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USMLE Step 3 MTB > Surgery > Flashcards

Surgery Flashcards

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USMLE® Step 1 flashcards
1
Q

If O2 sats are below 90, do

A

ABG

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2
Q

Normal bicarb =

A

24

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3
Q

Cardiac output =

A

Stroke volume x Heart rate

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4
Q

Stroke volume =

A

End Diastolic Volume - End Systolic Volume

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5
Q

Total peripheral resistance =

A

Mean arterial pressure - Mean venous pressure

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6
Q

Blood pressure =

A

Cardiac Output x Total Peripheral Resistance

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7
Q

Immediately perform __ in pericardial tamponade

Immediately place ____ into pleural cavity at ___ intercostal space

A

pericardiocentesis

large bore needle or IV catheter; 2nd

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8
Q

In preparation for immediate exploratory laparotomy in a abdominal trauma, do a bunch of things simultaneously:

A

2 large bore IV lines Type and cross Give fluids and blood Insert foley Administer IV antibiotics

Children <6 years old –> intraosseous cannulation in the proximal tibia

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9
Q

Surgery is always done for ___ head injuries, even if the patient is asymptomatic!

A

comminuted or depressed skull fracture

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10
Q

All patients with open skull fractures should receive

A

tetanus toxoid and prophylactic antibiotics

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11
Q

Management of basal skull fracture =

A

CT scan of head/nec CSF leak sill stop by itself (NO Antibiotics needed) Facial palsy may occur 2-3 days later

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12
Q

All epidermal hematomas (Lens, biconvex; Middle meningeal artery; lucid interval) require

A

emergency craniotomy

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13
Q

Epidural hematoma = injury to

A

middle meningeal artery

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14
Q

Subdural hematoma = injury to

A

bridging veins

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15
Q

Only do an emergency craniotomy in case of subdural hematoma if

A

there are lateralizing signs and midline displacement

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16
Q

Surgery cannot help in this head injury that is caused by acceleration-deceleration injuries to the head

A

diffuse axonal injury

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17
Q

Gradual dilatation of one pupil and a decreasing responsiveness to light is an important sign of

A

elevating intracranial pressure (Medical emergency)

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18
Q

DO NOT EVER DO THIS

A

perform an LP before getting a head CT. If you perform a lumbar puncture on a person with increased intracranial pressure, you will HERNIATE THE BRAIN, KILL THE PATIENT, GET CHLAMYDIA AND DIE.

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19
Q

Hyperventilation causes vaso___ and decreased blood volume in the brain, causing ICP to ___

A

constriction; lower ICP

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20
Q

First line measures for high ICP are

A

elevated head of bed hyperventilation avoid fluid overload second line: mannitol, sedation/hypothermia

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21
Q

Anisocoria =

Ptosis of the left eye, Anisocoria, droopy left eyelid dx?

caused by?

Best initial test ?

Tx?

A

unequal size of pupils

3rd CN palsy

posterior communicating artery aneurysm

MRI of the brain with Angio

embolization thru endovascular repain

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22
Q

When is surgery the answer for acute abdomen?

A

Peritonitis (excluding primary peritonitis), Abdominal pain/tenderness plus sepsis signs, Pneumoperitoneum, Acute intestinal ischemia

Rule out pancreatitis first in all the above cases

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23
Q

Treatment for spontaneous bacterial peritonitis is

A

immediate paracentesis; diagnosis is made when fluid contains neutrophils greater than 250 cells per cubed mm

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24
Q

Treat SBP with

A

ceftriaxone and albumin at 1.5g/kg on day 1 and day 3 of hospitalization

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25
Q

First study of choice for esophageal perforation is

A

gastrografin contrast esophagram

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26
Q

Most accurate test for adult with GI obstruction is

Volvulus (ex: sudden abdominal pain in elderly)Dx ? Tx?

A

CT scan of abdomen and pelvis with contrast

Proctosigmoidoscopy w/ rigid instrument

Sigmoid resection

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27
Q

When diagnosing acute diverticulitis, don’t forget to order

DX w/

A

a pregnancy test in women of reproductive age!

CT WITH contrast

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28
Q

___ is absolutely contraindicated in acute diverticulitis

A

Colonoscopy

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29
Q

When palpation of the LLQ causes pain n the RLQ, think

A

acute appendicitis (Rovsing’s sign)

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30
Q

It’s important to administer ___ before appendectomy

A

IV antibiotics: -cipro and metronidazole -ampicillin/sulbactam -levofloxacin and clinda -cefoxitin or cefotetan

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31
Q

If chronic UC has been present for more than 20 years, ___ is indicated

A

elective surgery also if high dose chronic steroids are needed or toxic megacolon is present

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32
Q

What three major GI arteries arising from the abd aorta supply the gut?

Abdominal pain out of prportion to the physical findings; acidosis; sign of sepsis

TX: during sugery ? During Angio

A

celiac axis, the SMA, and the IMA; SMA is most commonly affected by ischemia

Mesentric ischemia

embolectomy & revascularization or resection; vasodilators and thrombolysis

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33
Q

The best initial and most accurate test for ischemic colitis is

A

CT abdomen showing thickening of the bowel in a segmental pattern

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34
Q

Therapy for ischemia colitis

A

IV fluid hydration and bowel rest

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35
Q

In chronic mesenteric ischemia, ___ is both therapeutic and diagnostic

A

computed tomography angiography

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36
Q

Development of symptoms (postprandial abd pain, unrelenting nausea, anorexia, weight loss) after a recent dramatic weight loss

A

Median Arcuate Ligament Syndrome treat by surgical decompression of the celiac artery

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37
Q

Always do what to an intra-abdominal abscess?

A

Drain it!

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38
Q

Which two ducts merge to form the common bile duct?

A

Common hepatic duct and Cystic duct

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39
Q

CT scan of obstructive jaundice caused by a tumor will show

A

double duct sign (aka simultaneous dilatation of both the common bile duct and the pancreatic duct)

40
Q

Treat acute cholecystitis is

A

NG suction NPO IV fluids antibiotics then cholecystectomy after 6-12 weeks

41
Q

Reynold’s pentad:

A

jaundice RUQ pain fever AMS shock

42
Q

Treat acute ascending cholangitis with

A

IV antibiotics Emergency decompression of the common duct ERCP or percutaneous transhepatic cholangiogram Surgery isn’t often necessary

43
Q

The most accurate test for fecal incontinence is

A

anorectal manometry

44
Q

Do not perform surgery in patients with multiple

A

derangements in hepatic risk factors

*Bilirubin >2; albumin <3; PT >16; encephalopathy

45
Q

The most lethal cause of post-op disorientation if not recognized and treated early is

COPD (FEV1 <1.5) increases post surgical risk of ___

A

hypoxia, so order an ABG

Pneumonia

46
Q

The leakage of fecal, gastric, or duodenal contents to the outside postoperatively is ___

A

not an indication for emergency surgery! observe stable patients; if the patient had fever and internal fistual than do drainage and surgery maybe

47
Q

Manage malignant hyperthermia (fever >104) after administration of halothene or succinylcholine by

A

IV dantrolene, 100% O2, acidosis correction, cooling blankets watching for development of myoglobinuria

48
Q

Manage bacteremia and fever >104 with

A

blood cultures x3 and empiric abx

49
Q

The most important step before surgery at birth is

A

check for congenital anomalies and look for VACTERL constellation

50
Q

If excessive salivation or chocking spells are noted shortly after first feeding, it could be

A

esophageal atresia

51
Q

What causes esophageal atresia?

A

Ventrally displaced location of the notochord in an embryo

52
Q

Confirm diagnosis of esophageal atresia with

Tx: if the surgery needs to be delayed

A

NG tube, which becomes coiled in the upper chest on x-ray

Gastrostomy (feeding tube)to protect the lungs from acid reflux

53
Q

If anal atresia is suspected, look for

A

a fistula nearby; if no fistula present, perform a colostomy

54
Q

The primary abnormality of congenital diaphragmatic hernia is

A

hypoplastic lung with fetal type circulation

55
Q

Treat CDH with

A

endotracheal intubation, low pressure ventilation, sedation, NG suction

delay repair 3-4 days to allow lungs to mature

56
Q

Where is the defect in gastroschisis?

A

To the right of the umbilical cord due to failure of neural crest cells to migrate; no protective membrane

57
Q

Incomplete fusion during the fourth week of development results in

A

omphalocele

*has a thin membrane cover

58
Q

Which trisomies are a/w omphalocele?

A

Edwards syndrome and Patau syndrome

59
Q

Exstrophy of the urinary bladder requires

(abdominal wall defect over the pubis)

A

Surgical repair in the first 1-2 days of life! Transfer to a specialized center

60
Q

What can present with double bubble sign?

They all require ?

A

Annular pancreas, malrotation (most dangerous), duodenal atresia

Surgical correction

61
Q

Intestinal atresia is not associated with___

Presents with

A

other congenital abnormalities bc this is caused by vascular accident in utero

Green vommit and multiple air fluid levels thoughout the abdomen

62
Q

A sign of sepsis in newborns is

A

rapidly dropping platelet count

63
Q

The most common pathogens in necrotizing enterocolitis are

NE presentation ___

A

E. coli and Klebsiella pneumonia

Feeding intolerance in PREmature infants on 1st feed; abdominal distension + rapidly dropping platelets

Pneumatosis intestinals – gas w/in bowel wall

64
Q

Feeding intolerance + bilious vomiting + CF =

X-ray shows__ in CF

A

meconium ileus

Multiple dialated loops of bowel & ground glass appearance in lower abdomen

65
Q

In meconium ileus, ___ is both diagnostic and therapeutic

A

gastrografin enema

66
Q

Diagnose hypertrophic pyloric stenosis with

A

sonogram showing target sign

67
Q

Treat pyloric stenosis by

A

first correcting metabolic abnormalities (Hypochloremic, Hypokalemic metabolic alkalosis) and dehydration, then performing a pyloromyotomy

68
Q

Persistent progressively increasing jaundice in 6-8 week old babies =

A

biliary atresia: no excreation of bile from liver to gallbladder to duodenum

Abnormal narrowing or blockage of the duct leading to Bile accumulating inside the liver and causing damage and scarring of the liver cells leading to:

complications: cholestasis, fibrosis –> cirrhosis

69
Q

Treat biliary atresia with

A

HIDA scan after 1 week of phenobarbital, then surgery if that doesn’t work

70
Q

diagnose Hirschsprung Disease (neurocrest cells fail to migrate) with

A

full-thickness biopsy of rectal mucosa

71
Q

When does intussusception show up?

A

6-12 months of age, chubby healthy looking kids with brief episodes of colicky abdominal pain

w/ Currant jelly stools and vague mass on the right side of abdomen & empty lower quadrant

72
Q

Lower GI bleeding in a child of pediatric age =

A

Meckel diverticulum

73
Q

When a fracture is suspected, order

A

2 views at 90 degrees to one another and always include the joints above and below the broken bone

74
Q

When a fracture is displaced severely or angulated or cannot be aligned, what should you do?

A

Open reduction and internal fixation

75
Q

When does an open fracture need to be reduced?

A

within 6 hours from time of injury

76
Q

Neuro dysfunction, petechial rash, respiratory distress, fracture =

A

fat embolism

77
Q

Fixing a long-bone fracture within ___ reduces the incidence of respiratory distress from embolic phenomena

A

24 hours

78
Q

Which type of shoulder dislocation is possible in a patient with a recent seizure?

A

Posterior shoulder dislocations. Otherwise, anterior shoulder dislocations are the most common

79
Q

What type of xray should you order in a patient with a recent seizure and shoulder pain?

A

axillary or scapular views of the affected shoulder

80
Q

Painful wrist + dinner fork deformity =

A

Colle’s fracture

81
Q

Direct blow to the ulna or radius results in a combo __ and __ fracture

A

diaphyseal and displaced dislocation. Treat w/ ORIF

82
Q

Suspected scaphoid fracture, treat w/

A

thumb spica cast

83
Q

Treat femoral neck fractures with

A

femoral head replacement

84
Q

Intertrochanteric fractures are treated with

A

open reduction and pinning

85
Q

Femoral shaft fractures are treated with

A

intramedullary rod fixation

86
Q

Posterior dislocation of the hip (knees hit dashboard in MVA) =

A

orthopedic emergency! Leg is internally rotated and shortened

87
Q

Symptoms caused by tapping the nerve over the flexor retinaculum and awaiting parasthesias =

A

Tinel’s sign for CTS

88
Q

Flexing the wrist gently and holding the position =

A

Phalen’s test for CTS

89
Q

Signs of a __ injury include inability to dorsiflex (extend) the wrist

A

oblique distal humerus, complicated by radial nerve paralysis

90
Q

The most important intervention for a urologic obstruction is

A

a ureteral stent or percutaneous nephrostomy

91
Q

A child who has hematuria from a trivial trauma has ___ until proven otherwise

A child who has UTI has ___ until proven otherwise.

Tst to order?

A

undiagnosed congenital urologic anomaly

Undiagnosed congenital urologic anomaly

voiding cystogram

92
Q

A teenager drinks large volumes of beer and develops colicky flank pain

A

Ureteropelvic Junction Obstruction -only symptomatic with diuretics

obstruction is a partial or intermittent total blockage of the flow of urine that occurs where the ureter enters the kidney. UPJ obstruction is the most common pathologic cause of antenatally detected hydronephrosis.

93
Q

Treat subclavian steal syndrome with

A

bypass surgery

94
Q

Classic symptoms of subclavian steal syndrome are

A

visual symptoms, equilibrium problems, and claudication in the arm during arm exercises

DON’T CONFUSE it with thoracic outlet symdrome which presents with vascular sxs but NOT neurological sxs

95
Q

Can result from thoracic trauma

present w/ Distended neck veins or High Central venous pressure

A

Pericardial temponade

Tension pneumothorax

USMLE Step 3 MTB (20 decks)

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