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USMLE STEP 2 > UW - Surgery > Flashcards

UW - Surgery Flashcards

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USMLE® Step 1 flashcards
1
Q

What is acute mediastinitis and how do patients usually present? what is the proper treatment?

A

-Complication of cardiac surgery from wound complication
-Fever, tachycardic, chest pain, leukocytosis, sternal wound drainage/purulent discharge
Tx: surgical debridement and antibiotics

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2
Q

What is the treatment for a patient presenting with scaphoid fracture (radiolucent line across bone on xray)? when would this treatment change?

A

Wrist immobilizaiton for 6-10 weeks

Open Red and IF if initial xray shows >2mm fracture displacement

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3
Q

What are common causes of gastric outlet obstruction and how can you ascertain this?

A
  • Malignancy, PUD, crohn’s, strictures (w/ pyloric stenosis) 2/2 ingestion of acid or other caustic agents, gastric bezoars
  • May hear abdominal succussion splash
  • confirm with endoscopy
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4
Q

How long can hemiarthroplasty for femoral neck fractures be delayed, and what me a reason for doing this?

A

Delay up to 72 hours, if other medical comorbidities (e.g. MI) need to be investigated

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5
Q

What is the cause of atelectasis post-op?

A

Pain and changes in lung compliance may cause impaired cough and shallow breathing –> limited recruitment of alveoli at lung bases

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6
Q

how can you distinguish tension pneumothorax vs. diaphragmatic hernia from blunt abdominal injury?

A

TPX - pt would be hypotensive, pulmonary vasculature less prominent on CXR

Hernia - usually left side, resp distress or delayed n/v, NGT in pulmonary cavity on CXR

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7
Q

What is the cause of volkmann’s contracture?

A

compartment syndrome, leading to ischemia and infarction

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8
Q

What are the most common complications of supracondylar fractures of the humerus?

A

entrapment/injury to brachial artery or median nerve

less likely: cubitus varus deformity and volkmann contracture

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9
Q

When should sodium bicarbonate be used for treating acidosis?

A

Severe cases, where pH is

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10
Q

What are the two most common causes of syringomyelia?

A

-Arnold chiari malformation and previous spinal cord injury

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11
Q

What are worrisome signs of ruputured AAA?

A

acute onset severe back pain, syncope, hypotension,

-possible formation of aortocaval fistula with IVC leading to venous congestion in retroperitoneal structures (e.g. bladder, causing gross hematuria)

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12
Q

What are signs of a retroperitoneal abscess?

A

Fever, chills, and deep abdominal pain

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13
Q

What is sphincter of Oddi dysfunction and how do you treat?

A

Elevated sphincter pressure causing post -cholecystectomy pain

Treat with ERCP and sphincterotomy

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14
Q

How can you differentiate the bacteria involved for prosthetic joint infection? What is the management of each?

A

Early onset infection - 3 months; Coag - staph, propionibacterium, enterococci; remove/replace implant

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15
Q

What abdominal injury/disease can cause referred pain to the shoulder and why?

A

Peritonitis (as from leaked gastric, bowel, or bladder contents) which will irritate the hemidiaphragm whose phrenic nerve branches refer pain to shoulder

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16
Q

Who are prone to form duodenal hematomas and where do these occur? How do you treat?

A
  • Blunt abdominal trauma to peds
  • forms from blood collecting between submucosal and muscular layers of duodenum causing obstruction
  • NGT and TPN, will resolve in 1-2 weeks
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17
Q

What is included in the Ddx of anterior mediastinal mass?

A

The 4 T’s : Thymoma, teratoma, thyroid neoplasm, and terrible lymphoma

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18
Q

What is a respiratory quotient and what does this number tell you?

A

Steady-state ratio of CO2 produced to O2 consumed per unit time

Makes assesments on metabolism in the body, close to 1 = mostly carb diet, 0.8 = mostly proteins, 0.7 = mostly fatty acids

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19
Q

What do patients with medial meniscus tears usually complain of?

A

Popping sound followed by severe pain at time of injury

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20
Q

What test can confirm medial collateral ligament injury?

A

valgus stress test

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21
Q

What is an absolute contraindication to surgery?

A

DKA - sky high glucose

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22
Q

What are major contraindications to surgery?

A

DKA, poor nutrition (albumin 20% weight loss, transferrin

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23
Q

What is the most optimal way to provide patients with nutrition preop?

A

enteral feeding

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24
Q

Where should O2 be kept for patients with COPD or smokers getting surgery/coming out of anesthesia?

A

Keep relatively low, because these patients are chronic CO2 retainers and you don’t want to suppress respiratory drive

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25
Q

What are the most important risk factors in the Goldman’s Index?

A
  1. CHF (biggest predictor of preop mortality) - get EF
  2. Recent MI (w/in 6 mo) - get EKG, stress test, CABG
  3. Arrhythmia
  4. Age (>70)
  5. Emergent operation
  6. Aortic stenosis - LISTEN FOR MURMUR
26
Q

What is Leriche syndrome?

A

Chronic ischemia of both LEs causing bilateral claudication of hip thigh and buttocks, impotence and muscle atrophy

27
Q

What conditions will cause paralytic ileus?

A

Exaggerated intestinal rxn after abdominal Surgery, retro peritoneal hemorrhage after vertebral fractures,

28
Q

What are the main priorities in managing patients with rib fractures?

A

Pain management and respiratory support, to prevent hypo ventilation which would lead to atelectasis and PNA

29
Q

What should be the next step once perforated peptic ulcer is discovered?

A

Immediate surgical intervention

30
Q

What is early dumping syndrome?

A

Occurs in patients who are post gastrectomy, involves rapid emptying of hypertonic fluid from stomach into duodenum causing fluid shifts from intravascular space, release of intestinal vasoactive polypeptides, and stimulation of autonomic reflexes

31
Q

What is a likely cause of isolated symptomatic hypokalemia?

A

Autoimmune primary hypoparathyroidism

32
Q

What are signs of alveolar hypoventilation postop?

A
  • Elevated pCO2 (50-80mmHg)
  • Respiratory Acidosis
  • Normal A-a gradient
33
Q

What is the most likely cause of persistent PTX and SubQ emphysema following blunt abdominal trauma?

A

Tracheobronchial perforation (esoph rare, because elastic)

34
Q

How long does it take for S/S of fat embolism to set in following long bone fracture, or other major bone trauma?

A

12-72 hours

35
Q

What is the compensatory response to atelectasis post op, and what can result from this?

A

Hyperventilation –> Respiratory Alkalosis

36
Q

How can diagnosis of a retroperitoneal hematoma from femoral cath site be confirmed?

A

Non-Con CT

37
Q

What is the proper management of acute cholecystitis?

A

Cholecystectomy within 72 hrs

38
Q

What meds need to be stopped preop?

A

Aspirin (7-10 days), Warfarin (INR

39
Q

How can ventilator settings be adjusted if PaCO2 is too low or too high?

A

Change Rate or Tidal Volume (but TV is preferred because increasing rate has no effect on non-ventilating alveoli in lungs)

40
Q

How long does it take for S/S of fat embolism to set in following long bone fracture, or other major bone trauma?

A

12-72 hours

41
Q

What can’t be given to patients with ATIII deficiency?

A

Heparing, wont work

42
Q

What blood lab abnormalties are seen with von willebrand deficiency?

A

Normal platelets, but increased bleeding time and PTT

43
Q

How do you differentiate which antibiotic to use for burn patients (describe downside of each)?

A
  1. Silver Sulfadiazine - doesn’t penetrate eschar and may cause leukopenia
  2. Methanide - Penetrates eschar but hurts a lot
  3. Silver Nitrate - Doesn’t penetrate eschar, causes HypoK and HypoNa
44
Q

What is the first step to do following electrical burn?

A

Do EKG, if abnormal 48 hrs of tele

45
Q

What is the main worrisome side effect of myoglobinuria?

A

High K+

46
Q

What physical exam findings may be seen with fat embolism?

A

Petechial rash in chest axilla and neck, with confusion

47
Q

What may be the cause of retroperitoneal fluid + blunt abdominal trauma?

A

Duodenal rupture

48
Q

What is Colle’s fracture?

A

Old lady falls on outstretched hand, distal radius displaced, make cause “dinner fork” deformity

49
Q

What could be a cause of very high fever and ill appearing patient on POD 1?

A

Major atelectasis, or Nec Fasc along SubQ (Scarpa’s fascia)

50
Q

What is the first treatment modality for an abscess w/in the lung cavity?

A

Antibiotics first

Surgery if Abx fail or if there is an empyema

51
Q

What is a characteristic effusion in lung adenocarcinoma?

A

Exudative with high hyaluronidase

52
Q

What are the main peripherally located lesions?

A

Adenocarcinoma and large cell carcinoma

53
Q

What criteria diagnose ARDS?

A
  1. PaO2/FiO2
54
Q

What are the symptoms associated with insulinoma?

A

Sweat, tremors, hunger, seizures

55
Q

What could be a cause of very high fever and ill appearing patient on POD 1?

A

Major atelectasis, or Nec Fasc along SubQ (Scarpa’s fascia)

56
Q

What is the first treatment modality for an abscess w/in the lung cavity?

A

Antibiotics first

Surgery if Abx fail or if there is an empyema

57
Q

What is a characteristic effusion in lung adenocarcinoma?

A

Exudative with high hyaluronidase

58
Q

What are the main peripherally located lesions?

A

Adenocarcinoma and large cell carcinoma

59
Q

What criteria diagnose ARDS?

A
  1. PaO2/FiO2
60
Q

What are the symptoms associated with insulinoma?

A

Sweat, tremors, hunger, seizures

61
Q

What are the most common causes of hepatic bacterial abscess?

A

E Coli, bacteriodes, enterococcus

USMLE STEP 2 (21 decks)

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