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Master the Boards Step 3 > Surgery > Flashcards

Surgery Flashcards

1
Q

If O2 sats are below 90, do

A

ABG

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2
Q

Normal bicarb =

A

24

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3
Q

Cardiac output =

A

Stroke volume x Heart rate

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4
Q

Stroke volume =

A

End Diastolic Volume - End Systolic Volume

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5
Q

Total peripheral resistance =

A

Mean arterial pressure - Mean venous pressure

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6
Q

Blood pressure =

A

Cardiac Output x Total Peripheral Resistance

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7
Q

Immediately perform __ in pericardial tamponade

A

pericardiocentesis

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8
Q

In preparation for immediate exploratory laparotomy, do a bunch of things simultaneously:

A 
2 large bore IV lines
Type and cross
Give fluids and blood
Insert foley
Administer IV antibiotics
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9
Q

Surgery is always done for ___ head injuries, even if the patient is asymptomatic!

A

comminuted or depressed skull fracture

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10
Q

All patients with open skull fractures should receive

A

tetanus toxoid and prophylactic antibiotics

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11
Q

Management of basal skull fracture =

A

CT scan of head/nec
CSF leak sill stop by itself
Facial palsy may occur 2-3 days later

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12
Q

All epidermal hematomas require

A

emergency craniotomy

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13
Q

Epidural hematoma = injury to

A

middle meningeal artery

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14
Q

Subdural hematoma = injury to

A

bridging veins

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15
Q

Only do an emergency craniotomy in case of subdural hematoma if

A

there are lateralizing signs and midline displacement

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16
Q

Surgery cannot help in this head injury that is caused by acceleration-deceleration injuries to the head

A

diffuse axonal injury

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17
Q

Gradual dilatation of one pupil and a decreasing responsiveness to light is an important sign of

A

elevating intracranial pressure

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18
Q

DO NOT EVER DO THIS

A

perform an LP before getting a head CT. If you perform a lumbar puncture on a person with increased intracranial pressure, you will HERNIATE THE BRAIN, KILL THE PATIENT, GET CHLAMYDIA AND DIE.

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19
Q

Hyperventilation causes vaso___ and decreased blood volume in the brain, causing ICP to ___

A

constriction; lower ICP

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20
Q

First line measures for high ICP are

A

elevated head of bed
hyperventilation
avoid fluid overload

second line: mannitol, sedation/hypothermia

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21
Q

Anisocoria =

A

unequal size of pupils

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22
Q

When is surgery the answer for acute abdomen?

A

Peritonitis
Abdominal pain/tenderness plus sepsis signs
Pneumoperitoneum
Acute intestinal ischemia

rule out pancreatitis first

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23
Q

Treatment for spontaneous bacterial peritonitis is

A

immediate paracentesis; diagnosis is made when fluid contains neutrophils greater than 250 cells per cubed mm

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24
Q

Treat SBP with

A

ceftriaxone and albumin at 1.5g/kg on day 1 and day 3 of hospitalization

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25
Q

First study of choice for esophageal perforation is

A

gastrografin contrast esophagram

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26
Q

Most accurate test for adult with GI obstruction is

A

CT scan of abdomen and pelvis with contrast

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27
Q

When diagnosing acute diverticulitis, don’t forget to order

A

a pregnancy test in women of reproductive age!

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28
Q

___ is absolutely contraindicated in acute diverticulitis

A

Colonoscopy

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29
Q

When palpation of the LLQ causes pain n the RLQ, think

A

acute appendicitis (Rovsing’s sign)

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30
Q

It’s important to administer ___ before appendectomy

A

IV antibiotics:

  • cipro and metronidazole
  • ampicillin/sulbactam
  • levofloxacin and clinda
  • cefoxitin or cefotetan
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31
Q

If chronic UC has been present for more than 20 years, ___ is indicated

A

elective surgery

also if high dose chronic steroids are needed or toxic megacolon is present

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32
Q

What three major GI arteries arising from the abd aorta supply the gut?

A

celiac axis, the SMA, and the IMA

SMA is most commonly affected by ischemia

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33
Q

The best initial and most accurate test for ischemic colitis is

A

CT abdomen showing thickening of the bowel in a segmental pattern

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34
Q

Therapy for ischemia colitis

A

IV fluid hydration and bowel rest

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35
Q

In chronic mesenteric ischemia, ___ is both therapeutic and diagnostic

A

computed tomography angiography

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36
Q

Development of symptoms (postprandial abd pain, unrelenting nausea, anorexia, weight loss) after a recent dramatic weight loss

A

Median Arcuate Ligament Syndrome

treat by surgical decompression of the celiac artery

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37
Q

Always do what to an intra-abdominal abscess?

A

Drain it!

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38
Q

Which two ducts merge to form the common bile duct?

A

Common hepatic duct and Cystic duct

39
Q

CT scan of obstructive jaundice caused by a tumor will show

A

double duct sign (aka simultaneous dilatation of both the common bile duct and the pancreatic duct)

40
Q

Treat acute cholecystitis is

A 
NG suction
NPO
IV fluids
antibiotics
then cholecystectomy after 6-12 weeks
41
Q

Reynold’s pentad:

A 
jaundice
RUQ pain
fever
AMS
shock
42
Q

Treat acute ascending cholangitis with

A

IV antibiotics
Emergency decompression of the common duct
ERCP or percutaneous transhepatic cholangiogram
Surgery isn’t often necessary

43
Q

The most accurate test for fecal incontinence is

A

anorectal manometry

44
Q

Do not perform surgery in patients with multiple

A

derangements in hepatic risk factors

45
Q

The most lethal cause of post-op disorientation if not recognized and treated early is

A

hypoxia, so order an ABG

46
Q

The leakage of fecal, gastric, or duodenal contents to the outside opstoperatively is ___

A

not an indication for emergency surgery! observe stable patients

47
Q

Manage malignant hyperthermia by

A

IV dantrolene, 100% O2, acidosis correction, cooling blankets

watching for development of myoglobinuria

48
Q

Manage bacteremia and fever >104 with

A

blood cultures x3 and empiric abx

49
Q

The most important step before surgery at birth is

A

check for congenital anomalies and look for VACTERL constellation

50
Q

If excessive salivation or chocking spells are noted shortly after birth, it could be

A

esophageal atresia

51
Q

What causes esophageal atresia?

A

Ventrally displaced location of the notochord in an embryo

52
Q

Confirm diagnosis of esophageal atresia with

A

NG tube, which becomes coiled in the upper chest on x-ray

53
Q

If anal atresia is suspected, look for

A

a fistula nearby; if no fistula present, perform a colostomy

54
Q

The primary abnormality of congenital diaphragmatic hernia is

A

hypoplastic lung with fetal type circulation

55
Q

Treat CDH with

A

endotracheal intubation
low pressure ventilation
sedation
NG suction

56
Q

Where is the defect in gastroschisis?

A

To the right of the umbilical cord

due to failure of neural crest cells to migrate

57
Q

Incomplete fusion during the fourth week of development results in

A

omphalocele

58
Q

Which trisomies are a/w omphalocele?

A

Edwards syndrome and Patau syndrome

59
Q

Exstrophy of the urinary bladder requires

A

Surgical repair in the first 1-2 days of life! Transfer to a specialized center

60
Q

What can present with double bubble sign?

A

Annular pancreas
malrotation
duodenal atresia

61
Q

Intestinal atresia is not associated with

A

other congenital abnormalities

62
Q

A sign of sepsis in newborns is

A

rapidly dropping platelet count

63
Q

The most common pathogens in necrotizing enterocolitis are

A

E. coli and Klebsiella pneumonia

64
Q

Feeding intolerance + bilious vomiting + CF =

A

meconium ileus

65
Q

In meconium ileus, ___ is both diagnostic and therapeutic

A

gastrografin enema

66
Q

Diagnose hypertrophic pyloric stenosis with

A

sonogram showing target sign

67
Q

Treat pyloric stenosis by

A

first correcting metabolic abnormalities and dehydration, then performing a pyloromyotomy

68
Q

Persistent progressively increasing jaundice in 6-8 week old babies =

A

biliary atresia

69
Q

Treat biliary atresia with

A

HIDA scan after 1 week of phenobarbital, then surgery if that doesn’t work

70
Q

diagnose Hirschsprung Disease with

A

full-thickness biopsy of rectal mucosa

71
Q

When does intussusception show up?

A

6-12 months of age, chubby healthy looking kids with brief episodes of colicky abdominal pain

72
Q

Lower GI bleeding in a child of pediatric age =

A

Meckel diverticulum

73
Q

When a fracture is suspected, order

A

2 views at 90 degrees to one another and always include the joints above and below the broken bone

74
Q

When a fracture is displaced severely or angulated or cannot be aligned, what should you do?

A

Open reduction and internal fixation

75
Q

When does an open fracture need to be reduced?

A

within 6 hours from time of injury

76
Q

Neuro dysfunction, petechial rash, respiratory distress, fracture =

A

fat embolism

77
Q

Fixing a long-bone fracture within ___ reduces the incidence of respiratory distress from embolic phenomena

A

24 hours

78
Q

Which type of shoulder dislocation is possible in a patient with a recent seizure?

A

Posterior shoulder dislocations.

Otherwise, anterior shoulder dislocations are the most common

79
Q

What type of xray should you order in a patient with a recent seizure and shoulder pain?

A

axillary or scapular views of the affected shoulder

80
Q

Painful wrist + dinner fork deformity =

A

Colle’s fracture

81
Q

Direct blow to the ulna or radius results in a combo __ and __ fracture

A

diaphyseal and displaced dislocation. Treat w/ ORIF

82
Q

Suspected scaphoid fracture, treat w/

A

thumb spica cast

83
Q

Treat femoral neck fractures with

A

femoral head replacement

84
Q

Intertrochanteric fractures are treated with

A

open reduction and pinning

85
Q

Femoral shaft fractures are treated with

A

intramedullary rod fixation

86
Q

Posterior dislocation of the hip (knees hit dashboard in MVA) =

A

orthopedic emergency! Leg is internally rotated and shortened

87
Q

Symptoms caused by tapping the nerve over the flexor retinaculum and awaiting parasthesias =

A

Tinel’s sign for CTS

88
Q

Flexing the wrist gently and holding the position =

A

Phalen’s test for CTS

89
Q

Signs of a __ injury include inability to dorsiflex (extend) the wrist

A

oblique distal humerus, complicated by radial nerve paralysis

90
Q

The most important intervention for a urologic obstruction is

A

a ureteral stent or percutaneous nephrostomy

91
Q

A child who has hematuria from a trivial trauma has ___ until proven otherwise

A

undiagnosed congenital urologic anomaly

92
Q

A teenager drinks large volumes of beer and develops colicky flank pain

A

Ureteropelvic Junction Obstruction

-only symptomatic with diuretics

93
Q

Treat subclavian steal syndrome with

A

bypass surgery

94
Q

Classic symptoms of subclavian steal syndrome are

A

visual symptoms, equilibrium problems, and claudication in the arm during arm exercises

Master the Boards Step 3 (19 decks)

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