uworld 3 surg

Question 1

positive impingement tests (neer, hawkins), think…

Answer 1

rotator cuff tendionopathy/impingement

Question 2

rotator cuff impingement presentation

Answer 2

pain with abduction, external rotation

from repetitive activity above shoulder height

Question 3

test to do for intermittent claudication

Answer 3

ABI

Question 4

results of ABI and significance

Answer 4

<0.9: abnormal (occlusive PAD)
0.9-1.30: normal
>1.30: calcified, uncompressible vessels

Question 5

which region of abdomen does mesenteric ischemia usually present

Answer 5

periumbilical

Question 6

labs of mesenteric ischemia

Answer 6

high WBCs
elevated amylase and phosphate
metabolic acidosis (lactate)

Question 7

what should be done right after chest venous catheter placement?

Answer 7

CXR to confirm correct placement (want to avoid pneumo or pericardial tamponade)
–unless US guided placement

Question 8

reasons for post op fever within 2 hours of surgery

Answer 8

malignant hyperthermia
blood transfusion rxn
prior trauma/infection

Question 9

reasons for post op fever within 1 week of surgery

Answer 9

nosocomial infections (UTI, pneumonia)
MI, DVT, PE

Question 10

drug fever

Answer 10

diagnosis of exclusion

1-2 weeks after med

rash, eosinophilia, subacute fever

Question 11

signs of retroperitoneal hematoma

Answer 11

hypotension, tachy, flat neck veins

recent cardiac catheterization, heparin

Question 12

most hemorrhage or hematoma forms __ hours after cardiac catheterization

Answer 12

12

Question 13

diagnosis and treatment of retroperitoneal hematoma

Answer 13

dx: CT without contrast (or US)
tx: supportive

Question 14

atelectasis most common which days post op

Answer 14

2-5

Question 15

atelectasis has what blood gases levels

Answer 15

low O2, low CO2

resp alkalosis

Question 16

emphysematous cholecystitis pathology

Answer 16

threatening

infection of gall bladder wall with gas-forming bacteria (clostridium, e coli)

Question 17

emphysematous cholecystitis presentation

Answer 17

common in: gallstones, immunosupressed, vascular compromise

crepitus

Question 18

diagnosis of emphysematous cholecystitis

Answer 18

air fluid levels in gall bladder

gas in gallbladder

pneumobilia

labs: hyperbilirubinemia, elevation in AST/ALT

Question 19

treatment of emphysematous cholecystitis

Answer 19

emergent broad spectrum, broad abx

Question 20

initial mangaement of hemoptysis

Answer 20

patent airway, adequate ventilation/perfusion
hemodynamic stability

put in dependent position (lateral)

Question 21

initial imaging and therapy of choice for hemoptysis

Answer 21

bronchoscopy- suctions, can do electrocautery, baloon tamponade, etc.

Question 22

Leriche syndrome

Answer 22

artial occlusion at bifurcation of aorta into iliacs

triad:

• bilateral, hip, thigh claudication
• impotence!!! always impotence
• symmetric atrophy of lower extremities (ischemia)

Question 23

can you do a lap appendectomy just based on clinical diagnosis?

Answer 23

yes!

Question 24

interpret blood with voiding in beginning, end, or throughout urinating

Answer 24

initial: urethritis, trauma
terminal: bladder, prostate, posterior urethra problems
throughout: kidney or ureter issues (eg. glomerular dz)

Question 25

duodenal hematoms occur in

Answer 25

blunt abdominal trauma

Question 26

duodenal hematoma presentation

Answer 26

peds patient- trauma

epigrastric pain, vomiting 24-36 after trauma

resolve in 1-2 weeks

Question 27

what to do if duodenal hematoma doesnt resolve?

Answer 27

gastric decompression, percutaneous drainage

parenteral nutrition

Question 28

bile reflux gastritis cause and symptoms

Answer 28

incompetent pyloric sphincter (following surgery) –> retrograde flow of bile into stomach and esophagus

–> vomiting, heartburn, abd. pain

Question 29

sphincter of oddi presentation

Answer 29

recurrent, episodic RUQ or epigastric pain

aminotransferase and alk phos elevations

worse with opioids (cause sphincter contraction)

Question 30

diagnosis and treatment of sphicter of oddi

Answer 30

dx: manometry
treat: sphincterotomy

Question 31

2 separate pathophys mechanisms of sphincter of oddi

Answer 31

dyskinesia

stenosis

Question 32

eval of blunt genitourinary trauma should always include what 2 things in hemodynamically stable patients

Answer 32

• UA

- CT of abdomen and pelvis

Question 33

criteria for flail chest

Answer 33

> 3 contiguous ribs fractured in >2 locations

Question 34

population for pilonidal cyst

Answer 34

obese, sedentary males aged 15-30

Question 35

pilonidal cyst pathophys

Answer 35

hair follice infected in intergluteal region–> abscess

Question 36

cyst distribution of pilonidal cyst vs folliculitis vs hidrantenitis suppurativa

Answer 36

pilnidal cyst: single 4-5 cm fluctuant mass

folliculitis: multiple small pruritic pustules
hidra: multiple recurrent painful nodules in axilla, inguinal and perianal areas

Question 37

trochanteric bursitis presentation

Answer 37

pain when:

• pressure applied (eg. sleeping)
• external rotation
• resisted abduction

Question 38

trochanteric bursitis cause

Answer 38

excessive frictional forces (overuse, trauma, crystals, infection)

Question 39

how best to transport body organs

Answer 39

wrap in saline-moistened gauze in plastic bag

place bag on bed of ice