Surgery Shelf Prep Flashcards
What is the most commonly used antibiotic regimen in prophylaxis of endocarditis (e.g. prior to dental procedure in post-valve replacement pts)?
Oral Amoxicillin - administered 60 min. prior to high risk procedure. [Clindamycin is 2nd line agent if allergic to penicillin]
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)?
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.
What type of medication is Cabergoline?
Long acting Dopamine agonist and prolactin inhibitor
What is the initial treatment for a Prolactinoma
Dopamine agonist therapy e.g. Cabergoline
What is the treatment for Peritonsillar Abscess
- Airway management.
- IV anitbiotics gram + & anaerobic coverage - Clindamycin or ampicillin-sulbactam
- I&D or needle aspiration if risk of airway obstruction, complications or immunodeficiency
- Tonsillectomy if unresponsive to prior tx, recurrent, + complications, or airway obstruction
What are the potential complications of Peritonsillar abscess
- Airway compromise
- Spread of infection
- Aspiration pneumonia
- Internal jugular vein thrombosis or thrombophlebitis
- Bacteremia/sepsis
The term synechiae is equivalent to the term “____”
Adhesions
What are the common clinical signs of a Gastrinoma (Zollinger-Ellison Syndrome)
Recurrent peptic ulcer disease - multiple ulcers & jejunal ulceration, refractery ulcers to PPI
Hx of MEN1
Thickened gastric folds on Endoscopy
What is the initial medical treatment for Dermatitis Herpetiformis
Dapsone
What is the main difference between Type 1 and Type 2 Heparin Induced Thrombocytopenia (HIT syndrome)
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
The presence of what in the CSF is specific for HIV associated primary CNS Lymphoma
EBV DNA in the CSF
Progressive multifocal leukoencephalopathy lesions (in HIV + pts) are ring _____(enhancing/nonenhancing)
Non-enhancing
Primary CNS lymphoma lesion(s) in HIV+ pts are ring-____ (enhancing/nonenhancing)
weakly ring enhancing
In pts w/ AIDS dementia complex, imaging studies reveal…
cortical and subcortical atrophy & secondary ventricular enlargement
What are the common clinical features of compartment syndrome?
Pain out of proportion to injury
Increased pain on passive stretch
Rapid increasing/tensing swelling
Paresthesias
What are some uncommon clinical features of compartment syndrome
- decreased sensation
- motor weakness
- paralysis
- decreased distal pulses
What is the treatment of choice for compartment syndrome
Fasciotomy
What are the common complications of a rhinoplasty
-pt dissatisfaction
-nasal obstruction
-epistaxis
Less commonly a nasal septum perforation may occur secondary to septal hematoma or septal abscess
Rapid correction of warfarin-induced elevated INR prior to emergent surgery is achieved by administration of …?
Fresh Frozen Plasma to replace vitamin K dependent clotting factors
______ is given pre-operatively to patients with Hemophilia A to reduce bleeding risk. Why?
Desmopressin in order to indirectly increase factor VIII by increasing vWF release from endothelial cells
The most specific test for diagnosing osteomyelitis is…?
Bone biopsy & culture
Which organisms are most commonly responsible for deep infections following a puncture wound
Staph aureus and Pseudomonas aeruginosa.
P. aeruginosa is especially common after puncture wound through the shoe
Pasteurella multocida, common microbe following cat bite, is an _____ bacteria
Gram negative coccobacilli
What is the Management for Cat bites
- Copious irrigation & cleaning
- Prophylactic amoxicillin/clavulanate
- Tetanus booster
- Avoid closure of wound
Tetanus boosters should be considered with injury in children if last dose was __ years ago
5
What is the cause of Zenker Diverticulum
Upper Esophageal sphincter dysfunction and esophageal dysmotility
What skin pathology starts as small pustule/papule/nodule that develops into an ulcer and is associated with IBD
Pyoderma gangrenosum
Porcelain gallbladder is associated with an increased risk of what cancer
Gallbladder Adenocarcinoma
What are the local vascular complications (e.g. in the groin) of a cardiac catheterization
- Hematoma
- Pseudoaneurysm
- Arteriovenous Fistula
How do the local vascular complications of cardiac catheterization differ on physical exam
- Hematoma: +/- mass, no bruit
- Pseudoaneurysm: Bulging, pulsatile mass, Systolic Bruit
- AV Fistula: No mass, Continuous bruit, +/- palpable thrill`
What is the “Ugly Duckling Sign”
A skin lesion that is different from the surrounding lesions, i.e. the ugly duckling, is most likely melanoma (90% Sensitivity)
What is the criteria for a diagnosis of a solid testicular mass
Painless hard mass in testicle + suggestive ultrasound
Pancreatic tumors in the head of the pancreas are most likely to present with what symptoms
jaundice, weight loss, steatorrhea
Pancreatic body and tail tumors are most likely to present with what symptoms
dull upper abdominal pain radiating to the back, weight loss
What are the most likely pathologies given the location of a mass in the mediastinum (anterior, middle, & posterior)
Thymomas in the anterior mediastinum
Bronchogenic cysts in the middle mediastinum
Neurogenic tumors in the posterior mediastinum
Cardiac Index is a measure of what
Cardiac Output
How are Cardiac Output, PCWP, and PVR affected by hypovolemic shock
Cardiac Output decreased
PCWP decreased
PVR increased
How are the Cardiac Output, PCWP, and PVR affected by Cardiogenic shock
Cardiac Output decreased
PCWP increased
PVR increased
How are Cardiac Output, PCWP, and PVR affected by Distributive Shock (e.g. sepsis, anaphylaxis, SIRS, neurogenic)
Cardiac Output increased
PCWP decreased
PVR decreased
Pulmonary Capillary Wedge Pressure (PCWP) is a measure of what
An estimation of the left atrial pressure
How are Cardiac Output, PCWP, and PVR affected by obstructive shock (e.g. cardiac tamponade, tension pneumothorax, massive PE)
Cardiac output decreased
PCWP increased
PVR increased
What muscles does the axillary nerve innervate
Teres Minor and Deltoid
What nerve innervates the Teres Minor and Deltoid muscles
Axillary nerve
Which nerve is most likely to be compromised in an anterior shoulder dislocation
Axillary nerve
What is the clinical triad of fat embolism syndrome
- Respiratory Distress
- Neurologic dysfunction
- Petechial rash
Respiratory distress, neurologic dysfunction, and petechial rash following orthopedic injury or pancreatitis suggest _____
Fat embolism syndrome
Describe the characteristics of a typical meningioma
Intracranial lesion w/ Extra-axial well-circumscribed or round homogenously enhancing dural-based mass on MRI
What is the treatment for acute viral pericarditis
NSAIDs + Colchicine + Activity restriction
Use lowest dose of steroids only if NSAIDs contraindicated
Describe the physical exam findings for a lung consolidation
- Increased Breath Sounds
- Increased Tactile Fremitis
- Dullness to percussion
Describe the physical exam findings for a pleural effusion
- Decreased Breath Sounds
- Decreased Tactile Fremitis
- Dullness to percussion
- Mediastinal shift away from effusion
A Giant Cell Tumor of the bone has what appearance on X-ray
eccentric lytic lesion, aka “Soap Bubble”
Where are Giant Cell Tumors of the bone most commonly located
The epiphysis of long bones
Eccentric lytic lesions of long bones that has a Soap Bubble appearance on X-ray is suggest of ______
Giant Cell Tumor of the bone
What is the most common X-ray appearance of an osteoid osteoma
Small round lucency
Night pain and a small round lucency on X-ray is suggestive of what
Osteoid osteoma (benign bone tumor)
What are the major risk factors for Aortic Dissection
Hypertension (most common)
Marfan Syndrome
Cocaine use
What is a Marjolin ulcer
A squamous cell carcinoma arising within a burn
What are the risk factors for acalculus cholecystitis
- Severe trauma or recent surgery
- TPN or prolonged fasting
- Critical illness (sepsis, ICU, etc.)
What are the secondary endocrine causes of osteoporosis
- Hyperparathyroidism
- Hyperthyroidism
- Hypercortisolism
- Hypogonadism
How does celiac disease contribute to secondary osteoporosis
By causing malabsorption of vitamin D
What is the gold standard for diagnosis of sphincter of Oddi malfunction
Sphincter manometry
What is the basic difference between cellulitis and necrotizing fascitis
Cellulitis is pretty much just in the skin
Necrotizing fascitis causes patients to be sick with systemic symptoms and rapid spread
An Ankle Brachial Index of =0.9 is significant for what
Diagnosistic for occlusive PAD, 90% sensitive, 95% specific in pts w/ symptoms
What are the components of the Glascow Coma Score
- Eye Movement
- Verbal Response
- Motor Response
Secondary polycythemia without signs of chronic hypoxia is worrisome for
EPO producing tumor such as renal cell carcinoma
what is the male to female incidence ratio for imperforate anus
- Occurs equally in both (1 in 20,000 live births)
Imperforate anus is due to what
Failure of the urorectal septum to descend
Low cases of imperforate anus typically have rectal termination in the ______
Perineal fistula
High cases of imperforate anus typically have rectal termination in the _____
prostatic urethra or vagina
What is the most common serious complication of an end ostomy
Parastomal herniation (skin irritation/breakdown is not considered serious)
What is the 5 yr survival for pancreatic adenocarcinoma following a whipple procedure for cure
5-20% (according to PreTest Surgery book)
How does achalasia affect the risk of esophageal cancer
7 times increased risk of Squamous Cell Carcinoma (even after treatment)
Where are Meckel’s diverticula usually located relative to the ileocecal valve
50-70 cm proximal
Meckel’s diverticula may contain ______
gastric and/or pancreatic tissue
Which is the more common complication of Meckel diverticula: hemorrhage/obstruction or acute inflammation?
Hemorrhage/obstruction
What is the best indicator that a splenectomy is beneficial in the management of Immune (Idiopathic) Thrombocytopentic Purpura (ITP)
75% increase in platelet count following corticosteroid therapy. Most cases of ITP do not need surgical intervention
True or False: Peutz-jeghers syndrome increases risk of malignancy
False: Peutz-Jeghers syndrome is associated w/ intestinal polyposis, typically harmartomas, and melanin spots of oral mucosa
How is H. pylori diagnosis established
Serologic & urea breath tests.
Endoscopy biopsy/scrapings can also be used but is impractical given necessary culture requirements
What is the initial treatment for Hirschsprung’s
Diverting colostomy in neonates to allow the bowel to grow in length and decompress before re-anastamosis with the rectum
