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Surgery > Uworld > Flashcards

Uworld Flashcards

1
Q

if suspect variceal hemorrhage, do what before getting EGD?

A

place 2 large bore IV catheter for fluid resuscitation
give IV octreotide and abx
THEN EGD

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2
Q

the most likely diagnosis in a patient with abdominal pain following a traumatic injury and abd. XR with gas-filled loops in small and large intestine + gastric dilation

A

paralytic ileus

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3
Q

ileus is commonly due to ?

other causes?

A

retroperitoneal/abdominal hemorrhage or inflammation, intestinal ischemia, e-lyte abnormalities

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4
Q

perforated PUD should be diagnosed with ? which may show ?

A

upright XR of chest and abd

would show free intraperitoneal air under the diaphragm

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5
Q

hidradenitis suppurativa vs pilonidal disease

A

HD: multiple, recurrent painful nodules in the axillae, inguinal folds and perineal areas
PD: single fluctuant mass midline in gluteal clefts

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6
Q

painful active range of motion but normal passive range of motion think ?

A

bursitis

prepatellar bursitis may be cause by S. aureus

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7
Q

episodic pain at the inferior patella and patellar tendon, think?

A

patellar tendinitis

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8
Q

chronic anterior knee pain worse with activity or prolonged sitting, think what condition?

A

patellofemoral pain syndrome

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9
Q

3-4% of patients with spinal cord injuries will develop post-traumatic ?

A

syringomyelia

enlargement of central canal of the SC due to CSF retention

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10
Q

cervical spondylosis results from ?

A

disc degeneration in pts over 40

may develop stenosis, resulting in neuro deficits

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11
Q

atelectasis will show what on ABG?

A

hypoxemia, hypocapnia and respiratory alkalosis

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12
Q

supracondylar fracture of humerus most commonly happens from what injury?
complications?

A 
FOOSH
branchial artery injury
median n. injury
cubitus varus deformity
compartment syndrome
Volkmann ischemic contracture
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13
Q

common first sign of burn wound infection

A

change in wound appearance/loss of viable graft
other findings: temp less than 97.7 or greater than 102.2, tachy greater than 90, tachypnea greater than 30, hypotension (refract) systolic less than 90, oliguria, hyperglycemia, thrombocytopenia, AMS

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14
Q

common bugs in burn wound infections

treatment?

A

immediate: G+ (s. aureus)
5+ days: G-/fungi (pseudomonas, candida)
pip/tazo or carbapenem + vanc (MRSA) +/- aminoglycoside (pseudomonas)

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15
Q

treatment of duodenal hematoma

A

decompression with NG tube; may need surgery or percutaneous drainage

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16
Q

ddx of anterior neck mass (4 “Ts”)
if B-hCG elevated, think ?
if B-hCG and a-FP elevated think ?

A

thymoma, teratoma, thyroid neoplasm, terrible lymphoma
B-hCG elevated in 1/3 of seminomas
both elevated think nonseminomatous/mixed germ cell tumor

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17
Q

nonseminomatous forms of germ cell tumors

A

yolk sac, embryonal, choriocarcinoma

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18
Q

if pt presents with insidious onset constant gnawing epigastric pain worse at night, anorexia/weight loss, jaundice, think ?

A

pancreatic adenocarcinoma

jaundice from extrahepatic biliary obstruction

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19
Q

pancreatic cancer is diagnosed with ? if jaundice present and ? if no jaundice

A

US (head tumor)

CT (body/tail tumor)

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20
Q

ischemic colitis typically affects what areas?

A

“watershed” areas: splenic flexure (SMA/IMA) and rectosigmoid junction (sigmoid/SRA)

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21
Q

clinical feature ischemic colitis

A

mild pain/tenderness
hematochezia, diarrhea
metabolic (lactic) acidosis

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22
Q

dx ischemic colitis

A

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

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23
Q

management ischemic colitis

A

IVF, bowel rest, IV abx, colon resection

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24
Q

a life-threateneing form of acute cholecystitis due to infection with gas-forming bacteria (Clostridium, E. coli)

A

emphysematous cholecystitis
may see air-fluid levels, gas in the GB wall, pneumobilia
tx with emergent cholecystectomy + IV abx (amp + sulbactam)

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25
Q

what clavicular fractures may require ORIF?

A

fractures of the distal 1/3rd

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26
Q

FFP may be indicated in hemoptysis if INR is greater than ?

A

1.5

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27
Q

injury to the long thoracic nerve causes weakness of what muscle ? with impairments of ?
may happen during ?

A

the serratus anterior
extreme abduction (greater than 90 degrees) due to inability to rotate the scapula forward
penetrating trauma, med/sx procedures (chest tube placement)

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28
Q

succinylcholine is a ? that may cause life-threatening ? in what patients
use what instead?

A

depolarizing neuromuscular blocker
hyperkalemia
patients with up regulation of postsynaptic acetylcholine receptors (burns, sk. musc. trauma, stroke)
use rocuronium, vecuronium

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29
Q

blunt chest trauma presenting with tachycardia, hypotension, JVD
+/- pleural effusion +normal cardiac contours on CXR
think what?

A

acute pericardial tamponade
100-200mL is enough to compromise venous return (JVD) and cardiac output (^HR, dec. BP) while not changing the cardiac contours (pericardium is stiff)

30
Q 
aortoiliac occlusion (Leriche syndrome) causes chronic ischemia
classic triad?
A

b/l hip, thigh, buttock claudication
impotence
symmetric atrophy of b/l LE

31
Q

how does hyperventilating decrease ICP?

A

it lowers cerebral paCO2 resulting in rapid vasoconstriction

32
Q

what testicular mass increases in size with valsalva and standing and does not transilluminate?

A

varicocele
(spermatocele will not change in size)
(hydrocele will transilluminate)

33
Q

varicocele treatment

A

gonadal vein ligation (boys and y. adult males with testicular atrophy)
scrotal support and NSAIDs (older men)

34
Q

the most common cause of ureteral injury

A

iatrogenic trauma during abdominal surgery

injury due to blunt trauma is relatively rare

35
Q

urethral injury presents with ?

A

inability to pass a foley, blood at the meatus, high-riding prostate

36
Q

extraperitoneal bladder injury (EPBI) presents how

A

localized pain in low abdomen/pelvis
gross hematuria
urinary retention

37
Q

intraperitoneal bladder rupture presents how

A

diffuse abdominal tenderness, guarding, rebound tenderness (signs of chemical peritonitis)

38
Q

there may be metabolic acidosis and elevated amylase in these GI conditions (hint: not pancreatitis)

A

severe SBO, bowel ischemia
may also have leukocytosis and ^hgb
due to infarction, perforation, or peritonitis

39
Q

how to diagnosis acute mesenteric ischemia

A

CT (2nd: MRA)

only mesenteric angiography if dx unclear

40
Q

presentation of transtentorial herniation of the parahippocampal uncus (uncal herniation)

A

ipsilat hemiparesis (compression of contralto crus cerebri)
ipsilat mydriasis (loss of PS innervation)
strabismus- down and out (compression of ipsilate oculomotor n.)
contralat homonymous hemianopsia (compression of ipsilat PCA)
AMS/coma (compression of reticular formation)

41
Q

what is Cushing’s reflex?

what does it indicate?

A

HTN, bradycardia, respiratory depression

indicates ^ICP

42
Q

what may you see on CT with diffuse axonal injury?

A

diffuse small bleeds at the grey-white matter junction

pts typically are in a coma and px is grim

43
Q

rupture of the dome of the bladder may cause shoulder pain due to what mechanism?

A

irritation of the peritoneal lining of l or r hemidaphragm may cause referred pain to the ipsilat shoulder (Kehr sign) as sensory innervation to the shoulder originates form the C3-5 spinal roots which are also the origin of the phrenic nerve innervating the diaphragm

44
Q 
GI complaints (nausea, abdominal pain, diarrhea) and vasomotor symptoms (palpitations, hypotension, tachycardia) after meals in a post-gastrectomy patient, think ?
how to manage?
A 
dumping syndrome: rapid emptying of gastric contents into duodenum/sm. intestine due to pyloric sphincter dysfunction from injury in bypass surgery
diet modifications (sm. meals)
45
Q

prolonged QT interval, think ?

if shortened, think ?

A

hypocalcemia

hypercalcemia

46
Q

myocardial contusion vs. myocardial rupture

A

contusion cause tachycardia, BBBs, or arrhythmia; classic injury is sternal fracture
rupture causes cardiac tamponade that presents with muffled heart sounds, hypotension, and distended neck veins; dx with US and tx with emergent sx

47
Q

esophageal rupture is typically caused by ?

manifestations on CXR?

A

iatrogenic (EGDs) and esophagitis
rarely cause by blunt trauma
pneumomediastinum and pleural effusions

48
Q

hemothorax may result from injury to ?

A

aorta, myocardium, hilar blood vessels or lung parenchyma

symptoms from shortness of breath to shock

49
Q

persistent pneumothorax and significant air leak following chest tube placement in a blunt chest trauma pt, think ?
findings on CXR ?

A

tracheobronchial rupture

pneumomediastinum and subcutaneous emphysema

50
Q

one of the most common solid organ injuries due to blunt abdominal trauma
manifests how?

A

hepatic laceration

hypotension, RUQ pain and bruising, free intraperitoneal fluid, R shoulder pain due to phrenic irritation

51
Q

fever, leukocytosis, chest pain, mediastinal widening in a post-cardiac surgery patient, think ?

A

acute mediastinitis

tx with abx, drainage and surgical debridement

52
Q

what is abdominal succession splash and what does it imply?

A

auscultating a “splash” sound when rocking pt back and forth by hips 3+ hrs after meal
implies both fluid and gas in stomach, there is gastric outlet obstruction

53
Q

anterior spinal cord infarction typically presents with ?

A

spinal shock: bilateral flaccid paralysis + loss of pain/temp below level of injury
UMN symptoms (spasticity and hyperreflexia) develop over days-weeks
vibration and proprioception are usually preserved

54
Q

anterior spinal cord infarction is a potential complication of what surgery?

A

thoracic aortic aneurysm surgery

55
Q

ischemic stroke tends to present with neurologic deficits on what side compared to lesion?

A

contralateral

56
Q

an exploratory laparotomy is indicated in a patient with a penetrating abdominal wound in what situations ?

A

indicated if pt is unstable, if peritonitis or have evisceration of organs, or blood from a NG tube or on rectal exam
combank: +FAST or DPL, free air/diaphragm rupture, contrast imaging with ruptured GIT, intraperitoneal bladder injury, severe solid organ injury
soft signs: acidosis, ^WBC, persistent pain, tachy

57
Q

clinical features of pre-renal injury

how to manage

A

serum Cr ^50%, decreased UOP, BUN/Cr greater than 20:1, FEN less than 1

treat with IV fluids to restore renal perfusion

58
Q

intrinsic AKI due to acute interstitial nephritis (AIN) is commonly caused by ?
clinical features?

A

B-lactam abx (pip/tazo)

leukocytes on UA, skin rash

59
Q

Factor Xa inhibitors

A

direct:
rivararoxaban (Xarelto)
apixaban (Eliquis)
indirect: fondaparinux (Arixtra)

60
Q

Direct Thrombin Inhibitors

A

argatroban
bivalirudin (Angiomax)
dabigatran (Pradaxa)

61
Q

what anticoagulants are contraindicated in ESRD?

A

LMWH (enoxaparin (Lovenox))
rivararoxaban (and assumably other Xa inhibitors and direct thrombin inhibitors)
IV UNFRACTIONATED heparin is ok

62
Q

brain mets vs meningioma

A

brain mets typically present as multiple ring enhancing lesions at the grey-white junction (intra-axial), look for origin with CT of chest, abdomen and pelvis
meningioma presents as extra-axial well circumscribed dural based mass, although benign treat with surgical resection as it can cause headaches, seizure, focal neuro deficits

63
Q

when is chemotherapy appropriate for brain tumors?

A

may be coupled with resection and radiation for highly malignant primary brain tumors (GBM, medulloblastoma) or highly chemosensitive mets (from testicular germ cell tumor)

64
Q

when is radiation appropriate for brain tumors?

A

whole brain radiation if diffuse metastatic brain disease

focused tumor radiation (stereotactic radiosurgery) for partially resected or unresectable meningiomas

65
Q

Lactated Ringers composition

why is it a good choice in the trauma setting?

A

130 mEq Na+, 109 mEq Cl-. 28 mEq lactate, 4 mEq K+, 3 mEq Ca+ (NS: 154 mEq Cl- and Na+)
lactate is converted to bicarb and can buffer the hypovolemia-induced metabolic acidosis

66
Q

crystalloids vs colloids

A

crystalloids have e-lyte composition similar to plasma (LR, NS)
colloids include blood products, albumin, hetastarch, hespan: greater ability to stay IV, given if pt doesn’t respond to crystalloids (2-3 L)

67
Q

treatment for gastric adenocarcinoma in antrum

A 
subtotal gastrectomy (removes distal 3/4 of stomach) 
need total gastrectomy if tumor is located in body or fundus of stomach (then Roux-en-Y to esophagus)
68
Q

Shock classifications

A

Class I: up to 750 mL blood loss (15%), normal vitals, some anxiety
Class II: 750-1500 mL (15-30%), HR 100-120, RR 20-24, anxiety, normal SBO, decrease PP, +/- delayed cap refill
Class III: 1500-2000 mL (30-40%, drop in SBP, HR 120+, RR^, UOP decreased, delayed cap refill
Class IV: 2L+ (40%), AMS, dec. BP, HR 140+, UOP minimal/absent, delayed cap refill

69
Q

succinylcholine can cause hyperkalemia in what pts?

what will you see on EKG?

A

burn and SCI pts
peaked T waves, shortened QT interval
later progressive lengthening of PR interval and QRS duration
P wave may eventually disappear and ultimately the QRS widens to a sine pattern

70
Q

goals in treating a spontaneous pneumothorax

A

(1) eliminate air from the pleural space
(2) reduce air leakage
(3) heal the pleural fistula
(4) re-expand the lung
(5) prevent future occurrences

71
Q

bronchoscopy useful in hemoptysis patient how so ?

A

localizing bleeding site, provide suctioning to improve visualization, and other therapy (balloon tamponade, electrocautery)

Surgery (15 decks)

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