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Uworld Shelf Questions DF > Surgery > Flashcards

Surgery Flashcards

1
Q

acute mediastinitis is a possible complication of cardiac surgery usually due to what

what is presentation

A

intraoperative wound contamination

fever, tachy, cehst pain, leukocytosis and wound drainage post op

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2
Q

serum phos in vitamin D def

A

low

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3
Q

what is a common precipitating event to ischemic colitis

A

repair of AAA

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4
Q

what helps achalasia position wise

A

upright position

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5
Q

what age does child need surgery if umbilical hernia persists

A

5 or so

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6
Q

pts with penetrating trauma who have what need urgent exploratory lap

A

hemodynamic instab
peritonitis
evisceration
or blood from NG tube

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7
Q

managment of amputation and reimplantation

A

limb or digit wrapped in sterile gauze, moistened with sterile saline and placed in plastic bag on ice to ED

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8
Q

what can be injured in a supracondylar fracture of the humerus

A

brachial artery

median nerve injury

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9
Q

AE dapsone

A

hemolytic anemia (check G6PD)

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10
Q

PE showing an abdominal succussion splash

A

pyloric stricture

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11
Q

dysphagia, halitosis, and fullness of the throat in pts over 60

A

zenker diverticulum

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12
Q

if have persistent hemoptysis and initial bronchoscopy doesnt work to localize source what is next

A

pulmonary arteriography

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13
Q

clinical features of pulmonary contusion

A

presents within 24 hours of blunt thoracic trauma with

tachypnea, tachy, hypoxia

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14
Q

management of complicated gallstone diseas like cholecyst, choledoch, or gallstone panc

A

choleccystectomy within 72 hours

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15
Q

SBO where is location: colicky abdominal pain, delayed vomiting, prominent abdonminal distension, constipation, hyperactive BS and dilated loops of bowel on x ray

A

mid or distal

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16
Q

CT scan showing ruptured aorta with blood collection in the adventitial layer is what

A

ruptured AAA

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17
Q

soft signs of extremity vasular trauma

A

history of hemorrhage
diminished pulse
bone injury
neuro abnormality

tx: injured extremity index (if under 0.9 then CT)
CT scan with angiography
duplux doppler US

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18
Q

steps in cervical spine trauma after a fall in pt that is hypoxic and hypopneic

A

stabilize spine

assess airway, if above C3 can cause immediate paralysis and lower C lesions can damage phrenic nerve

orotracheal intubation unless massive facial trauma

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19
Q

Afib after CABG

normal or nah?

treatment

A

15-40% get it, usually self limited and resolves within 24 hours

can use BBor amiodarone

only anticoags and or cardoversion if lasts over 24 hours

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20
Q

suspected scaphoid fracture managment

A

xray at time of injury is low sensitivity

CT scan or MRI to confirm

or

immobilize with splint and repeat imaging in 7-10 days

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21
Q

scrotal mass that decreases with supine position and increases with standin/valsalva maneuvers

A

varicocele (dilation of pampiniform plexus)

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22
Q

management in flail chest

what can occur often

A

pain control and supplemental oxygen early

resp failure can occur from pulmonary contusion leading to edema/blood in the alveoli and intubation with mechanical PPV is req in many pts

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23
Q

tibial nerve supplies what muscles and what actions and sensation

A

posterior compartment of thigh and leg and plantar muscles of foot

flexion of knee and digits and plantar flexion of foot

sensation to leg (except medial side) and plantar foot

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24
Q

cause of acalculous cholecystitis and what patients is it seen in

A

idiopathic and seen in pts with sever underlying illness:

dehydration, ischemia, burns, severe trauma, post op state

same signs and sx as acute cholecystitis

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25
Q

stasis dermatitis most classically involves what

A

the medial leg below the knee and above the medial malleolus

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26
Q

anterior spinal cord syndrome can occur in what surgery

A

thoracic aortic aneurysm repair (reduced radiuclar artery flow like in artery of adamkieqicz)

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27
Q

penile fracutre is rupture of what

A

corpus cavernosum from teari in tunica albuginea

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28
Q

for pts involved in MVA or falls from over 10 feet physicians must have high suspicion for what

A

blunt aortic injury

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29
Q

pt had blunt trauma in MVA then persistent pneumothorax despite chest tube placement and pneumomediatstinum and subcut emphysema

A

tracheobronchial perforation secondary to blunt thoracic trauma

confirm dx with Ct scan, bronchoscopy or surgical exploration

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30
Q

managment of clavicular fractures

A

all need neurovascular exam to r/o injury to subclavian artery and brachial plexus

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31
Q

post op measures used to decrease the risk of pneumonia

A

lung expansion

spirometry, deep breathing exercises, continous positive airway pressure

spirometry most effective

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32
Q

greatest danger in massive hemoptysis

what position to put pt

A

asphyxiation bc of airway flooding with blood

place pt in lateral position to avoid blood collection in opp lung

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33
Q

subacute pain over the midline sacrococygeal with mucoid and blood drainage most likely has what

A

pionidal disease

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34
Q

treatment of pre-renal AKI

A

IV isotonic fluid

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35
Q

positive airway pressure is indicated in what fracture

A

flail chest

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36
Q

evaluation of hemoptysis if have massive bleeding do what

if stops bleed then what

if bleeding continues then what

A

secure the airway, breathing and circulation

  • if stops bleeding then workup with CXR, coag studies, renal fnct, UA, rheum workup
  • then CT scan +/- bronchoscopy
  • then treat cause

if bleeding does no stop then
-straight to treating cause via bronchoscopic interventions, embolization or resection

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37
Q

bilateral cellulitis of the submandibular and sublingual spaces from infected mandibular molar

A

ludwig angina

see drooling

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38
Q

managment of small bowel obstruction

A

bowel rest, NG tube suction, IVF

surgical exploration for sinngs of complications

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39
Q

sudden onset severe unilateral lower abdominal pain immediately following strenusous or sexual activity in woman and US shows free pelvic free fluid

A

ruptured ovarian cyst

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40
Q

abdominal pain and hematochezia in old man with CAD getting AAA repair

A

colonic ischemia

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41
Q

spontaneous pneumothorax treatment if small or large

A

2 cm or smaller then observe and oxygen

if large and stable then needle aspiration or chest tube

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42
Q

steps of dx PAD

A

ABI first then arterial US bc less senstivie and specific, do in sx pts

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43
Q

preventing pre and post op bacterial parotitis

most common bug?

A

adequate fluid hydration and oral hygiene

staph aureus

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44
Q

treatment for anal fissures

A

higher fiber diet and fluids
stool softener
sitz baths
topical anesthetics and vasodilators like nifedipine and nitroglycerin

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45
Q

terminal hematuria with clots suggests what

A

bleeding within bladder or ureters and is concerning for urothelial cancer

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46
Q

what injury can cause posterior urethral injury and how to diagnose

A

pelvic fractures

retrograde urethrogram

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47
Q

atelectasis and oxygen co2 level

most severe when

A

ventilation perfusion mismatch leading to hypoxemia nad increased work of breathing

most severe during 2nd postoperative night

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48
Q

managment of splenic injury from BAT

hemodynamically stable, still risk factors

stable pts with AMS

A

hemodynam stable: FAST, if normal but high riskfeatures like anemia or guarding then CT

stable pts with AMS go straight to CT

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49
Q

dudoenal hematoma occurs after what and can lead to what

A

blunt abdominal trauma

can lead to partial or complete obstruction

24-36 hours after initial event get epigastric pain and comit from obstruction

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50
Q

epidural hematoma treatment in pt with focal deficits or signs of intracranial HTN

A

emergent neurosurgical hematoma evacuation

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51
Q

subacute post op fever timing and etiology

A

1 week to 1 month

SSI/cath infection

C diff
drug fever

PE/DVT

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52
Q

ingesting acid is risk factor for developing what

dx

tx

A

pyloric stricture

upper endoscopy

surgery

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53
Q

where to place needle thoracostomy in tension pneumo

f/u with what

A

2nd intercostal space in midclavicular line, if this fails then

fifth intercostal space in the midaxillary line

then do emergency tube thoracostomy

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54
Q

when would you do CT scan or US for suspected appendectomy

A

non classical symptoms

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55
Q

what does the LV do in hypovolemic shock

A

decreases in size bc of decrased filling volume so it increases its ejection fraction

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56
Q

PPV in hypovolemic shock

A

causes acute increase in intrathoracic pressure which in severly hypovolemic pt with low central venous pressure can collapse venous capacitance vessels like IVC and cut off venous return = sudden loss of RV preload

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57
Q

what provokes gilbert syndome

A

stress like infection, fasting, vig exercise, surgery

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58
Q

polymyalgia rheumatica

A

muscle pain and stiffness in shoulder and pelvic girdle
decreased ROM in shoulder, neck, hip
responds to glucocortiicoids

can be associated with temporal arteritis

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59
Q

when do you use bronchoscopy in hemoptysis

A

when have >600 mL/day or 100 mL/hr

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60
Q

delayed fever (>1month after surgery) usually caused by what

A

surigcal site infection

virus

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61
Q

fibrosis and contracture of the glenohumeral joint capsule. causes persistent pain along with decreased ROM in multiple planes

A

adhesive capsulitits

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62
Q

blunt abdominal trauma in hemodynamically stable pt that is not alert or normal mental status

what if normal metnal status

A

seriel abdominal exams +/- CT

if normal

FAST
- = seriel abdominal exams +/- CT
+ = CT scan abdomen

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63
Q

small pneumothoraces in clinically stable pt treatment

A

observation and supplemental oxygen

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64
Q

first step if pt is ID’d to have pulmonary TB

A

isolation

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65
Q

varicoceles are more common on which side and why?

A

left side

bc gonadal vein on left drains to the left renal vein and can be compressed

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66
Q

atelectasis is most common postop day what

A

2 and 3

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67
Q

severe burn assocaited with extensive scar formation and a chronic non healing wound is what

A

SCC

this is a Marjolin ulcer

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68
Q

chest xray for PCP pneumonia what is often elevated in serum

A

bilateral interstitial infiltrates

serum LDH often elevated

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69
Q

the most important risk factor of a gallstone ileus

dx

tx

A

cholecystitis which predisposes to biliary-enteric adhesions

CT scan shows GB thickenink, pneumobilia (air in biliary tree) and stone

tx with remoing stone and +/- cholecystectomy

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70
Q

treatment of postoperative mediastinitis

A

drainage, surgical debridement with immediate closure and prolonged abx therapy

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71
Q

other studies considered in pts with blunt genitourinary trauma

A

radiographs for frx
US for testicle injury
retrograde cystouretrhrogram for urethral ainjury and bladder rutpure (these pts usually have gross hematuria, and difficult peeing and blood at meatus)

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72
Q

managment of ischemic colitis

A

IV fluids and bowel rest

abx with enteric coverage

colonic resection if necrosis develops

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73
Q

what kind of trauma causes diffuse axonal injury

A

accel/decel

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74
Q

pain location for mesenteric ischemia

A

periumbilical and hematochezia

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75
Q

gross hematuria based on stage of voiding at which it occurs

terminal

A

prostate, bladder neck or trigone, or posteior urethra

urothelial cancer, cystitis, urolithiasis, bph prostate cancer

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76
Q

hemodynamically unstable pt with pneumothorax treatment

A

immediate tube thoracostomy, if not available then urgent needle decompression

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77
Q

what part of the bladder if ruptured can lead to fluid into the peritoneum and cause acute chemical peritonitis

A

dome of the bladder (intraperit)

can cause referred pain to ipsilateral shoulder

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78
Q

stable pt with large pneumothoraces treatement

A

decompression with large bore needle in 2nd or 3rd ICS midclavicular line or at 5th ICS mid axillary line

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79
Q

what would you see in bladder rupture and diagnosis

A

gross hematuria nad possibly difficulty voiding

retrograde cystogram

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80
Q

what is elevated in a nonseminomatous germ cell tumor

A

elevated AFP and b-HCG

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81
Q

____ is episodic pain and tenderness at inferior patella and paterllar tedon. seen in athletes in jumping sports or occupations with repetitive forcefull knee extension

A

paterllar tendinitis

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82
Q

fistula in abdominal aortic aneurysm rutpure

A

can create an aortocaval fistula with IVC leading to venous congestion in retroperitoneal structures like bladder nad these viens in bladder can rupture and cause gross hematuria

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83
Q

ribs broken in flail chest

A

3 or more contiguous ribs fractured in 2 or more locations

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84
Q

treatment for emphysematous cholecystitis

A

emergent cholecystectomy

broad spectrum antibiotics with clostridium coverage (amp-sulbactam) also e coli

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85
Q

what is the most frequent cause of bloodstream infection in pts with intravasuclar devices

A

staph epidermidis

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86
Q

diagnosing pulmonary contusion

A

rales or decreased BS

CT scan or CXR with patch alveolar infiltrate not restricted by anatomical borders

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87
Q

meningioma found mainly in what pop

A

middle age to elderly women

thing meningioma and menses

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88
Q

SBO vs ileus which has increased BS

A

SBO start increased then go to absent

ileus has reduced/absent

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89
Q

ABI under .9 is dx for what

A

peripheral artery disease

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90
Q

pt: MVA then elevated JVP and tachycardia and hypotension

chest xray

A

pericardial tamponade

xray can show normal cardiac silhouette bc small amt pericardial fluid

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91
Q

treatment for dumping syndrome

A

small/freq meals

replace simple sugars with complex carbs

incorporate high fiber and protein rich food

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92
Q

testing for meniscal tear

A

thessaly test
-pt stands on 1 leg and knee flexed 20 degrees then internally and externally rotates on flexed knee

mcmurray test
passive knee flexion and extension while holding in internal or external rotation

pain, click, or catch indicates tear

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93
Q

ondansetron can contribute to what and how

A

serotonin receptor antagonist can contribute to constipation

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94
Q

when would you use ERCP in pancreatitis

A

when have cholangitis, visible CBD dilation/obstruction or increaseing liver enzyme elevels

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95
Q

infection within the retropharyngeal space drains where and can lead to what

A

drains inferiorly to the superior mediatstinum

spread to the carotid sheath can cause thrombosis of the internal jugular vein and deficits in CN 9-12

extension through the alar fascia into the danger space can rapidly transmit infx into posterior mediastinum to diaphragm

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96
Q

syringomyelia sx

A

decrased strength and diminished pain and temp sensation affecting the arms/hands or having a cape-like distribution

preservation of dorsal column function

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97
Q

burn wound sepsis odd changes

A

oliguria, hyperglycemia, thrombocytopenia and AMS

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98
Q

sings and sx suggestive of necrotizing surgical site infection

A 
pain, edma, erythema beyone surgical site
systemic signs
paresthesia at edge of wound
purulent cloudy-gray discharge
subcut gas or crepitus
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99
Q

hard signs of extremity vascular trauma and treatment

A

observed pulsatile bleed
bruit/thrill over injury
expanding hematoma
sings distal ischemia

surgically explore

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100
Q

RUQ or epigastric pain with elevated aminotransfereases and alk phos. give morphine and makes worse

visualization of dilated CBD with no stones is big key

A

sphincter of oddi dysfunction bc causes contraction

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101
Q

ST depression on ECG indicate what

A

ischemia

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102
Q

urine sodium under 25

A

volume depletion
CHF
cirrhosis

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103
Q

chronic dysphagia to both solids and liquids, difficulty belching, and mild weight loss are all common manifestations of what

A

achalasia

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104
Q

what is given pre-operatively to patients with mild hemophilia A in order to prevent excessive bleeding

A

desmopressin

105
Q

what injury is associated with aotic injury

A

rapid deceleration injury like MVA over 30 mph
falls from 10 ft or more

severe crush injury

106
Q

alternative agents for PCP besides TMP-SMX

A

pentamidine

atovaquone

Trimethoprim + dapsone

clindamycin + primaquine

107
Q

bugs in necrotizing fascitis

A

strep pyogenes
staph aureus
c perfringens

108
Q

fractures of the middle third clavicle treated how

what obout distal third

A

middle, nonop ,with brace, rest and ice

distal third: open reduction and internal fixation

109
Q

what other sx of tension pneumo that you know is diff from spont pneumothor

A

hemodynamic instability

tracheal deviation away from affected side

110
Q

bilateral flaccid paralysis and loss of P and T below level of injury

then UMN signs develop over days to weeks

vibration and proprioception are preserved

A

anterior spinal cord syndrome

111
Q

cerebellar dysfunction from alcoholic cerebellar degen features

A

progressive gait dysfunction
truncal ataxia
nystagmus
intention tremor or dysmetria (tremor when trying to touch target

impaired rapid alt movement (dysdiadochokinesia)

muscle hypotonia–> pendular knee reflex

112
Q

what is required to diagnose a psoas abscess

treatment?

A

CT scan

drain and abx

113
Q

what innervates quadriceps femoris, sartorius and pectineus and responisble for what action of knee and hip

A

femoral nerve

knee extension and hip flexion

114
Q

metoclopramide is what

A

dopamine antagonist with promotility effects

115
Q

treatement for ruptured AAA

A

exploratory abdominal surgery no time for laparoscopy

116
Q

gold standard for diagnosis of sphincter of ODdi dysfunction is what and treatment

A

manometry

sphincterotomy is treatment of choice

117
Q

gallstone pancreatitis should be suspected in pts who have evidence of pancreatitis with ALT over what

A

150

118
Q

what is the most common complications of cardiac catheterization

how long after does occur

A

local vascular comp at insertion site like:

bleeding or 
hematoma, 
arterial dissection, 
acute thrombosis, 
pseudoaneurysm or 
AV fistula

usually 12 hours later

119
Q

old pt with hip fracture should undergo definitive surgical correction as soon as reasonably possible but surgery ma be delayed up to ___ hours to evaluate surgical risk and ensure medical stability

A

72

120
Q

extra axial well circumscribed round dural based mass on mri with calcifications is what and treatment

A

meningioma

benign so resect to cure

121
Q

managment of blunt genitourinary trauma with renal injury and stable

A

GU exam
UA
contrast enhanced CT if have hematuria and stable

122
Q

tx for pt with acalcuous cholecystitis

A

ABX and emergent cholecystectomy

pts who can’t have srgy do percutaneous drainage of GB with choleccytostomy

123
Q

swelling of feed with dorsa of feet being affected and marked thickening and rigidity of the skin

A

lymphatic obstruction

124
Q

how to diagnose GI perforation

A

upright x rahy of chest and abdomen

shows free air under diaphragm

125
Q

complications of central venous cath tip placement in wrong spot

A

venous perforation

lung puncture —> pneumothorax

myocardial perf –> pericardial tamponade

126
Q

most common cause of massive hemothorax are lacerations to what

A

lung parenchyma or damage to intercostal or internal mammary artery

127
Q

pts with appendicits that have delayed presentation and longer duration of symptoms usually have what and how to diagnose

tx

A

appendiceal rupture with contained abscess

palpation will be negative but things like

psoas sign, obturator sign, and rectal exam may be positive, CT can confirm

tx: IV ABX, and drainage if needed. can get appendectomy electively 6-8 weeks later

128
Q

cervical radiculopathy typically presents with what

A

pain and paresthesias of the neck and arm along with upper extremity weakness

129
Q

acute mesenteric ischemia is most commonly due to abrupt arterial occlusion from either of the following:

A

cardiac embolic events like afib or valve disease (IE) or cardiovascular aneurysms

acute thrombosis due to PAD or low CO states

130
Q

treatment for varicocele

A

gonadal vein ligation

scrotal support and NSAIDs in older men who don’t want more children

131
Q

acute cholecystitis without stones obstructing the cystic duct

A

acalculous cholecystitis

same signs and sx

132
Q

complicated diverticulitis is diverticulitis with what and managment

A

abscess, perforation, obstrucation or fistula formation
-fluid uder 3 cm can be treated with IV abx and observation

> 3 cmfluid have CT guided percutaneous drainage

then surgical drain and debridement if this does not work

133
Q

what nerve damaged in anterior shoulder dislocation

what m does it innervate and weakness with what

A

axillary

teres minor and deltoid

weak shouder abduction

134
Q

AE TMP-SMX

A

rash, neutropenia, hyperkalemia, elevated transaminases

135
Q

diagnsosing acalculous cholecystitis

A

imagin that shows GB wall thickening and distension and presence of pericholecystic fluid

136
Q

pain out of proportion to injury, pain on pasive stretch, swelling and paresthesia

arterial pulses?

A

compartment syndrome

arterial pulses usually present

137
Q

lab testing in acute mseneteric ischemia

A

leukocytosis, hemoconcentration, elevated amylase, and metabolic acidosis

138
Q

decreased breath sounds at the right lung base with no wheezes or prolonged expiration and normal temp. Chest xray shows dense opacity at right lung base

dx?

A

atelectasis

139
Q

____ following major thoracic trauma that presents with acute circulatory failure or neurological signs and tracheobronchial

A

air embolism

140
Q

what kind of hernia is associated with af americans, premautre birth ehlers danlos and beckwith wiedeamann syndrome and hypothyroid

A

umbilical

141
Q

managment of someone with acute pancreatitis from gallstones

A

cholecystectomy

142
Q

platelet count greater than what provides adequate hemostasis for most invasive procedures

A

50,000/mm3

143
Q

prostehetic joint infection bugs

under 3 months
3-12 months
>12 months

A

under 3 = staph aureus

3-12 = coagulase neg staph, propionibacterium, enterococci (PEC)

> 12 = staph aureus, gram neg rods, beta hemolytic strep

144
Q

when does aspiration of gastric contents usually take place after surgery and sings?

A

within the first few hours after surgery

sx: sudden onset dyspnea, cough, fever, and rhonchi/crackles on exam

145
Q

when do you do surgery for anal fissure

A

fissures that are refractory to medical managment

146
Q

porgressive proximal muscle weakness and atrophy without pain or tenderness in LE muscles most common

normal ESR and CK

drug induced

A

glucocorticoid induced myopathy

147
Q

DVT treatment with pt taht has ESRD

A

unfractionated heparin then warfarin

148
Q

path of dumping syndrome

A

common postgastrectomy complication in 50% of pts

loss of normal action of pyloric sphincter, leads to rapid emptying of hypertonic gastric contents into the duodenum and SI

-fluid shift from intravascular space to SI, = hypotension and stim of autonomic reflexes and release of intestinal VIP

149
Q

imaging for penile fracture

A

retrograde urethrogram when suspected urethral injury:

blood at meatus
hematuria
dysuria
urinary retention

150
Q

most sensitive test to achalasia

A

manometry

151
Q

intraperitoneal bladder rupture

A

rupture of the dome of the bladder

intraperitoneal urine leak with signs of chemical peritonitis (diffuse abdom tenderness, guarding and rebound)

152
Q

most comon cause of acute liver failure

A

drug tox and acute viral hepatitis

153
Q

bowel ischemia post AAA repair from what arteries lost

A

loss IMA during aortic graft placement

left and sigmoid colon perfusion lost

154
Q

when would you add ccorticosteroids when treating PCP pneumonia

A

partial pressure of oxygen (PaO2) @ or under 70 mm hg or an A-a gradient of 35 or more

155
Q

ABG in atelectasis

A

pH elevated, PO2 decreased, PCO2 decreased

156
Q

acute post op fever

timing nad cause

A

24 hrs to 1 weeks

nosocomial infx
SSI
noninfection like MI, PE, DVT

157
Q

emphysematous cholecystitis risk factors

A

take a VID for EC

vascular compromise
immunosupp
DM

158
Q

lab values in acute mesenteric ischemia

A

leukocytosis, hemoconcentration, elevated amylase and metaboic acidosis

159
Q

most common peripheral artery aneurysms

A

popliteal and femoral

160
Q

impaired cough and shallow breathing following a abdominal or thoracoabominal surgery can lead to what

A

atelectasis

161
Q

left sided abdominal pain with radiation to the shoulder, fever, and vomiting and free fluid not common

A

splenic infarct

162
Q

nerve?

foot eversion

sensation overlateral leg and dorsum of foot

A

superficial peroneal nerve

163
Q

in blunt abdominal trauma if have right shoulder pain from what

A

Hepatic laceration has hemorrhage that irritates the phrenic nerve

164
Q

necrotizing surgical site infections occur more commolnly in what pts and what bugs

treatement?

A

pts with diabets usually poymicrobial

emergency early surgical exploration with debridement

also broad spectrum abx

165
Q

if cannot abduct over 90 degrees what nerve and m may be compromised

A

long thoracic

serratus anterior

166
Q

when do you not need an xray for CVC placement

A

if use US guided CVC placement

167
Q

acute necrotizing mediastintis can be from spread from where and sx and tx

A

spread from retropharyngeal abscess

fever, chest pain, dyspnea, odynophagia

need surgical intervention

168
Q

most essential managment of pt with rib fracture that has atelectasis and hypovent an dpneumoina

A

pain control

169
Q

primaquine AE

A

methemoglbinemia, hemolytic anemia

170
Q

fluid filled cyst of head of epididymis that presents as painless mass at the superior pole of the testis

A

spermatocele

171
Q

burn wound sepsis is associated with what systemic findings

A

temp above 102 or below 98

tachycardia

tachypnea

hypotension

172
Q

first 15 degrees of abduction shoulder
15-90 degrees

muscles

A

first 15 = supraspinatous

deloid = rest

173
Q

what is cerebral angiography a useful diagnostic tool for

A

ID cerebral aneurysms and AV malformations

174
Q

criteria for long term home oxygen therapy in pts with progresive hypoxemia from COPD

A

1) resting arterial oxygen tension of 55 mm hg or less (PaO2) or pulse ox at or under 88%
2) PaO2 at or under 59 or SaO2 at or under 89% in pts with cor pulmonale, evidence of R heart failure or hematocrit under 55%

175
Q

hematocrit with rupruted ovarian cyst

referred pain

chest pain?

A

decresed

to shoulder

pleuritic

176
Q

pts on long term glucocorticoid therapy who have cushingoid features are at high risk for what

A

adrenal crisis

can be seen in 3 weeks in pts taking 20 or more mg/day of prednisone

177
Q

SBO where is location: early vomiting, abdominal discomfort, and abnormal contast filling on x-ray

A

proximal

178
Q

what is almost always present in an extraperitoneal bladder injury?

A

pelvic fracture and gross hematuria

sometimes urinary retention

179
Q

IV corticosteroids may be indicated in pts with intracranial HTN due to what

A

brain tumor or abscess

180
Q

JVD with PE?

A

yes bc of pulnonary vascular resistance and R side HF

181
Q

treatment of pilonidal disease

A

drain abscess and collect debris followed by excision of sinus tracts

ope closure too

182
Q

treatment for postpericardiotomy syndome

A

NSAIDs or steroids bc immune reaction

183
Q

rotator cuff muslces

A

supraspinatous (MC injury)
infraspinatus
teres minor
subscapularis

184
Q

pt with subacute shoulder pain on abduction most likely has what

A

rotator cuff tendinopathy

from repetitive activity above shoulder heigt

185
Q

most common cause of syringomyelia are what

A

arnold chiari malformations and prior spinal cord injuries

186
Q

fever and abdominal pain radiating to groin and pain with hip extension

A

psoas abscess

187
Q

nerve damaged in humeral mid shaft fracture

A

radial nerve

188
Q

uncal herniation lesions and cause

A

compression contralat crus cerebri = ipsilat hemiparesis

compression ipsilateral CN III = loss paraymp innervation (mydriasis, down and out gaze)

compression ipsilat PCA = contralat homnymous hemianopsia

compression of reticular formation = Altered consciousness, coma

189
Q

atelectasiss occurs often after what surgery

A

abdominal and thoracoabdominal procedures

190
Q

abdominal pain, diarrhea, nausea, hypotension/tachycardia, dizziness/confusion, fatigue, diaphoresis 15-30 minutes after meals

A

dumping syndrome

191
Q

differential diagnosis for an anterior mediastinal mass includes what

A

4 Ts

thymoma, teratoma, thyroid neoplasm, terrible lymphoma

teratoma (and other germ cell tumors)

192
Q

treatment for peritonsillar abscess

A

needle aspiration or I and D plus antibiotic therapy to cover GAS and anerobes

193
Q

clinical presentation of bowel ischemia

A

abdominal pain and blood diarrhea

fever and leukocytosis may also be present

194
Q

pt: use of NSAIDs and several day history of episodic postprandial epigastric pain followed by acute onset severe constant pain =

A

perforated peptic ulcer

urgent exploratory lap

195
Q

pt is hemodynamically unstable after blunt abdominal trauma and FAST is inconclusive, what should you do next

A

diagnostic peritoneal lavage

196
Q

managment of duodenal hematoma

A

decompression by NG tube, and possible parenteral nutrition

197
Q

treatment of acute adrenal insufficiency

A

hydrocortisone or dexamethaasone

high flow IVF

198
Q

spontaneous pneumothorax pts

A

thin young men or underlying lung disease like COPD

199
Q

diagnostic requirements of acute liver failure

A

ALT and AST in 1000 or more
signs of hepatic encephalopathy
synthetic liver dysfunction (INR at or above 1.5)

200
Q

if arterial puncture site is above where then a hematoma can extend into the retroperitoneal space

and what are clx features
and diagnosing it
and treatment

A

above inguinal ligament

hemodynamic instability and flank or back pain

confirm with non contrast CT scan of A and P or abdominal US

supportive treatment usually

201
Q

unilateral LE edema that worsens when the leg is dependent (pt at work) and improves with leg elevation (when pt sleeping)

pathophys

A

venous valvular incompetence

decreases intravscular volume bc fluid out of caps into interstiial fluid and stimulates kidney to retain water which makes even worse

202
Q

myocaredial contusion classically causes what

A

tachycardia, new BBB or arrhytmia

often see sternal fx

203
Q

HF and angina several months following an MI with possible ventricular arrhythmia and systemic embolization

A

left ventricular aneurysm

204
Q

immediately after a severe burn, what organisms dominate, then 5 days later what does

A

gram positive at first like staph aureus

5 days later gram negs like pseudomonas and candida

205
Q

fracture of surgical neck of humerus may cause what

A

axillary nerve injury

206
Q

femoral nerve provides sensation to what

A

anterior thigh and medial leg via saphenous branch

207
Q

what is the most common nonsurgical hypoparathyroidism

lab findings

A

autoimmune

hypocalcemia, and hyperphosphatemia in presence of normal renal function

208
Q

ECG shows persisten ST elevation and deep Q waves

A

LV aneurysm

209
Q

pain out of proportion to clinical findings is first presenting sx and worsening pain may occur with passive stretch of affected muscle compartment

A

acute compartment syndrome

210
Q

pts on what meds are at increaesd risk for hemoperitoneum from a ruptured ovarian cyst

A

anticoagulation

211
Q

AE atovaquone

A

GI distress, rash

212
Q

eval of hyponatremia: urine osmolality under 100

A

primary polydipsia

malnutrition (beer drinkers phenom)

213
Q

urethral injury

A

blood at urethral meatus, high riding prostate

214
Q

echo shoes thin and dyskinetic myocardial wall

A

LV aneursym

215
Q

opoid withdrawal has signs of what activation

A

sypathetic nervous system

216
Q

management of a stress fractutre

A

reduce weight bearing for 4-6 weeks

217
Q

blood at urethral meauts, eccyhmosis of scrotum and high riding prostate

A

posteior urehtral injury

218
Q

infection with nasopharyngeo carcinoma

A

epstein barr

219
Q

what is cushings reflex and what does it mean

A

HTN, bradycardia and resp depression (BRH)

incresed ICP

220
Q

what infection considered in ventilator associated pneumonia

A

pseudomonas

221
Q

what pts most get pilnidal disease

A

15-30 year old young males, obese and sedentary lifestyles

222
Q

what gallbladder path uses HIDA scan and when

A

cholecystitis when US inderterminate

223
Q

preferred points of central venous access cath are where

A

internal jugular vein

subclavian vein

224
Q

MC cause of ureteral injury

A

iatrogenic trauma during abdominal surgery
rare from blunt trauma but when happens its at ureteropelivc junction

-hematuria, fever, flank pain and hydronephrosis

225
Q

diagnosing ischemic colitits

A

CT scan: colonic wall thickening, fat stranding

endoscopy: edematous and friable mucosa

226
Q

hyponatremia

serum osmolality over 290

A

marked hyperglycemia

advanced RF

227
Q

esophageal webs

A

most commonly located in the upper esophagus and only cause mild focal narrowing (dysphagia to solids but not liquids) IDA too plummer vinson

228
Q

management of blunt genitourinary trauma in hemodynamically unstable pt with renal trauma eveidence

A

undergo IV pyelography prior to surgical evaluation

229
Q

any penetrating wound below the ___ ICS is considered to involve the abdomen and requires what

A

4th

laparotomy in unstable pts

230
Q

left sided hemothorax could cause what findings

A

some tracheal deviation to right and reduced breath sounds and dullness to percussion over involved side

231
Q

pt with motor vehicle accident and chest x ray showing bowel loops within thoracic cavity and shift of mediatstinum suggest what and next step managment

A

diaphragmatic rutpure

Chest CT can confirm diagnosis

232
Q

____ is chronic anterior knee pain and MC in women. PEripatellar pain worsened by activity or prolonged sitting

A

patellfemoral pain syndrome

233
Q

erythema sweeling POOP to PE and CT scan showing air in deep tissue

A

necrotizing faciitis

234
Q

initial stream hematuria

A

urethritis

trauma to urethra like foley cath

235
Q

was is acute adrenal insufficiency characterized by

A

severe and often refract hypotension, vomiting, abdo pain and fever

hyponatremia and hyperkalemia (normal potassium in central AI)

236
Q

RA often involves what joints

A

MCP

237
Q

benign bony growth located on the midline suture of the hard palate

A

torus palantinus

genetic and environmentla

common in young women asians

238
Q

nasal septal perforation is common following what surgery

presents how

A

rhinoplasty

post op whistling noise with respiration

perf from septal hematoma

239
Q

what is common in occupations requirng repetivie kneeling and carpet laying and plumbing

A

prepatellar bursitis from staph aureus

aspirate and cell count and gram stain
if neg then NSAIDs and rest

if positive then drain and abx

240
Q

bilateral lower extremity edema and stasis dermatitis is what

A

LE venous valvular incompetence

241
Q

treating burn wound sepsis

A

pipe/tazo, carbapenum with vanco or aminoglycoside

242
Q

axillary nerve injured during what humerus fracture

A

proximal

243
Q

massive PE typically presents with what bp and neck veins

A

hypotension and distended neck veins

244
Q

compartment pressure over ____nmm Hg or (diastolic - comparment pressure) under what indicates significant compartment syndrome

A

30

under 20-30

245
Q

how to reduce warfarin anticoagulation

A

FFP

246
Q

fever 1 week after surgery usually due to what

A

drug fever
surgical site infx
PE

247
Q

leukocytosis with neutrophilic predominance is side effect of what med

A

systemic glucocorticoids

248
Q

nerve?

foot dorsiflexion and toe extension and sensation where flip flops are

A

deep peroneal nerve

249
Q

ideal placement of a central venous cath tip is where

A

lower superior vena cava

250
Q

multiple, recurrent, painful nodules in the axillae, inguinal folds and perineal areas

A

hidradenitis suppurativa

251
Q

ABI interpretation

abnormal, normal and low

A
  1. 90 or lower = abnormal
  2. 91-1.30 = normal
  3. 30 and over = calcified and uncompressible vessles, do more studies
252
Q

symtomatic pancreatic pseudocyst treatment

A

endocsopic drainage

if no sx then expectant managment

253
Q

fever occuring immediately (within a few hours) in the operative or postop period is typically due to what

A

prior infection or trauma, inflammation due to surgery, malignant hyperthermia, or meds or blood produts given prior to surgery

254
Q

hip pain when pressure is applied as when sleeping and with external rotation or resisted abduction

from excess friction

A

trochanteric bursitis

255
Q

hemodynamically stable pts with intraperitoneal fluid ID’d on FAST should have what done

A

CT scan of abdomen

can distinguish blood from urine or ascites and show site

256
Q

obturator nerve innervates what comparment and muscles of thigh and action and sensation

A

medial compartment

gracillis adductor longus, adductor brevis, anterior portion of adductor magnus

adduction of thigh

sensation over medial thigh

257
Q

AE pentamidine

A

nephrotox, hypotension, hypoglycemia, cardiac arrhythmias, pancreatitis, elevated transaminases

258
Q

adrenal insufficieny and water stuff

A

presents with hypovolemia which leads to increased ADH and hyponatremia

this would concentrate urine

259
Q

uncomplicated diverticulitis in stable patients can be managed how

A

outpatient setting with bowel rest, oral antibiotics and observation

if really old or CIP then hospital IV abx

Uworld Shelf Questions DF (8 decks)

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