UWorld - Surgery questions Flashcards by Cameron Niswander

4 tumors in anterior mediastinum

4 T's:
Thymoma
Teratoma (AFP, ß-hcg)
Thyroid
Terrible lymphoma)

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Late complication of blunt force trauma to abdomen

Diaphragmatic hernia
Need CXR (bowel loops in chest)
Need CT

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Anal fissures
Most common location?
Treatment?

Posterior midline
Fiber/fluids
Sitz bath
Topical anesthetic
Vasodilators (reduce pressure, increase flow for healing)

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Field amputations (eg digits) should be….

Wrapped in sterile gauze, soaked in saline, and put on ice

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Chronic pancreaitis complication and treatment

Pseudocyst
ASx = initial expectant management
Sx = Drain
No IV abx unless infected

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Nasal furunculosis

“Rudolph sign”

Infected deep hair follicle

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Rhinoplasty complications

Nasal obstruction
Epistaxis
Septal perforation (also from trauma, syphillis, TB, sarcoid, GPA)

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Supracondylar fracture of humerus:
Common complications
Other complications

Brachial artery entrapment, median nerve injury

Rare: compartment syndrome -> volkman contracture

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Acute mesenteric ischemia
Pres:
RF:
Lab:
Dx:

Rapid actue, severe onset periumbilical pain
Pain out of proportion to exam
RF: atherosclerosis, embolic sources, hypercoag d/o
Lab: WBC, amylase, phosphate, lactate (met acid)
Dx: (Best) CT -> MR angio -> Mesenteric angio (if unclear)

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Blunt abdominal trauma pathway in a hemodynamically stable patient

FAST -> CT if positive

Negative but high risk mech or PE = CT w/ con anyway

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SBO management

Nml VS w/ colicky pain: bowel rest, NG suction, IVF

Fever, leukocytosis, constant pain: urgent surgery

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Pediatric abdominal wall defects

Umbilical hernia: skin covering, monitor till age 5
Gastroschisis: Bowel sticking out, surgery
Omphalocele: Peritoneum covering, surgery

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Scaphoid fracture workup

Immediate XR: often negative
Either confirm with CT/MR or
Thumb spica for 2 weeks and re-XR

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Post-op elderly person with poor oral hygiene/dehydration: infection risk

Acute bacterial parotitis
PPx: Adequate fluid, oral hygiene
Tx: Abx, drainage

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AAA screening age range

65-75 with history of smoking

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ABI interpretation

1.3 = Suggestive of calcified/incompressible vessel

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Blunt kidney trauma workup

UA -> CT A/P -> IVP -> sugery

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Flow of tx for suspected esophageal varacies

Two large bore IV's (16's)
IVF and octreotide
Urgent EGD with banding
No further bleed: 2˚ ppx (ß-blocker)
Cont bleed: balloon tamp (temp) -> TIPS
Early rebleed: repeat EGD, still bleeding? -> TIPS

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Pneumothorax, pneumomediastinum, subq emphysema all suggest?

Tracheobronchial rupture (R>L)
Need airway
Dx: CT, bronchoscopy, surgical exploration
Tx: Surgical repair

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Penile fracture
Pathophys:
Maybe imaging?:
Tx:

Rupture of corpus cavernosum d/t tear in tunica albuginea
Retrograde urethrogram if: blood, urinary retention
Tx: emergency urologic surgery

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Patient post-heart cath with back pain, hypotension/shocky, unchanged ECG

Bleeding from arterial access site with retroperitoneal extension
Dx: Non-con CT A/P or abd U/S
Tx: Supportive, IVF, transfusion if necessary

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Pediatric patient with h/o BAT (days) presenting with bilious vomiting, abd pain

Duodenal hematoma
Dx: CT abd
Tx: Nonop = NG suction, parenteral nutrition
Tx: Op = if nonop fails, evacuation or percutaneous drainage

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Who gets acalculous cholecystitis?

Sick as shit
Multiorgan failure, severe trauma/surgery/burns, prolong parenteral nutrition
Likely d/t cholestasis and gallbladder ischemia -> infxn

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Diagnosis and treatment of acalculous cholecytitis

Gallbladder distention with pericholecystic fluid
Tx: Percutaneous cholecystotomy while still sick
Tx: Cholecystectomy once condition improves

Etiologies of fat embolism | Triad of fat embolism

Fx of marrow containing bone (classic = femur), ortho surg, pancreatitis 1. Respiratory distress 2. Altered CNS 3. Petechial rash

Charcot's triad? | Reynolds pentad?

1. Fever 2. RUQ pain 3. Jaundice 4. Hypotension 5. AMS = Acute cholangitis

Compartment syndrome S/Sx?

``` Pain out of proportion Pain on passive stretch Rapid increase swelling Paraesthesias (early) Decreased distal pulses (very uncommon) ```

Difference between compartment syndrome and DVT presentation?

``` Acuity Neurologic involvement (paraesthesia) = compartment ```

Presenting symptom of myocardial rupture?

Death

Lower GI bleed after episode of hypotension? | Where is the defect?

``` Ischemic colitis Splenic flexure (watershed between SMA and IMA) ```

Next step in penetrating abdominal trauma with possible injury to organ? (positive FAST or rebound?)

Ex Lap (skip the CT)

Emphysematous cholecystitis - findings and management?

Fever, RUQ pain (no jaundice) Gas in gallbladder wall (d/t gas producing infection) Emergent chole, broad spec abx

Initial approach to trauma patient

Cardio/respiratory stability C spine precautions Neuro deficit? Foley to eval (as long as no suspected injury)

Blunt thoracic injury with delayed tachycardia, tachypnea, and irregular alveolar filling

Pulmonary contusion with alveolar hemorrhage

Provoked DVT treatment in ESRD patient

Unfractionated heparin with transition to warfarin | No lovenox or novel agents in ESRD

Etiology of acute adrenal insufficency

Adrenal infarction or hemorrhage | Acute illness or surgery in patient with history of chronic adrenal insufficiency OR long term steroid use

Clinical features of adrenal insufficiency

Hypotension, shock N/V Abdominal pain Fever

Treatment of adrenal insufficency

High flow IVF | Hydrocortisone or Dex

Presentation of acute mesenteric ischemia

Pain out of proportion on exam Rapid onset of peri-umbilical pain Hematochezia (LATE COMPLICATION)

What is prepatellar bursitis?

Nursemaid's knee Anterior patellar swelling with sharp pain Common in professions with lots of kneeling Often staph aureus Requires drainage and abx

Succinylcholine mech Side effect Avoid in

Depolarizing, Na in, K out Hyperkalemia, arrhythmia Skeletal muscle trauma, burn, stroke

``` Classic side effects: Halothane Etiomidate NO Propofol ```

Halothane: liver tox, rarely used Etiomidate: 11ß-hydroxylase inhibition, AI NO: inactivates B12, methionine synthase, neurotox Propofol: myocardial depression, hypotension

Aflatoxin B1 association?

Agriculture | Hepatocellular carcinoma

Nasalpharyngeal carcinoma association?

EBV

Differentiating shin splints (medial tibial stress syndrome) vs. stress fracture

Point tenderness | Both non-visable on XR

Clinical features of dumping syndrome

Abd pain, diarrhea, nausea Hypotension, tachycardia Dizzy, fatigue, diaphoretic

S/Sx of hypocalcemia

Perioral tingling Finger paraesthesia Muscle cramps Prolonged QTc

Signs for urgent surgical exploration of vascular extremity trauma

Pulsatile bleeding Bruit/thrill Expanding hematoma Signs of distal ischemia

Trauma with hypotension that is unresponsive to fluid and elevated JVP

Pericardial tamponade

Cutaneous malignancy that arises in burn patients after years of inflammation

SCC

Treatment for patient on warfarin that needs to go to OR?

FFP

``` Scrotal masses: Soft mass increases with valsalva, no translumination? Translumination? Cyst at head of epididymis? Hard mass in testicle? ```

1. Varicocele, bag of worms, left 2. Hydrocele, fluid b/t p/v layer of tunica vaginalis 3. Spermatocele 4. Cancer

Treatment of varicocele?

Young with atrophy: gonadal vein ligation | Old who don't want kids: NSAIDs

Concern for abdominal involvement in penetrating trauma?

Nipple line

Penetrating trauma with equivocal fast, questionable abdominal and/or thoracic involvement, and unstable vitals?

``` Ex Lap (skip CT) CT with stable vitals ```

Signs of necrotizing skin wound infection (requiring urgent debridement?)

``` Pain, edema beyond surgical site Systemic signs Paraesthesia/anesthesia around wound site "Dishwater drainage" Gas/crepitus ```

Leriche syndrome (aka occlusion of arteries at aortic bifurcation)

Triad: Hip/thigh/butt pain Impotence Symmetric atrophy of LE

Retropharyngeal abscess concern

"Danger space" | Extension down to mediastinum

Burn wound sepsis criteria

High or low temp Tachycardia Tachypnea Hypotension