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Surgery > UWorld - Surgery questions > Flashcards

UWorld - Surgery questions Flashcards

1
Q

4 tumors in anterior mediastinum

A 
4 T's:
Thymoma
Teratoma (AFP, ß-hcg)
Thyroid
Terrible lymphoma)
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2
Q

Late complication of blunt force trauma to abdomen

A

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

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3
Q

Anal fissures
Most common location?
Treatment?

A 
Posterior midline
Fiber/fluids
Sitz bath
Topical anesthetic
Vasodilators (reduce pressure, increase flow for healing)
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4
Q

Field amputations (eg digits) should be….

A

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

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5
Q

Chronic pancreaitis complication and treatment

A

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

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6
Q

Nasal furunculosis

A

“Rudolph sign”

Infected deep hair follicle

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7
Q

Rhinoplasty complications

A 
Nasal obstruction
Epistaxis
Septal perforation (also from trauma, syphillis, TB, sarcoid, GPA)
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8
Q

Supracondylar fracture of humerus:
Common complications
Other complications

A

Brachial artery entrapment, median nerve injury

Rare: compartment syndrome -> volkman contracture

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9
Q 
Acute mesenteric ischemia
Pres:
RF:
Lab:
Dx:
A

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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10
Q

Blunt abdominal trauma pathway in a hemodynamically stable patient

A

FAST -> CT if positive

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

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11
Q

SBO management

A

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

Fever, leukocytosis, constant pain: urgent surgery

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12
Q

Pediatric abdominal wall defects

A

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

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13
Q

Scaphoid fracture workup

A

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

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14
Q

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

A

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

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15
Q

AAA screening age range

A

65-75 with history of smoking

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16
Q

ABI interpretation

A

1.3 = Suggestive of calcified/incompressible vessel

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17
Q

Blunt kidney trauma workup

A

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

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18
Q

Flow of tx for suspected esophageal varacies

A 
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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19
Q

Pneumothorax, pneumomediastinum, subq emphysema all suggest?

A

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

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20
Q

Penile fracture
Pathophys:
Maybe imaging?:
Tx:

A

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

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21
Q

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

A

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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22
Q

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

A

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

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23
Q

Who gets acalculous cholecystitis?

A

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

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24
Q

Diagnosis and treatment of acalculous cholecytitis

A

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

25
Q

Etiologies of fat embolism

Triad of fat embolism

A

Fx of marrow containing bone (classic = femur), ortho surg, pancreatitis

  1. Respiratory distress
  2. Altered CNS
  3. Petechial rash
26
Q

Charcot’s triad?

Reynolds pentad?

A
  1. Fever 2. RUQ pain 3. Jaundice
  2. Hypotension 5. AMS

= Acute cholangitis

27
Q

Compartment syndrome S/Sx?

A 
Pain out of proportion
Pain on passive stretch
Rapid increase swelling
Paraesthesias (early)
Decreased distal pulses (very uncommon)
28
Q

Difference between compartment syndrome and DVT presentation?

A 
Acuity
Neurologic involvement (paraesthesia) = compartment
29
Q

Presenting symptom of myocardial rupture?

A

Death

30
Q

Lower GI bleed after episode of hypotension?

Where is the defect?

A 
Ischemic colitis
Splenic flexure (watershed between SMA and IMA)
31
Q

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

A

Ex Lap (skip the CT)

32
Q

Emphysematous cholecystitis - findings and management?

A

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

33
Q

Initial approach to trauma patient

A

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

34
Q

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

A

Pulmonary contusion with alveolar hemorrhage

35
Q

Provoked DVT treatment in ESRD patient

A

Unfractionated heparin with transition to warfarin

No lovenox or novel agents in ESRD

36
Q

Etiology of acute adrenal insufficency

A

Adrenal infarction or hemorrhage

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

37
Q

Clinical features of adrenal insufficiency

A

Hypotension, shock
N/V
Abdominal pain
Fever

38
Q

Treatment of adrenal insufficency

A

High flow IVF

Hydrocortisone or Dex

39
Q

Presentation of acute mesenteric ischemia

A

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

40
Q

What is prepatellar bursitis?

A

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

41
Q

Succinylcholine mech
Side effect
Avoid in

A

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

42
Q 
Classic side effects:
Halothane
Etiomidate
NO
Propofol
A

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

43
Q

Aflatoxin B1 association?

A

Agriculture

Hepatocellular carcinoma

44
Q

Nasalpharyngeal carcinoma association?

A

EBV

45
Q

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

A

Point tenderness

Both non-visable on XR

46
Q

Clinical features of dumping syndrome

A

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

47
Q

S/Sx of hypocalcemia

A

Perioral tingling
Finger paraesthesia
Muscle cramps
Prolonged QTc

48
Q

Signs for urgent surgical exploration of vascular extremity trauma

A

Pulsatile bleeding
Bruit/thrill
Expanding hematoma
Signs of distal ischemia

49
Q

Trauma with hypotension that is unresponsive to fluid and elevated JVP

A

Pericardial tamponade

50
Q

Cutaneous malignancy that arises in burn patients after years of inflammation

A

SCC

51
Q

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

A

FFP

52
Q 
Scrotal masses:
Soft mass increases with valsalva, no translumination?
Translumination?
Cyst at head of epididymis?
Hard mass in testicle?
A
  1. Varicocele, bag of worms, left
  2. Hydrocele, fluid b/t p/v layer of tunica vaginalis
  3. Spermatocele
  4. Cancer
53
Q

Treatment of varicocele?

A

Young with atrophy: gonadal vein ligation

Old who don’t want kids: NSAIDs

54
Q

Concern for abdominal involvement in penetrating trauma?

A

Nipple line

55
Q

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

A 
Ex Lap (skip CT)
CT with stable vitals
56
Q

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

A 
Pain, edema beyond surgical site
Systemic signs
Paraesthesia/anesthesia around wound site
"Dishwater drainage"
Gas/crepitus
57
Q

Leriche syndrome (aka occlusion of arteries at aortic bifurcation)

A

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

58
Q

Retropharyngeal abscess concern

A

“Danger space”

Extension down to mediastinum

59
Q

Burn wound sepsis criteria

A

High or low temp
Tachycardia
Tachypnea
Hypotension

Surgery (14 decks)

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