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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
Q

Murphy’s sign

A

cholecystitis

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26
Q

Reynold’s pentad

A

ascending cholangitis

fever
jaundice
RUQ pain
hypotension
AMS
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27
Q

Psoas sign

A

retrograde appendicitis

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28
Q

Obturator sign

A

appendicitis on obturator internus

(internal rotation = ankle out_

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29
Q

Kehr’s sign

A

referred pain to LEFT shoulder from blood under left hemidiaphragm

splenic rupture

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30
Q

Grey-Turner’s sign

A

pancreatitis

ecchymosis on flank

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31
Q

Cullen’s sign

A

cUL UmbiLicus

pancreatitis

periumbilical ecchymosis

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32
Q

McBurney’s sign

A

appendicitis

pain radiates from umbilicus to 2/3 to right ASIS

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33
Q

Rovsing’s sign

A

appendicitis

right sided abdominal pain on left sided percussion/palpation

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34
Q

MC injured knee ligament

A

MCL

medial collateral ligament

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35
Q

Positive Lachman test

A

ACL tear

Flex knee @ 30*, stabilize femur, pull tibia forward, + if tibia does not resist and comes forward

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36
Q

Positive McMurray test

A

Meniscus tear

Flex knee, rotate tibia, presure on either side of knee, + if pain or clicking

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37
Q

Common dashboard knee injury in MVA

A

PCL

posterior collateral ligament

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38
Q

Ranson criteria for determining prognosis of acute pancreatitis, at admission

A

@ admission = GA LAW

  • Glucose > 200
  • AST > 250
  • LDH > 350
  • Age > 60
  • WBC > 16
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39
Q

Ranson criteria for determining prognosis of acute pancreatitis, in first 48 h

A

Calvin and HOBBS

  • sCa2+ < 8
  • HCT decreased > 10%
  • PO2 < 60 mmHg
  • BUN increase > 5
  • Base deficit > 4
  • Sequestration of fluid > 6L
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40
Q

Associated mortality per Ranson criteria score

A

0 - 2 = 0 - 3% mortality
3 - 5 = 11 - 15% mortality
6 - 11 = > 40% mortality

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41
Q

When estimating TBSA for burns, what is the rule of 9s?

A 
head - 9
neck - 1
front trunk - 9
back trunk - 9
right arm - 18
left arm - 18
right leg - 18
left leg - 18
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42
Q

classic presentation of acute appendicitis

A 
periumbilical pain
migrates to McBurney's point
N/V
decrased appetite
Rovsing sign
Psoas sign
Obturator sign
Peritonieal irritation (guarding, rebound tenderness)
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43
Q

Tx appendicitis

A

surgical appendectomy
pain med
abx

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44
Q

classic si/sx of carotid artery stenosis

A

bruit (not sp/sn)
hx of TIA/stroke
amurosis fugax

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45
Q

major RF breast cancer

A 
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
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46
Q

MC type of breast cancer

A

invasive ductal carcinoma

75% of all breast cancer

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47
Q

Hx afib, now with severe periumbilical abdominal pain x 12 h –>

A

AMI

MI/CVA of the gut!

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48
Q

RF acute mesenteric ischemia (AMI)

A 
afib/arrhythmias
CAD/atherosclerosis
hx TIA/stroke
increased age
severe cardiac valve dz
recent MI
intra abd cancer
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49
Q

imaging test of choice to diagnose AMI

A

CT angiography

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50
Q

treatment of AMI

A

IMMEDIATE OR

  • embolectomy
  • resection of necrotic bowel
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51
Q

incisional hernia

A

post-op hernia

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52
Q

epigastric hernia

A

above umbilicus, through linea alba

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53
Q

umbilical hernia

A

through umbilical ring

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54
Q

femoral hernia

A

through femoral ring

medial to femoral vessels

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55
Q

Hesselbach hernia

A

under inguinal ligament

lateral to femoral vessels

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56
Q

Bochdalek hernia

A

hernia of stomach through posterior diaphragm

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57
Q

Morgagni hernia

A

hernia of stomach through anterior diaphragm

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58
Q

indirect inguinal hernia

A

travels through ing canal

palpate @ superficial inguinal ring

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59
Q

direct inguinal hernia

A

palpate @ superficial inguinal ring

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60
Q

hiatal hernia

A

through diaphragmatic defect at GE junction/@ esophageal hiatus

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61
Q

ventral hernia

A

incisional hernia in ventral abdominal wall

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62
Q

gastrostomy

A

surgical connection of stomach to skin for feeding (G-tube)

+ percutaneous PEG tube placement

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63
Q

ileostomy

A

small bowel opened and attached to skin for stool output

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64
Q

colostomy

A

colon bowel opened and attached to skin for stool output

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65
Q

laparoscopy

A

visualization of peritoneal cavity using laparoscope

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66
Q

laparotomy (celiotomy)

A

incision into abdominal cavity

67
Q

what is intussusception?

A

telescoping of bowel intro a downstream section of bowel causing an obstruction

68
Q

intussusception MC in which population?

A

toddlers < 2 yo

69
Q

treatment intussusception

A

preferred air or barium enema to surgical reduction

70
Q

MC benign cardiac tumor in adults and where

A

left atrial myxoma

71
Q

features of compartment syndrome

A

6 Ps

  • pain
  • pallor
  • parathesias
  • poikilothermia
  • paralysis
  • pulselessness
72
Q

MC cause of compartment syndrome

A

fractures

73
Q

Tx compartment syndrome

A

immediate fasciotomy to relieve compartment pressure, increase tissue perfusion, prevent permanent neurovascular damage

74
Q

diagnostic test of choice for acute cholecystitis

A

RUQ US

75
Q

MC location gallstones in acute cholecystitis

A

cystic duct

76
Q

sign assoc with acute chole

A

Murphy’s sign

77
Q

zone 1 of the neck

A

clavicle to cricoid cartilage

great vessels
aortic arch
trachea
esophagus
lung apices
c-spine
spinal cord
CN roots
78
Q

zone 2 of neck

A

cricoid cartilage to angle of mandible

carotid A
vertebral A
jugular V
pharygnx
larynx
trachea
eso
C-spine
spinal cord
79
Q

zone 3 of neck

A

angle of mandible to base of skull

salivary and parotide glands
carotid A
vertebral A
trachea
eso
C- spine
major CNS
80
Q

GI derived from foregut

A

esophagus/stomach to 1st part duodenum + spleen

celiac A

81
Q

GI derived from midgut

A

2nd part duodenum to proximal 2/3 of transverse colon

SMA

82
Q

GI derived from hindgut

A

distal 1/3 of transverse colon to above dentate line

IMA

83
Q

what is a cholesteatoma and how does is present

A

a keratinized mass in middle ear or mastoid

acquired or congenital

otorrhea
hearing loss
dizziness
pearly mass behind TM

84
Q

treatment of cholesteatoma

A

cholesteatomotomy

tympanoplasty

85
Q

causes of SBO

A

MC: adhesions
hernias
cancer tumor
volvulus

LC:
intuss
Crohns
gallstone ileus
bezoar
bowel wall hematoma x trauma
congenital
radiation enteritis
86
Q

depth and treatment of 1st degree burn

A

supericial
epidermis

clean

87
Q

depth and treatment of 2nd degree burn

A

partial thickness
epidermis and portions of dermis

remove blisters
silvadene cream
abx ointment

88
Q

depth and treatment of 3rd degree burn

A

full thickness
all layers of dermis

escharotomy
grafting

89
Q

depth and treatment of 4th degree burn

A

muscle and bone involvement

escharotomy
grafting

90
Q

difference between Mallory-Weiss tear and Boerhaave syndrome

A

Mallory-Weiss

  • mucosal
  • longitudinal
  • distal eso/prox stomach

Boerhaave

  • full thickness
  • distal eso
  • LIFE THREATENING
91
Q

vaccines recommended to patients undergoing splenectomy

A

pneumovax
HiB
N. meningiditis
influenza just because

92
Q

Eye opening GCS score

A

Does not open - 1
Opens to painful stim - 2
Opens to voice - 3
Opens spontaneously - 4

93
Q

Motor response GCS score

A 
No movement - 1
Decerebrate - 2
Decorticate - 3
Withdraws from pain - 4
Localizes painful stimulus - 5
Obeys commands - 6
94
Q

Verbal response GCS score

A 
No sounds - 1
Incomprehensible sounds - 2
Inappropriate words - 3
Confused - 4
Appropriate and oriented - 5
95
Q

GCS in significant brain injury

A

< 8

96
Q

GCS with moderate TBI

A

9-12

97
Q

GCS with mild TBI

A

13-15

98
Q

causes of gynecomastia

A 
STACKED drugs
cirrhosis/liver failure
Klinefelter
hyperprolactinemia
decrased testosterone
testicular tumor
hyperTHY
persistent pubertal (not transient)
99
Q

STACKED drugs that cause gynecomastia

A 
Spironolactone
THC
Alcohol
Cimetidine
Ketoconazole
Estrogen
Digoxin

heroin
anabolic steroids

100
Q

Secondary trauma survey

A

detailed Hx
detailed PEx
check all orifices: ear, nose, mouth, vagina, rectum

101
Q

RF AAA rupture

A

smoking
atherosclerosis
HTN
size

102
Q

Si/sx ruptured AAA

A

acute severe tearing abdominal to back pain
syncope
hypotension
palpable pulsatile abdominal mass

=> STAT CT + vascular surgeon

103
Q

mortality of ruptured AAA

A

95% mortality

104
Q

Epidural hematoma vessels

A

middle meningeal A

between skull and dura

105
Q

Subdural hematoma vessels

A

bridging veins

between dura and brain

106
Q

Epidural hematoma presentation

A

trauma to temporal head and LOC, lucid interval, then lethargic, obtuneded, neuro deficits, dilapted pupils, HA

107
Q

Subdural hematoma presentation

A

HA
AMS
confusion
gradulal change in AMS if chronic

108
Q

Managment epidural vs subdural hematoma

A

epidural:
- craniotomy and surgical evacuation

subdural:

  • if increased ICP –> craniotomy and surgical evacuation
  • OR obs in ICU
109
Q

main causes of acute abdomen

A

inflammation/infection (appendicitis, cholangitis, pancreatitis, SBP, diverticulitis)

perforation and hemorrhage (PUD, appendicitis)

ischemia (AMI)

obstruction (SBO)

ectopic pregnancy

110
Q

what is sigmoid volvulus

A

twisting/torsion of sigmoid colon causing obstruction

111
Q

Si/sx of sigmoid volvulus

A 
acute abdomen
N/V
anorexia
abd distension
obstipation
112
Q

Dx/tx of sigmoid volvulus

A
  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
Q

difference between Monteggia fx and a Galeazzi fx

A

Monteggia fx: proximal ulnar fx
anterior dislocation of radial head

Galeazzi fx: distal radial fx
dislocation of distal ulnar joint

114
Q

Rule of 2s for Meckel’s diverticulum

A 
2% population
2 yo 
2 inches long
2 feet from IC valve
2 types of tissue
2 X M:F
115
Q

Typical presentation of Meckel’s diverticulum

A

abd pain
lower gi bleeding
+/- SBO

116
Q

Dx/tx Meckel’s diverticulum

A

Meckel’s scan

surgical resection

117
Q

Si/sx of tension PTX

A 
sudden dyspea
one sided pleuritic CP
anxiety
decreased breath sounds
hyperresonance
hypotension
JVD
tracheal shift contralateral
118
Q

Tx TPTX

A

needle decompression and chest tube placement

119
Q

anosmia

A

loss of smell

120
Q

otorrhea

A

ear drainage

121
Q

rhinorrhea

A

nasal drainage

122
Q

dysphagia

A

difficulty sallowing

123
Q

odynophagia

A

pain with swallowing

124
Q

globus

A

sensation of “lump” in throat

125
Q

otalgia

A

ear pain

126
Q

trismus

A

difficulty opening mouth

127
Q

tinnitus

A

ear ringing

128
Q

MC cause LLQ abd pain with hemoccult positive stool?

A

diverticulitis

tx; metronidazole

129
Q

what is a fibroadenoma?

A

solid, mobile, well-defined, round

benign breast mass of glandular and fibrous tissue

130
Q

fibroadenoma MC in

A

< 30 F

131
Q

Tx of fibroadenoma

A

small = observe and monitor

large = surgical resection

132
Q

initial medical management of GERD

A

diet/lifesytle changes
antacids
PPI trial

133
Q

surgical management for refractor GERD

A

Nissin fundoplication

- wrap fundus of stomach around lower esophagus

134
Q

surgical indications for carotid endarterectomy (CEA)

A

symptomatic
> 70% stenosis (M and F)
50-69% in M

asymptomatic
> 60% stenosis
periop risk < 3%
> 10 y life expectancy

135
Q

crush injury means at risk for what renal complications, so prevent how?

A

rhabdomyolosis causes muscle to release myoglobin, which travels to the kidney and obstructs kidney tubules –> ATN/AKI

prevent with aggressive IV hydration

136
Q

difference between indirect and direct inguinal hernias

A

direct: congenital patent process vaginalis, through deep ring to superficial, lateral to epigastric vessels, MC
indirect: abd wall defect, medial to epigastrics, acquired

137
Q

Beck’s triad and for what?

A

cardiac tamponade

hypotension
JVD
muffled heart sounds

138
Q

Most appropraite emergency treatment for cardiac tamponade

A

pericardiocentesis

139
Q

what is gallstone ileus and MC site of obstruction

A

> 2.5 cm gallstone erodes through gallbladder into duodenum, travels until obstructs at ileocecal valve

140
Q

clinical features of subclavian steal syndrome

A

arm pain with exercise
syncope
HA

(subclavian steals blood from vertebral arteries)

141
Q

64 yo male smoker PMH CAD, worening abd pain after eating, lost 20#, what is diagnosis

A

chronic mesenteric ischemia

like a long-term gut heart attack

142
Q

clinical features of acute peripheral arterial occlusion

A 
6 Ps
pain at rest
pallor/cyanosis
parathesias
poikilothermia/cold
paralysis
pulselessness
143
Q

acute scrotal pain, what suggests testicular torsion?

A

no cremasteric reflex
high riding testis
horizontal orientation of testis
negative Prehn sign (painnot removed by elevating scrotum)

144
Q

FOOSH, next step management

A

thumb spica cast x 1 week

re-xray in 7-10 days

145
Q

13 yo teen obese boy, hip pain, limp, diagnosis and test?

A

slipped capital femoral epiphysis

Xray hip: posterior displacement of femoral epiphysis
“ice cream falling off the cone”

146
Q

interventions to prevent post-op DVT

A

SCDs
ppx heparin SUBQ 5000u TID
early ambulation

147
Q

which type of thoracic aortic dissection requires emergent surgical intervention?

A

Stanford type A - ascending aorta

148
Q

how treat Standford type B thoracic aortic dissection?

A

beta-blockers

if not end organ ischemia

149
Q

gallstones located in gallbladder =

A

cholelithiasis

150
Q

gallstone obstructs cystic duct –> gallbladder inflammation/infection =

A

acute cholecystitis

151
Q

gallstone located in common bile duct =

A

choledocholithiasis

152
Q

gallstone obstructs common bile duct –> biliary tract infection =

A

acute cholangitis

153
Q

hoarse voice immediately foloiwng thyroidectomy, cause?

A

iatrogenic recurrent largyngeal nerve damage

5-7% transient loss
3-4% permanent loss

154
Q

numbness around mouth and tingling of hands on POD #2 s/p thyroidectomy, diagnosis

A

hypocalcemia –> hypoPTH

iatrogenic

155
Q

wound closure by primary intention

A

reapproximate edges of wound and close with sutures/staples/adhesive

clean wounds, not much loss of tissue

156
Q

wound closure by secondary intention

A

wound edges left open and wound slowly closes by granulation and epithelialization

wound vac and dressings

bigger scar, longer healing

157
Q

wound closure by delayed primary closure

A

wound left open x4-5d before closing with primary sutures/staples/adhesive

contaminated wounds (concern for trapping bacteria)

158
Q

free air under right hemidiaphragm

A

MC: perforated ulcer

159
Q

USPSTF recs on screening for AAA

A

one time
male
65 - 75 yo
hx of smoking

160
Q

Roux-en-Y gastric bypass is

A

laproscopic gastrojejunostomy anastamosis

161
Q

Gastric banding is

A

laproscopic tight adjustable silicone band around top of stomach (connected to port ot inc/dec saline pump)

162
Q

Sleeve gastrectomy is

A

removal of body of stomach

remove the banana

163
Q

type of IBD can be cured surgically

A

ulcertive colitis

DIT Step 2 (8 decks)

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