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MCCQE1: Surgery > Surgery > Flashcards

Surgery Flashcards

1
Q

Does gynecomastia in men present more commonly as unilateral or bilateral?

A

unilateral. but can often be bilateral.

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2
Q

When does physiologic gynecomastia occur?

A

after brith and at puberty

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3
Q

what are physiologic and non physiologic causes of gynecomastia?

A

an altered ration of estrogen and testosterone. due to an increase in estrogen production, decrease in testosterone production, or both. Non physiologic causes include kidney or liver failure, testicular or adrenocortical tumors, secondary to some medication

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4
Q

Name drug causes of gynecomastia. (hormonal and non-hormonal)

A

it is an adverse effect of drugs that stimulate prolactin. such as; anti-psychotic drugs (risperidone and haloperidol) and tricyclic antidepressants. Non hormonal medications include: Ketonazole, Spirinolactone, cimetidine, 5-alpha-reductase inhibitors like finasteride.

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5
Q

What 6 secondary causes of gynecomastia and how do you test for them?

A
  • Liver cirrohsis –> LFTs
  • estrogen tumor –> estrogen levels
  • Chronic Kidney disease –. BUN and creatnine levels
  • Undernutrition –> albumin level
  • Hypogonadism –> testosterone level , LH, FSH
  • Estradiol Testicular tumor –> HCG (only in a man past his adolescense)
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6
Q

Name the red flags of gynecomastia.

A

Might indicate malignancy: -Any hard or fixed swelling -Any painful areas or tender to palpation -nipple discharge -nipple retarction

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7
Q

Describe the points system of the Glasgow Come Scale

A
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8
Q

Name the 3 most common causes of Lower GI Bleeding in patients over the age of 65.

A
  1. Colonic diverticula
  2. Vascular Ectasias
  3. Colonic Ischemia
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9
Q

What is the treatment of choice for Basal Cell Carcinoma?

A

MOHs Micrographic surgery

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10
Q

Describe the rule of 9s for burn victims: adults and children

A
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11
Q

How do you categorize severity of bures? (mild, moderate, severe)

A
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12
Q

How do you use the parkland formula administer fluid resuscitation for patients? What is the fluid of choice?

A
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13
Q

Describe the common presentation of plantar fascitis.

A

history of obesity, prolonged standing and jumping, worse with the first few steps in the morning and after periods of inactivity, throbbing, flat feet, reduced ankle dorsiflexion, discomfort improves with ambulation and is made worse by persistent use.

Presents with inferior heel pain on weight bearing and often persists for months to years.

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14
Q

Describe the location of a Meckel’s Diverticulum

A

occurs in the distal ileum

2% of people

2 inches in sice

2 feet from ileocecal valve

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15
Q

What types of tissues are commonly found in a Meckel’s diverticulum?

A

Ectopic gastric or pancreatic tissue

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16
Q

What are the complications of a Merkel’s diverticulum?

A

Bleeding, Obstruction, Diverticulitis, tumors

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17
Q

How do you test for a Merkel’s diverticulum? Treatment?

A

Radionuclide scan (technetium scan)

Identifies gastric exctopic tissue.

Surgical excesion of the the diverticulum.

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18
Q

Murphy’s sign is positive in which condition?

A

Acute cholecystitis

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19
Q

Describe murphy’s sign.

A

Inspiratory arrest upon palpation of the right upper quadrant. Indicative of acute cholecystitis

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20
Q

How do you assess adequacy of fluid resuscitation after a burn injury?

A

Urinary output and central venous pressure.

Urinary output: 1-2ml/kg/hr

CVP 10-15mmHg

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21
Q

What is the Parkland formula?

A

4ml/kg x __kg x % (total body surface area) = total amount of fluid given to patient in first 24hrs of burn.

First half given in first 8hrs, second half given in the next 16.

(Modified parkland formula includes an additional 2000ml of fluids to account for maintenance.)

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22
Q

What is the Kerh’s sign?

A

Kehr’s sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Kehr’s sign in the left shoulder is considered a classic symptom of a ruptured spleen.

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23
Q

What is the grading of splenic ruptures?

A
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24
Q

What role does Alanine Transanimase play in diagnosing pancreatitis?

A

An ALT level that 3 times greater than normal indicated that the cause of the pancreatitis is likely gallstone pancreatitis

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25
Q

What role does C-reactive protein play in diagnosing pancreatitis?

A

high levels of c-reactive protein indicate pancreatic necrosis.

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26
Q

Lateral epicondilitis is caused by exccessive wrist flexion or extension?

A

extension

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27
Q

Do you continue a patient on metoprolol in the perioperative period?

A

Yes. Beta blockers are continued during the perioperative period unless the patient presents to surgery with a low systolic BP. If that is the case, you should consider decreasing or witholding the dosage of the beta blocker.

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28
Q

Do you continue a patient on ACEI/ARB in the perioperative period?

A

ARBs/ACEI should be withheld 24 hours prior to non-cardiac surgery, and restarted on day 2 post-op if the patient is hemodynamically stable

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29
Q

What is Grey Turner’s sign?

A

Hemmorhagic discoloration of the the flanks.

It is a sign of retroperitoneal hemorrhage, or bleeding behind the peritoneum, which is a lining of the abdominal cavity. Indicates pancreatic necrosis and can present with cullen sign as well.

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30
Q

What is Cullen’s sign?

A

Cullen’s sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.

This sign takes 24–48 hours to appear and can predict acute pancreatitis, with mortality rising from 8–10% to 40%. It may be accompanied by Grey Turner’s sign[3] (bruising of the flank), which may then be indicative of pancreatic necrosis with retroperitoneal or intra-abdominal bleeding.

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31
Q

What is the criteria used to stage acute pancreatitis?

A

The Ranson Criteria:

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32
Q

What is the treatment of Osgood-Schlatter disease?

A

Typically begins at the onset of adolescence and will often resolve on its own in 18-24 months.

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33
Q

What should be used to drain a hemothorax?

A

tube thoracostomy

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34
Q

What can result from inadequate management of a torn central slip ligament?

A

Boutonnieres deformity.

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35
Q

How much volar angulation is acceptable is a boxer’s fracture?

A

2nd digit: 10*

3rd: 20*

4th and 5th: up to 40*

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36
Q

What is the recommended initial treatment for a spinal cord injury?

A

if presenting within 3 hours of injury, administer loading dose of methylprednisolone IV. Steroid treatment has been shown to be nonbeneficial after 8hrs.

Step 2 is a closed reduction

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37
Q

What is the leading cause of death following theraputic bariatric surgery?

A
  1. Pulmonary embolism
  2. Cardiac events (Coronary heart disease)
  3. Sepsis
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38
Q

What is the optimal INR for patients on warfarin therapy that have a mechanical heart valve?

A

Optimal INR is 2.5-3.5

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39
Q

What distinguishes polymyagia rhumatica from polymyositis?

A

normal creatnine kinase (muscle enzyme) levels are indicative of polymyalgia rhumatica.

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40
Q

What conditions must be present to make a diagnosis of polymyalgia rhumatica?

A
  • Bilateral shoulder or hip stiffness and ache for atleast one month.
  • Age >50
  • Elevated ESR (40mm)/CRP
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41
Q

What is the diagnostic test of choice for acute diverticulitis?

A

CT scan of the abdomen and pelvis.

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42
Q

What nerve is affected when a patient presents with ape-hand deformity?

A

median nerve

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43
Q

Describe ape hand deformity.

A

median nerve damage that results in the inability to abduct and oppose the thumb due to paralysis of the thenar muscles.

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44
Q

What is the diagnostic test of choice for suspicion of colon cancer?

A

colonoscopy

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45
Q

What is the treatment option of choice for patient with Ulcerative Colitis?

A

Restorative proctocolectomy and ileal pouch-anal anastomosis. This removes the entire colon, upper rectum and anal mucosa. Anastomosis to the anus preserves continence function.

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46
Q

How are varicoceles diagnosed? What is the indication for repairing varicoceles in adolescents?

A
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47
Q

What are the indications for a surgical repair/referral of a varicocele

A
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48
Q

What is the most common cause pf unilateral chronic nasal obstruction in adults?

A

Nasal septal deviation

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49
Q

What is the most common cause of nasal obstruction across all age groups?

A

the common cold which is classified as a mucosal disease.

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50
Q

What are some causes of galactorrhea

A
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51
Q

What differenciated between a pituitary micro- and macro- adenoma? What is the Hook effect?

A

A prolactin level >150micrograms/L are suggestive of a microadenoma, A prolactin level >250micrograms/L is suggestive of a macroadenoma.

The Hook effect accounts for falsely negative prolactin levels in patients with a macroadeno that is >3cm. The high levels of prolactin create an assay artifact.

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52
Q

Tendinopathy is associated to which antibiotic class? Which is the most commonly affected tendon?

A

fluoroquinolones; Achilles

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53
Q

What is the preferred site for an emergency airway?

A

The cricothyroid membrane, directly above the cricoid cartilage.

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54
Q

What nerve is injured inape hand deformity? Where is there likely to be sensory loss with ape hand deformity?

A

Median nerve; The palmer aspect of the thumb, 2nd, 3rd, and the lateral half of the 4th digit.

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55
Q

What is the most common risk factor for a frozen shoulder?

A

Diabetes mellitus is the most common risk factor, it usually affects patients between the ages of 40 and 60.

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56
Q

Why do you use surgical excision over rubber band ligation in the removal of thrombosed external hemorrhoid?

A

Rubber band ligation of an external hemmerhoid would be incredibly painful

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57
Q

What does the Lachman test diagnose?

A

Anterior cruciate ligament tears

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58
Q

What is the most common type of meniscal tear?

A

The lateral meniscus is mobile whereas the medial meniscus is more fixed. Therefore medial meniscus tears are more common.

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59
Q

Lateral epicondylitis, A.K.A _______, is the most common overuse syndrome and is caused by excessive ________.

A

Tennis elbow; excessive wrist extension

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60
Q

Medial epicondylitis, A.K.A _______, is the most common overuse syndrome and is caused by excessive ________.

A

golfers elbow; excessive wrist flexion

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61
Q

What is a Courvoissier sign?

A

Courvoissier’s law/sign stated that in the presence of jaundice, a palpable gall bladder is unlikely to be caused by gallstones. Usually caused by a neoplastic stricture obstructing the CBD.

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62
Q

What neurovascular structure is most likely to be damaged in a midhumeral shaft fracture with displacement?

A

Radial Nerve

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63
Q

What is the management of a stress fracture of the foot?

A

Most commonly affects the second metatarsal, the management involves ice, acetominaphen, and cessation of the offending activity.

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64
Q

What is the most common cause and most commonly affected vein in varicose veins?

A

incompetent valves; greater saphenous veins

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65
Q

What is the most serious complication of a slipped capital femoral epiphysis? Others?

A

Most serious: Avascular necrosis

Chondrolysis, Residual proximal fermoral deformity, osteomyelitis, pathologic fracture

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66
Q

If a CT scan does not show a pancreatic tumor when investigating malignancy, what test should be ordered next?

A

ERCP (endoscopic retrograde cholangiopancreatography)

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67
Q

DDx of traumatic chest injury.

A
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68
Q

What is the most common post surgical complication for a man who has a transurethral resection performed for his BPH

A

Retrograde ejaculation: Ejaculation back into the bladder instead of down the penis

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69
Q

What is the first step of management in a suspected melanoma? Second?

A

The first step is an excisional biopsy with 1mm margins.

Wide excision with or without node biopsy is indicated depending on the results of the biopsy

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70
Q

What is the most common cause of visual impairment after a cataract surgery?

A

Cystoid macular edema. (typically improves over time)

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71
Q

What are the indications for radiography following a suspected c-spine injury?

A
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72
Q

What is the classic presentation of plantar fascitis?

A

Pain in the medial heel that is worse with the first few steps in the morning. The pain is usually insidious without a history of acute trauma.

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73
Q

What is the initial treatment for non-inflammatory osteoarthritis?

A

Oral and topical NSAIDs

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74
Q

In which layer of the aorta does a tear most commonly occur?

A

Intima

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75
Q

What is the difference between a type and a type b aortic dissection?

A

Type a: Ascending aorta is affected. Type b: descending aorta is affected.

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76
Q

What is the most significant risk factor for an aortic dissection?

A
  1. Hypertension (uncontrolled)

Less common:

Marfan’s & Elhner danlos

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77
Q

What is the difference in treatment of Type A and Type B aortic dissections?

A

Type A: (ascending aorta) Surgery always indicated if dissection involves proximal aorta

Type B: (descending) Beta-blockers (labetalol and metroprolol)

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78
Q

What are the indications for urgent surgery in a patient with ulcerative colitis?

A
  • Toxic megacolon refractory to medical management (acute segmental or total dilatation of the colon)
  • Fulminant attack refractory to medical management
  • Uncontrolled (massive) colonic bleeding
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79
Q

Which part of the duodenum is most prone to injury from blunt abdominal trauma?

A

The second part of the duodenum is the least mobile and retroperitoneal. This puts it at risk for getting crushed between a vertebra and blunt object like a seatbelt. Therefore, it is more likely to get inured in blunt abdoninal trauma. (only 10-20% of blunt abdominal trauma result in duodenal injury)

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80
Q

When should you do with patient on aspirin to prevent perioperative bleeing for non-cardia surgery? Cardia Surgery?

A

For non-cardiac surgery; aspirin should be discontinued 3-5 days prior to surgery

For cardiac surgery; continue aspirin (like CABG)

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81
Q

What are the tests used to evaluate a suspected Achilles tendon rupture?

A
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82
Q

Describe the Ottawa Ankle and Ottawa foot rules for preventing unnecessary radiographs when evaluating an ankle injury.

A
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83
Q

Scapular winging results from injury to which nerve?

A

Long thoracic nerve

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84
Q

Which muscle is affected when a patient presents with scapular winging?

A

Serratus Anterior muscle

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85
Q

What is the treatment of choice for patient with acute cholecystitis?

A

Surgery; cholesystectomy

95% of patients with acute cholecystitis have cholelithiasis.

86
Q

What is the first step in managing hypertrophic pyloric stenosis?

A

The first step is hospital admission in order to treat fluid, electrolyte, acid-bace inbalances.

87
Q

What is the Hawkins Maneuver and what does it assess?

A

The hawkins maneuver involved flexing the patients elbow to 90* then internally rotating the shoulder. Pain with this maneuver signifies subacromial impingement, including rotator cuff tendinopathy or tear.

88
Q

What is the management of a vertebral compression fracture?

A

Managed conservatively with decreased activity until the pain is tolerable.

Surgery is indicated if there is a neurological impairment or radiographic evidence of instability.

Verteroplasty is an option when the pain hasnt improved in 2 weeks.

89
Q

what size stone requires surgical removal in urolithiasis?

A

stones that are 5-6mm and smaller will likely pass on their own with medical management (hospitalization for rehydration and analgesia). Stones larger that 5-6mm in diameter might not pass on their own and are likely to require surgical intervention.

90
Q

Describe malignant hyperthermia.

A
91
Q

What causes myglobinurea?

A
  • during states of muscle destruction, myoglobin can be released into the blood stream causing an increased protein level in urine.
  • high levels of myglobinurea can lead to renal failure
92
Q

What does rhabdomyolysis cause to increase in the urine?

A

myoglobin.

93
Q

What are the symptoms of myglobinurea?

A
  • swollen and painful muscles.
  • myalgias
  • dark red/brown urine/burgandy
    *
94
Q

what is used to diagnose myoglibinurea?

A
  1. diptick look for blood –> need to differenciate between myoglobin or hemoglobin
  2. Centrifuge urine; if myoglobin, urine will be clear. if a lot of hemoglobin, it will be pink or red)
95
Q

How do you treat myglobinurea?

A

agressive hydration with normal saline. Goal: diuresis. You want to prevent the myglobin from depositing in the kidney.

Mannitol can be used for diuresis.

96
Q

What is the first step of management of a testicular tumor?

A

Refer to surgery. Never biopsy a suspicious testicular mass.

97
Q

Cyclic changes of breast lump size point towards what etiology?

A

fibrocystic changes are most likely due to fluctuating hormone levels . The next step is to determine if they are truely cystic or solid which can be done with ultasound.

98
Q

What is femoroacetabular impingement?

A
99
Q

What is the most common benign tumor?

A

Lipoma

  • Lpomas can arise in any connective tissue but are most commonly in subcutaneous fat.
    *
100
Q

what are some features that point to UC instead of Crohn’s?

A
  • Virtually all pateints with UC have rectal involvement. (Variable involvement of the rectum in Crohns)
  • Toxic megacolon is more commonly associated to US
  • non-continuous and transmural involvement is more commonly associated to Crohn’s
  • Fistula formation commonly occurs in Crohn’s
101
Q

How do you differenciate a corneal abraison from a ocular forgein body?

A

fluorescein test will be positive in a corneal abraison.

102
Q

sigmoidoscopy of the lower colon is recommended to start at what age?

A

at age 50

103
Q

Which age group of people most commonly experience fractures of the proximal humerous?

A

the elderly. due to increased fall risk and increased incidence of osteoporosis

104
Q

which secondary injuries can occur as a result of a fracture of the proximal humerous? (anatomical)

A
105
Q

What are the DSM-V criteria for delirium?

A
106
Q

How do you manage a prolactinoma?

A
107
Q

Describe the classification and treatment of internal hemorrhoids?

A
108
Q

what is the most feared complication of rubbard band ligation of internal hemorrhoids?

A

Necrotizing pelvic sepsis.

109
Q

What is the Kehr’s sign?

A
110
Q

What is used to determine the presence and location of intraabdominal bleeding in trauma patients?

A
  • The FAST technique; Focused Abdominal Sonographic Technique.
  • Can be performed safely and used to determine the presence of intraabdominal bleeding –> the need for surgical intervention
111
Q

Which nerve injury is most commonly associated to a fracture of the proximal humerous?

A
  1. The axillary nerve (decrease in sensation over the deltoid muscle)
  2. suprascapular nerve (supraspinatus and infraspinatus muscles)
112
Q

What is the treatment of a frozen shoulder? (adhesive capsulitis)

A

NSAIDs, Subacromial cortisone injection, and physical therapy

113
Q

What is the differenciating feature of leg bain caused by peripheral arterial disease and lag pain caused by spinal stenosis?

A
114
Q

What type of knee dislocation is associated to hyperextension of the knee? What is the most important complication to be aware of?

A
115
Q

What is the most common cause of heel pain in the geriatric population?

A

plantar fasciitis (or plantar fasciosis), which happens as a result of wear and tear on the plantar fascia (or arch of the foot), degeneration of the heel fat pad, overuse, or inflammation.

116
Q

Which pateints require radiographic imaging of the ankle after an injury according to the Ottawa Ankle Rules?

A
117
Q

How do you reduce a Colle’s Fracture?

A
118
Q

Why is terazosin used in the management of BPH?

A

It is an alpha adrenergic blocker that relaxes the muscles of the prostate and opening of the bladder.

119
Q

What is the most common complication of a scaphoid fracture?

A

Avascular necrosis (more common with fractures of the proximal scaphoid)

120
Q

What is the gold standard imaging technique for evaluating urethral injury?

A

Retrograde urethrography; (most pelving injuries from MVAs result in damage to tnhe posterior urethra)

121
Q

What is the first line investigation for a zenker’s diverticulum?

A

Barium swallow.

122
Q

What are the clinical feature of cauda equina syndrome?

A
123
Q

Which test is used to diagnose De Quarvain Tendinopathy?

A

Finklestein test; Passive ulnar deviation of the wrist, with the thumb held flexed in the palm. Tension on the tendons of the first extensor compartment creates pain over the radial styloid.

124
Q

Describe De Quarvain Tendinopathy.

A
125
Q

Preoperative antibiotics should be given within what time frame?

A

Within 1 hour prior to surgery.

126
Q

What are the features of hypertrophic pyloric stenosis? Investigations? Treatment?

A
127
Q

What is autonomic hyperreflexia?

A
128
Q

What is a late complication of epi dural hematomas?

A

Dural arteriovenous fistulas

129
Q

What can be done to decrease the liklelyhood of causing contrast-related nephropathy?

A

IV isotonic fluids prior to, and continued for several hours after the procedure.

130
Q

What can be done to prevent the recurrence of calcium oxalate kidney stones?

A
  • A high calcium diet (the proportion of oxalate absorption is negatively correlated with calcium intake. More calcium, less oxalate absorption)
  • Low fat intake. Fat competes with oxalate to bind to calcium. More fat = less circulating calcium to bind to oxalate.
  • Citrate ingestion reduced stone-formaing capacity of kidneys.
131
Q

What is the management for a suspected radial head sublaxation?

A

attempt a manual reduction using the suppination-flexion technique or the hyperpronation techinque

132
Q

What is a buckle fracture? what is the treatment of choice?

A
133
Q

What is the role of gabexate mesilate in pancreatitis?

A
134
Q

What does an AST/ALT >2 indicate?

A

An AST/ALT ratio of 2.0 or higher or ALT level exceeding 300 U/L may be indicative of alcoholic liver disease. However, the AST/ALT ratio is usually 1.0 or less in nonalcoholic fatty liver disease

135
Q

What is a Lisfranc injury?

A
136
Q

What is the treatment for asymptomatic epidermoid cysts? symptomatic?

A

Asymotomatic cysts do not require intervention. Counselling to wait for spontaneous resolution is appropriate.

For symtomatic cysts, incision an drainage with triamcinolone injection is the preferred treatment

137
Q

What is the most common and first sign of appendicitis?

A

Abdominal pain, nausea and vomitting usually occur after the onset of pain. Fever and leukocytosis follow later in the disease course.

138
Q

How is the diagnosis of brain death made?

A
139
Q

Which immunosupressive medication can have the side effect of lowering WBC and platelet count?

A

Azathioprine; this can result in increased risk of infections. This effect is reveresed when the dose is decresed or temporarily discontinued.

140
Q

What is the routine post operative immunosuppresive regimen for a kidney transplant patient?

What are their side effects?

A

Cyclosporins, azathioprine, steroids

  • Cyclosporins: nephrotoxic, and usually withheld in the postoperative period until creatnine levels return to normal.
  • Azathioprine: Decrese in WBC count a platelet levels (leading to increased risk of infection)
  • Steiods; side effects include endocrine disorders like Cushings, diabetes, and poor wound-healing.
141
Q

What is the management of brain metastases by squamous cell carcinoma of the lung?

A
142
Q

What does a fibroadenoma look like in mammography?

A
  • Larger than malignant calcification
  • round with smooth margins
  • Regional, scattered and diffuse

large and course popcorn type calcifications indicate a fibroadenoma.

143
Q

What is the investigation of a thyroid nodule?

A

If the patient has normal TSH, the thyroid nodule should be biopsied (FNA) and visualized with US. If TSH is suppressed, patients should be evaluated with a radionucleide thyroid scan (increased isotope uptake “hot” almost never malignant)

144
Q

Which is the first cranial nerve to be affected in an epidural hematoma?

A

CNIII.

The resultant unopposed trochlear and abducens nerve result in the eye being in a down and out position

145
Q

What is the most common complication of a Roux-En-Y gastric bypass?

A

Iron and vitamin b12 defficiency

146
Q

What aortic area is an indication for aortic valve replacement?

A

aortic areas of less that 0.7cm should be replaced.

147
Q

What is a Virchow’s node?

A

It is the site of Virchow’s metastasis for gastric cancer. It is a left sided supraclavicular adneopathy that suggests abdominal malignancy (gastric, gallbladder, pancreas, kidneys, testes, ovaries or prostate) By the time the cancer presents with a Virchows node it is already in its late stages.

148
Q

What is the main symptom of post-cardiac surgery depression?

A
149
Q

What is sclerotherapy? When is it used?

A
150
Q

What complication of sclerotherapy is shown in the image below?

A

Superficial thrombophlebitis

151
Q

Increased pain with lumbar spine extension is most consistent with which diagnosis?

A

lumbar spinal strenosis.

152
Q

Some epidermoid cysts have been known to develop into what?

A

Squamous cell carcinoma

153
Q

How are hemmorhoids categorized? Treatment?

A
154
Q

What effect does choledocholithiasis have on bilirubin.

A

Markedly increased direct (conjugated) bilirubin. The increase in direct bili will be more significant than an increase of indirect bili

155
Q

Where is the location of a direct inguinal hernia?

A
156
Q

What is the difference between direct and indiract inguinal hernias?

A
  • Indirect: Abdominal contents protrude through the deep ingunal ring. Lateral to the inferior epigastric vessels.
  • Direct:Protrudes through the abdominal wall. Medial to the inferior epigastric vessels
157
Q

What is the end stage of chronic reflux esophagitis? How does it present?

A

Peptic strictures.

158
Q

What are the 3 main causes of hypotension in trauma patients? How is this managed?

A
159
Q

Which surgeries carry the highest risk of perioperative myocardial ischemia?

A

Aortic and peripheral vascular procedures. Especially if the patient is over the age of 75.

160
Q

What can be done to prevent post-op thromboembolism in a patient with a history of post-op VTE?

A
161
Q

What are the major and minor risk factors for developing osteoporosis?

A
162
Q

What are the most commonly seen fractures in osteoporosis?

A
163
Q

Which muscles comprise the rotator cuff? how are they tested when a tear is suspected?

A
164
Q

What is the management ofa suspected acute mesenteric ischemia?

A

exploratory laparotomy

165
Q

What is the most common neoplasm of the thyroid?

A

Follicular adenoma. (decreased TSH, increased T4)

166
Q

What effect does Estrogen receptor and Her-2 status have on breast cancer prognosis?

A

Estrogen receptor positive: more favorable prognosis

Her-2 receptor positive: less favorable because of aggressive nature of tumor.

167
Q

How are post surgical adhesions that lead to small bowel obstruction managed?

A
168
Q

What is the most effective treatment for De Quervain Tendinopathy?

A

Local corticosteroid injection

169
Q

What is the mechanism of action for sulphasalazine in Ulcerative Colitis?

A
170
Q

What is the difference in presentation between a tibial stress fracture and tibial stress syndrome?

A
171
Q

How are femoral neck fractures and intertrochanteric fractures managed?

A
172
Q

What is the best treatment option for an elderly patient with a hammer toe deformity?

A
173
Q

What causes a hammer-toe deformity?

A
174
Q

How is Tennis Elbow diagnosed and treated?

A
  • Diagnosed: History and physical exam
  • Treated: Activity modification, bracing, NSAIDs, physical therapy
175
Q

When is angiography used in the diagnosis of acute lower GI bleeding?

A
176
Q

What is the management of Delerium tremens?

A

IM lorazepam

The management is lorazepam (benzodiazepines). Diazepam (not as good IM as Lorazepam) and chlordiazepoxide can be used. Nutritional status can be corrected with thiamine and magnesium.

177
Q

What are the 4 stages (and symptoms) of alcohol withdrawal?

A

With delerium tremens, the patient can spike a fever.

178
Q

Which symptom of alcohol withdrawal occurs only with delerium tremens?

A

fever

179
Q

How are renal transplants monitored in the post-op phase?

A
180
Q

What are the absolute and relative contraindications to diagnostic laparoscopy?

A
181
Q

How is acute hepatitis differenciated from acute cholangitis?

A
  • acute hepatits usually presents as mild right upper quadrant pain, nausea, anorexia and a low-grade fever. However, serum alanine aminotransferase and aspartate aminotransferase will be markerdly elevated.
  • Acute cholangitis will present with elevated bilirubin and alkaline phosphatase
182
Q

What is the indication for surgical intervention of a mallet finger?

A
183
Q

How is proctalgia fugax diagnosed?

A
184
Q

What fluid ressucitation should be administered to a pateint with a splenic rupture?

A
185
Q

What causes gamekeeper’s thumb (skier’s thumb)?

A
186
Q

Describe De Quarvain tendinopathy.

A
187
Q

What is most predictive of increased peri operative cardiovascular events in non-cardiac surgery?

A
188
Q

How do you assess for motor injury to the median nerve?

A
189
Q

How is a non-displaced rib fracture managed?

A
190
Q

What kind of testicular tumor carries the worst prognosis?

A
191
Q

Which manoeuvre is used to assess the integrity of the ulnar nerve?

A
192
Q

Whats is Purtscher-like retinopathy?

A
193
Q

What is bull’s eye retinopathy?

A
194
Q

What is Central Serous Retinopathy?

A
195
Q

Which surgical approach to repairing a blow-out fracture is most likely to result in ectropion?

A
196
Q

What are the sources of vitamin k?

A

Two sources: Exogenous (from food) and Endogenous (production from colonic bacteria)

197
Q

What does the coagulation profile look like in a patient with Vit K deficiency?

A

Usually shows prolongation of PT followed by prolongation of PTT. PT is almost always more elevated than PTT.

198
Q

What are the causes of Vit K deficiency?

A
  • inadequate dietary intake
  • inadequate production by the gut
  • Medications such as coumadin
    • Interferes with the synthesis of Vit K dependant clotting factors
199
Q

What are the Vit K dependant coagulation factors?

A

Factor 2, 7, 9, 10

200
Q

What are the symtoms of Vit K deficiency?

A

Bleeding (epistaxis, GI, Intracranial beeling) and echymosis

201
Q

How is Vit K deficiency diagnosed?

A
  • Low Vit K level,
  • increased PT and INR
202
Q

What is a Monteggia fracture?

A
203
Q

What are the characteristics of Multiple Endocrine Neoplasia type 1?

A
204
Q

What is Reynolds Pentad?

A
205
Q

What is the most common location for internal hemmerhoids?

A
206
Q

The tumor marker Cancer Antigen 27-29 (CA 27-29) is elevated in which cancer?

A

CA 27-29 are elevated in breast cancer. It is elevated in 33% of early stage cancers and 66% of late stage.

207
Q

The tumor marker Cancer Antigen 125 (CA 125) is elevated in which cancer?

A

It is elevated in 85% of ovarian cancers and only 50% of early stage ovarian cancer.

208
Q

The tumor marker Alpha Fetoprotein is elevated in which cancer?

A

it is a marker for hepatocellular carcinoma. Elevated in 80% of hepatocellular carcinoma

209
Q

The tumor marker Carcinoembryonic antigen (CEA) is elevated in which cancer?

A

Colon, esophageal and hepatic cancers.

210
Q
A

MCCQE1: Surgery (1 decks)

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