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Rizk Review > Surgery > Flashcards

Surgery Flashcards

1
Q

Best treatment for patient with subdural hematoma without midline shift?

A

Hyperventilation, Diuretics, Fluid restriction

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2
Q

Post-traumatic HA is more common in patients with HX of …

A

Depression

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3
Q

NML intracranial pressure?

A

< 15

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4
Q

When do symptoms of elevated intracranial pressure develop?

A

> 20

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5
Q

Which CN is most commonly affected by elevated intracranial pressure?

A

CN 6

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6
Q

Why is CN 6 most commonly affected by elevated intracranial pressure?

A

Long intracranial course

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7
Q

DOC for prevention of cerebral vascular spasm following SAH?

A

Nimodipine

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8
Q

Zone 1 of neck trauma?

A

Thoracic outlet&raquo_space; Cricoid cartilage

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9
Q

Zone 2 of neck trauma?

A

Cricoid cartilage&raquo_space; Angle of mandible

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10
Q

Zone 3 of neck trauma?

A

Angle of mandible&raquo_space; Skull base

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11
Q

Best management of neck trauma to Zone 1?

A

Conservative

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12
Q

Best management of neck trauma to Zone 2?

A

Surgical

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13
Q

Best management of neck trauma to Zone 3?

A

Conservative

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14
Q

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?

A

Simple PNX

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15
Q

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?

A

CXR + chest tube placement

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16
Q

Which tendon flexes the DIP?

A

Flexor digitorum profundus

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17
Q

Which tendon flexes the PIP?

A

Flexor digitorum superficialis

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18
Q

Which muscles flex the MCP joints?

A

Lumbricals + interossei

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19
Q

Most common fatal complications of acute compartment syndrome?

A

Rhabdomyolysis, Renal failure

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20
Q

Best next step of management for patient who sustains 3rd degree burn?

A

Monitor peripheral pulses and capillary refill

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21
Q

According to Rule of 9s – surface area of head?

A

9%

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22
Q

According to Rule of 9s – surface area of each arm?

A

9%

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23
Q

According to Rule of 9s – surface area of each leg?

A

18%

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24
Q

According to Rule of 9s – surface area of anterior torso?

A

18%

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25
Q

According to Rule of 9s – surface area of posterior torso?

A

18%

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26
Q

According to Rule of 9s – surface area of perineum?

A

1%

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27
Q

Parkland formula?

A

(4 mL) * (% of body surface) * (kg)

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28
Q

How quickly should fluid be replaced in Parkland formula?

A

Half of fluid in first 8 hours; Half of fluid in first 16 hours

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29
Q

6 criteria for transferring burn patients to burn center?

A

Electric burn, Respiratory injury, Circumferential burn, Genital + Face involvement. Partial thickness > 10%, Full thickness > 5%

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30
Q

Etiology of J waves on EKG?

A

Hypothermia

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31
Q

Appearance of J waves on EKG?

A

Camel’s hump following QRS complex in V2-V6

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32
Q

Which 2 post-exposure prophylactic vaccines should be given to patients after sexual assault?

A

HIV, Hepatitis B

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33
Q

Best treatment for black widow spider bite?

A

Antivenin

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34
Q

Diagnostic test for Pseudotumor Cerebri?

A

Head CT or MRI … (to rule out other cause of elevated ICP)

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35
Q

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)?

A

Central Retinal Artery Occlusion

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36
Q

Next step in CRAO?

A

Carotid Duplex US

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37
Q

Quality of vision loss in CRAO?

A

Painless vision loss

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38
Q

Difference between CRAO and Retinal Vein Occlusion?

A

RVO = polycythemia (causing vein thrombosis), fundoscopy also looks much angrier than CRAO train-tracking

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39
Q

Clinical presentation of retinal detachment?

A

Brief flashes of light in peripheral eye fields + floaters + night shade

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40
Q

Next step of management for retinal detachment?

A

Urgent ophthalmology consult

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41
Q

59 yo female presents for HTN follow-up; Reports blurry vision R>L; Fundoscopic exam shows increased optic disk ratio – diagnosis?

A

Glaucoma

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42
Q

Which type of glaucoma is associated with painful red eye?

A

Closed angle

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43
Q

Appearance of macular degeneration on fundoscopic exam?

A

Yellow drusen spots

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44
Q

Pattern of vision loss in macular degeneration?

A

Loss of CENTRAL vision

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45
Q

Painful sudden vision loss that presents with decreased red reflex?

A

Endophthalmitis

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46
Q

Painful sudden vision loss that presents with NML red reflex?

A

Retrobulbar neuritis

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47
Q

Condition associated with Retrobulbar neuritis?

A

MS

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48
Q

26 yo HIV patient presents with floaters in visual therapy; CD4 count is 26 – diagnosis?

A

CMV retinitis

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49
Q

Most common ocular infection in HIV patients?

A

CMV retinitis

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50
Q

CD4 count associated with increased risk for CMV retinitis?

A

CD4 < 50

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51
Q

45 yo male presents with unilateral ocular pain, redness, vomiting; Reports blurry vision with halos around lights – diagnosis?

A

Closed angle glaucoma

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52
Q

Most common ocular manifestation of RA?

A

Scleritis

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53
Q

38 yo male presents with personality changes, jaundice, joint pain; PE shows Kiser-Fleischer ring – diagnosis?

A

Wilson Disease

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54
Q

Inheritance pattern of Wilson Disease?

A

AR

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55
Q

Value of D-penicillamine in treatment of Wilson Disease?

A

Increases excretion of copper in urine

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56
Q

Value of zinc in treatment of Wilson Disease?

A

Inhibits intestinal copper absorption

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57
Q

Colles fracture affects which bone?

A

Radius

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58
Q

Direction of distal radius displacement in Colles fracture?

A

Dorsal

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59
Q

Best management of suspected scaphoid fracture, even if initial XR shows no fracture?

A

Casting

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60
Q

Boxer’s fracture affects which bone?

A

5th metacarpal

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61
Q

Alternate name for Tennis elbow?

A

Lateral epicondylitis

62
Q

Alternate name for Golfers elbow?

A

Medial epicondylitis

63
Q

Which nerve is typically injured during anterior should dislocation?

A

Axillary nerve

64
Q

Motion of proximal fragment during clavicle fracture?

A

Upward

65
Q

Motion of distal fragment during clavicle fracture?

A

Downward

66
Q

Motion of leg after femoral head fracture?

A

ER

67
Q

Terrible triad of lateral knee injury?

A

ACL, MCL, Lateral meniscus

68
Q

Best test for suspected trauma to Terrible Triad?

A

MRI

69
Q

Most common medial meniscus injury?

A

Bucket handle tear

70
Q

PE finding for medial meniscus tear?

A

Knee locking with extension

71
Q

Description of Lachman Test?

A

Knee flexion to 30° … Leg is pulled forward … Increased displacement of patient’s knee

72
Q

Typical event leading to PCL tear?

A

Dashboard injury

73
Q

Description of Pott’s Fracture?

A

Transverse avulsion of medial malleolus

74
Q

What accounts for medial malleolus damage in Pott’s Fracture?

A

Strength of medial (deltoid) ligament

75
Q

Event that leads to Pott’s Fracture?

A

Severe foot eversion

76
Q

Addition fracture that affects Pott’s Fracture?

A

Oblique fibula fracture

77
Q

2 benign bone tumors?

A

Osteochondroma, Giant cell tumor

78
Q

Most common benign bone tumor?

A

Osteochondroma

79
Q

Complication of Osteochondroma?

A

Chondrosarcoma

80
Q

Classic XR appearance of Giant cell tumor?

A

Soap bubble appearance in epiphysis

81
Q

3 malignant bone tumors?

A

Osteosarcoma

82
Q

Location of Osteosarcoma in bone?

A

Metaphysis

83
Q

4 RFs for development of Osteosarcoma?

A

Fibrous dysplasia, Paget’s disease, Familial retinoblastoma, Bone radiation

84
Q

2 characteristics of Osteosarcoma on XR?

A

Sunburst appearance; Periosteal elevation

85
Q

3 most common sites of metastasis for Osteosarcoma?

A

Brain, Lung, Liver

86
Q

Lab result associated with Osteosarcoma?

A

Elevated alkaline phosphatase

87
Q

Location of bones affected by Chondrosarcoma?

A

Pelvic bones, Proximal femur

88
Q

Appearance of Ewing Sarcoma on XR?

A

Onion skinning + Lytic lesions

89
Q

Bone location of Ewing Sarcoma?

A

Medulla of long bones

90
Q

Histologic appearance of Ewing Sarcoma?

A

Pseudorosettes

91
Q

Spinal roots affected by Erb’s Palsy?

A

C5-C6

92
Q

Clinical presentation of Erb’s Palsy?

A

Intact grip strength; Upper arm is IR + Extended

93
Q

2 nerves affected by Erb’s Palsy?

A

Musculocutaneous, Axillary

94
Q

Which 2 muscles undergo atrophy in setting of Erb’s Palsy?

A

Brachialis, Deltoid

95
Q

Spinal roots affected by Klumpke’s Palsy?

A

C8-T1

96
Q

How can you distinguish Klumpke’s Palsy from Erb’s Palsy?

A

Klumpke = diminished grip strength; Erb = intact grip strength

97
Q

Patient presents with inability to oppose thumb + weak wrist flexion – which nerve was damage?

A

Median nerve

98
Q

Which 2 arteries are likely injured during surgical neck fracture?

A

Anterior + posterior circumflex humeral arteries

99
Q

2 motions completed by Median nerve?

A

Thumb opposition, Wrist flexion

100
Q

Which nerve + vessel run in the radial groove of humerus?

A

Radial nerve + Deep brachial artery

101
Q

Hand motion completed by radial nerve?

A

Wrist dorsiflexion

102
Q

Spinal roots of long thoracic nerve?

A

C5-C6-C7

103
Q

Clinical presentation of damage to long thoracic nerve?

A

Winged scapula

104
Q

Event that may lead to damage to long thoracic nerve?

A

Mastectomy

105
Q

3 muscles that are innervated by musculocutaneous nerve?

A

Biceps brachii, Brachialis, Coracobrachialis

106
Q

2 actions completed by musculocutaneous nerve?

A

Elbow flexion, Forearm supination

107
Q

Event that leads to ulnar nerve damage?

A

Injury to medial epicondyle of humerus

108
Q

2 systemic conditions that may lead to Carpal Tunnel Syndrome?

A

Pregnancy, Hypothyroidism, Acromegaly, Hemodialysis

109
Q

Deposition of ___ results in Carpal Tunnel Syndrome

A

b2 microglobulin

110
Q

b2 microglobulin is a component of …

A

Amyloid

111
Q

Which nerves are associated with development of foot drop?

A

Common fibular nerve; L5 radiculopathy

112
Q

How can you distinguish between L5 radiculopathy causing foot drop vs. Common fibular nerve causing foot drop?

A

L5 = BOTH inversion + eversion lost; Common Fibular Nerve = inversion intact, eversion lost

113
Q

Spinal roots associated with pudendal nerve?

A

S2-S3-S4

114
Q

Which structure does the pudendal nerve run with through the greater sciatic foramen?

A

Pudendal artery

115
Q

Value of pudendal nerve block during labor?

A

Decreased perineal pain; No effect on contraction pain

116
Q

Best strategy for obtaining tissue for diagnosis of testicular CA?

A

Radical inguinal orchiectomy

117
Q

Most common LNs involved in metastasis of testicular CA?

A

Para-aortic

118
Q

Location of Para-aortic LNs?

A

Retroperitoneal

119
Q

Skin of scrotum drains into which LN … (significant if you do a trans-scrotal biopsy)?

A

Superficial Inguinal LN

120
Q

Which type of testicular CA presents with elevated AFP?

A

Non-Seminoma

121
Q

3 types of Non-Seminoma testicular CA?

A

Embryonal, Teratoma, Choriocarcinoma

122
Q

Which type of testicular CA has better prognosis?

A

Seminoma

123
Q

Which tumor marker may be present in seminomatous testicular CA?

A

b-HCG

124
Q

Treatment of stage 1 seminoma?

A

Radiation

125
Q

Treatment of stage 1 non-seminoma?

A

Observation

126
Q

Treatment of stage 2 seminoma?

A

Radiation

127
Q

Treatment of stage 2 non-seminoma?

A

Chemotherapy

128
Q

Treatment of stage 3 seminoma?

A

Chemotherapy

129
Q

Treatment of stage 3 non-seminoma?

A

Chemotherapy

130
Q

Pathology report shows testicular CA, seminomatous type; Labs show elevated AFP – best management?

A

Treat as non-seminoma

131
Q

Most significant RF for bladder CA?

A

Smoking

132
Q

What type of bladder CA is caused by Schistosoma infection?

A

Squamous Cell Carcinoma

133
Q

Next best step of workup for patient with firm nodule on prostate?

A

TURP

134
Q

What are do factors that do NOT pose a risk for Prostate CA?

A

Smoking, BPH

135
Q

What is the survival benefit of PSA screening?

A

None

136
Q

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?

A

Leuprolide + Flutamide; Orchiectomy

137
Q

MOA of Leuprolide + Flutamide in treatment of asymptomatic metastatic prostate CA?

A

LHRH agonists

138
Q

Distinct odor of Arsenic poisoning?

A

Garlic breath

139
Q

Best treatment for Arsenic poisoning?

A

Dimercaprol

140
Q

Which type of RTA is associated with Fanconi Syndrome?

A

Type 2

141
Q

Etiology of Fanconi Syndrome?

A

Impaired resorption of glucose, uric acid, phosphate, HCO3-

142
Q

Type of peripheral neuropathy associated with Fanconi Syndrome?

A

Wrist drop + Foot drop

143
Q

Best treatment for acute lead poisoning?

A

EDTA

144
Q

Best treatment for iron poisoning?

A

Deferoxamine

145
Q

Oil of Wintergreen contains a high concentration of which toxic substance?

A

Salicylates

146
Q

Which acetaminophen metabolic is responsible for liver toxicity?

A

NAPQI

147
Q

Best treatment of acetaminophen poisoning?

A

N-acetylcysteine … Increases hepatic supply of glutathione

148
Q

Best antidote for benzodiazepine toxicity?

A

Flumazenil

149
Q

Which medication should be avoided in setting of cocaine toxicity?

A

b blockers

150
Q

Which 2 NTs are responsible for development of cocaine addiction?

A

Dopamine, Norepinephrine

Rizk Review (19 decks)

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