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Kaplan Shelf prep > Surgery > Flashcards

Surgery Flashcards

1
Q

________ presents with mid-systolic, crescendo-decrescrendo right 2nd intercostal+ left sternal border

A

Aortic stenosis

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2
Q

Aortic stenosis radiates to _________

A

carotid

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3
Q

______ increases the murmur of aortic stenosis

A

squatting

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4
Q

_______ decreases the murmur of aortic stenosis

A

valsalva

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5
Q

when is the valve replaced in aortic stenosis

A

if symptomatic, gradient > 50 or CHF

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6
Q

________ presents with Holosystolic murmur with click at the apex radiating to axilla

A

mitral regurgitation

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7
Q

Most common cause of mirtal regurgitation

A

MVP (Marfans)

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8
Q

Early peaking systolic ejection murmur increased by Valsalva,
decreased by squatting/handgrip

A

HOCM

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9
Q

if pt with HOCM present with syncope, arrhythmia or FH of HOCM

A

place an Implantable Cardioverter Defibrillator

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10
Q

Acute: young person with endocarditis & sudden CHF with

loud diastolic murmur at right 2nd intercostal space

A

Acute Aortic Regurgitation/Insufficiency

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11
Q

blowing high-pitched diastolic at 2nd intercostal space

+ left lower sternal border assoc’d with wide pulse pressure.

A

Chronic Aortic Regurgitation/Insufficiency

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12
Q

what is the first line treatment of chronic aortic regurgitation

A

medical therapy with vasodilators

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13
Q

Low pitched rumbling diastolic at apex with opening snap

A

mitral stenosis

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14
Q

complication of mitral stenosis

A

atrial fibrillation

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15
Q

extreme drop in platelets + clots in post-op patient who has received
heparin within 5-14 days

A

Heparin Induced Thrombocytopenia

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16
Q

treatment of heparin Induced Thrmbocytopenia includes _________

A

STOP HEPARIN, give lepirudin or argatroban

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17
Q

Lidocaine + epinephrine should not be given in the following places: ______, _______, _______ and _____

A

fingers, nose, penis and toes

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18
Q

A patient takes amlodipine for hypertension. When should

this patient discontinue this medication prior to surgery?

A

Hold morning dose

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19
Q

For how long should an active smoker be told to quit before surgery?

A

8 weeks

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20
Q

why are patients with nephrotic syndrome at increased risk of clotting?

A

loss of antithrombin III in urine

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21
Q

symptoms of malignant hyperthermia

A

high fever (>104 degrees celcius), muscle rigidity, metabolic acidosis, hyperkalemia

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22
Q

treatment of malignant hyperthermia

A

IV dantrolene, 100% oxygen, Cooling blankets, correct acidosis

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23
Q

patient presents with fever less than 24hrs of surgical operation. most likely cause?

A

malignant hyperthermia

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24
Q

patient presents with fever within 24hrs of surgical operation. most likely causes?

A

atelectasis, necrotizing fasciitis

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25
Q

management of atelectasis

A

incentive spirometry, mobilization

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26
Q

symptoms of atelectasis

A

low-grade fever, non productive cough

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27
Q

CXR findings for atelectasis

A

bilateral fluffy lower lobe infiltrates without consolidation

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28
Q

management of necrotizing fasciitis

A

surgical debridement, antibiotics

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29
Q

symptoms of necrotizing fasciitis post operatively

A

high fever, ill, rash

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30
Q

findings for necrotizing fasciitis

A

gas in tissue

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31
Q

post operative fever Day 2-5. Most likely causes?

A

Pneumonia
UTI
Thrombophlebitis

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32
Q

post operative fever Day 7. Most likely causes?

A 
central line infection
cellulitis
wound infection
dehiscence
pulmonary embolus
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33
Q

post operative fever Day 10-15. Most likely cause?

A

abscess

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34
Q

prevention of decubitus (pressure) ulcers

A

change position every two hours

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35
Q

light criteria

A

LDH> 200
LDH effusion/LDH serum > 0.6
Protein effusion/protein serum >0.5

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36
Q

what stage of pressure ulcer- intact skin, red, blanches with pressure

A

Stage 1

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37
Q

what stage of pressure ulcer- break in dermis, blister

A

Stage 2

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38
Q

what stage of pressure ulcer -into subcutaneous tissue and muscle?

A

Stage 3

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39
Q

what stage of pressure ulcer- involvement of bone?

A

Stage 4

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40
Q

what makes an exudative effusion complicated?

A

flank pus, +gram/culture, pH <7.2

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41
Q

diagnostic criteria of ARDS

A
  • PaCO2/ FiO2 < 200 (< 300=acute lung injury)
  • Bilateral alveolar infiltrates
  • PCWP < 18 (Rules out cardiogenic cause of pulmonary edema)
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42
Q

when should 3% Normal saline be used

A

severe hyponatremia (<110), seizures

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43
Q

rapid correction of hyponatremia could lead to ____

A

central pontine myelinosis

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44
Q

rapid correction of hypernatremia could lead to _____

A

cerebral edema

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45
Q

Pain/dysphagia worse with liquids, chest pain, no regurgitation. Suspect?

A

Diffuse esophageal spasm

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46
Q

Confirmatory diagnosis of diffuse esophageal spasm

A

Manometry

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47
Q

Management of diffuse esophageal spasm

A

CCB or nitrates

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48
Q

Barium swallow done at the time of pain showing “corkscrew esophagus” is suspicious of

A

Diffuse esophageal spasm

49
Q

Usually idiopathic, can be associated with Chagas’ disease and patient presents with dysphagia to liquids and solids. Suspect?

A

Achalasia

50
Q

Barium swallow for achalasia shows?

A

Bird’s beak

51
Q

Management of achalasia

A

CCB; Nitrates; Botox; Dilation; heller myotomy

52
Q

Terrible breath, regurgitation of dinner in the morning. Suspect?

A

Zenker diverticulum

False diverticulum, only contains mucosa

53
Q

Progressive dysphagia, weight loos with h/o smoking or alcoholism . Suspect?

A

Squamous cell esophageal carcinoma

54
Q

Progressive dysphagia, weight loos with h/o GERD/ Barrett’s. Suspect?

A

Adenocarcinoma of the esophagus

55
Q

Management of early stage esophageal carcinoma

A

Esophagectomy

56
Q

Management of advanced esophageal carcinoma

A

Chemo + RT and then surgery

57
Q

Management of metastatic esophageal carcinoma

A

Chemotherapy

58
Q

Epigastric pain worse after eating or laying down with h/o hiatal hernia. Suspect?

A

GERD

59
Q

Risk factors for GERD

A 
Hiatal hernia 
Obesity 
Pregnancy 
EtOH/ smoking
Acidic, spicy foods/caffeine
Certain meds
60
Q

Best diagnostic test for GERD

A

24-hr pH monitoring

61
Q

What can be used to treat GERD if incompetent LES or symptoms persists after maximum dose of PPI

A

A Nissen fundoplication

62
Q

Alcoholic presents with bright red blood in emesis after severe vomiting. Suspect?

A

Mallory-Weiss tear

63
Q

To confirm diagnosis of Mallory-Weiss tear do?

A

Endoscopy

64
Q

Hematemesis after vomiting, subcutaneous emphysema, severe pain, fever leukocytosis and ill appearing. Suspect?

A

Boerhaave syndrome

Full thickness esophageal rupture

65
Q

Diagnostic test when you suspect full thickness esophageal rupture

A

Gastrografin swallow

66
Q

Management of boerhaave syndrome

A

Surgical repair

67
Q

Management of varices

A 
Octreotide/SST 
Balloon tamponade
Endoscopic sclerotherapy
Banding
Beta blocker if asymptomatic
68
Q

Risk factors of gastric ulcers

A

H. Pylori
NSAIDS use
Steroids

69
Q

When is the pain from gastric ulcer worse

A

Worse with eating

70
Q

Treatment of H.pylori cause of gastric ulcer

A

Clarithromycin
Amoxicillin/metronidazole
PPI

71
Q

Complications of partial/total gastrectomy

A

Gastric dumping
Pernicious anemia
Fe-deficiency anemia

72
Q

Management of H.pylori gastric lymphoma

A

Treat H.pylori with triple therapy

73
Q

Epigastric pain of duodenal ulcer improves with

A

Eating

74
Q

Management of Duodenal ulcer

A

Triple therapy for 14 days then test for eradication

75
Q

Unremitting peptic ulcers + watery diarrhea. Suspect?

A

Zollinger-Ellison syndrome

76
Q

Diagnostic test for Zollinger-Ellison Syndrome

A

Secretin stimulation test (inappropriately high gastrin)

CT

77
Q

Management of Zollinger-Ellison Syndrome

A

Surgery
Check for MEN syndrome
Omeprazole for metastases

78
Q

Epigastric pain, nausea, vomiting with increased amylase + lipase. Diagnosis?

A

Acute pancreatitis

79
Q

Complications of acute pancreatitis

A 
Pseudo cyst
Hemorrhage 
Abscess 
Sepsis 
ARDS
80
Q

Complication of chronic pancreatitis

A

Splenic vein thrombosis which leads to gastric varices

81
Q

Large, non-tender gallbladder, itching, jaundice - what sign?

A

Courvoiser’s sign of pancreatic cancer

82
Q

Migratory thrombophlebitis- what sign

A

Trousseau’s sign of pancreatic cancer

83
Q

Which endocrine pancreatic tumor presents with malabsorption and steatorrhea

A

Somatostatinoma

84
Q

Complications of gallbladder

A

Rupture
Fistula formation
Gallstone ileus

85
Q

RUQ pain, elevated bilirubin + alkaline phosphatase

Suspect?

A

Choledocholithiasis

86
Q

RUQ pain, fever, jaundice, hypotension, AMS

Suspect?

A

Reynolds pentad

Ascending cholangitis

87
Q

Which hematoma does not cross the suture lines

A

Epidural hematoma

88
Q

Which hematoma shows biconvex lens on non-contrast CT scan

A

Epidural hematoma

89
Q

What vessel is responsible for epidural hematoma?

A

Middle meningeal artery

90
Q

Semilunar, crescent shaped on CT. What hematoma?

A

Subdural hematoma

91
Q

What vessel is responsible for subdural hematoma?

A

Bridging vein

92
Q

Raccoon eyes, CSF rhinorrhea/otorrhea, ecchymosis behind the ear is suggestive of?

A

Basilar skull fracture

93
Q

Management of ICP

A

Elevation of head of bed
Hyperventilating to PCO2 35
Mannitol/ furosemide & avoid excess IVF
Maintain adequate CPP (MAP- ICP)

94
Q

What zone of penetrating neck injury warrants surgical exploration?

A

Zone 2

95
Q

Forced neck hyperextension (whiplash); paralysis & burning pain in the upper extremities. Suspect?

A

Central cord syndrome

96
Q

Vertebral body burst fractures; loss of motor, pain and temperature distal to injury on both sides. Suspect?

A

Anterior cord syndrome

97
Q

Gun shot wounds or stab cutting the cord at one level; paralysis & loss of proprioception distal to injury on the same side; loss of pain & temperature sensation on opposite side. Diagnosis?

A

Brown-Sequard syndrome

98
Q

Flail chest symptom to watch out for

A

Inward movement of chest with inspiration

99
Q

Complication to watch out for with flail chest

A

Aortic transection

100
Q

Management of rib fracture

A

Pain control w/ aggressive respiratory therapy

101
Q

What do you see on CXR 48 hours after for the diagnosis of pulmonary contusion

A

White out of lungs on CXR

102
Q

Difference between pneumothorax and hemothorax

A

Dullness to percussion for hemothorax

103
Q

Difference between tension pneumothorax and hemothorax

A

Trachea deviates toward the side of injury

104
Q

What injuries increases the suspicion of aortic rupture

A
  • scapular
  • 1st rib
  • Sternal fracture
105
Q

How do you intubate a patient with tracheal rupture?

A

Fiber optic bronchoscopy

106
Q

The four spaces FAST exam checks

A

Perihepatic
Perisplenic
Pericardium
Pelvis

107
Q

Next step in a stable patient who had an abdominal trauma

A

CT scan

108
Q

Lower rib + abdominal bleed

A

Splenic/ liver laceration

109
Q

Lower rib fracture + hematuria

A

Kidney laceration

110
Q

Kher sign + viscera in the left thorax on XR

A

Diaphragmatic rupture

111
Q

Handlebar sign

A

Pancreatic rupture

112
Q

Retro peritoneal fluid + epigastric pain

A

Duodenal rupture

113
Q

Seizure/electric burn; arm is internally rotated and addicted on exam. ?

A

Posterior shoulder dislocation

114
Q

Fall on outstretched hand; arm externally rotated and abducted arm

A

Anterior shoulder dislocation

115
Q

Direct blow to proximal ulna, anterior dislocation of radial head

A

Monteggia fracture

116
Q

Direct blow to distal radius, dorsal dislocation of radioulnar joint

A

Galeazzi fracture

117
Q

Shortened and externally rotated leg

A

Hip fracture

118
Q

Parkland formula:

A

kg x BSA% x 4

119
Q

Management of circumferential burns

A

Escharotomy

Kaplan Shelf prep (11 decks)

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