Surgery IV Flashcards
What head and neck infection is characterized by trismus, muffled voice, and deviation of the uvula on physical exam?
Peritonsillar abscess (quinsy)
other symptoms include fever, pharyngeal pain, and earache
What hip movement (flexion or extension) worsens the pain associated with a hip septic arthritis?
Hip flexion
What hip movement (flexion or extension) worsens the pain associated with a psoas abscess?
Hip extension
i.e. the psoas sign
What imaging modality can confirm the diagnosis of diaphragmatic rupture in patients with suggestive X-ray findings?
CT scan (chest, abdomen)
What imaging modality is best for confirming a meniscal tear?
MRI
What imaging modality is preferred for diagnosis of acute mesenteric ischemia?
CT angiography
What imaging modality is typically used to diagnose acute cholecystitis?
Ultrasound
CT scan also be used but is less sensitive; HIDA scan is useful when US findings are indeterminate
What imaging modality is used for diagnosis of a psoas abscess?
CT scan of abdomen/pelvis
What imaging modality is used for the definitive diagnosis of syringomyelia?
MRI
What imaging modality is used to confirm a diagnosis of duodenal hematoma?
Abdominal CT
What imaging modality is used to confirm a rotator cuff tear?
MRI
What imaging modality is used to determine the need for urgent surgical intervention in patients with ischemic colitis (e.g. extensive bowel damage, perforation)?
CT scan
What imaging modality is used to diagnose urethral injury?
Retrograde urethrogram
What imaging modality is useful for hemodynamically stable patients with blunt abdominal trauma and a positive FAST exam?
CT scan of the abdomen
helps distinguish blood from urine or ascites and can help quantify the amount of intraperitoneal blood
What imaging modality should be used to confirm placement of a central venous catheter tip?
Chest X-ray
this step may be omitted in the setting of an uncomplicated ultrasound-guided CVC placement
What imaging modality should be used to evaluate a suspected urethral injury (e.g. patient with a penile fracture)?
Retrograde urethrogram
symptoms may include blood at the meatus, dysuria, urinary retention
What imaging test can confirm the diagnosis of ischemic colitis after a CT scan has been obtained?
Colonoscopy
What initial imaging modality is used to diagnose GI perforation?
Upright X-ray of chest and abdomen
What is a common early clinical feature of compartment syndrome?
Paresthesia
due to sensory nerve ischemia
What is next step for blunt abdominal trauma with GI perforation identified on CT?
Exploratory laparotomy
What is the best initial step in the management of a hemodynamically stable patient with hemoptysis and a high clinical suspicion for tuberculosis?
Respiratory isolation
What is the emergency treatment of choice for acalculous cholecystitis in a critically ill patient?
antibiotics and percutaneous cholecystostomy
followed by cholecystectomy when the medical condition stabilizes
What is the first step in the management of a necrotizing surgical site infection?
Surgical exploration and debridement
adjunctive therapies including broad-spectrum antibiotics, adequate hydation, and tight glycemic control are also important
What is the first step in the management of cervical spinal trauma?
Spine immobilization
What is the first step in the treatment of acute upper GI bleed (e.g. variceal hemorrhage) in a patient with a normal airway/breathing?
Vascular access with 2 large-bore IV catheters
What is the first test used to evaluate splenic injury in a hemodynamically stable and alert patient?
Focused Assessment with Sonography for Trauma (FAST)
What is the first test used to evaluate splenic injury in a hemodynamically stable patient with altered mental status?
CT scan of abdomen
in stable patients with AMS, the FAST exam is often skipped
What is the fluid of choice to restore volume quickly in the management of septic shock?
IV 0.9% saline (crystalloid)
equally effective as albumin, but less costly and easier to acquire
What is the gold standard for diagnosis of sphincter of Oddi dysfunction?
sphincter of Oddi manometry
What is the ideal placement for a central venous catheter tip?
Lower superior vena cava
What is the initial intervention for the management of stress fractures of the 2nd, 3rd, or 4th metatarsals?
rest and simple analgesics (e.g. acetaminophen)
non-union is uncommon
What is the initial management for a large pneumothorax in a hemodynamically stable patient?
Needle decompression
What is the initial management for a small (< 2 cm), spontaneous pneumothorax?
observation and supplemental O2
most common in tall, thin, men in their early 20s
What is the initial management for a tension pneumothorax in a hemodynamically unstable patient?
Urgent tube thoracostomy or needle decompression
What is the initial management for hemodynamically stable patients with an appendiceal abscess?
IV hydration, antibiotics, and bowel rest
appendectomy should not be performed right away (may return in 6-8 weeks for elective appendectomy, “interval appendectomy”); abscess formation should be suspected in patients who present > 5 days after the onset of symptoms
What is the initial screening test for blunt aortic trauma?
Chest X-ray
should be ruled out in patients with blunt deceleration trauma (MVA or fall from > 10 feet)
What is the initial step in management of dumping syndrome?
Dietary modification
What is the initial step in the management of small-bowel obstruction that is complicated by fever, hypotension, and tachycardia?
Urgent surgical exploration
What is the initial treatment for prerenal acute kidney injury in patients with evidence of hypovolemia?
IV fluid bolus
What is the likely cause of gastric outlet obstruction in a patient with a history of acid ingestion?
Pyloric stricture
characterized by early satiety, nausea, non-bilious vomiting, weight loss, and abdominal succussion splash
What is the management for a young patient with persistent symptoms due to a meniscal tear?
Surgery (after evaluation by MRI)
What is the management for older and/or mildly symptomatic patients with meniscal tears?
rest/activity modification
What is the most common blood transfusion reaction?
Febrile non-hemolytic reaction
What is the most common cause of lower extremity edema?
Venous insufficiency (valvular incompetence)
classically worsens throughout the day and resolves overnight
What is the most common cause of primary hypoparathyroidism?
Post-surgical
What is the most common cause of small-bowel obstruction (SBO) in the U.S?
Adhesions
typically result from abdominal operations or inflammatory processes; other common causes include hernias (#1 cause in developing countries) and malignancy
What is the most common location for anal fissures?
Posterior midline
