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USMLE STEP 2 CK RETAKE > Surgery > Flashcards

Surgery Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the causes of post-op fever

A

Wind

water

walking

wound

wonder drugs

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2
Q

Wind Post-op Fever

timing and Disease

A

Malignant Hyperthermia, During Surgery

Bacteremia, Right after Surgery

Atlectasis, POD 1

Pneumonia POD 2

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3
Q

Water Post-Op Fever

Disease, Timing

Dx, Tx, PPX

A

UTI, POD 3

U/a, UCx (WBC casts=Pyelonephritis)

Tx: Abx

PPx=take foley out

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4
Q

Walking Post-op Fever

Disease, Timing

Dx, Tx, PPx

A

DVT/PE, POD 5

U/S Bilatleral Lower Extremity

Tx: Heparin to warfarin bridge

PPX: LMWH, Out of bed as soon as possible

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5
Q

Wound Post Op Fever

Disease, Timing

Dx, Tx, PPX

A

Cellulitis, POD 7

  • U/S (-)
  • Tx: Abx
  • PPx: keep it sterile and clean

Abscess, POD 10-14

  • U/S (+) for abscess
  • Tx: Abx and I&D
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6
Q

Malignant Hyperthermia

Timing

Tx, PPx

A

During Surgery

O2, Dantrolene, Cool IVF

Family Hx

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7
Q

Bacteremia

timing

Dx, Tx, PPx

A

Right after Surgery

Dx: Blood Cx

Tx: Broad Spectrum Abx

maintain the sterile Field

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8
Q

Atlectasis

Timing

Dx, Tx, PPx

A

POD 1

Dx: CXR

PPx: spirometry breathing, Out of bed

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9
Q

Pneumonia

Timing

Dx, Tx, PPx

A

POD 2

Dx: CXR

Tx: Broad Spec Abx

PPx: Breathing Spirometry, Out of bed

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10
Q

What is sun downing?

A

AMS in elderly patients after surgery, treat with Atypical antipsychotics

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11
Q

decreased urinary output algorithm after surgery

A
  1. Decreased urinary output
  2. Urge to void
    * Yes

Obstruction, perform Bladder scan or in and out cath

  • No=Renal Failure
    3. Renal failure
    4. Any output?
  • None

Mechanical cause, unkink or irrigate

  • decreased output=Renal Disease
    5. Renal Disease, perform 500cc Bolus
  • increase output
    • volume down status, give IVF
  • no increase=medical disease
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12
Q

Gallstones

Obstructive Jaundice

Presentation

Dx, Tx

A

Presentation

  • Obstructive jaundice
  • increased temp, WBCs
  • positive Murphy
  • painful

Dx

  • RUQ U/S
  • MRCP

Tx

  • ERCP
  • Cholecystectomy
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13
Q

Gallbladder Cancer/Stricture

Obstructive Jaundice

Presentation

Dx, Tx

A

Presentation

  • Painless, No temp or increase in WBCs, negative murphy sign

Dx

  • RUQ U/S
  • MRCP
  • (Massively dilated ducts)

Tx

  • Endoscopic U/S with biopsy
  • ERCP with Biopsy
  • Stenting/Resection
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14
Q

Boorheaves

Presentation

Dx, Tx

A

Presentation

  • “Career Vomiter” ie Bulimia or alcoholic
  • Air in the mediastinum
  • Possible Mediastinitis

Dx

  1. Gastrograffin
  2. Barium Swallow
  3. EGD

Tx

  • Surgery
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15
Q

Small Bowel Obstruction

Presentation

Dx, Tx

A

Presentation

  • Colicky Abdominal pain
  • Abdominal Distention

Dx

  • KUB shows air fluid levels
  • Perform CT scan to determine complete or incomplete

Tx

  • Complete=surgery
  • Incomplete=Watch and wait, NG tube, K+, IVF; No change after three days go to surgery
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16
Q

Pancreatic workup and presentation

A

Presentation

  • Epigastric pain, boring to the back
  • peritoneal
  • nausea/vomiting

Dx Workup

  1. Lipase
  2. CT Scan will show either necortizing Pacreatitis, An Abscess, or Pseudocyst
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17
Q

Psuedocyst

Findings and treatment

A

<6wks old, <6 cm in size

  • Uncomplicated, watch and wait
  • follow up U/S

>6 wks old, > 6 cm in size

  • Complicated
  • Drain
18
Q

Cholelithiasis

Presentation

Dx, Tx

A

Presentation

  • Fat, Forty, Female
  • RUQ colicky abdominal pain
  • Pain radiates to the shoulder
  • Worse with fatty foods

Dx

  • RUQ US=Gallstones

Tx=Cholecystectomy

19
Q

Cholecystits

Presentation

Dx, Tx

A

Presentation

  • Pericholecystic fluid
  • thickened wall
  • gallstones in CBD
  • Constant RUQ pain
  • (+) murphy
  • Signs of inflammation

Dx

  • RUQ US=inflammation, no stones
  • HIDA Scan

Tx

  • NPO, IVF, IV Abx
    • Urgent Cholecystectomy
20
Q

Choledocolithiasis

Presentation

Dx, Tx

A

Presentation

  • Painful Jaundice
  • +/- murphy sign
  • inflammation
  • Possible increase in AST, ALT and Amylase and lipase

Dx

  • RUQ US= Dialted ducts
  • MRCP

Tx

  • NPO, IVF, IV Abx
  • ERCP
  • Cholecystectomy
21
Q

Cholangitis

Presentation

Dx, Tx

A

Ascending infection

Presentation

  • RUQ pain
  • Jaundice
  • fever
  • Hypotension
  • AMS

Dx

  • RUQ US=Obstruction

Tx

  • NPO, IVF, IV Abx
  • Emergent ERCP
  • Cholecystectomy
22
Q

What antibiotics do you use for the gallbladder

A

Ciprofloxacin + MTZ

Ampicillin/Gentamicin + MTZ

23
Q

Ulcerative Colitis

Presentation

Dx, Tx

A

Presentation

  • Affects the superficial mucosa
  • bloody BM and weight loss

Dx

  • Colonoscopy shows continuous inflammation

Tx

  • 8 years after diagnosis screen yearly
  • prophylactic colectomy
24
Q

Hemorrhoids

Presentation

Dx, Tx

A

Presentation

  • Internal-painless bleeding
  • External-Painful no bleeding

Dx

  • Visual Inspection
  • Anoscopy

Tx

  • Internal-banding
  • External-Resection
  • PrepH or a sitz bath
25
Q

Presentation of Obstructive Abdominal pain

A

Colicky in nature

No fever, no leukocytosis ie-cholelithiasis, nephrolithiasis

No Comfortable position

26
Q

Inflammatory abdominal pain presentation

A

Constant pain

Positive fever and leukocytosis

no comfortable position ie- cholecystitis, pyelonephritis

27
Q

Perforated abdominal pain

A

Super sick, constant pain, patient will be motionless

x-ray will show free air

PUD, Cancer, Penetrating trauma

28
Q

Ischemic abdominal pain

A

bloody BM, Sepsis, CAD, A-Fib, Mesenteric ischemia

29
Q

Arterial Insufficiency

Presentation

Dx, Tx

A

Presentation

  • Peripheral vascular disease
  • hairless legs, shiny scaly skin, absent pulses, tips of toes

Dx

  • arterial brachial index
  • US doppler
  • Angiogram

Tx

  • Stent or bypassing
30
Q

Closed Angle Glaucoma

Presentation

Dx, Tx

A

“Pressure with pupil dilation”

Presentation

  • in low light pressure will increase causing pain, headache, rigid eyeball
  • pupil non-reactive

Dx

  • Clinical, ocular pressure

Tx

  • Constrict the pupil
  • alpha-2-agonists
  • beta blockers
31
Q

Retinal Artery Occlusion

Presentation

Dx, Tx

A

Presentation

  • Painless unilateral vision loss
  • no focal neurological deficits
  • Cherry red spot fovea

Tx

  • tPA
  • Hypoventilation
  • Global pressure
32
Q

Basal Cell Ca

Presentation

Dx, Tx

A

Presentation

  • Pearly lesion
  • sun exposed areas
  • Fails to heal, and bleeds

Dx

  • Excisional Biopsy

Tx

  • Face=mohs
  • Limb (Mild)=excision
  • Limb (Large)=Amputate
33
Q

Squamous Cell Ca

Presentation

Dx, Tx

A

Presentation

  • Well defined red papule
  • ulcer heals and breaks
  • Can metastasize

Dx

  • Excisional Bx

Tx

  • The same as BCC
34
Q

Anterior Brain Tumors

A

Anterior lesions most often affect adults

Meningioma-affects the dura, resection is curative

Glioblastoma-affects the parenchyma, ring-enhancing lesion, bats wing appearance-crosses the midline

35
Q

Posterior brain tumors

A

posterior lesions most often affect kids

Medulloblastoma-seeds arachnoid space, distal lesion, resection and radiation

Ependymoma-4th ventricle lesion, obstructive hydrocephalus, fetal position, resection

36
Q

Testicular Torsion

Presentation

Dx, Tx

A

Presentation

  • Spontaneous scrotal pain
  • Horizontal lie and pain on elevation

Dx

  • US Doppler

Tx

  • Untwist
  • bilateral orchiectomy
37
Q

Epididymitis

Presentation

Dx, Tx

A

Presentation

  • Spontaneous pain
  • Vertical lie
  • relief of pain on elevation

Dx

  • US Doppler

Tx

  • Abx
  • <35 ceftriaxone and azithromycin
  • >55 ciprofloxacin
38
Q

Bone Tumors

Presentation

Dx, Tx

A

Presentation

  • focal Atraumatic bone pain

Dx

  • X- Ray
  • MRI
  • Bx

Tx

  • Resection

Ewings - t11,12, midshaft, onion skin appearance

Osteosarcoma- Rb Gene, sunburst pattern

39
Q

Hard signs of penetrating neck injury

A

Airway: Gurgling, stridor, loss of airway

Vascular: Expanding hematoma, pulsatile bleeding, stroke, shock

40
Q

Soft signs of penetrating neck injury

A

Dysphonia

dysphagia

subcutaneous air

USMLE STEP 2 CK RETAKE (15 decks)

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