Surgery Flashcards
Pts that perform repetitive arm movement above shoulder height that present w/subacute pain on abduction have what?
What is a common characteristic?
Rotator cuff tendinopathy
Impingement syndrome
What can Etomidate cause? How?
Propofol can cause what?
AI - bc it inhibits 11B-hydroxylase
severe HoTN d/t myocardial depression
What causes herpangina?
Presents how?
Coxsackie A
Fever, sore throat, odynophagia
Place ET tube in pt and it fills up w/more than 600 mL of blood, do what next?
Bronchoscopy
What is the MC complication of supracondylar fracture of the humerus?
What is a v. Rare complication?
What else are they at risk for?
Brachial artery and median nerve entrapment
Compartment syndrome —> leads to Volkmann contracture
Cubitus Varus deformity
What presents w/fever, chest pain, leukocytosis, mediastinal widening on CXR after cardiac surgery?
Treat how?
Acute mediastinitis
ABx and surgical debridement
Pt w/respiratory distress after BAT w/dec breath sounds at left lung base can have what?
What is diagnostic?
Diaphragmatic injury
NG tube in lung field
Pt that has a fall from > 10 feet or MVA, what must be ruled out in the upper chest area?
What is the initial screening test?
What finding is the most sensitive?
Blunt aortic trauma
CXR
Widened mediastinum
Pt that has blunt GU trauma and is hemodynamically stable but has evidence of hematuria needs what?
Contrast CT of ABD and Pelvis
What is described by b/L hip, thigh and buttock claudication; absent/diminished femoral pulses; and impotence?
What is ALWAYS present?
Leriche syndrome
Impotence
Alcoholic that has poor wound healing due to what?
Nutritional deficiency (vitamin C)
What presents w/neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx?
Can cause what?
Retropharyngeal abscess
Infection w/in superior mediastinum and cause acute necrotizing mediastinitis
Pt w/BAT, left sided-ABD pain, anemia most likely has what?
Need to do what 1st?
Then what?
Splenic injury
FAST
CT ABD w/contrast
Pt that has acute onset of HoTN, ABD or back pain, syncope with gross hematuria most likely has what?
Ruptured AAA
Pt w/traumatic spinal cord injury needs to have what?
Urinary CATH to asses for urinary retention and prevent acute bladder distention and damage
CT scan or CXR of pt after MVA that shows patchy, irregular alveolar infiltrate w/ABG that shows hypoxemia indicates what?
Pulmonary contusion
SCC arising within a burn is called what?
Marjolin ulcer
Respiratory distress, neurologic dysfunction, and a petechial rash 24 hours post op indicates what?
Fat embolism
What is Cushing’s reflex (triad)?
Indicates what?
Bradycardia, dec respirations, INC systolic BP
Inc ICP
Pt with DVT and ESRD, what is the treatment?
What is contraindicated
Unfractionated heparin bridge to Warfarin
Low molecular weight heparin and rivaroxaban (xarelto)
NSAID use and episodic postprandial epigastric pain = ?
Perforated peptic ulcer disease
What presents as an irregular genital mass that increases in size w/standing and valsalva?
Varicocele
Any pt with knife trauma to ABD and peritoneal signs even if they are hemodynamically stable need what?
Ex Lap
Pt w/fever, leukocytosis, and parotid inflammation in a post op pt has what?
MC agent?
Who is most prone to it?
Acute bacterial parotitis
S aureus
Elderly dehydrate pts
What are conservative meds to give to a pt w/an anal fissure?
Lidocaine
Nitroglycerin
Nifedipine
What causes penile fracture?
Rupture of corpus cavernous d/t tear in tunica albuginea
What causes anterior knee pain, tenderness, erythema, and localized swelling and is common w/repetitive kneeling?
D/t what?
Perpatellar bursitis
S aureus
What presents w/flaccid paraplegia and loss of pain in the LE. Vibratory sensation remains intact and UE is ok?
D/t what?
Anterior cord syndrome
Spinal cord infarction
What is dumping syndrome?
Occurs when?
D/t what?
N/D/ABD cramps, palpitations, diaphoresis
Postgastrectomy
Loss of normal action of pyloric sphincter d/t surgical bypass
Pt that presents w/upper ABD pain that is constant and interferes with sleep, has poor appetite, weight loss, fatigue, and 30 year pack history has what?
Pancreatic adenocarcinoma
Blow to the head which causes uncal herniation is most likely what?
What can uncal herniation cause?
Epidural hematoma
CN 3 palsy and hemiparesis
What presents in children after BAT w/epigastric pain and vomiting 24-36 hours after initial injury?
Manage how?
duodenal hematoma
Gastric decompression and parenteral nutrition
How does hyperventilation decrease ICP?
How does CO2 effect cerebral blood flow?
CO2 washout —> cerebral vasoconstriction
As cerebral paCO2 rise, so does blood flow
Pt w/fever, HoTN, erythema and swelling after a cut on the leg and has a CT that shows air in the deep tissue has what?
MC pathogen?
Necrotizing fasciitis
grp A strep, but MC polymicrobial
GSW below what level requires Ex Lap in unstable pts?
Bedside ultrasound shows what?
T4 (nipple)
Equivocal
What does intraperitoneal bladder describe?
dome of the bladder - superior and lateral bladder walls and directly abuts the peritoneal space
How are fractures of the middle third of the clavicle treated?
Distal third? Why?
Brace, rest, ice
ORIF to prevent nonunion
What is tic douloureux?
Trigeminal neuralgia
What causes pooling of saliva and deviation of uvula from the affected side of throat pain?
Peritonsillar abscess
What can Succinylcholine cause in pts w/skeletal muscle trauma, burns or strokes?
How?
Life-threatening HyperKalemia
Binds to post-synaptic ACh-R’s which trigger influx of Na ions and Efflux of K+ ions
Pt w/a small (< 1.5 cm) congenital umbilical hernia is managed how?
What about later in life?
Observation, they close spontaneously
Need surgery if they do not close by Age 5
Pt w/recent cardiac catheterization, anticoagulation w/heparin, HoTN, tachycardia, flat neck veins and back pain has what?
D/t what?
Next step in management?
Retroperitoneal hematoma
Bleeding from arterial access site
NonCon CT ABD and Pelvis
Pt w/blunt head trauma has concern for what?
2/2 to what?
May cause what?
Transtentorial (uncal) herniation
Epidural hematoma
CN 3 palsy, i/L hemiparesis, c/L hemianopsia
What does the CXR show in pericardial tamponade?
NORMAL cardiac silhouette w/out tension pneumothorax
What findings indicate a complicated SBO?
Fever
Hemodynamical instability - HoTN, tachycardia
Metabolic acidosis —> Look for LOW HCO3
Guarding
Pt that experiences recurrent episodic pain in the RUQ or epigastric region w/elevated LFTs and ALP after an inflammatory process (surgery, pancreatitis) has what?
What can precipitate symptoms?
Sphincter of Oddi dysfunction
Opioids
What nerve is responsible for knee extension and hip flexion?
Innervates muscles of which compartment of the thigh?
Femoral
Anterior
What presents w/a popping sound followed by acute pain and pt has reduced extension, a sensation of instability, and a knee effusion?
Medial meniscus tear
Pt w/complicated diverticulitis w/abscess formation should be managed how?
What size fluid collection warrants this?
If symptoms not controlled by when, what is recommended?
CT-guided percutaneous drainage
> 3 cm
5th day, then do surgical I&D
Extraperitoneal bladder injury includes what?
What is almost ALWAYS present?
What other features?
neck, ant wall, anterolateral wall of the bladder
pelvic fracture
gross hematuria and urinary retention
Blunt chest trauma which causes hemorrhagic shock w/decreased breath sounds and dullness to percussion over 1 hemithorax and c/L tracheal deviation d/t what?
Large i/L hemithorax
Stable pt w/LARGE Pneumothorax needs what?
Pt that is unstable needs what?
Needle decompression
Tube thoracostomy (chest tube placement)
What causes peritonitis (diffuse ABD tenderness, guarding, rebound), referred pain to the i/L shoulder after a direct blow to the lower ABD and pelvis?
bladder dome rupture
What is a possible complication of AAA repair that presents w/bloody diarrhea and ABD pain?
Ischemia of the bowel
Acalculous cholecystitis occurs in whom?
Imaging shows what?
Treat how?
Critically ill pts
GB wall thickening and distention, pericholecystic fluid
ABx and percutaneous cholecystectomy
Pt that has been using lots of NSAIDs and presents w/ABD pain, fever, tachycardia w/ABD exam that shows rigidity, guarding, reduce bowel sounds and rebound tenderness has what?
Dx how?
Perforated viscous d/t PUD
Upright Xray of chest and ABD
Nonseminomatous germ cell tumors have what tumor markers?
Elevated AFP and elevated b-HCG
Pt w/extensive burns that develops an infection is most likely d/t what organisms?
G- Pseudomonas or Fungi
Pt w/N/V, pneumobilia (air in biliary tree), hyperactive bowel sounds, and dilated loops of bowel has what?
Gallstone ileus
needle thoracostomy should be placed where in tension pneumo?
if it fails go where?
2nd ICS midclavicular line
5th ICS midaxillary line
Pt that presents w/N/V/ABD bloating and dilated loops of bowel on ABD xray has what?
MC d/t what in history?
Complete SBO
Adhesions from prior ABD surgery
Pt w/UE sensory deficits (pain/temp) and weakness after a whiplash injury has what?
What is another common cause?
Best way to diagnose?
Syringomelia
Arnold Chiari
MRI
What is psoas sign?
Indicates what?
RLQ pain w/extension of the right thigh
Abscess adjacent to psoas or retrocecal appendix
Pt that has IE and cardiac valve vegetation is at risk of getting what ABD event?
Acute mesenteric ischemia d/t embolism
What are the 4 T’s of anterior mediastinal masses?
Thymoma
Terrible lymphoma
Thyroid cancer
Teratoma
Pt that has severe pain and parasthesia following a LE embolectomy just a few hours earlier most likely has what?
Compartment syndrome aka soft-tissue swelling
Myocardial rupture after MVA indicates what?
Immediate DEATH
What causes paradoxical respiration?
D/t what?
Flail chest
> 2 contiguous ribs fractures in 2 or more spots
What is the MC cause of LE edema?
Classic symptoms?
Venous insufficiency (valve incompetence)
Worse throughout the day, resolves overnight
What causes epidural hematoma anatomically?
Trauma to sphenoid bone —> tears MMA
Child w/blunt trauma or MVA that has left lower lung opacity, elevated hemidiaphragm and mediastinal deviation have what?
Diagnose how?
Diaphragmatic rupture
CT chest and ABD
Parotid surgery involves risk of injuring what?
Causing what?
Facial nerve
Facial droop
Acute knee pain assoc w/catching or reduced range of motion suggests what?
Persistent symptoms should be evaluated how?
Meniscal injury
MRI
Pneumomediastinum and subcutaneous emphysema after MVA indicates what?
Tracheobronchial rupture
What is the most frequent cause of nosocomial bloodstream infection in pts w/intramuscular devices?
Coagulase-negative Staph (epidermidis)
What is the management of a small spontaneous Pneumothorax?
What is the MC pt?
Oxygen and observation
Tall, thin man in early 20s
Pelvic fractures cause what in men?
This includes what?
Posterior urethral injury
Membranous and prostatic urethra
Gallstone pancreatitis presents how?
ALT > 150
Prosthetic joint infection that occurs w/in the 1st three months is d/t what?
3-12 months?
After 12 months?
S aureus, pseudomonas
S epidermidis, propionibacterium, enterococcus
Hematogenous spread by distant infxn (uti)
What is a life-threatening form of acute cholecystitis that occurs more commonly in immunosuppressed pts (diabetes) that arises d/t infection of GB wall w/gas-forming bacteria?
Treatment?
Emphysematous cholecystitis
Emergent cholecystectomy
Widened mediastinum and left-sided hemithorax after MVA indicates what?
Aortic rupture
