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MS3 > Surgery Rotation 3 > Flashcards

Surgery Rotation 3 Flashcards

1
Q

Causes of air in the neck

A

Esophageal rupture
Tension pneumothorax
Tracheobronchial injury

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2
Q

Vitelline duct vs. urachus

A

Vitelline duct = connects the midgut to the yolk sac (persistance = Meckel’s_

Urachus = connection between bladder and belly button (remnant of allantois)

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3
Q

First step in management of patients with acute stroke

A

CT scan of the head without contrast to rule out hemorrhage

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4
Q

Clinical findings in lateral epicondylitis

A

Due to overuse of extensor muscles leading to non-inflammatory tendinosis at the common extensor origin on the lateral epicondyle

Presents with tenderness at the lateral epicondyle and reproduction on pain with resisted extension or passive flexion of the wrist

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5
Q

Most important intervention in COPD for prolonged survival

A

Long-term supplemental oxygen therapy

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6
Q

Treatment of acute disabling symptoms of Multiple sclerosis

A

Glucocorticoids - they hasten neurologic recovery

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7
Q

Uses of interferon alpha

A

Hep B and C, hairy cell leukemia, malignant melanoma, Kaposi sarcoma, Condyloma accuminata, RCC

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8
Q

Uses of interferon beta

A

Relapsing type multiple sclerosis

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9
Q

Uses of interferon gamma

A

Chronic granulomatous disease (CGD)

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10
Q

How do you differentiate between Serotonin syndrome and Neuroleptic malignant syndrome

A

SS = altered mental status, autonomic instability, and HYPERREFLEXIA and MYOCLONUS

NMS = altered mental status, autonomic instability, RIGIDITY and HYPOREFLEXIA

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11
Q

Recommended pneumococcus vaccines for adults

A

No vaccination for healthy individuals

Age 19-64

  • PPSV23 (23-valent pneumococcial polysaccharide vaccine) alone
      • Chronic hear, lung, or liver disease
      • Diabetes, current smokers, alcoholics
  • Sequential PCV13 (13-valent pneumococcal conjugate vaccine) + PPSV23
      • For very high risk patients
      • CSF leaks, cochiear implants
      • Sickle cell disease, asplenia
      • Immunocompromised (e.g. HIV, malignancy)
      • Chronic idney disease

Age > 65

  • Sequential PCV13 + PPSV23
      • 1 dose of PCV13 followed by PPSV23 at a later time
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12
Q

Indications for Td vs. Tdap vaccination as an adult

A

All adults should recieve a one-time dose of Tdap in place of Td, followed by Td every 10 years thereafter

Tdap applies to patients who have not recieved Tdap as an adult or if the patient’s prior vaccine history is unknown

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13
Q

What is the cause and classical presentation of multiple myeloma

A
  • Malignant proliferation of monoclonal plasma cell within the marrow
  • Increased production of IgG and IgA (M spike on electrophoresis)
  • Lytic bone lesions -
    back pain (plasma cells activate osteoclasts)
  • Hypercalcemia
  • Rouleaux formation of RBCs (increased serum protein leads to decreased charge between RBCs)
  • Anemia (plasma cells packed in bone marrow inhibit production of other cells)
  • Renal insufficiency (excessive antibodies plug up kidney)
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14
Q

What are maneuvers that can be used to identify an appendiceal abscess

A

Psoas sign
Obturator sign
Rovsing sign
Rectal tenderness

Peritoneal signs (rebound, guarding, rigidity) are more indicative of acute appendicitis/rupture

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15
Q

Definition of heat stroke

A

Core temp > 40 degrees and AMS

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16
Q

What arrythmia is this: chaotic and erratic baseline with no discrete P waves in between irregularly spaced QRS complexes

A

Atrial fibrillation

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17
Q

Treatment of A-fib in a patient with hemodynamic instability

A

Direct current cardioversion

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18
Q

Treatment of V-fib

A

Defibrillation

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19
Q

Differentiate between 1st, 2nd and 3rd degree heart block

A

1st = prolonged PR interval > 200 ms (time between atrial and ventricular depolarization)

2nd = progressive lengthening of PR until a beat is dropped or a beat dropping with no warning

3rd = atria and ventricles beat independently of each other

20
Q

Management of hypersensitivity pneumonitis (Pigeon breeder’s lung)

A

Avoidance of antigen

21
Q

What is the cause of S3 heart sound

A

Rapid flow of blood from atria to ventricles

Caused by volume overload (e.g. CHF, mitral/tricuspid regurg)

22
Q

What is the cause of S4 heart sound

A

Atrium contracting against a stiff ventricle (e.g. hypertrophic cardiomyopathy, aortic stenosis, LV hypertrophy)

23
Q

What is the treatment of choice in acute pulmonary edema caused by MI?

A

Loop diuretic (e.g. Furosemide)

24
Q

Layers of the abd wall

A

Skin –> subcutaneous tissue –> fascia (Camper’s and Scarpa) –> external oblique m. –> internal oblique m. –> transversus abdominis m. –> transversalis fascia –> adipose tissue –> peritoneum

25
Q

NAVeL

A

Femoral nerve, external iliac artery and vein, lymphatics

26
Q

Contents of lateral, medial, and medial umbilical folds

A

Lateral = inferior epigastric vessels

Medial = obliterated umbilical artery

Median = obliterated urachus; para-umbilical veins

27
Q

What is the midline line that connects the aponeurosis of the abdominal muscles

A

Linea alba

28
Q

What is Hesselbach’s triangle

A

Inguinal triangle:

Medial = rectus sheath
Lateral = inferior epigastric vessels
Base = inguinal ligament
29
Q

Insertion points of the inguinal ligament

A

Anterior superior iliac spine + inferomedial pubic tubercle

30
Q

Inferior epigastric artery is a branch of what?

A

External ilia

31
Q

Superior epigastric artery is a branch of what artery?

A

Internal thoracic, which is a branch of subclavian

32
Q

Blood supply of anterior abd wall

A

Superior and inferior epigastric artery

33
Q

Blood supply of lateral abd wall

A

Musculophrenic (branch of internal thoracic) + deep circumflex iliac (branch of external iliac) + subcostal (branches of thoracic aorta)

34
Q

Branches of the celiac trunk

A

Splenic artery

Left gastric artery

Common hepatic artery (proper hepatic, R gastric, gastroduodenal)

35
Q

Lobes of the liver

A

L and R
Anterior = quadrate
Posterior = caudate

36
Q

What is the name of the triangle near the gallbladder

A

Calot’s triangle

37
Q

Borders of Calot’s triangle

A

Medial = common hepatic duct

Inferior = cystic duct

Superior = cystic artery

38
Q

What makes up the portal triad

A

Common bile duct
Portal vein
Hepatic artery proper

39
Q

What hormones stimulate the pancreas

A

CCK from small intestine (pancreas and gallbladder)

Secretin from small intestine (stimulates pancreas to secreted HCO3-)

40
Q

Causes of acute pancreatitis

A

• I GET SMASHED:
o Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypertriglyceridemia/Hypercalcemia, ERCP, Drugs (e.g. Sulfa, NRTIs, protease inhibitors)

41
Q

Major drugs used for immunosuppression in transplant

A

Triple therapy: corticosteroids, azathioprine, cyclosporine/tacrolimus

42
Q

MOA of azathioprine

A

Prodrug of 6-mercaptopurine (purine analog)

Inhibits lymphocyte proliferation by blocking nucleotide synthesis

43
Q

MOA of cyclosporine/tacrolimus

A

Blocks T-cell activation by preventing IL-2 transcription

44
Q

Most commonly used corticosteroid used for immunosuppression in transplant

A

Prednisone

45
Q

MOA of Thymoglobulin

A

Polyclonal rabbit antibodies raised against human T-cells

Bind and deplete T cells

OKT3 is an anti-CD3 monoclonal antibody that depletes T-cells specifically

46
Q

what is Unasyn?

A

Ampicillin + Sulbactam

MS3 (88 decks)

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