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Surgery > UWorld Surgery Qs > Flashcards

UWorld Surgery Qs Flashcards

1
Q

What are the 3 causes of vascular occlusion of the lower extremity?

A
  1. Embolus
  2. Thrombosis
  3. Trauma
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2
Q

Sudden and severe pain and pulseless-ness indicates what cause of vascular occlusion of the lower extremity?

A

Arterial embolus

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3
Q

Warmth and dull, aching pain, with present pulses, indicates what cause of vascular occlusion of the lower extremity?

A

Venous thrombosis (DVT)

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4
Q

What is a common complication of aortoiliac procedures that shows up on imaging as a discrete segment of cyanotic and ulcerated bowel?

A 
Colonic ischemia (usually left)
- Follows 7% of aortoiliac procedures
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5
Q

What is the imaging is used to evaluate hemoptysis in a patient that is unstable and also requires a therapeutic intervention?

A

Bronchoscopy

  • But first, secure the ABCs
  • If the patient were stable, then CT, not bronchoscopy
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6
Q

What are the causes of iMMMediate post-op fever (0-2hrs)?

A

Mismatched blood
Meds (anesthesia)
Malignant hyperthermia

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7
Q

What are the causes of acute post-op fever (24hrs-1wk)?

A

Nosocomial infections
SSI 1: GAS and Clostridium perfringens
MI, PE, DVT

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8
Q

What are the causes of subacute post-op fever (1wk-1mo)?

A

SSI 2/Catheter infections: not GAS or C. perfringens
C. diff
Drug fever
PE/DVT

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9
Q

What are the causes of delayed post-op fever (>1mo)?

A

Viral infections

SSI 3: indolent organisms

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10
Q

What breast disease is indicated by:

  • Intermittent bloody discharge from one nipple
  • No masses palpated
  • Perimenopausal woman
A

Intraductal papilloma

- Lesion is right under the nipple so no mass is felt

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11
Q

What vessel is ruptured to cause epidural hematomas?

A

Middle meningeal artery

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12
Q

What is a a complication of epidural hematomas that causes ipsilateral hemiparesis, ipsilateral mydriasis and strabismus, contralateral hemianopsia, and altered mentation?

A

Uncal herniation (transtentorial herniation of the parahippocampal uncus)

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13
Q

This constellation of symptoms indicates:

  • Tachypnea
  • Absent breath sounds on one side
  • Tympanic percussion
  • Mediastinal deviation on contralateral side
  • JVD
  • Hypotension
A

Tension pneumo

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14
Q

Individual presents with fleshy immobile mass on the midline hard palate. Most likely dx?

A

Torus palatinus

  • Exostosis located ont he midline suture of the hard aplate
  • Benign bony growth
  • No intervention required
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15
Q

What is the presumptive dx of an individual presenting with acute onset back pain and profound hypotension?

A

Ruptured AAA

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16
Q

What is the rx of a hemodynamically UNSTABLE patient with penetrating abdominal trauma?

A

Laparotomy

- Diagnose the source of the bleeding and treat it

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17
Q

Chronically ill patient presents with fever and leukocytosis, distention of bowel stomach and gb, and some pericholecysitc fluid is concerning for…

A

Acalculous cholecystitis

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18
Q

What is the definition of flail chest?

A

Paradoxical thoracic wall movements that correct with positive pressure mechanical ventilation

  • Caused by contiguous rib fractures that cause ribs to lose continuity with remainder of thoracic wall
  • Positive pressure puts disconnected segment back in sync
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19
Q

What is a common complication of gastrectomy characterized by:

  • Abd. cramps
  • Weakness
  • Light-headedness
  • Diaphoresis
A

Dumping Syndrome

Rx:

  • Dietary modification
  • Octreotide
  • Surgery
20
Q

What is the most common carpal bone fracture?

What is the Rx?

A

Scaphoid

Thumb spica cast and repeat radiography in 7-10d

21
Q

What is the most commonly injured nerve in a midshaft humeral fracture?

A

Radial nerve > limited wrist extension, wrist drop

22
Q

What is the rx of duodenal hematoma (most commonly occurring children following blunt trauma)?

A

Nasogastric suction, TPN

23
Q

Patient presents with sore throat, dysphagia, pain with swallowing, pain with certain neck movements, and pain with extension. If the patient has a history of surgery or trauma, what is a possible diagnosis?

A

Retropharyngeal abscess

  • Urgent drainage of abscess
  • Broad spectrum antibiotics to ensure it doesn’t spread to mediastinum
24
Q

What is the most common cause of SBO?

A

Adhesions, post-surgery

25
Q

How is the presence or absence of intraperitoneal hemorrhage determined in patients who are hemodynamically unstable and have an equivocal FAST exam?

A

Diagnostic peritoneal lavage

26
Q

What imaging does the clinical diagnosis of appendicitis warrant to confirm?

A

None! Can do CT or US if not sure, but otherwise can go straight to lap appy

27
Q

What are the 5Ps that make up the presentation of acute arterial occlusion w limb ischemia?

A
  • Pain
  • Pallor
  • Pulselessness
  • Paresthesia
  • Paralysis
  • Usually presents in lower > upper extremity
  • Rx = emergency vascular surgery evaluation
28
Q

What are the most common organisms for acute infections of joint prostheses?

A

Staph aureus
Gram (-) rods
Anaerobes

29
Q

What are the most common organisms for sub-acute infections of joint prostheses?

A

Coagulase (-) staphy (Staph epi)
Propionobacterium
Enterococci

30
Q

Post-op atelectasis is associated with:

  • Acidosis or alkalosis?
  • High or low PO2?
  • High or low PCO2?
A

Acidosis: pts are hyperventilating to compensate for hypoxemia

Low PO2 (hypoxemia due to less active lung)

Low PCO2 (breathing it all off)

Ex. pH 7.49, PO2 70 mmHg, PCO2 27 mmHg

Mostly seen on post-op days 2-5

31
Q

What is the clinical picture associated with acute mesenteric ischemia?

A

Post-op patient with diffuse abdominal tenderness, pain out of proportion to exam

  • Setting of atherosclerotic disease or AFib
32
Q

What lab findings are associated with acute mesenteric ischemia?

A
  • Leukocytosis
  • Elevated serum lactate
  • Elevated serum amylase
  • Elevated serum phosphate
  • Metabolic acidosis
33
Q

What’s the gold standard for diagnosis of acute mesenteric ischemia?

A

Mesenteric angiography

34
Q

Patient with blunt chest trauma presents with:

  • Persistent JVD
  • Tachycardia
  • Hypotension despite fluid resuscitation
  • CXR showing normal cardiac silhoutte

Diagnosis?

A

Cardiac tamponade

35
Q

What is done to evaluate patients with probable meniscal injury?

A

MRI

36
Q

What is the strongest risk factor for nasopharyngeal carcinoma?

A

Epstein Barr Virus

37
Q

Patient (non-alcoholic) presents with acute pancreatitis, likely due to gallstone obstruction. Episode is managed and resolved with analgesia and antibiotics.

  1. What’s the next step in this patient’s care?
  2. What would be the next step if the acute pancreatitis did not resolve?
A
  1. Cholecystectomy: indicated in all symptomatic patients with gallstones
  2. ERCP, early intervention
38
Q

Patient has hypocalcemia and hyperphosphatemia in the presence of normal renal fx. What is the cause?

A

Hypoparathyroidism

  • Post-surgical
  • Autoimmune
  • Non-immune parathyroid destruction
  • Defective calcium sensing receptor
39
Q

Patient presents with bilateral lower extremity edema and scaly skin. What is the most likely cause?

A

Lower extremity venous valvular incompetence

  • Pooling of venous blood
  • Increased pressure damages caps
  • Proteins and erythrocytes leak into tissue
  • Extravasation causes hemosiderin deposits
  • Discoloration and stasis dermatitis
  • Late stage disease involves ulcerations
40
Q

What nerve innervates the muscles of the anterior compartment of the thigh (knee extension and hip flexion) and provides sensation to the anterior thigh/medial leg?

A

Femoral nerve

- Sensation provided via Saphenous branch

41
Q

What are some risk factors for aortic dissection?

A
  • HTN (most comon)
  • Marfan’s
  • Cocaine use
42
Q

What are some complications of aortic dissection?

A
  • Stroke (carotids)
  • Acute aortic regurge (aortic valves)
  • Horner’s syndrome (superior cerivical sympathetic ganglion)
  • Acute MI (coronary artery)
  • Pericardial effusion/tamponade (pericardial cavity)
  • Hemothorax (pleural cavity
  • Lower extremity weakness (spinal or common iliac arteries)
  • Abdominal pain (mesenteric artery)
43
Q

What tests are done to confirm aortic aneurysm?

A

Chest CT with contrast, or TEE

44
Q

What is a complication of cardiac cath that presents with sudden hemodynamic instability and flank/back pain?

A

Retroperitoneal hematoma

- Non-contrast CT abd + pelvis to confirm

45
Q

What condition presents with fever, chest pain, leukocytosis, and mediastinal widening on CXR, usually following cardiac surgery?

A

Acute mediastinitis

46
Q

What is the rx of acute diverticulutis (soft tissue stranding and colonic wall thickening), plus abscess formation?

A

Percutaneous drainage of abscess with CT guidance

  • This is complicated diverticulitis bc abscess
  • Uncomplicated: antibiotic course
47
Q

What is a complication of cardiac cath that presents with sudden hemodynamic instability and flank/back pain?

A

Retroperitoneal hematoma

- Non-contrast CT abd + pelvis to confirm

Surgery (3 decks)

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