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Surgery > UWORLD > Flashcards

UWORLD Flashcards

1
Q

Acute chemical peritonitis due to urine leak following trauma?

A

Rupture of dome of bladder

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2
Q

African American kid with bulge in abdomen …

Surgery required?

A

umbilical hernia

Surgery not usually required

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3
Q

Tx for large vs small pneumothorax in stable patients?

A

Large - needle thoracostomy

Small - supplemental O2

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4
Q

“Catching” knee pain, poss reduced range of motion, poss intermittent?

A

Meniscal tear, get MRI to assess if persistent

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5
Q

Early satiety, nausea, NONbilious vomiting, weight loss (esp with history of acid ingestions) - diagnx?
Common causes?

A

Pyloric stricture

Caused by Crohn’s, malignancy, PUD, ingestion of caustic agents

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6
Q

Abd pain, gross hematuria with pelvic fracture - WITHOUT signs of peritonitis?

A

Extraperitoneal bladder injury (i.e. neck, anterior wall, anterolateral wall of bladder NOT the dome)

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7
Q

Post-op AKI: BUN to Cr ratio? Two other signs?
Common cause?
Treat?

A

> 20:1, oliguria, no sediment
Intravascular volume depletion
Fluids

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8
Q

Traumatic amputation - what to do with body part?

A

Wrap in saline gauze, put in bag, put bag in ice

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9
Q

Skin cancer associated with chronic wounds/scars/inflamed skin?

A

SCC

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10
Q

Warning signs for splenic injury following BAT?

Course of action?

A

Hypotension, pleuritic chest pain, left abd wall bruising, LUQ tenderness, guarging, referred pain to left shoulder
HD stable: FAST exam then CT if warning signs
AMS: straight to CT

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11
Q

Nerves and vessels at risk in supracondylar fractures of humerus?

A

Brachial artery and nerve
(no brachial or radil pulses)
Median nerve

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12
Q

Suspected urethral injury- what to do?

A

retrograde urethrogram

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13
Q

Pancreatitis with ALT >150 think?

Treat?

A

Gallstone pancreatitis

Cholecystectomy when medically stable enough for surgery

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14
Q

Hypotension (and HD instability) following cardiac catheterization (with possible ipsilateral flank or back pain) - THINK?
Diagnostics and tx?

A

Retroperitoneal hematoma
Get non-contrast CT of abd and pelvis
OR US abd
Then supportive tx, montoring and fluids/transfusion

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15
Q

Diffuse abd pain, in settign of cardiac embolic events , or A-fib?
(high WBC, high HgB, high amylase, metabolic acidosis)

A

Ischemic bowel
Immediate surgery
Or CT angio to confirm diagnosis

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16
Q

Cervical spine injuries intubation order?

A

stabilize the C-spine first then orotracheal intubation with rapid sequence if apneic

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17
Q

Fever, chest pain, high WBC, mediastinal widening post cardiac surgery - think?
Treat?

A

acute mediatinitis

drainage, surgiucal debridement and ABX

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18
Q

Twisting knee injury likely to be?

A

Meniscal tear

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19
Q

HD unstable BAT: order of management?

A

1) fluids
2) FAST exam
3) if fluid seen on FAST then urgent lap

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20
Q

Acute hemotpyysis management (4 steps):

A

1) establish airway
2) ensure HD stbility
3) lateral position with bleeding lung down
4) bronchoscopy to identify site

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21
Q

Penetrating wound (eg GSW) below 4th intercostal space (nipple level) - management if unstable or stable?

A

unstable: ex lap
stable: CT

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22
Q

Abd pain and bloody diarrhea (poss fever and leukocytosis) post-op on abd aorta (eg AAA repair)? Diagnosis?

A

Bowel ischemia/infarction

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23
Q

RUQ pain that gets WORSE with morphine and opioids?

Lab elevations?

A

Sphincter of Oddi dysfucntion

AST/ALT, alk phos

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24
Q

Pusatile groin mass (below inguinal lig) with ANTERIOR THIGH PIAN, worse with walking? Diagnx?

A

Femoral artery aneurysm

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25
Q

Fever and lower abd/flank pain radiating to groin (PAIN WITH HIP EXTENSION) - think? Diagnose? Treat?

A

Psoas abscess
CT
Drainage/ABX

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26
Q

BGT trauma workup (HD stable vs unstable)

A

Urinalysis
(If hematuria then) CT abd pelvis with contrast (if HD stable)
If HD unstable, IV pyelogtpahy THEN surgical evaluation

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27
Q

Erythema and swelling, with SEVERE “out of proportion” pain, with creiptus, drianigs, gas in deep tissues … and then hypotension …THINK

A

Nec fasc

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28
Q

Sudden increase in activty, pain, second metatarsal - think?

Treat?

A

Stress fracture

Rest and analgesics

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29
Q

Best test for PAD (peripheral artery dz)?

A

Ankle-brachial index

better than duplex US - do after ABI if eval for intervention

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30
Q

Folks at greater risk for succinylcholine hyperkalemia?

A

Skeletal muscle trauma, burn, stroke, sedentary/paralyzed

So use rocuronium or vecuronium

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31
Q

How to diagnose possible diaphragm ruture when bowels in chest seen on KUB?

A

CT

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32
Q

Hypovolemic shock: intial decrease in preload and cardiac output, followed by …

A

Incr SVR, Incr HR, Incr EF

33
Q

Common complication of scaphoid fratures?

A

Osteonecrosis

34
Q

Hip pain that’s bad when lying in bed, middle aged adult?

A

Trochanteric bursitis

35
Q

How to avoid post-op parotitis?

Bug?

A

Hydrate well and good oral hygiene

Staph aureus

36
Q

PAT: indications for ex lap?

A

HD unstable, peritonitis, blood in NG tube or per rectum, evisceration

37
Q

Septic shock - management?

A

Replete fluids, then pressors to increase perfusion

38
Q

Compartment syndrome when edema casues pressure to rise above ______ during reperfusion?

A

30mmHg

39
Q

What anti-coag can you give with ESRD?

A

Unfractionated heparin and warfarin

40
Q

PostOp PNA risks?

Prevention?

A

smoking, pulm dz, age >50, thoracic or abd surgery, longer than 3 hours, poor health
Prevent with incentive spirometry/deep breathing exercises

41
Q

If hypocalcemic - look at what other electrolyte to check for hypoparathyroid?

A

Phosphorus

42
Q

Mild jaudice post surgery with unconjugated bilirubin the ONLY lab elevations?

A

Gilbert

43
Q

Acute cholecystitis confirmed - management?

A

Lap chole within 72 hours

44
Q

Very sick patient with gallstone cholecystitis sx but no gallstones (wal thickeing, distension, pericholecystic fluid - think?
Treat?

A

Acalculous cholecystitis

Treat with abx and percutaneous cholecystostomy then surgery when stable

45
Q

Infection organisms for burn patients?

Sign of infection?

A

Early: GP (staph)
After 5 days: GN (pseudomonas) or fungi (candida)
Sign: change in burn wound appearance or loss of skin graft

46
Q

Blunt trauma, widened mediastinum and left-sided hemothorax? (if pt not already dead)

A

aortic injury

47
Q

Pericardial tamponade - normal or abnormal cardiac contours/silhouette?

A

Normal

48
Q

Shock after MVA with elevated baseline PCWP that goes even higher with fluid bolus?

A

Hypovolemic shock 2/2 myocardial contusion

49
Q

Most common cause of SBO?

A

Post-surgical adhesions, even months ago

50
Q

Effect of positive pressure ventilation on decreased CVP (eg hypovolemic shock)?

A

Increased intrathoracic pressure that leads to … Acute loss of RV preload, loss of cardiac output, and sudden cardiac death

51
Q

Gallstone passes through biliary-enteric fistula casues?

A 
Gallstone ileus (a mechanical bowel obstruction), then you get air in loops of bowel
Treat with surgical stone removal and cholecystectomy
52
Q

Infections of prosthesis organisms and presentation (early vs late)?

A

Early: staph aureus (first 3 months) - acute pain, fever, local infx signs
LAte: cog-neg staph - chronic pain, implant loose, gait impairment, sinus tract formation

53
Q

GI and vasomotor sx (sweating, palps) post-gastectomy - think?
Treat?

A 
Dumping syndrome (rapid emptying of stomach contents)
Treat with dietary modification
54
Q

Appearance of ischemic bowel on imaging (post vasc surg)?

And on colonscopy?

A

Thickening of bowel wall

Cyanotic mucosa and hemorrhagic ulcerations

55
Q

Knee pain with erythema after repetitive kneeling?

Organism?

A

Prepatellar bursitis

Staph aureus

56
Q

Initial hematuria suggests?
Terminal hematuria?
Totoal hematuria?

A

Urethral damage
Bladder or prostate
Kidney or ureter (no clots here)

57
Q

Kid with epigastric pain and obstruction (bilious vomiting) following trauma?

A

Duodenal hematoma

58
Q

Anal fissure tx?

A

Increase fiber and fluid intake, stool softeners, sitz baths, topical anesthetics and vasodilators

59
Q

LE edema that worsen throughout day and resolves at night?

A

venous insufficiency

60
Q

Whistling post rhinoplasty?

A

nasal septal perforation

61
Q

Persistent pneumothorax with air leak following chest tube placement (also pseumomediastinum and sub-C emphyseam)?

A

tracheobronchial rupture

62
Q

Eschar in third degree (full thickness, circumferential) burns restrcicts venous and lymphatic drainage and leads to …

A

compartment syndrome

63
Q

Multiple rib fractures and resp distress (with lung contusion on CXR) .. think?

A

Flail chest

64
Q

Fever, sore throat, earache with muffled voice, tonsillar swelling, deviation of uvula - think?
Treat?

A

Peritonsillar abscess

Aspiration or I and D

65
Q

Retropharyngeal abscess (after trauma to posterior pharynx) can spread to??

A

Mediastinum (acute necrotizing)

66
Q

Folks at risk for emphysematous cholecystitis?
Arise due to?
Treat?

A

Immunosuppressed (eg diabetic)
Infx of gallbladder wall with gas-forming bacteria
Emergent cholecystectomy

67
Q

intense pain in wound, decreased sensivity, cloudy gray (dishwater) discharge, poss crepitus - signs of?
Treat?

A

Necrotizing surgical infx

Surgical debridement and abx

68
Q

4 Ts of mediastinal tumor?

A

Thymoma, teratoma, thyroid neoplasm, terrible lymphoma

69
Q

Most common areas for ischemic bowel?

A

Splenic flexure, rectosigmoid junction

70
Q

Tachypnea, tachycardia and hypoxia developingp in 24 hours after trauma with patchy alveolar infiltrate on CXR?

A

pulmonary contusion

71
Q

Acute-onset, sever, mid abdominal pain out of proportion to physical exam findings (can be after infected valve leaflets)?

A

Acute mesenteric ischemia

72
Q

Diverticulitis with abscess formation treatment?

A

Percutaneous dranage with CT and surgical drainage if that fails

73
Q

Irregular scrotal mass that increases in size with standing and Valsalva - do not transilluminate?

A

Dilation of pampniform plexus (varicocele)

74
Q

After placing central line, always next step?

A

Check placement with CXR

75
Q

Three Ps of compartment syndrome?

A

severe PAIN
PAIN with PASSIVE ROM
PARESTHESIAS
Then sensory and motor defecits

76
Q

Define ileus?

A

Functional defect in bowel motility without associated physical obstruction

77
Q

Acute abdomen in women - don’t forget on differential?

A

Ruptured ovarian cyst

78
Q

Constant gnawing epigastric pain, worse at night, anorexia with weight loss, jaundice, esp in smoker with fatigue?

A

Pancreatic cancer

Surgery (2 decks)

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