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MS3 > Surgery Rotation 2 > Flashcards

Surgery Rotation 2 Flashcards

1
Q

What percent is normal saline?

A

0.9%

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2
Q

Next steps in a patient with signs of GERD

A

Upper GI endoscopy

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3
Q

Causes of post-operative atelectasis

A

♣ Accumulation of pharyngeal secretions
♣ Tongue prolapsing posteriorly into the pharynx
♣ Airway tissue edema
♣ Residual anesthetic effects

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4
Q

What are the ways in which head trauma can cause problems

A
  • Damage of the initial blow
  • Intracranial bleed displacing brain structures
  • Intracranial hemorrhage
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5
Q

What is the difference between an epidural and subdural hematoma (on XR and clinically)

A

Epidural = lens shaped; can occur from less serious trauma; longer lucid interval

Subdural = crescent shaped; can be acute with severe trauma, or chronic

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6
Q

What type of brain bleed can easily occur the elderly and alcoholics and why

A

Subdural

Their brains have shrunk but cranial cavity is the same size so it is easy for the brain to be “rattled” and to tear bridging veins

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7
Q

How do you manage head trauma in a patient with no bleed

A

Prepare for edema

Mannitol, furosimide, hyperventilation

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8
Q

Describe Cushing reaction (Triad of hypertension, bradycardia, and respiratory depression in response to increased intracranial pressure)

A

Increased ICP = pressure constricts arterioles in brain = cerebral ischemia = sympathetic response increases peripheral vasoconstriction, thus increasing BP = aortic baroreceptors sense increased BP = respond with reflex bradycardia and respiratory depression

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9
Q

How does hyperventilation help with cerebral edema

A

A drop in PaCO2 due to hyperventilation causes vasoconstriction = decreased cerebral blood flow = decreased ICP

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10
Q

Which way will the trachea deviate in tension pneumothorax

A

Away from side of lesion

Air enters the pleural space but cannot exit, and air continues to build up with each breath

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11
Q

What is a pleural effusion

A

Build up of fluid around the lung

Trachea deviates away from side of lesion

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12
Q

Where is the damage in initial hematuria (blood only at beginning of voiding)

A

Urethral damage

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13
Q

Where is the problem in terminal hematuria (blood at end of voiding)

A

Bladder, prostate, or posterior urethra

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14
Q

Where is the problem in total hematuria (blood throughout entire voiding)

A

Kidney or ureters

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15
Q

What is the “psoas sign”

A

Abd pain with hip extension

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16
Q

Damage to what part of the bladder may cause peritonitis (diffuse abdominal pain and guarding)

A

Dome of the bladder (superior and lateral surfaces of the bladder which are bordered by the peritoneal cavity)

Rupture can cause the spilling of urine into the peritoneum

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17
Q

Irritation of what structure causes referred pain to the shoulder

A

Diaphragm

Can be irritated by many things (e.g. peritonitis or pericarditis)

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18
Q

What would be the clinical presentation of rupture to anterior bladder wall or bladder neck?

A

Usually caused by pelvic fracture

Causes extraperitoneal leakage of urine, leading to localized lower abdominal pain; signs of peritonitis should not be present

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19
Q

What are the retroperitoneal structures?

A 
o	SAD PUCKER
♣	S  Suprarenal (adrenal gland)
♣	A  Aorta and IVC
♣	D  Duodenum (2nd through 4th parts)
♣	P  Pancreas (except tail)
♣	U  Ureters
♣	C  Colon (descending and ascending)
♣	K  Kidneys
♣	E  Esophagus (thoracic portion)
♣	R  Rectum (partially)
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20
Q

Signs of basilar skull fracture

A
  • Hematoma of the mastoid process or periauricular hematoma (Battle’s sign)
  • Bilateral peri-orbital hematoma (raccoon eyes)
  • Hemotympanum
  • CSF fluid otorrhea
  • Cranial nerve palsies (resulting in anosmia, vertigo, tinnitus, or hearing loss)
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21
Q

Potential complication of thoracic aortic aneurysm surgery that causes bilateral flaccid paralysis and loss of pain/temp in lower extremities

A

Spinal cord infarction (due to aortic cross-clamping) leading to anterior spinal cord syndrome

22
Q

What do hyperactive bowel sounds suggest?

A

Diarrhea, malabsorption (e.g. Celiac or lactose intolerance), incomplete mechanical bowel obstruction

23
Q

Most common cause of bowel obstruction

A

Adhesions

24
Q

Presentation of syringomyelia

A

• Anterior white commissure:
o Loss of pain and temp with sparing of fine touch and position “cape-like” distribution
• Anterior horn involvement can occur with progression of disease
o Lower motor neuron effects
• Lateral horn of hypothalamospinal tract
o Horner syndrome

25
Q

Presentation of ALS

A

UM and LMN deficits (twitching, muscle weakness, cramping)

NO loss of sensory function

26
Q

Presentation of multiple sclerosis

A 
Due to autoimmune demyelination of CNS
♣	Charcot triad of symptoms  SIN:
•	Scanning speech
•	Intention tremor, Incontinence, Internuclear ophthalmoplegia
•	Nystagmus 
♣	Hemiparesis, hemisensory symptoms
27
Q

Causes of syringomyelia

A

• Arnold Chiari I malformation
• Prior spinal cord injury
o Clasically an MVC with whiplash
o Symptoms develop months or years after the initial injury and progress gradually

28
Q

What are the 3 components of Glasgow coma scale (GCS)

A

Eye opening

Verbal response

Motor response

29
Q

What is a furunculosis

A

Deep infection of the hair follicle leading to abscess formation and accumulation of pus and necrotic tissue

30
Q

How do you differentiate between compartment syndrome and DVT

A

CS = swelling + excruciating pain worse with passive movement; presence of neuro sx; diagnosed with compartment pressure

DVT = pain and swelling with less insidious onset and less severe; diagnosed with doppler US

31
Q

What are the 2 main complications caused by rib fractures

What is the most important part of management

A

Pain leads to hypoventilation which may cause atelectasis and pneumonia

Pain control is the most important part of management

32
Q

When is surgical repair of rib fracture indicated?

A

Flail chest with failure to wean from ventilator, refractory pain, significant chest wall deformity

Not indicated in single, uncomplicated rib fractures

33
Q

What will be the BUN:Cr ratio in Pre-renal, intrinsic, and post-renal azotemia

A

Pre-renal = BUN:Cr > 20 (BUN is reabsorbed and Cr is not)

Intrinsic = BUN:Cr < 15 (damage to tubules)

Post-renal = > 20 early on and < 15 later stage when tubular damage occurs

34
Q

What form of diagnosis is needed for appendectomy

A

Classic clinical and lab findings of appendicitis

Imaging (US or CT) is not needed unless patient has atypical presentation or other possible causes of RLQ pain

35
Q

Presentation of Toxic shock syndrome

A

Fever, hypotension, diffuse rash

36
Q

What are the ABCs of melanoma

A 
A = asymmetry
B = irregular border
C = color variability
D = diameter > 6 mm
E = evolution of size/appearance
37
Q

What is the difference between conductive and sensorineural hearing loss

A

Conductive
• Obstruction of external sound to inner ear
Sensorineural
• Involves the inner ear, cochlea, or auditory nerve

38
Q

Describe Rinne test and how results differ in conductive vs. sensorineural hearing loss

A

♣ Vibrating tuning fork placed on mastoid bone until patient can’t hear it
♣ Still-vibrating fork then held outside auditory canal until patient can’t hear it
♣ Results:
• Normal = Air-conducted (AC) sound should be heard twice as long as bone-conducted (BC) sound
• Conductive hearing loss = BC > AC in affected ear; AC > BC in unaffected ear
• Sensorineural hearing loss = AC > BC in both ears

39
Q

Describe Weber test and how results differ in conductive vs. sensorineural hearing loss

A

♣ Vibrating tuning fork placed on middle of head or forehead equidistant from both ears
♣ Results:
• Normal:
o Midline
• Conductive hearing loss:
o Lateralizes to the affected ear because that ear cannot hear ambient noise of the room
• Sensorineural hearing loss:
o Lateralize to the unaffected ear because the inner ear of the affected ear cannot sense the vibration

40
Q

What is otosclerosis

A

Abnormal remodeling of the otic capsule though to be a possible autoimmune process; the stapes footplate becomes fixed to the oval window

Causes conductive hearing loss

41
Q

What type of hearing loss is caused by ototoxic antibiotics

A

Sensorineural

42
Q

What is Meniere disease

A 
•	Increased pressure and volume of endolymph
•	Features:
o	Recurrent vertigo
o	Ear fullness/pain
o	Unilateral sensorineural hearing loss 
o	Tinnitus
43
Q

Affected areas in rheumatic heart disease

A

Early disease = mitral regurg

Late disease = mitral stenosis

44
Q

Cause of secondary hyperparathyroidism

A

Due to decreased calcium, usually secondary to renal disease

45
Q

Cause and content of transudative pleural effusion

A

Low protein content (Think: TRANSudate = TRANSparent)

Due to increased hydrostatic pressure (e.g. CHF) or decreased oncotic pressure (e.g. cirrhosis or nephrotic syndrome)

46
Q

Cause and content of exudative pleural effusion

A

High protein content, cloudy

Due to pleural and lung inflammation resulting in increased capillary and pleural membrane permeability (e.g. malignancy, pneumonia, trauma, connective tissue disease)

47
Q

What is atrioventricular nodal reentry tachycardia

A

Subtype of SVT

Caused by a reentrant circuit formed by 2 separate conducting pathways (one fast and the other slow) within the AV node

Characterized by sudden onset and termination, rapid (140-250/min) regular rhythm, narrow QRS complexes, and absence of definite P waves

48
Q

Most common cause of atrial fibrillation

A

Ectopic foci within the the pulmonary veins

49
Q

Treatment of Prinzmetal / Vasospastic angina

A
  • Calcium channel blocker (preventive)

- Sublingual nitroglycerin (abortive)

50
Q

What are the dihydropyridine CCBs?

A

“-dipine” suffix

Nifedipine, Nimodipine

51
Q

What are the non-dihydropyridine CCBs?

A

Verapamil

Diltiazem

52
Q

Management of healthy patient with a thyroid nodule

A

Measurement of TSH + thyroid US

MS3 (88 decks)

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