Surgery I Flashcards
A critically ill patient is found to have gallbladder wall thickening/distention and pericholecystic fluid without gallstones on imaging studies, what is likely the diagnosis?
Acalculous cholecystitis
After > 5 days following a severe burn, most infections are due to gram-[…] organisms or fungi.
After > 5 days following a severe burn, most infections are due to gram-negative organisms or fungi.
An ABI of […] is considered diagnostic of occlusive peripheral arterial disease (PAD) in symptomatic patients.
An ABI of < 0.9 is considered diagnostic of occlusive peripheral arterial disease (PAD) in symptomatic patients.
Anterior cord syndrome initially presents with […] paralysis due to spinal shock (spastic or flaccid).
Anterior cord syndrome initially presents with flaccid paralysis due to spinal shock (spastic or flaccid).
UMN signs (e.g. spasticity, hyperreflexia) develop over days to weeks
Any penetrating wound below the […] intercostal space is considered to involve the abdomen.
Any penetrating wound below the 4th intercostal space is considered to involve the abdomen.
Aortoiliac occlusion (Leriche syndrome) is characterized by a triad of bilateral hip, thigh, and buttock […], impotence, and absent/diminished femoral pulses.
Aortoiliac occlusion (Leriche syndrome) is characterized by a triad of bilateral hip, thigh, and buttock claudication, impotence, and absent/diminished femoral pulses.
due to arterial occlusion at the birfurcation of the aorta into the common iliac arteries; typically results in symmetric atrophy of the bilateral lower extremities
Aortoiliac occlusion (Leriche syndrome) is characterized by a triad of bilateral hip, thigh, and buttock claudication, […], and absent/diminished femoral pulses.
Aortoiliac occlusion (Leriche syndrome) is characterized by a triad of bilateral hip, thigh, and buttock claudication, impotence, and absent/diminished femoral pulses.
due to arterial occlusion at the birfurcation of the aorta into the common iliac arteries; typically results in symmetric atrophy of the bilateral lower extremities
Are fractures of the middle-third of the clavicle typically treated operatively?
No
usually treated non-operatively with a brace, rest, and ice; careful neurovascular examination is required to rule out underlying brachial plexus and/or subclavian artery injury
Are most cases of urethral injury treated with immediate or delayed surgical repair?
Delayed
typically treated with temporary urinary diversion by suprapubic catheter, followed by delayed repair
Are penile fractures typically managed medically or surgically?
Surgically
medical management of PF has a higher rate of complications
Atelectasis commonly occurs post-operatively due to […] breathing (depth) and weak cough secondary to pain.
Atelectasis commonly occurs post-operatively due to shallow breathing (depth) and weak cough secondary to pain.
shallow breathing causes hypoxia with resultant tachypnea and low CO2
Blunt abdominal trauma may result in damage to the […] blood supply, leading to subsequent necrosis and eventual GI perforation.
Blunt abdominal trauma may result in damage to the mesenteric blood supply, leading to subsequent necrosis and eventual GI perforation.
occurs several days after the initial event (versus penetrating trauma which presents acutely)
Burn victims with oropharyngeal inflammation/blistering or carboxyhemoglobin levels > […]% should be intubated to prevent upper airway obstruction by edema.
Burn victims with oropharyngeal inflammation/blistering or carboxyhemoglobin levels > 10% should be intubated to prevent upper airway obstruction by edema.
other indications for intubation include burns on the face, oropharyngeal carbon deposits, stridor, and history of confinement in a burning building; the supraglottic airway is very sensitive to direct thermal injury with subsequent edema/blistering, which can cause obstruction
Change in appearance of a burn wound or loss of a viable skin graft is often the earliest sign of wound […].
Change in appearance of a burn wound or loss of a viable skin graft is often the earliest sign of wound infection.
e.g. partial-thickness injury turns into full-thickness injury
Circumferential, full-thickness burns can result in eschar formation that restricts venous/lymphatic drainage, leading to […] syndrome.
Circumferential, full-thickness burns can result in eschar formation that restricts venous/lymphatic drainage, leading to acute compartment syndrome.
may warrant surgical escharotomy to relieve pressure
Compartment syndrome is characterized by increased pain with […] stretching (active or passive).
Compartment syndrome is characterized by increased pain with passive stretching (active or passive).
CT findings indicative of ischemic colitis include colonic wall […] and fat stranding.
CT findings indicative of ischemic colitis include colonic wall thickening (edema) and fat stranding.
also may have air (pneumatosis) in the bowel wall, as evidenced below
CXR showing a nasogastric tube in the pulmonary cavity is diagnostic of […].
CXR showing a nasogastric tube in the pulmonary cavity is diagnostic of diaphragmatic hernia.
other signs include deviation of mediastinal contents to opposite side and elevation of the hemidiaphragm
Diagnosis of a retroperitoneal hematoma is confirmed with […] or abdominal ultrasound.
Diagnosis of a retroperitoneal hematoma is confirmed with non-contrast CT scan of abdomen/pelvis or abdominal ultrasound.
Diaphragmatic rupture is more common on the patient’s […] side.
Diaphragmatic rupture is more common on the patient’s left side.
due to congenital weakness in left posterolateral region and liver’s protective effects on right; CXR showing a nasogastric tube in the pulmonary cavity is diagnostic
Do umbilical hernias typically require surgical intervention?
No (most close spontaneously before age 5)
spontaneous closure is less likely with large umbilical hernias; surgery IS recommended around age 5 for persistent hernias
Does anterior cord syndrome result in loss of pain and temperature?
Yes
Does anterior cord syndrome result in loss of vibration and proprioception?
No
posterior cord is spared
Does gastroschisis typically require surgical intervention?
Yes (surgical emergency)
Does omphalocele typically require surgical intervention?
Yes (surgical emergency)
Dumping syndrome is a common post-gastrectomy complication due to rapid emptying of […]-tonic gastric contents into the small intestine.
Dumping syndrome is a common post-gastrectomy complication due to rapid emptying of hyper-tonic gastric contents into the small intestine.
causes a fluid shift from intravascular space to the small intestine, resulting in hypotension, autonomic reflex stimulation, and release of intestinal vasoactive peptides
Duodenal hematomas classically develop in pediatric patients […] - […] hours after an initial injury, causing epigastric pain and vomiting.
Duodenal hematomas classically develop in pediatric patients 24 - 36 hours after an initial injury, causing epigastric pain and vomiting.
symptoms due to failure to pass gastric contents beyond the obstructing hematoma
Early spread of nasopharyngeal carcinoma to the […] lymph nodes is common.
Early spread of nasopharyngeal carcinoma to the cervical lymph nodes is common.
Epidural hematoma occurs due to sphenoid bone trauma with laceration of the […] (vasculature).
Epidural hematoma occurs due to sphenoid bone trauma with laceration of the middle meningeal artery (vasculature).
classically presents as a brief period of loss of consciousness followed by a lucid interval
Evaluation of kidney injury in blunt genitourinary trauma should include urinalysis and […] (imaging) in hemodynamically stable patients with evidence of microscopic hematuria.
Evaluation of kidney injury in blunt genitourinary trauma should include urinalysis and contrast-enhanced CT of abdomen/pelvis (imaging) in hemodynamically stable patients with evidence of microscopic hematuria.
may warrant retrograde cystourethrogram if patients have gross hematuria, difficulty urinating, blood at the meatus, or suprapubic pain
Extraperitoneal bladder injury is associated with […] fracture and manifests as localized pain and gross hematuria.
Extraperitoneal bladder injury is associated with pelvic fracture and manifests as localized pain and gross hematuria .
urinary retention may occur as well; ability to insert a Foley catheter helps distinguish EPBI from urethral injury
Febrile non-hemolytic transfusion reaction typically occurs […] - […] hours after transfusion.
Febrile non-hemolytic transfusion reaction typically occurs 1 - 6 hours after transfusion.
caused by cytokines released from residual plasma or leukocyte debris
Fracture of which wrist bone is often complicated by median nerve compression?
Lunate
Fracture of which wrist bone is often complicated by osteonecrosis?
Scaphoid
Gastroschisis is characterized by protrusion of bright red intestines to the […] side of a normal umbilicus (direction).
Gastroschisis is characterized by protrusion of bright red intestines to the right side of a normal umbilicus (direction).
Gilbert syndrome is diagnosed by elevated levels of […] bilirubin on repeat testing with normal LFTs and CBC.
Gilbert syndrome is diagnosed by elevated levels of unconjugated bilirubin on repeat testing with normal LFTs and CBC.
due to reduced bilirubin glucuronidation
Hemodynamically unstable patients with evidence of renal trauma should undergo […] (imaging) prior to surgical evaluation.
Hemodynamically unstable patients with evidence of renal trauma should undergo IV pyelography (imaging) prior to surgical evaluation.
How does afterload (SVR) change in cardiogenic shock?
Increased
How does afterload (SVR) change in hypovolemic shock?
Increased
How does afterload (SVR) change in septic shock?
Decreased
important distinguishing feature from cardiogenic and hypovolemic shock
How does cardiac index change in cardiogenic shock?
Decreased
How does cardiac index change in hypovolemic shock?
Decreased
How does cardiac index change in septic shock?
Increased
important distinguishing feature from cardiogenic and hypovolemic shock
How does ejection fraction change with hypovolemic shock?
Increased
due to compensatory sympathetic response, which increases SVR, HR, and EF
How does hypocalcemia effect the corrected QT interval (QTc)?
Prolonged QTc
How does PaCO2 change in patients with atelectasis?
Decreased
due to hyperventilation to compensate for hypoxemia
How does preload (RA pressure or PCWP) change in cardiogenic shock?
Increased
important distinguishing feature from hypovolemic shock
