vertebral A jugular V pharygnx larynx trachea eso C-spine spinal cord ```
79
zone 3 of neck
angle of mandible to base of skull ``` salivary and parotide glands carotid A vertebral A trachea eso C- spine major CNS ```
80
GI derived from foregut
esophagus/stomach to 1st part duodenum + spleen celiac A
81
GI derived from midgut
2nd part duodenum to proximal 2/3 of transverse colon SMA
82
GI derived from hindgut
distal 1/3 of transverse colon to above dentate line IMA
83
what is a cholesteatoma and how does is present
a keratinized mass in middle ear or mastoid acquired or congenital otorrhea hearing loss dizziness pearly mass behind TM
84
treatment of cholesteatoma
cholesteatomotomy | tympanoplasty
85
causes of SBO
MC: adhesions hernias cancer tumor volvulus ``` LC: intuss Crohns gallstone ileus bezoar bowel wall hematoma x trauma congenital radiation enteritis ```
86
depth and treatment of 1st degree burn
supericial epidermis clean
87
depth and treatment of 2nd degree burn
partial thickness epidermis and portions of dermis remove blisters silvadene cream abx ointment
88
depth and treatment of 3rd degree burn
full thickness all layers of dermis escharotomy grafting
89
depth and treatment of 4th degree burn
muscle and bone involvement escharotomy grafting
90
difference between Mallory-Weiss tear and Boerhaave syndrome
Mallory-Weiss - mucosal - longitudinal - distal eso/prox stomach Boerhaave - full thickness - distal eso - LIFE THREATENING
91
vaccines recommended to patients undergoing splenectomy
pneumovax HiB N. meningiditis influenza just because
92
Eye opening GCS score
Does not open - 1 Opens to painful stim - 2 Opens to voice - 3 Opens spontaneously - 4
93
Motor response GCS score
``` No movement - 1 Decerebrate - 2 Decorticate - 3 Withdraws from pain - 4 Localizes painful stimulus - 5 Obeys commands - 6 ```
94
Verbal response GCS score
``` No sounds - 1 Incomprehensible sounds - 2 Inappropriate words - 3 Confused - 4 Appropriate and oriented - 5 ```
95
GCS in significant brain injury
< 8
96
GCS with moderate TBI
9-12
97
GCS with mild TBI
13-15
98
causes of gynecomastia
``` STACKED drugs cirrhosis/liver failure Klinefelter hyperprolactinemia decrased testosterone testicular tumor hyperTHY persistent pubertal (not transient) ```
99
STACKED drugs that cause gynecomastia
``` Spironolactone THC Alcohol Cimetidine Ketoconazole Estrogen Digoxin ``` heroin anabolic steroids
100
Secondary trauma survey
detailed Hx detailed PEx check all orifices: ear, nose, mouth, vagina, rectum
101
RF AAA rupture
smoking atherosclerosis HTN size
102
Si/sx ruptured AAA
acute severe tearing abdominal to back pain syncope hypotension palpable pulsatile abdominal mass => STAT CT + vascular surgeon
103
mortality of ruptured AAA
95% mortality
104
Epidural hematoma vessels
middle meningeal A | between skull and dura
105
Subdural hematoma vessels
bridging veins | between dura and brain
106
Epidural hematoma presentation
trauma to temporal head and LOC, lucid interval, then lethargic, obtuneded, neuro deficits, dilapted pupils, HA
107
Subdural hematoma presentation
HA AMS confusion gradulal change in AMS if chronic
108
Managment epidural vs subdural hematoma
epidural: - craniotomy and surgical evacuation subdural: - if increased ICP --> craniotomy and surgical evacuation - OR obs in ICU
109
main causes of acute abdomen
inflammation/infection (appendicitis, cholangitis, pancreatitis, SBP, diverticulitis) perforation and hemorrhage (PUD, appendicitis) ischemia (AMI) obstruction (SBO) ectopic pregnancy
110
what is sigmoid volvulus
twisting/torsion of sigmoid colon causing obstruction
111
Si/sx of sigmoid volvulus
``` acute abdomen N/V anorexia abd distension obstipation ```
112
Dx/tx of sigmoid volvulus
1. flex sig 2. supine and upright AXR - "omega sign" is distended loop bowel pointing up to RUQ surgical decompression by signoidoscopy/colonoscopy --> bowel resection
113
difference between Monteggia fx and a Galeazzi fx
Monteggia fx: proximal ulnar fx anterior dislocation of radial head Galeazzi fx: distal radial fx dislocation of distal ulnar joint
114
Rule of 2s for Meckel's diverticulum
``` 2% population 2 yo 2 inches long 2 feet from IC valve 2 types of tissue 2 X M:F ```
115
Typical presentation of Meckel's diverticulum
abd pain lower gi bleeding +/- SBO
116
Dx/tx Meckel's diverticulum
Meckel's scan surgical resection
117
Si/sx of tension PTX
``` sudden dyspea one sided pleuritic CP anxiety decreased breath sounds hyperresonance hypotension JVD tracheal shift contralateral ```
118
Tx TPTX
needle decompression and chest tube placement
119
anosmia
loss of smell
120
otorrhea
ear drainage
121
rhinorrhea
nasal drainage
122
dysphagia
difficulty sallowing
123
odynophagia
pain with swallowing
124
globus
sensation of "lump" in throat
125
otalgia
ear pain
126
trismus
difficulty opening mouth
127
tinnitus
ear ringing
128
MC cause LLQ abd pain with hemoccult positive stool?
diverticulitis tx; metronidazole
129
what is a fibroadenoma?
solid, mobile, well-defined, round benign breast mass of glandular and fibrous tissue
130
fibroadenoma MC in
< 30 F
131
Tx of fibroadenoma
small = observe and monitor large = surgical resection
132
initial medical management of GERD
diet/lifesytle changes antacids PPI trial
133
surgical management for refractor GERD
Nissin fundoplication | - wrap fundus of stomach around lower esophagus
134
surgical indications for carotid endarterectomy (CEA)
symptomatic > 70% stenosis (M and F) 50-69% in M asymptomatic > 60% stenosis periop risk < 3% > 10 y life expectancy
135
crush injury means at risk for what renal complications, so prevent how?
rhabdomyolosis causes muscle to release myoglobin, which travels to the kidney and obstructs kidney tubules --> ATN/AKI prevent with aggressive IV hydration
136
difference between indirect and direct inguinal hernias
direct: congenital patent process vaginalis, through deep ring to superficial, lateral to epigastric vessels, MC indirect: abd wall defect, medial to epigastrics, acquired
137
Beck's triad and for what?
cardiac tamponade hypotension JVD muffled heart sounds
138
Most appropraite emergency treatment for cardiac tamponade
pericardiocentesis
139
what is gallstone ileus and MC site of obstruction
> 2.5 cm gallstone erodes through gallbladder into duodenum, travels until obstructs at ileocecal valve
140
clinical features of subclavian steal syndrome
arm pain with exercise syncope HA (subclavian steals blood from vertebral arteries)
141
64 yo male smoker PMH CAD, worening abd pain after eating, lost 20#, what is diagnosis
chronic mesenteric ischemia | like a long-term gut heart attack
142
clinical features of acute peripheral arterial occlusion
``` 6 Ps pain at rest pallor/cyanosis parathesias poikilothermia/cold paralysis pulselessness ```
143
acute scrotal pain, what suggests testicular torsion?
no cremasteric reflex high riding testis horizontal orientation of testis negative Prehn sign (painnot removed by elevating scrotum)
144
FOOSH, next step management
thumb spica cast x 1 week | re-xray in 7-10 days
145
13 yo teen obese boy, hip pain, limp, diagnosis and test?
slipped capital femoral epiphysis Xray hip: posterior displacement of femoral epiphysis "ice cream falling off the cone"
146
interventions to prevent post-op DVT
SCDs ppx heparin SUBQ 5000u TID early ambulation
147
which type of thoracic aortic dissection requires emergent surgical intervention?
Stanford type A - ascending aorta
148
how treat Standford type B thoracic aortic dissection?
beta-blockers | if not end organ ischemia
149
gallstones located in gallbladder =
cholelithiasis
150
gallstone obstructs cystic duct --> gallbladder inflammation/infection =
acute cholecystitis
151
gallstone located in common bile duct =
choledocholithiasis
152
gallstone obstructs common bile duct --> biliary tract infection =
acute cholangitis
153
hoarse voice immediately foloiwng thyroidectomy, cause?
iatrogenic recurrent largyngeal nerve damage 5-7% transient loss 3-4% permanent loss
154
numbness around mouth and tingling of hands on POD #2 s/p thyroidectomy, diagnosis
hypocalcemia --> hypoPTH | iatrogenic
155
wound closure by primary intention
reapproximate edges of wound and close with sutures/staples/adhesive clean wounds, not much loss of tissue
156
wound closure by secondary intention
wound edges left open and wound slowly closes by granulation and epithelialization wound vac and dressings bigger scar, longer healing
157
wound closure by delayed primary closure
wound left open x4-5d before closing with primary sutures/staples/adhesive contaminated wounds (concern for trapping bacteria)
158
free air under right hemidiaphragm
MC: perforated ulcer
159
USPSTF recs on screening for AAA
one time male 65 - 75 yo hx of smoking
160
Roux-en-Y gastric bypass is
laproscopic gastrojejunostomy anastamosis
161
Gastric banding is
laproscopic tight adjustable silicone band around top of stomach (connected to port ot inc/dec saline pump)
162
Sleeve gastrectomy is
removal of body of stomach | remove the banana
163
type of IBD can be cured surgically
ulcertive colitis

DIT Step 2 (8 decks)

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