Surgery Flashcards
Best treatment for patient with subdural hematoma without midline shift?
Hyperventilation, Diuretics, Fluid restriction
Post-traumatic HA is more common in patients with HX of …
Depression
NML intracranial pressure?
< 15
When do symptoms of elevated intracranial pressure develop?
> 20
Which CN is most commonly affected by elevated intracranial pressure?
CN 6
Why is CN 6 most commonly affected by elevated intracranial pressure?
Long intracranial course
DOC for prevention of cerebral vascular spasm following SAH?
Nimodipine
Zone 1 of neck trauma?
Thoracic outlet»_space; Cricoid cartilage
Zone 2 of neck trauma?
Cricoid cartilage»_space; Angle of mandible
Zone 3 of neck trauma?
Angle of mandible»_space; Skull base
Best management of neck trauma to Zone 1?
Conservative
Best management of neck trauma to Zone 2?
Surgical
Best management of neck trauma to Zone 3?
Conservative
32 yo male presents with R chest pain after MVC; L hemithorax is hyper-resonant to percussion, without breath sounds; Pulse Ox shows O2 sat = 88%; Vitals are otherwise NML - diagnosis?
Simple PNX
32 yo male presents with R chest pain after MVC; L hemithorax is hyper-resonant to percussion, without breath sounds; Pulse Ox shows O2 sat = 88% - best initial treatment?
CXR + chest tube placement
Which tendon flexes the DIP?
Flexor digitorum profundus
Which tendon flexes the PIP?
Flexor digitorum superficialis
Which muscles flex the MCP joints?
Lumbricals + interossei
Most common fatal complications of acute compartment syndrome?
Rhabdomyolysis, Renal failure
Best next step of management for patient who sustains 3rd degree burn?
Monitor peripheral pulses and capillary refill
According to Rule of 9s – surface area of head?
9%
According to Rule of 9s – surface area of each arm?
9%
According to Rule of 9s – surface area of each leg?
18%
According to Rule of 9s – surface area of anterior torso?
18%
According to Rule of 9s – surface area of posterior torso?
18%
According to Rule of 9s – surface area of perineum?
1%
Parkland formula?
(4 mL) * (% of body surface) * (kg)
How quickly should fluid be replaced in Parkland formula?
Half of fluid in first 8 hours; Half of fluid in first 16 hours
6 criteria for transferring burn patients to burn center?
Electric burn, Respiratory injury, Circumferential burn, Genital + Face involvement. Partial thickness > 10%, Full thickness > 5%
Etiology of J waves on EKG?
Hypothermia
Appearance of J waves on EKG?
Camel’s hump following QRS complex in V2-V6
Which 2 post-exposure prophylactic vaccines should be given to patients after sexual assault?
HIV, Hepatitis B
Best treatment for black widow spider bite?
Antivenin
Diagnostic test for Pseudotumor Cerebri?
Head CT or MRI … (to rule out other cause of elevated ICP)
70 yo male with T2DM presents with sudden R eye vision loss; Eye exam shows train-tracking of retinal arteries, very pale, except for 1 focal area of redness (cherry red spot)?
Central Retinal Artery Occlusion
Next step in CRAO?
Carotid Duplex US
Quality of vision loss in CRAO?
Painless vision loss
Difference between CRAO and Retinal Vein Occlusion?
RVO = polycythemia (causing vein thrombosis), fundoscopy also looks much angrier than CRAO train-tracking
Clinical presentation of retinal detachment?
Brief flashes of light in peripheral eye fields + floaters + night shade
Next step of management for retinal detachment?
Urgent ophthalmology consult
59 yo female presents for HTN follow-up; Reports blurry vision R>L; Fundoscopic exam shows increased optic disk ratio – diagnosis?
Glaucoma
Which type of glaucoma is associated with painful red eye?
Closed angle
Appearance of macular degeneration on fundoscopic exam?
Yellow drusen spots
Pattern of vision loss in macular degeneration?
Loss of CENTRAL vision
Painful sudden vision loss that presents with decreased red reflex?
Endophthalmitis
Painful sudden vision loss that presents with NML red reflex?
Retrobulbar neuritis
Condition associated with Retrobulbar neuritis?
MS
26 yo HIV patient presents with floaters in visual therapy; CD4 count is 26 – diagnosis?
CMV retinitis
Most common ocular infection in HIV patients?
CMV retinitis
CD4 count associated with increased risk for CMV retinitis?
CD4 < 50
45 yo male presents with unilateral ocular pain, redness, vomiting; Reports blurry vision with halos around lights – diagnosis?
Closed angle glaucoma
Most common ocular manifestation of RA?
Scleritis
38 yo male presents with personality changes, jaundice, joint pain; PE shows Kiser-Fleischer ring – diagnosis?
Wilson Disease
Inheritance pattern of Wilson Disease?
AR
Value of D-penicillamine in treatment of Wilson Disease?
Increases excretion of copper in urine
Value of zinc in treatment of Wilson Disease?
Inhibits intestinal copper absorption
Colles fracture affects which bone?
Radius
Direction of distal radius displacement in Colles fracture?
Dorsal
Best management of suspected scaphoid fracture, even if initial XR shows no fracture?
Casting
Boxer’s fracture affects which bone?
5th metacarpal
Alternate name for Tennis elbow?
Lateral epicondylitis
Alternate name for Golfers elbow?
Medial epicondylitis
Which nerve is typically injured during anterior should dislocation?
Axillary nerve
Motion of proximal fragment during clavicle fracture?
Upward
Motion of distal fragment during clavicle fracture?
Downward
Motion of leg after femoral head fracture?
ER
Terrible triad of lateral knee injury?
ACL, MCL, Lateral meniscus
Best test for suspected trauma to Terrible Triad?
MRI
Most common medial meniscus injury?
Bucket handle tear
PE finding for medial meniscus tear?
Knee locking with extension
Description of Lachman Test?
Knee flexion to 30° … Leg is pulled forward … Increased displacement of patient’s knee
Typical event leading to PCL tear?
Dashboard injury
Description of Pott’s Fracture?
Transverse avulsion of medial malleolus
What accounts for medial malleolus damage in Pott’s Fracture?
Strength of medial (deltoid) ligament
Event that leads to Pott’s Fracture?
Severe foot eversion
Addition fracture that affects Pott’s Fracture?
Oblique fibula fracture
2 benign bone tumors?
Osteochondroma, Giant cell tumor
Most common benign bone tumor?
Osteochondroma
Complication of Osteochondroma?
Chondrosarcoma
Classic XR appearance of Giant cell tumor?
Soap bubble appearance in epiphysis
3 malignant bone tumors?
Osteosarcoma
Location of Osteosarcoma in bone?
Metaphysis
4 RFs for development of Osteosarcoma?
Fibrous dysplasia, Paget’s disease, Familial retinoblastoma, Bone radiation
2 characteristics of Osteosarcoma on XR?
Sunburst appearance; Periosteal elevation
3 most common sites of metastasis for Osteosarcoma?
Brain, Lung, Liver
Lab result associated with Osteosarcoma?
Elevated alkaline phosphatase
Location of bones affected by Chondrosarcoma?
Pelvic bones, Proximal femur
Appearance of Ewing Sarcoma on XR?
Onion skinning + Lytic lesions
Bone location of Ewing Sarcoma?
Medulla of long bones
Histologic appearance of Ewing Sarcoma?
Pseudorosettes
Spinal roots affected by Erb’s Palsy?
C5-C6
Clinical presentation of Erb’s Palsy?
Intact grip strength; Upper arm is IR + Extended
2 nerves affected by Erb’s Palsy?
Musculocutaneous, Axillary
Which 2 muscles undergo atrophy in setting of Erb’s Palsy?
Brachialis, Deltoid
Spinal roots affected by Klumpke’s Palsy?
C8-T1
How can you distinguish Klumpke’s Palsy from Erb’s Palsy?
Klumpke = diminished grip strength; Erb = intact grip strength
Patient presents with inability to oppose thumb + weak wrist flexion – which nerve was damage?
Median nerve
Which 2 arteries are likely injured during surgical neck fracture?
Anterior + posterior circumflex humeral arteries
2 motions completed by Median nerve?
Thumb opposition, Wrist flexion
Which nerve + vessel run in the radial groove of humerus?
Radial nerve + Deep brachial artery
Hand motion completed by radial nerve?
Wrist dorsiflexion
Spinal roots of long thoracic nerve?
C5-C6-C7
Clinical presentation of damage to long thoracic nerve?
Winged scapula
Event that may lead to damage to long thoracic nerve?
Mastectomy
3 muscles that are innervated by musculocutaneous nerve?
Biceps brachii, Brachialis, Coracobrachialis
2 actions completed by musculocutaneous nerve?
Elbow flexion, Forearm supination
Event that leads to ulnar nerve damage?
Injury to medial epicondyle of humerus
2 systemic conditions that may lead to Carpal Tunnel Syndrome?
Pregnancy, Hypothyroidism, Acromegaly, Hemodialysis
Deposition of ___ results in Carpal Tunnel Syndrome
b2 microglobulin
b2 microglobulin is a component of …
Amyloid
Which nerves are associated with development of foot drop?
Common fibular nerve; L5 radiculopathy
How can you distinguish between L5 radiculopathy causing foot drop vs. Common fibular nerve causing foot drop?
L5 = BOTH inversion + eversion lost; Common Fibular Nerve = inversion intact, eversion lost
Spinal roots associated with pudendal nerve?
S2-S3-S4
Which structure does the pudendal nerve run with through the greater sciatic foramen?
Pudendal artery
Value of pudendal nerve block during labor?
Decreased perineal pain; No effect on contraction pain
Best strategy for obtaining tissue for diagnosis of testicular CA?
Radical inguinal orchiectomy
Most common LNs involved in metastasis of testicular CA?
Para-aortic
Location of Para-aortic LNs?
Retroperitoneal
Skin of scrotum drains into which LN … (significant if you do a trans-scrotal biopsy)?
Superficial Inguinal LN
Which type of testicular CA presents with elevated AFP?
Non-Seminoma
3 types of Non-Seminoma testicular CA?
Embryonal, Teratoma, Choriocarcinoma
Which type of testicular CA has better prognosis?
Seminoma
Which tumor marker may be present in seminomatous testicular CA?
b-HCG
Treatment of stage 1 seminoma?
Radiation
Treatment of stage 1 non-seminoma?
Observation
Treatment of stage 2 seminoma?
Radiation
Treatment of stage 2 non-seminoma?
Chemotherapy
Treatment of stage 3 seminoma?
Chemotherapy
Treatment of stage 3 non-seminoma?
Chemotherapy
Pathology report shows testicular CA, seminomatous type; Labs show elevated AFP – best management?
Treat as non-seminoma
Most significant RF for bladder CA?
Smoking
What type of bladder CA is caused by Schistosoma infection?
Squamous Cell Carcinoma
Next best step of workup for patient with firm nodule on prostate?
TURP
What are do factors that do NOT pose a risk for Prostate CA?
Smoking, BPH
What is the survival benefit of PSA screening?
None
69 yo male with PMHX of Prostate CA treated with XRT; PSA today is 12.0, was undetectable about 1 year ago; Bone scan shows multiple mets in T/L spine – what is next best step of management?
Leuprolide + Flutamide; Orchiectomy
MOA of Leuprolide + Flutamide in treatment of asymptomatic metastatic prostate CA?
LHRH agonists
Distinct odor of Arsenic poisoning?
Garlic breath
Best treatment for Arsenic poisoning?
Dimercaprol
Which type of RTA is associated with Fanconi Syndrome?
Type 2
Etiology of Fanconi Syndrome?
Impaired resorption of glucose, uric acid, phosphate, HCO3-
Type of peripheral neuropathy associated with Fanconi Syndrome?
Wrist drop + Foot drop
Best treatment for acute lead poisoning?
EDTA
Best treatment for iron poisoning?
Deferoxamine
Oil of Wintergreen contains a high concentration of which toxic substance?
Salicylates
Which acetaminophen metabolic is responsible for liver toxicity?
NAPQI
Best treatment of acetaminophen poisoning?
N-acetylcysteine … Increases hepatic supply of glutathione
Best antidote for benzodiazepine toxicity?
Flumazenil
Which medication should be avoided in setting of cocaine toxicity?
b blockers
Which 2 NTs are responsible for development of cocaine addiction?
Dopamine, Norepinephrine