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Surgery Step 2 > Uworld > Flashcards

Uworld Flashcards

1
Q

RUQ pain, CT scan showing gaseous distension in SB/LB, GB distended with some pericholecystic fluid, no gallstones, think?

A

acalculous cholecystitis: occurs in severely ill pts, likely due to cholestasis and GB ischemia–>infection/necrosis
tx: abx + percutaneous cholecystOSTOMY followed by cholecystectomy when pt improves

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2
Q

5 hrs after cardiac cath pt develops hypotension, ^HR, back pain, diaphoresis, flat neck veins, think ?
dx?

A

retroperitoneal hematoma due to bleeding from arterial access site (femoral)
dx: noncontrast CT of abdomen/pelvis or U/S

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3
Q

what to do next with pt with blunt abdominal trauma + high risk features and negative FAST?

A

CT abdomen
high risk features: abdominal wall bruising, tenderness, guarding, hypotension, pleuritic CT, anemia
most likely splenic rupture!
if unstable: ex-lap

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4
Q

initiation of PPV can cause what changes in the heart?

A

decrease in RV preload due to ^intrathoracic pressure

results in decreased CO

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5
Q

EXTRA-axia well-circumscribed dural-based mass that is partially calcified on neuroimaging think? how to treat?

A

meningioma (+/- HA, FNDs, seizure)
tx: surgical resection
mets typ. INTRAaxial and multiple (radiation + CT scan of body)
chemo for GBM, medullo. (more malignant)

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6
Q

pneumomediastinum, subQ emphysema, persistent PTX even after chest tube placement, think ?

A

tracheobronchial rupture

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7
Q

causes of hemoptysis

A

pulm: bronchitis, PE, bronchiectasis, lung cancer
CV: mitral stenosis, AVM, coagulopathy
infectious: TB, lung abscess
systemic: Wegener’s, Goodpasture, SLE, vasculitis

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8
Q

hemoptysis pt is intubated, blood fills ET tube, what to do next?

A

bronchoscopy: can ID the bleed site and can tx while in there (tamponade, electrocautery)
if fails THEN pulm. arteriography
if that fails THEN thoracotomy

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9
Q

UG injury after pelvic rami fracture, think ?

A

EXTRAperitoneal bladder injury (EPBI)
gross hematuria, urinary retention
INTRAperitoneal involves the dome: will present with peritoneal signs

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10
Q

what deficit seen with anterior shoulder dislocation?

A

axillary n. injury: teres minor and deltoid, so weakened shoulder abduction

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11
Q

what deficit with mid-shaft humerus fx or poorly fitting crutches?

A

radial n. injury: extensor deficit of wrist and digits

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12
Q

what deficit with fracture of medial epicondyle of humerus?

A

ulnar n.: “claw hand”

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13
Q

findings with SBO that indicate emergent surgical exploration

A

changes in the character of pain, fever, hemodynamic instability, guarding, ^WBC, metabolic acidosis
otherwise: NPO, NG tube, IVF

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14
Q

cardio changes in hypovolemic shock

A

decreased preload and CO causes the heart to compensate with ^HR, ^SVR
also, decreased filling volume in the LV causes the heart to compensate with increasing the EF

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15
Q

post-op atelectasis is usually due to ?

A

accumulation of pharyngeal secretions, tongue prolapse, airway tissue edema, residual anesthetic effects, post-op pain inhibiting deep breathing/coughing

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16
Q

acid/base derangement seen with atelectasis?

A

they hyperventilate to compensate for the hypoxemia: respiratory alkalosis with low pCO2

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17
Q

labs in mesenteric ischemia

A

^WBCs, ^Hgb (hemoconcentration), ^amylase, metabolic acidosis due to ^lactate

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18
Q

acute calf pain and paresthesias following a LE embolectomy, think?

A

ischemic-reperfusion syndrome (form of compartment syndrome)

embolus would have decreased pulses distal to occlusion, DVT is often asymptomatic and has only “vague aching pain”

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19
Q

what to do if penetrating abdominal trauma and negative FAST + high risk features?

A

ex-lap!
high risk features: hemodyn. instability, peritoneal signs, evisceration, blood from NG tube or rectal exam
(in contrast to blunt trauma, in which you would do CT unless hemo. unstable–>ex-lap)

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20
Q

fever, chest pain, ^WBCs, mediastinal widening following cardiac sx, think? what to do next?

A

acute mediastinitis

drainage, surgical debridement, abx therapy

21
Q

infection from retropharyngeal abscess can spread to ?

A

posterior mediastinum via extension through the alar fascia

22
Q

any penetrating trauma below the nipples is considered abdomen and requires ? in unstable pts

A

ex-lap

23
Q

what may be the first signs of a burn wound infection?

A

change in burn wound appearance or loss of skin graft

24
Q

fever 1-6 hrs post op think?

A

febrile nonhemolytic transfusion reaction

others: prior infection/trauma, inflammation due to sx, malignant hyperthermia, meds (anesthetics)

25
Q

bloody diarrhea + abdominal pain POD #1 surgical repair of infrarenal aortic aneurysm, think?

A

bowel ischemia/infaction
if inadequate collateral perfusion after loss of IMA during aortic graft placement
in contrast, C. diff is not bloody and takes 4-5 ds after abx initiation

26
Q

Pilonidal disease vs perianal abscess

A

pilonidal: painful mass above anus in the crack with pus/bloody drainage
perianal: fever, mass at the anal verge (inside)

27
Q

ischemic colitis typically follows an episode of hypotension and affects what areas on the colon?
may see what on CT?

A

splenic flexure and rectosigmoid junction (watershed areas)
thickened bowel +/- air in bowel wall on CT, may confirm with colonoscopy (may see cyanotic mucosa and hemorrhagic ulcerations)

28
Q

patient with n/v, air in the biliary tree, hyperactive bowel sounds, dilated loops of bowel, think?

A

gallstone ileus, form of SBO
dx: CT scan tx: removal of stone + cholecystectomy
in contrast, emphysematous cholecystitis has fever, RUQ pain +/- ileus, not HYPERactive bowel sounds

29
Q

eval of GU trauma + micro hematuria: stable vs unstable

A

stable: U/A and CT abd/pelvis with contrast
unstable: IVP then surgery
RUG if gross hematuria, difficulty urinating, blood at the meatus, suprapubic pain, dysuria, retention (evidence of urethral injury)

30
Q

if classic appendicitis presentation, what to do next?

A

lap appy, no need for imaging unless unsure, it is a clinical diagnosis

31
Q

nausea, weakness, palpitations, diaphoresis after meals in post-gastrectomy pt, think?

A

dumping syndrome, loss of normal pylorus functioning, dumping into duodenum/sm. intestine
tx: small meals with complex carbs, protein

32
Q

gallstone pancreatitis, what to do next?

A

early cholecystectomy

33
Q

anterior mediastinal masses

A

thymoma
teratoma (+ other germ cell tumors)
thyroid neoplasm
terrible lymphoma

34
Q

^B-hCG and ^AFP with anterior mediastinal mass

A

mixed germ cell tumor

35
Q

what to do with complicated diverticulitis with abscess formation?

A

CT-guided percutaneous drainage

if fails, surgical drainage

36
Q

anticoagulation in DVT tx in pt with ESRD

A

unfractionated heparin to warfarin

37
Q

atelectasis results from ? after surgery

A

shallow breathing and impaired cough due to pain

38
Q

uncal herniation can cause paralysis of what CN?

A

CNIII (oculomotor)

39
Q

burns may compromise vascular supply, how?

A

circumferential, full-thickness burns may lead to compartment syndrome due to constriction of venous/lymphatic drainage

40
Q

acute b/l flaccid paralysis and loss of pain/temp with UMN signs (days-wks later), think?

A

spinal shock, anterior spinal cord infarction
complication of thoracic aortic aneurysm sx
vibr/proprio typically intact

41
Q

PPV can lead to what cardiac change

A

acute loss of RV preload due to ^^intrathoracic pressure

42
Q

pt with should pain after abdominal trauma, think?

A

referred pain from peritonitis (C3-5)

i.e. rupture of the dome of the bladder (intraperitoneal)

43
Q

timing of hematuria:
throughout:
late:
early:

A

throughout: renal/ureteral
late: bladder/prostate
early: urethral

44
Q

what do increasing levels of paCO2 do to CBF?

A

^paCO2 increases CBF (vasodilation)

hyperventilating decreases paCO2, causing vasoconstriction and reduced CBF/ICP

45
Q

if think diaphragmatic rupture on CXR, what to do next?

A

CT chest to confirm

46
Q

what to do if flail chest

A

PPV to improve oxygenation, it also causes the flail segment to move normally

47
Q

medial meniscus vs medial ligament tear

A

meniscus: typically shows small effusion and creptitus, locking/catching
ligament: tenderness and laxity +/- ecchymosis

48
Q

rotator cuff tendonitis vs tear

A

both will have pain with abduction + external rotation

tear: WEAKNESS with external rotation as well

49
Q

complications of supracondylar humerus fractures (MC fx in kiddos!- FOOSH)

A

brachial artery + median nerve injury (entrapment)
leads to loss of brachial and radial pulses
cubitus varus deformity
rare: compartment syndrome –> Volkmann contracture

Surgery Step 2 (2 decks)

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