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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
how do you know if bladder neck is the cause the the extraperiotneal bladder injury
URINARY RETENTION
26
cause of urethrral injury
iatrogenic cause during abode surgery - hematuria may be present, fever, flank pain, renal mass ( from hydro ) - may develops hours after injury
27
inability to pass a foley into males bladder .. makes you think?
urethral injury - ass/ w/ 25% of male pelvic fractures | simp: blood at urethral meatus, high riding prostate
28
rupture of the dome
urine to leak into the peritoneal cavity and can lead to chemical peritonitis pain in one or both shoulders ( referred pain from dubdiaphramatic peritonitis)
29
most common intra-abdominal organ injuries to to BAT ( blunt abdominal trauma)
hepatic and splenic lacerations
30
if FAST ultrasound scan does not show intraperitoneal fluid BUT high suspicion of perf .. what do you do?
CT scan with contrast
31
if FAST does show intraperitoneal fluid what do you do?
urgent laparotomy
32
embolism from cardiac valve lesions - affects on GI system
acute mesenteric schema
33
symptoms of mesenteric ischema
RAPID onset periumbilical pain Pain out of proportion hematochexia
34
adults with Blunt chest trauma presenting with persistent jugular distention, tachycardia , hypotension despite fluid rests
Cardiac tamponade
35
penetrating abdominal trauma who have significant injury to abdominal organs - hemodynamic instability - peritonitis - evisceration - blood from NG tube or on rectal exam
exploratory laparotomy if didn't have one of those 4 features could consider doing a CT image
36
s/e of succinocholine
depolarizing NM blocker HYPERKALEMIA s/e - cardiac arrhythmia
37
clavicle fracture with bruit heard just beneath clavicle
you are worried about danger to the subclavian artery - what to do? ANGIOGRAM
38
distal third clavicle fracture treatment
open reduction and internal fixation to prevent nonunion
39
middle third clavicle fracture
brace rest ice
40
leriche syndrome
triad B/l hip / thigh pain - buttock claudication impotence atrophy of b/l lower extremity weakness due to chronic schema
41
atelectasis patients have what happens to breathing and coughing?
difficulty coughing and sallow breathing
42
patient on warfarin but requires immediate laparotomy
GIVE FFP
43
acute mediastinhtis
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
hepatic laceration
``` blunt abodo injury hypotension free intraperitoneal fluid RUQ pain and bruising right shoulder pain ```
45
patient with acute cholecystitis - when should you do cholesctectomy
WITHIN 72 hours
46
idicaion for ERCP
when gallstone is in the CBD
47
irregular alveolar infiltrates of right middle and lower lobes patient was in mVA
pulmonary contusion
48
Aspiration pneumonia -
restricted to one lobe
49
blunt thoracic trauma tachypnea , tachycardia and hypoxia with rales or decrease breath sounds after MVA
pulmonary contusion | - pain control , O2 and vent support , neb treatment and chest physio
50
FAST negative but heamodynamical unstable what to do?
Don't wait for CT STRAIGHT FOR Sugery
51
patient has hemoptysis and from mexico think
TB
52
treatment of massive hemoptysis ( > 600ml/ 24 hours)
ABC | BRONCHOSCOPY - to treat cause , embolization or resection
53
diaphragmatic rupture
abdominal viscera above the diaphragm
54
superficial facial trauma - what type of incubation
orotracheal intubation ( same as if no facial trauma ) If facial trauma you would use cricothyroidotomy
55
pain in epigastrium WL plus non specific symptoms and a significant smoking history
malignancy - upper Gi | liver, gallbladder or pancreas
56
Pancreatic cancer number 1 risk factor
SMOKING
57
emphysematous cholecystitis
life threatening location of acute cholecystitis due to infection with gas forming bacteria ( clostridium, E.coli)
58
RF for emphysematous cholecystitis
DM Vascular compromise Immunosuppression
59
air fluid levels in gallbladder, gas in gallbladder wall - what do you think ?
emphysematous cholecystitis
60
pneumobilia and evidence of intestinal obstruction ( dilated loops of bowl)
Gallstone ileus
61
are arterial pulses present in compartment syndrome
yes for the majority of patients
62
what kind of bug grows in a line infection
coag negative staph infection
63
terminal hematuria suggest
prostate, bladder neck or trigone
64
clots in urine
think bladder or ureters - concern for urothelial cancer - > 40 , smoking , sex
65
pneumobilia
aire in the billary tree
66
N and V, air in billiard tree with hyperactive bowl sounds and dilated loops of bowl - what Dx
Gallstone ileus
67
supracondylar fracture of the humerus
brachial artery injury ( MOST COMMON) median nerve injury Cubitus varus deformity Compartment syndrome / workman ischemic contracture
68
anterior shoulder dislocation injury
axillary - shoulder abduction weakness (b/c axillary nerve innervates deltoid and teres minor )
69
acalculus cholecystitis
``` severely ill multi organ failure severe trauma surgery sepsis ```
70
image for acalculus cholecystitis
gallbladder wall thickening and distension and pericholecystic fluid
71
post partial gastrectomy - abdo pain, diarrheha , nausea, hypotension/ tachycardia, dizziness fatigue and diaphoresis - happens 15-30 minutes after meals
DUMPING SYNDROME
72
pre-renal AKI
Urea: creatinine ration >20:1 Give IV fluid ( since patient is intravascular volume deplete )
73
hypocalcemia and hyperphosphatemia
hypoparathyroidism
74
if gallstone is cause of acute pancreatitis - what do you do
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
infections with severe burns
Immediate after: Gram positive ( stap aureus) 5 days after: Gram negative (pseudomonas ) or fungi ( candida)
76
what is the first sign of infection of burn site
change in burn wound appearance or loss of skin graft
77
hypovolemic shock - characterized by
initial decrease CO follow by compensatory increase in SVR, HR, EF ( this causes tachycardia, cold extremities and hypovolemia - decrease JV pressure)
78
cariogenic shock characteristics
dilated left ventricle with apical hypokinesis and engorement of the inferior vena cava
79
dilated collapse with elevated right ventricular pressure
- think cardiac tamponade
80
initial test ofr blunt traumatic injury
- DO A BEDSIDE ULTRASOUND ( FAST)
81
what is the criteria for an emergent non contrast head CT
1. low GCS 2. signs of basilar fracture 3. repeated vomiting
82
DDX of anterior mediastinal mass
1. Thymoma 2. Teratoma ( germ cell tumour) 3. Tyroid neoplasm 4. Terrible lymphoma
83
elevated bHCG and AFP
non seminoma germ cell tumour
84
how many days does it take to develop C.diff after starting antibiotics
4-5 days
85
AAA repair - what is patient at risk for
bowl ischemia
86
urethral trauma - what to do ?
retrograde urethrogram Then most treatment is: - temporary urinary diversion by SP catheter - followed by delayed surgical repair
87
persistent pneumothorax despite chest tube placement and pneumomediastium and subcutaneous emphysema - what is Dx
bronchial rupture
88
abdo pain with hip extension
think psoas access | - draining with broad spectrum antibiotics
89
exztraperitoneal bladder injury
rupture of next, anterior wall, of bladder
90
localized pain gross hematuria Pelvic fracture
extraperiotneal bladder injury
91
hypotension ( unresponsive to IV fluid bolus) , tachycardia and elevated jugular venous pressure after blunt thoracic trauma - what is Dx?
acute cardiac tamponade

uworld (11 decks)

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