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MS3 > Surgery Rotation 7 > Flashcards

Surgery Rotation 7 Flashcards

1
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

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2
Q

Presentation of ALS

A

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

NO loss of sensory function

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3
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
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4
Q

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

A

Eye opening

Verbal response

Motor response

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5
Q

What is the “psoas sign”

A

Abd pain with hip extension

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6
Q

Presentation of Toxic shock syndrome

A

Fever, hypotension, diffuse rash

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7
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 nerv

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8
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

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9
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

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10
Q

What type of hearing loss is caused by ototoxic antibiotics

A

Sensorineural

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11
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

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12
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
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13
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)

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14
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)

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15
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

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16
Q

What are the non-dihydropyridine CCBs?

A

Verapamil

Diltiazem

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17
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

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18
Q

Treatment of Prinzmetal / Vasospastic angina

A
  • Calcium channel blocker (preventive)

- Sublingual nitroglycerin (abortive)

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19
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)

20
Q

First step in management of patients with acute stroke

A

CT scan of the head without contrast to rule out hemorrhage

21
Q

Most important intervention in COPD for prolonged survival

A

Long-term supplemental oxygen therapy

22
Q

Uses of interferon alpha

A

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

23
Q

Uses of interferon beta

A

Relapsing type multiple sclerosis

24
Q

Uses of interferon gamma

A

Chronic granulomatous disease (CGD)

25
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

26
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)
27
Q

Treatment of A-fib in a patient with hemodynamic instability

A

Direct current cardioversion

28
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)

29
Q

What is the cause of S4 heart sound

A

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

30
Q

Contents of lateral, medial, and medial umbilical folds

A

Lateral = inferior epigastric vessels

Medial = obliterated umbilical artery

Median = obliterated urachus; para-umbilical veins

31
Q

Causes of acute pancreatitis

A

I GET SMASHED:

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

32
Q

What type of fluid is used for maintenance IVF?

A

D5 1/2NS

+ 20 KCl (if pt is peeing)

33
Q

What is the significance of singed nose hairs / soot around mouth/nose in a pt who was in a fire?

A

Low threshold for intubation

34
Q

What causes bleeding with isolated decrease in platelets

A

ITP

35
Q

What causes bleeding with nl platelets but increased BT and PTT

A

von Willebrand disease (genetic deficiency in vWF)

Increased BT = decreased platelet adhesion
Increased PTT = vWF normally stabilizes factor VIII

36
Q

Bleeding in pt with low platelets, increased PT, PTT, BT, low fibrinogen, Ddimer, and schistocytes

A

DIC

37
Q

What are the 3 types of topical abx given to burn patients?

A
  1. Silver nitrate
  2. Silver sulfadiazine
  3. Mafenide
38
Q

Which abx does not penetrate eschar and can cause leukopenia

A

Silver sulfadiazine

THINK: sulfaDIazine = DIE WBCs! DIE!

39
Q

Which abx penetrates eschar but is very painful

A

Mafenide

40
Q

Which abx does not penetrate eschar and causes hypokalemia and hyponatremia

A

Silver nitrate

41
Q

First step of management in chemical burn

A

Irrigation

42
Q

First step of management in electrical burn

A

EKG - most likely cause of death will be arrhythmias

43
Q

If electrical burn pt has urine dipstick + blood but neg for RBC under microscope, what does this mean?

A

Rhabdomyolysis causes myoglobinuria

44
Q

What must you check if you find myoglobinuria?

A

K+ levels (this would be the cause of death)

45
Q

What is it called if burned extremity is tender, numb, white, cold, with barely dopplerable pulses?

A

Compartment syndrome

MS3 (88 decks)

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