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uworld > Surgery > Flashcards

Surgery Flashcards

1
Q

absent bowl sounds

A

THINK OBSTRUCTION

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2
Q

neck pain odynophagia and fever following penetrating trauma to the posterior pharynx dx

A

retropharynheal abscess

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3
Q

Complication of retropharyngeal abscess

A

Acute necrotizing mediastinhti ( if extends into danger space - b/e the alar and pre vertebral fasciae) -

b/c infection from retrophayngeal space drains inferiorly to superior mediastinum –> spread thrombosis of the internal jugular vein and deficits in CN 9.10.11.12

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4
Q

ludwig angina

A

bilateral cellulitis of the submandibular and subinjuinal space from an infected mandibular molar - fever , dysphagia, drooling , odynophagia

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5
Q

pilonidal disase

A

males obsess sedentary lifesyle , fluctuant mass 4-5cm cephalic to the anus in the intergluteal region w/ mucoid, purulent or bloody discharge
AFEBRILE

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6
Q

perianal abscess

A

fever, malaise and pain and tender, erythematous bulge at the anal verge

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7
Q

most common cause of syringomyelia

A

Arnold Chiari malformation and prior SCI

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8
Q

clinical of syringomyelia

A
  1. spinothamjlmic - Pain and temp
  2. Medial corticospinal - weakness motor finers
  3. spares dorsal columns
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9
Q

transtentorial uncle herniation symptoms

A
  • ipsilateral hemiparesis
  • loss of parasympathetic innervation (CN3)
  • contralateral homonymous hemianopsia
  • altered LOC . coma
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10
Q

complication of epidural hematoma

A

transtentorial herniation

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11
Q

what nerve is involved with transtentorial herniation

A

CN3

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12
Q

what nerve is involved in uncle herniation

A

Abducens

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13
Q

treatment of meningioma

A

surgical resection

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14
Q

recurrent episodic pain in RUQ or epigastric region elevation in ALT AST Aand ALP
already had cholecystectomy and given opioids

A

patient has sphincter of Oddi dysfunction

  • opiod precipitate symptoms
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15
Q

duodenal hematomas

Cause

A

Blunt abdominal trauma

  • seen in children due to
    1. thinner abode wall musculature
    2. less adipose tissue
    3. more pliable ribs
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16
Q

plain abdo x-ray shows dilated stomach with scanty distal gas

Dx?

A

duodenal hematoma

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17
Q

clinical Duodenal hematoma

A

abode wall trauma
- tenderness
vomit ( b/c fails to pass gastric contents pasted obstruction ( DH expands)

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18
Q

treatment of duodenal hematoma

A

resolve in 1-2 weeks
Tx: decompression , Parentaral nutrition

Surgery - if non operative measures fail

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19
Q

liver lacerations

A

will show intraperitoneal fluid , hemodynamic instability and high cell counts

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20
Q

when do pancreatic pseudocyst develop

A
  • DAYS TO WEEKS following pancreatitis
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21
Q

what will ABG show for atelectasis

A

Atelcatasis increase res drive - HYPERVENTILATION

Hypoxemia ( low PO2)

Hypocapnia ( low pCo2)

Resp alkaosis ( high ph , low CO2 and Low bicarb )

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22
Q

ABG if on narcotics

A

Hypoventilation
hypoxemia
hypercapnia
resp acidosis

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23
Q

what is the minimal duration of smoking cessation needed to improve patients overall post op lung condition

A

8 weeks

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24
Q

exztraperitoneal bladder injury

A

can cause contusion or rupture of bladder neck , anterior wall or anterolateral wall

pelvic fracture

signs of peritonitis

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25
Q

how do you know if bladder neck is the cause the the extraperiotneal bladder injury

A

URINARY RETENTION

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26
Q

cause of urethrral injury

A

iatrogenic cause during abode surgery

  • hematuria may be present, fever, flank pain, renal mass ( from hydro ) - may develops hours after injury
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27
Q

inability to pass a foley into males bladder .. makes you think?

A

urethral injury - ass/ w/ 25% of male pelvic fractures

simp: blood at urethral meatus, high riding prostate

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28
Q

rupture of the dome

A

urine to leak into the peritoneal cavity and can lead to chemical peritonitis

pain in one or both shoulders ( referred pain from dubdiaphramatic peritonitis)

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29
Q

most common intra-abdominal organ injuries to to BAT ( blunt abdominal trauma)

A

hepatic and splenic lacerations

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30
Q

if FAST ultrasound scan does not show intraperitoneal fluid BUT high suspicion of perf .. what do you do?

A

CT scan with contrast

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31
Q

if FAST does show intraperitoneal fluid what do you do?

A

urgent laparotomy

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32
Q

embolism from cardiac valve lesions - affects on GI system

A

acute mesenteric schema

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33
Q

symptoms of mesenteric ischema

A

RAPID onset periumbilical pain
Pain out of proportion
hematochexia

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34
Q

adults with Blunt chest trauma presenting with persistent jugular distention, tachycardia , hypotension despite fluid rests

A

Cardiac tamponade

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35
Q

penetrating abdominal trauma who have significant injury to abdominal organs

  • hemodynamic instability
  • peritonitis
  • evisceration
  • blood from NG tube or on rectal exam
A

exploratory laparotomy

if didn’t have one of those 4 features could consider doing a CT image

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36
Q

s/e of succinocholine

A

depolarizing NM blocker

HYPERKALEMIA s/e - cardiac arrhythmia

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37
Q

clavicle fracture with bruit heard just beneath clavicle

A

you are worried about danger to the subclavian artery - what to do?

ANGIOGRAM

38
Q

distal third clavicle fracture treatment

A

open reduction and internal fixation to prevent nonunion

39
Q

middle third clavicle fracture

A

brace rest ice

40
Q

leriche syndrome

A

triad
B/l hip / thigh pain - buttock claudication
impotence
atrophy of b/l lower extremity weakness due to chronic schema

41
Q

atelectasis patients have what happens to breathing and coughing?

A

difficulty coughing and sallow breathing

42
Q

patient on warfarin but requires immediate laparotomy

A

GIVE FFP

43
Q

acute mediastinhtis

A

Cause: post cardiac surgery

Clinical: fever chest pain , leukocytosis and widened mediastinum on x-ray

Treatment: draining and surgical debridement and prolonged antibiotic treatment

44
Q

hepatic laceration

A 
blunt abodo injury 
hypotension 
free intraperitoneal fluid 
RUQ pain and bruising 
right shoulder pain
45
Q

patient with acute cholecystitis - when should you do cholesctectomy

A

WITHIN 72 hours

46
Q

idicaion for ERCP

A

when gallstone is in the CBD

47
Q

irregular alveolar infiltrates of right middle and lower lobes
patient was in mVA

A

pulmonary contusion

48
Q

Aspiration pneumonia -

A

restricted to one lobe

49
Q

blunt thoracic trauma tachypnea , tachycardia and hypoxia with rales or decrease breath sounds after MVA

A

pulmonary contusion

- pain control , O2 and vent support , neb treatment and chest physio

50
Q

FAST negative but heamodynamical unstable what to do?

A

Don’t wait for CT

STRAIGHT FOR Sugery

51
Q

patient has hemoptysis and from mexico think

A

TB

52
Q

treatment of massive hemoptysis ( > 600ml/ 24 hours)

A

ABC

BRONCHOSCOPY - to treat cause , embolization or resection

53
Q

diaphragmatic rupture

A

abdominal viscera above the diaphragm

54
Q

superficial facial trauma - what type of incubation

A

orotracheal intubation ( same as if no facial trauma )

If facial trauma you would use cricothyroidotomy

55
Q

pain in epigastrium WL plus non specific symptoms and a significant smoking history

A

malignancy - upper Gi

liver, gallbladder or pancreas

56
Q

Pancreatic cancer number 1 risk factor

A

SMOKING

57
Q

emphysematous cholecystitis

A

life threatening location of acute cholecystitis due to infection with gas forming bacteria ( clostridium, E.coli)

58
Q

RF for emphysematous cholecystitis

A

DM
Vascular compromise
Immunosuppression

59
Q

air fluid levels in gallbladder, gas in gallbladder wall - what do you think ?

A

emphysematous cholecystitis

60
Q

pneumobilia and evidence of intestinal obstruction ( dilated loops of bowl)

A

Gallstone ileus

61
Q

are arterial pulses present in compartment syndrome

A

yes for the majority of patients

62
Q

what kind of bug grows in a line infection

A

coag negative staph infection

63
Q

terminal hematuria suggest

A

prostate, bladder neck or trigone

64
Q

clots in urine

A

think bladder or ureters - concern for urothelial cancer - > 40 , smoking , sex

65
Q

pneumobilia

A

aire in the billary tree

66
Q

N and V, air in billiard tree with hyperactive bowl sounds and dilated loops of bowl - what Dx

A

Gallstone ileus

67
Q

supracondylar fracture of the humerus

A

brachial artery injury ( MOST COMMON)
median nerve injury
Cubitus varus deformity
Compartment syndrome / workman ischemic contracture

68
Q

anterior shoulder dislocation injury

A

axillary - shoulder abduction weakness (b/c axillary nerve innervates deltoid and teres minor )

69
Q

acalculus cholecystitis

A 
severely ill 
multi organ failure 
severe trauma 
surgery 
sepsis
70
Q

image for acalculus cholecystitis

A

gallbladder wall thickening and distension and pericholecystic fluid

71
Q

post partial gastrectomy - abdo pain, diarrheha , nausea, hypotension/ tachycardia, dizziness fatigue and diaphoresis - happens 15-30 minutes after meals

A

DUMPING SYNDROME

72
Q

pre-renal AKI

A

Urea: creatinine ration >20:1

Give IV fluid ( since patient is intravascular volume deplete )

73
Q

hypocalcemia and hyperphosphatemia

A

hypoparathyroidism

74
Q

if gallstone is cause of acute pancreatitis - what do you do

A

early cholecystectomy - if medically stable

If patient has acute pancreatitis with cholangitis - visible dilation / obstruction of bile duct - ECRP to attempt to relieve the obstruction

75
Q

infections with severe burns

A

Immediate after: Gram positive ( stap aureus)

5 days after: Gram negative (pseudomonas ) or fungi ( candida)

76
Q

what is the first sign of infection of burn site

A

change in burn wound appearance or loss of skin graft

77
Q

hypovolemic shock - characterized by

A

initial decrease CO follow by compensatory increase in SVR, HR, EF ( this causes tachycardia, cold extremities and hypovolemia - decrease JV pressure)

78
Q

cariogenic shock characteristics

A

dilated left ventricle with apical hypokinesis and engorement of the inferior vena cava

79
Q

dilated collapse with elevated right ventricular pressure

A
  • think cardiac tamponade
80
Q

initial test ofr blunt traumatic injury

A
  • DO A BEDSIDE ULTRASOUND ( FAST)
81
Q

what is the criteria for an emergent non contrast head CT

A
  1. low GCS
  2. signs of basilar fracture
  3. repeated vomiting
82
Q

DDX of anterior mediastinal mass

A
  1. Thymoma
  2. Teratoma ( germ cell tumour)
  3. Tyroid neoplasm
  4. Terrible lymphoma
83
Q

elevated bHCG and AFP

A

non seminoma germ cell tumour

84
Q

how many days does it take to develop C.diff after starting antibiotics

A

4-5 days

85
Q

AAA repair - what is patient at risk for

A

bowl ischemia

86
Q

urethral trauma - what to do ?

A

retrograde urethrogram
Then most treatment is:
- temporary urinary diversion by SP catheter
- followed by delayed surgical repair

87
Q

persistent pneumothorax despite chest tube placement and pneumomediastium and subcutaneous emphysema - what is Dx

A

bronchial rupture

88
Q

abdo pain with hip extension

A

think psoas access

- draining with broad spectrum antibiotics

89
Q

exztraperitoneal bladder injury

A

rupture of next, anterior wall, of bladder

90
Q

localized pain
gross hematuria
Pelvic fracture

A

extraperiotneal bladder injury

91
Q

hypotension ( unresponsive to IV fluid bolus) , tachycardia and elevated jugular venous pressure after blunt thoracic trauma - what is Dx?

A

acute cardiac tamponade

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