Surgery Final Exam Flashcards
1
Q
best management to reduce risk of thromboembolic complications
A
subcut LMW heparin
2
Q
primary goal of postop fluid management
A
maintain at euvolemia
3
Q
pregnant with hard, non-tender upper outer quadrant mass of breast
A
excisional biopsy of mass
4
Q
components of MELD score
A
bilirubin, INR, creatinine
5
Q
MI decrease risk of cardiac complications
A
postpone surgery for 6 months post MI
6
Q
increase risk of perioperative cardiac complications
A
audible S3 gallop
7
Q
perioperative glucose management in insulin dependent DM
A
half usual dose of long acting insulin morning of surgery
8
Q
agent most likely to produce hyperkalemia after hemodialysis
A
succinylcholine
9
Q
informed consent
A
patient and surgeon decide on a plan
10
Q
patients with pre-op EKG
A
HTN evaluation for CEA
11
Q
tingling and numbness s/p total thyroidectomy with additional finding
A
carpopdeal spasm
12
Q
s/p total parathyroidectomy with muscle cramps and confusion
A
severe hypocalcemia
13
Q
appropriate fluid for replacing fluid loss from fistula
A
lactated ringers
14
Q
electrolyte composition of bile-colored fluid
A
Na 130
Cl 100
K 4
Bicarb 25
15
Q
bilious drainage s/p gastric resection
A
bilairy leak from duodenal stump
16
Q
hypertrophic pylorus metabolic derangement
A
hypochloremic hypokalemic metabolic alkalosis
17
Q
proximal muscle weakness s/p refeeding anorexic d/t
A
hypophosphatemia
18
Q
hyponatremia and hyperglycemia
A
measured serum sodium decreased as a result of dilution in response to osmolar gradient created by increase in serum glucose
19
Q
treatment of SIADH
A
water restriction to less than 1000mL/day
20
Q
N/V in ED most assistance in diagnosis and treatment from
A
serum electrolytes
21
Q
obese nutrtional classification
A
high risk of nutrtional deficiency
22
Q
microcytic anemia resection
A
jejunum
23
Q
lab measurement that reflects recturn to normal protein anabolism
A
pre-albumin
24
Q
kilocals from lowest to highest
A
lipids, proteins, carbs
25
oral meds absorbed in
duodenum
26
anemia and respiratory distress from
re-feeding syndrome
27
major cause of cachexia in patient with short bowel syndrome
malabsorption
28
diarrhea from tube feedings
high osmolarity feedings
29
PN stopped when EN reaches what percent of PN
66%
30
body weight and caloric needs
160 lbs/1545 kcal
31
cause of elevated PT and PTT
vitamin K deficiency
32
greatest risk following transfusion
hep B
33
best treatment option for bleeding vW patient
cryoprecipitate (8, vWF, 13)
34
patient temp to 39C during transfusion
stop transfusion and go to ward to assess patient
35
increased bleeding from OTC
garlic
36
EKG after blood transfusion and muscle cramps
prolonged QT secondary to ST elevation
| d/t citrate toxicity
37
blood clot after 3 hr plane ride d/t
factor V neutralization impairment
38
best lab test to assess bleeding in patient with LMWH and nosebleed
anti-Xa activity
39
distended abdomen after administration of heparin post op d/t
inadequate surgical hemostasis during first operation
40
optimal use of blood product transfusion
red cells, FFP and platelets in 1:1:1 ratio
41
EKG with ischemia, sudden onset of agitation and hypertension d/t
cardiogenic hypoperfusion
42
principle value of lactic acid measurement marker of
response to circulatory resuscitation
43
65 yo aortofemoral bypass
euvolemic, normal perfusion
44
ongoing HoTN d/t
decreased venous return
45
edematous pancreas therapy
three liters of isotonic crystalloid
46
35 yo after gallstone pancreatitis
hyperdynamic perfusion
47
distended neck veins, crackles in lungs and gallop
cardiac contractility
48
increase in hgb is plasma volume depletion from
diffuse interstitial fluid accumulation
49
20 yo after car accident with distended neck veins
venous return
50
65 yo perforated diverticulitis
hypovolemic hypoperfusion
51
hyperglycemia increases
infectious complications
52
intervention can help prevent ventilator associated pneumonia
keeping head of bed elevated
53
diagnosis of thyroid storm
nearly nondetectable TSH levels, elevated T3, T4 and glucose levels
54
urgent indication for renal replacement therapy
hyperkalemia
55
most common cause of death in acute liver failure
cerebral edema
56
patient with HIT and PE
argratroban
57
alcohol abuse pt with confusion and agitation
diazepam
58
ventilator mode in pt with respiratory failure
assist control ventilation
59
improve oxygenation
increase PEEP
60
hyponatremia in 45 yo
administer hydrocortisone
61
small bowel resection and poor wound healing
d/t decreased fibroblast proliferation, decreased collagen synthesis, and impaired overall wound strenght
62
most effective next step to reduce bacterial load
debride necrotic tissue from wound
63
granuloma with refractive material
suture granuloma
64
2 wks after inguinal hernia repair biopsy
predominanty collagen with scarce inflammatory cells
65
small ulcerated nodule on midline draining serous fluid
excision of lesion and tract with pathologic analysis
66
chronic leg ulcer with thickening
biopsy wound edges
67
supplementation in obese patient before hernia repair
vitamin C
68
safest maximum volume of 1% lidocaine for local anesthesia
40 mL
69
postoperative antibiotic for colon resection
no need for antibiotics
70
raised, red, and thick beyond confines of original incisions
keloids
71
periprocedural prophylactic ABX for patients
patient who requires open repair of an abdominal aortic aneurysm
72
C diff management
oral vancomycin therapy
73
IV prophylactic ABX in patient with sessile polyp
administer one hour prior to operation
74
decreased hearing acuity from ABX
vancomycin
75
purulent drainage from old IV site
excision of IV site
76
acceptability for organ donation
latent HTLV is documented by ELISA and confirmed by NAT
77
best management of patient with peritoenal tap showing 500 leukocytes and G+ cocci
admit to hospital for IV ABX therapy
78
subhepatic abscess on CT
image guided percutaneous drainage
79
ABX for insulin dependent DM
administer one hour prior to incision
80
E coli blood cultures-source
UTI
81
protocol for tetanus prevention
0.5mL absorbed tetanus toxin
82
smoker with erythema at base of nail that dos not extend beyond DIP
excision of overlying nail plate
83
motor weakness of both arms but able to move lower extremities
central cord syndrome
84
blunt trauma, FAST negative
CT of abdomen and pelvis
85
convex collection of blood
epidural hematoma
86
tense calf and numbness of toes
operative fasciotomy
87
tender abdomen and respiratory acidosis
abdominal compartment syndrome
88
opens eyes to pain, decorticate, moans GCS
7
89
shot to left umbilicus
ex lap
90
stab to left anterior neck
emergent operative neck exploration
91
pericardial fluid, undetectable BP
left thoracotomy and cardiac repair
92
hemorrhage shock clasification
III
| HR>120, confusion, UOP 5-15cc/h
93
appropriate rehab for 60% burn patient
directed to restoring patients to functional status by preventing scar contraction and immobility
94
best choice for preventing burn wound sepsis
excision and grafting within 5-7 days of injury
95
burns from house fire
intubate patient and administer 100% O2
96
correct sequence for patient
secure airway, obtain 2 large bore IVs, bolus 2L LR, examine CT scan, calculate TBSA, treat burns with silvadine
97
size of burn-half anterior trunk, right thigh, upper extremity
45%
98
burn injury least painful
hands
99
best pain management partial thickness burn
IV narcotics, transition to oral narcotics and NSAIDs
100
no pulse in burn patient
confirm presence of vascular compromise, perform lateral and medial escharotomies of lower extremity from hip to ankle
101
allograft
skin graft taken from human cadaver
102
treatments functional cosmetic outcome
tangential excision and full thickness grafting
103
camper fascia, next layer
external oblique aponeuroses
104
follow scarpa medially to turn into
Dartos fascia
105
obturator hernia symptoms
symptoms of intermittent bowel obstruction
106
no bulge in external ring
femoral hernia
107
Ricter's hernia finding at first repair
non-circumferential incarceration of bowel wall
108
ASIS and parallel to external oblique
McBurney
109
relative contraindication in man with left sided inguinal hernia
total extraperitoneal laproscopic repair
110
large abdominal wall veins
high blood pressure portal vein blood is diverted to lower pressure veins of the abdominal wall via paraumbilical veins
111
bulge in epigastrum below umbilicus
diastasis recti
112
greatest risk for incisional hernia formation
wound infection
113
initial priority after ingesting drain cleaner
endotracheal tube
114
treatment of Zenker diverticulum
diverticulectomy with cricopharyngeal and lower esophageal mytomy
115
management Barrett's with low grade dysplasia
repeat endoscopy in 6 months with repeat 4 quadrant biopsy of the Barretts
116
large type II paraesophageal hernia
observant management
117
dysphagia and elevated lower esophageal sphincter
combined Heller myotomy and Nissen fundoplication
118
Stage I esophageal adenocarcinoma bilateral pulmonary emphysematous disease s/p bilateral thoracotomy
transhiatal esophagectomy with gastric pull-up
119
smooth mass in muscularis best approach
enucleation of the lesion with reapproximation of muscle layer
120
gastroesophageal reflux not controlled surgical approach
Collis gastroplasty with Nissen fundiplication
121
fishbone most likely
posterior mediastinum
122
adenocarcinoma diagnostic procedure to T stage
endoscopic ultrasound
123
sibutramine
serotonin and NE uptake inhibitor; SE-HTN
124
initial acid secretion
Ach
125
nonhealing gastric ulcer with signet rings work up
diagnostic laproscopy
126
persistent type III ulcer negative for malignancy
antrectomy with trunacal vagotomy
127
considered potential contraindication for surgical intervention to assist with weight loss
colon cancer
128
projectile vomiting resuscitation
normal saline
129
rapid urease testing negative and corkscrew submucosal vessels
cholestyramine
130
milkshake after bilroth I
somatostatin
131
gastrin 1200, calcium 11.3
| management
parathyroidectomy
132
deficiency after Roux-en Y
iron
133
small intestinal absorptive function
linked to Na-coupled absorption
134
malrotation after falling off bicycle
midgut volvulus
135
migrating motor complex
helps prevent stasis and bacterial overgrowth
136
ileocolic Crohn's disease
vitamin B12 deficiency
137
fistulous complications of Crohn's requires surgery
enterovesical
138
extracolonic malignancy FAP
periampullary duodenum
139
NG tube thick green fluid next best step
schedule an emergent laprotomy
140
postsurgical scenarios most consistent for short bowel syndrome
less than 60cm small intestine preserved
141
Meckel's diverticulum test
technetium pertechnetate scan
142
APUD from cells
carcinoid tumor
143
LLQ tender to palpation
order CT scan of abdomen and pelvis
144
hematochezia best choice for identification of bleeding site
tehnetium labeled RBC scan
145
episodic bleeding with hemorrhoid
increase dietary fiber and fluids and reevaluate in 2-3 months
146
dilated colon loops and no free air diagnosis
colonic volvulus
147
RLQ pain
appendectomy
148
sigmoid diverticulosis
CT
149
air filled loops interpreted as sigmoid volvuls
sigmoidoscopic attempt at reduction
150
external hemorrhoids
surgical hemorrhoidectomy
151
fluctant swelling at right anterior perianal skin
operating room and exam under anesthesia and abscess drainage
152
colonoscopy with ulcerations but normal terminal ileum
ulcerative colitis
153
recommendation for obs without surgery
asymptomatic gallstones
154
fever, jaundice, pain treatment
resuscitation, IV ABX, urgent ERCP to relieve bile duct obstruction
155
ALK, bili, AST and ALT
choledocholithiasis
156
RUQ with guarding
cholecystitis b/c patients with cholangitis are often jaundiced
157
Cr 0.7 to 1.3, amylase
ask office staff to call patient to ER
158
biliary tree is dilated proximal, common bile duct distal is not dilated
Mirizzi syndrome
159
gallstone formation in native american
cholesterol
160
benefits of laproscopic
safely performed in patients who have already had open abdominal surgery
161
GS since last pregnancy with elevated amylase, alk phos, bili
ERCP with sphincterotomy and gallstone removal if lab values do not improve
162
highest risk of gallstones
female gender
163
most likely cause of recurrent pancreatitis
pancreas divisum
164
place to find her gastrinoma
descending duodenum
165
tumor does not involve vascular structures-pancreatic cancer
surgical excision
166
ERCP shows cyst communicates with main pancreatic duct
pancreatic cyst gastrostomy
167
fasting blood sugar is 40
insulinoma
168
in addition to gastroduodenal artery must be ligated and divided
inferior anterior pancreaticoduodenal
169
risk for developing complication of chronic pancreatitis
diabetes
170
best indication for surgical intervention in severe pancreatitis
gastric outlet obstruction
171
DM after surgery
islets of langerhans are more abundant in the tail than the head and uncinate
172
adeno of pancreas best procedure
pancreaticoduodenectomy
173
no extravasation of contrast
observation only
174
hepatic colorectal mets
evaluation for surgical resection
175
7 cm mass on liver
liver resection
176
portal HTN
transjugular intrahepatic portocaval shunt
177
diagnosis and management
cystadenoma, resection
178
not candidate
severe pulmonary disease
179
most appropriate next step without peritonitis
interventional radiology with selective hepatic artery embolization if a bleeding site is identified
180
21 yo after MVC RLL contusion
observation with close monitoring
181
diagnosis and management
hepatic adenoma, arterial embolization
182
pharmacologic agents for treatment of chronic hepC with asterixis
lactulose
183
pain and swelling behind nipple
antibiotics followed by excision of subareolar ducts and fistula tract
184
22 yo needle biopsy with fibroadenoma
observation
185
29 yo with breast mass
breast ultrasound
186
contraindication to lumpectomy
pregnancy
187
44 yo with cancer
stage III
188
next 3 years
history and physical exam every 6 months, annual mammogram
189
numbness and tingling on posterior aspect of upper left arm
intercostal brachial nerve
190
hypoechoic
aspirate lesion
191
greatest risk for BC
family histroy
192
adverse effect of whole breast radiation
fibrosis
193
blood test prior to distal pancreatectomy
calcium
194
Hurthle cells
thyroid lobectomy
195
HTN
serum metanephrines
196
rising calcium
autonomous parathyroid gland function
197
FNA shows papillary carcinoma
total thyroidectomy
198
hypercalcemia worsened by
hydrochlorothiazide
199
calcitonin elevated thyroid cancer
urinary catecholamine levels
200
25 yo with HTN
primary hyperaldosteronism
201
borders of mass are defined
repeat adrenal CT scan
202
thyroid enlarged with palpitations
circulating IgG antibody that stimulates TSH receptors on follicular cells
203
increased megs and purpuric lesions
observation
204
polyvalent pneumococcal vaccine
2 weeks before splenectomy
205
nonoperative management of splenic trauma
4 yo fell from swing, CT shows subcapsular splenic hematoma involving 10% of splenic surface
206
transfuse platelets
after splenic artery has been clamped
207
enlarged spleen, neutropenia
splenectomy
208
noncaseating granulomas
sarcoidosis
209
benefit of splenectomy in thal major
decrease transfusion requirements
210
FNA near angle of jaw
carcinoma
211
spleen infarcts
increased Howell-Jolly bodies
212
optimal timing for polyvalent pneumococcal vaccine
on day of d/c from hospital
213
5.6 cm AAA
endovascular repair since it is assoc with improved survival compared to open AAA
214
most appropriate way to assess for vascular anatomy prior to revascularization
CT angio of pelvis and LE
215
highest risk for developing AAA
personal history of an elective popliteal aneurysm repair
216
indication to intervene in symptomatic right leg PAD
on medical leave from her job as a letter carrier
217
diagnosis in woman
fibromuscular dysplasia of a renal artery
218
largest decrease in pressure gradient across a stenosis
radius of lesion
219
CT confirms type A dissection
urgent operative repair
220
smoking cessation, leg claudication
bilateral aortobifemoral bypass
221
if left untreated
ankle ulceration
222
most consistent with PAD
aching foot pain exacerbated with leg elevation
223
best immunosuppression regimen
no immunosuppression because of lack of immune reactivity to donor graft isoantigen
224
onset of HTN, tremors, LFTs
tacrolimus
225
1 yr survival for cardiac transplantation
80%
226
most useful in maintaining BP until organ donation
dopamine
227
cause of leukopenia
increased cellcept dose (mycophenolate mofetil)
228
longest optimum time liver can be kept on ice
18 hrs
229
MOA of alemtuzumab
depletes T and B lymphocytes
230
determines cessation of brain function for organ donation
absence of spontaneous respirations
231
best immunologic test to detect Ags from cellular arm
mixed lymphocyte culture
232
higher place on waiting list
44 yo with acute liver failure secondary to Wilson disease
233
mores suitable for lung transplant than isolate heart transplant
severe pulmonary hypertension
234
most likely cause of intolerance
tacrolimus
235
most likely effect of oral fluconazole
elevated serum creatinine
236
obliterative bronchiolitis
chronic rejection
237
six antigen match immunosuppression strategies
combination of agents
238
pathologist stain for
ckit
239
TMN melanoma left calf
T1bN0M0
240
most appropriate step in management
wide local excision of forearm scar with sentinel lymph node biopsy
241
nontender mass, possible sarcoma
incisional biopsy
242
decrease risk in BRCA
bilateral mastectomy
243
Mohs therapy
specialized surgical technique used to excise skin cancers
244
no lymphadenopathy and 1 cm lesion
biopsy with 1-2mm margin of normal skin
245
PET avid lesion in left upper lobe
video assisted thoracoscopic resection of the lesion
246
chemotherapy after lumpectomy
adjuvant
247
left neck mass
FNA of neck lesion
