Surgery II Flashcards
How does preload (RA pressure or PCWP) change in hypovolemic shock?
Decreased
important distinguishing feature from cardiogenic shock
How does the flail chest segment move with inspiration?
Moves inward (paradoxical chest wall motion)
due to negative intrathoracic pressure
How should displaced scaphoid fractures be managed?
Surgical intervention
How should non-displaced scaphoid fractures be managed?
Wrist immobilization with a cast
patients should also be monitored with serial X-ray to rule out osteonecrosis of the proximal segment and non-union of the fracture
Hyperventilation may be used to lower intracranial pressure by decreasing […], causing vasoconstriction.
Hyperventilation may be used to lower intracranial pressure by decreasing PaCO2, causing vasoconstriction.
If a hemodynamically stable and alert patient with suspected splenic injury due to blunt abdominal trauma has a normal FAST exam despite high-risk features (e.g. guarding), what is the next step?
CT scan of abdomen
patients with suspected splenic injury secondary to blunt abdominal trauma without signs of peritoneal irritation may be monitored with serial abdominal exams
If a patient develops a whistling noise during respiration following rhinoplasty, what is likely the diagnosis?
Nasal septal perforation
likely resulting from a septal hematoma (more common) or septal abscess (less common)
If a patient with septic shock fails to respond to IV fluids, then […] should be started to improve perfusion.
If a patient with septic shock fails to respond to IV fluids, then vasopressors (e.g. dopamine) should be started to improve perfusion.
If gram stain and culture of bursal fluid in a patient with prepatellar bursitis is negative, what is the next step in management?
NSAIDs and activity modification
If gram stain and culture of bursal fluid in a patient with prepatellar bursitis is positive, what is the next step in management?
drainage and systemic antibiotics
Immediately after a severe burn, most infections are due to gram-[…] organisms.
Immediately after a severe burn, most infections are due to gram-positive organisms.
In amputation injuries, amputated parts should be wrapped in […]-moistened gauze, sealed in a plastic bag, placed on ice and brought to the ED with the patient.
In amputation injuries, amputated parts should be wrapped in saline-moistened gauze, sealed in a plastic bag, placed on ice and brought to the ED with the patient.
In patients with traumatic spinal cord injury, […] placement can assess for urinary retention and prevent acute bladder distention/damage.
In patients with traumatic spinal cord injury, urinary catheter placement can assess for urinary retention and prevent acute bladder distention/damage.
In stable patients, packed RBC transfusion is indicated once the hemoglobin drops below […] g/dL.
In stable patients, packed RBC transfusion is indicated once the hemoglobin drops below 7 g/dL.
higher thresholds (e.g. < 9 g/dL) may be required for unstable patients with acute coronary syndromes or active bleeds
Initial hematuria is suggestive of […] damage.
Initial hematuria is suggestive of urethral damage.
Is a Foley catheter recommended for patients with suspected urethral injury?
No
can worsen periurethral or perivesical hematomas and/or convert a partial urethral laceration into a complete laceration
Is bursitis characterized by pain with active or passive range of motion?
Active ROM
important distinguishing feature from septic arthritis (pain with both active and passive ROM only)
Is post-operative ileus characterized by a clear transition point on abdominal X-ray?
No
both small and large bowel dilation
Is septic arthritis characterized by pain with active or passive range of motion?
Both active and passive ROM
important distinguishing feature from bursitis (pain with active ROM only)
Is small bowel obstruction characterized by a clear transition point on abdominal X-ray?
Yes
Management of a duodenal hematoma typically involves […] and possibly parenteral nutrition.
Management of a duodenal hematoma typically involves gastric decompression (NG tube) and possibly parenteral nutrition.
surgery or percutaneous drainage may be considered to evacuate hematoma if non-operative management fails
MCL tear is characterized by medial knee tenderness and […] laxity on physical exam (valgus or varus).
MCL tear is characterized by medial knee tenderness and valgus laxity on physical exam (valgus or varus).
Necrotizing surgical site infections are usually […]-microbial (mono- or poly-).
Necrotizing surgical site infections are usually poly-microbial (mono- or poly-).
Non-seminomatous germ cell tumors often present with […] AFP levels.
Non-seminomatous germ cell tumors often present with elevated AFP levels.
both seminomas and non-seminomas may have elevated beta-hCG therefore not useful distinguishing feature
Pancreatic cancer classically presents with constant and/or gnawing epigastric pain that is worse at […].
Pancreatic cancer classically presents with constant and/or gnawing epigastric pain that is worse at night.
other classic signs include jaundice, anorexia with weight loss, and migratory thrombophlebitis
Pancreatitis with an ALT > 150 U/L is suggestive of […].
Pancreatitis with an ALT > 150 U/L is suggestive of gallstone pancreatitis.
Pancreatitis with an […] > 150 U/L is suggestive of gallstone pancreatitis.
Pancreatitis with an ALT > 150 U/L is suggestive of gallstone pancreatitis.
Patients who develop ischemic colitis often have extensive underlying […] disease.
Patients who develop ischemic colitis often have extensive underlying atherosclerotic disease.
Patients who present with acute onset back pain and profound hypotension should be evaluated for a presumptive diagnosis of […].
Patients who present with acute onset back pain and profound hypotension should be evaluated for a presumptive diagnosis of ruptured abdominal aortic aneurysm (AAA).
surgical emergency
Patients with scaphoid fractures should be monitored with serial X-rays to rule out […].
Patients with scaphoid fractures should be monitored with serial X-rays to rule out osteonecrosis.
alternatively, MRI or CT scan can diagnose a scaphoid fracture earlier, though it is more expensive
Persistent pneumothorax and significant air leak following chest tube placement in a patient with blunt chest trauma suggests […] (diagnosis).
Persistent pneumothorax and significant air leak following chest tube placement in a patient with blunt chest trauma suggests tracheobronchial rupture (diagnosis).
other findings include pneumomediastinum and subcutaneous emphysema
Physical examination of a ruptured ovarian cyst shows unilateral […] quadrant tenderness.
Physical examination of a ruptured ovarian cyst shows unilateral lower quadrant tenderness.
Platelet counts > […] provide adequate hemostasis.
Platelet counts > 50,000/mm3 provide adequate hemostasis.
thus platelet transfusion is generally reserved for patients with active bleeds and platelet counts < 50,000/mm3 or < 10,000 with no bleeding
Positive pressure mechanical ventilation causes an acute […] in intrathoracic pressure (increase or decrease).
Positive pressure mechanical ventilation causes an acute increase in intrathoracic pressure (increase or decrease).
in the setting of decreased CVP (e.g. hypovolemic shock), this can cause acute loss of right ventricular preload with resultant sudden cardiac death
Pre-operative smoking cessation should occur at least […] week(s) prior to surgery.
Pre-operative smoking cessation should occur at least 8 week(s) prior to surgery.
Prolonged post-operative ileus is characterized by […]-active bowel sounds.
Prolonged post-operative ileus is characterized by hypo-active bowel sounds.
Reactivation of which virus is associated with nasopharyngeal carcinoma?
EBV
Reperfusion of a limb following arterio-occlusive ischemia for longer than 4 - 6 hours can lead to intracellular and interstitial edema with possible […] syndrome.
Reperfusion of a limb following arterio-occlusive ischemia for longer than 4 - 6 hours can lead to intracellular and interstitial edema with possible compartment syndrome.
compartment syndrome is diagnosed when the pressure within a muscular fascial compartment rises above 30 mmHg
Scurvy (vitamin C deficiency) is associated with poor […] healing.
Scurvy (vitamin C deficiency) is associated with poor wound healing.
Seminomatous germ cell tumors often present with […] AFP levels.
Seminomatous germ cell tumors often present with normal AFP levels.
both seminomas and non-seminomas may have elevated beta-hCG therefore not useful distinguishing feature
Signs of […] injury include blood at the urethral meatus and a high-riding prostate on DRE.
Signs of posterior urethral injury include blood at the urethral meatus and a high-riding prostate on DRE.
Small bowel obstruction is characterized by […]-active bowel sounds initially.
Small bowel obstruction is characterized by hyper-active bowel sounds initially.
may eventually progress to decreased or absent bowel sounds
Sphincter of Oddi dysfunction produces recurrent, episodic pain in the […] quadrant or epigastric region with elevations in AST/ALT.
Sphincter of Oddi dysfunction produces recurrent, episodic pain in the right upper quadrant or epigastric region with elevations in AST/ALT.
visualization of a dilated common bile duct in the absence of stones favors this diagnosis
Subdural hematoma occurs due to tearing of […] (vasculature).
Subdural hematoma occurs due to tearing of bridging veins (vasculature).
classically presents with symptoms of headache and confusion that occur gradually (1-2 days)
Succinylcholine works by binding to post-synaptic […] receptors, triggering an influx of Na+ and efflux of K+ (depolarization).
Succinylcholine works by binding to post-synaptic ACh receptors, triggering an influx of Na+ and efflux of K+ (depolarization).
conditions that upregulate post-synaptic ACh receptors may lead to life-threatening hyperkalemia (e.g. skeletal muscle trauma, burn injury, stroke)
Symptoms of atelectasis (e.g. dyspnea, tachypnea) typically manifest on post-operative day […] and […].
Symptoms of atelectasis (e.g. dyspnea, tachypnea) typically manifest on post-operative day 2 and 3.
Terminal hematuria is suggestive of […] or prostatic damage.
Terminal hematuria is suggestive of bladder or prostatic damage.
