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Surgery > U-World > Flashcards

U-World Flashcards

1
Q

Who is most likely to get acute bacterial parotitis? Most common agent?

A

Dehydrated post op patients and the elderly

S aureus most common agent

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2
Q

ABI diagnostic for PAD

A

ABI

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3
Q

Besides ABCs, what must always be done in trauma pt’s

A

Rigid fixation of the cervical spine

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4
Q

Drug fever facts

A

Ass w/ use of anticonvulsants, antibiotics (b-lactams, sulfas) or allopuinon
Typically 1-2 weeks after initiation of therapy

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5
Q

Cushing’s reflex signs

A

Hypertension, bradycardia, and respiratory depression following inc ICP

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6
Q

What herniates in transtentorial herniation

A

Parahippocampal uncus

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7
Q

What causes the classic coloration of stasis dermatitis

A

Erythrocyte extravasation causing hemosiderin deposition

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8
Q

Most common early sign of venous stasis? late disease?

A

Xerosis early

Lipodermatosclerosis and ulcerations later

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9
Q

Heparin regimen after first DVT

A

Started then transitioned to >3 months warfarin therapy with INR goal 2-3

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10
Q

When do you start heparin after surgery

A

48-72 hours

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11
Q

Charcot’s triad

A

Fever, severe jaundice, and RUQ pain
For ascending colangitis
(+ confusion and hypotension for Reynold’s pentad)

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12
Q

First line tx in preventing post-op pneumonia

A

Incentive spirometry

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13
Q

Non-displaced scaphoid fracture mgmt

A

Wrist immobilization for 6-10 weeks

If x-ray neg, immobilize for 7-10 days and follow up X-ray

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14
Q

Artery and nerve likely damaged in anterior shoulder dislocation

A

Axillary

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15
Q

3 main contributors to post op ileus

A
  1. Increased splanchnic nerve sympathetic tone following violation of peritoneum
  2. Local release of inflammatory mediators
  3. Post op pain meds
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16
Q

Pro-motility antibiotic

A

Erythromycin

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17
Q

Next step after inconclusive FAST? If neg?

A

DPL

If neg - look for signs of extra-abdominal hemorrhage

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18
Q

Multiple air-fluid levels on abdominal x-ray

A

Small bowel obstruction

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19
Q

Inc lactic acid in SMO indicates

A

Sign of strangulation –> go to OR

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20
Q

Treatment of choice for sphincter of Oddi dysfunction

A

ERCP with sphincterotomy

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21
Q

Most common site of acute mesenteric ischemia? Gold standard for Dx?

A

SMA
pain out of proportion to exam findings
Mesenteric angiography is gold standard for diagnosis

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22
Q

Key reason for intubation in airway burn patients

A

Progressive airway edema may preclude intubation later in patients clinical course

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23
Q

Abdominal succussion splash a sign of? dx test?

A

Pyloric stricture

Endoscopy is dx test

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24
Q

3 symptoms of retroperitoneal abscess

A

fever, chills, and deep abdominal pain

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25
Q

What does not help in diagnosis of pancreatic trauma

A

Serum amylase values

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26
Q

Atelectasis blood gas picture

A

Respiratory alkalosis due to increased work of breathing

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27
Q

Patchy alveolar infiltrate after chest wall trauma

A

Pulmonary contusion

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28
Q

CXR of pericardial tamponade

A

Normal cardiac silhouette without tension pneumothorax

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29
Q

Most common pediatric fracture? Risks?

A

Supracondylar humerus fractures

Risk of entrapment of brachial artery or median nerve

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30
Q

Femoral nerve action and senstation

A

Lex flexion at the hip and extension at the knee

Gets medial aspect of thigh and lower leg

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31
Q

CXR for aortic injury

A

Widened mediastinum and left sided hemothorax

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32
Q

Acute back pain + profound hypotension

A

AAA rupture

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33
Q

What is dumping syndrome

A

After gastrectomy, emptying of hypertonic gastric content into duodenum –> fluid shift into small intestine, stimulating autonomic reflexes (cramps, weakness, diaphoresis)

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34
Q

Best time to take out gallbladder in cholecystitis

A

Within 72 hours

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35
Q

Posterior urethral injury is associated with what kind of fractures

A

Pelvic

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36
Q

Who can have a delayed presentation to diaphragmatic rupture

A

Children

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37
Q

What can increase FRC after surgery besides spirometry

A

Elevating the head of the bed, chest physiotherapy, and coughing

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38
Q

Virus assocaited with nasopharyngeal carcinoma

A

EBV

seen in far east and mediterranean

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39
Q

Hypotension after cardiac cath with back or flank pain? Dx test

A

Retroperitoneal hematoma

CT abdomen/pelvis

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40
Q

Cancer that arises from a non-healing burn would

A

SCC

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41
Q

Strangulation def

A

Loss of blood supply to the bowel wall

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42
Q

Blood loss % for orthostatic hypo? General hypo + Tachy

A

Ortho: 20-30%

Resting tach: 30-40%

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43
Q

How much blood can one hemithorax hold

A

50% of blood volume

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44
Q

Leriche syndrome triad

A

Bilateral LE claudication, impotence, and symmetric atrophy of the bilateral LE

45
Q

Cause of subacute presentation of delayed onset prosthetic joint infection? Tx?

A

Staph epi

Removal of the infected prosthesis

46
Q

Most commonly injured nerve in mid-shaft of the humerus fracture

A

Radial nerve

Weakness in extension - drop wrist

47
Q

Ulnar nerve injury causes

A

Claw hand

48
Q

Immediate fever after surgery (101-103) likely?

A

Transfusion reaction

49
Q

Paget’s lab

A

Elevated bone specific alk phos

50
Q

Most common cause of lower extremity edema

A

Venous insufficiency (valvular incompetence)

51
Q

Unstable fall in elderly with broken hip first step

A

Cardiac workup (concerning for syncope)

52
Q

Rapid decompensation after subclavian catheter placement could be

A

Tension pneumothorax -> do needle decompression

53
Q

Neck pain, fever, and limited neck mobility secondary to pain

A

Retropharyngeal abscess

54
Q

Where should a needle thoracostomy be performed

A

Second intercostal space (b/w 3rd and 4th ribs) at the midclavicular line

55
Q

First step in limb ischemia treatment

A

Heparin bolus followed by continuous heparin infusion

56
Q

PEEP in hypovolemic shock

A

Bad, decreases venous return to heart, thus decreasing preload

57
Q

Procedure of choice for bad lung bleeding

A

Bronchoscopy - identifies site of bleed and helps attempt early therapeutic intervention
Thoractomy after

58
Q

Superficial unilateral hip pain exacerbated by external pressure to upper lateral thigh (like when lying in bed)

A

Trochanteric bursitis

59
Q

After trauma, slightly elevated PCWP that increases greatly after volume repletion

A

Left ventricular dysfunction caused by myocardial contusion

60
Q

First two indicators of hypovolemia

A

Tachycardia and peripheral vascular constriction

61
Q

Most common predisposing factor for aortic dissection

A

Hypertension

62
Q

Most common cause of hypoparathyroidism

A

Post-surgical

hypocalcemia and hyperphosphatemia in presence of normal renal function

63
Q

Serum PO4 in vit D def

A

Usually low

64
Q

Most common bone to be affected by stress fracturs

A

Tibia

65
Q

Colonoscopy of bowel ischemia

A

Discrete segment of cyanotic and ulcerated bowel

66
Q

Patients who present with appendicitis >5 days after onset of symptoms have a high incidence of?

A

Perforation with abscess formation

67
Q

Nasal septum perforation likely a result of?

A

Septal hematoma

68
Q

Standard treatment approach for complicated diverticulitis with abscess formation

A

CT guided percutaneous drainage

69
Q

Most feared complication of retropharyngeal abscess

A

Infection into the mediastinum –> can lead to acute necrotizing mediastinitis

70
Q

Type of hypoxia narcotics can cause

A 
Alveolar hypoventilation
(normal A-a gradient and respiratory acidosis)
71
Q

What is torus palantinus

A

Benign bony growth located on the midline suture of the hard palate

72
Q

Most important early steps in flail chest

A

Pain control and supplemental oxygen

PEEP causes flail chest to move normally

73
Q

Oliguria and inc. BUN > Cr ratio post op likely? Rule out what first

A

Likely acute pre-renal from hypovolemia

Rule out catheter obstruction

74
Q

Tx for duodenal hematoma

A

NG tube with parenteral nutrition

75
Q

4 T’s for mediastinal mass diff fx

A

Thymoma
Teratoma (and other germ cell tumors)
Thyroid neoplasm
Terrible lymphoma

76
Q

Seminoma tumor marker

A

Elevated b-HCG

Normal AFP

77
Q

RLQ pain without guarding or rigidity could be

A

Psoas abscess

Do CT abdomen

78
Q

MCC of blood nipple discharge

A

Intraductal papilloma

US can be normal b/c can only pickup 1 cm and greater

79
Q

Odd pancreatic Ca features

A

constant, gnawing epigastric pain that is frequently worse at night
Anorexia with weight loss
Jaundice

80
Q

All patients with a clavicle fracture should have what? Why?

A

Careful neuromuscular exam (angiogram and physical for neuro)
Rules out injury to underlying brachial plexus and subclavian artery

81
Q

Penile fracture tx

A

Retrograde urethrogram followed by surgical exploration of the penis

82
Q

Ab x-ray of paralytic ileus shows

A

air-fluid levels and distended gas filled loops of both the small and large intestines

83
Q

What is the RQ

A

Respiratory quotient: depends on the proportion of metabolic fuels being oxidized for ATP
1.0 = predominant oxidation of carbs and net lipogenesis
>1 carbs
0.8 = protein
0.7 = lipids

84
Q

Amputated finger prep

A

Wrap part in saline-moisturized gauze, seal in a plastic bag, and place on ice

85
Q

Positive arm drop sign in shoulder injury indicats

A

Rotator cuff tear

86
Q

Long thoracic nerve injury causes

A

Winged scapula

87
Q

Who gets acalculous cholecystitis? Tx?

A

Critically ill patients -> Tx if Ab and percutaneous cholecystostomy followed by cholecystectomy when medical condition stabilizes

88
Q

Acalculous cholecystitis likely from

A

Cholestasis and gallbladder ischemia leading to secondary infection by enteric organisms, leading to edema and necrosis

89
Q

What causes bowel ischemia after AAA repair

A

Inadequate colonic collateral arterial perfusion to left and sigmoid colon after loss of IMA during aortic graft placement

90
Q

Mediastinitis presentation

A

Post op (w/in 14 days) with fever, tachycardia, CP, leukocytosis, and sternal wound drainage

91
Q

Mediastinitis treatment

A

Drainage, Surgical debridement and antibiotic therapy

92
Q

3 most reliable signs of blunt abdominal trauma

A

Abdominal pain
Tenderness
Peritoneal signs

93
Q

Valgus stress test for what ligament

A

MCL

94
Q

Hypoparathyroidism characterized by?

A

Low calcium and elevated PO4 levels in presence of normal renal function

95
Q

Most common complication of thyroidectomy

A

Hypocalemia

96
Q

Prolonged surgery followed by hypotension, extensive blood loss into tissues, and massive blood replacement likely

A

Postoperative cholestasis

97
Q

Parotid surgery involving the deep lobe of the parotid gland carries and significant risk of?

A

Facial nerve palsy resulting in facial droop

98
Q

What is indicated for circumferential full-thickness burns of an extremity with an eschar? Why?

A

Escharotomy

Eschar formation can compromise circulation, causing significant edema distal to burn

99
Q

When is a penetrating would considered to involve the abdomen

A

Any below the 4th intercostal space (i.e below the nipples)

100
Q

What can aortic dissection cause when it extends into the major vessels

A

Impending stroke, acute renal failure, and LE weakness or paraplegia

101
Q

Most important steps in management of lactic acidosis from septic shock

A

IV normal saline with or without vasopressor therapy to maintain pressure and Ab to correct underlying infection

102
Q

Why shouldn’t you put a foley in w/ suspect urethral trauma

A

Predisposes patient to abscess formation and worsening of the urethral damage

103
Q

What is eschar

A

Firm necrotic tissue classical formed on exposed tissue following burn wounds

104
Q

Quickest way to reverse warfarin anti-coagulation

A

Infusion of FFP

105
Q

When to give T-dap shot vs T-dap + Tetanus Ig

A

Tdap + tetanus IV in severe dirty wound and unclear immunization history
Just Tdap if pt had a booster 5 years ago with dirty wound or 10 years with mildly clean wound

106
Q

How does short term hyperventilation decrease ICP

A

Causing cerebral washout of CO2, leading to vasoconstriction and decreased cerebral blood flow

107
Q

When do patients have risk of adrenal insufficiency following surgery

A

Daily prednisone > 20 mg taken for > 3 weeks

108
Q

What is Kehr’s sign

A

Abdominal pain that refers to the shoulder from subdiaphragmatic peritonitis
must be peritoneal

109
Q

Only part of the bladder that is peritoneal

A

Bladder dome

Surgery (8 decks)

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