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surgery Flashcards

1
Q

most common cause of lower extremity edema

A

venous valve incompetence.

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2
Q

ischemia-reprefusion injury can commonly lead to what critical condition

A

Compartment syndrome

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3
Q

vomitting and abdominal pain after blunt abdominal trauma in a kiddo

A

Duodenal Hematoma

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4
Q

abdominal succusion splash

A

ausc a splashing at epigastrium when rocking pt back and forth
suggesting retained gastric material.
seen often in pyloric stenosis/stricture

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5
Q

what is Flail Chest

A

> /= 3 rib fractures in >2 places

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6
Q

Marjolin Ulcer

A

burn injury with resulting SCC

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7
Q

fluid resucitation in burn victims

A

LR

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8
Q

treatment for complicated diverticulitis with >3 cm fluid

A

CT guided drainage

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9
Q

prosthetic joint infection, whats the bug?

A

w/in 3 months of surgery- virulent organism ie S Aureus or P Auerginosa
3 mo- 1 yr- low virulence organism ie S.Epi
1 yr+- post op infection ie S.aureus from hematogenous spread

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10
Q

testicular mass that increases with valsalva and doesnt transilluminate

A

varicocele- dilated pampiniform plexus

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11
Q

FOOSH with hyperextended arm can cause

A

supracodylar fracture

Median N and brachial A at risk

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12
Q

shin splints vs stress fractures

A

shin splints: diffuse anterior leg pain, in overweights

stress fracture: pointed pain, in underweights

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13
Q

blunt trauma pt who is unstable with signs of peritonitis? whats the next step?

A

diagnostic peritoneal lavage

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14
Q

penetrating trauma pt who is unstable with signs of peritonitis?

A

exploratory lap

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15
Q

penetrating trauma pt who is STABLE with signs of peritonitis?

A

CT

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16
Q

Gilbert’s Syndrome

A

inherited disorder of bilirubin glucoronidase precipitated by stressors.
jaundice in the setting of normal CBC, normal ALP, and liver enzymes

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17
Q

how to transport an amputated limb

A

saline gauze in bag, on ice

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18
Q

what is torus palatinus?

A

a fleshy hard mass midline on the hard palate

the cause is congenital NOT traumatic

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19
Q

how to differentiate an intra-peritoneal and extra-peritoneal rupture?

A

intra-peritoneal: injury to the dome (superior/lateral) portion of the bladder. this can cause chemical peritonitis (burning abdominal pain) because urine may enter the peritoneum
etra-peritoneal: injury to the anterior bladder, usually secondary to a pelvic fracture. can cause hematuria

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20
Q

what diaphragm is more prone to tear?

A

L side following trauma b/c no liver to reinforce it

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21
Q

Small Bowel Obstruction management

A
  • fluids, NG tube, bowel rest
  • small bowel follow through series if stable
  • surgical exploration if unstable
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22
Q

when to transfuse platelets before surgery

A

if under 50k

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23
Q

how to reverse warfarin before surgery

A

FFP (even if the INR is therapeutic! you need to give FFP before surgery)

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24
Q

fat embolism syndrome

A

usually following a long bone fracture

  • petechiae
  • respiratory distress
  • neuro/cognitive changes
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25
Q

McBurney sign

A

appendicitis

pain in RLQ

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26
Q

Rosving sign

A

appendicitis

pain in RLQ when LLQ palpated

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27
Q

perianal abscess

A

caused by obstruction of crypt gland related to receptive intercourse and constipation
fluctuant painful
fever, leukocytosis,

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28
Q

how does succinylcholine work?

A

depolarizing NMJ blockade at Ach receptors. More Na influx and K+ outflux. Can be used rapidly bc it takes <1 min to onset and 10 mins to offset.
cardiac arrhythmia 2ndary to hyperkalemia is a a.e.

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29
Q

nasopharyngeal carcinoma

A

think eastern china, with EBV

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30
Q

what is emphysematous cholycystitis

A

an infection of the GB with a gas producing organism like clostridium, causing gas in the GB.
this is a surgical emergency

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31
Q

for BAT w/ suspected splenic lac whats the next step

A

FAST US if SBP >90, if this is normal but pt is anemic do a f/up CT.
if pt is unstable go to lap

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32
Q

pneumobilia, air in sm bowel, hyperactive bowel sounds

A

gallstone ileus picture

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33
Q

spontaneous pneumothorax management

A

spontaneous (NOT tension) and small(<2cm) witnessed clinically by being well oxygenated and hemostable can be managed with just oxygen supp and observatin

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34
Q

anterior mediastinal mass diff dx

A 
the 4 T's 
thymoma 
thyroid cancer 
teratoma and other germ cell tumors(AFP and bHCG high) 
terrible lymphoma
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35
Q

malignancies in young men

A

testicular cancer, lymphoma, leukemia

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36
Q

in a penetrating abdominal injury what are indications for ex lap

A

signs of urgent ex lap: peritonitis, blood per rectum or NG, hemo unstable, evisceration

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37
Q

pilonidal disease

A

a blocked hair follicle develops an abscess in the intergluteal cleft

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38
Q

scaphoid fracture and imaging

A

will not show up on an Xray immediately following trauma. two options- get CT/MRI or put in thumb spica splint and Xray in 7-10days

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39
Q

what are the 3 components of GCS

A

eye opening
verbal response
motor response

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40
Q

purpose of GCS

A

prognosis of coma, NOT diagnosis of coma

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41
Q

normal ROM but positive impingement test (Neer, Hawkins)

A

rotator cuff tendinopathy

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42
Q

decreased ROM of shoulder with pos impingement test

A

adhesive capsulitis, frozen shoulder

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43
Q

how to manage a DVT

A

warfarin with a heparin bridge

avoid LMWH and rivaroxaban if pt has ESRD

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44
Q

when to do surgery on asymptomatic umbilical hernia (congenital)

A

age 5 if persistent

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45
Q

whistling after rhinoplastry

A

nasal septum perf

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46
Q

central line placement in the subclavian v can go wrong in what way?

A

tension pneumothorax with tracheal deviation, decreased breath sounds, and distension of neck veins bc SVC is compressed

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47
Q

which metatarsal stress fracture do you cast or internally fixate

A

5th bc it is more likely to have non-unionization

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48
Q

what is Kehr sign?

A

referred pain to the shoulder due to peritoneal irritation leading to diaphragmatic irritations as the phrenic N is inn by the same roots as the shoulder

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49
Q

what is Leriche syndrome?

A

aortico-iliac occlusion causing

  1. buttock/groin/thigh pain
  2. absent or diminished FP,PP, DP
  3. impotence
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50
Q

management of anal fissure

A

(often accompanied by a skin tag, do not worry!)
- sitz bath
stool softener and dietary mod
topical anesthetics and vasodilators to increase blood flow/healing to anus

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51
Q

if you suspect urethral injury do?

A

retrograde urethrogram

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52
Q

peritonsillar abscess looks like?

A

uvula deviated, trismus, hot potato voice, anterior lymphadenopathy,
ear pain and throat pain

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53
Q

atelectasis abg’s

A

happens on day 2-3 after surgery
shallow breathing, low alveolar recruitment, so low pO2, then this stimulates increased RR, causing low pCO2 and basic pH

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54
Q

how to deal with massive hemoptysis ?

A

first secure airway (ABCs)
then if bleed continues, do bronchoscopic intervention
if after intervention and pulmonary artery embolization bleeding continues do thoracotomy

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55
Q

acute mediastinitis

A

can occur after sternotomy. proof: discharge from surgical site. often has widened mediastinum as well. fever, leukocytosis common.
tx: surgical debridement, and long course of antibiotics.

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56
Q

afib after CABG

A

very normal for the first 24 hours.

if over 24 hours, can consider Anticoagulation therapy.

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57
Q

what is a marjolin ulcer

A

SCC arising from wound or burn, usually has higher mets rate

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58
Q

pre-patellar bursitis

A
  • housemaid knee
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59
Q

when do you give bicarbonate

A

severe acidosis pH<7.2

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60
Q

what should you do after placing a central catheter?

A

portable xray. correct placement is in lower SVC, can cause pneumothorax/venous perf and other complications if in the wrong spot

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61
Q

what are hints of a medial meniscus tear

A

twisting on a planted foot

‘popping’

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62
Q

pulmonary contusion vs hemothorax on cxray

A

pulmonary contusion shows intra-alveolar hemorrhage

hemothorax shows pulmonary effusion

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63
Q

what does ankle brachial index show?

A

high specificity and sensitivity for PAD.

if <0.9

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64
Q

psoas abscess signs

A

psoas sign +
hip/flank/abdominal pain
hx of recent infection nearby

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65
Q

who is affected by slipped capital femoral epiphysis

A

obese kiddos, male, early adolescence

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66
Q

low CI and high PCWP is

A

MI

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67
Q

air under diaphragm vs air fluid levels in bowel

A
  1. air under diaphragm- perforation

2. air fluid levels- SBO

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68
Q

whats the McMurray test?

A

external and internal rotation of the knee

69
Q

whats the Thessaly test?

A

external and internal rotation of the hip while keeping knee stable

70
Q

terminal hematuria

A

bladder/prostate

71
Q

initial hematuria

A

urethra

72
Q

total hematuria

A

kidneys

73
Q

patellar dislocation

A

<20 yo, lateral mass which is patella that has dislocated, medial pain

74
Q

what is Ludwig’s angina

A

rapidly progressive cellulitis in submandibular and submental region due to infected molar

75
Q

what is dumping syndrome?

A

pyloric sphincter looseness after gastric surgery

sx are diarrhea, abdominal pain, as well as vasomotor sx of palpitations and lightheadedness

76
Q

suspicious of testicular cancer? whats next?

A

do NOT do FNA or biopsy, this can cause spillage and seeding
a mass+ US findings is enough for orchioectomy
based on pathology from this you can decide on chemo

77
Q

sliding hernia

A

hernial sack has a thickened posterior wall formed by a retroperitoneal organ, usually left sided indirect inguinal and descended into scrotum
is either colon or bladder, so you cannot dissect or divide it due to risk of injury

78
Q

whats the most common type of hernia? in women?

A

indirect inguinal hernia is the most common type in both

79
Q

surgery on an asymptomatic femoral hernia?

A

YES, the chance of strangulation is too high.

80
Q

what is management of post-op ileus?

A

switch pain meds from opiates to NSAIDs

if symptomatic with vomitting consider bowel decompression with NG tube

81
Q

what is a richter hernia?

A

when only one wall of the bowel is in the hernial sac, so it isnt visible on imaging, and sometimes classic sx are missing. and so is often missed as being strangulated.

82
Q

SBO management

A
  • bowel rest
  • IV fluids
  • NG tube
    consider surgery based on pain, leukocytosis, acidosis
    can self resolve
83
Q

pediatric umbilical hernia guidelines

A

do not operate until 4 yo greater than 2cm (likely to close spontaneously), growing defect, or evidence of strangulation
rarely incarcerates.

84
Q

testicular pain with decreased or absent doppler flow? following surgery?

A

IF following surgery , likely due to ischemic orchitis secondary to vascular injury of pampiniform plexus (more likely than test A).
(otherwise testicular torsion is also likely, but less likely than vasc cause following sx)

85
Q

most common cause of bloody nipple discharge

A

intraductal papilloma

86
Q

appropriate followup for inflammatory breast cancer suspicion

A

punch biopsy of skin

MRI

87
Q

what type of breast finding is an indicator for cancer in either breast

A

LCIS

88
Q

following an MI no elective surgery for how long?

A

min 4 wks.

6 mos is preferred, but if pt passess stress test its ok

89
Q

post op STEMI vs NSTEMI management

A

NSTEMI- medical management no PCI indicated f/up with stress test in 6 wks
STEMI- PCI

90
Q

HOCM signs

A

increase with valsalva
decrease with squatting
remember not laterally displaced PMI bc its just a hypertrophied septum

91
Q

pericarditis signs

A

worse pain on inspiration, lessened by leaning forward
friction rub on auscultation
global ST elevation PR depression

92
Q

Dressler syndrome

A

pericarditis following MI,weeks to months after

93
Q

first 48 hrs after MI death is likely due to

A

arrhythmia

94
Q

4-5 days after MI death is likely due to

A

myocardial rupture, free wall or septal

95
Q

most accurate way to measure EF?

A

MUGA scan

96
Q

Stanford A vs Standord B dissection

A

A- ascending aorta and aortic arch- complications are deadly need immediate surgery
B - descending aorta, can be medically managed unless malperfusion

97
Q

stroke sx following MI

A

most likely ventricular thromboembolism

98
Q

R sided MI management?

A

IV fluids to increase preload

99
Q

Hammam’s sign?

A

crunching heard in systole, most likely acute mediastinitis

100
Q

what are the three signs of severe aortic stenosis and what causes the worst outcomes

A

angina, syncope, CHF

CHF is indicative of 2 yr max prognosis

101
Q

pulsus bispherens

A

2 systolic peaks with a dip/divot

most commonly seen in AR

102
Q

IV thrombolytics following an MI is contraindicated in what condition?

A

aortic dissection

103
Q

primary parathyroidism leads to what bone disorder?

A

osteitis fibrosa cystica

104
Q

adrenal incidentalomas smaller than what size are unlikley to be malignant

A

<6 cm

105
Q

what are the symptoms of a glucagonoma?

A
  • new onset diabetes, polyuria polydypsia

- migrating rash, (necrolytic migratory erythema)

106
Q

MEN1 symptoms

A

3P’s (pancreatic, parathyroid, pituitary)

107
Q

MEN 2 findings

A

Parathyroid, Pheo, and Medullary Thyroid Ca (check calcitonin)

108
Q

suspected thyroglossal duct cyst, next step?

A

if in an adult, must remove because high infection and malignancy risk
no need to FNA.

109
Q

what elevated in pheo

A

chromagraninA, metanephrine, VMA

110
Q

following adrenalectomy what is a complication

A

addisonian crisis, check cortisol levels- BPs will tank

presents as abdominal pain, nausea, vom, hyponatremia, and hyperkalemia

111
Q

polycythemia vera as a paraneoplastic syndrome is associated with?

A

HCC, RCC, hemangioblastoma, pheo

112
Q

paragangliomas vs pheos

A

look exactly like pheos but are outside the adrenals, but most common place is the abdomen.
more likely to be malignant, more likely to have heriditary causes
can be missed on CT/MRI, use a functional scan.

113
Q

superior laryngeal n transection,

A

high pitch deficit , runs with superior thyroid A and V

114
Q

recurrent laryngeal N transection

A

hoarseness

115
Q

primary hyperparathyroidism w/ 4 enlarged glands

A

remove 3.5

116
Q

in the case of biopsied laryngeal cancer what kind of imaging do you need to check for more cancer

A

chest xray , lung cancer

117
Q

what is otomycosis

A

grey discharge, intense pruiritus and fullness,
tympanic membrane unaffected.
usually seen in AML and diabetes
Aspergillus Niger most common cause

118
Q

what n traverses through the parotid?

A

Facial N

119
Q

most common aspiration site?

A

child <1 larynx

older children trachea, r main stem bronchus

120
Q

most common salivary gland tumor is?

A

pleiomorphic adenoma

in smokers its warthrin’s

121
Q

suspicious of Plummer Vinson syndrome? whats the next step in diagnosis?

A

esophaGRAM to visualize the webs

122
Q

indirect vs direct laryngoscopy?

A

indirect done in the office to visualize vocal cord (uses a mirror so considered indirect)
direct done in the OR

123
Q

Courvoisier’s sign

A

palpable non-tender gallbladder distended due to obstruction, most likely pancreatic adenocarcinoma,
can be accompanied by jaundice etc.

124
Q

Charcot triad vs Reynaud’s pentad

A

charcot triad- RUQ pain, jaudice, fever
pentad: + hypotension, altered mental status
acute cholangitis, often secondary to gallstone obstruction

125
Q

Cullen’s sign

A

red-blue around umbilicus
suggestive of retroperitoneal bleeding
may be seen in hemorrhagic pancreatitis too

126
Q

when to entereal feed in pancreatitis

A

around hospital day 5-7 if pancreatitis not resolving

127
Q

gallbladder polyps management

A

<10 cm- monitor with US

>10 cm- lap choly

128
Q

management of isolated GASTRIC varices

A

due to splenic vein thrombosis, often secondary to pancreatitis
banding, sclerotherapy, etc do not work
not a prob with the liver so no point in TIPS
do splenectomy to treat

129
Q

after a whipple, or any pancreatic procedure, there is a leak? whats the next step in working this up

A

get the amylase of the drain fluid

if high in amylase go NPO to decrease secretion

130
Q

when to do cholecystectomy for gallstone pancreatitis

A

immediately (w/in 48 hrs) if pancreatitis is mild, no need to wait for labs to normalize
if severe or necrotizing, do not operate yet

131
Q

common complication after AAA leading to abdominal pain and bloody stools? dx and management?

A

ischemic colitis

flexible sigmoidoscopy- NPO and fluids

132
Q

screening for child with APC+

A

flexible sigmoidoscopy from 10 yo, removal of colon if polyps seen

133
Q

UC and colon cancer, when to screen?

A
  • risk for colon cancer goes up after 8 yrs, so after 8 yr from diagnosis can start yearly colonoscopies and biopsies.
134
Q

Ogilvie’s syndrome?

A

markedly distended colon, with no notable obstruction of the colon.
:pseudo obstruction

135
Q

most common site of perforation

A
  • cecum
136
Q

what prevents fistulas from closing

A 
HIS FRIENDS 
H- high output 
I- IBD 
S-short fistula 
F-foreign body 
R- radiation 
I- infections
E- epithelialization 
N neoplams 
D- distal obstruction
137
Q

whats an alternative to colonoscopy for screening

A

flexible sigmoidoscopy and FOBT

138
Q

“bent inner tube” or “coffee bean sign” mean?

A

sigmoid volvulus

139
Q

carcinoid in the appendix, how to manage?

A

<1 cm , appendectomy is fine

>1 cm, need R hemicolectomy

140
Q

what can falsely elevate CEA

A

smoking 4 hrs before the lab

141
Q

most common cause of appendicitis

A

fecalith in adults

lympoid aggregation in kiddos

142
Q

melanosis coli

A

uniformly darkened colon, secondary to laxative abuse.

143
Q

recurrent diverticulitis increases risk for what?

A

stricture

144
Q

endocarditis associated with what bugs is associated with colon cancer

A

S.bovis and clostridium septicum

145
Q

most common primary malignant brain tumor in adults

A

GBM, astrocytoma IV

146
Q

what does it mean when a brain MRI shows blurring of grey and white junction

A

a rapid deceleration trauma causing diffuse axonal injury, shearing forces,

147
Q

next step if ring enhacing brain lesion found in HIV

A

tmp/smx if no response get stereotactic biopsy to prove lymphoma

148
Q

what would the aspiration of a septic joint show?

A

green/brown fluid
WBC>2.0x10
glucose <25

149
Q

carpal tunnel syndrome, is the palm affected or no?

A

NO, it is not affected. it is supplied by the median recurrent nerve. which does not travel through the tunnel

150
Q

drop arm test is for what nerve?

A

supraspinatus

151
Q

Legg Calves Perthes?

A

osteonecrosis of the hip in kiddos. sometimes the complaint will be knee pain bc kids cannot express

152
Q

fist bite injury, most common bug?

A

eikenella corrodoris

153
Q

DDH?

A

developmental dysplasiaof the hip
dx by ortalani and barlow manuevers, then US (bones not ossified in babies)
tx: get ortho! might use Pavlik harness

154
Q

what are the types of shoulder dislocations?

A

anterior: most common
Posterior: not common, can be caused by seizures and electrocution.

155
Q

McMurray’s sign?

A

meniscus tear. when applying tibial torsion and extending foot from flexion position

156
Q

sunburst vs onion peel

A

sunburst- osteosarcoma

onion peel- ewings

157
Q

unhappy triad

A

medial meniscus tear
medial collateral ligament tear
ACL

158
Q

duodenal atresia sign and factors?

A

double bubble

risks: Down syndrome, polyhydramnios,

159
Q

what is tracheomalacia?

A

softness of the tracheal cartilage causes collapse, especially when supine. can notice whistling and cyanosis

160
Q

Mohs surgery is not recommended forwhat cancer type

A

melanoma

161
Q

what type of melanoma has the worst prognosis

A

nodular

berry colored lesion, extensive vertical growth before radial growth

162
Q

hampton hump

A

a wedge shaped opacity usually near the costo-phrenic angle that RARELY occurs in setting of PE

163
Q

Westermark’s sign

A

dilation of pulmonary vessels with a sudden cut off where its no longer able to be seen
rarely occurs in the setting of a PE

164
Q

S1Q3T3

A

rarely seen on EKG in PE (remember most common finding is sinus tach)
S wave in lead 1, Q wave in lead 3, inverted T wave in lead 3

165
Q

most common DVT location

A

L common iliac V

166
Q

most common cause of intrinsic renal AKI

A

ATN> AIN

167
Q

what are the 4 types of wounds?

A

clean- not involving organ or cavity
clean contaminated- aseptic incision into organ or cavity
contaminated- secondary to trauma
dirty infected- ex: an abscess or perforated viscera

168
Q

septic shock managemetn

A

IV fluids

NE

MS3 (6 decks)

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