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Kaplan step 2 qbank > surgery > Flashcards

surgery Flashcards

* remember clinical correlation

1
Q

history of intense epigastric pain and longstanding heavy alcohol with steatorrhea and diabetes are suspicious for …………

A

chronic pancreatitis

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2
Q

what do you see on plain film in acute pancreatitis

A

“colon cut-off sign” ( gaseous distension seen in proximal colon associated with narrowing of the splenic flexure)

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3
Q

what is the most accurate test for chronic pancreatitis?

A

secretin stimulation (90% specificity)

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4
Q

the best initial tests for chronic pancreatitis are …

A

abdominal x-ray film and abdominal CT scan

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5
Q

what is the appropriate treatment for symptomatic acute epidural hematoma?

A

craniotomy and burr hole hematoma evacuation

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6
Q

what is the correct course of action for acute epidural hematoma with stable neurologic exam and no ICP

A

observation with interval repeat of CT scan

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7
Q

what conservative measure can be done for a stable patient with epidural hematoma to reduce ICP?

A

hyperventilation on mechanical ventilation

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8
Q

in what way does follicular cancer usually metastasize

A

hematogenously

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9
Q

follicular cancer usually metastasize to the …., …., ……, or…..

A

liver, lung, brain or bone

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10
Q

what is the treatment of choice for follicular cancer?

A

total thyroidectomy and radioactive iodine therapy

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11
Q

when is iodine therapy ineffective and why?

A

if there is residual thyroid tissue as it will preferentially absorb the iodine.

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12
Q

for how long should the radioactive iodine therapy continue

A

until there is no further uptake noted

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13
Q

peripheral vascular injuries from a penetrating trauma are initially evaluated with ……………. ……………….

A

physical exam

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14
Q

a clear vascular injury should be……………

A

promptly explored

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15
Q

in a patient older than 50 years with the combination of red blood coating stool, change in bowel habits and stool caliber, there should be a high suspicion of …….. ……

A

rectal cancer

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16
Q

in a patient suspected of cancer of the rectum what is the diagnostic test after physical exam

A

endoscopic evaluation

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17
Q

what is fistula-in-ano

A

this is a chronic form of perianal abscess that is spontaneously or surgically drained but the abscess does not heal completely leading to partial tract epithelization .

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18
Q

a fistula-in-ano results as a complication of …………..or ………….. in the ………………..area

A

perirectal abscess or surgical procedures; anorectal area

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19
Q

how does fistula-in ano present?

A

constant drainage

on PE a small opening on the anus with granulation tissue and a fistulous tract is visible.

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20
Q

treatment of fistula-in-ano

A

fistulotomy

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21
Q

before treatment of fistula-in-ano , what do you rule out and how?

A

necrotic and draining anorectal malignancy via proctoscopy or sigmoidoscopy

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22
Q

a patient with history of mitral stenosis and an irregular pulse point towards a diagnosis of ……. ………………

A

atrial fibrillation

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23
Q

Atrial fibrillation is a common cause of ……………………… (GI)

A

mesenteric thromboembolism

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24
Q

abdominal tenderness with metabolic acidosis is highly concerning for …… ……

A

bowel necrosis

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25
Q

concern for bowel ischemia warrants what intervention?

A

surgical exploration

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26
Q

Graft-versus-host Disease presents with …… ……… ………….. ……………….

A

rash, jaundice, diarrhea, intestinal bleeding, death

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27
Q

graft-versus-host disease (GVHD) is mediated by ………..

A

donor T lymphocytes

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28
Q

the most severely affected organs in graft-versus-host disease are

A

the immune system, GIT, liver, skin and lungs

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29
Q

a frequent fatal complication in the acute stage of graft-versus-host disease is

A

CMV pneumonia

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30
Q

surgical resection of pituitary adenoma with dramatic increase in urine output and altered mental status is highly suggestive of ………………. caused by …………….

A

hypernatremia caused by central diabetes insipidus

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31
Q

central diabetes insipidus can be treated with

A

IVF hydration and desmopressin

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32
Q

Patient >60 years with h/o smoking, urinary obstruction (which can lead to hydronephrosis) and/or hematuria is highly suggestive of …………………

A

bladder cancer

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33
Q

what is the initial treatment of choice for severe hyponatremia (<110 mEq/L)? and rate shouldn’t exceed ………..

A

hypertonic 3% saline

0.5-1 mEq/L/hr

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34
Q

Cushing triad comprises of an is indication of?

A
  • bradycardia
  • hypertension
  • irregular respiratory patterns.
  • Increased Intracranial pressure (ICP)
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35
Q

mention six strategies that can be used to decrease ICP

A
  • raising the head of the bed
  • mechanical ventilation
  • sedation with propofol
  • hyperventilation (PaCO2 btw 30-35 mmHg)
  • administration of mannitol
  • surgical decompression with a burr hole or craniotomy
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36
Q

how do one distinguish ABO-compatible transfusion vs ABO-incompatible transfusion?

A

on basis of hematocrit. It is unchanged in the compatible one and decreased in the incompatible transfusion

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37
Q

the most common transfusion reaction is ………….

A

a febrile non-heamolytic transfusion reaction

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38
Q

what causes a febrile non-hemolytic transfusion in compatible donors?

A

the recipient antibodies targeting donor WBC

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39
Q

the most common cause of death by transfusion reaction due to

A

ABO incompatibility due to a clerical error

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40
Q

what is the most common complication of the ventriculo-peritoneal (VP) shunts? and how is it treated?

A
  • mechanical obstruction

- replacement of the device

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41
Q

visceral artery aneurysms most often involve the …………..

A

splenic artery

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42
Q

what is carpal tunnel syndrome?

A

It is an entrapment neuropathy of the median nerve as it passes through the carpal tunnel at the wrist

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43
Q

symptoms of carpal tunnel often begins with ………………. and ………..

A

paresthesia and numbness

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44
Q

when does symptoms of carpal tunnel syndrome get worse?

A

at night

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45
Q

what is the initial treatment of carpal tunnel syndrome?

A

splinting and anti-inflammatory agents

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46
Q

in the case of carpal tunnel syndrome, what can be done to rule other etiologies and confirm the diagnosis

A

wrist x-rays and electromyelography

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47
Q

risk factors for carpal tunnel syndrome?

A

DM, thyroid disease, occupation and pregnancy

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48
Q

what do you suspect when facing sudden dyspnea

A

pneumothorax

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49
Q

how is pneumotorax on chest radiograph identified

A

by lack of pulmonary markings

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50
Q

what are the most common causes of early functional deterioration following a liver transplantation

A

technical problems with biliary and vascular anastomoses

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51
Q

what happens following a liver transplantation if biliary and vascular anastomoses appear normal

A

appropriate liver biopsy to confirm diagnosis of organ rejection

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52
Q

abdominal pain and distention, nausea, constipation and dilated large bowel typically in post operative period is highly suggestive of

A

colonic pseudo-obstruction or Ogilvie syndrome

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53
Q

management of Ogilvie syndrome

A

mechanical or pharmacological decompression

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54
Q

in a patient with deep epigastric blunt tauma with elevated amylase and lipase levels, what type of injury will you suspect?

A

pancreatic injuries

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55
Q

what are the “hard” signs of vascular injury to an extremity?

A
  • active hemorrhage
  • expanding hematoma
  • absent pulse
  • bruit or thrills
  • distal ischemia
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56
Q

how are “hard” signs of vascular injury to an extremity managed?

A

immediate surgical exploration

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57
Q

what are the “soft” signs of vascular injury to an extremity

A
  • h/o hemorrhage at the scene
  • stable, non-expanding hematoma
  • proximity to a major vessel
  • anatomically related nerve deficit
  • ankle-brachial index <0.9
  • unequal pulses
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58
Q

how are “soft” signs of vascular injury to an extremity managed?

A

further evaluation of affected vessels e.g. CT angiography of the extremity

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59
Q

describe the onset of neurological symptoms in intracerebral hemorrhage

A

it is not abrupt and it progresses slowly

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60
Q

describe the onset of neurological symptom in intracerebellar hematoma

A

abrupt onset

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61
Q

mention some of the characteristics presented in cerebellar hemorrhage

A

inability to walk due to lose of balance, vomiting, headache, neck stiffness, gaze palsy and facial weakness

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62
Q

what kind of injuries are supracondylar fratures specifically prone to ?

A

brachial artery and median nerve damage

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63
Q

reversal of an elevated INR is best done with administration of ………

A

fresh frozen plasma

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64
Q

Progressive dysphagia from solids to liquids is ………. until proven otherwise.

A

Esophageal cancer

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65
Q

Smoking and drinking are strong risk factors for the development of ………… (GI)

A

Squamous cell carcinoma

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66
Q

Longstanding GERD and Barrett esophagus are associated with

A

Adenocarcinoma of the esophagus

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67
Q

Class 1 according to wound classification and the risk for infection is

A

Clean wound: 1-1.5%

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68
Q

Class 2 according to wound classification and the risk for infection is

A

Clean- contaminated (sterile environment but involves entry into the respiratory, GI or genitourinary system): 3-5%

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69
Q

what is the mainstay treatment for primary biliary cirrhosis

A

ursodeoxycholic acid

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70
Q

porcelain gallbladder (intramural calcification) is associated with high risk for progression to

A

gallbladder cancer

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71
Q

a prostate specific antigen (PSA) level of 4nm/ml with a palpable nodule on DRE should raise suspicion of ……………..

A

prostate cancer

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72
Q

the most effective method for early detection of prostate cancer is …………………….

A

the combined use of DRE and PSA level

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73
Q

what is the most appropriate step to rule out adenocarcinoma of the prostate?

A

transrectal ultrasound-guided biopsy

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74
Q

dyspnea on exertion, rales and jugular venous distension are all markers of

A

congestive heart failure

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75
Q

medical optimization of congestive heart failure includes medical therapy with

A

ACE-inhibitors, beta-blockers and diuretics

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76
Q

why is estrogen-progestin therapy beneficial in post menopausal women with primary hyperparathyroidism?

A

ability to reduce bone resorption, increase bone density and decrease serum calcium concentration

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77
Q

what is the first line therapy for erectile dysfunction (ED)?

A

phosphodiesterase inhibitors e.g sildenafil

78
Q

when are phosphodiesterase inhibitors contrandicated?

A

contraindicated with nitrate use

79
Q

what is the second-line therapy for erectile dysfunction?

A

vacuum device

80
Q

what is used as a last resort for ED patients who fail all other conventional therapy?

A

penile implant surgery

81
Q

Class 3 according to wound classification and the risk for infection is

A 
Contaminated wound ( there is gross spillage from respiratory, GI or genitourinary system, result of recent trauma or an outright violation of sterile techniques in the OR) 
10-15%
82
Q

Class 4 according to wound classification and the risk for infection is

A 
Dirty wound (result of trauma that contains devitalized tissue or is in the presence of established infection).
30-35%
83
Q

What are the criteria for proceeding with thoracotomy in a patient with chest trauma

A
  • recovering >20mL/kg on placement of the chest tube

- shock and persistent and substantial bleeding of > 3mL/kg/h

84
Q

What are the indications for intubation in a burn patient?

A
  • dyspnea
  • stridor
  • wheezing or coughing
  • hoarseness
  • burn or soot inside pt’s mouth or nose
85
Q

Nondisplaced fractures of the carpal navicular (scaphoid bone) are often not visualized on X-ray. True/False

A

True

86
Q

Management of nondisplaced fractures of the carpal navicular (scaphoid bone) includes

A

Thumb spica cast

87
Q

the most common cause of colovesical fistulas is …..

A

diverticulitis

88
Q

the most sensitive test for detecting a colovesical fistula is

A

contrast CT scan

89
Q

flank pain radiating to the groin or suprapubic region is highly suspicious of

A

nephrolitiasis

90
Q

what is the diagsnostic modality of nephrolithiasis?

A

plain x-ray after which CT scan without IV contrast

91
Q

why is there a higher incidence of calcium oxalate and uric acid nephrolithiasis in Crohn disease pt?

A

it is because of fat malabsorption and excess oxalate

92
Q

abdominal distention, obstipation and radiographic bowel distention is consistent with ………………….

A

a small bowel obstruction

93
Q

diagnosis of small bowel obstruction caused by adhesion is by …………..

A

CT scan

94
Q

management of all gunshot wound of the abdomen requires …………………..

A

exploratory lapatomy

95
Q

when is a gunshot wound considered to involve the abdomen?

A

below the nipples and above the pubic symphysis

96
Q

Meckler triad includes and is suggestive of ……

A
  • vomiting
  • chest pain
  • subcutaneous emphysema
  • boerhaave syndrome
97
Q

painless masses in the neck in an older patient are considered to be ………. until proven otherwise

A

cancer

98
Q

workup for diagnosis of an unknown cancer in the neck includes

A
  • direct visualization of the oropharynx with panendoscopy
  • Fine needle aspirate (FNA)
  • imaging with CT and/or MRI scan
99
Q

direct inguinal protrudes ……………

A

directly through the defect in the floor of the inguinal canal

100
Q

where is a direct hernia felt when an examiner’s finger is placed in the external inguinal ring?

A

the hernia is is felt along the lateral aspect of the examiner’s finger

101
Q

what produces indirect hernia

A

a defect in the deep inguinal ring

102
Q

what happens when an examiner’s finger is placed in the external inguinal ring?

A

the examiner feels the herniation on the tip of the finger

103
Q

drainage of pink or “salmon-colored” fluid following abdominal surgery is diagnostic for …………………..

A

fascial dehiscence

104
Q

pancreatic abscess typically occurs when and after what

A

10-14 days after the onset of acute pancreatitis

105
Q

how is the diagnosis of pancreatic abscess made?

A

CT scan

106
Q

how is pancreatic abscess managed?

A

management is percutaneous or surgical drainage

107
Q

tumors with evidence of metastasis require …………

A

chemotherapy

108
Q

what type of abscess responds to antimicrobial therapy

A

amebic abscess

109
Q

liver abscess caused by superinfection from the biliary tree are termed

A

pyogenic abscess

110
Q

what is the management of pyogenic liver abscess

A

drainage: percutaneous more favored over surgical drainage

111
Q

what do you do with potential sources of infection in relation to altered mental status

A

evaluate and treat

112
Q

in the elderly with a h/o frequent falls and rapid mental deterioration, what should one think of?

A

subdural hematoma

113
Q

what is pathognomonic for colovesical fistulas

A

pneumaturia

114
Q

what is the initial management of colovesical fistulas

A

NPO and IV antibiotics

115
Q

in a situation of pneumothorax and there is a large amount of air draining continuously through chest tube with failure of lungs to re-expand suspect ……….

A

bronchial tear

116
Q

epidural hematoma results from

A

tearing of the middle meningeal artery

117
Q

how is an amputated digit preserved

A

wrap the digit in moist gauze,
put it in a plastic bag and
place the bag on a bed of ice

118
Q

in preserving an amputated digit, the digit must be kept from drying out and must not be injured with any chemical agents. True/ False

A

True

119
Q

in the preservation of an amputated digit, the digit should be placed in direct contact with ice but must not be allowed to freeze. True/ false

A

False

120
Q

what is the fastest and least invasive management of an unstable patient with pelvic fracture?

A

external fixation

121
Q

charcot’s triad is characteristic for …….. and is consist of ……………………

A

cholangitis
RUQ pain
fever
jaundice

122
Q

what is the management that is both diagnostic and therapeutic for cholangitis

A

Endoscopic retrograde cholangiopancreatography (ERCP)

123
Q

what is recommended when foley urinary catheter cannot be placed in a pt with BPH?

A

bladder decompression with a suprapubic tube

124
Q

what is the number one cause of subarachnoid blood

A

trauma

125
Q

blowout fracture of the orbit is an ophthalmologic emergency. True/False

A

True

126
Q

what is the consequence of blowout fracture of the orbit?

A

inferior rectus entrapment and enophthalmos

127
Q

a patient that presents with rapidly progressive erythema and edema with pain and tenderness significantly out of proportion to the physical finding is highly suspicious of what?

A

necrotizing fasciitis

128
Q

necrotizing fasciitis is a surgical emergency. True/False

A

true

129
Q

aneurysms >5cm or with a rapid growth have a higher risk of ………….. and are recommended for ………….

A
  • rupture

- open or endovascular repair

130
Q

features seen in rupturing abdominal aortic aneurysm include:

A
  • severe, tearing back pain
  • h/o high bp
  • pulsatile abdominal mass
131
Q

describe the pain of bony metastasis

A

constant, dull,low-grade and worse at night

132
Q

describe the pain from a herniated disc

A

pain runs down the leg and is exacerbated by sneezing and coughing

133
Q

describe the pain from dissecting thoracic aortic aneurysm

A

excruciating back pain that starts retrosternally and migrates inferiorly

134
Q

what is the most common congenital cystic midline neck mass?

A

thyroglossal duct cyst

135
Q

how does thyroglossal duct cyst present?

A

a mobile nontender midline mass at the level of the thyroid cartilage and can fluctuate in size

136
Q

how is thyroglossal duct cyst managed?

A

surgical excision via the Sistrunk Procedure

137
Q

oral contraceptives increase the risk of hepatic adenoma. True/False

A

true

138
Q

actively bleeding adenomas present with

A

abdominal pain, hypotension, tahycardia and anemia

139
Q

what is the first-line for diagnosing osteomyelitis in the early post-operative period

A

bone scan

140
Q

clinical suspicion for a pancreatic head mass should be evaluated with

A

CT scan

141
Q

what is the locked-in syndrome?

A

this is the complete paralysis of voluntary muscles in all parts of the body except for those that control eye movement

142
Q

causes of locked-in syndrome

A
  • stroke in the base of the pons
  • traumatic brain injury
  • demyelinating diseases
143
Q

what neurological condition is associated with rapid correction of chronic hyponatremia

A

central pontine myelinolysis

144
Q

what is seen on MRI scan in central pontine myelinolysis?

A

white patches within the central basis of the pons

145
Q

what are the characteristic features o pericardial tamponade?

A
  • low blood pressure
  • distended neck veins (high CVP)
  • muffled heart sounds
146
Q

treatment for pericardial tamponade includes ……

A

a pericardial window or a pericardiocentesis

147
Q

what is essential in treating burn patients?

A

fluid resuscitation

148
Q

what are the first-line fluids used in resuscitation?

A

normal saline or ringer’s lactate

149
Q

isolated, acute meniscal tears are initially managed with

A

physical therapy and NSAIDs

150
Q

failure of conservative management or the presence of chronic symptoms warrants

A

surgical intervention with either arthroscopic partial meniscectomy or repair

151
Q

fever that starts approximately 10 to 15 days after a contaminated abdominal surgical procedure is most likely caused by a ……….

A

deep pelvic or subphrenic abscess

152
Q

how can pelvic abscess be ruled out ?

A

by rectal examination

153
Q

how can diagnosis of subphrenic abscess be confirmed?

A

CT scan

154
Q

what is the most undifferentiated form of germ cell tumor?

A

embryonal carcinoma

155
Q

describe the histologic features of embryonal carcinoma

A

sheets of undifferntiated cells with scant cytoplasm,
indistinct cell borders,
crowded nuclei,
numerous mitoses and necrosis

156
Q

embryonal carcinoma is aggressive with early metastasis. True/False

A

True

157
Q

serum alpha-fetoprotein level is elevated in embryonal carcinoma. true/false

A

true

158
Q

what is the tumor marker for seminoma?

A

placental alkaline phosphatase (PLAP)

159
Q

ischemic colitis is a known complication of AAA repair secondary to ……………….

A

occlusion of the inferior mesentric artery

160
Q

how is ischemic colitis diagnosed?

A

colonoscopy

161
Q

what is the management for ishemic colitis?

A

resection of the colon with a colostomy

162
Q

bariatric surgical procedures are indicated in the following conditions:

A
  • motivated patient
  • BMI >40kg/m2
  • BMI> 35kg/m2 with serious comorbidities
  • reasonable sugrical risk
  • failure of previous weight-loss regimens
163
Q

combination lidocaine with epinephrine should be avoided in areas prone to ischemia without redundant blood flow. True/ False

A

True

164
Q

a non-diagnostic FNA of a suspicious parotid mass is an indication for ………………………. to function as an excisional biopsy.

A

superficial parotidectomy

165
Q

what are the classic clinical symptoms of anal fissure

A

equisite pain and minimal bright red bleeding seen on toilet paper with defecation as well as pain with coughing and sitting

166
Q

On examination, 90% of fissures are seen at the …………………..

A

posterior midline, distal to the dentate line

167
Q

in trauma cases with significant volume infusion, what can be done prophylactically to prevent abdominal compartment syndrome?

A

leave the abdomen open with a negative pressure therapy system

168
Q

what is the management of abdominal compartment syndrome?

A
  • paralysis
  • GI decompression
  • decompressive laparotomy
169
Q

intraoperative development of coagulopathy during prolonged abdominal surgery for multiple trauma with multiple transfusions is treated empirically with …………….

A

platelet packs and fresh-frozen plasma

170
Q

what is the next step in management in a situation of coagulopathy, hypothermia and acidosis during a laparotomy?

A

pack the bleeding surfaces and close the abdomen temporarily with towel clips

171
Q

what is the typical presentation of femoral fractures?

A

hip pain and limited range of motion often abduction and external rotation and sometimes limb shortening

172
Q

how is femoral fracture diagnosed?

A

plain x-ray films

173
Q

what is the definitive treatment of femoral fracture

A

surgical fixation

174
Q

what management is indicated in a situation of intrinsic cardiogenic shock?

A

Inotropic drugs like dobutamine and milrinone

175
Q

what are the presenting symptoms of papillary muscle rupture?

A

pansystolic murmur radiating to the axilla, sudden drop in blood pressure and acute heart failure

176
Q

what is the management of acute papillary muscle rupture?

A

emergent surgical intervention

177
Q

In a patient whose symptoms of GERD are not resolved with medical therapy if is unable to tolerate medical therapy, what is the best step in management?

A

Nissen fundoplication

178
Q

What is the best next step in a stable child with a femur fracture

A

Skeletal survey

179
Q

What is a common complication of pancreatitis which is often the cause of death?

A

Pancreatic abscess

180
Q

Large volume fluid and blood product resuscitation in trauma cases requires ……..……… catheter namely……….. which varies from ……to …… gauge.

A

Larger-bore catheter
Introducer
10 to 16 gauge

181
Q

If IV access cannot be obtained, ………….. can be performed.

A

Intraosseous cannulation

182
Q

Examples of inhaled corticosteroids

A
  • Fluticaeone
  • Budesonide
  • Mometasone
  • Beclomethasone
  • Ciclesonide
183
Q

The signature of septic shock in the normovolemic patient is ……. cardiac output and ………..

A

High cardiac output and low peripheral resistance

184
Q

The signature of hypovolemic shock is …….. cardiac output and ……..central venous pressure

A

Low

Low

185
Q

The signature of neurogenic shock is ……. cardiac output and ………CVP with ……

A

Low
Low
High spinal cord transection

186
Q

The signature of cardiogenic shock is …….. cardiac output and ………CVP

A

Low

High

187
Q

Signs and symptoms of alcohol withdrawal delirium (6)

A
  • autonomic hyperreactivity
  • perceptual disturbances
  • diaphoresis
  • agitation
  • hyperreflexia
  • seizures
188
Q

What is the treatment of choice for alcohol withdrawal delirium?

A

Benzodiazepines such as lorazepam

189
Q

………….. presents with abdominal distention, obstipation, vomiting, and hyperactive bowel sounds

A

Small bowel obstructions

190
Q

The most common cause of bowel obstruction is ……….. from a ……..

A
  • adhesion

- previous surgery

191
Q

The most common cause of small bowel obstruction in a patient with no history of previous surgery is ……….

A

Hernia

Kaplan step 2 qbank (5 decks)

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