Surgery Form 1-4 Flashcards
alcoholism, diarrhea, generalized weakness, enlarged liver, disuse tenderness, shifting dullness, Calcium 6 & normal amylase. Cause of hypocalcemia?
Hypomagnesemia
Why does low magnesiums causes low calcium?
PTH cannot be released
Hx of heartburn, cxray air-fluid level posterior to the cardiac silhouette. Barium swallow stomach herniating through the esophageal hiatus. Dx? NSIM?
- hiatal hernia
- EGD (esophagogastroduodenoscopy)
Small painless sore with defined edges and a flat base containing purulent debris in ulcerative colitis
Pyoderma gangrenosum
Pyoderma gangrenous, abd pain and nausea
Crohn’s disease
Pyoderma gangrenous, mouth ulcer, genital ulcer
Behcet’s disease (silk road disease), rare blood vessel inflammation throughout the body
Pyoderma gangrenosum, bloody in stool and anemia
Ulcerative colitis
NSIM for possible popliteal aneurysm?
Arteriography with runoff
After arteriography procedure using right groin, pt noted with palpable thrill and a continuous machinery murmur at the site. Dx? Predictive info for hearth failure?
- AV fistula
- Size of the abnormalities (cause of increased venous return, high CO, heart failure)
Very high ALP (Alkaline phosphatase) & narrow bile ducts on ERCP. Dx? predisposing factor?
- Primary sclerosis cholangitis
- Ulcerative colitis
Bright red blood per rectum, ulcer in the posterior midlines of the anal canal, edematous skin tag at the anal verge. Dx? Tx?
- Anal fissure
- Sitz bath
Hx HTN, DM, cholesterol embolus in a retinal artery. Cause?
Carotid plaque (Hollenhorst plaque)
Dysphagia and chest pian, GERD, inability to swallow solid food
- Stricture of the distal esophagus
Inability to swallow both liquid and solid
Achalasia
Uncircumcised older man, multiple partners, painless ulcer on the penile glans that is growing
Penile cancer (multiple partner indicates possible HPV)
37F with liver mass that has central scar. Dx? NSIM?
- Focal nodular hyperplasia (Benign)
- No further workup needed
37F, neck swelling, no weight changes or temp intolerance, Normal TSH, T4 & T3. Positive Thyroid peroxidase and thyroglobulin antibodies. Dx?
Early Hashimoto disease (before TSH, T3,T4 changes)- chronic lymphocytic thyroiditis
14YO boy, obese with hip and knee pain
Slipped capital femoral epiphysis (SCFE)
Child after URI with hip pain, high WBC
Viral arthritis (Toxic synovitis)
Pt on mechanical ventilation, ARDS, washing out numerous organisms on abx, Cavitation lesion on right upper lobe of the lung. Dx?
Lung abscess
deep stupor, high BP, left hemiparesis and early decerebrate posturing, NO trauma. Dx?
Ruptured intracerebral aneurysm
a sudden severe headache, with NO focal neuro deficits
SAH , possible from AVM, berry aneurysm
82 post cholecystectomy two days ago, got pneumonia, cause
impaired cough mechanism
PE confirmed with no hypotension. Tx?
Heparin
PE confirmed with hypotension. Tx?
Pulmonary embolectomy
Coffe bean in abd xray. Dx? NSIM?
- Sigmoid volvulus
- Sigmoidoscopy-guded placement of a rectal tube
Elderly with high calcium and bone resorption. Dx? what other lab?
Hyperparathyroidism and low phosphorus
HIV male pt with cauliflower-like mass on perineum. Dx? NSIM?
- SSC
- Biopsy of the mass
MVA, femur fracture operation done, PRRC given, Jaundice after 9 days, elevated indirect bilirubin. Cause?
Overproduction of bilirubin
5 days Post pancreticoduodenectomy surgery after trauma. What is the best nutrition delivery method?
Enteral tube feedings
Pt with CKD who got AV fistula 24hr ago has SOB, tachpenic, , JVD, S3 is
High-output CHF, due to AV fistula having more fluid overload
rust-colored breast discharge in 42 yo woman.
Intraductal papilloma (usually in premenopausal women) or papillary carcinoma
Pt with CV risk for surgery and can’t tolerate stress test do
pharmacologic stress test (Dipyridamole-thallium scanning) Radionuclide scan
Pallor optic disc, macular edema, thin arterioles, and sausage-like narrowing of the retinal veins. Dx?
Central retinal artery occlusion
Whipple triad is
- hypoglycemia symptoms brought on by fasting
- BS < 50 during symptomatic attack
- Glucose administration brings relief of symptoms
Laparoscopy vs laparatomy
-Laparotomy is open like celiotomy, where as laparoscopy is not
Infections in axilla and groin area on 30YO, purulent drainage from small sinus opening along the indurated skin of the axilla. Infection involves
Apocrine glands - Hydradenitis
Steps to how to treat esophageal varies
- 2 large IV catheters
- IVF
- Octeriotide
- Abx
- Once pt is stable Upper GI endoscopy
Cornual pregnancy is
considered ectopic pregnancy that can rupture
Borborgymi sounds heard in upper abd indicates
early SBO with hyperactive and loud gurgling sound. Late SOB becomes hypoactive bowel
Succussion splash heard on abd indicates
gastric outlet obstruction
Pt with hearing loss and ringing on r ear, unsteadying on gait. Weber test localized to the L ear, Ring test air conduction is greater than bone conduction bilaterally. Sensation to temperature is decreased over the R side of face, and decreased movement of the face on R side. MRI will show
Acoustic neuroma (vestibular shwannoma)
persistent air leak after chest tube placement for pneumothorax is
-tracheobronchial injury
Giant cell vasculitis tx
-Immediate prednisone therapy and temporal artery biosy
Rupture of the descending thoracic aorta b/p is ______ vs ascending _______
hypertensive vs hypotensive in ascending
Roby mass in the hemiscrotum
Varicocele, also called “Bag of worms”
The purpose of Indomethacin in PDA is
cyclo-oxygenase inhibition with increased NE releases
- it is inhibitor of prostaglandin E2
19 year old female with server abd pain. U/S abd with cystic mass increasing in size and leucocytosis. Dx? NSIM?
- Ovarian torsion
- Exploratory operation (if only cyst watch on contraceptive)
19 YO with RLQ pain after sexual activities
Rupture of ovarian cyst
“Hot nodules” on thyroid scan are
Toxic thyroid adenoma
Cachectic is caused by what factor?
Tumor necrosis factor (TNF)
Knee pain from sitting to standing position & tenderness to palpation along the medial joint line with effusion
Torn meniscus (Meniscus tear)
8yo with eye sensation, treating with erythema or the conjunctiva, photophobia and small vesicles with an erythematous base on the eyelid
Herpes simplex conjunctivitis
Diagnostic for carpal tunnel
Nerve conduction studies (it is not EMG)
multiple dilated loop of small bowel suggests
obstruction
gas in small bowel and liver suggests
communication between enteric and biliary tract (possible due to stones)
-Cholecystoduodenal fistula
What is the best indicator for adequate fluid resuscitation
Urine output 30-40ml/hr
Pearly surfaced lesion on upper lip
Basal cell carcinoma
Keratin surface lesion on the lower lip
Squamous cell carcinoma
treatment for biliary atresia
liver transplantation
which shock has high PCWP?
Cardiogenic
Treatment for intermittent leg claudication or PDA
stope smoking
walking program
aspirin with clopidogrel
Cilostazol
Best screening test for Cervical trauma
X-ray
82YO man with L groin pain, N/V, febrile, 90/60, 110, leukocytosis. Dx?
Strangulated inguinal hernia
In traumatic injures, in what order do you fix the order of injury to structural damage
- Bone
- Vascular
- Nerve
What are the two paraneoplastic syndrome that secret PRHrp?
- Squamous cell carcinoma or lung
- Renal cell carcinoma
Low pitched, rumbling diastolic murmur heard at the apex, that disappears when pt lies on the R side
Atrial myxoma
Venous Duplex US with occlusion of left iliac veins, what should be given prior to perineal resection for rectal cancer
Low-dose heparin prophylaxis
Renal stenosis on R kidney which kidney will produce more renin or is it both?
Only the affected kidney
52 with R foot swelling, Hx of DM, x-ray R ankle osteopenia and disruption of disorganization of the joints
Charcot joint (Neuropathic arthropathy)
A hernia medial to the femoral vein
A femoral hernia
EGD shows stricture of the GJ junction and barrett’s esophagus
Sliding hiatal hernia (associated with GERD)
symptomatic nephrolithiasis will have __ in urinalysis?
RBC segmented (gross or microscopic hematuria)
Nulligravid women with ascites
Ovarian tumor- Meigs syndrome
Failure to suppress class II antigen recognition in the host, what kind of transplant rejection is it?
acute