Brainscape's Knowledge GenomeTM

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


See full index

Surgery > UWorld Questions > Flashcards

UWorld Questions Flashcards

0
Q

Early dumping syndrome

A

50% w/ partial gastrectomy experience it.

Rapid emptying of hypertonic gastric content into duodenum and small intestine –> fluid shift from Intravascular space to sm. int., release of vasoactive polypeptides, and stimulation of autonomic reflexes –> Tx = dietary changes (octreotide in rx cases)

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

What is most important goal in management of rib fx w/ dec. respiratory movements on that side?

A

Adequate analgesia –> allows proper ventilation and prevents atelectasis and pna

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

Newborn hydrocele –> Management?

A

Observe –> most resolve in 12 months

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

MCC of acute mesenteric ischemia?

A

Emboli from the heart (Afib)

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

Pain associated w/ PVD?

A

Exercise-induced

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

Post-op fever, GO!

A

Days 1-2 = Pna, atelectasis
Days 3-5 = UTI
Days 4-6 = DVT, catheters (femoral > subclavian)
Days 5-7 = Wound infection (SSI)
> 7 days = Meds (drug fever) –> Anticonvulsants, TMP/SMX

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

Anterior Cord Syndrome

A

Associated w/ burst fx of vertebra + total loss of motor function below the lesion w/ loss of temperature and pain bilaterally

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

Hypoparathyroid signs/sx

A
  1. May be asx at initial presentation (incidental finding)
  2. Fatigue, anxiety, depression
  3. Tetany (lips, face, extremities) and sz in severe hypocalcemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ECG finding associated w/ hypocalcemia?

A

QT prolongation

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

MC complication of thyroidectomy?

A

Post-op hypoparathyroidism –> hypocalcemia

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

1st step in management of suspected urethral injury?

A

Retrograde urethrogram. Foley predisposes to abscess formation

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

Classic presentation of intraductal papilloma?

A

Intermittent bloody d/c from one nipple (benign). Masses generally not appreciated

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

MC situation to see acalculous cholecystitis?

A

Chronically hospitalized ICU pts w/: multiorgan failure, severe trauma, surgery, burns, sepsis or prolonged TPN

Most likely due to cholestasis and GB ischemia leading to infection, edema, and necrosis

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

Pt develops whistling during respiration following rhinoplasty

A

Nasal septal perforation from septal hematoma

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

Scaphoid fx management

A

Initial XR, Thumb spica w/ f/u radiography in 7-10 days

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

Classic location of venous HTN in legs (stasis dermatitis)

A

Medial leg superior to medial malleolus

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

Solitary Pulmonary Nodule algorithm

A

SPN on CXR –> Chest CT –> Benign –> serial CT

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

Lower GI bleed algorithm

A

Severe hematochezia (bright blood) –> Supportive therapy –> NGT –> No blood + bile (colonoscopy) –> Negative –> pt stops bleeding (no) –> labeled RBC scintigraphy (Te-99) localizes bleeding

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

IJ cath placement –> next step?

A

CXR

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

SCFE tx ?

A

Promptly tx w/ surgical pinning of slipped epiphysis where it lies to lessen risk of avascular necrosis of femoral head and chondrolysis

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

Pulmonary contusion presentation

A

Common in MVA … Sx usually develop in first 24 hours w/ patchy alveolar infiltrate on CXR

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

Orotracheal intubation (RSI) procedure

A

4 people: stabilize pt, induce w/ anesthesia, applies cricoid pressure to prevent passive regurgitation until tube is placed, place tube

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

Definition of oliguria in pt w/out preexisting kidney disease?

A

< 400 cc/day .. will also see elevated BUN:Cr (> 20:1) and FENa < 1

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

New onset oliguria management?

A

Change foley. IV fluid bolus.

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

Acute shoulder pain after forceful abduction and external rotation

A

Anterior shoulder dislocation –> axillary nerve/artery injury

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

Joint aspiration finding common to ACL tear?

A

Hemarthrosis

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

Acute GI perforation requires emergent ex-lap. If pt is on Warfarin, how do you reverse the anticoagulation rapidly pre-op?

A

FFP (not Vit K)

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

Shoulder complication of grand mal tonic-clonic sz?

A

Posterior dislocation (adducted, internally rotated w/ inability to externally rotate)

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

MC bone to be affected by stress fx?

A

Anterior tibia in middle 1/3 (jumping sports) and posteromedial distal 1/3 (runners) … XR frequently normal

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

Urethral injury associated w/ pelvic fx?

A

Posterior urethral injury (blood at meatus, high riding prostate, scrotal hematoma, inability to void despite urge, palpably distended bladder)

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

Simple way to inc. Functional Residual Capacity (FRC)

A

Move from supine to sitting (inc. 20-35%) can help prevent post-op atelectasis

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

Traumatic spinal cord injury important early step after Air/Breathe

A

Urinary cath to assess for urinary retention and prevent distention and damage. Femoral line only if Peripheral IV unable to be obtained or emergent access needed

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

HoTN despite aggressive fluid resuscitation?

A

Cardiac tamponade is possible (esp. w/ JVD, tachycardia, blunt chest trauma)

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

Major risk factor for pyloric stricture?

A

acid ingestion

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

Sx of gastric outlet obstruction?

A

early satiety, N/nonbilious Vomiting, weight loss, succussion splash in epigastrium

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

Paget’s disease of bone dx

A

Inc. bone-specific ALP on routine lab eval usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Paget’s disease of bone

A

osteitis deformans –> disordered bone remodeling –> inc. osteoclast activity –> pain resulting from bowing or fx

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

XR and bone scan findings of Paget’s disease of bone

A

Enlargement of skull bones (frontal bossing, inc. head size), headaches, CN palsies. HEARING LOSS due to cochlear nerve damage

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

Hemoptysis and high clinical suspicion for TB –> management?

A

Respiratory isolation

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

Hemoptysis algorithm

A

H&P to r/o other causes –> Mild/moderate –> CXR, CBC, coags, renal function, U/A, rheum —> CT +/- bronch –> tx via bronch, embolization, resection

Massive bleeding (> 600 mL/24 hrs or 100 mL/hr) –> Secure ABCs –> stops (CXR, CBC, etc) –> cont. (tx)

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

HoTN and back pain after cardiac cath? Management?

A

Retroperitoneal bleeding –> CT abdomen, pelvis w/ supportive tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

CT findings of diffuse axonal injury?

A

Numerous punctate hemorrhages w/ blurring of grey-white interface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Initial DVT tx?

A

Heparin acutely, Warfarin long-term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Uric acid stone eval

A

Radiolucent –> CT or IV pyelogram to see –> can can cause ureteral colic and a vagal reaction causing an ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

When do you typically see atelectasis? Results from what?

A

POD 2-3 … results from weak cough and shallow breathing due to pain following abdominal or thoracoabdominal surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Prevention of atelectasis?

A

Adequate pain control, deep-breathing exercises, directed coughing, early mobilization, incentive spirometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Signs of fat embolism

A

respiratory distress, mental status changes and petechiae following latent period of 12-72 hours after initial injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pulmonary contusion signs/sx

A

dyspnea, tachypnea, chest pain, hypoxemia worsened by intravascular volume expansion, patchy and irregular alveolar infiltrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Femoral nerve anatomic innervation

A

Anterior compartment of thigh (quadriceps femoris, sartorius, pectineus) and is responsible for knee extension and hip flexion. Sensation to anterior thigh and medial leg (saphenous nerve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Tibial nerve innervation

A

posterior compartment of thigh, leg, and plantar muscles of foot. Flexion of knee and digits, and plantar flexion. Sensation to leg (not medial) and plantar foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Obturator nerve innervation

A

Medial compartment of thigh (gracilis adductor longus, adductor brevis, anterior adductor magnus) and adducts thigh. Sensation over medial thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Common peroneal nerve innervation

A

Superficial and deep peroneal nerves. Anterior and lateral leg. Sensation to anterolateral leg and dorsum of foot

52
Q

Another name for common peroneal nerve?

A

Fibular nerve

53
Q

Nasopharyngeal cancer (Mediterranean and Far East)

A

EBV association

54
Q

AAA repair complications

A

Bowel ischemia (can present w/ abdominal pain, bloody diarrhea, fever, leukocytosis) and can present w/in 24 hours of surgery

55
Q

Post-op parotitis

A

Acute bacterial parotitis w/ painful swelling can present w/ fever and tenderness, edema, erythema and can be prevented by adequate fluid hydration and oral hygiene. S. aureus

56
Q

Clavicular fx work-up?

A

Neurovascular exam (angiogram especially if bruit heard)

57
Q

carboxyhemoglobin level indicative of upper airway and/or smoke inhalation injury?

A

> 10%

58
Q

Ischemia-reperfusion syndrome

A

Following 4-6 hours of ischemia, tissues suffer intracellular and interstitial edema on reperfusion –> compartment syndrome

59
Q

Non bleeding esophageal varices tx?

A

Nonselective beta antagonists (Propranolol –> dec. portal venous pressure) , IV PPI, oral lactulose for encephalopathy (if present), diuresis for ascites (if present)

60
Q

When would hypoglossal nerve be vulnerable to injury?

A

Tongue palsy –> surgery below mandible (submandibular salivary gland)

61
Q

Central cord syndrome

A

Hyperextension injuries (elderly w/ spondylosis)

weakness more pronounced in UE than LE w/ localized pain/temp deficits

62
Q

Early signs/sx of CO inhalation

A

Neurological and include agitation, confusion, somnolence

63
Q

Transtentorial (Uncal) Herniation

A

Compression of contralateral crus cerebri –> ipsilateral hemiparesis
Compression of ipsilateral CN III by herniated uncus –> Loss of PNS (mydriasis ; occurs early), loss of motor (ptosis, down and out gaze via unopposed CN IV, VI ; late)

Compression of ipsilateral posterior cerebral aa. (visual cortex) –> contralateral homonymous hemianopsia

Compression of reticular formation –> altered LOC, coma

64
Q

Cushing’s reflex

A

HTN, bradycardia, respiratory depression indicates elevated ICP

65
Q

How does hyperventilation dec. ICP?

A

CO2 washout –> vasoconstriction

66
Q

Signs/sx of post-traumatic syringomyelia

A

Whiplash often inciting event; sx mo to years later; enlargement of central canal due to CSF retention

Impaired strength, pain/temp sensation in UE

67
Q

Acute onset back pain, profound HoTN, syncope, gross hematuria

A

AAA rupture; gross hematuria from rupture of fragile and distended bladder veins from an aortocaval fistula

68
Q

Unilateral subacute hip pain in male child w/ progressive antalgic gait, thigh muscle atrophy, dec. hip ROM, collapse of ipsilateral femoral head

A

Suggestive of avascular necrosis associated w/ Legg-Calve-Perthes

69
Q

Legg-Calve-Perthes etiology?

A

MC in boys 4-10 w/ classic presentation as hip, knee or groin pain + antalgic gait

70
Q

Management of Legg-Calve-Perthes

A

Observation and bracing but surgery if femoral head not well contained in acetabulum

71
Q

Duodenal hematoma pathophysiology?

A

MC seen in children; blood collects between submucosa and muscular layers causing obstruction

72
Q

Classic presentation of duodenal hematoma?

A

Epigastric pain + N/V

73
Q

Course and management of duodenal hematoma?

A

Typically resolve spontaneously in 1-2 weeks w/ NGT and parenteral nutrition. Surgery if non-op fails or if hemorrhage or perforation

74
Q

Widened mediastinum w/ mediastinal air…

A

Esophageal perforation (iatrogenic, Boerhaave, pill esophagitis [KCL], ulcer, infectious [Candida], caustic ingestion)

75
Q

Presentation of esophageal perforation?

A

Sudden-onset and severe pain located retrosternally, or in neck/back/abdomen made worse w/ swallowing. Subcutaneous emphysema (Hamman sign)

76
Q

Dx of esophageal perforation?

A

Contrast esophagogram (Gastrografin)

77
Q

Management of esophageal perforation?

A

Broad-spectrum ABx, parenteral nutrition, surgical repair

78
Q

MCC of bright red bleeding in an elderly pt?

A

Diverticulosis

79
Q

Formation of colonic diverticula?

A

High intraluminal colonic pressure –> mucosa and muscularis herniate through wall (false)

80
Q

Colonic angiodysplasia

A

inc. w/ age, but still uncommon and less likely cause of hemorrhage

81
Q

Rare neurologic complication of aortic aneurysm surgery?

A

Spinal cord ischemia –> abrupt onset of weakness and bowel/bladder dysfunction, flaccid paralysis, sexual dysfunction, HoTN, loss of DTRs

82
Q

Post-op ischemic stroke a likely possibility w/ intact vibratory, BL involvement and normal UE function?

A

Probably not

83
Q

When is CT/US scan useful in a suspected apply?

A

Atypical presentations, pregnant women, elderly

84
Q

Would you see pneumomediastinum w/ Mallory-Weiss tears? Boerhaave?

A

No, as the tear is incomplete. Yes, the tear is complete.

85
Q

Management of stress/hairline fx of metatarsal?

A

Rest and analgesics. Plaster cast if failure of this.

86
Q

At what level is a penetrating injury considered to be in the abdomen?

A

Anything below 4th ICS (level of nipples) is considered to involve the abdomen and requires an ex-lap in unstable patients

87
Q

(+) Trendelenburg sign?

A

Contralateral hip drop when standing on one foot. Superior gluteal nerve injury (innervates gluteus medius and minimus)

88
Q

Morton neuroma PE signs?

A

Clicking sensation when squeezing 3rd/4th metatarsals together w/ pain on plantar surface

89
Q

What is Morton neuroma? Tx?

A

Mechanically induced degenerative neuropathy commonly seen in runners. Conservative w/ bilateral shoe inserts, surgery for failure

90
Q

Tx of Nursemaid elbow (subluxation of radial head)?

A
  1. Extend and distract the elbow
  2. Supinate the forearm
  3. Hyperflex the elbow w/ thumb over radial head to feel the reduction
91
Q

Management of complicated diverticulitis w/ abscess formation?

A

Percutaneous drainage

92
Q

Splenic trauma. Dx?

A

Can present w/ delayed sx including HoTN, abdominal pain, left shoulder pain. CT w/ contrast

93
Q

Typical presentation of venous valve incompetence?

A

MCC of LE edema. Worsens throughout the day and resolves overnight

94
Q

Imaging of choice for suspected urinary stone?

A

Non-contrast spiral CT

95
Q

Nerve commonly injured w/ midshaft humerus fx?

A

Radial nerve –> numbness and extensor weakness

96
Q

Fluid in spleno-renal angle. BP responsive to fluids –> next step? BP unresponsive to fluids?

A

Responsive and stable = CT

Unresponsive unstable = immediate ex-lap

97
Q

Common cause of post-op atelectasis?

A

pharyngeal secretions, tongue prolapsing into pharynx, airway tissue edema, residual anesthetic effects

98
Q

When is atelectasis more common?

A

Following abdominal and thoracoabdominal procedures

99
Q

Physiology behind ABG of atelectasis?

A

Compensation for hypoxemia –> hyperventilation –> respiratory alkalosis –> dec. PaCO2 –>

100
Q

What is the upper triangle sign?

A

Some pts w/ R lower lobe collapse you can see a triangular shadow in RUL field cont. w/ mediastinum and apex pointing towards the right hills. Represents a shift of upper anterior mediastinum to the right

101
Q

Direct radiologic signs of atelectasis? Indirect?

A

Crowded pulmonary vessels, crowded air bronchograms, displacement of interlobar fissures.

Opacification, elevation of diaphragm, shift of [trachea, heart, mediastinum], hilar displacement, compensatory hyperexpansion of surrounding parenchyma, approximation of the ribs, shifting granulomas

102
Q

Types of atelectasis?

A

Segmental, lobar, whole lung

103
Q

Fat necrosis vs cancer of breast?

A

Fat necrosis = fat globules and foamy macrophages

Can mimic cancer on imaging

No tx

105
Q

Volkmann’s ischemic contracture?

A

final sequel of compartment syndrome in which dead muscle has been replaced w/ fibrous tissue

106
Q

MC peripheral artery aneurysms?

A

Popliteal > femoral –> both associated w/ AAA

107
Q

Pain w/ forceful torsion of knee at 90, popping sound at injury, commonly (+) McMurray’s

A

Meniscus tear. Bucket handle tear leads to locking w/ terminal extension

108
Q

S/p repair of femoral fx and femoral artery injury –> now has passive movement pain, paresthesias, pallor, paresis

A

Compartment syndrome –> fasciotomy

109
Q

Dx of esophageal perforation

A

Water-soluble contrast esophagogram

110
Q

Penile fx management

A

Emergent retrograde urethrogram and surgical exploration

111
Q

Acute mediastinitis tx

A

can occur following surgery and presents w/ fever, CP, leukocytosis, and mediastinal widening on CXR

requires drainage, debridement, ABx

112
Q

First physiologic changes visible in hypovolemia

A

Tachycardia and peripheral vascular constriction are first changes

113
Q

Class I hemorrhage

A

< 750 cc lost, normal BP, normal HR, normal cap refill, normal CNS sx

114
Q

Class II hemorrhage

A

750 - 1500 cc, slight dec. BP, HR: 100-120, delayed cap refill, dec. urine output

115
Q

Class III hemorrhage

A

1500-2000 cc, HR > 120, markedly dec. BP, dec. urine output, confusion

116
Q

Retroperitoneal hemorrhage + lumbar fx w/ gaseous distention and absent bowel sounds

A

Paralytic ileus

117
Q

Classic presentation of embolic occlusion in extremity?

A

sudden-onset severe pain w/ asymmetric pulses

118
Q

TBI w/ LOC, vomiting, headache need what? TBI w/out sx need what?

A

CT scan. No scan neeeded, just brief ED observation

119
Q

Tetanus prophylaxis after injury?

A

Unimmunized, uncertain, or < 3 toxoid doses

 - Minor and clean wound --> tetanus toxoid only
 - Severe/dirt --> Toxoid and Ig

> 3 toxoid doses

 - Minor/clean --> None
 - Severe/dirt --> toxoid if  booster given > 5 yrs ago
120
Q

Presentation of varicocele

A

dull, aching testis pain and MC on left side, inc. w/ Valsalva

121
Q

Epidural vs subdural

A

Epidural –> LOC followed by lucid interval followed by deterioration (N/V, headache)

122
Q

(+) psoas sign

A

Psoas abscess which is known complication of perforated appendicitis

123
Q

Normal resting respiratory quotient (RQ)

A

0.8

124
Q

RQ > 1

A

indicates carbs are being served as sole nutritional source and net lipogenesis is occurring

125
Q

Metabolism of proteins alone = ? RQ

A

0.8

126
Q

Metabolism of fatty acids alone = ? RQ

A

0.7

127
Q

Importance of RQ in mechanical ventilation?

A

Overfeeding w/ carbs can cause excessive CO2 production making weaning more challenging

128
Q

Ludwig angina? Classic origin? Cause?

A

rapidly progressive bilateral cellulitis of submandibular and sublingual area. 2nd or 3rd molar. Streptococcus and anaerobes

129
Q

Presentation of ludwig angina?

A

fever, dysphagia, odynophagia, and drooling, crepitus w/ asphyxiation MCC of death

Surgery (7 decks)

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