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surgery > uWorld > Flashcards

uWorld Flashcards

1
Q

Classic presentation of gallstones

A
  1. Biliary colic
  2. nausea/vomiting
  3. right sided shoulder/subscapular pain (referred)

Episode caused by viscus distention

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2
Q

Splenic injury from blunt trauma is managed how?

A

By patient’s hemodynamic status and response for IV fluids.

  1. If responsive- CT scan
  2. If unresponsive- laparotomy
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3
Q

Solitary Pulmonary Nodule (SPN)

A

< 3 cm in diameter
completely surrounded by lung parenchyma
does not contact pleura, hilum, or mediastinum

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4
Q

Atelectasis

A

Lobar or segmental collapse of lung that causes decreased lung volume.

Most severe during 2nd post-op night, can last up to 5 days.

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5
Q

Hypovolemic shock

A
  1. Flat neck veins
  2. Bruising
  3. Abdominal distention
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6
Q

Eschar

A

Firm, necrotic tissue formed on exposed tissue following burn wounds.

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7
Q

Signs of compartment syndrome

A
  1. Deep pain out of proportion to injury
  2. Pulselessness
  3. Paresthesias
  4. Cyanosis and pallor of extremity
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8
Q

Treatment for Slipped Capital Femoral Epiphysis (SCFE)

A

Surgical pinning of of slipped epiphysis in situ (where it is) to lessen risk of avascular necrosis of femoral head and chondrolysis.

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9
Q

Oliguria

A

< 400 cc urine/day, or < 6 cc/kg/day

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10
Q

Psoas abcess

A

complication of perforated appendix
significant abdominal pain with flexion of hip against resistance
Treat with antibiotics, IVF, bowel rest
appendectomy 6-8 weeks later

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11
Q

Dumping syndrome

A

Common postgastrectomy complication.
Caused by rapid emptying of hypertonic gastric content into duodenum and sm intestine. Leads to fluid shift from intravascular space to sm intestine, release of intestinal vasoactive polypeptide, stimulation of autonomic reflexes

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12
Q

Nasopharyngeal carcinoma (NPC)

A

higher frequency in mediterranean/far east
high association with epstein barr virus (EBV)
present with recurrent otitis media, recurrent epistaxis, nasal obstruction

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13
Q

signs of retroperitoneal abcess

A

fever
chills
deep abdominal pain

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14
Q

CO toxicity

A

mild: headache, nausea, dyspnea, malaise, altered mental status, dizziness
severe: seizure, come, syncope, heart failures, arrhythmias

Tx: 100% O2 via nonrebreather

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15
Q

most common benign breast disease in perimenopausal women

A

Intraductal papilloma

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16
Q

fibrocystic change of breast

A

benign

bilateral breast pain
cystic changes of breast
cyclic symptoms with cycle

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17
Q

Fibroadenoma of breast

A

benign

solitary lesion
painless
firm, mobile mass
15-25 yars old, does NOT change w/cycle

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18
Q

Ductal carcinoma in situ

A

postmenopausal women
nipple discharge
breast mass
ductal epithelium changes, do NOT penetrate basement membrane

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19
Q

Paget’s disease of breast

A

eczematous changes of nipple

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20
Q

Mediastinitis

A 
Fever
Tachycardia
Chest pain
Leukocytosis
Sternal wound drainage or purulent drainage

Tx: drainage, debridement, abx

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21
Q

Virchow triad

A

stasis
endothelial injury
hypercoaguability

22
Q

Signs of posterior urethral injury

A

blood at urethral meatus
inability to void
high-riding prostate

Tx: retrograde urethrogram (do NOT blindly insert Foley)

23
Q

Pulmonary contusion

A

can be caused by severe blunt trauma

sxs: dyspnea, tachypnea, chest pain, hypoxia worsened by intravascular volume expansion, patchy alveolar infiltrates on CXR

24
Q

most common cause of small bowel obstruction

A

adhesions

25
Q

Ladd’s bands

A

congenital adhesions in children

26
Q

Complete SBO

A

n/v
abdominal bloating
dilated loops of bowel on xray

27
Q

most common cause of lower extremity edema

A

venous insufficiency (valvular incompetence)

28
Q

risk factors of Peripheral Artery Disease (PAD)

A
  1. increasing age
  2. DM
  3. cigarette smoking
  4. HTN
  5. HLD

Dx: ankle-brachial index (ABI) using Doppler

29
Q

Ankle-Brachial Index (ABI)

A

ratio of systolic blood pressure of posterior tibial and dorsalis pedis arteries over systolic of brachial artery

NL: 1-1.3
abnormal 50% occlusion
< 0.4 consistent with limb ischemia

Tx: ASA and cilostazol

30
Q

Post-procedure with dull abdominal pain and bloody diarrhea

A

Colonic ischemia

causes: loss of collateral circulation
manipulation of vessels with instruments
prolonged aortic clamping
impaired blood flow through inferior mesentaric

31
Q

increased alkaline phosphatase

normal serum calcium and phosphorous

A

Paget’s disease of bone

32
Q

Sxs of splenic injury

A 
LUQ abd pain
Abdominal wall contusion
Left lower chest wall tenderness
Hypotension
Left shoulder pain (referred- irritation of phrenic nerve and diaphragm, Kehr's sign)
33
Q

Hamman sign

A

crunching sound on auscultation of the heart due to mediastinal emphysema
sign of esophageal perforation

34
Q

Causes of diabetic foot ulcers

A

neuropathy
microvascular insufficiency
immunosuppression

35
Q

Minor head trauma

A

GCS of 15
normal mental status
normal neurologic and funduscopic exam
no physical findings of skull fracture

Tx: no neuroimaging, discharge observe for 24 hrs

36
Q

Mild Traumatic Brain Imaging (TBI)

A 
GCS 13-15
brief loss of consciousness
vomiting
headache
disorientation

Tx: CT head, if normal discharge home
observe 4-6 hours if no symptoms

37
Q

Moderate TBI

A 
GCS 9-12
brief LOC
vomiting
headache
disorientation

Tx: CT head, if normal discharge home
observe 4-6 hours if no symptoms

38
Q

Severe TBI

A 
GCS <8
focal neurologic signs
seizure
prolonged LOC
evident skull fracture

Tx: CT head, admit for neuro checks

39
Q

Signs of necrotizing surgical infection

A 
Intense pain in wound
Fever, hypotension, tachycardia
Decreased sensation at edges of wound
Cloudy-gray discharge
Tense edema outside involved skin
Subcutaneous gas with crepitus

Tx: early surgical exploration

40
Q

Uncomplicated diverticulitis

A

LLQ pain, tenderness
fever
leukocytosis
inflammation and colonic wall thickening on CT

Tx: bowel rest, oral abx, observation
if elderly/immunocompromised- hospitalization

41
Q

Complicated diverticulitis

A

diverticulitis with an abscess, perforation, obstruction, or fistula formation

Tx: < 3cm fluid collection- IV abx, observation
> 3cm fluid coll- CT guided drainage, drainage and debridement if CT guided does not work

colonic resection if recurrent symptoms

42
Q

Legg-Calve-Perthes disease

A

idiopathic avascular necrosis of the femoral capital epiphysis

boys between 4-10
sxs: hip, knee, or groin pain with antalgic gait
Tx: observation and bracing

43
Q

vaccinations after splenectomy

A

S. pneumoniae
N. meningitidis
H. influenzae

(encapsulated organisms)

44
Q

anterior cord syndrome

A

commonly associated with burst fracture of vertebrae

total loss of motor function below lesion, loss of pain and temp below lesion bilaterally, intact proprioception

45
Q

Systemic Inflammatory Response Syndrome (SIRS)

A

2 of 4

Temp > 38.5 C (101.3F) or < 35 C (95F)
HR > 90 bpm
RR > 20 /min
WBC > 12k, < 4K, or > 10% bands

seen in pancreatitis, autoimmune disease, vasculitis, burns

46
Q

Glasgow Coma Scale

A

Eye opening (1-4), Verbal response (1-5), Motor response (1-6)

47
Q

Ludwig angina

A

infection of submandibular and sublingual glands. Source usually from infected tooth (2nd or 3rd mandibular molar)
risk of asphyxiation

48
Q

Marjolin ulcer

A

Squamous Cell Carcinoma arising with burn wounds

49
Q

Succussion splash

A

indicative of pyloric stenosis/stricture

auscultate upper abdomen, rock patient at hips

50
Q

Sxs of compartment syndrome

A

Severe pain
Pain with passive range of motion
Paresthesias
Pallor and paresis of affected limb

pulse presence does not rule out

surgery (5 decks)

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