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Surgery > USMLE 1 > Flashcards

USMLE 1 Flashcards

1
Q

SHOCKY MVC patient receives 1L of saline. His PCWP increases but his BP does not. What type of Shock is this? How is it treated?

A

Cardiogenic Shock. Inotropic agents - Dobutamine.

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2
Q

What is Kehr sign? Cause? Injury to what part of the bladder could cause Kehr sign?

A

Abdominal pain that refers to the shoulder from irritation to the diaphragm. Subdiaphragmatic peritonitis. Injury to the bladder dome (covered by peritoneum) causing rupture.

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3
Q

Class I Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?

A

1000cc, 20%, Compensated, <100, 14-20.

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4
Q

Class II Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?

A

1000-1500cc, 20-30%, Orthostatic, >100, 20-30.

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5
Q

Class III Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?

A

1500-2000cc, 30-40%, Decreased, >120, 30-40.

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6
Q

Class IV Hemorrhage Classification. Blood Loss #, %, BP, HR, RR?

A

> 2000cc, >40%, Profoundly Decreased, >140, >40.

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7
Q

Blunt trauma resulting in epigastric tenderness. One week later develops fever, chills, and deep abdominal pain? Example?

A

Retroperitoneal abscess. Pancreatic laceration.

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8
Q

First step to managing massive (100-600ml w/in 24 hr) non-traumatic hemoptysis?

A

Bronchoscopy to localize and control source of bleeding.

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9
Q

Viscus distension in a forty year old woman with transient severe epigastric pain that radiates to the back after a fatty meal?

A

Biliary Colic.

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10
Q

A patient that received blood during a surgery becomes febrile one hour post op?

A

Acute Febrile nonhemolytic transfusion reaction (AFNTR)

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11
Q

Normal values for Sodium?

A

135-145

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12
Q

Normal values for Chloride?

A

98-106

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13
Q

Normal values for BUN?

A

7-18

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14
Q

Normal values for Glucose?

A

70-115

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15
Q

Normal values for Potassium?

A

3.5-5.1

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16
Q

Normal values for Bicarbonate?

A

22-29

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17
Q

Normal values for Creatinine?

A

0.6-1.2

18
Q

Normal values PT time?

A

11-15 sec

19
Q

Normal values for PTT time?

A

20-35 sec

20
Q

Normal values for WBC?

A

4500-11,000

21
Q

Normal values for platelets?

A

150k-450k

22
Q

Normal values for INR? INR on Warfarin?

A

0.8-1.2 – 2.0-3.0

23
Q

A patient needs urgent surgery, they take Warfarin, what do you give them pre-operatively so that they don’t bleed out?

A

Fresh frozen plasma.

24
Q

Which drugs lower perioperative mortality in elderly patient with cardiac risk factors receiving elective surgery?

A

Beta blockers such as metoprolol.

25
Q

What is the first step in diagnosing peripheral artery disease? Normal findings? Abnormal findings?

A

Ankle-Brachial Index testing. 1-1.3 = normal. <.4 = limb ischemia.

26
Q

What can produce excess CO2 production in ventilated post op patients?

A

Excess carbohydrate ingestion.

27
Q

What is the normal full body steady state RQ? What about for glucose heavy diets?

A

0.7-8. 1.

28
Q

A patient suffers a blunt force trauma. They have distended JVP, look SHOCKY despite resuscitation, and have a normal cardiac silhouette?

A

Cardiac tamponade.

29
Q

A patient is ventilated and requires PEEP after trauma. What should precede the PEEP as to prevent cardiac arrest.

A

Fluid resuscitation. PEEP can impede venous return.

30
Q

An insult to the parotid gland can damage which structure? What will be noticed on exam?

A

Facial nerve. Unilateral facial droop.

31
Q

What does a positive drop arm sign suggest on PE?

A

Rotator cuff tear.

32
Q

A male in his 20’s presents with acute pain and swelling over his coccyx for the first time?

A

Pilonidal cyst infection.

33
Q

An 18 year old presents with a dull aching and fullness of the scrotum, which swells further during the Valsalva maneuver? Cause?

A

Varicocele - dilation of the pampiniform plexus.

34
Q

After a car crash a patient develops tachypnea, tachycardia, and hypoxia. Fluid resuscitation does not improve his symptoms. They have diminished breath sounds. You notice a patchy alveolar infiltrate (opacification) on chest x-ray? Are broken ribs always found?

A

Pulmonary Contusion. No.

35
Q

What is the easiest way to increase FRC in a post op patient (you are worried about post op atelectasis)?

A

Tilt the head of the bead up! Decreases intraabdominal pressure on the diaphragm.

36
Q

Normal values for Calcium?

A

8.4-10.2

37
Q

Normal values for total Bilirubin?

A

0.2-1

38
Q

What can cause sudden onset of tearing back pain, along with lower extremity weakness?

A

Thoracic Aortic Dissection.

39
Q

Arterial occlusion at the aorto-illiac bifurcation is called? Symptoms? Most common risk factor.

A

Leriche Syndrome. Hip/thigh/buttock claudication, impotence, bilateral lower extremity atrophy. Atherosclerosis from smoking.

40
Q

Do old patients who suffer orthopedic injuries require immediate surgery?

A

No. Look for other comorbidities first that might complicate the surgery.

Surgery (34 decks)

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