Surgery VI Flashcards
What nerve is responsible for flexion at the hip and extension at the knee?
Femoral nerve
What nerve is responsible for foot eversion and dorsiflexion?
Peroneal (fibular) nerve
“PEDs”: Peroneal Eversion Dorsiflexion
What nerve is responsible for foot inversion and plantar flexion?
Tibial nerve
“TIPs”: Tibial Inversion Plantarflexion
What nerve provides sensation to the anterior thigh and medial leg?
Femoral nerve (saphenous branch)
What nerve provides sensation to the area between the 1st and 2nd toes?
Deep peroneal (fibular) nerve
What nerve provides sensation to the dorsum of the foot?
Superficial peroneal (fibular) nerve
What nerve provides sensation to the medial thigh?
Obturator nerve
What nerve provides sensation to the sole of the foot?
Tibial nerve
What neurological pathology presents with pain/temperature loss and muscle weakness in the upper extremities?
Syringomyelia
“cape-like distribution”
What pathology classically presents with periumbilical abdominal pain out of proportion to PE findings?
Acute mesenteric ischemia
What post-gastrectomy complication presents with GI and vasomotor symptoms?
Dumping syndrome
e.g. nausea, diarrhea, abdominal cramps (GI) and palpitations, diaphoresis (vasomotor)
What preventive measures are useful for preventing post-operative acute bacterial parotitis?
adequate fluid hydration and oral hygeine
What rash in pictured in the image below?
Stasis dermatitis (secondary to venous insufficiency)
What Staphylococcus species is typically the cause of delayed-onset (3-12 months) prosthetic joint infection?
S. epidermidis
infections are due to less virulent organisms and present with chronic pain
What surgical intervention, if any, is recommended for patients with gallstone pancreatitis when medically stable?
Cholecystectomy
What syndrome is characterized by a triad of respiratory distress, neurologic dysfunction, and petechial rash?
Fat embolism syndrome
typically develops following a latent period of 12 - 72 hours after the initial injury
What testicular mass is a painless fluid-filled cyst at the head of the epididymis?
Spermatocele
What testicular mass is easily transilluminated?
Hydrocele
What three symptoms make up the Cushing’s reflex/triad?
hypertension, bradycardia, and respiratory depression
indicates elevated intracranial pressure
What tissue pressure is diagnostic of compartment syndrome?
> 30 mmHg
What trauma pathology occurs when > 3 continuous ribs are fractured in > 2 places?
Flail chest
What type of bursitis is seen with repetitive kneeling?
Prepatellar bursitis (“housemaid’s knee”)
What type of cholecystitis arises due to infection of the gallbladder wall with gas-forming bacteria (e.g. Clostridium)?
Emphysematous cholecystitis
treatment requires emergent cholecystectomy and broad-spectrum antibiotics
What type of neuromuscular blocking agent should be used in patients with upregulated post-synaptic ACh receptors (e.g. skeletal muscle trauma, burn injury, stroke)?
Non-depolarizing agents (e.g. vecuronium, rocuronium)
What type of surgical infection presents with intense pain in the wound, decreased sensitivity at wound-edges, cloudy-gray discharge, +/- crepitus?
Necrotizing infection
What type of urethral injury (anterior or posterior) is typically caused by pelvic fractures in men?
Posterior urethral injury
most commonly the membranous urethra at the bulbomembranous junction
What type of urethral injury (anterior or posterior) is typically caused by straddle injuries in men?
Anterior urethral injury
What vital signs (BP, HR) are concerning for hemorrhage following blunt abdominal or thoracic trauma?
hypotension and/or tachycardia
What vitamin deficiency is characterized by swollen gums, petechiae, and impaired wound healing?
Vitamin C deficiency (scurvy)
more common in patients with alcoholism, drug abuse, or psychiatric illness; diagnosis is made with plasma or leukocyte vitamin C levels
When should older patients with hip fractures undergo definitive surgical correction?
As soon as reasonably possible
may delay up to 72 hours to evaluate surgical risk and ensure medical stability
When should patients with acute cholecystitis have a cholecystectomy?
Within 72 hours
the same applies to other complicated gallstone diseases (e.g. choledocholithiasis, gallstone pancreatitis)
When should patients with uncomplicated biliary colic have a cholecystectomy?
Electively
Which metatarsal has an increased risk for non-union following a stress fracture, thus requiring more aggressive treatment?
5th metatarsal
hus typically managed with casting or internal fixation
Which metatarsal is most commonly injured by stress fractures?
2nd metatarsal
second metatarsal is subjected to significant load during gait
Which organs (2) are most commonly injured with blunt abdominal trauma?
liver and spleen
Which region of the bladder may cause chemical peritonitis if ruptured?
Dome of the bladder
this part of the bladder borders the peritoneal cavity, i.e. intraperitoneal bladder rupture
Which side are varicoceles more common on?
Left
due to drainage into the left renal vein, which is vulnerable to compression between the SMA and aorta (“nutcracker effect”)
Which Staphylococcus species is typically the cause of acute-onset (< 3 months) prosthetic joint infection?
S. aureus
infections are due to more virulent organisms and present with acute pain
Which tibial pathology, shin splints or stress fracture, is more common in underweight individuals?
Stress fracture
especially common in women with the female athlete triad
Which tibial pathology, shin splints or stress fracture, presents with a diffuse area of tenderness on palpation?
Shin splints (medial tibial stress syndrome)
important distinguishing feature from tibial stress fractures
Which tibial pathology, shin splints or stress fracture, presents with a point tenderness on palpation?
Stress fracture
important distinguishing feature from shin splints
Which type of brain tumor typically appears as a well-circumscribed calcified extra-axial mass in a female?
Meningioma
Which type of brain tumor typically appears as multiple ring-enhancing lesions at the gray-white junction?
Brain metastasis
may do CT scan of chest, abdomen, and pelvis to look for primary tumor
Which type of shock is characterized by decreased central venous pressure (CVP) and cardiac output?
Hypovolemic shock
Which type of shock is characterized by increased mixed venous O2 saturation (MvO2)?
Septic shock
Which type of skin cancer is most likely to arise from chronically wounded, scarred, or inflamed skin?
Squamous cell carcinoma
SCC arising in chronic wounds tends to be more aggressive with an increased risk of metastasis; SCC arising from burn wound is termed a Marjolin ulcer
[…] abscess often presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx (e.g. fish bone).
Retropharyngeal abscess often presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx (e.g. fish bone).
may also have nuchal rigidity and bulging of the pharyngeal wall
