Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > UWORLD > Flashcards

UWORLD Flashcards

1
Q

Pt complains of popping sound followed by severe pain at the time of injury when his foot was fixed and was twisted. PE reveals localized tenderness on medial side of knee. THis is a meniscal tear. What is the “bucket handle” tears and “McMurray’s sign”?

A

“bucket handle tears” -locking of the knee joint on extension

McMurray’s sign: palpable or audible snap occurring while slowly extending the leg at the knee from full flexion while simultaneously applying tibial torsion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pt complains of popping sound followed by severe pain at the time of injury when his foot was fixed and was twisted. PE reveals localized tenderness on medial side of knee. THis is a meniscal tear. What is the “bucket handle” tears and “McMurray’s sign”?

A

“bucket handle tears” -locking of the knee joint on extension

McMurray’s sign: palpable or audible snap occurring while slowly extending the leg at the knee from full flexion while simultaneously applying tibial torsion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Medial collateral ligament injury is assoc with abduction injury to the knee. What test will help in clinical diagnosis

A

valgus stress test (when you move the knee laterally)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lateral collateral ligament is rare and would be seen in adduction injury to the knee. What test can clinically diagnose it

A

varus stress test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Respiratory Quotient = CO2 produced/rate of O2 uptake

An RQ close to 1 –>
An RQ at 0.8 –>
An RQ at 0.7 –>

A

An RQ close to 1 –> carbohydrates major nutrient oxidized
An RQ at 0.8 –> protein
An RQ at 0.7 –> lipid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Sepsis is a hypermetabolic, hypercatabolic state wherein both fat and protein are broken down in addition to gluose. Respiratory quotient in a septic patient is? >1, = 1,

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

amt of O2 consumed =

A

PaO2-PvO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Someone with winged scapula post axillary lymphadenectomy for treatment of breast cancer due to?

A

injury to long thoracic nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Someone with winged scapula post axillary lymphadenectomy for treatment of breast cancer due to?

A

injury to long thoracic nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is torus palatinus

A

a congenital condition characterized by chronic growth on hard palate. It is a benign bony growth located on midline suture of hard palate. More common in younger patients, women and Asians. No medical or surgical therapy required unless symptomatic or interferes with speech or eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What’s the most reliable means of monitoring adequacy of circulation in a circumferentially burned limb?

A

serial exam using doppler US flow meter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Respiratory Quotient = CO2 produced/rate of O2 uptake

An RQ close to 1 –>
An RQ at 0.8 –>
An RQ at 0.7 –>

A

An RQ close to 1 –> carbohydrates major nutrient oxidized
An RQ at 0.8 –> protein
An RQ at 0.7 –> lipid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

amt of O2 consumed =

A

PaO2-PvO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx rxn: anaphylactic rxn presents with rapid onset of shock, angioedema/urticaria, and resp distress w/in a few secs of transfusion. Caused by?

A

Caused by recipient anti-IgA abs in someone with IgA def

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Someone with winged scapula post axillary lymphadenectomy for treatment of breast cancer due to?

A

injury to long thoracic nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Someone with pulsatile groin mass below the inguinal ligament with anterior thigh pain 2/2 to compression of femoral nerve. Suspect.

A

femoral artery aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is torus palatinus

A

a congenital condition characterized by chronic growth on hard palate. It is a benign bony growth located on midline suture of hard palate. More common in younger patients, women and Asians. No medical or surgical therapy required unless symptomatic or interferes with speech or eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A change in which parameter is the FIRST indicator of hypovolemia?

A

HR goes up and peripheral vasoconstriction occur to maintain BP w/in normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tx rxn: Febrile nonhemolytic is most common that presents with fever and chills w/in 1-6 hrs of tx. Caused by?

A

cytokine accumulation during blood storage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx rxn: acute hemolytic presents with fever, flank pain, hemoglobinuria, renal failure and DIC. Usu occurs w/in 1 hr of tx. What test to order? Caused by?

A

Test: positive direct Coombs test

Caused by ABO incompatibility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tx rxn: delayed hemolytic rxn presents with mild fever and hemolytic anemia w/in 2-10 days after transfusion. What tests are positive. Caused by?

A

Test: positive direct Coombs test, positive new antibody screen
Caused by anamnestic antibody response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hemorrhagic shock can be divded into 4 categories depending on amt of blood loss.
Class IV

A

> 40% (>2000 ml)
HR > 140
BP markedly decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tx rxn: urticarial/allergic presents with urticaria, flushing, angioedema and pruitis within 2-3 hrs of tx. Caused by

A

Caused by recipient IgE antibodies and mast cell activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Tx rxn: Transfusion-related acute lung injury presents with resp distress and signs of noncardiogenic pulmonary edema w/in 6 hrs of tx. Caused by?

A

Caused by donor anti-leukocyte abs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hypoxemia can be caused by reduced inspired O2 tension, hypoventilation, diffusion limitation, shunt, and V/Q mismatch. What is characteristic of alveolar hypoventilation?

A

respiratory acidosis

normal A-a gradient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Nerve damage from wearing crutches

A

radial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hemorrhagic shock can be divded into 4 categories depending on amt of blood loss.
Class I

A

72

BP normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

After MVC, someone develops dyspnea, tacypnea, chest pain, hypoxemia that worsened by fluids and patchy irregular alveolar infiltrates on chest x-ray. Suspect?

A

pulmonary contusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Whistling noise during respiration after rhinoplasty? Suspect?

A

nasal septal perforation likely from septal hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Hemorrhagic shock can be divded into 4 categories depending on amt of blood loss.
Class IV

A

> 40% (>2000 ml)
HR > 140
BP markedly decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Cricothyroidectomy should be converted to formal tracheostomy if MV is needed past 5-7 days. Why?

A

high incidence of tracheal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

A-a gradient is normal when it’s

A

Pulmonary Embolism
Atelectasis
Pleural effusion
Pulmonary edema

There is a decrease in PCO2 (respiratory alkalosis) due to compensatory hyperventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Persistent pneumothorax and significant air leak following chest tube placement in a pt who has sustained blunt chest trauma suggests?

A

tracheobronchial rupture. (normally right main bronchus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Trismus (inability to open the mouth normally), limited cervical extension, neck pain, fever… suspect

A

retropharyngeal abscess -usual source is from local penetrating trauma. In order to fully evaluate the extent of the infection, do a CT of the neck and/or lateral radiographs of the neck which may show lordosis of cervical spine with gas and swelling in retropharygneal area. Treatment is IV abx and urgent drainage of abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

4 T’s for ddx for anterior mediasinum mass.

A
  • thymoma
  • teratoma
  • thyroid neoplasm
  • terrible lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

After MVC, someone develops dyspnea, tacypnea, chest pain, hypoxemia that worsened by fluids and patchy irregular alveolar infiltrates on chest x-ray. Suspect?

A

pulmonary contusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Whistling noise during respiration after rhinoplasty? Suspect?

A

nasal septal perforation likely from septal hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What fixes paradoxical movement in flail chest?

A

positive pressure mech ventilation by replacing the normal negative intrapleural pressure during spon vent with positive intrapleural press

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Cricothyroidectomy should be converted to formal tracheostomy if MV is needed past 5-7 days. Why?

A

high incidence of tracheal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are some common causes of gastric outlet obstruction?

A
  • malignancy
  • PUD
  • chrohn
  • strictures 2/2 to ingestion of caustic agents
  • gastric bezoars
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Persistent pneumothorax and significant air leak following chest tube placement in a pt who has sustained blunt chest trauma suggests?

A

tracheobronchial rupture. (normally right main bronchus)

42
Q

Trismus (inability to open the mouth normally), limited cervical extension, neck pain, fever… suspect

A

retropharyngeal abscess -usual source is from local penetrating trauma. In order to fully evaluate the extent of the infection, do a CT of the neck and/or lateral radiographs of the neck which may show lordosis of cervical spine with gas and swelling in retropharygneal area. Treatment is IV abx and urgent drainage of abscess

43
Q

Blunt abd trauma –> delayed onset hypotension, LUQ abd pain, left shoulder pain (kehr sign). If hemo stable, do what? If not hemo stable, do what?

A

if stable –> abdominal CT scan wtih IV contrast to look for splenic injury

if unstable –> urgent laparatomy

44
Q

Gastrochisis is a protrusion of bright red intestines to the ___ side of a normal umbilicus without a membrane. What to do

A

RIGHT

surgical emergency

45
Q

FOr any pt who suffers blunt deceleration trauma (MVA or fall from > 10 feet), what must be ruled out? What’s the initial screening test? and the most sensitive finding?

A

blunt aortic trauma must be ruled out and CXR is the initial screening test and widening of the mediastinum is the most sensitive finding.

46
Q

Plain films of the foot show a hairline fracture of the shaft of the second metatarsal in someone who has had painin that foot that started wks again with activity and now with rest. Dx? What to do?

A

Stress aka hairline fracture

Treatment: rest, analgesia, and a hard-soled shoe

47
Q

When do you actually give someone tetanus abs

A

any individual with a severe or dirty wound WITH really immunocompromised state or an unclear or incomplete immunization history

48
Q

HOw does positive pressure MV worsen someone in hypovolemic shock that has not been adequately resuscitated?

A

-positive pressure MV increases intrathoracic pressure which decreases venous return to heart and thereby decreases ventricular preload. In someone who is already in hypovolemic shock, this can cause circulatory collapse unless volume adequately resuscitated

49
Q 
widened mediastinum
large left-sided hemothorax
deviation of mediastinum to the right
disruption of aortic contour
on cxr

-all signs of possible

A

aortic injury

can be confirmed with CT

50
Q

Prosthetic joint infection: early vs delayed-onset infection

A

early-onset: w/in 3 months of primary arthroplasty; most common org is staph aureus; treat with implant removal/exchange

delayed-onset: > 3 mo after primary arthroplasty; most common org is staph epid; treat with implant removal/exchange

51
Q

what characterizes post-operative cholestasis?

A

benign condition that often develops after a major surgery characterized by hypotension, extensive blood loss into tissues, and massive blood repalcement. Jaundice develops due to increased pigment load from tx, decreased liver function due to hypotension and decreased renal bilirubin excretion from tubular necrosis. Jaundice is evident by 2nd or 3rd day with bilirubin peaking by POD10

52
Q

How to manage someone with duodenal hematoma (most commonly due to direct blunt abd trauma in children)

A

Usually self-resolving so manage with NG suction and parenteral nutrition. If fails, then surgery

53
Q

How soon after surgery can you start anticoagulation in a patient who needs it

A

48-72 hrs post-surgery in hemodynamically stable pts

54
Q

how does thoracic artery aneurysm repair lead to anterior spinal cord syndrome (loss of spinothalamic and corticospinal)

A

the artery that supplies the anterior spinal cord is the anterior spinal artery which is a branch of the artery of Adamkiewicz from the thoracic arota. Therefore, thoracic aortic surgery can result in reduced blood flow during aortic cross clamping or hypotension and lead to anterior spinal cord infarction

55
Q

Bacterial infection usu bronchopneumonia or burn wound infection leading to sepsis is the leading complication of burn victims after adequate fluid resusc. which are the 2 most likely organisms involved

A

staph aureus

pseudomonas

56
Q

How can one confirm fat embolism

A

presence of fat droplets in urine

presence of intra-arterial fat globules on fundoscopy

57
Q

How do these interventions help with lowering ICP:

1) head elevation
2) sedation
3) IV mannitol
4) hyperventilation
5) removal of CSF

A

1) head elevation: increased venous outflow from the brain
2) sedation: decreased metabolic demand & control of HTN
3) IV mannitol: extraction of free water from brain tissue –> osmotic diuresis
4) hyperventilation: CO2 washout –> cerebral vasoconstriction
5) removal of CSF –> reduction of CSF volume/pressure

58
Q

What’s the most common bone in the body to be affected by stress fractures

A

tibia (“shint splints” or medial tibial stress syndrome”)

59
Q

Acute bacterial parotitis can occur in older pts post-surgery presenting as fever, leukocytosis and parotid inflammation. How to prevent? What’s the most common causative agent?

A
  • adequate fluid hydration and oral hygiene can prevent

- Staph aureus

60
Q

Leriche syndrome -triad of symptoms?

A

arterial occlusion at the bifurcation of aorta into common iliac arteries aka aortoiliac occlusion.

Triad: bilateral hip/thigh/buttock claudication, impotence, and symmetric atrophy of b/l LE due to chronic ischemia

61
Q

Who is at greatest risk of Leriche syndrome/aortoiliac occlusion

A

men at high risk for atherosclerosis (e.g. smokers)

62
Q

Congenital adhesions are called

A

Ladd’s bands

63
Q

What are the most impt steps in management of lactic acidosis from septic shock?

A

IV normal saline with or without vasopressure therapy to maintain the intravascular pressure and abx to correct the underlying infection

64
Q

Femoral nerve: motor and sensory functions?

A

motor: muscles of anterior compartment so impt for knee extension and hip flexion.
Sensation: anterior thigh and medial leg via the saphenous branch

65
Q

Obturator nerve: motor and sensory functions?

A

motor: muscles of medial compartment so impt in adduction of thighs
sensation: medial thigh

66
Q

What’s impt about moving pt from supine to sitting post-op

A

supine to sitting can increase the functional residual capacity by 20-35%.

67
Q

What to do if someone needs urgent surgery and is on warfarin?

A

will need to reverse INR to lessen chances of bleeding excessively during surgery by giving infusion of FFP to restore vit K-dependent clotting factors.

68
Q

define massive hemoptysis

A

> 600 ml of expectorated blood over a 24 hr period or a bleeding rate > 100 mL/hr

69
Q

WHat’s initial management of someone with massive hemoptysis

A
  • adequate airway
  • aqequate ventilation and gas exchnage
  • make sure hemo stable
  • placed with bleeding lung in dependent postion to avoid blood collection of opposite lung
  • bronchoscopy is initial procedure of choice as it can localize bleed, and can intervene therapeutically
70
Q

positive drop arm sign when you passively abduct pt’s arm and then release and ask pt to lower it. instead of lowering it, it just drops down, signfying

A

rotator cuff tear

71
Q

after gynecologic surgeries, a woman develops unexplained fever and you suspect thromboplebitis. How to treat?

A
  • heparin

- abx

72
Q

Pressure ulcers are caused by impaired blood flow leading to ischemia. Check CBC and blood cx as culturing will just get skin flora. Can do tissue biopsy to r/o marjolins ulcer. Best prevention is turning pt q2h. What are the 4 stages of pressure ulcers

A

stage 1 = skin intact but red and still blanches with pressure
stage 2 = blister or break in the dermis
stage 3 = subcutaneous destruction into the muscle
stage 4= involvement of joint or bone

73
Q

adenocarcinoma of the lungs can cause pleural effusions characterized by

A

exudative with high hyaluronidase

74
Q

Lung cancer assoc with hypercalcemia

A

squamous cell -PTHrp

75
Q

Pt with shoulder pain, ptosis, constricted pupil and facial edema?

A

pancoast tumor/superior sulcus syndrome usu from small cell

76
Q

pt with lung cancer with ptosis that is better after 1 min of upward gaze

A

lambert eaton assoc with small cell carcinoma from ab to presynaptic calcium channels

77
Q

what is krukenberg cancer?

A

gastric cancer that has metasized to ovaries

78
Q

What is virchow’s node

A

gastric cancer with swollen supraclavicular LNs

79
Q

What is gastric lymphoma assoc with

A

HIV

80
Q

What is MALT lymphoma assoc with

A

H. pylori and can be treated with triple therapy

81
Q

What is blummer’s shelf

A

gastric cancer metastasis that can be felt on digital rectal exam.

82
Q

What is sister mary joseph

A

gastric cancer with umbilical LNs

83
Q

What is mentriers’

A

protein losing enteropathy on EGD can see enlarged rugae

84
Q

Pt has bilious vomiting, post-prandial pain and recently lost 200 lbs.

A

SMA syndrome happens when 3rd part of duodenum is compressed by aorta and SMA. Treatment is nutrition.

85
Q

Choledochal cysts can present as persistent jaundice in a newborn. What’s the diff btw type 1 and type 4

A

type 1 = fusiform dilatation of CBD -> treat with excision

type 4 = caroli’s disease when cysts are in intrahepatic ducts that will necessitate liver tx

86
Q

TIPS can improve portal HTN but can worsen

A

hepatic encephalopathy by interrupting clearance of ammonia.

87
Q

Post-op splenectomy can lead to thrombocytosis when plts are above 1,000,000. How to treat.

A

Give aspirin (anti-plt)

88
Q

Post-splenectomy vaccines

A

s. pneumo
h influenzae
n meningitides

(also post-op penicillin -impt in immune function)

89
Q

+ Casoni skin test and liver cysts and eosinophilia

A

echinococcus

will do surgery to remove cysts but be careful of anaphy rxn and give albendazole

90
Q

which deficiency is assoc with carcinoid tumor

A

niacin deficiency bc tryptophan is used to make niacin and is used to make all the excess serotonin instead

niacin is assoc with the Ds: diarrhea, dermatitis, death, dementia

91
Q

List the 3 Light’s criteria to determine if an effusion is exudative or not.

A

Pleural fluid protein/Serum protein > 0.5
Pleural fluid LDH/Serum LDH > 0.6
Pleural fluid LDH > 2/3 upper limit of normal

92
Q

How to calculate basal energy expenditure in males and females

A

males: 25 kcal/kg/day
females: 22 kcal/kg/day

93
Q

Pt with recent h/o of skin infection presenting with fever and abdominal pain radiating to the groin and pain with hip extension points to what dx? How to dx and treat?

A

psoas abscess which can occur either hematologic seeding from a distant infection or from direct extension of an intraabdominal infection (diverticulitis, osteomyeltis)

Risk factors: HIV, IV drug use, diabetes, Chrohns
Dx: CT scan of abdomen & pelvis; blood and abscess cxs
Treatment: Drainage and broad spectrum abxs

94
Q

In supracondylar fracture, one should worry about brachial artery or median nerve injury. Compartment syndrome is concerning as well although rare. What can compartment syndrome lead to/?

A

Volkman contracture which is permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers. Passive extension of fingers is restricted and painful. Volkmann’s Ischemic Contracture is the direct result of undiagnosed Compartment Syndrome. It is excruciatingly painful and disabling

95
Q

What to suspect when a pt presents with recent cardiac cath, anticoagulation with heparin, sudden onset of hypotension, tachycardia, flat neck veins and back pain? How to diagnose and treat?

A

retroperitoneal hematoma due to bleeding from arterial access site that usu occurs w/n 12 hrs of catheterization.

Dx is confirmed with NON-contrast CT or ultrasound
Treatment is bed rest, IV fluids or blood tx

96
Q

Which part of the bladder is the only region covered by peritoneum and can cause referred pain to left shoulder (kehr sign)?

A

dome of the bladder

97
Q

How to treat penile fracture?

A

emergent urethrogram to assess for urethral injury and emergent surgery to evacuate the hematoma to mend the torn tunica albuginea

98
Q

Pts who take daily prednisone >/- 20 mg for > 3 wks are at high risk of adrenal insufficiency when in stressful conditions like surgery. Impt to give stress dose of steroids during the acute stressful condition. What are some clinical clues that may suggest perioperative adrenal insufficiency?

A
  • unexplained nausea/vomiting, abd pain
  • hyponatremia, hyperkalemia
  • hypoglycemia
  • hypotension
99
Q

Acute mediastinitis is a possible complication of cardiac surgery that is usually due to intraop wound contamination. What is typical presentation? What can you see on xray? How to dx and treat?

A

presentation: usu w/in 14d with fever, tachycardia, chest pain, leukocytosis, sternal wound drainage or purulent discharge

CXR: may show widened mediastinum

Dx is clinically made

Treatment is drainage, surgical debridement wtih immediate closure and abx therapy.

100
Q

AF can occur after CABG but is usually self-limiting with resolution

A

rate control best with beta blockers or amiodarone

> 24 hrs of AF, can consider anticoagulation and/or cardioversion

101
Q

Post-thyroidectomy is the most common cause of hypoparathyroidism. What is the second most common case of primary hypoparathyroidism?

A

autoimmune

102
Q

nasopharyngeal carcinoma is an undifferentiated carcinma of squamous cell origin that is usu asymp until too late. They often present with recurrent otitis media (due to tumor obstructing eustacian tube), recurrent epistaxis, and/or nasal obstruction. This is strongly assoc with what virus and what social risk factors

A

strongly assoc with EBV

assoc with smoking and chronic nitrosamine consumption (salted fish)

Surgery (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions