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Surgery Clerkship > UWorld > Flashcards

UWorld Flashcards

1
Q

What is mech of head elevation to lower ICP?

A

increased venous outflow from brain

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2
Q

What is mech for hyperventilation to lower ICP?

A

CO2 washout –> causes cerebral vasoconstriction

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3
Q

What is presentation of compartment syndrome?

A

pain out of proportion
pain on passive sretch
rapid increasing and tense swelling
paresthesia

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4
Q

What type of knee injury presents w/ acute knee injury w/ popping sensation and gradual development of joint swelling over days?

A

meniscus

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5
Q

What is presentation of trochanteric bursitis?

A

superficial u/l hip pain exacerbated by external pressure to lateral thigh (when lying on affected side in bed)

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6
Q

What is next step if pt w/ persistent sx of meniscal injury?

A

MRI, then athroscopic surgery if needed

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7
Q

Dx test for syringomyelia?

A

MRI

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8
Q

What is presentation of tibial stress fracture? Dx?

A

anterior part of middle 1/3 of tibia in pt involved in jumping injury
xrays frequently normal, dx by MRI or bone scan

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9
Q

What is next step if pt w/ clavicular fracture?

A

do neovascular exam

if bruit –> do angiogram to rule out injury to underlying vessel

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10
Q

What is tx for clavicle fracture?

A

fracture milddle third = tx nonoperatively w/ brace, rest, ice
fracture distal 1/3 = open reduction and fixation

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11
Q

What is presentation of MCL tear?

A

abduction injury to knee

valgus stress test

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12
Q

What part of knee is likely injured if locking of knee joint during terminal extension and palpable/audible snap while slowly extending leg from full flexion with applying tibial torsion?

A

medial meniscus = mcmurrays sign

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13
Q

What is presentation of uncal herniation?

A

2/2 R epidural hematoma

  • ipsilateral hemiparesis
  • mydriasis, ptosis, down and out gaze 2/2 to compression ipsilateral oculomotor n.
  • contralateral homonymous hemianopsia from compression ipsi possterial cerebral artery
  • altered consciousness
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14
Q

What is likely cause of LE paraplegia after thoracic aortic aneurysm repair?

A

anterior spinal cord syndrome –> infarcation of anterior 2/3 of spinal cord

  • flaccid paralysis
  • loss of pain/temp
  • UMN sx
  • bowl and bladder dysfunction
  • preserved vibration and proprioception
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15
Q

What is next step if pt w/ signs of scaphoid fracture but normal xray?

A

do thumb immobilization in spica cast and repeat XR in 7-10 days

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16
Q

What are complications of supracondylar fracture of humerus?

A
  • brachial artery injury or median nerve injury = most common complications
  • cubitus varus deformity
  • compartment syndrome/volkman ischemic contracture are rare
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17
Q

What nerve is likely injured in pt who has shoulder pain , holds arm in external rotation and resists internal rotation?

A

axillary nerve may be injured 2/2 anterior shoulder dislocation

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18
Q

What motor and sensory function of femoral nerve?

A
  • leg flexion at hip, extension at knee

- sensation anterior thigh and medial leg via saphenous

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19
Q

What motor and sensory function of tibial nerve?

A
  • flexion of knee and digits, plantar flexion of foot

- sensation of leg except medial side and plantar foot

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20
Q

What motor and sensory function of obturator nerve?

A
  • adduction of thigh

- sensation over medial thigh

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21
Q

What motor and sensory function of common peroneal nerve?

A
  • muscles of anterior and lateral leg

- sensation to anterolateral leg and dorsum of foot

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22
Q

What is tx for scaphoid fracture?

A

wrist immobilization 6-10 wks

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23
Q

What is tx for stress hairline fracture of metatarsal?

A

rest, analgesia, hard soled shoe

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24
Q

What is presentation of rotator cuff tendinopathy?

A

pain w/ abduction, external rotation

normal ROM w/ positive neer/hawkins tests

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25
Q

What is presentation of rotator cuff tear?

A

weakness w/ external rotation, age > 40

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26
Q

What is presentation of adhesive capsulitis (frozen shoulder)?

A

decreased passive and active ROM

more stiffness than pain

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27
Q

What is presentation of biceps tendinopathy/rupture?

A

anterior shoulder pain
pain w/ lifting, carrying or overhead reaching
weakness less common

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28
Q

What is presentation of glenohumeral osteoarthritis?

A
  • uncommon and usually 2/2 trauma
  • gradual onset anterior or deep shoulder pain
  • decreased active and passive abduction and external rotation
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29
Q

What are risk factors, presentation for ischemic colitits?

A

risks: age > 60, chronic renal dz/hemodialysis, MI, repair of AAA or ther vascular procedure
clinical: pain and tender, hematochezia, diarrhea, lactic acidosis

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30
Q

How do you dx ischemic colititis?

A

CT: thick bowel wall, double halo sign, pneumatosis coli

colonoscopy: mucosal pallor or cyanosis, petechia, hemorrhage

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31
Q

What are sx of pancreatic adenocarcinoma?

A 
wt loss, anorexia
ab pain/back pain --> epigastric pain worse at night
jaundice
recent onset DM
migratory superficial thrombophlebitis
hepatomegaly and ascites
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32
Q

What is presentation of duodenal ulcer?

A

periodic epigastric pain relieved by meals

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33
Q

What is next best step if pt w/ massive hemoptysis continuing to bleed?

A

bronchoscopy to localize bleeding site, suction to visualize and therapeutic intervention

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34
Q

What is likely dx if pt w/ fever, chills, deep abdominal pain after ab trauma?

A

pancreatic laceration w/ retroperitoneal abscess

pancreatic laceration can be missed by CT immediately following trauma, may need to do serial CTs

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35
Q

What do you see on ABG in atelectasis?

A
  • high pH
  • low PO2
  • low PCO2
    = resp alkalosis
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36
Q

What are pre-op strategies to reduce risk of post-op pulmonary complications?

A
  • smoking cessation 8 wks before surgery

- control COPD

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37
Q

What are post-op strategies to decrease post-op pulmonary complications?

A
  • incentive spirometry
  • deep breathing exercises
  • epidural analgesia instead of opioids
  • continuous positive airway pressure
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38
Q

What should you think if pt w/ blunt ab trauma, delayed onset hypotension, LUQ pain, L shoulder pain? dx?

A

splenic injury
dx = CT w/ IV contrast

if persistent hemodynamic instability –> urgen laparotomy

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39
Q

What is order of next steps if pt is hemodynamically unstablee and suspected blunt ab trauma?

A
  • immobilize cervical spine
  • IVF
  • FAST = U/S
  • if U/S w/ blood in hemodynamically unstable –> do urgen laparotomy
  • if U/S w/ blood but hemodynamically stable –> do CT w/contrast
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40
Q

What is presentation of dumping syndrome?

A

ab pain, D/N, hypotension, tachycardia, dizziness, confusion, fatigue, diaphoresis

timing: 15-30 min after meals
path: rapid emptying of hypertonic gastric contents

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41
Q

What is likely etiology if pt w/ respiratory acidosis but normal Aa gradient?

A

hypoventilation

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42
Q

How do you calculate A-a gradient? what has high Aa gradient? normal?

A

Aa = PAO2 - Pao2, normal

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43
Q

What is pilonidal disease?

A

acute pain and swelling of midline sacrococcygeal skin and SQ tissue, may present as dermal sinus tract

tx: I&D

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44
Q

What should you do if pt w/ acute GI perforation requiring emergent laparotomy but on warfarin?

A

pre-op FFP

45
Q

What is initial sign of hypovolemia?

A

HR increase

46
Q

What are the components of GCS?

A
  • eye opening
  • verbal response
  • motor response
47
Q

What is next step if pt in hemodynamic shock w/ sharp penetrating ab trauma?

A

do emergent laparotomy (do not delay for imaging procedure)

48
Q

What is presentation of postop ileus?

A
  • N/V, ab distension, failure to pass flatus/stool

- hypoactive bowel sounds (vs obstruction = hyperactive tinkling)

49
Q

What is likely etiology of nontender bony mass on hard palate?

A

torus palatinus = chronic benign bony growth

- congenital

50
Q

What are likely causes of immediate post op fever (w/in 2 hrs)?

A
  • prior trauma/infection
  • blood products
  • malignant hyperthermia
51
Q

What are likely causes of acute post op fever (24hr-1wk)?

A
  • nosocomial infection
  • surgical site infection
  • MI
  • PE
  • DVT
52
Q

What are likely causes of subacute post op fever (1k - 1mo)?

A
  • surgical site infeciton
  • catheter infection
  • CDiff
  • Drug fever
  • PE/DVT
53
Q

What are likely causes of delayed post op fever (> 1 mo)?

A

viral

surgical site infection

54
Q

What is next step if pt w/ eschar constriction of hand?

A

present: decreased pulses, edema distal to burn
tx: eschartotomy to relive pressure on vascular supply

55
Q

What is presentation of psoas abscess?

A
  • subacute fever, ab/flank pain radiating to groin
  • anorexia, wt loss
  • ab pain w/ hip extension (psoas sign)
56
Q

How do you dx psoas abscess? tx?

A

CT ab/pelvis

tx: drain, abx

57
Q

What is presentation of hemothorax?

A
  • pt w/ signs of hemorrhage/vol depletion
  • trachial deviation to opposite site
  • decreased breath sounds, dullness to percussion
58
Q

What is presentation of pulm contusion?

A
  • chest wall bruise, decreased breath sounds, CXR w/ patchy irregular alveolar infiltrates
  • differentiate from ARDS b/c occurs w/in 24 hrs and U/l (vs ards 24-48 hrs and B/L)
59
Q

What are some things you can do to increase functional residual capacity post-op?

A
  • control pain
  • avoid too many narcotics which decrease resp drive
  • sit upright if obese
  • encourage deep breaths, IS
60
Q

What is presentation of umbilical hernia? tx?

A

defect at linea alba covered by skin, sometimes has bowel in it, umbicilar cord inserts at apex of defect

associated w/ hypothyroid, premature, beckwith wiedemann

if small –> close spontaneously
if hasnt closed by 5yo –> surgical closure

61
Q

What is presentation of gastroschisis?

A

defect to R of cord insertion and not covered by membrane or skin
umbilical cord next to defect

tx: surgical emergency

62
Q

What is presentation of omphalocele?

A

midline ab wall defect covered by peritoneum containing ab organs

tx: immediate surgery

63
Q

What is next step if pt w/ small bowel obstruction?

A

initially conservative w/ NGT, pain control, fluid resuscitation

fever, tachycardia, leukocytosis, met acidosis or other sx of strangulation –> do urgent surgery

64
Q

What is next step if FAST exam inconclusive in hemodynamically unstable pt?

A

do diagnostic peritoneal lavage

65
Q

What does it mean if pt has ab succussion splash?

A

gastric outlet obstruction

66
Q

What is common complication of acid ingestion causing N/V, early satiety?

A

pyloric stricture

67
Q

What is leriche syndrome?

A

aortoiliac occlusion

riad = bilateral hip, thigh, and buttock claudication, impotence, symmetric atrophy of B/L lower extremities

68
Q

What is next step if pt w/ duodenal hematoma following blunt ab trauma?

A

usually resolves spontaneously –> NG suction and parental nutrition

surgery to evacuate hematoma if fails to resolve

69
Q

What is tx for DVT?

A

heparin, to warfarin for 3 months

70
Q

What is presentation of pulm contusion?

A
  • hypoxia, resp distress, pulm edema
  • worse w/ IVF
  • resp alkalsosis, hypocarbia
71
Q

What is presentation of myocardial contusion?

A

present w/ arrhythmia, HF, chest pain

high PCWP

72
Q

What is a marjolin ulcer?

A

SCC arising within burn mound

73
Q

What sould you think if pt w/ pulsatile groin mass and thing pain?

A

femoral artery aneurysm causing compression of femoral nerve lateral to the artery

74
Q

What is classic presentation of appendicitis such that you don’t need to get CT and can go straight to appendectomy?

A
  • migratory pain, nausea, vomiting, fever, leukocytosis, mcburney point tenderness, rovsing sign
75
Q

What is next step if suspect penile fracture?

A

retrograde urethrogram to rule out urethral injury and then surgical exploration

76
Q

How do you dx aortic dissection?

A

contrast chest CT or TEE

77
Q

What should you think if pt w/ neck pain, fever, limited neck mobility 2/2 pain, inability to open mouth normally, and limited cervical extension?

A

retropharyngeal abscess

78
Q

what is dx? tx? for retropharyngeal abscess?

A

dx: CT neck or lateral radiographs
tx: IV abx and drainage

79
Q

What does it mean if pt has high respiratory quotient (ratio co2 produced to O2 consumed)?

A

net lipogenesis and high oxidation of carbohydrates

80
Q

What should you think if pt presents w/ acute onset severe back pain, syncope, and hypotension?

A

AAA rupture

81
Q

What levels of ABI are normal?

A

normal 0.91-1.3

> 1.3 = calcified

82
Q

What should you think if pt w/ persistent pneumothorax and air leak after chest tube pt in pt w/ blunt chest trauma?

A

tracheobronchial rupture

dx high rest CT or bronchoscopy

83
Q

What should you think if pt w/ blunt ab/pelvis trauma and pain referring to shoulder? what urological injury could cause this?

A

intraperitoneal rupture of bladder dome can cause chemical peritonitis

84
Q

What is presentation of posterior urethral injury?

A

associated w/ pelvic fracture

blood at urethral meatus, high riding prostate, scrotal hematoma, inability to void despite urge, distended bladder

85
Q

What is presentation of anterior urethral injury?

A

2/2 straddle injury
or instrumentation
sx: perineal tender, hematoma, normal prostate, bleeding from urethra, no inability to urinate

86
Q

What should you think if pt w/ blunt thoracic trauma presents w/ hypotension, tahcycardia, elevated JVP with normal CXR?

A

cardiac tamponade

tx: decompress by pericardiocentesis or surgical pericardiotomy

87
Q

What is mc organism in prosthetic joint infection w/in 3 mo of arthroplasty? presentation? tx?

A

mc = staph aurea, gram neg, anaerobes
wound drains, erythema, swelling, fever

tx: remove implant or debride and retain implant

88
Q

What is mc organism in prosthetic joint infection after 3 mo of arthroplasty? presentation? tx?

A

mc = coag neg staph, enterococci

persistent joint pain, implant loosening
tx: usually remove/exchange implant

89
Q

What is next step in dx workup if concern for retroperitoneal hematoma?

A

noncontrast CT abdomen/pelvis or ab US

90
Q

What are the 4Ts of anterior mediastinal masses?

A
  • thymoma
  • teratoma + other germ cell tumors
  • thyroid neoplasma
  • terrible lymphoma
91
Q

What is tx for appendiceal abscess?

A

IV abx, bowel rest, possible percutaneous drainage

interval appendectomy in 6-8 wks once inflammation has gone down a bit

92
Q

What should you suspect if pt following cardiac surgery w/ fever, CP, leukocytosis, mediastinal widening on CXR? next step?

A

likely post op mediastinitis, also see pus in mediastinum

tx = surgical debride and immediate closure w/ abx

93
Q

What is tx for complicated diverticulitis w/ abscess, perforation, obstruction, or fistula?

A

fluid collection > 3cm should have CT guided percutaneous drainage

if sx not controlled by d5 do surgical drain and debride

sigmoid resection only for pt w/ fistula, perforation w/ peritonitis, obstruction

94
Q

When do you give just tetanus vaccine in pt w/ wound? what about both vaccine and IG?

A

just vacine = if clean wound and last dose > 10 yrs ago, or dirty wound w/ last dose > 5 yrs ago
OR if unimmunized and clean/minor wound

do vaccine + IG if dirty wound and unimmunized or uncertain

95
Q

What is presentation of chronic pancreatitis?

A

chronic epigastric ab pain radiating to back and relieved by leanding fwd
+ steatorrhea, wt loss, diarrhea

96
Q

What are lynch syndrome criteria? what types of tumors?

A
  1. 3 relatives w/ CRC one must be first degree of other two
    involves 2+ genereations
    one case dx
97
Q

What is workup of minimal BRBPR?

A

50 or red flags: do colonoscopy

98
Q

What is next step after suspect cirrhosis?

A

assess for complications:

  • do EGD yearly (and start BB for prevention)
  • screen for ascites, HE
99
Q

What screening exams should pts w/ cirrhosis have?

A
  • yearly EGD for varices

- US q6mo for HCC surveillance

100
Q

What is initial dx test for toxic megacolon?

A

ab xr w/ colon > 6cm

101
Q

What is tx for toxic megacolon?

A

NGT, NPO, steroids or abx

will need emergent surgery if does not respond to medical therapy

102
Q

What does initial hematuria suggest? terminal hematuria? total hematuria?

A

initial: urethral damage
terminal: bladder or prostate
total: kidney or ureters

clots = rarely seen w/ renal

103
Q

What FeNa, Urine Na, Urine Osm suggest ATN?

A

urine osm 300-350
Urine Na > 20
FeNa > 2%

104
Q

What does urine Cl >20 suggest in metabolic alkalosis?

A

high urine chloride suggests saline unresponsive metabolic alkalosis

105
Q

How do you assess acutely compensation in metabolic acdiosis? met alk? resp acid? resp alk?

A

met acidosis: winters
- expected PO2 = 1.5 x HCO3 + 8 +/-2

met alk:
- increase PCO2 by 0.7 for every 1 increase in HCO3

resp acid:
- increase HCO3 by 1 for every 10 increase in PCO2

resp alk:
- decrease HCO3 by 2 for every 10 decreased in PCO2

106
Q

What electrolyte disturbances in adrenal insufficiency?

A

non-gap metabolic acidosis

  • hyponatremia
  • hyperkalemia
107
Q

What electrolyte disturbances associated w/ loop diuretic?

A
  • elevated BUN 2/2 losing volume
  • metabolic alkalosis
  • prerenal AKI
  • hypokalemia
108
Q

What is tx for SIADH?

A

fluid restriction

if sever symptomatic or resistant hyponatremia can give hypertonic saline

Surgery Clerkship (5 decks)

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