Surgery Flashcards
1
Q
what’s the most common fracture of the wrist
A
scaphoid
2
Q
risk in scaphoid fracture
A
avascular necrosis
3
Q
work for scaphoid fracture
A
plain xrays
4
Q
particularity of plain xrays in scsphoid fracture(2)
A
can be normal
needs 10 days to show abnormalities
5
Q
negative xray in susoect scaphoide fracture next step?(2)
A
thumb spica
xray in 10 days
6
Q
clue for scaphoid scaphoid fracture
A
pain in anatomic snuffbox
7
Q
cause of dermatitis in lower legs
A
venous stasis
venous hypertension
8
Q
physio patho of venous satsis
A
vein insufficiency
9
Q
minor traumatic brain injury next step
A
glasgow 15
discharge
10
Q
management of mild TBI
A
glasgow 13-15 and vomiting’
discharge and sent home under surveillance
if normal ct
11
Q
Management of moderate TBI
A
glasgow 9-12
sednt home under surveillance if normal CT
12
Q
management of severe TBI
A
glasgow < ou egal a 8
CT scan and observation
13
Q
cause of hematochezia(5)
A
diverticulosis angiodysplasia ischemia infectious neoplasm
14
Q
first thing to di if you suspect lower GI bleeding
A
nasogastric tube
15
Q
you suspect lower GI bleeding nasogastric tube has no blood next step
A
colonoscopy
16
Q
in case of diverticulosis if colonoscopy is negative in a setting of hematochezia next step(2)
A
erythrocye scyntigraphy
or
angiography
17
Q
technique to perfrom scintigraphy
A
technetium 99 labeled erytrocyte scynctigraphy
18
Q
quid of lower GI bleeding
A
bhelow treitz ligament
19
Q
patient with AFIB with abdominal pain and heme positive stools
A
bowel infarction
20
Q
most common cause of acute mesenteric ischemia
A
embolus from the heart
21
Q
quid of trendelenburg sign
A
drooping of controlateral pelvis occuring when the patient is standing
22
Q
cause of trendelenburg sign(2)
A
gluteus medius muscle weakness
gluteus minus muscle
23
Q
in case of gluteus medius mx weakness where is located the pain
A
in the knee
24
Q
abdominal pain and bloody diarrhea following abdominal aortic aneurism repair
A
bowel ischemia
25
what to do to prevent bowel ischemia during aortic aneurism rapair surgery
check sigmoid perfusion following the placement of aortic graft
26
quid lugwig angina
cellulitis of submandibular and sublingual spaces
27
clinical clue for lugwig angina(3)
dysphagia
drooling
crepitus of submandibular area
28
most common cause of death in ludwig angina
asphyxia
29
what cause ludwig angina
infection in 2 et 3 e mandibular molar
30
rx of ludwig angina(2)
remove the infected teeth
| antibiotics
31
led edema worst when the leg is dependent and improves with leg elevation
venous valve incompetence
32
could varice be unilateral
yes can be unilateral
33
pulastile mass in the groin
femoral artery aneurism
34
the most common peripheral aneurism
popliteal aneurism
35
what to do in front of peripheral aneurism
check abdominal aneurism
36
RLQ pain plus positive psoas sign
psoas abcess
37
scaphoid fracture management
plain xray
38
plain xray in scaphoid fracture
radioluscent line across the wrist
39
management of scaphoid fracture
wrist immobilization for 6-10 weeks
40
what to do if you suspect scaphoid fracture with negative Xray(2)
immobilize wrist
| repeat xray in 7-10 jours
41
why immobilization in suspect scaphoid fracture
because of the risk of non union
42
management of spinal cord injury(4)
stabilize cervical spine
stabilize airway
hemodynamic stabilization
urine catheter in place
43
mechanism of spinal cord injury in traumatic patient
compression
contusion
shear injury
spinal cord edema leadig to hemorragic central necrosis
44
important step in teh management of spinal cord injury
bladder catherization
45
patient presenting whistling noise after rhinoplasty
nasal septal perforation
46
cause of septal of nasal septal perforation(6)
```
self inflicted trauma during picking nose
syphilis
TB
intranasal cocaine use
sarcoidosis
wegener(granulomatosis with polyangitis)
```
47
what cause the perforation in the case of rhinoplasty
septal hematoma
48
pale and cold arm after closed reduction of humerus fracture what complication you can have in the future
volkman contracture
49
rx of compartment syndrome
immediate fasciotomy
50
widened mediatinum in patient taking KCL pills
perforation esophagienne compliquee de mediastinitis
51
quid of hamman sign
crunching sound in the haert due to emphysema in esophageal perforation
52
confirmatory test in esophageal perforation
esophagography with water soluble contrast
53
cause of esophageal perforation(6)
```
trauma
pills esophagitis
Barret
caustic substance ingestion
infection a candida
Boherhave syndrome
```
54
clue for esophageal perforation
emphysema
55
patient presents with free peritoneal fluid the most likely finding during laparotomy
splenic laceration
56
traumatic injuric most common cause of intraabdominal hemorrage(3)
1-spleen 60%
kidney
liver
57
patient with dyspnea petechiae after tibial fracture dx
fat embolism
58
confirmatory DX of fat embolism(2)
fat droplets in urine
| presence of intra arterial fat globule on fondoscopy
59
rx of fat embolism
respiratory support
60
after trauma patient present with only upper extremities weakness
central cord syndrome
61
mechanism trauma causing central cord syndrome(2)
hyperextension injury
| degenerative cervical changes in spine
62
what position of spine is reached in central cord syndrome
central position of anterior spinal cord
63
clue for central cord syndrome
weakness more prononced in upper extremities than in lower extremities
64
why pain and temperature problem in central cord syndrome
damage of spino thalamic tract
65
what to do if you suspect cervical spinal cord injury
orotracheal intubation
66
when to suspect cervical spine
any patient with trauma with maxillofacial and neck edema
67
patient with unRX appendicitis develops ten days later tender boggy fluctuant mass in rectal examination DX (2)
perforated appendix with fluid in rectovesical pouch
| it's a pelvic abscess formation
68
complication of ruptured appencitis
pelvic abcess
69
patietn develops pain and paresthesis below right elbow after full thickness burn Dx
compartment syndrome
70
rx for compartemnt syndrome induced by burne
escharotomy to relieve constriction
71
dx of compartment syndrome
doppler ultrasonography
72
what pressure during Dopler should mandate escharotomy
25-40 mm de Hg
73
if escharotomy fails next step in Rx compartment syndrome induced by burn
fasciotomy
74
child 5-7 ans with hip pain xray shows flatenned ofr fragmented left femoral head dx?
idiopathic avascular necrosis
| or Legg calve perthes diseae
75
classic presentation of slipped femoral capital epiphysis
obese children with complaint of pain hip
76
clue for slipped femoral capital epiphysis
capital femoral epiphysis remains intact within the acetabulum
77
risk in patient with pelvic frasture
posterior uretral injury
78
clue post uretral injury(5)
```
blood at urertral meatus
high riding prostate
scrotal hematoma
inability to void
palpable distended bladder
```
79
cause of anterior uretral injury(3)
perineal tenderness
or perineal hematoma
no inability to void
80
why patient with post uretral injury can develop sepsis
because of risk of extravasation of urine in the scrotum peritonerum and abdominal wall
81
quid of anterior uretra
uretra distal to urogenital diaphragm
82
quid of post uretra
prostatic and membranous uretra
83
patient with eschar on the chest , consequence of that
respiratory failure
84
patient with hip pain and elevated ALP
paget
85
complication of Paget
hearing loss
86
athlete or military recruit with foot pain
stress fracture
87
rx of stress fracture
rest and pain control
88
the most common metatara involved in stress fracture
the second
89
management of 2e 3e 4e metatarsal fracture (2)
conservatively
| or hard soled shoe
90
patients present with epigastric pain and vomiting after trauma
duodenal hematoma
91
why the duodenal hematoma is formed
collection of blood between submucosal and muscular layer
92
mamagement of duodenal hematoma(2)
nasogastric tube
| and parenteral nutrition
93
after an accident patient developsn decreased breath sounds after chest tube placement patient stilll has air in pleural space and pneumodiastinum Dx
bronchial rupture
94
dx of bronchial rupture
ct of the chest
95
after an accident patient develops subcutaneos emphysema and pneumomediastinum
tracheobronchial rupture
96
after catherisation patient develops bacvk pain and hypotension dx
retroperitoneal hematoma
97
dx of retroperitoneral pain
ct scan of abdomen
98
major complication of heart catheterization(3)
MI
stroke
death
99
minor complication of cardiac catheterization(7)
```
hemostasis at access site
hematoma formation
AV fistula
pseudo aneurism
arterial thrombosis
perforation
contrast allergy
```
100
the most common cause of death in brain injury
diffuse axonal injury
101
ct scan of diffuse axonal injury
numerous punctuate hemorrage at gray white matter junction with blurring of gray white interface
102
hydrocele in newborn infant(2)
reassurance
| observation
103
time limit for hydrocele to resove in children
12 months
104
why hydrocele should be remove if persistance after 12 months
because of risk of inguinal hernia
105
why the left Diapphragm is more susceptilble of trauma than the right
protective reffect of the liver
106
best test to Dx ruptured diaphragm
CT of chest and abdomen
107
cause of diaphragm rupture
vehicle accident
108
xray in diaphragm rupture(2)
shifting of mediastinum to the right
| left lower lung opacity with obscure left hemidiaphragm
109
first step after central line placement
portable chest xray
110
why portable chest xray after central line placement
to rule out complications
111
complications of central line placement(6)
```
arterial puncture
pneumothorax
hemothorax
thrombosis
air embolism
sepsis
vascular perforation
MI leading to tamponade
```
112
before you administer drugs in central line placement next step
chest xray
113
clue for fat necrosis of breast
breast mass with biopsy revealing foamy macrophages with fat globules
114
cause of fat necrosis of breast(2)
breast trauma
| surgery
115
characteristics of breast calcification in breast cancer
microcalcification
116
characteristics of breast calcification in fat breast necrosis
coarse calcifivcation
117
rx of fat breast necrosis
no rx
118
patient with marked limitation of extension of the wrist following a midshaft humerus fracture
radial nerve injury
119
patient with lupus develops hypotension hyponatremia
adrenal crisis
120
why lupus is important in this vignette
association entre lupus and prednisone intake
121
condition predisposing fro adrenal crisis
prednisosne >/ a 20 mg par jour pendant 3 semaines
122
clue for cushing features(4)
buffalo hump
central obesity
moon facies
weight gain
123
what happens to patient taking prednisone
risk for hypothalamic pituitary adrenal axis suppression(HPA)
124
if you suspect HPA suppresion during surgery what to give in term of medication
ETOMIDATE
125
patient with LLQ pain older with prior dx of diverticulitis develops perisigmoid fluid collection dx?
perisigmoid abcess
126
rx of perisigmoid abcess
percutaneous drainage
127
complication of diverticulitis(4)
abcess
perforation
0bstruction
fistula formation
128
first step in front of clavicular fracture(2)
angiogram
| neurovascular exam
129
why in front of clavicular fracture angiogram and neurovascular exam are mandatory
because of proximity of subclavian artery and plexus brachial
130
patient with clavicle fracture presents loud bruit during auscultation beneath the clavicle
rapidly ask angiogram
131
clue for anterior cruciate ligament tear ACL(3)
popping sensation
followed by rapid hemarthrosis
instability in bearing weight on the affected side
132
dx of ACL tear
MRI
133
physical exam finding in ACL tear
laxity of anterior motion of tibia relative to femur
134
knee pain with valgus stress test positive
medial collateral ligament tear(MCL)
135
the most common ligament involved in knee trauma
MCL
136
best dx test for ligament tear of knee
MRI of knee joint
137
rx of MCL tear(2)
bracing
| early ambulation
138
origin of torus mandibularis/palatinus
congenital
139
hard palate mass with bony hard consistence
torus mandibularis or palatinus
140
when to operate torus
when the mass interferes with eating or speaking
141
patient presenting with with crepitus in suprasternal notchafter effort of vomiting
esophagus perforation Known as boherhave syndrome
142
condition to have boherhave syndrome
when the patient is resisting the urge to vomit
143
complication of Boherhave
pneumomediastinum
144
meniscal injury
Knee pain
| popping sensation under the examination fingers
145
work up of meniscal injury
MRI
146
rx of meniscal injury
surgery
147
worsening substernal chest pain and mild shortness of breath after endoscipy
esophageal rupture
148
next step if you suspect esophageal rupture
esophagoghraphy with water soluble contrast substance
149
common chest xray finding in in esophageal rupture(3)
left pleural effusion
pneumomediastinum
pneumothorax
150
test of choice to Dx esophageal rupture
esophagoghraphy with water soluble contrast substance
151
after surgery patient develops fever cloudy grey discharge and dusky friable subcutaneous tissue
decreased sensation on the edges of the woung dx?
necrotizing surgical infection
152
rx of necrotizing surgical infection
urgent surgical exploration
153
risk factor for necrotizing surgical infection
diabetics
154
cause of medial meniscus injury
twisting of the knee with fixed foot
155
clue for meniscal injury(2)
popping sensation
| no effusion following the injury
156
why no effusion in meniscal tear
meniscus are not perfused
157
quid of murray sign
audible snap during slowly extending the leg at the knee from full extension while simultaneously applying tibial torsion
158
why the knee is locked at terminal extension in Murray sign
bucket handle tear
159
patient presenting one arm weakness after clonic tonic seizures
posterior shoulder dislocation
160
clue for posterior shoulder dislocation(2)
inability to externally rotate the right arm
or
arm is adducted and internally rotate
161
what cause the dislocation of shoulder during seizure
violent muscle contraction during tonic clonic seizure
162
popping sensation at the knee and knee swelling occuring 12-24 h later
meniscal tear
163
clue for ligamentous tear(2)
after the trauma immediate effusion
| popping sensation
164
indicator in glasgow(3)
eye opening
speech
motor response
165
motor response
```
0bey =6
localizes pain=5
withdrawal=4
decortication=3
decerebration=2
no mvt =1
```
166
which is worst decortication or decerebration
decerebration
167
decerebration(3)
extension
3 E
you got 3 in glasgow
168
back pain plus hypotension plus syncope
ruptured AAA
169
physiopatho of hematuria in AAA rupture
blood in retroperitoneum creates aorto caval fistula leading to venous congestion in tretroperitoneal structure (bladder)
fragile the bladder can dbe distended and rupture
170
one YO patient comes with lesion of epidermolysis first thing to do
admit the patient and do a skeletal suvey
171
3 steps to tkae if you suspect child abuse(4)
physical examination
skeletal survey
report to care to child protective services
admit the patient
172
patient with brain trauma simple measur eto decrease high ICP(4)
head elevation
or sedation
or IV mannitol
hyperventilation
173
eye mvt in glasgow(4)
open spontanously=4
open a la demande=3
open with pain stimulation=2
closed eyes =1
174
speech in glasgow(5)
```
oriente=5
confuse=4
inapropppriate words=3
whisper incomprehensive words=2
say nothing=1
```
175
how elevation helps in decreasing high ICP
by decreasing venous flow from the head
176
how sedation helps in decreasing high ICP
by decreasing the metabolic demand
| control of the hypertension
177
how iv mannitol helps in decreasing high ICP
extraction of free water out the brain tissue causing osmotic diuresis
178
how hyperventilation helps in decreasing high ICP
allowing co2 wash out leading to cerebral vasoconstriction
179
appropriate next step in penile fracture(2)
retrograd uretrogram
plus
surgical exploration
180
risk factor for penile fracture
woman on top of the man during sexual intercourse
181
pain of Mac Burney(1)
RLQ pain
182
rovsing sign
palpation of LLQ causes pain in RLQ
183
Dx of appendicitis(3)
it's clinic
if all the symptoms are present no image needed
surgery tet dwat
184
when asking sono or CT for appendicitis
whrn the typical features are absent
185
physiopatho of ombilical pain in appendicitis
it's visceral pain
186
physiopatho of RLQ pain in appendicitis(2)
it's somatic
| irritation locale of parietal peritoneum
187
dx differentiel of appendicitis(3)
diverticulitis
ileitis
IBD
188
subluxation of radial head in kid cause(2)
risky behavior
| lifting the child with with child's forearm
189
management of subluxation of radial head in kid
gentle passive elbow flexion and forearm supination
190
maneuver to reduce radial head subluxation(3)
extend the elbow and distract it
supinate the forearm
hyperflex the elbow with your thumb over the radial head in order to feel the reduction
191
patient with head trauma lost consciousness and has lucid interval followed by progressive deteriorationof consciousness DX?
epidural hematoma
192
dilated pupil in epidural hematoma why?
oculomotor compression in the side of the lesion
193
ct of epidural hematoma
biconvex hematoma
194
rx of epidural hematoma
emergent craniotomy
195
burn injury becoming chronically drained and painfull
SCC
196
condition favorising SCC(3)
skin over chronic osteomyelitis
radiotherapy scars
venous ulcers
197
all chronic wound with failure to heal next step?
biopsy
198
SCC from burn woung
marjolin ulcer
199
cause of paralytic ileus(3)
abdominal surgery
| retroperitoneal hemorrage associated with vertebral fractures
200
radio of ileus paralytic(2)
air fluid levels
| distended fas filled loops
201
history clinical of retroperitoneal hemorrage(2)
history of falling back
| vertebral fracture
202
first thing to do if you suspect post yretral injury
retrograde uretrogram
203
what to not to if uretral injury is suspected
foley catheterization
204
why to not use foley catheterization if uretral injury is suspected
risk of abcess formation
| worsen of uretral damage
205
why can you have atelectasia and pneumonia in rib fracture
hypoventilation
206
goal in rib fracture
ensure appropriate analgesia
207
patient hemodynamically unstable with sharp penetrating abdominal trauma and gunshot wound next step
exploratory laparotomy
208
why you should act emergently on unstable blunt abdominal trauma(2)
to prevent sepsis
| to repair bleeding organ
209
patient begins to develop shortness of breath after placement of central venous catheter in the right subclavian vein dx
tension pneumothorax
210
rx of tension pneumothorax induced by placement of central venous catheter
needle thoracostomy
211
unstable patient after blunt ntrauma abdomen what to do
1-Fast
212
quid of fast
focused assessment with sono for trauma
213
Fast shows blood in the peritoneum next step
laparotomy
214
if fast is not available what to do in any patient with unstable blunt trauma
laparotomy
215
patient with blunt trauma with low TA first step
2 IV lines placement
216
Patient with blunt trauma TA stable FAST shows blood in spleno renal angle next step
CT of abdomen
217
blunt trauma abdominal in a patient unstable and fails to respond to hydration next step
Laparotomy
218
blunt trauma abdominal in a patient with low TA after rehydration SBP> ou egal a 100 mm de HG next step
CT is the best next step
219
what to do if perform splenectomy for a patient
immunization against encapsulated bacteria
220
patient with gastrectomy develops digestive symptoms 20-30 mn after eating:cramps,weakness,diaphoresis,light headedness Dx?
Dumping syndrome
221
physio patho of dumping syndrome
rapid emptying of gastric content into duodenum and small intestine
222
first thing to do in dumping syndrome(2)
dietary changes
| small and frequent diet
223
second thing to do in dumping syndrome
octreoctide if failure of dietary changes
224
what to in refractory case of dumping syndrome
reconstructive surgery
225
clue for co poisonning(3)
wheezing
confusion
seizure
226
confirmatory dx of carbon monoxyde poisonning(2)
carboxyhemoglobin level >3% in non smoker
| > 15% in smoker
227
Rx of carbon monoxyde poisonning
100% face mask oxygen
228
Rx of carbon monoxyde poisonning 100% face mask oxygen failure
hyperbaric oxygen
229
most commonly affected part of the colon following procedures on aortoilliac vessels
distal left colon
230
which procedure on artery can cause problem in colon
AAA procedure
231
what causes distal left colon ischemia during AAA procedure
prolonged clamping and impaired blood flow through the < mesenteric artery
232
Patient presents with enlarged breast with edema and erythema dx
inflammatory breasst carcinoma
233
pathognomonic sign of breast ca
scant bloody discharge in nipple
234
first step in breast ca
biopsy
235
patietn presents severe abdominal pain with hypotension suddenly
rupture of AAA
236
next step in AAA rupture(2)
bedside U/S
| surgery
237
rarely patient with AAA rupture is stable next step
CT of abdomen
238
the first cause of acute biliairy pancreatitis
gallstones
239
other causes of acute pancreatitis(3)
alcohol
post ERCP
hypertriglyceridemia
240
clue for acute biliairy pancreatitis(4)
epigastric pain
high lipase
high ALP
high alanine amino transferase
241
first thing to to in acute biliary pancreatitis
right upper quadrant U/S
242
what to do in acute biliairy pancreatitis(2)
rx pancreatitis
| schedule cholecystestomy
243
clue for tension pneumothorax(3)
trachea deviated to the left
decreased breath sound on the right
neck veins distended bilaterally
244
rx of tension pneumothorax
needle thoracostomy
245
where to place the needles in needle thoracostomy
between first and second ribs
246
dx of needle thoracostomy(2)
it's clinic
| no image needed to make decision
247
patient with epigastric pain develops pneumoperitoneum dx?
viscus organ perforation
248
clue for viscus organ perforation
air blelow hemicoupole diaphragm in the right
249
penetrating abdominal trauma in unstable patient
surgery
250
patient with distal humerus fracture develops pain and paresthesia of fingers after close reduction dx
compartment syndrome
251
longterm complication of compartment syndrome
volkman ischemis contracture
252
most common fracture involved in compartment syndrome
supracondylar fractures
253
mechanism of volkman ischemis contracture
dead muscle is replaced by fibrous tissue
254
clue for splenic injury in a context of blunt abdominal trauma
epigastric or LUQ pain
| shoulder pain in the left
255
quid of Kehr sign
shoulder pain in the left in a context of splenic injury
256
patient with blunt trauma abdomen develops later epigastric pain and hypotension
splenic injury with delayed onset
257
patient with blunt trauma abdomen develops later epigastric pain and hypotension in the USMLE next step
laparotomy
258
dx of splenic injury
CT of abdomen only in stable patient
259
dancer presenting with shin pain ,right leg and normal xray dx?
stress fracture
260
activities linked with stress fracture(2)
athletes
| military recruits
261
zone of tibia invoved in stress fracture
distal third of tibia
262
cause of foot ulcer in diabetics
peripheral neuropathy
263
charcot joint
deformed foot seen in diabetics
264
3 main factors in diabetic foot in diabetics
1-Neuropathy causes painless trauma
2-Microvx insuffciency causes poor wound healing
3-immunosuppression causes infection
265
localisation of ulcer in diabetics foot and why
first metatarsal bone the head
| zone of greater pressure
266
patient in ICU for brain trauma develops epigastric pain
cholecystitis
267
risk for cholecustitis(6)
```
hospitalizsed patient
severe trauma
multiorgan failure
prolonged parenteral diet
sepsis
burn
```
268
physiopatho of cholecystitis in hosptialized patient(2)
cholestasis
| gallbladder ischemia
269
patient in ICU for brain trauma develops cholecystitis next step(2)
percutaneous cholecystostomy
| cholecystectomy after stablization
270
clue for cholecystitis in hosptialized patient
pericholecystic fluid in U/S
271
patietn develops falccid paralysis after AAA repair
spinal cord ischemia
272
the most common cause of spinal cord ischemia or infarct
surgery to repair thoracic or thoracoabdominal aneurism
273
what artery is reached in cord ischemia following AAA repair
adamchiewics artery
274
quid of adamchiewics artery
it arises from the aorta
| feed the anterior spinal artery in the T9-T12 level
275
vessel feeding the spinal cord(2)
anterior spinal artery ASA
| two post spinal arteries PSA
276
origin of ASA and PSA
vertebral artery
277
artery feeding ASA(3)
radicular artery from
vertebral artery
intercostal arteries
aorta
278
why during cord ischemia after AAA surgery,proprioception and vibration are preserved
post circulation are preserved
279
other finding in cord ischemia after AAA surgery(2)
bowel
| bladder dysfunction
280
first indicator of hypovolemia
pulse rate
281
after a fall patient develops paraplegia with loss of pain and T. in both legs
anterior cord syndrome
282
condition to have anteriod cord syndrome
burst fracture
283
clue for anterior cord syndrome(2)
motor problem below the level of lesion with loss of pain and T on both sides below the lesion
proprioception is intact
284
best test to DX anterior cord syndrome
MRI
285
after an accident patient presents with sensory problem over the medial side of the right lower thigh and leg what's nerve is involved
femoral nerve
286
motor role of femoral nerve(2)
hip flexion
| knee extension
287
sensory role of femoral nerve(2)
anterior thigh
| medial leg via saphenous branch
288
quid of leg flexion at the hip
hip flexion
289
quid of leg extension at the knee
knee extension
290
stress fracture tetrad(4)
female
amenorrhea
osteoporosis
poor eating habit
291
dx differentiel in in painful sore foot (4)
stress fracture
arthritis
bursitis
mortin neuroma
292
clue for stress fracture(2)
sharp and localised pain over bony surface
| worse with palpation of taht area
293
clue for arthritis
all the metatarsal joints are involved
294
clue for Morton neuroma
pain in 3e et 4 e toe on plantar surface with clicking sensation
295
clue for mulder sign
when simultaneously palpate space of 3e and 4e and squeezing the metatarsal joints, you have a clicking sensation
296
risk of foot bursitis
poor fitting shoes during extended period leading to inflammation of the metatarsal heads
297
quid of trochanteric bursitis(2)
patient with hip pain when pressure is applied when sleeping on the affected side
pain with external rotation or resisted abduction
298
dx differentiel of unilateral pain(5)
```
infection
trauma
arthritis
bursitis
radiculopathy
```
299
after CABG patient develops small cloudy fluid in the sternal wound drain and widened mediastinum next step(2)
surgical debridement and drainage
| antibiotherapy
300
after CABG patient develops small cloudy fluid in the sternal wound drain and widened mediastinum dx
post op mediastinitis
301
risk for mediastinitis
any sternotomies
302
patient with RLQ pain and absent bowel sounds present with normal WBC and urine sediment:15 rbc par HPf
examination shows needle shape crystals
kidney stones with paralytic ileus
303
best test to DX kidney stones
CT of abdomen
304
why ct abdomen is the best test now to Diagnose kidney stones
to see radioluscent stones
| to ruleout appendix abcess
305
rx of stone < 0,6 mm
may pass with
liquid
analgesia
306
best way to evaluate acid uric stone (2)
abdomen CT
or
IV pyelography
307
breast mass work up in woman < 30 ans
U/S
308
breast mass work up in woman > 30 ans(2)
U/S +
| mammo
309
patient < 30 ans with simple cyst a U/S
needle aspiration
310
patient < 30 ans with complex mass cyst in U/S next step
image guided biopsy
311
woman of > 30 ans with suspiscion of malignancy in U/s and mammo next step
core biopsy
312
quid of diverticulosis
mucosa and muscularis mucosa herniation through bowell wall
313
why bleeding in diverticula
diverticula can erode penetrating artery
314
most common site of diverticulosis
sigmoid
315
dx of diverticulosis(2)
CT abdomen
or
fluoroscopy
316
what to suspect in any appendix perforation
abcess formation
317
clue for appendix perforation and abcess formation
longer duration of symptom more than 5 jours
318
meaning of psoas sign (2)
retrocaecal appendix
| abcess adjacent to psoas
319
quid of psoas sign
extension of hip against resistance elicits abdominal pain
| RLQ pain with extension of right thigh
320
appendix abcess in stable patient(4)
rehydration
antibiotherapy
bowel rest and drainage
surgery in 6-8 weeeks---->appendectomy
321
obturator sign
RLQ pain with internal rotation of right thigh
322
meaning of obturator sign(2)
pelvic appendix
or
pelvic abcess
323
rovsign sign
pressure in LLQ elicits pain in RLQ
324
meaning of rovsign sign(2)
pelvic appendicitis
| pelvic abcess
325
2 types of femoral neck fractures(2)
intracapsular
| extracapsular
326
risk of avx necrosis
intracapsular fracture of femoral neck
327
older patient during a fall develops neck femoral fracture what's the next step) and why(5)
```
EKG
cardiac marker
chest Xray
raison:bilan cardio pulmonaire pre op
rule out a cardiac syncope responsable for the fracture
```
328
when the surgery will take place for the neck femoral fracture
delay surgery up to 72 h to evaluate heart and lung
329
older patient with femoral neck fracture why don't you pick crystalloid in vignette
because intracapsular fracture has low risk of bleeding and hypotension
330
amputation injury next step(2)
place the amputed finger in saline moistured gauze in a plastic bag
place the bag on a bed of ice and bring it along with the patient to the emergency department
331
clinical indication of thermal injury of the upper respiratory airway(8)
```
burn of the face
singing of eyebrows
oropharyngeal inflammation or blistering
oropharyngeal carbon deposits
carboneceous sputum
stridor
carboxyhb>10%
history of confinement in burning building
```
332
what to do if you have one indicator of thermal injury of upper respiratory airway
early intubation to prevent upper airway obstruction by edema
333
patient on endotracheal intubation with mechanical ventilation has a rate of c02 produced to the rate of 02 uptake of 1,05 why
carbon dioxyde excess in the diet
334
quid of respiratory quotient close 1.0
predominant oxydation of carbohydrates and net lipogenesis
335
respiratory quotient for protein
o,8
336
respiratory quotient for lipid
0.7
337
after accident patient develops hypotension ,flat veins neck tachycardia and cold extremities despite of IV fluid resuscitation why
hypovolemic shock
338
pulmonary post op complication in the first 24 h after surgery
atelectasia
339
why atelectasia in post op(3)
narcotic use in decreases the respiratory drive
anesthetics agent decreases mucociliary clearance
pickwikian like syndrome
340
cause of pickwikian like syndrome
patient is kept supine after surgery
341
what can be done to increase functionnal residual capacity FRC after surgery(4)
chest physiotherapy
incentice spirometry
coughing and frequent positionning
early ambulation
342
simple measure to increase the FRC de 20 a 35%
elevation of the head of the bed
343
patietn develops shortness of breath and chest pain after motor vehicle accident ,xray shows alveolar opacity dx?
pulmonary contusion
344
clue for pulmonary contusion
when you rehydrate these patients PO2 decreases
345
clue for flail chest(2)
inward motion of the right side ot the chest during respiration
also called paradoxical motion
346
rx of flail chest
positive pressure mechanical ventilation
347
clue for post op atelectasia(2)
hyperventilation
| dense opactity in chest xray
348
gas sanguin in atelectasis(3)
hypoxie
hypocapnie
respiratory alkalosis
349
critical period for post op atelectasis
2 e jor post op a 5 e jour
350
rx preventive of post op atelectasis(4)
incentive spirometry
deep breathing exercices
epidural anesthesia instead of opiod
comtinuous positive airway pressure
351
pulmonary post op complications(4)
atelectasis plus infection
bronchospasm
exacerbation of COPD
prolonged mechanical ventilation
352
risk factor for pulmonary post op complication(7)
```
> 50 ans
emergency surgery
surgery duration more than 3 h
heart failure
COPD
poor general health
abdominal and thoracic surgery
```
353
strategies to reduce risk of post op atelectasis prior to surgery(4)
smoking cessation at least 8 weeks prior to surgery
control symptom of COPD
rx of any respiratory infection
patient education
354
clue for pulmonary contusion(2)
symptoms begin 24 h after he accident
| patchy alveolar infiltrate on chest xray
355
after an accident patient develops hypotension dyspnea distension of neck veins and deviation of trachea
tension pneumothorax
356
best rx of tension pneumothorax
needle insertion in the second intercostal spacein the left midclavicular line (left pneumothorax)
357
3 types of pneumothorax
primary spontanoeus
secondary spontaneous
tension pneumothorax
358
primary spontaneous pneumothorax
no preceding event
359
quid of secondary spontaneous pneumothorax
complication of a lung disease COPD for instance
360
tension pneumothorax
lifethreatning trapped air wuth mediastinal shift and compromised cardiopulmonary function
361
rx of tension pneumothorax
depends on the size of the pneumothorax
362
small tension pneumothorax management(2)
observation
| O2
363
large stable tension pneumothorax management(2)
urgent needle decompression
| later chest tube placement
364
why to never use positive ventilation in tension pneumothorax
it will exacerbate it
365
quid of massive hemothorax
more than 1,5 l in pleural space
366
most common cause of massive hemothorax
traumatic laceration of the lung parenchyma
367
arteries damaged in massive hemothorax(2)
intercostal artery
or
internal mammary artery
368
clue for hemothorax(3)
hypotension
absent breath sounds
flat neck veins
369
patient in hemorragic shock develops cardiac arrest after being placed on mechanichal ventilation what measure would prevent that
volume resucitation
370
why mechanical ventilation could cause cardiac arrest in unstable patient(2)
positiv pressure mechanical ventilation increase intra thoracic pressure which decreases venous return to the haert and thereby decrease ventricular preload
in patient with hypovolemic shock this can cause circulatory collapse
371
evaluation of solitary nodule
first compare with old xray
| followed by chest CT
372
from what depends the decision of biosy,abserve or resection of solitary nodule(3)
size of lesion
age of patient
smoking history
373
risk of cancer in solitary pulmonary nodule(4)
Diameter > ou egal a 2,3
age > 60
smoker > 20 paquets/day
corona radiate or spiculated appearance
374
when smoking cessation lowes risk of cancer
when you stop smoking > ou egal 7 ans
375
best way to decrease the incidence of of atelectasis in post op(2)
incentive spirometry
| deep breathing exercices
376
in the vignette cause of atelectasis(2)
impaired cough
| shallow breathing causes atelectasis in post op
377
patient from mexico develops hemoptysis with dense opacity inthe right upper lobe the first step?
respiratory isolation
378
first step in patietn with massive hemoptysis
place the bleeding lung in a dependent position
379
second step in massive hemoptysis
bronchoscopy to localize the bleeding site and attempt early therapeutic intervention
380
quid massive hemoptysis(2)
> 600 ml/24 h
or
100 ml/h
381
patietn with vehicle motor accident or fall > 10 feet with mediastinal enlargement dx?
rule out aortic injury
382
screening test for aortic injury
chest xray
383
eqivococal chest xray in aortic injury(2)
CT chest
or
angiography
384
how 's TA in aortic injury(3)
```
normal
or
HTA
or
hypotension
```
385
patient after accident with hypotension with high pulmonary capillary wedge pressure (12 mm)
after 1 l de liquide PCWP a 22
Myocardial contusion
386
type of shock in trauma
hypovolemia
387
patient with hypotension after accident ,aftee IV fluids ,failure to correct the hypotension and development of high PCWP
rule out myocardial contusion
388
dx of myocardial contusion(2)
EKG
| positive cardiac markers
389
patient with intermittent claudication and pain in buttock,hip and thigh muscles dx
aorto illiac occlusion
390
additionnal finding in aorto illiac occlusion
impotence
391
quid of leriche syndrome(3)
hip and thigh buttock pain
impotence
symetric atrophy of bilateral loweer extremities
392
cause of leriche syndrome
aorto illiac occlusion
393
after accident patient develops hypotension and neck veins distended adn tachycardia dx
tamponnade
394
quantity of blood to cause tamponnade
100-200 ml
395
in chronic disease amount of fluid to cause acute cardiac tamponnade
1-2 l
396
chest ray in cardiac tamponnade post trauma
normal
397
clue ofro cardiac tamponnade
hypotension despite of rehydration
398
clue for aortic injury(4)
widened mediastinum
large sided hemothorax
deviation of the mediastinum to the right
disruption of the normal aortic contour
399
ABI < 0,9
PAD
400
ABI > 1,33
calcified or uncompressed vessels
401
clue for arterial embolism(5)
```
pain
pulselessness
pallor
peresthesia
paralysis
```
402
casue of arterial embolism
emboli
403
PAD
chronic disease in artery
404
arterial occlusion
acute embolic event
405
origin of emboli(2)
ventricle from MI
| atrium from AFIB
406
patient develops right calf pain after femoral artery embolectomy cause of the pain
soft tissue swelling
407
patient develops right calf pain after femoral artery embolectomy dx
ischemia reperfusion syndrome
408
quid of ischemia reperfusion syndrome
it's a compartment syndrome
409
condition predisposing to ischemia reperfusion syndrome
ischemia lasting more than 4 a 6 hours
410
quid of compartment syndrome
increased pressure within an enclosed facial space causing ischemia of muscles and nerves
411
indication of fasciotomy in compartment syndrome
pressure excess 30 mm de hg
412
what will happen after 4 a 6 hours of ischemia you reperfuse an area
both intra cellular and intersticial edema upon reperfusion
413
complication of pancreatic injury(2)
pancreatic abcesss
| also called retro peritoneal abcess
414
accident causing pancreatic trauma
bicycle
415
best step in suspect pancreatic trauma and why?(2)
serial CT
| because early CT less than 6 hours coul not show anything
416
complication of untreated pancreatic injury
pseudocyst formation
417
patient develops abdominal discomfort afterabdominal surgery with distended abdomen and decreased bowel sounds DX
post surgery ileus
418
cause of post surgery ileus
use of morphine
419
cause of post surgical ileus(3)
opiods use
penetrating cavity peritoneal
local relaese of inflammatory mediators
420
clue for pyloric stricture
succussion splash
421
cause of gastric outlet obstruction(6)
```
ca
PUD
chron
strictures
caustic agent
bezoar
```
422
patient with abdominal pain no bowel mvts for 2 days dx
small bowell obstruction
423
cause # 1 of small bowell obstruction
any surgery on abdominal wall
424
whyany surgery on abdominal wal can cause small bowell obstruction
adhesions
425
congenital adhesion causing obstruction of small bowell
Ladd's bands
426
xray for small bowel obstruction
dilated loops of bowel
427
most common etiology of small bowel obstruction
adhesions
428
patient presenting with pain and swelling over the coccyx dx?
pilonidal abcess
429
rx of pilonidal abcess(2)
drainage
| excision of sinus tract
430
patient on warfarin with platelet 40000 develops acute abdomen what should be done prior entry to operating room
fresh frozen plasma
431
patient on warfarin with platelet 40000 develops acute abdomen what should be done prior entry to operating room why using fresh frozen plasma ti correct this problem(2)
the most common way to normalize the PF
and
restoration of vit K dependent factors
432
clue for pancreatic cancer(2)
epigastric pain
| weight loss
433
trousseau sign in pancreatic cancer
migratory thrombophlebitis
434
pancreatic cancer with jaundice
head pancreas tumor
435
first thing in pancreas head tumor
U/S
436
localisation ca pancreatic with no jaundice(2)
body
and
tail
437
dx of body and tail pancreatic cancer
Ct scan of abdomen
438
incase of blunt trauma abdominal with hypotension what the first thing to do(2)
assess intraperitoneum free fluid
| bedside ultra sonography
439
quid of FAST
focused assess sono for trauma
440
what you assess during FAST(2)
pericardium
| peritoneum after trauma
441
if FAST equivococal next step
diagnostic peritoneal lavage (DPL)
442
patietn with positive FAST or positive DPL next step
laparotomy
443
hemodynamicaly stable patient with negative FAST next step
CT of abdomen
444
cause of syringomyelia(2)
prior spinal cord injury type whiplash
| arnold chiari
445
what fibers are reached in syringomyelia
spinothalamic tract
446
manif of spinothalamic tract problem(2)
pain
| Temperature are decreased
447
manif of syrigomyelie(2)
motor fiber s problem in upper extremities
| Pain and T
448
physio patho of syringomyelia
csf drainage from the central canal of spinal cord is disrupted leading to a fluid filled cavity that compress surrrounding normal tissue
449
DX synringomyelia
MRI
450
Laps of tiem between the accident and beginning of syringomyelia
month to years later
451
risk in complete excision of parotid tumor
facial droop caused by facial nerve problem
452
cause of transtentorial herniation(uncal)
right sided epidural hematoma
453
artery rupture in epidural hematoma
middle menigeal artery
454
what nerve can be involed in transtentorial herniation
oculomotor nerve
455
manif of oculomotor problem(5)
```
ipsilateral hemiparesis
Mydriasis
strabismus
controlateral hemianopsia
altered mentation
```
456
quid of drop arm test
doctors abduct passively both arm above head end then ask to bring arm down slowly
in case of Rotator cuff tear, arm drops rapidly
457
signification of drop arm test
rotator cuff tear problem
458
Mx of rotator cuff tendon(4)
supra spinatus
infraspinatus
teres minor
subscpularis muscles
459
pain shoulder with arm in external rotation with resistance in internal rotation
axillary nerve is injured
460
pain shoulder with arm in external rotation with resistance in internal rotation
anterior dislocation of shoulder
461
arm in ant dislocation
external rotation
462
quid of oliguria(2)
< 6 cc kg/day
463
first thing to do in patient with foley catheter developping prerenal azotemia
remove the catheter to see if it's not clogged
464
how' s K+ in prerenal azotemia
high
465
first thing to do in prerenal azotemia with high K+
bolus of IV fluids
466
indicator of prenal azotemia
BUN/Creat>20/1
| FeNA< 1
467
patient with pain in scrotumdevelops left sided scrotal swelling which increases with valsalva maneuver dx
varicocele
468
quid of varicocele
dilation of pampiniform plexus
469
why varicocle happens in the left
left testicular vein enters left renal vein inferiorly at a right angle thereby predisposing to impaired drainage
470
physical exam of varicocele
impression of bag of worms
471
why you can have shoulder irradiated pain during abdominal pain
intraabdominal pathology can cause peritonitis and irritation of diaphragm
472
patient with direct blow to the lower abdomen has pain in hypogastre radiated to the left shoulder
dome vesical rupture
473
the only part of the bladder covered by peritoneum
dome of bladder
474
cause of chemical peritonitis(5)
hemoperitoneum
spillage of bowel contents
bile pancreatic secretions
urine in peritoneum
475
most susceptible point of rupture of bladder
dome
476
why irritation of parietal peritoneum will cause shoulder pain (2)
peritoneur covers undersurface of diaphragm is innervated by C3 to C5 spinal levels
C3 to C5 also bring sensation to shoulder
477
best dx test for urolithiasis
CT of abdomen and pelvis without contrast
478
test for urolithiasis in pregnant women
US
479
cause of post op fever(5)
```
pneumonia
UTI
DVT
wound infection
drugs
```
480
cause of post op fever and chronology(5)
```
wind-----1 a 2 jours
water--------3 a 5 jours
walking-----4 a 6 jours
woung-----5 a 7 jours
wonder drugs --more than 7 days
```
481
fever with coagulase - in bacteria culture cause
indwelling catheter
482
femoral catheter infection
gram negative bacteria(enteric organism)
483
IV catheter or indwelling catheter
staph epidermidis
484
fever develops 1-6 months post op in a patient who has received blood products
febrile non hemolytic transfusion reaction
485
8 e day after surgery patient develops pain and swelling of the left angle of the jaw dx
post op parotiditis
486
what can prevent post op parotiditis(2)
adequate fluid intake
| oral hygiene
487
bug causing of post op parotiditis
staph aureus
488
fever and knee swelling after right total knee replacement 6 months after the procedure
prosthetic joint infection
489
bugs in cause of prosthetic joint infection within 3 months after arthroplasty(3)
staph aureus
gram negative rods
anaerobes
490
bugs in cause of prosthetic joint infection more than 3 months after arthroplasty(3)
staph epidermidis
propionibacterium
enterococci
491
rx of prosthetic joint infection
remove the prothesis
492
patient 32 yo with intermittent bloody nipple discharge
intraductal papilloma
493
physical exam of intraductal papilloma
can be normal
494
size of tumor in intraductal papilloma
no larger than 2 mm
495
size of intraductal papilloma to be detected by US
greater than 1 cm
496
difference between intraductal papilloma and paget
in paget you eczematous changes in nipple
497
after thyroidectomy patietn develops mx cramps prolonged corrected qt interval(N<460ms) dx?
hypocalcemia caused by secondary hypoparathyroidism
498
why hypoparathyroidism after thyroidectomy
removal of 4 parathyroid glands
499
consequence of hypocalcemia(2)
tetany
| seizure
500
patient with DVT and clot in distal portion of femoral vein CAT
Heparin
501
quid virchow triad(3)
stasis
endothelial injury
hypercoagulable state
502
guideline to prevent DVT after major surgery
stable patient begin anticoagulation 48-72 h after surgery
503
quid acute cholecystitis(2)
inflammation and distension of gallbladder
| obstruction of cystic duct by calcul
504
Murphy sign
palpation on RUQ elicits shoulder pain
505
US of acute cholecystitis(3)
gallstones
thickened gallbladder with edema
normal common bile duct
506
management of acute cholecystitis(2)
rx conservatively
| 3 jours later laparoscopic cholecystectomy
507
vaccine in splenectomised patient
against encapsulated germs
508
most common encapsulated germs in sepsis chez les splenectomises(3)
S pneumoniae
meningoccoque
Hi flu
509
role of the spleen(4)
antigen uptake by dendritic cells in spleen
presentation to T cell
T cell activates B cells
b cell become plasma cells and form antibody
510
why you have sepsis in splenectomy
you need antibody to opsonise encapsulated gems to make phagocytosis effective
511
when to to give vaccine for encapsulated germs
before surgery on spleen
512
physiopatho of colicky pain in gallstones
fatty meal cause contraction of gall bladder
| gallstone block the contraction causing intra gallbladder pressure to rise distend and cause the pain
513
how to differentiate acute cholecystitis from biliairy colic(3)
the second is intermittent
in relation with food
absence of fever
514
why the pain is intermittent in biliary colic
relaxation of the gallbladdder causes the gallstone to fallback from the duct
515
quid of bilairy colic
pain occurring when gallblader distends against an obstructed cystic duct
516
patietn burn 2e degree on day 3 develops hypothermia,hypotension and WBC >10000 dx
burn sepsis
517
clue for sepsis(5)
```
fever or hypothermia< 35
pulse >90/mn
resp>20/mn
wbc >12000 or< 4000
or 10 % bands
```
518
when to consider sepsis(6)
```
when you have ended organ damage
oliguria
hypotension
low platelet
metabolic acidosis
hypoxemia
```
519
quid of systemic inflammatory response syndrome(2)
you can have non infectious inflammatory response
| can be infectious
520
cause of non infectious inflammatory response(4)
pancreatitis
Burn
vasculitis
autoimmune disease
521
quid of sepsis
systemic inflammatory response caused by infection
522
how's glucose in sepsis and why(2)
high
| worsening insulin resistance
523
cause of death in patient with burn(2)
hypovolemic shock
| later sepsis
524
clue for morton neuroma(2)
foot pain
| mulder sign
525
quid of mulder sign
clicking sensation when simultaneously palapating 3e et 4 e metatarsal heads and squeezind
526
people at risk for morton neuroma
runners
527
rx of morton neuroma
bilateral shoe inserts
528
failure of bilateral shoe inserts in morton neuroma
surgery
