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A Medicine Study Session > Surgery Shelf Prep > Flashcards

Surgery Shelf Prep Flashcards

1
Q

What is the most commonly used antibiotic regimen in prophylaxis of endocarditis (e.g. prior to dental procedure in post-valve replacement pts)?

A

Oral Amoxicillin - administered 60 min. prior to high risk procedure. [Clindamycin is 2nd line agent if allergic to penicillin]

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2
Q

Which antibiotic regimen is ideal in prophylaxis of endocarditis in patients with penicillin allergy (e.g. prior to dental procedure in post-valve replacement pts)?

A

Clindamycin. Clindamycin is 2nd line agent if allergic to penicillin. Oral Amoxicillin is first line w/o allergy.
Either administered 60 min. prior to high risk procedure.

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3
Q

What type of medication is Cabergoline?

A

Long acting Dopamine agonist and prolactin inhibitor

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4
Q

What is the initial treatment for a Prolactinoma

A

Dopamine agonist therapy e.g. Cabergoline

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5
Q

What is the treatment for Peritonsillar Abscess

A
  1. Airway management.
  2. IV anitbiotics gram + & anaerobic coverage - Clindamycin or ampicillin-sulbactam
  3. I&D or needle aspiration if risk of airway obstruction, complications or immunodeficiency
  4. Tonsillectomy if unresponsive to prior tx, recurrent, + complications, or airway obstruction
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6
Q

What are the potential complications of Peritonsillar abscess

A
  • Airway compromise
  • Spread of infection
  • Aspiration pneumonia
  • Internal jugular vein thrombosis or thrombophlebitis
  • Bacteremia/sepsis
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7
Q

The term synechiae is equivalent to the term “____”

A

Adhesions

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8
Q

What are the common clinical signs of a Gastrinoma (Zollinger-Ellison Syndrome)

A

Recurrent peptic ulcer disease - multiple ulcers & jejunal ulceration, refractery ulcers to PPI
Hx of MEN1
Thickened gastric folds on Endoscopy

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9
Q

What is the initial medical treatment for Dermatitis Herpetiformis

A

Dapsone

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10
Q

What is the main difference between Type 1 and Type 2 Heparin Induced Thrombocytopenia (HIT syndrome)

A

Type 1 is non-immune mediated and platelet counts decrease only mildly (usually stay >100,000)
Type 2 is autoimmune mediated w/ autoantibody against endogenous Platelet Factor 4 complexed with heparin and results in significant platelet drops often >50% w/in 5-10 days

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11
Q

The presence of what in the CSF is specific for HIV associated primary CNS Lymphoma

A

EBV DNA in the CSF

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12
Q

Progressive multifocal leukoencephalopathy lesions (in HIV + pts) are ring _____(enhancing/nonenhancing)

A

Non-enhancing

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13
Q

Primary CNS lymphoma lesion(s) in HIV+ pts are ring-____ (enhancing/nonenhancing)

A

weakly ring enhancing

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14
Q

In pts w/ AIDS dementia complex, imaging studies reveal…

A

cortical and subcortical atrophy & secondary ventricular enlargement

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15
Q

What are the common clinical features of compartment syndrome?

A

Pain out of proportion to injury
Increased pain on passive stretch
Rapid increasing/tensing swelling
Paresthesias

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16
Q

What are some uncommon clinical features of compartment syndrome

A
  • decreased sensation
  • motor weakness
  • paralysis
  • decreased distal pulses
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17
Q

What is the treatment of choice for compartment syndrome

A

Fasciotomy

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18
Q

What are the common complications of a rhinoplasty

A

-pt dissatisfaction
-nasal obstruction
-epistaxis
Less commonly a nasal septum perforation may occur secondary to septal hematoma or septal abscess

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19
Q

Rapid correction of warfarin-induced elevated INR prior to emergent surgery is achieved by administration of …?

A

Fresh Frozen Plasma to replace vitamin K dependent clotting factors

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20
Q

______ is given pre-operatively to patients with Hemophilia A to reduce bleeding risk. Why?

A

Desmopressin in order to indirectly increase factor VIII by increasing vWF release from endothelial cells

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21
Q

The most specific test for diagnosing osteomyelitis is…?

A

Bone biopsy & culture

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22
Q

Which organisms are most commonly responsible for deep infections following a puncture wound

A

Staph aureus and Pseudomonas aeruginosa.

P. aeruginosa is especially common after puncture wound through the shoe

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23
Q

Pasteurella multocida, common microbe following cat bite, is an _____ bacteria

A

Gram negative coccobacilli

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24
Q

What is the Management for Cat bites

A
  • Copious irrigation & cleaning
  • Prophylactic amoxicillin/clavulanate
  • Tetanus booster
  • Avoid closure of wound
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25
Q

Tetanus boosters should be considered with injury in children if last dose was __ years ago

A

5

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26
Q

What is the cause of Zenker Diverticulum

A

Upper Esophageal sphincter dysfunction and esophageal dysmotility

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27
Q

What skin pathology starts as small pustule/papule/nodule that develops into an ulcer and is associated with IBD

A

Pyoderma gangrenosum

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28
Q

Porcelain gallbladder is associated with an increased risk of what cancer

A

Gallbladder Adenocarcinoma

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29
Q

What are the local vascular complications (e.g. in the groin) of a cardiac catheterization

A
  • Hematoma
  • Pseudoaneurysm
  • Arteriovenous Fistula
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30
Q

How do the local vascular complications of cardiac catheterization differ on physical exam

A
  • Hematoma: +/- mass, no bruit
  • Pseudoaneurysm: Bulging, pulsatile mass, Systolic Bruit
  • AV Fistula: No mass, Continuous bruit, +/- palpable thrill`
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31
Q

What is the “Ugly Duckling Sign”

A

A skin lesion that is different from the surrounding lesions, i.e. the ugly duckling, is most likely melanoma (90% Sensitivity)

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32
Q

What is the criteria for a diagnosis of a solid testicular mass

A

Painless hard mass in testicle + suggestive ultrasound

33
Q

Pancreatic tumors in the head of the pancreas are most likely to present with what symptoms

A

jaundice, weight loss, steatorrhea

34
Q

Pancreatic body and tail tumors are most likely to present with what symptoms

A

dull upper abdominal pain radiating to the back, weight loss

35
Q

What are the most likely pathologies given the location of a mass in the mediastinum (anterior, middle, & posterior)

A

Thymomas in the anterior mediastinum
Bronchogenic cysts in the middle mediastinum
Neurogenic tumors in the posterior mediastinum

36
Q

Cardiac Index is a measure of what

A

Cardiac Output

37
Q

How are Cardiac Output, PCWP, and PVR affected by hypovolemic shock

A

Cardiac Output decreased
PCWP decreased
PVR increased

38
Q

How are the Cardiac Output, PCWP, and PVR affected by Cardiogenic shock

A

Cardiac Output decreased
PCWP increased
PVR increased

39
Q

How are Cardiac Output, PCWP, and PVR affected by Distributive Shock (e.g. sepsis, anaphylaxis, SIRS, neurogenic)

A

Cardiac Output increased
PCWP decreased
PVR decreased

40
Q

Pulmonary Capillary Wedge Pressure (PCWP) is a measure of what

A

An estimation of the left atrial pressure

41
Q

How are Cardiac Output, PCWP, and PVR affected by obstructive shock (e.g. cardiac tamponade, tension pneumothorax, massive PE)

A

Cardiac output decreased
PCWP increased
PVR increased

42
Q

What muscles does the axillary nerve innervate

A

Teres Minor and Deltoid

43
Q

What nerve innervates the Teres Minor and Deltoid muscles

A

Axillary nerve

44
Q

Which nerve is most likely to be compromised in an anterior shoulder dislocation

A

Axillary nerve

45
Q

What is the clinical triad of fat embolism syndrome

A
  • Respiratory Distress
  • Neurologic dysfunction
  • Petechial rash
46
Q

Respiratory distress, neurologic dysfunction, and petechial rash following orthopedic injury or pancreatitis suggest _____

A

Fat embolism syndrome

47
Q

Describe the characteristics of a typical meningioma

A

Intracranial lesion w/ Extra-axial well-circumscribed or round homogenously enhancing dural-based mass on MRI

48
Q

What is the treatment for acute viral pericarditis

A

NSAIDs + Colchicine + Activity restriction

Use lowest dose of steroids only if NSAIDs contraindicated

49
Q

Describe the physical exam findings for a lung consolidation

A
  • Increased Breath Sounds
  • Increased Tactile Fremitis
  • Dullness to percussion
50
Q

Describe the physical exam findings for a pleural effusion

A
  • Decreased Breath Sounds
  • Decreased Tactile Fremitis
  • Dullness to percussion
  • Mediastinal shift away from effusion
51
Q

A Giant Cell Tumor of the bone has what appearance on X-ray

A

eccentric lytic lesion, aka “Soap Bubble”

52
Q

Where are Giant Cell Tumors of the bone most commonly located

A

The epiphysis of long bones

53
Q

Eccentric lytic lesions of long bones that has a Soap Bubble appearance on X-ray is suggest of ______

A

Giant Cell Tumor of the bone

54
Q

What is the most common X-ray appearance of an osteoid osteoma

A

Small round lucency

55
Q

Night pain and a small round lucency on X-ray is suggestive of what

A

Osteoid osteoma (benign bone tumor)

56
Q

What are the major risk factors for Aortic Dissection

A

Hypertension (most common)
Marfan Syndrome
Cocaine use

57
Q

What is a Marjolin ulcer

A

A squamous cell carcinoma arising within a burn

58
Q

What are the risk factors for acalculus cholecystitis

A
  • Severe trauma or recent surgery
  • TPN or prolonged fasting
  • Critical illness (sepsis, ICU, etc.)
59
Q

What are the secondary endocrine causes of osteoporosis

A
  • Hyperparathyroidism
  • Hyperthyroidism
  • Hypercortisolism
  • Hypogonadism
60
Q

How does celiac disease contribute to secondary osteoporosis

A

By causing malabsorption of vitamin D

61
Q

What is the gold standard for diagnosis of sphincter of Oddi malfunction

A

Sphincter manometry

62
Q

What is the basic difference between cellulitis and necrotizing fascitis

A

Cellulitis is pretty much just in the skin

Necrotizing fascitis causes patients to be sick with systemic symptoms and rapid spread

63
Q

An Ankle Brachial Index of =0.9 is significant for what

A

Diagnosistic for occlusive PAD, 90% sensitive, 95% specific in pts w/ symptoms

64
Q

What are the components of the Glascow Coma Score

A
  • Eye Movement
  • Verbal Response
  • Motor Response
65
Q

Secondary polycythemia without signs of chronic hypoxia is worrisome for

A

EPO producing tumor such as renal cell carcinoma

66
Q

what is the male to female incidence ratio for imperforate anus

A
  1. Occurs equally in both (1 in 20,000 live births)
67
Q

Imperforate anus is due to what

A

Failure of the urorectal septum to descend

68
Q

Low cases of imperforate anus typically have rectal termination in the ______

A

Perineal fistula

69
Q

High cases of imperforate anus typically have rectal termination in the _____

A

prostatic urethra or vagina

70
Q

What is the most common serious complication of an end ostomy

A

Parastomal herniation (skin irritation/breakdown is not considered serious)

71
Q

What is the 5 yr survival for pancreatic adenocarcinoma following a whipple procedure for cure

A

5-20% (according to PreTest Surgery book)

72
Q

How does achalasia affect the risk of esophageal cancer

A

7 times increased risk of Squamous Cell Carcinoma (even after treatment)

73
Q

Where are Meckel’s diverticula usually located relative to the ileocecal valve

A

50-70 cm proximal

74
Q

Meckel’s diverticula may contain ______

A

gastric and/or pancreatic tissue

75
Q

Which is the more common complication of Meckel diverticula: hemorrhage/obstruction or acute inflammation?

A

Hemorrhage/obstruction

76
Q

What is the best indicator that a splenectomy is beneficial in the management of Immune (Idiopathic) Thrombocytopentic Purpura (ITP)

A

75% increase in platelet count following corticosteroid therapy. Most cases of ITP do not need surgical intervention

77
Q

True or False: Peutz-jeghers syndrome increases risk of malignancy

A

False: Peutz-Jeghers syndrome is associated w/ intestinal polyposis, typically harmartomas, and melanin spots of oral mucosa

78
Q

How is H. pylori diagnosis established

A

Serologic & urea breath tests.

Endoscopy biopsy/scrapings can also be used but is impractical given necessary culture requirements

79
Q

What is the initial treatment for Hirschsprung’s

A

Diverting colostomy in neonates to allow the bowel to grow in length and decompress before re-anastamosis with the rectum

A Medicine Study Session (5 decks)

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