Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Shelves > Surgery - Kap > Flashcards

Surgery - Kap Flashcards

1
Q

Male pt has pneumaturia and fecaluria. Dx and studies?

A

GI fustulas (colovesical most common, but also enterocolic, colocolonic, vaginal-colonic).
Usually in sigmoid
Usually caused by diverticulitis, sigmoid cancer
Studies - CT scan to confirm presence of inflammatory diverticular mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pt falls and tries to catch themself with an outstretched arm. Type of fx and management?

A

Colles’ fracture - dorsally displaced, angulated fx of the distal radius and ulnar styloid
Managment - short armed cast to immobilize the wrist while allowing elbow mobility - provides for good QOL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pt gave birth a few weeks ago and has had ongoing rectal pain ever since. Extreme pain with defecation and bright red blood. Dx and location of lesion?

A

Anal fissure
Syx - exquisite pain and minimal bright red bleeding, pain with coughing and sitting
Usually young female, can have anal pruritus
Location - posterior to midline, distal to dentate line
10% are anterior to midline
Most common cause - constipation with hard stools, childbirth, Crohn’s
Management - warm water after BM, analgesics, stool softners, high-fiber diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pt is 3 days post op and develops acute abdominal pain and distention. PE - distended. Studies - minimally dilated small bowel, max dilated large bowel. Dx and management?

A

Dx - colonic pseudo obstruction (Ogilvie syndrome). Caused by symp/parasymp imbalance
Common in post op period
Exacerbated by narcotics and electrolyte imbalance
Management - 2 mg neostigmine slowly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Male pt has chills, fevers, low back/perineal pain, and urinary hesitancy. Dx and Tx?

A 
Acute prostatis
Generalized athralgia/myalgias common
PE - prostate tender, warm, swollen
E. coli or Chlamydia
Tx - Quinolones (ofloxacin 4-6 weeks)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Atrial fib is at risk of which GI injury?

A

Mesenteric thromboembolism
Early cases - angio
Late cases - exploratory laparotomy
Pain out of proportion to exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a clean-contaminated surgery and what is the risk of a post surgery infection.

A

Clean contaminated - created in a sterile environment but involves entry into the respiratory, GI, or genital systems with limited spillage from that system
Risk of infection - 3-5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

2 weeks post a GI surgery pt presents with obstruction. Cause and best way to Dx?

A

Obstruction due to adhesions

CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Elderly pt has a fall and presents in pain with one leg appearing shorter and externally rotated. Management?

A

Displaced femoral neck fracture
Replace femoral head with metal prosthesis
The fractured head is at significant risk for avascular necrosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A CHF pt cannot maintain an erection. What should he be given?

A

A vacuum device

NEVER give sildenafil in a CHF pt especially when they are taking nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Best way to prevent postop pneumonia in a pt with multiple RF’s?

A

Anything that encourages lung expansion: Incentive spirometry, deep breathing, PEEP
RF’s: age, smoking, pulm dz, poor health, long surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

AAA Pt post op 1 day presents with bloody diarrhea. Dx?

A

Bowel ischemia

Especially in AAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should be done immediately after placing a central line?

A

CXR to confirm placement in to the subclavian vein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pt has free air on CT. What do you do?

A

exploratory lap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pelvic fx pt has localized pain, urinary retention, and hematuria

A

Extraperitoneal bladder injury

Contusion or rupture of the neck, anterior wall, or anteriolateral wall of bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Initial management for a renal failure pt with DVT

A

Warfarin + heparin

warfarin causes procoagulable state in first 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cause of edema, stasis dermatitis, and venous ulcerations

A

Venous insufficiency, valve incompetence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

4 weeks post MI pt presents with periumbilical pain out of proportion to exam, leukocytosis, high Hgb, High amylase, and metabolic acidosis. Dx?

A

Acute mesenteric ischemia
Caused by cardiac emboli
Confirm with CT angio
Tx - embolectomy, abx, and anticoags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Locations in the colon most sensitive to ischemia?

A

Splenic flexure

Rectosigmoid junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Male pt has dysuria, frequency, urgency, painless hematuria. Rectal exam and U/A negative. Now what?

A

High risk of bladder cancer
Perform cystoscopy with bx
Bladder cancer frequently presents with painless hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Appropriate meds for conscious sedation of a child?

A

po or pr midazolam or diazepam
Pt is able to maintain airway, reflexes, and response to physical stimuli
Indicated when a pt hasn’t fasted (ie trauma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Most common COD in a transfusion reaction?

A

febrile hemolytic transfusion rxn (low HCT)
Caused by ABO mismatch
Ab mediated hemolysis -> fever, tachy, anemia, and hemoglobinuria
Tx with IVF, diuresis, sodium bicarb, and vasopressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What should be done to correct a medial meniscus tear?

A

Acute - PT and NSAIDS

Chronic - Arthroscopic evaluation and intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do you do when you can’t Foley a pt that has urinary retention?

A

Suprapubic tube placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

LLQ pain

A

Diverticulitis

Often require sigmoidectomy after the acute flair is over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Main concern after reducing a supracondylar fracture?

A

Vascular and nerve injury (brachial a. and/or median n.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Premature infant with feeding intolerance, thrombocytopenia, and air in the loops of the bowel. Dx?

A

Necrotizing enterocolitis

air in the bowel is pathognomonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Lab findings in primary hyperparathyroidism

A 
High PTH
Hypercalcemia
Hypophosphatemia
Elevated urine calcium
"Stones, bones, abd groans, and psych moans"
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is an appropriate surgery for a breast lump >4cm in diameter?

A

Mastectomy, too large for a lumpectomy

Also do axillary node sampling to determine post op systemic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Charcots triad

A

Fever, RUQ pain, jaundice

Dx - cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

RUQ pain - for stones. CCK stimulation revealed EF <35%. Dx?

A

Chole dyskinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

During lap chole, adhesions surrounding the liver and gallbladder. Dx?

A

Fitz-Hugh-Curtis Syndrome

Intra abdominal dissemination of PID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Cholangiocarcinoma at the confluence of the R and L hepatic ducts?

A

Klatskin tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Etiology of bacterial cholangitis?

A

E. coli, Klebsiella, Pseudomonas, enterococci, proteus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which landmarks demarcate the R and L hepatic lobes?

A

The gallbladder fossa and the IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

where is the CBD in the hepatoduodenal ligament?

A

Usually CBD is lateral
Hepatic a medial
Portal v. posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Tx for pt that is morbidly obese with GERD or Barrets?

A

Gastric bypass with Roux N-Y gastrojejunostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the main cause of gastric bypass failure despite the repair being intact?

A

High volume intake of high calorie liquids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Potential micronutrient deficiencies from gastric bypass?

A

Fe deficiency from duodenal bypass (microcytic anemia)

B12 deficiency from lack of IF (macrocytic anemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Most likely site for colon volvulus?

A

Sigmoid
Presents with abd distention and obstruction. KUB reveal tire sign
Tx - decompression with sigmoidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How do you tx a pt that has had 2 or more divirticulitis flairs requiring hospitalization?

A

Sigmoid resection after resolution of the acute flair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Blood supply to the gallbladder?

A

Cystic a. (from the R hepatic a.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Gallbaldder secretion is stimulated by?

A

CCK

cystic duct -> CBD -> ampulla of Vater (controlled by sphincter of Oddi)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Where does the bile that is stored in the gallbladder come from?

A

The liver

Pancreatic bile stays in the pancreatic duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What joins the cystic duct to form the CBD?

A

Common hepatic duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What prevents the reflux of bile into the gallblader?

A

The spiral Valves of Heister

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Borders of the triangle of Calot?

A

Cystic duct - lateral
Common hepatic duct - medial
Liver edge - superior
The cystic a. courses through this triangle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

gallstones in the gallbladder

A

Cholithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Stones in the common bile duct

A

Choledocholithiasis

Major cause of pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What causes biliary colic pain?

A

When CCK stimulates the gallbladder to contract it contracts down on the stone and there is either partial or total occlusion of the duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

gallstones are made of?

A

Cholesterol (75%)
Calcium bilirubinate (pigmented)
or a mix
Occurs when bile is supersaturated with cholesterol or cirrhosis/hemolysis (pigmented)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Infection of the bile ducts extending into the liver?

A

Cholangitis

RUQ pain, fever, jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Gallbladder dz presenting with elevated LFTs?

A

Choledocholithiasis
Stones in the common bile duct
Can cause gallstone pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

NIH Criteria for bariatric surgery

A

BMI>40 or >35 + comorbids (DM, HTN, OSA)
No metabolic abn causing weight gain
attempted and failed weight loss
Psychologically stable w/o eating disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is dumping syndrome?

A

Post gastric bypass ingestion of concentrated sweets
Occurs due to bypassing of the intestines
abd cramps, n/v, flushing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Risks of gastric bypass surgery?

A 
Dumping syndrome
Intestinal anastomoses
Ulcers
Strictures
Internal hernias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Chronic alcoholic presents with acute pancreatitis plus free air. Dx?

A 
Perforated viscus (ulcer)
Emergency lap
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Management of SIADH?

A

Fluid restrict and diuresis

if this fails, ADH antagonist (demeclocycline, lithium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Child has recurrent unilateral nosebleeds that are now malodorous

A

Foreign body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How do you manage a diverticulitis pt presenting in sepsis

A

IVF, abx

Surgically remove the sigmoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

A herniated lumbar disk is identified on MRI. How do you manage?

A

Pain control and monitor for spontaneous resolution
Surgical intervention is required if neurologic syx progress
Emergency intervention in cauda equina syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What happens in nonocclusive mesenteric ischemia (NOMI)?

A

alternating narrowing and dilation of mesenteric a. causing hypoperfusion of small bowel
Elderly pt with diffuse abd pain following hypotensive episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

mid 40’s male has a UTI that improves with abx but quickly returns after d/c. Dx?

A

Prostatic abscess
PE - tender prostate with a fluctuant mass
Tx - evacuation followed by abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Graft vs. host is mediated by which cells?

A

Donor T cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Cholangitis pt develops a liver abscess. Now what?

A

Percutaneous drainage of the pyogenic liver abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

How do you diagnose congenital hip dislocation?

A

PE and U/S

Tx - Pavlik harness with splinting in abduction x 6 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Tx for acute prostatitis

A

Fluoroquinolones 4-6 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Hypotension, tachycardia, low urine output

A

Cardiogenic shock

B1 agonist - dobutamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Why is a bx of a prostate helpful

A

The gleason score determines severity and therefore need for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

DM has bx of nasal mucosa revealing thrombosed vessels with multiple broad non-septate hyphae with right angle branches. Dx and management?

A

Mucormycosis

Amphotericin B and debridement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Surgical management of thyroid follicular cancer?

A

Total thyroidectomy plus post op radioactive iodine
High hematogenous metastasis risk
Radioactive iodine destroys the remaining malignant cells, but only succesful if these cells aren’t competing with normal tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Workup for a scrotal hematoma due to trauma?

A

Scrotal sonogram - suspicion of a testicular, epididymal, or vascular compromise requiring surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

following an anorectal procedure pt presents with contant soiling of the underwear. Dx?

A

Fistula-in-ano
PE - small opening on the anus with granulation tissue and a fistulous tract.
Rule out malignancy and/or necrosis with sigmoidoscopy
Tx - fistulotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Which two ocular tumors can require enucleation?

A

Retinoblastoma

Melanoma - can still metastasis up to 20 years later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

How do you decide if a pt should be intubated?

A

If their GCS is <8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Vomiting + chest pain + sub q emphysema

A

Meckler triad -> perf esophagus
sub q emphysema = air under the skin
Dx with Gastrografin swallow study - demonstrates contrast extravasating from the esophageal lumen. Nontoxic to the surrounding structures, unlike barium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is a beneficial medical tx in a pt with hyperPTH and Serum Ca2+ ~12?

A

Estrogen-progestin therapy

beneficial in postmenopausal women, reduces bone resorption (increase bond density and decreases serum Ca2+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

5 P’s of compartment syndrome

A 
Pain
Pallor
Parethesia
Poikilothermia
Pulselessness
Time to decompress the wound surgically
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What causes a direct inguinal hernia?

A

Defect in the posterior wall (transversalis fascia)
RF’s - age, male, obese
Fever and unreducible suggest that the bowel is strangulated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

8 hrs following removal of a prolactinoma a pt becomes comatose. Shes received 800 mL IVF and UO is 600 mL. Dx?

A

Diabetes insipidous

Check serum salt level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

unilateral intrascrotal pain, swelling fever. Pain relieved by lifting the testes

A

Epidiymitis
Usually caused by chlamydia
Tx - Azithro, doxy, or tetracycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Young male presents with unilateral testiticular pain that is not relieved by lifting the testes

A

Testicular torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Pt is unable to extend wrist and sensation is compromised in the thumb and forefingers

A

Radial n. palsy

Common in humerous fx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Elderly pt becomes senile after a minor fall 2 weeks ago

A

Chronic subdural hematoma

Tearing of bridging veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

When would you see post op ileus

A

4-5 days after an abdominal operation
Dx with Xray or CT - see air in the bowel rather than obstruction
Keep pt NPO and insert an NG tube to decompress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Primary Sclerosing cholangitis is highly associated with?

A

IBD, especially ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

PSC increases the risk for?

A

Cholangiocarcinoma

Colon cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Pt with elevated cortisol that is not suppressed by high dose dexamethasone. Dx?

A

Ectopic ACTH production
Consitent with small cell carcinoma of the lung.
Requires radiation and chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Kissing lesion in the stomach reveals high grade lymphoma. What is important to know prior to selecting treatment?

A

Depth and invasion of the tumor into the gastric wall
If it has invaded the entire depth, the organ will perf with chemo alone
Surgery is preferred when it is full thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Flank pain radiating to the inner thigh + hematuria is?

A

Nephrolithiasis
Xray
Unless pt has crohn’s -> more likely to have uric acid and calcium oxalate stones, get a CT w/o contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Pt has radial n. pain that is reproduced when holding her thumb inside of her fist and forcing the wrist into ulnar deviation. Dx?

A

Tenosynovitis of the abductor or extensor tendons of the thumb (de Quervain’s tenosynovitis)
Finkelstein test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Pt has absent pedal pulses and is opnely bleeding following a trauma but there is no fx. What do you do next?

A

Exploratory surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

If a pt has weak distal pulses in the setting of a fx without bleeding, what do you do next?

A

Splint the fx and CT angio of the limb to identify where the vascular injury is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

An impotent pt is able to get erections o/n. Dx and management?

A

Organic impotence

augment iwht sildenafil, tadalafil, vardenafil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What should be given intraoperatively to a pt that has been on steroids for a long time

A

Intraoperative steroids

given to avoid adrenal crisis secondary to HPA suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

When knees hit the dashboard in a MVA what should you be worried about?

A

Posterior dslocation of the hips

Avascular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Long standing HCV and cirrhosis predisposes a person to? What level should be checked?

A

Hepatocellular carcinoma

alpha fetoprotein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is the pathophys of dumping syndrome

A

Rapid gastric emptying
undigested food enters the duodenum
generally have hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

pt with sclerosing cholangitis is at risk of developing?

A

cholangiocarcinoma

Klatskin tumor at the confluence of the hepatic ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Prostate cancer was confirmed by u/s guided biopsy. Now what?

A

Radical prostatectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Pt has a painless testicular mass that transilluminates. Now what?

A

Nothing. It’s a simple cyst and will resolve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Most common cause of fever 1 day s/p surgery

A

Atelectasis

Encourage incentive spirometry and deep breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Most common cause of fever 3 day s/p surgery

A

UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Most common cause of fever 5 day s/p surgery

A

DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Most common cause of fever 7 day s/p surgery

A

incisional infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Most common cause of fever 10-15 day s/p surgery

A

deep abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

How do you tx ascending cholangitis?

A

emergency ERCP

LCC is urgent, but not emergent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

When do you start looking for Barrett’s?

A

Pt >50 with GERD >5years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Pt >50 with flattened stool and blood

A

Left sided colon cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

How do you treat early breast cancer?

A

Lumpectomy + sentinel LN bx + adjuvant radiation + tamoxifen (if ER +)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Pt with chronic UC presents with a dilated and distended transverse colon

A

Toxic megacolon
Complication of UC
Tx - supportive care + sbx
May require a total colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Common complication after a AAA repair?

A

Ischemic colitits
Occurs when IMA is covered by the aortic graft
Presents with bloody diarrhea and leukocytosis
Almost always requires resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Preggo that dies due to syx similar to aortic diseciton?

A

Disection of visceral aneurysm
Splenic a. aneurysms tend to rupture during pregnancy
Should be repaired in all women of childbearing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Weight lifter has arm swelling when he holds his arm over head

A

Thoracic outlet syndrome
Can be neurologic arterial or venous in etiology
Venous -> edema and venous engorgement
Weight lifting -> hypertrophy of the anterior scaline m. and subclavian v. becomes pinched between the muscle and clavicle
Tx - surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Burn pt develops excessive edema under the burn

A

Eschar
Con lead to compartment syndrome
Tx - decompress the eschar (escharotomy) to prevent limb loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Post seizure, pt has shoulder pain but AP Xrays are negative. Returns the next day clutching her injured arm over her chest

A

Posterior dislocation of the should
NEED AP AND AXILLARY views
Typically only see posterior dislocation in MVA, seizure and electrocution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Closed skin fx with weak distal pulses. You need a

A

CT angio - vascular injury is an emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Signs of rhabdo

A

Creatanine Kinase elevated
Hyperkalemia
Tx - emergency dialysis
Suspect a crush injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Pt develops scrotal abscess

A

surgically drain

ensures complete drainage of fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

This pt with epigastric blunt trauma

A

Pancreatic injury

Elevated amylase, lipase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Pt with vomiting, chest pain, subQ emphysema

A

Esophageal perf (Boerhaave syndrome)
Full thickness transmural perf (vs, Mallory-Weiss, tear of the inner layer)
Dx with Gastrografin swallow study (water based and nontoxic)
Tx - thoracotomy, or NPO IVF and abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Pt that frequently wears heels has exquisite pain between the third and fourth toes

A

Morton neuroma

Tx - avoid heels, or surgery to remove the neuroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Management of an ACL

A

Average person - knee immobilization and rehab, surgery if failure
Athletes require surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Former alcoholic and smoker has a nontender firm nonfluctuant mass x 6 months in his neck. Most likely?

A

Met cancer until proven otherwise
Most likely Squamous cell from the lung or GI (primary pharyngeal is suspicious here)
Work up - panendoscopy, FNA, CT or MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

How do you evaluate a pt with blood at the urethral meatus?

A

Retrograde urethrogram
Never cath
Associated with pelvic fx, get a CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Management of acute abdomen

A

Exp Lap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Management of acute epididymitis

A

Scrotal elevation + abx
Younger male - G/Ch
Older - UTI organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

After a fall, pt is clutching arm in external rotation as if about to shake hands. Shoulder looks square

A

Anterior dislocation

Often has numbness over the axillary n. area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Pt is unable to flatten their hand out and has palpable fascial nodules

A

Dupuytren contracture

Fibrotic dz of the palmar fascia causing shortening and thickening of the palms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

How long do you observe a umbilical hernia in a child?

A

For 2 years, most will spontaneously close by age 2

Exception is if the baby becomes symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Woman has unilateral bloody nipple discharge and MRI is negative for masses. Now what?

A

Galactography

Look for intraductal papilloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

BPH pt is still symptomatic while taking tamsulosin. What can be added?

A

Finasteride, (or dutasteride but this drug is pricy

5alpha reductase inhibitor reduces presence on dihydrotestoerone -> prostate should shrink after 6 mo of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Pt had a previous GI surgery that resulted in an untreated ulcer, now has severe halitosis and diarrhea

A

Gastrojejunocolic fistula

gastric ulcer eroded into jejunum -> fecal contents into the stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

How long after induction of anesthesia can a pt demonstrate malignant hyperthermia?

A

Up to 30 minutes, especially when succinylcholine is used

Give dantrolene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Pt has pneumaturia (air in urine), be suspicious for

A

Colovesical fistula

Get a CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

High Alk Phos
High total bili
Angemia
Guiac + stool

A

Duodenal tumor obstructing the common bile duct (most likely at the ampulla of Vater)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Primary hyperparathyroidism causes which electrolyte abnormalities?

A

Hypercalcemia
Hypophosphatemia
Syx - Stones, bones, abdominal groans, psych moans)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Smoker with progressive dysphagia (meat -> mashed potatoes)

A

Squamous cell carcinoma of the esophagus

RF’s - smoking, drinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Workup for SBO?

A

Clinical Dx based on syx and hypoactive/high pitched bowle sounds
Abd Xray to r/o free air. Dilated loops of bowel confirms dx of SBO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Best option for GERD pt that has failed PPI’s

A

Lap Nissen Fudoplication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Diagnositc test for Meckel diverticulum?

A

Technetium pertechnetate scan

Radioisotope has high affinity for gastric mucosa allowing visualiation of the ectopic tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

How do you diagnose Venous insufficiency?

A

Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Complication of penile foreskin being retracted for a long period of time

A

Paraphimosis
The foreskin acts as a tourniquet around the penis
Medical emergency - must reduce the foreskin by adding pressure
Occurs after catheter placement if foreskin is not replaced over the glans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Baby fails to pass meconium in first 36 hours, distended abdomen, no stool in rectum

A 
Hirschprug dz (aganglionosis)
Dx - rectal bx that is devoid of ganglion cells
Tx - surgical resection of the aganglionic segment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Pt has a non-healing punched out ulcer on the skin

A

Skin cancer

Dx with bx of the edge of the lesion, need to assess the interface with normal skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Consequence of prolonged urinary retention

A

B/l hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What is the pringle maneuver?

A

Clamping the portal triad in the hepatoduodenal ligament. Controls inflow (hepatic a., portal v. and CBD), but no effect on livers outflow. So, if bleeding persists after this suspect the hepatic v.’s which drain into the IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Most common cause of fever 10-15 days s/p a contaminated abd procedure?

A

Anastomotic disruption or
Deep abscess
Get a CT of the abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Work up for pt with lower extremity claudication and decreased ABI

A

Get a peripheral artery duplex
Claudication is caused by arterial insufficiency
Need to see vascular surgery to revascularization or endovascular techniques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Management for b/l displacement of the malleoli

A

closed reduction and splint at 90degrees until they can see surgery, also soft tissue edema needs to resolve prior to surgery (urgent, not emergent)
Ultimately will require open reduction and internal fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Tx for BPH unresponsive to tamulosin

A

Finasteride (5alpha-reductase inhibitor)

Prevents conversion of testorsterone to dihydrotestosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Management of a hypernatrimic pt?

A

Half normal saline (0.45%) + D5

Note for every 3mEq increase in Na+= 1L of water deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Pt has organic erectile dysfunction

A

Determine amount of bioavailable testosterone (can be caused by hypogonadism; pt may also have decreased libido and osteoperosis)
If low start a trial of phosphodiesterase 5 inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Child in a trauma and we are unable to get a peripheral IV. What is the next best option?

A

IO in the proximal tibia

Try to avoid damage to the growth plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Unilateral pitting edema x years

Audible femoral bruit and palpable thrill

A

Look for hx of penetrating trauma -> AVM

Can develop significant venous HTN -> edema, varicose veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

At what point can prostate cancer screening be omitted?

A

When the pt has a life expectancy less than 10 years

ie if more likely to die from other comorbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Days after liver transplant pt has elevated levels of GGT, alk phos, and bili

A

Get a U/S of the biliary tract and doppler of the vessels
Technical problems of anastomoses are most common cause of early deterioration in liver transplant
Antigenic reaction is less common in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Dysphagia to solids and liquids + Barium swallow shows massively dilated proximal esophagus with narrow tapered appearance at the lower sphincter

A

Achlasia (“failure to relax)
“birds beak appearance”
Loss of inhibitory neurons in the lower esophageal sphincter
Idiopathic, Chagas, lymphoma, gastric carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Male >50 with rectal bleeding

A

Colon cancer until proven otherwise

Need colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Work up for PE

A

Spiral CT
Look for chest pain 1 wk after a major surgery
Tachycard, tachypnea, anxiety, diaphoresis, S2
ABG shows hypoxemia, hypocapneia, alkalosis
EKG normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Solitary painless testicular mass

A

Testicular cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Testicular mass

Bx - small cells with indistict borders, scant cytoplasm, sheets of crosded nuclei. Elevated alpha-fetoprotein

A

Embryonal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Testicular mass +

cytotrophoblastic, synctitophoblastic cells Elevated Bhcg

A

Choriocarcinoma

Looks like chorionic villi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Testicular mass +
Nests of large, round clear cells with centrally placed nuclei resembling primary spermatocytes, elevated placental alk phos (PLAP)

A

Seminoma
Cause of more than half of testicular cancers
Presents in young men (20-40)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Testicular mass +

Layers from all 3 germ layers

A

Teratoma

May be bening (especially in the young) or malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Testicular mass +

Papillary structures resemblin glomeruli (Schiller-Duval bodies), elevated Alpha-fetoprotein

A

Yolk sac carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Alcoholic with abd pain, n/v and b/l bruising along the flanks

A

Pancreatitis
b/l bruising on the flanks - Grey-Turner sign, caused by SubQ tacking of digested blood around the abdomen from the inflamed pancreas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

10-14 days Following tx for pancreatitis pt returns with high fever and leukocytosis

A

Pancreatic abscess

Get CT of the abdomen to assess if the abscess can be drained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

Male has a painless penile ulcer x months but not an STI

A

Squamous cell carcinoma
Most common penile cancer
Usually presents on the glans or foreskin
RF’s: HPV, smoking, megma, phimosis, AIDs
Circumcision is protective
Dx with bx
Tx - penectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Pulstile mass at epigastrum + excruciating back pain?

A

Leaky AAA
Leaky blood in the retroperitoneal space can occur before a full dissection
>5 cm is high risk for dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Trauma pt is stable, but then dies very suddenly

A

Air emobolis
When > 120 mL of air enters the venous circulation within seconds.
Place pt in Tburg with left lateral decubitus position -> traps bubble in heart apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

Indications for CABG

A
  • Signigicant Left main coronary artery stenosis
  • 70% stenosis of the proximal LAD and proximal left circumflex a.
  • 3 vessel disease
  • Ongoing ischemia in symptomatic acute coronary syndrome not responsive to maximal nonsurgical therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Mastectomy is offered when a malignant mass is

A

> 4cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

Early localized prostate cancer is id’d on bx, tx?

A

Prostatectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

LLQ + tenderness + leukocytosis + fever

A

diverticulosis

Colonoscopy is contra in the acute attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

Congenital biliary tree dilation causing mild RUQ in a young adult

A

Choledochal cyst

Need surgical excision d/t increased risk of cholangiocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

First sign of hypermagnesmia

A

Loss of DTR’s

respiratory depression in extreme cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

Tx for asymptomatic hyponatremia?

A

Free water restriction

Symptomatic when Na < 120 (HA, seizure, coma), this requires hypertonic saline infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Why are gastric bypass pts at increased risk for nephrolithiasis?

A

If a pt loses their ileum but colon is intact they are at increased risk of hyperoxaluria.
Fatty acids are absorbed in the terminal ileum allowing calcium and oxalate to form an insoluble (unabsorbalbe compound). When the ileum is bypassed, fatty acids combine with calcium in the colon, leaving oxalate soluble/absorbale. Also, unabsorbed fatty acids and bile in the colon promotes oxalate uptake in the colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

What finding confirms oliguria d/t hypovolemia

A

FENA <1% suggests prerenal etiology

FENA = (urine NA x Sr Cr)/ (Sr Na x urine Cr) x 100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Post op pt has muscle spasms, hyperreflexia, tetany, but Ca2+ is NL

A

Mg deficiency
Common in malnourished pts and those with large GI fluid loses
EKG changes look like HYPERcalcemia (prolonged QT, T inversion, heart blocks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

Pt w/ LE claudication needs a cardiac eval to be cleared for surgery

A

Get a persantine thallium stress test

He won’t be able to acheive an exercise stress test with claudication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

OD pt has tinnitus w/ mixed metabolic acidosis and respiratory alkalosis.

A

Aspirin/salicyclate intoxication

Look for an increased anion gap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

watery diarrhea + GERd x months

A

Get a serum gastrin

Zollinger-Ellison syndome (gastrinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

Hepatitis with + ANA and anti-smooth muscle

A

autoimmune hepatitis

Tx - steroids +/- azathioprine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

Dysphagia with lesion in upper half of esophagus with hanging edges and luminal narrowing

A

squamous cell carcinoma of the Esophagous
upper half of esophagus = squamous cell
RF’s - smoking, EtOH, achlasia, other cancer, lye ingestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

Multiparous woman with chronic constipation

A

Pelvic floor disfunction
Can cause urinary/fecal incontinence or constipation
Get an anorectal manometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

Why does acute pancreatitis increase risk of ARDS?

A

Circulating phospholipase
Active pancreatic enzymes are released when Exocrine tissue is damaged. Many of these (incl PLP) cause inflammation throughout the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

Pt with trach has bleeding from the trach. What is going on?

A

Tracheoinmominate artery fistula (50% mortality rate)
If bleeding stops - immediate fiberoptic exploration in OR
if bleeding is ongoing - inflate trach balloon for compression, reintubate with endotracheal tube, or remove trach and compress anteriorly with finger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

How do you assess readiness for extubation?

A 
MUST:
Correction of underlying pathology
Hemodynamic stability
Others:
Rapid shallow breathing index (rr:TV) 60-105
Negative inspiratory force>-20
Weaned off of PEEP
Minute ventilation < 10L/min
RR < 20
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

How do you manage a pt with a hemolytic reaction d/t an incompatible blood transfusion

A

Stop the transfusion
insert a foley, measure urine output hourly (Hgb causes renal damage)
Stimulate diuresis with mannitol and alkalinize urine with NaBicarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

Which anesthesia should be avoided in pts with abd distention due to air in the bowels?

A

NO

Causes progressive distention in air-filed spaces during long procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

Diagnostic criteria for ARDS

A

CXR with b/l pulmonary infiltrates
PaO2/FiO2 ratio < 200
Pulmonary wedge pressure <18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

What are the physiologic changes in ARDS?

A
  1. hypoxemia unresponsive to O2 levels
  2. Decreased pulmonary compliance (stiff)
  3. Decreased FRC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

Which changes will shift the Hgb dissociation curve to the right and encourage tissue uptake of O2?

A 
Acidosis
Increase in PaCO2
Elevation in temperature
High 2,3-DPG (increases with hypoxia)
Think of the changes in exercise that can meet tissue oxygen demand
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

Pt has respiratory acidosis due to hypercapneia and hypoxemia

A

Intubte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

How do you manage a pt with TRALI?

A

Stop the transfusion and provide respiratory support

Presents as ARDS, hypoxemia, CXR w/ b/l pulm infiltrates not due to volume overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

What is required when intubating a pt with subQ emphysema in the neck?

A

A fiberoptic bronchoscope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

How do you treat hemorrhagic shock?

A

Fluid resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

What is complicated diverticulitis?

A

Diverticulitis + perforation, abscess, or fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

How do you manage a septic shock pt with complicated diverticulitis?

A

Fluid resuscitation
Broad spectrum abx
Surgical resection of sigmoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

How do you manage a septic shock pt with uncomplicated diverticulitis?

A

Admit
Fluids
IV abx
NPO (bowel rest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

What study should you order if you suspect Boerhaave syndrome

A

Gastrografin swallow

Barium is toxic to the thoracic structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

Pt 5 days s/p abd surgery has drainage of pink fluid. Why?

A

Fascial dehiscence (wound won’t look infected or dehisced)
Tape the wound securely and bind the abdomen
May eventually require elective fascial closure or hernia repair
If the wound eviscerates -> emergent surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

Bloody diarrhea and anemia after AAA repair

A

Ischemic colitis
Occurs after AAA repair d/t occlusion of the inferior mesenteric a.
Dx with colonoscopy
Will require colon resection with colostomy to prevent sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

Pt has a radial n. palsy after reduction of a distal humerus fractures

A

Ortho to re-manipulate the fx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

Pt has papillary m. rupture ~12 hrs after a MI. Manage?

A

Send to the OR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

Pt has wasting of the intrinsic muscles of the hand

A

Ulnar n. injury

Median is more sensory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

What size margins are needed to excise a melanoma?

A

Depends on the depth of the lesion
Thin (<1mm thick) -> 1 cm margin
Intermediate (1-4mm) -> 2cm
Thick (>4mm) -> 2-3 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

Treatment for alkali skin burns

A

Remove the agent and wash with large volumes of water

May require surgical debridment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

Chron’s pt with deep ulcers

A

Pyoderma gangrenosum
Associated with IBD and other immune disorders
Tx - systemic steroids and immunosuppresants (ie cyclosporine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

Initial treatment of frostbite

A

Immersion in 40-44C water, elevation, abx, Tetanus toxoid

May require debridment of necrotic tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

Rapid progression of erythema and bullae concerning for?

A

Necrotizing soft tissue infection

Need immediate surgical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

What is Mohs surgery?

A

Resection of basal or SCC on the face with optimal cosmetic result
Resection in small increments with immediate frozen surgery analysis
Ensures clear margins
Takes longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

Pt gets a SCC following a thermal injury

A

Marjolin ulcer

SCC is less common but more devastating d/t invasiveness and metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

Bowen disease

A

In situ SCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

Erythroplasia of Qeyrat

A

SCC tumor of the penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

Tenosynovitis of the abductor or extensor tendons of the thumb

A

de Quervain tenosynovitis

Seen in new moms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

Tx of diaphragmatic rupture?

A

Emergency lap
Risk of vascular compromise in the hiatal hernia
Dx - air fluid level in on e side of the chest, NG tube coiling into the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

Pain control for pts hospitalized with rib fx

A

Epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

Tx of venous transection in a hemodynamically unstable pt

A

Ligation

If pt were hemostable - suture, saphenous v. patches, synthetic interposition grafts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

Management of a transected common bile duct

A

Unstable - T tube

Stable - Roux-en Y choledochojejunostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

TNF is a peptide hormone produced by?

A

Activated monocytes/macrophages
Key cytokine in GN shock/sepsis
Fxn: activate and recruit PMN’s, increase vascular permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

Post liver transplant. liver bx reveals paucity of bile ducts

A

Chronic rejection

retransplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

What does a cross and match study in a transplant candidate

A

Studies if the recipient has circulating Ab’s against donor HLA Ag
Studied by adding recipient serum and complement to donor lymphocytes
If a + cross-match is detected on donor T cells, transplant would cause a hyperacute rejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

Tumor lysis syndrome is mediated by

A

Cytotoxic T cells

Hyperkalemia, hyperphos, hypocalcemia w/in 48 hours of starting chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

MOA of cyclosporine

A

inhibits IL2 production from T helper cells -> no clonal expansion of cytotoxic T cells and no Ab production from B cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

Contraindication for a cardiac transplant

A 
Increased pulmonary vascular resistance
Irreversible renal insufficiency
DM with end organ damage
Symptomatic extravascular  dz
Current or recurrent malignancy (<2 yrs)
Non cardiac comorbidity that would limit survival (cirrhosis, COPD, infection, PUD, etc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

2 months post renal transplant pt has increased Cr, Decreased UO, fevers, tenderness over graft

A

Acute rejection episode
1wk-3months s/p transplant
Dx w/ bx
Tx w/ high dose steroids and anti-T cell Ab (OKT3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

Hemodynamically stable pt with acute abdomen

A

Get a CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

Hemodynamically unstable pt with acute abdomen

A

Get a FAST exam

emergency lap if free fluid is found

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

Fever 10-15 days s/p abd surgery

A

Get a CT

Anastomotic disruption or deep abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

Epidural hematoma + unstable vital signs or neuro exam

A

Craniotolmy and hematoma evacuation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

Hyperthyroidism pt has a thyroid scan with a single focus of increased isotope uptake

A

“hot nodule”

iagnostic for a hyperfunctioning adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

Tx for adrenal insufficiency

A

Corticosteroids

Bronzed diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

What does multifocal dz mean in breast cancer?

A

multiple tumors w/in 1 quadrant of the breast

If the lesions are small compared to the size of the breast, pt may undergo conservation surgery

237
Q

Tumor in the tail of the pancreas
Rash (necrolytic migrating erythema)
DM
Anemia

A

Glucagnoma
Dx - CT
Tx - surgical excision w/ distal pancreatectomy
Met is common

238
Q

ACTH hypersecreting pituitary adenoma

A

Cushing dz

Cotisol is suppressed w/ high-dose of dexamethasone

239
Q

Management of a simple breast cyst

A

Reassurance and reexamine
Very low risk of malignancy, especially simple cysts
Complex cyst should be aspirated

240
Q

When is a thoracotomy required?

A

hemothorax with:
Recovering >20mL/kg of blood when chest tube placed (or >1500mL at initial placement)
OR
Shock and persistent bleeding of more than 3mL/kg/h

241
Q

PE finding in Achilles tendon rupture

A

Absence of plantar flexion on squeezing of the gastrocnemius m. in the prone position
Thompson Test

242
Q

best initial test for mesenteric ischemia

A

CT scan

243
Q

Tx for cardiogenic shock

A

Inotropic drugs

Increases myocardial contractility to improve CO

244
Q

Pt has dyspnea, peripheral edema, and coughing white sputum

A

Pulmonary edema secondary to CHF

Give 100% O2, loop diuretics, nitrates, morphine

245
Q

Following a blunt trauma pt has chest pain and a wide mediastinum on CXR. What study do you need?

A

Spiral CT

246
Q

MOA of omeprazole

A

Inhibits parietal cell hydrogen potassium ATPase

247
Q

Tx of ITP

A

Predinose, add IVIG if severe bleeding

Splenectomy if poor medical management (<30k x 3 mo, or <10k x 6 weeks on high dose steroids)

248
Q

Appendectomy pathology comes back as an appendiceal adenocarcinoma. Now what?

A

Need a R sided hemicolectomy

5 year survival is 55%

249
Q

Tx for esophageal achalasia

A

Failure of relaxation of the lower esophagous
Tx - esophagmyotomy
If surgery not possible -> CCB’s, nitrates, endoscopic dilation, botulinum

250
Q

Definitive surgical treatment for Ulcerative Colitis

A

Total proctocolectomy with end ileostomy (older incontenint patients)
OR Total proctocolectomy with ileoanal pouch anastomosis
mucosectomy is not offered to pts without rectal dysplasia

251
Q

Most common serious complication of an end colostomy?

A

Parastomal hernia
Occurs whent he stoma is placed lateral to the rectus abdominous m. (rather than through
Correct with relocation of the stoma or with a mesh

252
Q

Painless jaundice + weight loss

A

Pancreatic cancer

Get a contrast CT

253
Q

Tx of a perf duodenal ulcer in a pt with no hx of PUD

A

Closure with an omental patch

Vagotomy is only offered in pts with a long history of poor acid control

254
Q

Management of an axonal shear injury in the brain

A

Keep the intracranial pressure low to prevent further damage
Elevate the head, hyperventalate, avoid fluid overload
This will preserve cerebral perfusion pressure

255
Q

20-40 y/o female takes OCP’s presents with RUQ pain and hypotensive

A

Ruptured Hepatic adenoma
Get a CT and emergency lap
If found incidentally, the adenoma will spontaneously regress after cessation of OCP’s

256
Q

What medications put a person at risk of DKA or hyperosmolar hyperglycemic state (HHS)

A

Drugs that affect carbohydrate metabolism:
Glucocorticoids
High dose thiazides
Sympathomimetics (dobutamine, terbutaline)
Second gen antipsychotics

257
Q

When is valve replacement warranted in aoritc stenosis?

A

When the pt is symptomatic or the valve area is < 1 cm

258
Q

What are good prognostic factors for a pt to be able to tolerate a lobectomy

A

FEV1 > 60% of predicted

259
Q

Tx for small cell lung cancers

A

Chemo and radiation

260
Q

Tx of empyema w/ glucose < 40mg and pH<7

A

Most advanced or chronic stage of empyema

Thoracotomy w/ decortication to remove the purulent fluid. Abx therapy alone is not sufficient

261
Q

Facial swelling and cyanosis when a pt bends over

A

SVC compression is almost always due to malignancy (90%)

Bronchogenic most common

262
Q

Tx for perf esophagus

A

confirm dx with gastrografin swallow
Health pt - repair perf and drain mediastinum
pt with motility disorder, stricture, malignancy - fix perf and underlying abnormality
pt with esophageal carcinoma - esophagectomy
if perf esophagus is dx’d late - proximal diversion (cervical esophagostomy or “spit fistula)

263
Q

Management of a lung abscess

A

systemic abx

if fails to resolve after 12 weeks -> percutaneous drainage

264
Q

Initial tx of a descending aortic dissection

A

Bblocker - reduce rate of change in blood pressure and reduce shear on the aortic wall.
Can add nitroprusside
Take to urgery if there is evidence of end organ failure

265
Q

pt has severe chest pain on swallowing and there are prolonged high amplitude contractions in the esophagus

A

Diffuse esophageal spasm (DES)
Etiology unk
Tx - myotomy

266
Q

Kid swallowed alkaline cleaner. Manage?

A

Gastrografin swallow study
If perf present -> surgery
NPO until extent of damage determined
If severe give abx

267
Q

Pt has pelvic fx + bloody urine

A 
Bladder injury (+ urethral injury in males)
Do a retrograde cystogram + post-void films
Cystoscopy is was too invasive
268
Q

Pt has a battle sign and CSF otorrhea

A

Suggest basal skull fx

Get a CT that includes the neck to study the integrity of the cervical spine

269
Q

Tx for central DI

A

IVF hydration

desmopressin

270
Q

Older pt with painless neck mass

A

Most likley SCC, met from another site (GI or respiratory)

271
Q

Initial management of DVT?

A

Heparin

272
Q

Best way to evaluate the L side of the colon for ischemia?

A

Sigmoidoscopy

273
Q

<35 y/o Pt develops unilateral primary lymphedema

A

Lymphedema raecox

> 35 years is lymphedema tarda

274
Q

3 days s/p respair of AAA disection pt develops abd pain and bloody mucus per rectum

A

Ischemia of the L colon

275
Q

When do pts with peripheral a. disease qualify for arterial reconstructive surgery

A

Pain at rest

Gangrene

276
Q

Tx for superficial/submucosal transitional cell carcinoma of the bladder

A

Local excision and topical chemo

Look for man with hx of smoking

277
Q

Flank pain radiating to the testicle

A

Proximal ureteral or renal pelvic obstuction
Common innervation of the testicle and renal pelvis
Expect microhematuria (30 RBC/hpf in sediment) on UA

278
Q

Cause of kidney transplant rejection 1 month s/p transplant

A

Failure to suppress class II Ag recognition by the host

279
Q

Most common opportunistic GI infection in HIV +. Presents with fever, crampy abdominal pain, and frequent (often bloody) stool

A

CMV

280
Q

New onset of ecchymosis, low platlet count, but Bone marrow reveals increased megakaryocytes

A

Idiopathic thrombocytopenic purpura

Caused by preformed Antiplatelet Ab

281
Q

Femoral shaft fracture, sudden onset combative/disorientation, petechia over axillae

A

Fat embolism

282
Q

Pt with anemia, unintentional weight loss, and low-pitched rumbing diastolic murmur best heard over the apex

A

Atrial myxoma

283
Q

Paracentesis yielding milky chylous fluid

A

Lymphoma

284
Q

Post menopausal woman w/ CT of ascites, multiple pelvic masses, omental thickening

A

Ovarian adenocarcinoma

285
Q

smoker, coughing up blood, elevated serium calcium

A

SCC

These cancer secrete PTH related peptide

286
Q

Severe nosebleed with no obvious source on anterior rhinoscopy. Anterior nasal packing causes blood to now exit the mouth

A

Sphenopalantine a. bleed

287
Q

Pre op pt has chronic occlusion of illiac and femoral v.

A

Give low dose heparin prophylaxis immediately prior to surgery

288
Q

scleroderma pt with constipation x 6 days

A

Needs an exp lap

289
Q

Pt with hx of breast cancer remission experiencing SOB, weight loss, pain in chest wall

A

Malignant pleural effusion

290
Q

young female w/ hernia medial to the femoral v.

A

Femoral hernia

291
Q

Older pt had hemorrhage during sigmoid colectomy 2 days ago. Pt can’t void after removal of femoral catheter

A

Bladder outflow obstruction

292
Q

1 day s/p parathyroidectomy pt has perioral numbness/tingling

A

Give IV Ca2+ gluconate

293
Q

Sensation to pinprick is decreased bleow the nipples

A

Thoracic spine lesion

294
Q

Renal a. stenosis causes HTN by

A

Increased serum aldosterone

295
Q

When is extracorporeal shockwave lithotripsy indicated for nephrolithiasis?

A

When the stone is > 1cm
If <1cm -> hydration and analgesics, alpha adrenergic blockers may also prevent bladder outlet obstruction and promote expulsion of the stone

296
Q

When are percutaneous nephrostomy tubes indicated in nephrolithiasis

A

Unstable pt presenting with UTI and an obstructive stone

297
Q

Management of an infant w/ b/l undescended testicles

A

Chorionic gonadotropin therapy x 1 month -> operative placement into the scrotom before age 2 if it has not occurred

298
Q

Tx for testicular torsion

A

Orchiopexy of b/l testicles
Both testes have higher than normal risk of torsion so it is best to correct both at the same time
Most common in boys 12-18, present with pain and a high riding testicle
Occurs due to an abnormally narrowed testicular mesentery w/ tunica vaginalis surrounding the testis
Likely to save the testicle if surgery occurs w/in 4-6 hours

299
Q

Tx of renal cell carcinoma

A

Radical nephrecotomy

Not responsive to radiation or chemo

300
Q

Initial management of BPH w/ recurrent UTI’s?

A

TURP
also indicated in BPH pts with urinary retention, upper tract dilation, renal insufficiency, outflow obstruction, bladder stones

301
Q

Initial management of uncomplicated BPH

A

alpha-adrenergic antagonists and/or 5 alpha reductase inhibitors

302
Q

Management or ureter transection in an unstable pt

A

Place an external stent through the proximal ureteral stump w/ delayed reconstruction

303
Q

Initial management for spinal cord injury

A

IV high dose steroids

Been associated with better outcomes when given w/in 8 hours of injury

304
Q

pt with head injury develops bradycardia, HTN, irregular respiratory pattern

A

“cushing triad” of increased intracranial pressure
Raise the head of the bed, propofol, hyperventilate (PCO2 to 30-35), mannitol
If persists -> burr hole or craniotomy

305
Q

Athletic guy w/ chron’s dz, presenting with leg pain. Decreased hip ROM

A

Avascular necrosis of femoral head due to steroid use

Dx on MRI

306
Q

How do you dx osteomyelitis in the early post op period?

A

Nuclear triphasic bone scan

307
Q

Management of an open femur fx

A

Early irrigation and debridment, IV abx, fasciotomy, w/ internal or external fixation
Re-irrigate and debride in 1 wk to clear out all necrotic tissue

308
Q

Peds pt w/ limp x weeks.
TTP over R thigh.
Xray R femoral head is small and denser than NL

A

Legg-Calve-Perthes (LCP) dz
Occurs ages 2-12 more common in boys, can be b/l
Caused by period of ischemia in proximal femoral epiphysis followed by revascularization

309
Q

Peds pt with limp and pain in thigh or knee
Limited internal ROM in hip
Xray displacement of the metaphysis of the proximal femur

A

Slipped capital femoral epiphysis
Dissociation b/w epiphysis and metaphysis of proximal femur
Occurs in adolescents growth spurts, b/l in 1/3 of cases

310
Q

Injury to the radial n. at the wrist would primarily cause?

A

Sensory abnormalities of the dorusm of the hand from ring finger to thumb and palmar surface of thumb
A more proximal radial n. injury would compromise wrist extension and forearm supination

311
Q

Stable pt with displaced tibial shaft fx

A

Intramedullary nailing

Plates are used when the fx is too proximal or distal for nailing

312
Q

What are goal CPP and ICP?

A

CPP>70mmHg

ICP <20mmHg

313
Q

Most likely cause of a ring enhancing lesion in an otherwise healthy pt

A

metastatic dz

Lung, breast, kidney, melanoma, GI

314
Q

Pt w/ depressed skull fx has CSF draining from nose

A

Get immediate dural repair

315
Q

Pt has worst HA of life and LP consistently yields blood. Now what?

A

Get a 4 vessel cerebral angiogram

Tx - craniotomy w/ clipping of the aneurysm

316
Q

Acutely increasing ICP causes?

A

Irregular respirations, bradycardia, increased blood pressure
Cushing triad
Papilledema is associated with chronic increases in ICP

317
Q

Formula for burns

A

Kg x %BSA x 3-4cc (adults)
kg x %BSA x 2-4 cc (kids)
Give LR or normal saline

318
Q

CRF pt has abn electrolytes and elevated BUN/Cr. What do they need before surgery?

A

Dialysis 24 hrs prior

319
Q

BMI 67, frequent hospitalizations for panniculitis. Best long term management?

A

Gastric bypass

320
Q

Tx for nasopharyngeal carcinoma

A

Chemoradiation

321
Q

Tx of pleomorphic adenomas (mixed tumors) of the parotid gland

A

superficial parotidectomy w/ preservation of the facial n.

322
Q

FEbrile kid with a small mass near the anterior border of the SCM

A

Branchial cleft remnant

I&D acutely, completely excise when the infection has resolved

323
Q

Management of a thyroglossal duct cyst

A

Excision of the cyst and central portion of the hyoid bone (Sistrunk procedure)
Simple excision of the cyst has a high recurrence rate

324
Q

What is a thyroglossal cyst?

A

retention of an epithelial tract between the thyroid and its embryologic origin
Presents as a painless swelling in the midline of the neck that moves w/ swallowing

325
Q

Tx of SCC of the tongue?

A

Partial glossectomy and b/l neck dissections

326
Q

Post op hoarseness due to damage to?

A

The recurrent laryngeal n.

327
Q

Management of acute epiglottitis

A

Emergent intubation in the OR

Tracheostomy if unsuccessful

328
Q

Adult with a neck mass

A

Malignancy until proven otherwise

Do a FNA

329
Q

24 hours after surgery pt has SOB, S3 and S4 but VS’s are WNL

A

High-output CHF

330
Q

Which lung cancer leads to secretion of ACTH and ADH

A

Small cell

331
Q

T1DM Pt has a traumatic swelling of the ankle. Xray shows osteopenia and disorgzanization of the midtarasl and tarsometatarsal joints

A

Due to lack of normal joint sensation

332
Q

10 days post surgery pt develops a cyanotic toe and thrombocytopenia

A

Heparin-induced thrombocytopenia

333
Q

Work up for a kid presenting with a brainstem thrombus

A

Angio of the neck vessels

In kids w/ recent trauma, dissection of the vertebral a. w/ distal embolization is likely

334
Q

most common cause of unilateral bloody nipple discharge

A

Intraductal papilloma
Get a galactogram to guid the resection
Resection is curative

335
Q

Management of Hyperosmolar hyperglycemia w/ hypokalemia

A

Half NS + K+ replacement IV

Don’t use regular saline because the mixture with K+ would be too hypertonic to correct the problem

336
Q

Hearing loss due to tympanic rupture is?

A

A conductive hearing loss
The amplification system to the cochlea is disrupted
Weber test - sound will be louder in the affected ear (sensorineural loss would be opposite)

337
Q

Management of advance inflammatory carcinoma

A

Neoadjuvant chemo followed by mastectomy
Inflammatory = ulcerating through the skin
Considered a palliative QoL treatment to remove the breast

338
Q

Pt has lots of hematemasis and is getting hypotensive

A

Give IV NS prior to studies

339
Q

Calf claudication + diminished distal pulses. Next?

A

ABI

this is arterial pathology

340
Q

PT w/ dysphagia, GERD, occ n/v. EGD stricture at GE junction and Barret’s

A

Sliding hiatal hernia

341
Q

Tx of neonate with low imperforate anus

A

Perineal operation
caused by failure of descent of the urorectal septum
Associated with esophageal atresia or tethered spinal cord
2 stage procedures (surgery + diverting ileostomy) are generally only needed in high imperforate anus due to risk of incontinence

342
Q

Imperforate anus is associated with?

A 
Congenital heart disease
esophageal atresia
abn of the lumbar spine
double urinary collection systems
hydronephrosis
343
Q

Tx of ileal atresia

A

small bowel resection w/ anastamosis

344
Q

Tx for duodenal obstruction secondary to annular pancrease

A

duodenoduodenostomy

Basically a diversion of the pancreas. Resection is too extreme

345
Q

Dx/Tx intussusception?

A

Air enema

346
Q

Remnant of vitelline duct located 60 cm proximal to the ileocecal valve

A

Meckel diverticula

347
Q

Recommendation for a pt with a family hx of adenomatous polyposis

A

Protocolectomy w/ an ileoanal reservoir

348
Q

Management for heparin-induced throbocytopenia

A

stop all heparin (including LMWH), start non heparin anticoag (lepirudin, argatroban), and switch to po warfarin when platelet count back to >100k
HIT typically presents 5 days s/p starting heparin and drops platelets by 50% (<100k)

349
Q

Assume significant bleeding in the early post op period is due to

A

Error in surgical operative field, that a vessel is still bleeding
Underlying coagulopathies are more likely to present during the surgery

350
Q

Prolonged PTT

A

Factor VIII deficiency

351
Q

Goldman’s RF’s for perioperative MI

A

MI w/in last 6 months
CHF (JVD, S3)
Age > 70

352
Q

Elevated PTT
Increased Bleeding time
NL PT

A

Von Willebrand

if inherited -> give DDAVP (vasopressin) as this stimulates release of vWF from storge sites

353
Q

What fluids do you give to a pt with a massive transfussion

A

PRBC’s + early administration of FFP and platelets

Do not wait for laboratory values to confirm coagulopathy

354
Q

How do you integrate feeding into a pt with a new jejunostomy

A

Start enteral feeding via the jejunostomy tube w/in 24 hours post op
The small bowel is able to return to normal fxn within hours, but the stomach is not

355
Q

Post op pt develops a major retroperitoneal hematoma. How do you respond?

A

Immediately reverse heparin w/ a calculated dose of protamine and place a IVC filter
1 unite of protamine per 100 u of heparin

356
Q

Pt looks like a PTX but on Xray has a hemidaiphragm

A

Traumatic diaphragmatic rupture
Almost always on the left
Tx - surgical repaire

357
Q

Pt has a PTX that doesn’t improve with a chest tube

A

Pt has tracheal or bronchial damage

Happens when there is chest trauma and the glottis is closed

358
Q

Warfarin pt is acutely bleeding

A

Give FFP
Works faster than vit K
Vit k takes 6-12 hours to start working, but should also be given

359
Q

Pancreatic tumor w/ loose stools, facial rash, wt loss

A

VIPOMA

360
Q

Pancreatic tumor w/ necrotizing migratory erythema

A

Glucagonoma

361
Q

Pancreatic tumor w/ mild DM, steatorrhea, gallstones

A

Somatostatinoma

362
Q

Pancreatic tumor with neuro findings (HA, lethargy, diplopia, blurred vision) especially w/ exercise or fasting

A

Insulinoma

363
Q

Pancreatic tumor with flushing, diarrhea, wheezing, abd cramping, periperhal edeam

A

Carcinoid

364
Q

GSW to the calf, swelling, pain with passive range of movement

A

Compartment syndrome

Requires surgical decompression

365
Q

On mammo, woman has multiple microcalcifications in the UOQ of the breast. No lump. Now what?

A

Needs a needle localized open biopsy

FNa too likely to miss it

366
Q

Colostomy site becomes indurated and crepitant

A

C. perfringens

367
Q

Healthy adult w/ new HA’s, hypokalemia and HTN

A

Aldosteronoma

368
Q

Post surgery pt has PNA 5 days s/p surgery. GNR

A

Psuedomonas (HAP)

369
Q

Management of Ogilvie syndrome

A 
Correct electrolytes
Endoscopic decompression
IV neostigmine
If ischemic -> resect
Ogilvie = non mechanical pseudo-obstruction of the large intestine, typically seen in elderly post surgically
370
Q

How do you transport a severed finger?

A

Wrap the finger in a moist gauze, put it in a plastic bag, place on a bed of ice
Must not dry out, be exposed to chemicals, or freeze

371
Q

Graft vs. host dz is mediated by?

A

Donor T cells

Rash, jaundice, diarrhea, intestinal bleeding, death

372
Q

Risk of post op infection

A

Clean - 1-1.5%
Clean contaminated: 3-5%
Contaminated: 10-15%
Dirty: 30-35%

373
Q

Medical therapy of PTH adenoma in pts that dont want surgery

A

Estrogen-progestin
Beneficial in post menopausal women because it reduces bone resorption, increases bone density, and decreases serum calcium

374
Q

Months post LCC pt has colicky RUQ pain and jaundice

A

Iatrogenic stricutre of the common bile duct

Stricture becomes infected causing cholangitis

375
Q

How do you manage a porcelain gallbladder?

A

Prophylactic cholecystectomy

High risk to progress to gallbladder cancer

376
Q

Coagulopathy pt develops hypothermia during a prolonged surgery

A

Terminate the surgery

Pack the bleeding surfaces and temporarily close with towel clips

377
Q

Work up for a SBO

A

Clinical exam
Xray
Esp Lap

378
Q

Most accurate test for chronic pancreatitis

A 
Secretin stimulation (90% specific)
Chronic pancreatitis pt will not be able to realease a large volume of bicarb rich pancreatic fluid
379
Q

How do you dx ischemic colitis after a surgery?

A

Colonoscopy or flexible sigmoidoscopy

380
Q

Describe Dobutamine

A

Inotropic agent of choice in cardiogenic shock
B1 agonist
Improves cardiac performance in pump failure by both positive inotropy and peripheral vasodilation
Only marginally increases myocardial O2 demand

381
Q

How does increasing PEEP improve oxygenation?

A

By increasing functional residual capacity

Keeps alveoli open at the end of expiration, increasing surface area for gas exchange

382
Q

Tx of neurogenic shock (injury, bradycardia, hypotension)

A 
IVF
Vasoconstrictors (DA, phenylephrine)
383
Q

A pt with cholecystitis presents with Xray w/ multiple dilated loops of small bowel and air in the billiary tree

A

Gallstone ileus
A cholecstoenteric fistula is formed when a large stone erodes into the small bowel and lodges in the ileocecal valve
presents with air in the biliary tree (pneumobilia)

384
Q

Woman finds unilateral rust colored discharge in her bra. Most likely?

A

Intraductal papilloma

385
Q

Management of splenectomy pt presenting with PNA?

A

Ceftriaxone and Vanco

386
Q

Dysphagia pt with smoking and drinking hx needs a

A

EGD

387
Q

Workup for a AAA pt prior to elective surgery

A

EKG, stress test (radionucleide scan w/ thallium and dipyridamole)

388
Q

Acutely ill pt w/ mild acidemia, low PCO2, NL PO2

A

GI loss of bicarb

389
Q

3 day s/p MVA pt has abd Xray w/ a large gastric bubble

A

Duodenal hematoma

390
Q

New stroke pt with intraparenchymal hemorrhage is most likely caused by?

A

HTN

391
Q

Management of a stable pt w/ a small R sided PTX?

A

Observation

392
Q

kiddo w/ 1 day hx of unilateral photophobia, decreased vision. Small vesicles w/ erythematous base on the eyelid skin and conjunctiva

A

HSV conjunctivitis

393
Q

sudden onset of unilateral vision loss. Pallorof optic disc, macular edema, thin arterioles, sausage like narrowing of retinal v.

A

Central rentinal a. occlusion

394
Q

Xray with air under the diaphragm needs a

A

Lap

395
Q

Management of follicular neoplasm of they thyroid

A

Thyroidectomy

396
Q

Febrile pt with LLQ pain, this is his second episode, needs a?

A

CT

397
Q

30ish woman w/ 6 weeks hx of nervousness, sweating, weight loss. lump on side of neck. Thyroid scan only shows uptake in the nodule.

A

Toxic thyroid adenoma

398
Q

Toxic megacolon goes with

A

Chron dz

399
Q

Pt consents to a procedure, receives opiate premedication, and then panicks and says she doesn’t want to do it.

A

Cancel the operation

400
Q

New onset of bloody bowel movements x weeks, internal hemorrhoids on rectal exam. Now needs a?

A

Colonoscopy

401
Q

If you suspect Carpal tunnel, order a?

A

Nerve conduction study

402
Q

Pt has a large (4x7cm) cystadenoma in the tail of the pancreas. Now what?

A

Distal pancreatomy

403
Q

Stab wound over chest, tachy, hypotensive, breat sounds absent on R, trachea midline, neck veins flat

A

Massive hemothorax

404
Q

GCS 5, right pupil dilated, unresponsive, needs?

A

Intubation and hyperventilation (preserve CPP)

405
Q

Which local anesthetic is known for a long duration?

A

Bupivacaine

406
Q

Immeadiately post surgery pt is mildly acidodic, Low O2 and high PCO2

A

Reintubate and ventilate

407
Q

Pt with pearly surface papule w/ telangiectasis on face

A

Basal cell carcinoma

408
Q

Hidradenititis suprativa affects which glands?

A

Apocrine glands of the acilla, groin

409
Q

Female becoming obese increases her risk of?

A

Cholecystitis

410
Q

How does Indomethacin close a PDA?

A

Cyclooxygenase inhibition with increased norepinephrine release

411
Q

CRF pt has a compression fx due to low Ca2+ and high Phos,

A

Secondary hyperparathyroidism (due to her renal failure

412
Q

Afib pt with abd pain and stool + for blood

A 
Exploratory celiotomy (likely mesenteric ischemia)
celiotomy is another word for laparotomy
413
Q

Pt has RUQ mass, jaundice, -ve gallstones

A

Choledocal cyst

Tx - reux en Y cystojejunostomy

414
Q

1 wk hx of scleral icterus, nausea, R sided abdominal cramps 2 months s/p LCC w/o cholangiogram.

A

Choledocholithiasis

Cystic duct stone was not seen w/o the cholangiogram

415
Q

How do you manage a pt that you suspect has temporal arteritis

A

Prednisone and temporal a. bx immediately

416
Q

Pt w/ hx of femur fx complicated by DVT presents with 6m hx of ulcer over medial malleolus, 2+ edema. Other leg is NL. Why?

A

Venous valvular insufficiency

417
Q

Febrile pt with n/v, high pitched bowel sounds. Xray - multiple dilated loops of small bowel and gas w/in the small bowel lumen and w/in the liver

A

Cholecystoduodenal fistula with an impacted gallstone

418
Q

Pt 2 years s/p radiation therapy for laryngeal cancer presents with stridor. bulky tumor involving the upper and middle neck b/l on exam. Mild acedemia, increased CO2. Now what?

A

Needs a trachesotomy

Retention of CO2 is suggesting an impending respiratory collapse

419
Q

After an I&D pt presents to ER in pain and with a surgical incision that is black

A

Needs surgical debridement

420
Q

Pt is unable to extend his knee. Ligament stability is NL but ROM if 15-110degrees

A

Torn meniscus

Remember sensation of popping and getting stuck

421
Q

10 yr hx of intermittent palpitations, exacerbated by stress and caffeine. On exam, midsystolic click heard best at the apex

A

Mitral valve prolapse

422
Q

Kid has fever on POD1, why?

A

Collapse of right middle lobe of lung from decreased inspiratory effort (POD 1 fever is ATELECTASIS)

423
Q

What is the best indicator for adequate resuscitation in a trauma pt?

A

Urine output 30-40mL

424
Q

Unrestrained driver w/ retrosternal and interscapular chest pain, Xray w/ wide medistinum

A

Rupture of thoracic aorta

425
Q

Why do cancer pts get cachectic

A

Increased serum tumor necrosis factor concentration

426
Q

Man being screened for ifertility, semen analysis is NL, but one side of his scrotum has an irregular ropy mass. Why infertile?

A

Varicocele

427
Q

Older pt with multiple episodes of PNA and now developed halotosis. NL LFTs, CXR w/ scarring at the lung base

A

Pharyngoesophageal diverticulum (zenker’s)

428
Q

All gunshot wounds to the abdomen require a?

A

Exp lap

Abdomen is from the nipple to the pubis

429
Q

1st line test for dx’ing osteomyetitis in the post op period

A

Nuclear triphasic bone scan

Bone bx is the gold standard, but can be done second

430
Q

When do you send a SBO pt to surgery?

A

When there are signs of ischemia

431
Q

when is escharotomy indicated for a burn pt?

A

When you see vascular compromise (low threshold)

432
Q

What is a complication of using silver nitrate to treat a burn?

A 
Electrolyte abn (Hyponatremia, hypokalemia, hypocalcemia, hypochloremia) and methemoglobinemia
Silver sulfadiazine causes neutropenia
Mafenide acetate casuses metabolic acidosis (inhibits carbonic anhydrase)
433
Q

Pt has a tumor on the lips, it’s most likely to be

A

Squamous cell carcinoma

SCC tends to be lower ip and BCC tends to be upper lip

434
Q

3 types of wound closures

A 
Primary intention - edges of the wound are brought together and sealed with sutures
Secondary intention - leave the wound open w/o active intent to seal the wound (heals by re-epithelialization), reserved for highly contaminated wounds where primary repair would fail
Tertiarty intention (delayed primary closure) - treat medically until the wound can be grafted
435
Q

Pt has a white patch at the dentist

A

Leukoplakia
5% progress to cancer
Tx - strict oral hygiene, avoid alcohol and tobacco
bx is reserved for thick lesions

436
Q

Pt is getting a nose cancer removed and receiving a graft from his ear. This is a?

A

Composite tissue graft
These grafts contains tissue + epidermis + dermis, ideal for deep defects where other grafts would have a poor cosmetic outcome

437
Q

Best way to assess for compartment syndrome?

A

Doppler (Pressure >40mmHg is diagnostic)

438
Q

Pt presenting with >5 days of appendicitis syx, psoas sign

A

Appendiceal abscess
Caused by appendiceal rupture that remains in a contained abscess
Tx - IVF, abx, bowel rest, and “interval appendectomy” (pt returns in 6-8 weeks for appy on elective basis

439
Q

Following a head trauma pt becomes progressively drowsy and weak on one side of body

A

Transtentorial (uncal) herniation (midline shift due to epidural hematoma)
Ipsi hemiparesis, ipsi mydriasis/strabismus (oculomotor n.), cpntra hemianopsia, altered mentation

440
Q

How does atelectasis change the ABG?

A

respiratory alkalosis
Hypoxemia
hypocapneia

441
Q

How do you treat dumping syndrome?

A

Dietary modification, diminishes over time
Common postgastrectomy complication, caused by loss of NL pyloric sphincter action and hypertonic gastric contents enter the duodenum
Consume frequent small meals, slowly
Avoid simple sugars
Increase fiber/protein
Drink fluids b/w meals, not during

442
Q

Most common cause of impaired wound healing in a chronic alcoholic?

A 
Nutritional deficiency (scurvy/vit C)
Cutaneous changes (coiled hair), gingivitis, impaired wound healing, arthralgia/malaise
Can progress to hemolytic anemia and edema
443
Q

Most common cause of hypotension after a blunt abdominal trauma?

A

L side - spleen lac

R side - liver lac

444
Q

Female presents with sudden onset of RLQ pain and hematocrit is dropping

A

Ruptured ovarian cyst

445
Q

Tx of anal fissures

A 
Increased fiber and fluids
stool softeners
sitz baths
topical anesthetics
Vasodilators (nifedipine, nitroglycerine)
446
Q

Pt develops a whistling noise during respiration following a rhinoplasty. Suspect?

A

Nasal septal perforation

Probably from a septal hematoma

447
Q

Young male presents with SOB. Mediastinal mass compressing the trachea. Serum + for AFP and bHcg

A

Mixed germ cell tumor
Seminoma - elevated BHCG
Nonseminomatous germ cell tumors - AFP

448
Q

Differential for mediastinal mass

A 
4 T's
Thymoma
Teratoma (and other germ cell tumors)
Thyroid neoplasm
Terrible lymphoma
449
Q

Prime objective when managing a rib fx?

A

Adequate pain control

Helps to prevent hypoventilation as it is associated with atelectasis and PNA

450
Q

Pt with PMH of pancreatitis x wks ago presents with abdominal pain, vomiting, and pancreatic mass on CT

A

Pancreatic pseudocyst that is likely infected
Needs endoscopic drainage
Pts w/ minimal syx of pseudocysts can have expectant management

451
Q

BUN:CR is > 20:1

A

Prerenal azotemia

Needs fluids

452
Q

MI pt has a new pansystolic murmur best heard over the apex

A

Get to the OR
Acute papillary m. rupture, common 3-5 days s/p MI
High mortality rate
New murmur, sudden drop in bp and acute HF

453
Q

Why are blowout fx of the orbit an ophthalmological emergency?

A

Inferior rectus entrapment (upward gaze is affected and enophthalmos
May need emergent surgery

454
Q

Cholangitis pt should receive a?

A

ERCP - diagnostic and therapeutic

Elective LCC after

455
Q

Management for a symptomatic epidural hematoma

A

Emergent neurosurgical hematological excavation
Caused by tearing of the middle meningeal a.
If severe enough, uncal herniation can cause ipsi CN III palsy and hemiparesis

456
Q

4 days s/p LCC pt presents with distention and has not passed gas

A

Ileus (prolonged post op ileud (PPI) when syx are 3-5 days s/p operation
Think ileus when surgery is recent (hours to days) vs SBO where surgery is weeks to years ago
Ileus will have hypoactive BS
Caused by: splanchnic n. sympathetic tone, local inflammatory mediators, opiate analgesics
Dx - Abdominal Xray
Prevent w/ epidural anesthesia, minimally invasive surgery, and perioperative IVF

457
Q

Obstipation is?

A

Failure to pass flatus or stool

458
Q

Gnawing epigastric pain that is worse at night, anorexia/weight loss, jaundice

A

Pancreatic cancer

459
Q

Periodic epigastric pain relieved by meals

A

Peptic/duodenal ulcer

460
Q

How do you tx a penile fx?

A

Urologic emergency requiring urgen operative repair
Any pt with evidence of a urethral injury (blood at meatus, dysuria, or urinary retention) need a retrograde urethrogram first

461
Q

RUQ pain, imaging reveals distended gallbladder w/ gas in the gallbladder wall and lumen. No gas in biliary tree

A

Emphysematous cholecystitis
Can be life threatening, more commin in immunocompromised (incl. DM)
Caused by infection of the gallbladder wall w/ gas-forming bacteria
Requires emergent cholecystectomy
Confirm w/ CT demonstrating air-fluid level in the gallbladder

462
Q

Teen presents with fever, sore throat, earache. Exam - can’t open jaw all the way, pooling of saliva, unilateral enlarged tonsil with deviation of the uvula

A

Peritonsillar abscess (quinsy)
Tx - needle aspiration or I and D + abx
caused by acute bacterial infection b/w the tonsil and pharyngeal muscles

463
Q

Direct Inguinal hernias are due to a defect in

A

The posterior wall of the inguinal canal

464
Q

MI pts need a stress test

A

5-7 days s/p MI to identify if there is ischemia

Test must be submaximal stress test until pt is 10-14 days s/p MI

465
Q

What heodynamic changes are seen in hypovolemic shock?

A

Decreased - preload, CO
Increased - vascular resistance, HR, EF
on exam - hypotension, tachycardia, cold extremities, flat veins

466
Q

s/p cardiac surgery, pt has fever, chest pain, leukocytosis , and wide mediastinum

A

Acute mediastinitis
Requires drainage, surgical debridment and prolonged abx therapy
Caused by intraoperative wound contamination

467
Q

newborn w/ defect at linea alba covered by skin

A

umbilical hernia

Observe for resolution by 5

468
Q

Newborn w/ defect to the righ of the umbilical cord, not covered by membrane or skin, contains bowel

A

Gastroschisis

Immediate surgery after birth

469
Q

New born with midline abdominal wall defect covered by peritoneum

A

Omphalocele

Immediate surgery after birth

470
Q

Teenager presents with jaundice 3 days s/p appendectomy

A

Gilbert syndrom
Disorder of bilirubin glucoronidation, due to decreased activity of the UDP-glucuronosyltransferase
Reccurrent jaundice precipitated by stress
Eleveted unconjugated bili, but NL LFTs

471
Q

ICU pt 5 days s/p surgery with CT showing distended gallbaladder w/o stones w/ some pericholecystic fluid

A

Acolculous cholecystitis
Seen in the critically ill
presents similarily to cholecystitis
Tx - abx, percutaneous cholecystostomy w/ elective cholecystectomy when the condition stabilizes

472
Q

Removal of a recurrent parotid mass puts pt at risk of?

A

Facial n. palsy, facial droop

473
Q

Critically ill ICU pt’s blood cultures grow coag negative sphylococci

A

Likely due to an intravascular device

474
Q

Pt with a penetrating abdominal trauma + syx of abdominal injury needs a?

A

Exp Lap

Abd injury = hemodynamically unstable, peritonitis, evisceration, blood in ng tube or rectal

475
Q

Pt is asked to lower his arm, but as it gets below horizontal it suddenly drops. Painful

A

Rotator cuff tear

Get MRI to confirm dx

476
Q

Diverticulitis pt w/ CT showing rim-enhancing perisigmoid fluid collection.

A

Complicated diverticulitis (abscess formation)
Tx - percutaneous abscess drainage under CT guidance
If percutaneous drainage fails -> surgical drainage

477
Q

when does a scaphoid fx need surgery?

A

If it’s displaced

Non displaced can be splinted w/ wrist immobilization, need close follow up to r/o osteonecrosis of the proximal segment

478
Q

Post trauma, pt has abd pain and shoulder pain. No evidence of shoulder trauma. Hemodynamically stable. Be suspicious of?

A

Bladder dome rupture
Can be seen on CT
Pt will have abd pain and referred shoulder pain d/t urine leak into the periotneal cavity (chemical peritonitis)

479
Q

Burns or chronically inflammed skin is at risk of developing?

A

Squamous cell carcinoma
SCC from chronic wounds tends to be more aggressive
SCC from a burn = Marjolin ulcer

480
Q

Nasopharyngeal carcinoma is associated with?

A

Epstein-Barr virus
associated with China, Africa, and middle east
presents as nasal congestions w/ epistaxis, HA, CN palsies, otitis media
Early spread to the cervical lymph nodes

481
Q

s/p trauma pt is hemodynamically stable but tachypnic, hypoxic and Xray reveals patchy alveolar infiltrate

A

Pulmonary contusion
Bruising of the lung, causing intra-alveolar hemorrhage and edema
w/ or w/o rib fx
CT - patchy irregulat alveolar infiltrate
complication of blunt trauma

482
Q

Pt has blood at the end of urination

A

Bladder or prostatic damage

Terminal hematuria + clots = urothelial cancer of the bladder

483
Q

Blood at the beginning of urination

A

Urethral damage

484
Q

Blood throughout urinaiton

A

Damage in kidney or ureters

Clots are not seen in renal causes

485
Q

tx of gallstone ileus

A

Surgical removal of the stone and cholecystectomy

486
Q

Scrotal mass x months, does not transilluminate, increases in size w/ standing

A

Varicocele (dilation of the pampiniform plexus v.’s surrounding the spermatic cord)
More common on the L because the spermatic v. drains into the L renal v. whcih can be compressed as it basses between the sMA and the aorta

487
Q

hours following a femoral endartectomy pt presents with a swollen lower extremity

A

Ischemia-reperfusion syndrome
A type of compartment syndrome
fasciotomy if >30 mmHg

488
Q

Pt with a retropharyngeal abscess is at risk of developing?

A

Necrotizing mediastinitis

489
Q

Penetrating injury to the thigh + evidence of vascular injury requires?

A

exp lap

490
Q

Anterior shoulder dislocation is associated with damage to?

A

The axillary nerve
weak shoulder abduction
axillary n. inn teres minor and deltoid, sensation to lateral shoulder

491
Q

How does hyperventilation decrease ICP?

A

Cerebral vasoconstriction (decreased cerebral blood flow)

492
Q

signs of femoral n. palsy

A

reduced knee extension

decreased sensation over medial and lower thigh

493
Q

What causes an increased pulmonary cap wedge pressure?

A

PCWP measures the pressure in LA, so anything that would inhibit CO (MI, HTN, valve dz, cardiomyopathy, toxin, metabolic disorder, or myocarditis)
Increased PCWP associated w/ cardiogenic shock

494
Q

Alcoholic has had pancreatitis but now has oily stools w/ NL LFTs and Alk Phos

A

Pancreatic insufficiency

495
Q

Pt w/ 2m hx of intermittent gross hematuria, fatigue, and weight loss. N prostate.

A

Renal cell carcinoma

Can have secondary hyperparathyroidism

496
Q

GSW to thigh, popliteal, post tib, and dorsalis pedis pulses absent. Femur fx is reduced. What do you do next?

A

Exp lap. Vascular compromise due to absent pedal pulses. Don’t do imaging

497
Q

Trauma pt with flank pain and gross hematuria, hemodynamically stable

A

CT of abdomen and kidneys

498
Q

Smoker, prerenal azotemia. Renal U/S shows a 14cm L kidney and 7 cm R kidney. Why does he have HTN and renal atrophy?

A

Renal a. stenosis

499
Q

1 yr hx of progressive difficulty swallowing, intermittent vomiting of undigested food, and cough more severe at night.
Xray - air fluid level in posterior mediastinum at level of cardiac silhouette
Manometry - NL lower esophageal sphincter pressure, absent lower esophageal relaxation

A

Achlasia

500
Q

woman w/ 48 hr onset of sharp pain in upper outer quadrent of R breast, gradually resolving.
Exam - tender area w/ no mass

A

Reassurance

501
Q

Pt w/ R lower abdominal pain radiating to R groin x 7 days, fever, anorexia
PE - Increased pain w/ hip extension, flexion decreases pain

A 
Psoas abscess
Get CT of abdomen and pelvis
PE manuever = psoas sign
Look for recent hx of skin infection (distant or intraabdominal)
RF - HIV, IVDU, DM, Crohn dz
Tx - drain + abx
502
Q

pt s/p thyroidectomy presents w/ anxiety, muscle cramps, poor sleep, long QT interval

A

Hypocalcemia s/t hypoparathyroidism

503
Q

What do you need to dx flail chest

A

Xray w/ 3 or more contiguous rib fx in 2 or more location (need a floating segment)

504
Q

Pt gets dyspnea, hypotension, and tachy after placement of a subclavian central venous line

A

suspect a tension PTX

505
Q

R ant thigh pain worse with walking. pulsatile mass in R groin

A

R femoral a. aneurysm

associated with AAA

506
Q

Middle aged woman, new onset of HA’s and unilateral weakness

CT - well-circumscribed partitally calcified mass

A

Meningioma
Benign, lie close to the dura
Tx - surgical resection is curative for most

507
Q

POD 4 pt develops fever, tachy, hypotension, poor urine output

A 
Septic shock
Give IVF (normal saline is a crystalloid restores volume as adequately as albumin but is much cheaper) and vasopressors to restore tissue perfusion
508
Q

What do you recommend for a PAD pt w/ a ABI of 0.8

A

Recommend a walking program

509
Q

hours post surgery pt had decreased urine output but good bp?

A

Give saline bolus to increase output

Urine is the endpoint for resuscitation

510
Q

Pt receives multiple unites of pRBC’s intraoperatively but no FFP, presents with bleedign

A

thrombocytopenia

511
Q

Pt experiences multiple DVT’s despite heparin anticoagulation

A

Antithrombin III deficiency

512
Q

surgeon can’t hold pickups, numbness over ring and little fingers
PE - loss of intrinsic hand m. but no loss of reflexes

A

C8 nerve root

513
Q

Chronic pancreatitis pt presents with steatorrhea and high glucose

A

Needs insulin therapy

Entering pancreatic insufficiency

514
Q

ITP pt plt count is 20k despite steroid therapy and IVIG. BM bx shows normal megakaryocytes Now what?

A

Splenectomy

515
Q

Infant, jelly like stool, periodically brings knees to chest, elongated abdominal mass

A

Intsusscipation

Needs contrast or air enema

516
Q

4m hx of progressive hearing loss, ringing in same ear, an dunsteadiness with walking. Weber localizes to unaffected ear

A

Acoustic neuroma (vestibular schwannoma)

517
Q

Which measurement is the best way to predict if a pt will require a pneumonectomy prior to surgery?

A

FEV1

518
Q

Best way to assess cervical trauma?

A

Lateral x ray

519
Q

PUD pt tx w/ omeprazole, presents w/ n/v x 1 day
Hemodynamically stable
distended abdomen with borborygmi in epigastric area and succussion splash. Why?

A

Scarring and fibrosis of the duodenal ulcer crater

520
Q

Pt w/ vomiting and substernal chest pain radiating to back, hypotensive, blunting of L costophrenic angle
Esophagography - extravasation into the mediastium and L pleural cavity. IVF and abx are started. Now?

A

Exp thoracotomy

521
Q

Healthy young female. asyx. Patchy hilar infiltrate on xray

A

Sarcoidosis

522
Q

3wk old infant presents with jaundice, high total bili and direct bili

A

Biliary atresia

Occurs due to a clogged extrahepatic duct. Presents in first 6 weeks of life

523
Q

2 yrs s/p LCC pt presents w/ RUQ pain, elevated LFTS and alk phos, U/s -ve for stones, and tx w/ opioids make syx worse

A

Sphincter of Oddi dysfunction
Causes biliary colic due to dyskinesia and stenosis of the sphincter of Oddi
Dx with manometry
tx sphincterotomy

524
Q

Pt who had ingested acid months ago presents w/ early satiety, n, nonbillious vomiting, weight loss

A

Pyloric stricture causing gastric outlet obstruction
Pyloric stricture d/t acid ingestions
Other RF’s - gastric malignancy, PUD, Crhon’s, gastric bezoars

525
Q

What is succussion splash?

A

PE finding where stethescope is placed over the abdoment and the pt is rocked side to side. Retained material (>3 hrs after a meal) will generate a splash suggesting the organs are filled with fluid and gas

526
Q

5 days after a burn pt is at risk of

A

infection with GN organisms and fungi

527
Q

Shortly after a burn pt is at risk of?

A

Infection with GP organisms

528
Q

SIRS criteria

A 
<36.5C or >39C
Tachy >90/m
tachypnea >30/m
hypotension SBP <90 mmHg
Also oliguria, hyperglycemia, thrombocytopenia, AMS
529
Q

Middle aged adult w/ superficial unilateral hip pain exacerbated by pressure on the lateral thigh (ie lying on your side_

A

Trochanteric bursitis
Inflammation of the bursa surrounding the insertion of the gluteus medius onto the femur’s greater trochanter
Caused by overuse/frictional forces

530
Q

management of a stress fx?

A

Rest and analgesics
Can have a negative xray for up to 6 wks
commonly affects second metatarsal
5th metatarsal is at increased risk of non union and may require an ortho referral

531
Q

Hypocalcemia and Hyperphosphatemia w/ NL renal fxn

A

Hypoparathyroidism

Causes - post-surgical, autoimmune and non-autoimmune parathyroid destruction, defective Ca2+ sensing receptor

532
Q

Pt presents with a mass on the hard palate of the mouth that is immobile and has a bony hard consistency. Been there for years

A

Torus Palatinus
Conginetal, associated with the young, women, and Asians
Surgey is only indicated if the pt becomes syx (interfers w/ eating, speech)

533
Q

Pt has classing PE findings of appendicitis and high WBC

A

Get a lap appy

No need to confirm with CT. Only need CT if pt does not have classic syx/findings

534
Q

Pt has massive hemoptysis
>600mL/24hr OR
100mL/hr
What do you do?

A

Get an airway
Place the source of the bleeding low
Bronchoscopy to indentify the site and attempt intervention

535
Q

Years after a MVA, pt presents with weakness and sensory loss of upper extremities. Wasting of small hand m. and impaired pain/temperature sensation b/l

A

Syringomyelia
Can develop post-traumatically (often whiplash) w/ syx developing months to years later
Caused by enlargement of the central canal of the spinal cord d/t CSF retention
dx - MRI

536
Q

surgical wound with, purulent cloudy-gray discharge

A

Necrotizing surgical infection
Needs debridment and abx
“dishwater drainage”
typically polymicrobial and more common in DM pts

537
Q

b/l hip, thigh, buttock claudication
impotence
symmetic atrophy of b/l lower extremities d/t ischemia

A 
Aortoiliac occlusion (Leriche syndrome)
Occlusion at the bifucation of the aorta in to the common iliac a.'s
538
Q

hours after cardiac catherterization pt has sudden hemodynamic instability and flank or back pain

A

Retroperitoneal hematoma
Once stable, do a non contrast CT of abdomen/pelvis or abdominal U/S
Tx - supportive (bed rest, monitoring, IVF, transfussion)

539
Q

Tall skinny guy gets a PTX

A

Primary spontaneous PTX (PSP)

IF stable, obs/oxygen

540
Q

Old demented guy on POD 8 develops pain and swelling of the left angle of his jaw

A

Acute bacterial parotitis
Caused by inadequate fluid hydration and oral hygiene
Staph aureus

541
Q

Septic joint in a prosthesis is caused by?

A

Staph aureus - presents in first 3 months of replacement, acute pain, fever
Staph epi - 3-12 months since surgery, presents with chronic pain, gait impairment, loose implant, sinus tract formation

542
Q

New onset SOB, diastolic rumbling murmur best heard over apex

A

Mitral stenosis

543
Q

How do NSAIDS cause ARF?

A

Inhibit synthesis of prostacyclin

544
Q

Jehovahs witness needs emergent surgery but H&H is very low

A

Do the surgery w/o transfusion

545
Q

kid w/ continuous murmur over the pulmonary area and bounding peripheral pulses

A

Patent ductus arteriosis

546
Q

Chemo pt has a RA catheter placed. 10 days later his RUE is twice the size as the LUE and U/S shows occlusion of the R axillary and subclavian v.’s. Why?

A

Complication of the R atrial catheter

Not related to the cancer

547
Q

RF for unilateral temporary vision loss?

A

Carotid stenosis

needs a doppler

548
Q

Extensive 1st degree burn (sunburn) needs

A

Obs

549
Q 
Post op pt has:
pH 7.25
PCO2 55
PO2 75
Why?
A

Ventilatory insufficiency

550
Q

What is a cornual pregnancy?

A

AKA interstitial pregnancy
Considered an ectopic pregnancy
Located outside of the uterus in the part of the fallopian tube that penetrates the muscular layer of the uterus
Can also mean that the fetus is implanted in one of the two horns of a bicornate uterus

551
Q

What hormone changes are expected in a pt with a hot thyroid nodules

A

Decreased TSH
Increased T3/T4
Nodule is making T3/T4 causing suppression of TSH (hyperfunctioning nodule)

552
Q

You find a thyroid lump. What do you do?

A

If TSH NL or high - FNA
If TSH low - radionuclide scan
Cold nodule - FNA
Hot nodule - check T4/T3

553
Q

Dysphagia pt has a swallow study showing tapered distal esophageal stricture w/ moderate dilation of the proximal esophagus. Now what?

A

EGD and bx

554
Q

2 hours s/p transfusion pt develops chills and fever. Why?

A

Preformed Ab (donor) to Leukocyte Ag (host)

555
Q

ABG findings in atelectasis

A 
Respiratory alkalosis
Hypocapnia
Hypoxemia
Atelectasis -> decreased lung volumes -> V/Q mismatch -> hypoxemia -> pt hyperventilates to pull up oxygen -> respiratory alkalosis due to blowing off CO2
PE has a similar ABG
556
Q

The splenic flexure is the watershed betweent the?

A

Superior and inferior mesenteric a.

557
Q

The rectosigmoid junction is the watershed between the?

A

sigmoid a. and superior rectal a.

558
Q

Tenderness over medial aspect of knee.

Pt standing, knee bent slightly, internal rotation of the knee elicits a locking sensation and significant sharp pain

A 
Medial meniscus tear
Thessaly test
Confirm w/ MRI
If syx mild - rest it
If syx persistent - surgery
559
Q

You suspect bladder injury and perotineal signs are present

A

Intraperitoneal bladder injury - typically rupture of the dome of the bladder.
Extraperitoneal presents w/ high riding prostate, blood at meatus but not peritoneal signs

560
Q

Why should succinylcholine be avoided in pts with crush injury?

A

Life threatening hyperkalemia
Crush pts have cell death and can already be hyperkalemic
Succinylcholine depolarizes NM cells by triggering influx of Na and efflux of K
So, K from cell death and from NM depolarization can be super dangerous
Instead use a non depolarizing agent (vecuronium, rocuronium)

561
Q

Why is O2 supplementation give to guys with Primary spontaneous PTX?

A

Supplemental oxygen aids spontaneous resorption

562
Q

Pt develops jaundice after requiring several units of pRBCs

Hi total and direct bili

A

Overproduction of bilirubin d/t rBC breakdown

563
Q

Physiologic change in PHTN

A

Increased pulmonary vascular resistance

564
Q

Ab against thyroid peroxidase is most commonly associated with

A

Chronic lymphocytic thyroiditis (Hashimoto dz)

565
Q

Pt w/ prosthetic heart valve and schistocytes presenting w/ pallor fatigue needs

A

pRBCs

566
Q

L sided chest pain
Absent breath sounds, dullness to percussion
CXR - L sided pleural effusion and peripheral soft tissue density
Bx dimorphic malignant cells; spindle cells w/ may mitotic figures and buboidal epithelial cells. What was this guy exposed to?

A

Asbestos

567
Q

Construction worker

cellulitis of the dorsum of the hand x 2 days

A

Group A strep

568
Q

Bloody nipple discharge expressed from one nipple

A

Intraductal papilloma

569
Q

Pt w/ flap laceration s/t bite that extends into the Sub Q fat. Avulsed skin is cyanotic, no bleeding

A

Debridment and application of a sterile dressing to the open wound
secondary closure

570
Q

Cholesterol emboli in a branch of the retinal a. is d/t?

A

Carotid plaque

571
Q

Why does a varicocele cause decreased fertility?

A

Increased scrotal termperature

Can lead to a low sperm count

572
Q

Pt on a vent has developed ARDS and on abx for polymicrobial findings in bronchial washings
CXR cavitory lesion in the R upper lobe. What is it?

A

Lung abscess

573
Q

Chemo pt has pain of the extremities and ribs. Pain not well managed on codeine and amitriptyline

A

Try oxycodone

574
Q

Breast bx comes back as invasive estrogen + . Now what?

A

Resection of the bx site

575
Q

GERD pt
CXR - air fluid level posterior to cardiac silhouette
Barium swallow - proximal stomach herniating through esophageal hiatus
Now what?

A

EGD

576
Q

Dysphagia, chest painduring meals x months
GERD x yrs
Only taking in liquids because they regurg food
Why?

A

Stricture of the distal esophagus

RF’s - gerd, acid ingestion, anything that will scar the esophagus

577
Q

When it comes to aneurysms, what is the best predictor that the pt will develop HF?

A

The size of the abnormality

578
Q

Tx for pt w/ HTN s/t hyperaldosterone

A

Spironolactone
Ald:renin ratio is increased
Adrenal mass on CT

579
Q

UC pt develops jaudice, high total and direct bili, narrowing a biliary ducts d/t?

A

PSC

580
Q

kid w/ 2 wk hx of severe hip and knee pain w/ limp

abductio is decreased

A

Slipped capital femoral epiphysis

fx is through the growth plate -> avascular necrosis

581
Q

kid <10 y/o 2 wks s/p URI presents w/ a 2 day hx of limp. Pain over the hip, elevated ESR

A

Toxic (transient) synovitis
Dx of exclusion
Tx - rest, NSAIDS

582
Q

Pt has diarrhea s/t excessive constipation related to opioid use. She needs?

A

Enemas

583
Q

Healthy adult found in a deep stupor, Hypertensive

Left hemiparesis, early decerebrate posturing

A

Ruptured intracerebral aneurysm

584
Q

Pt has a cool foot, no pedal pulses, pulsatile mass in popliteal fossae. next step?

A

Arteriography w/ runoff

585
Q

Hx of VSD, HF, cyanosis

A

Eisenmenger syndrome

586
Q

12 y/o w/ weakness, pallor, black, shiny stools x 5 days. Microcytic anemia.
Scintigram - technetium shows RLQ separate fromthe activity in the stomach kidneys and bladder

A

Meckel diverticulum

587
Q

Hepatic mass w/ central scar on CT (incidental finding)

A

Focal nodular hyperplasia
Benign
No further testing needed

588
Q

See a wicked anal growth in a HIV positive guy do a

A

Bx

Shelves (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions