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UWorld Step 2 > Surgery > Flashcards

Surgery Flashcards

1
Q

Pts that perform repetitive arm movement above shoulder height that present w/subacute pain on abduction have what?

What is a common characteristic?

A

Rotator cuff tendinopathy

Impingement syndrome

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2
Q

What can Etomidate cause? How?

Propofol can cause what?

A

AI - bc it inhibits 11B-hydroxylase

severe HoTN d/t myocardial depression

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3
Q

What causes herpangina?

Presents how?

A

Coxsackie A

Fever, sore throat, odynophagia

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4
Q

Place ET tube in pt and it fills up w/more than 600 mL of blood, do what next?

A

Bronchoscopy

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5
Q

What is the MC complication of supracondylar fracture of the humerus?

What is a v. Rare complication?

What else are they at risk for?

A

Brachial artery and median nerve entrapment

Compartment syndrome —> leads to Volkmann contracture

Cubitus Varus deformity

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6
Q

What presents w/fever, chest pain, leukocytosis, mediastinal widening on CXR after cardiac surgery?

Treat how?

A

Acute mediastinitis

ABx and surgical debridement

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7
Q

Pt w/respiratory distress after BAT w/dec breath sounds at left lung base can have what?

What is diagnostic?

A

Diaphragmatic injury

NG tube in lung field

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8
Q

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?

A

Blunt aortic trauma

CXR

Widened mediastinum

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9
Q

Pt that has blunt GU trauma and is hemodynamically stable but has evidence of hematuria needs what?

A

Contrast CT of ABD and Pelvis

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10
Q

What is described by b/L hip, thigh and buttock claudication; absent/diminished femoral pulses; and impotence?

What is ALWAYS present?

A

Leriche syndrome

Impotence

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11
Q

Alcoholic that has poor wound healing due to what?

A

Nutritional deficiency (vitamin C)

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12
Q

What presents w/neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx?

Can cause what?

A

Retropharyngeal abscess

Infection w/in superior mediastinum and cause acute necrotizing mediastinitis

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13
Q

Pt w/BAT, left sided-ABD pain, anemia most likely has what?

Need to do what 1st?

Then what?

A

Splenic injury

FAST

CT ABD w/contrast

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14
Q

Pt that has acute onset of HoTN, ABD or back pain, syncope with gross hematuria most likely has what?

A

Ruptured AAA

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15
Q

Pt w/traumatic spinal cord injury needs to have what?

A

Urinary CATH to asses for urinary retention and prevent acute bladder distention and damage

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16
Q

CT scan or CXR of pt after MVA that shows patchy, irregular alveolar infiltrate w/ABG that shows hypoxemia indicates what?

A

Pulmonary contusion

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17
Q

SCC arising within a burn is called what?

A

Marjolin ulcer

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18
Q

Respiratory distress, neurologic dysfunction, and a petechial rash 24 hours post op indicates what?

A

Fat embolism

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19
Q

What is Cushing’s reflex (triad)?

Indicates what?

A

Bradycardia, dec respirations, INC systolic BP

Inc ICP

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20
Q

Pt with DVT and ESRD, what is the treatment?

What is contraindicated

A

Unfractionated heparin bridge to Warfarin

Low molecular weight heparin and rivaroxaban (xarelto)

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21
Q

NSAID use and episodic postprandial epigastric pain = ?

A

Perforated peptic ulcer disease

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22
Q

What presents as an irregular genital mass that increases in size w/standing and valsalva?

A

Varicocele

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23
Q

Any pt with knife trauma to ABD and peritoneal signs even if they are hemodynamically stable need what?

A

Ex Lap

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24
Q

Pt w/fever, leukocytosis, and parotid inflammation in a post op pt has what?

MC agent?

Who is most prone to it?

A

Acute bacterial parotitis

S aureus

Elderly dehydrate pts

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25
Q

What are conservative meds to give to a pt w/an anal fissure?

A

Lidocaine
Nitroglycerin
Nifedipine

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26
Q

What causes penile fracture?

A

Rupture of corpus cavernous d/t tear in tunica albuginea

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27
Q

What causes anterior knee pain, tenderness, erythema, and localized swelling and is common w/repetitive kneeling?

D/t what?

A

Perpatellar bursitis

S aureus

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28
Q

What presents w/flaccid paraplegia and loss of pain in the LE. Vibratory sensation remains intact and UE is ok?

D/t what?

A

Anterior cord syndrome

Spinal cord infarction

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29
Q

What is dumping syndrome?

Occurs when?

D/t what?

A

N/D/ABD cramps, palpitations, diaphoresis

Postgastrectomy

Loss of normal action of pyloric sphincter d/t surgical bypass

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30
Q

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?

A

Pancreatic adenocarcinoma

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31
Q

Blow to the head which causes uncal herniation is most likely what?

What can uncal herniation cause?

A

Epidural hematoma

CN 3 palsy and hemiparesis

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32
Q

What presents in children after BAT w/epigastric pain and vomiting 24-36 hours after initial injury?

Manage how?

A

duodenal hematoma

Gastric decompression and parenteral nutrition

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33
Q

How does hyperventilation decrease ICP?

How does CO2 effect cerebral blood flow?

A

CO2 washout —> cerebral vasoconstriction

As cerebral paCO2 rise, so does blood flow

34
Q

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?

A

Necrotizing fasciitis

grp A strep, but MC polymicrobial

35
Q

GSW below what level requires Ex Lap in unstable pts?

Bedside ultrasound shows what?

A

T4 (nipple)

Equivocal

36
Q

What does intraperitoneal bladder describe?

A

dome of the bladder - superior and lateral bladder walls and directly abuts the peritoneal space

37
Q

How are fractures of the middle third of the clavicle treated?

Distal third? Why?

A

Brace, rest, ice

ORIF to prevent nonunion

38
Q

What is tic douloureux?

A

Trigeminal neuralgia

39
Q

What causes pooling of saliva and deviation of uvula from the affected side of throat pain?

A

Peritonsillar abscess

40
Q

What can Succinylcholine cause in pts w/skeletal muscle trauma, burns or strokes?

How?

A

Life-threatening HyperKalemia

Binds to post-synaptic ACh-R’s which trigger influx of Na ions and Efflux of K+ ions

41
Q

Pt w/a small (< 1.5 cm) congenital umbilical hernia is managed how?

What about later in life?

A

Observation, they close spontaneously

Need surgery if they do not close by Age 5

42
Q

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?

A

Retroperitoneal hematoma

Bleeding from arterial access site

NonCon CT ABD and Pelvis

43
Q

Pt w/blunt head trauma has concern for what?

2/2 to what?

May cause what?

A

Transtentorial (uncal) herniation

Epidural hematoma

CN 3 palsy, i/L hemiparesis, c/L hemianopsia

44
Q

What does the CXR show in pericardial tamponade?

A

NORMAL cardiac silhouette w/out tension pneumothorax

45
Q

What findings indicate a complicated SBO?

A

Fever
Hemodynamical instability - HoTN, tachycardia
Metabolic acidosis —> Look for LOW HCO3
Guarding

46
Q

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?

A

Sphincter of Oddi dysfunction

Opioids

47
Q

What nerve is responsible for knee extension and hip flexion?

Innervates muscles of which compartment of the thigh?

A

Femoral

Anterior

48
Q

What presents w/a popping sound followed by acute pain and pt has reduced extension, a sensation of instability, and a knee effusion?

A

Medial meniscus tear

49
Q

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?

A

CT-guided percutaneous drainage

> 3 cm

5th day, then do surgical I&D

50
Q

Extraperitoneal bladder injury includes what?

What is almost ALWAYS present?

What other features?

A

neck, ant wall, anterolateral wall of the bladder

pelvic fracture

gross hematuria and urinary retention

51
Q

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?

A

Large i/L hemithorax

52
Q

Stable pt w/LARGE Pneumothorax needs what?

Pt that is unstable needs what?

A

Needle decompression

Tube thoracostomy (chest tube placement)

53
Q

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?

A

bladder dome rupture

54
Q

What is a possible complication of AAA repair that presents w/bloody diarrhea and ABD pain?

A

Ischemia of the bowel

55
Q

Acalculous cholecystitis occurs in whom?

Imaging shows what?

Treat how?

A

Critically ill pts

GB wall thickening and distention, pericholecystic fluid

ABx and percutaneous cholecystectomy

56
Q

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?

A

Perforated viscous d/t PUD

Upright Xray of chest and ABD

57
Q

Nonseminomatous germ cell tumors have what tumor markers?

A

Elevated AFP and elevated b-HCG

58
Q

Pt w/extensive burns that develops an infection is most likely d/t what organisms?

A

G- Pseudomonas or Fungi

59
Q

Pt w/N/V, pneumobilia (air in biliary tree), hyperactive bowel sounds, and dilated loops of bowel has what?

A

Gallstone ileus

60
Q

needle thoracostomy should be placed where in tension pneumo?

if it fails go where?

A

2nd ICS midclavicular line

5th ICS midaxillary line

61
Q

Pt that presents w/N/V/ABD bloating and dilated loops of bowel on ABD xray has what?

MC d/t what in history?

A

Complete SBO

Adhesions from prior ABD surgery

62
Q

Pt w/UE sensory deficits (pain/temp) and weakness after a whiplash injury has what?

What is another common cause?

Best way to diagnose?

A

Syringomelia

Arnold Chiari

MRI

63
Q

What is psoas sign?

Indicates what?

A

RLQ pain w/extension of the right thigh

Abscess adjacent to psoas or retrocecal appendix

64
Q

Pt that has IE and cardiac valve vegetation is at risk of getting what ABD event?

A

Acute mesenteric ischemia d/t embolism

65
Q

What are the 4 T’s of anterior mediastinal masses?

A

Thymoma
Terrible lymphoma
Thyroid cancer
Teratoma

66
Q

Pt that has severe pain and parasthesia following a LE embolectomy just a few hours earlier most likely has what?

A

Compartment syndrome aka soft-tissue swelling

67
Q

Myocardial rupture after MVA indicates what?

A

Immediate DEATH

68
Q

What causes paradoxical respiration?

D/t what?

A

Flail chest

> 2 contiguous ribs fractures in 2 or more spots

69
Q

What is the MC cause of LE edema?

Classic symptoms?

A

Venous insufficiency (valve incompetence)

Worse throughout the day, resolves overnight

70
Q

What causes epidural hematoma anatomically?

A

Trauma to sphenoid bone —> tears MMA

71
Q

Child w/blunt trauma or MVA that has left lower lung opacity, elevated hemidiaphragm and mediastinal deviation have what?

Diagnose how?

A

Diaphragmatic rupture

CT chest and ABD

72
Q

Parotid surgery involves risk of injuring what?

Causing what?

A

Facial nerve

Facial droop

73
Q

Acute knee pain assoc w/catching or reduced range of motion suggests what?

Persistent symptoms should be evaluated how?

A

Meniscal injury

MRI

74
Q

Pneumomediastinum and subcutaneous emphysema after MVA indicates what?

A

Tracheobronchial rupture

75
Q

What is the most frequent cause of nosocomial bloodstream infection in pts w/intramuscular devices?

A

Coagulase-negative Staph (epidermidis)

76
Q

What is the management of a small spontaneous Pneumothorax?

What is the MC pt?

A

Oxygen and observation

Tall, thin man in early 20s

77
Q

Pelvic fractures cause what in men?

This includes what?

A

Posterior urethral injury

Membranous and prostatic urethra

78
Q

Gallstone pancreatitis presents how?

A

ALT > 150

79
Q

Prosthetic joint infection that occurs w/in the 1st three months is d/t what?

3-12 months?

After 12 months?

A

S aureus, pseudomonas

S epidermidis, propionibacterium, enterococcus

Hematogenous spread by distant infxn (uti)

80
Q

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?

A

Emphysematous cholecystitis

Emergent cholecystectomy

81
Q

Widened mediastinum and left-sided hemithorax after MVA indicates what?

A

Aortic rupture

UWorld Step 2 (17 decks)

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