Surgery: Subspecialty Flashcards
1
Q
treatment of hirscprungs
A
resect bad colon
2
Q
treatment for dequerviens tensosynovitis
A
splint and NSAIDs
3
Q
diagnostic test of choice for aortic dissection is what
what if renal failure in pt
A
CT angiogram
shows false lumen
use TEE or MRI if renal disessae
4
Q
diagnosing malrotation
A
CU malrotates
contrast enema
then upper GI if needed
5
Q
which VSD need repair
A
children with R sided hypertrophy, increased right sided pressures, FTT, or HF need immediate repair
6
Q
painless acute loss of vision that is unilateral and no other FND is what
what else would you see
A
retinal artery occlusion
cherry red spot fovea
7
Q
treatment of carpal tunnel
A
splint and NSAID
intraarticular steroids
surgery
8
Q
pretreat pheo pts with what
A
a blockade before b blockade before surgery
9
Q
if suspect VACTERL what testing
A
sacral US, xray, VCUG, NG tube and echo
10
Q
are teratomas malignant in men or women in GU
A
men
11
Q
treatment for cleft lip
A
surgery at 10-12 weeks (feeding issue)
12
Q
valve: last under 10 years but no anticoags needed
A
bovine valves
13
Q
a scc arising from a chronic wound such as a previous burn scar that tends to be very aggressive
A
marjolin ulcer
14
Q
treatment for retinal artery occlusion
A
intraarterial TPA
hyperventilation rebreathed CO2 and apply global orbital pressure to buy time
15
Q
severe cases of hirschprung’s require what
A
colostomy
16
Q
pathology of dupuytrens contracture
clx feature
tx
A
seen in alcoholic males with scandinavian ancestry
hand cannot extend and see palmar nodes
surgery
17
Q
which of the anterior and post tumors only needs CT scan
A
meningioma
18
Q
early treatment of SAH within first 48 hrs
A
reduce bleeding by decreasing BP to under 140/90 with IV meds (BB or CCB)
Pt in bad shape
if do craniotomy to decrease ICP can do CLIP and VP shunt
otherwise:
serial LP and coil
19
Q
what if pt has noninfectious bacterial prostatitis what is tx
A
NSAIDs
20
Q
knee pain and click on full extension is what
tx and dx
A
meniscal tear
MRU and arthroscopic repair
21
Q
stenosing tensosynovitis, cannot extend, pops when forced
A
trigger finger
clx
splint and nsaids
22
Q
what skin cancer: well defined red papule, ulcer that heals and breaks down a lot
A
SCC
23
Q
in congenital diaphragmatic hernia what is the most importnant thing to baby
A
intubation and ventilation bc of hypoplastic lung
stabilize before surgery
24
Q
pt has persistent virulent peptic ulcer disease and diarrhea what should you suspect and management
A
gastrinoma
meausre serum gastrin then do secrtein test
ID tumor with CT scan and SRS scintigraphy, cut it out
25
asx screens with DRE and PSA for prostate cancer?
no unless very specific pop
many men will die with prostate cancer
26
first and best test for bladder cancer
treatment?
cystoscopy with biopsy
transurethral resection and BCG or Cisplatin based chemo
27
what tumor: in men: hypogonadism, decreased libido, infertility, impotence
prolactinoma
28
elderly pt with osteoporosis falls onto an outstretched hand, the radius "breaks up" which means dorsally displaced
looks like a dinner fork
what kind of fracture?
colles fracture
29
painless testicular mass in a young man
what test
testicular cancer is possible
do trans illumination, does not illuinate
biopsy by orchiectomy
30
preferred method of biopsy for prostate cancer
transrectal biopsy
31
what is SAH caused by
ruptured aneurysms in the brain
32
if pt has PAD but not significantly impacting life then whatq
conserative management and no investigation to be made
```
control risk factors
stop smoking
exedrcise
aspirin or clopidogrel if stented
cilostazol or pentoxifylline for sx control only
```
33
what cannot pt not do with ruptured achilles tendon
platarflex foot
34
old person with DM and progressive vision loss
what will you see on PE
cataracts
white thing in anterior chamber, decreased night time vision
35
treatment of tib/fib fracture if closed or open
casting if closed
nailing if open with ORIF
36
f/u of treatment of prostate cancer
if increased PSA and no sx
if increased PSA and sx
no sx = anti androgens
sx = radiation
37
flank pain, palp mass,painless hematuria and what else maybe with the dx of ___
RCC
erythrocytosis or anemia possible
38
basal cell carcinoma
mets?
locally invade?
no mets
| + locally invade
39
all SAH need what ppx
seizure with nay of the meds
40
diagnosing biliary atresia
US to show absence of ducts and r/o stones
phenobarbital then HIDA 5-7 days later (lack bile reaching duodenum)
intraoperative cholangiogram if still uncertain
41
managment of parathyroid adenoma
sestamibi scan to find which of the PT glands are enlarged bc usually just one
then resect, but watch for hypocalcemia
42
tumor in premenopausal women: menstrual irreg, oligomen, anovulation, infertility, vaginal dryness, risk osteoperosis
prolactinoma
43
diagnosing melanoma
punch biopsy if good large lesion and low suspicion
wide excisional bx if lesion is small or high index of suspicion
44
what increases risk of bladder cancer
smoking and exposure to B-alanine dyes
45
acute limb ischemia usually from what
Afib clot, cholesterol emboli, acute thrombosis
46
first step when think cushings
24 hour cortisol level and confirm with 1 mg low dose dexamethasone
if cortisol increases it is cushings
then do ACTH (if decreased then adrenal, if increased then extraadrenal)
if adrenal spot it with CT/MRI and resect
if extraadrenal then high dose dexameth test (suppress = pituitary, if no suppression then ectopic)
if pituit then MRI and resect
if ectopic then find with CTI/MRI of: chest, abd, pelvis
47
tumor found in CPA and if bilateral is part of what
other features
tx?
schwannoma
NF II
hearing loss, vertigo, N/V, tinnitus
resect and cure
48
increased pressure in low lighting and this leads to HA, pain, RIGID eyeball and the increased pressure doesn't allow the pupil to constrict anymore
closed angle glaucoma
49
tx cataract
resection is curative
50
location of force for PCL tear
anterior
51
when use CABG
70% stenosis, mainstem equiv (LAD or 3+ vessels) and good LV function
52
what fracture just needs casting
closed wound with good approximation
53
valve: 10-20 years but need anticoags, warfarin goal INR 2.5-3.5
mechanical valve
54
what would aldosterone and renin be with conn's syndrome
high aldosterone and low renin
55
management of conn's syndrome
diagnosing then tx
aldost:renin level over 20
f/u with a salt suppresion test, and if fails to suppress then CT/MRI
AVS to lateralize
resect
56
if obstructive uropathy in BPH what should you do
in and out cath and possible TURP (transurethral resection of prostate)
57
treatment for coarctation of aorta
resect and reanast
58
managing an increased ICP in SAH begins with what
elevation of head of bed
give hypertonic solutions
hyperventilate
59
PAD: a lesion that is both in the femoral artery and under 3 cm can be what
stented
everything else is bypass
60
what shoulder disloacation is in shaking hands potition
abduction and external roation
anterior
61
treating follicular cancer
radioactive iodine
62
diagnosing brain tumor
MRI
biopsy for definitive diagnosis
63
gastrin level
2 digits
3 digits
4 digits
```
2 = normal
3 = probably ppi
4 = gastrinoma
```
64
pt with migratory necrolytic dermatitis and some DM what is and how manage
glucagonoma
get glucagon level
CT to find and resect it
65
ASD treatment
closure if needed via cath directed device closure
66
what kind of cancer of skin
pearly lesion or one that is non-healing and bleeds easily
BCC
67
best test for coarctation of the aorta and what is sufficient too
arteriogram, but CTA or MRA can be sufficient
68
f/u bladder cancer treatment
recurs, so increase surveillance with cystoscopy
69
immediate sx relief and long term therapy for BPH
immediate: a blockers like tamulosin
5-a reductase inhibitor (finasteride) for long term therapy
70
treatment for cleft palate
surgery at 10-12 months
71
children with delayed growth, bitemporal hemianopsia, and sella clacifications on imaging
craniopharyngeoma
72
management of test torsion
US with doppler then surgery
73
diagnosing SAH
1)
2)
3) still uncertain
CT scan without contrast
-will show + blood but outside parenchyma and between the gyri
then MR or CT angiogram
if question about it do LP and look for xanthocrhomia (blood in tube still on 4th tube)
74
pt complaining of floateors or of a veil or cloud on top of their visual picture is what
retinal detachment
75
if pt has signs and sx of retinal detachment but they sx come and go then what is it
amaurosis fugax which is a preliminary sign of impending artery occluison
76
after 1) ABI what is almost always done and why
2) US doppler to look for pressure gradient drop which confirms the diagnosis of macrovascular disease
- if positive pressure gradient then macrovascular and do 3) arteriorgram to ID lesion and use stent or bypass
77
"pyelo" sx in old person with no CVA tenderness and do DRE and is tender what is and do what next
bacterial prostatitis
get UA then IV abx if shows bugs
no more DREs
send home on long term fluoroquinolones
78
tx of hip fracture: if at femoral head or intratroch, or shaft
femoral head = prosteshsis
intratrochanteric = plates
shaft = rods
79
what cancers can cause extra-adrenal cushings
lung cancer, pancreatic cancer
80
if baby has persistent or worsening jaundice after 2 weeks of age consider what diagnoses
biliary atresia
81
what brain tumor may be associated with DM and HTN
GH secreting tumor
82
goal of managment with intracranial hemorrhage
reduce ICP, same treatment as SAH without clip or coil
83
follow endodermal sinus tumor with what and choriocarcinoma with what in test cancer
AFP
B-HCG
84
measure what if think pheochromocytoma
24 hour urinary metanephrines and catecholamines
VMA most sensitive
85
diagnosing peripheral vascular disease
ABI
1.0-1.4 is normal
86
what type of heart shunts cause increased vascular markings on chest x-ray
left to right shunts
87
anterior fossa tumors?
OMG its you AUNT
oligo
meningioma
GBM
adults
A = adults
88
after cardiac sugery for CAD whats importanat
maintain CO: EKGs and IVF, CI with wedge pressure
BB, ACEi, STatin, ASA
avoid straining
89
xray of meconium plug shows what
gas filled plug
90
abscess in the pulp of the fingertip after penetrating injury
very tender and have fever
what is it and treatment
felon
dx clx
tx I and D
91
when should extrophy of bladder be corrected
within 2 days to 2 weeks
92
dx and treatmentof angkle fracture
if can walk do not image
in nonambulatory then xray and surgery
93
testicular torsion: testes will be exquisitely tender with what
horizontal lie and elevation will cause pain
94
pt with repeated hypoglycemia states especially when fasting and how to confirm
insulinoma
C peptide and insulin will both be elevated and sulfonylurea screen negative
CT scan to locate and resect
95
signs of acute limb ischemia
sudden onset of extremity that is painful, pale, pulseless, with paresthesias, paralysis and cold (poikilothermia)
96
punch aginsat wall where 4th and 5th digits break, what fracture
boxers fracture
97
to prevent vasospasm in SAH what does pt need
CCB, if too late and vasospasm occurs then BP actually must increase to maintain perfusion
98
aortic stenosis murmur
location
sound
radiation
treatment
2nd ICS RSB
crescendo, decrescendo
radiates to carotids
tx: replace the valve
99
diagnose epididymitis and treatement
US with doppler
<35 = abx: ceftriazone and azithro
>55: fluoroquinolone
100
tear extensor tendon and treatment
mallet finger
splint and NSAIDs
101
diagnosing carpal tunnel
clinical
EMG shows decreased conduction
only do before sx
102
snoring baby
choanal atresia
103
positve valgus stress test = what lig tear
what about varus?
Valgus: MCL
Varus: LCL
104
treatment of prostate cancer
local disease: resection, radiation, brachytherapy
meds: GnRH analogs (leuprolide) first choice
anti angrogens like flutamide is backup
105
treating melanoma
under 0.5 mm
1-2 mm
2-4mm
>4 mm
under 0.5 mm = then excision bx wide resection
-0.5 cm margins
1-2 mm = excision and cent LN dissection
-if tracer + then 1 cm margins
2-4 mm = excision and cent LN dissection
-if tracer + then 2 cm margins
>4 mm = chemo and radiation
-debulking nests of tumor for palliation, pt going to die
106
secondary hyperaldosteronism is caused either by what
bilateral renal artery stenosis in an old man with atherosclerotis disease (no srgy needed)
fibromuscular dysplasia (young woman, stent these hos)
107
lower lip hyperpigmentation skin cancer?
SCC
108
if have erectile dysfunction from spinla injury or AV malformation what is the treatment
vacuum pumps or prostehetic device
PEDi will not work
109
peripheral vascular disease treatment
angioplasty stent: above knee or small
bypass: long lesion or below the knee
110
cilostazol is contraindicated in what
CHF
111
Foosh fracture, and pain in anatomic snuff box
what fracture and diagnoses and tx
scaphoid
xr is normal day 1 but cast anyways bc XR positive days later
if don't repair will have necrosis bc of vasculature
if damage seen on day one you can do ORIF
112
treatment for MS
medical tx
balloon valvotomy
replacement
113
what brain tumor
kids with obstructive hydrocephalus in 4th ventricle, and kids curl up in ball it helps
tx?
ependymoma
resect
114
which shoulder rotation is in protected wrist position (adducted and internally rotated)
post dislocation
115
diagnosing acromegaly
whats elevated
glucose supression test which will not decrease GH
then MRI of pituitary
IGF-1 or somatomedin C signif elevated
116
diagnosing imperforate anus
cros table xray on a prone child with radiopaque perineal marking
117
prostate cancer vs BPH location
cancer in posterior part (starts periph and moves central)
BPH in periurethral region
118
treating descending aortic dissection
medically with IV beta blockers
119
which vessel is connected to internal mammary artery in CABG? what about others
LAD or most significant artery
others get great saphenous vein
120
colick flank pain that radiates to the groin with hematuria
kidney stones
121
chronic progressive central vision loss is what
macular degeneration
122
the majority of brain tumors are from mets or primary?
mets from lung, breast, GI
123
What is the most important indicator of prognosis for melanoma
depth of invasion
124
mitral valve regurgitation
location
sound
radiation
treatment
holosystolic murmur at cardiac apex
radiate to axilla
treatment: replace valve when desired or treat with LV dilation
125
treatment kidney stone
```
<0.5 cm
<0.7 cm
<1.5 cm
>1.5 cm
septic
```
```
<0.5 cm: hydration and analgesics
<0.7 cm add MET (tamulosin, amlodipnine)
<1.5 cm stent and lithotripsy
>1.5 cm surgery
septic nephrostomy tube
```
126
hip fracture in what pts
length and position of leg after
old women with osteoperosis, shor leg and ext rotated
127
PDA treatment
usually self resolve within 7 days
in preterm infants often need to be closed with indomethacin or surgery
128
pt: protection from a hit above, stirkes then ulna and breaks it and displaces radius
monteggia fracture
129
wide pulse pressure murmur
AI
130
acute limb ischemia diagnosing and treatment
F/U
have 6 hours to fix
US and arteriogram to find
embolectomy, localized tPA or heparin
F/U comparment syndrome
131
diagnosing hirschsprung's disease
KUB shows dilated colon (normal) and normal distal colon (abnormal
contrast enema is preferred initial test
suction biopsy is next step to confirm
132
treatment for retinal detachment
laser spotweld the retina back into place
133
macular degneration 2 types which is treatable
wet (blood or fluid), use a laser
dry (drusen/pigment changes) is supportive care
134
what fracture needs and emergency wash out
open
135
spontaneous testicular pain with a normal/vertical lie and releif with elevation of testes
cord is also tender
epididymitis
136
definitive diagnoses of pyloric stenosis
tx
US showing a donut sign
treatment is IVF replacement then pyloromyotomy
137
if single vessel or 2 vessel CAD disease consider what
balloon angioplasty (PCI) with stenting and clopidogrel
138
if have a hot nodule what can be done
resected or hit with radioiodine ablation
139
f/u with what for intracrnaial hemorrhage
CT scans to track how rapidly the hematoma is expanding and if midline shift
also reverse anticoagulation if able
140
treatment for AAA
over 3.5 Q12 month screen
>4.5 Q 6 months
>5.5 or change of 0.5 cm or more in 6 months then surgery (endovascular repair)
141
FNA managment based off results
1) cancer
2) non cancer
3) inconclusive
1) cancer = surgery (thyroidectomy)
2) non cancer, watch and wait 6 months later US
3) inconclusive = repeat FNA
142
ABCDE of melanoma
```
asymmetry
borders irregular
color change
diameter over 5 mm
evolving lesion
```
143
tx of corneal abrasions
irrigate a lot before dx
then do fluorescein dye test to see extent of damage
may or may not need surgery
144
dx and tx of SCC
same as BCC + radiation bc can metastasize
145
path of epididymisits
under 35 = STD
| over 55 = e coli
146
brain tumor that is attached to dura, highly curable, don't mets
how to diagnose
meningioma
CT scan showing connetion to bone and biopsy with psammoma bodies
resect
147
retinal detachment occurs how
spontaneously (marfan,HTN) or following major trauma
148
multiple air fluid levels on a babygram and bilious vomiting
intenstinal atresia
149
tx chonala atresia
surgery to fix passage
150
cushings is caused by what 4 things
iatrogenic
pituitary adenoma
adrenal tumor
ectopic ACTH
151
dixing high lesions (away from anus) imperforate anus
colostomy with future correction
152
labs on biliary atresia
direct hyperbilirubinemia
153
treatment for shoulder dislocation
relocate and sling
154
heart shunt with decrased vascular markings on chest x ray
R to L shunt
155
squamous cell carcinoma
mets?
locally invade?
can do both
156
diagnosing choanal atresia
cath, fails to pass if complete
fiberoptic scope ID lesion if incomplete
157
definitive diagnoses of RAS
angiogram
158
to work up a dissection first rule out waht
CAD with EKG and toponin
xray shows wide mediastinum
159
fracture of radius and dislplaced ulna from a radius being hit first
galezzia
160
what surgery if fracture is
open, angular or commutited
ORIF in the OR
161
location of force for ACL teaer and dx and tx
posterior
MRI
heals on own, athletes get surgical repair
162
Intraparenchyal hemmhorage occurs most often where
caudate and putamen
163
periorbital cellulitis dx and tx
if can move eye, ABX
if cannot move eye then CT scan, and if + then I and D or surgery and ABX
164
MS murmur
location
diastolic at cardiac apex
165
toddler, and trouble with overflow incontenince
hirschprungs
166
treating biliary atresia
kasai procedure
hepatoportoenterostomy
167
treating a ascending dissection (before great vessels)
operative bc can cause aortic regurge or cut off GVs
| replace aortic valve and consider CABG
168
if have elevated VMAs what do you do next
localize with CT scan or MRI
confirm laterality with MIBG scan or AVS
resect
169
jet black lesion with no hair is what skin cancer
melanoma
170
managment of gastroschisis and omphalocele
cover viscera in sterile bag and place saline soaked gauze over contents to stop desiccation and infection
place NG tube to keep bowel decompressed
fluid balance too
placement of covered silo if needed
171
pinpoint tibia pain and treatment
stress fracture
rest and nsaids
172
most common sites of mets to brain
lung >prostate/breast > colon
173
what may ease pts hip pain in a fracture while preparing transport
traction
174
treatment of basal cell carcinoma
small lesion not on face
large lesion not on face
large lesion on extremeity
any lesion on face
excisional
wide excision with >1 mm margins
amputation
mohs
175
if prostate cancer is refractory to meds what next
orchiectomy is option
176
dx kidney stones
UA and Ucx to look for crystals
then CT scan to find sixze and location
177
what should you order to diagnose hyperprolactinemia
serum prolactin
preg test and TSH level too
178
blue with feeding in kids and pink with crying
choanal atresia
179
pressure after dilation, fluid cannot leave the the anterior chamber
closed angle glaucoma
180
what tumor: 4th ventricle, highly malignant, children, seeds subarachnoid space, can lead to distal lesions in the cord
what is tx too
medulloblastoma
resection, chemo, and rads
181
hand injury: tear flexor tendon so cannot flex the digit
diagnoses and tx
jersey finger
splint and NSAIDs
182
dx and tx closed angle glaucoma
clx, occular pressure
tx: constrict pupil
- a agonist
- block betas
relieve presure with laser to make hole to relieve
183
aoritc regurge or AI
location
sound
radiation
tx
F/U
diatsolic murmur 4th ICS LSB
decrescendo, blowing murmur
replace the valve if chronic and LV dilation occured
f/u CABG
184
what is a cushing relfex
bradycardia and hypertension seen in brain tumors
185
complications of cleft lip and palate
OM, feeding difficulty hearing defect, speech path
186
rumbling diastolic murmur with opening snap murmur
MS
187
posterior fossa tumor
p = pediatrics, kids are a MES
medulloblastoma
ependymoma
schwannoma
188
diagnosing and tx RCC
US then CT then bx (nephrectomy)
surgery and possible chemo and radiation
189
dx NEC and tx
babygram shows pnematosis intestinalis
NPO, TPN, and IV ABX
only surgery with no improvement or worsened conditions
190
follow up with mecnoium plug
perforation can happen which can lead to meconium peritonitits
191
diagnosing basal cell carcinoma
small lesion not on face
large lesion not on face
any lesion on face
small lesion not on face = excisional bx
large lesion not on face = incisional bx
any lesion on face = incisional bx
192
seminoma testicular cancer treatment follow what
senstive to chemo and radiation follow LDH
193
managment of possible BPH
DRE, feel rubbery prostae
then UA and Ucx to r/o infx
then medical therapy no bx
194
pts that get aortic dissection
marfans
syphilis
HTN
195
diagnosing RAS
1) aldost to renin ratio (should be near 1)
2) U/S with doppler
3) angiogram is definitive diagnoses
196
double bubble sign is assocaited with what
if normal gas pattern distally which is most likely
dx
duodenal atresia, annular pancreas, and malrotation
malrotation
contrast enema then upper GI series
197
AAA if these signs present then surgery no matter what the size is
pain or tenderness of aneursym or there is back pain
198
which diseases have R to L shunt
T diseases
transposition of the great arteries
TOF
truncus arteriosis
tricuspid atresia
TAPVR
199
ABI
>1.4 then next do toe brachial index
1. 0-1.4 is normal
0. 9-1 is equivical so do exercise ABI
0.8-.0.9 = mild, doppler US
0.4-0.8 = moderate, doppler US
<0.4 = severe, doppler US
200
what disease associated with carpal tunnel
hypothyroid and DM
201
tx mcl and lcl
athelete = surgery
hinge cast for all else
202
butterfly lesion that can cross midline (tumor)
GBM
203
fixing low lesion imperforate anus
dilation or minor surgical procedure
204
treat achilles tendon tear
casting cures in months
| surgery cures in weeks
