surgery uworld

Question 1

Characteristics of pain of bursitis

Answer 1

shar, swelling, erythema, pain with active but not passive motion

Question 2

Knee pain associated with repetitive kneeling

Answer 2

prepatellar bursitis

Question 3

patella fracture

Answer 3

welling, tenderness, inability to extend knee; caused by sudden forse like falling from a height

Question 4

Patellar tendinitis

Answer 4

episodic pain and tenderness at the inferior patella and patellar tendon; seein athletes in jumping sports

Question 5

Patellofemoral pain syndrome

Answer 5

most common in women; presents with peripatellar pain wosrse with activity or prolonged sitting

Question 6

Tx of supracondylar fracture

Answer 6

analgesia and immobilization

Question 7

terminal hematuria

Answer 7

suggests bleeding form the prostate, bladder or posterior urethra

Question 8

initial step in workup for bladder cnacer

Answer 8

cystoscpy

Question 9

men with pelvic fractures are at significant risk for

Answer 9

posterior urethral injury

Question 10

First step in patients with suspected urethral injury

Answer 10

retrograde urethrogram

Question 11

Men with straddle injury are at risk for

Answer 11

anterior urethral injury

Question 12

Signs of pelvic fracture, gross hematuria, possibly voiding difficulty; next step

Answer 12

retrograde cystogram to assess for bladder rupture

Question 13

Diffuse axonal injury

Answer 13

traumatic acceleration/deceleration -> diffuse damage of axons presenting in coma with CT findings of small bleeds in the grey-white matter jct

Question 14

uncal hernia

Answer 14

ipsilateral hemiparesis; compression of ipsilateral oculomotor nerve (mydraiasis, ptosis and down and out gaze; compresion of ipsilateral posterior cerebral artery (contra homonymous hemianopsia) altered level of consciousness and coma

Question 15

Cushings triad

Answer 15

hypertension, bradycardia and respiratory depression)

Question 16

Acute popping sensation in knee, catching and locking sensation; how do you dx

Answer 16

MRI looking for meniscal tear

Question 17

short vs long term tx meniscal tear

Answer 17

short term NSAIDS and rest; if >3-4 weeks surgical intervention

Question 18

pain with abduction, external rotation; subacromial tenderness; normal range of motion with positive neer and hawkin signs

Answer 18

rotator cuff impingement or tendiopathy

Question 19

pain with abduction; weakness external rotation age >40

Answer 19

rotator cuff tear

Question 20

anterior shoulder pain; pain with lifting, carrying or overhead reaching, weakness less common

Answer 20

biceps tendinopaty/rupture

Question 21

respirtory distress, neurologic dysfunction and petechial rash

Answer 21

fat embolism

Question 22

recent history of skin infection, fever, abd pain that radiates to groin

Answer 22

psoas abscess

Question 23

abd pain with hip extension

Answer 23

psoas sign

Question 24

tx psoas abscess

Answer 24

drainage and blood and abscess cultures

Question 25

immediate fever post op

Answer 25

prior infection, blood products, malignant hyperthermia

Question 26

post op fever within 1-7 d

Answer 26

sirgical site infection, MI, PE< DVT, nosocomial infection

Question 27

post op fever 1-4 wks

Answer 27

catheter infection, c diff, drug fever, PE/DVT

Question 28

PE findings pneumothorax

Answer 28

hyperresonance over affected side and tracheal deviation to opposite side

Question 29

Signs of tracheobronchial tear

Answer 29

dyspnea, hemoptysis, subcut emphysema,, audible crepitus on cardiac auscultation

Question 30

indications for a urgent laparotomy

Answer 30

free intraperitoneal fluid in abd of a hemodynamically unstable patient

Question 31

indication for contrast andiography

Answer 31

unstable patient with pelvic fracture disrupting pelvic vessels and for patients with hemorrhage d/t spleci or hepatic lacerations

Question 32

signs of myocardial rupture

Answer 32

muffled heart sounds, hypotension and distended neck veins

Question 33

Dx of myocardial rupture

Answer 33

US with emergent surgical repair

Question 34

preferred wat to establish an airway in a cervical spinal injury if there is no significant facial trauma

Answer 34

orotracheal intubation

Question 35

fever, leukocytosis, parotid inflammation

Answer 35

bacterial parotitis most commonly cause bby S aureus

Question 36

best way to prevent bacterial parotitis post op

Answer 36

adequate fluids and oral hygience

Question 37

extra axial well circumscribed or round homogenously enhancing dural based mass on MRI suggest

Answer 37

meningioma

Question 38

tx meningioma

Answer 38

resection

Question 39

indications for an airway

Answer 39

severe inhalation injury (breathing smoke), cervical spine injury

Question 40

indication for fiberoptic bronchoscope securing of airway

Answer 40

subcut emphysema in the neck

Question 41

indication for cricothyroidotomy

Answer 41

intubation cannot be done in usual manner and time becomes an issue

Question 42

clinical signs of shock

Answer 42

low BP (<90), fast feeble pulse, low UO (<0.5 mL/kg/h), pale, cold sweating, thirsty

Question 43

causes of shock in the trauma setting

Answer 43

bleeding (hypovol), pericardial tamponade, tension pneumo

Question 44

trauma with low CVP (empty veins) vs high

Answer 44

low-bleeding-> hypovol | high- tamponade or tension pneumo

Question 45

respiratory distress, no breath sounds on right and hyperresonant to percussion and mediastinum displace to left

Answer 45

right sided pneumo

Question 46

preferred route of fluid resuscitation in trauma

Answer 46

2 16 gauage PIV if not possible femoral vein cath; if under 6 yo intraosseus cannulation of prox tibia

Question 47

management pericardial tamponade

Answer 47

clinical dx (no Xray needed maybe sonogram); pericardiocentesis, tube, pericardial window or open thracotomy; fluid and blood

Question 48

management tension pneumo

Answer 48

clinical dx; needle or cath into pleural space; follow with chest tube to underwater seal

Question 49

non trauma causes of hypovol shock

Answer 49

burns, peritonitis, pancreatitis, massive diarrhea

Question 50

causes of cardiogenic shock

Answer 50

massive MI, fulminating myocarditis

Question 51

tx penetrating head trauma

Answer 51

surgical intervention

Question 52

tx linear skull fractures

Answer 52

closed- leave open- wound closure comminuted or depressed- OR

Question 53

Anyone with head trauma who has become unconscious

Answer 53

get a CT to look for intracranial hematoma

Question 54

signs of fracture affecting the base of the skull

Answer 54

raccoon eyes, rhinorrhea, otorrhea

Question 55

head trauma, unconsciousness, lucid interval and gradual relapse into coma, fixed dilated pupils, and contralateral hemiparesis. CT finding

Answer 55

epidural hematoma shows biconvex hematoma

Question 56

tx epidural hematoma

Answer 56

emergency craniotomy

Question 57

ICP monitoring

Answer 57

elevae head, hyperventilate, avoid fluid overload, and give mannitol or furosemide

Question 58

ALS deficits

Answer 58

upper and lower motor neuron with no loss of sensory

Question 59

cervical spondylosis

Answer 59

neck pain and stiffness; spinal stenosis-> neuro defects

Question 60

herniated cervical disc

Answer 60

unilateral radiculopathy

Question 61

risk factors emphysematous cholecystitis

Answer 61

DM, vascular compromise immunosuppression

Question 62

tx emphysematous cholecystitis

Answer 62

cholecystectomy emergently and broad spectrum abx

Question 63

Sodium bicarb in the management of metabolic acidosis

Answer 63

severe with pH <7.1