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Surgery UWorld > Week 1-2 > Flashcards

Week 1-2 Flashcards

1
Q

what is a colles fracture?

A

distal radius fracture

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2
Q

what can be a complication of a colles fracture?

A

can have radial artery impingement

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3
Q

what should be done if patient has colles fracture and radial artery impingement?

A

immediate closed reduction of the fracture

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4
Q

what is a common complication of a glenohumeral displacement?

A

rotator cuff injry

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5
Q

what is a test that can be done for cervical radiculopathy? how does it work?

A

shoulder raise test…when raising arm, patients pain will decrease if they have a cervical radiculopathy

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6
Q

what are the two types of burn wound infections?

A

invasive vs non invasive

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7
Q

what is difference in invasive vs non invasive burn wound infection?

A

invasive will show systemic signs of infection and invades non burned tissue

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8
Q

what is difference in management of invasive vs non invasive burn wound infections?

A

invasive gets really broad abx coverage (meropenem and vanc) whereas non invasive gets narrow spectrum like cefazolin

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9
Q

does patient who is perioperative have to have chest pain to be having an MI?

A

no because likely on lots of pain meds so can be masked

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10
Q

what is a significant GI complication of C diff?

A

toxic megacolon

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11
Q

what are sx of toxic megacolon?

A

severe abdominal pain, fever tachycardia and hypotension

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12
Q

what will be seen on imaging in toxic megacolon?

A

large bowel dilation

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13
Q

what is management of toxic megacolon?

A

bowel rest, NG tube and treat C diff

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14
Q

what is short term management of malignant pericardial effusion?

A

drain that baby with pericardiocentesis

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15
Q

what is long term management of malignant pericardial effusion?

A

put in a cardiac window for drainage

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16
Q

what are three complications of cardiac cath at site of femoral access?

A

hematoma, avm, and pseudoaneurysm

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17
Q

what are physical exam findings of pseudoaneurysm of femoral artery after cardiac cath?

A

systolic bruit and pulsatile mass

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18
Q

what are physical exam findings of avm of femoral artery and vein after cardiac cath?

A

continuous bruit and no mass

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19
Q

what is management of AVMs of femorals after cardiac cath?

A

if large surgery, if small observe

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20
Q

what is imaging to find a meckel diverticulu,?

A

nuclear scintigraphy

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21
Q

what can cause intussusception?

A

inflammation of peyers patches from viral illness, pathologic cuases like meckels diverticulum, tumor or polyp

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22
Q

when should you think a pthologic not viral illness is causing intussuscpetion?

A

if happens multiple times

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23
Q

what is a flail chest?

A

3 or more contiguous rib fractures that negatively impacts respiration

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24
Q

what is common sign of a flail chest?

A

chest goes inward with inspiraiton

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25
Q

what can happen to heart in ankylosing spondylitis?

A

aortic regurgitation

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26
Q

eggshell calcification of liver cyst means what diagnosis?

A

hydatid cyst from echinococcus granulosa

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27
Q

what is usual cause of post op fever within hours of surgery

A

tissue trauma and cytokine reaction

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28
Q

what is cause of post op fever 1 day to 28 days after?

A

presumed bacterial infection

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29
Q

name two times it is common to get compartment syndrome?

A

after fracture and after ischemia to leg and surgery

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30
Q

how do you diagnose compartment syndrome?

A

delta pressure (diastolic minus compartment <30)

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31
Q

what is acute management of cerebreal edema following traumatic injury?

A

hypertonic saline/mannitol and head elevation

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32
Q

what is initial management of hypothermia?

A

rewarming in bath of water btw 98-102 degress

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33
Q

if warm water bath does not improve hypothermia of hands, what should be done and why?

A

angiography of affected area to investigate for thrombosis

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34
Q

what is imaging for suspected appendicitis?

A

US if pregnant or child, otherwise CT scan

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35
Q

why can you get hypercalcemia with immobilization?

A

from osteoclasts breaking down bone that isnt being used

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36
Q

what is acute mediastinitis?

A

infection of medisatinum following cardiothoracic surgery

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37
Q

what are signs and symptoms of acute mediastinitis?

A

fever, purulent drainage from sternal incision, high WBC count, chest pain

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38
Q

what is an imaging finding of acute mediastinitis?

A

widening of mediastinum

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39
Q

what is rx of acute mediastinitis?

A

surgical drainage and abx

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40
Q

what are signs and sx of an ileus?

A

nausea, vomiting, abdominal distension, abdominal pain. lack of bowel sounds

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41
Q

aside from surgery what are some other causes of ileus?

A

intraperitoneal/retroperitoneal hemorrhages, pancreatitis and electrolyte abnormalitis

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42
Q

what is rx of priapism?

A

aspirate blood from corpora cavernosa and give phenylephrine injection into cavernosa

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43
Q

what can be a complication of insufflation of patients abdomen with CO2 for laprascopic procedure?

A

can get increased vagal tone leading to severe bradycardia

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44
Q

when should you get a confirmatory chest xray for placement of a central venous catheter?

A

if it was complicated or did not use U S

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45
Q

what should you monitor if patient has medullary thyroid cancer?

A

calcitonin (represents risk of metastasis)

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46
Q

how does medullary thyroid cancer present

A

usually asymptomatic thyroid nodule

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47
Q

if patient has recently had cholecystectomy and has diarrhea, what is likely cause?

A

bile acid diarrhea

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48
Q

what is rx of bile acid diarrhea?

A

cholstyramine

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49
Q

what is pilonidal disease?

A

abscess formation/infection of bump between butt cheeks

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50
Q

what is rx of pilonidal disease

A

drainage

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51
Q

what type of herniation can occur with epidural hematomas

A

subfalcine herniation

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52
Q

which type of herniation does not involve the pupils?

A

subfalcine

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53
Q

what is rx of SCFE?

A

surgical pinning and non weight bearing

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54
Q

who gets SCFE?

A

adolescents that are obese

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55
Q

what is the difference in enteral and parenteral nutritional support?

A

enteral means via intestines and parenteral means via IV

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56
Q

in a burn patient, what should nutritional support be?

A

enteral nutrition as soon as possible

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57
Q

patients undergoing dialysis are at increased risk for what infection?

A

bacteremia

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58
Q

if patient with dialysis gets bacteremic following dialysis session, what abx should be given?

A

ceftazadime and vanc

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59
Q

what can be a significant complication related to epidural anesthesia?

A

epidural hematoma

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60
Q

what are sx of epidural hematomas?

A

sensation and motor disturbances, can also have bowel bladder issues

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61
Q

if a patient can hear better in loud situations than quiet, what should you think of as issue?

A

otosclerosis

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62
Q

what is a physical exam finding of otosclerosis?

A

reddish hue behind tympanic membrane

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63
Q

what is first line therapy for toxic megacolon fromIBD?

A

IV steroids

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64
Q

if patient with cirrhosis has new onset of ascites, what should be done? why?

A

abdominal US…despite ascites being normal in cirrhosis, if it is new raises concern for HCC

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65
Q

what is a common cause of laryngeal papillomas in kids?

A

HPV 6 or 11 from mom

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66
Q

what is symptoms of laryngeal papillomas?

A

usually just hoarseness

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67
Q

what is rx of laryngeal papillomas?

A

surgical debridemen

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68
Q

if following a trauma a patient is hemodynamically unstable but has no signs of internal bleeding on exam, what is most likely cause?

A

pelvic fracture and bleeding in to retroperitenum

69
Q

what meds can cause open angle glaucoma?

A

topical steroids

70
Q

what sx does a urethral stricture cause?

A

leads to weak or spraying stream, incomlete emptying and can cause increased frquency

71
Q

what is rx of urethral stricture?

A

dilation, urethroplasty

72
Q

if patient has had trauma and had pneumothorax with successful chest tube placement but it still leaking significant amounts of air through chest tube, what might be going on?

A

trachebronchial injry leading to air leakage

73
Q

how do you assess for a tracheobronchial injury?

A

bronchoscopy

74
Q

what is rx of tracheobronchial injury?

A

surgical fix

75
Q

a pelvic fracture can cause what type of urethral injry?

A

posterior urethral injury

76
Q

what are sx of posterior urethral injury?

A

blood at meatus, inability to pee, and high riding prostate

77
Q

what are 6 indications for cervical spine imaging following trauma?

A 
high energy mechanism
neurologic deficit
intoxication
AMS
spinal tenderness
distracting injury
78
Q

what is a septal hematoma?

A

blood/fluid collection in nasal septum following trauma to nose

79
Q

what are sx of septum hematoma of nose?

A

may have hard time breathing, will have fluctuant swelling of septum

80
Q

what is management of septal hematoma of nose?

A

surgical drainage

81
Q

if a septic joint is not responding to vancomycin and MRSA/Strep coverage, what bug should you think about and what abx?

A

kingella…ceftriaxone

82
Q

what is blunt cardiac injury?

A

direct blow to chest without obvious cardiac injury leading to hemodynamic instability

83
Q

what is risk with blunt cardiac injury?

A

big risk of arrythmias

84
Q

patients with blunt cardiac injury should undergo what testing?

A

TEE

85
Q

in shock, a low CVP means what type?

A

hypovolemic or distributive

86
Q

in shock, a high CVP means what type?

A

cardiogenic or obstructive

87
Q

what is management of a peritonsillar abscess if patient stable?

A

drain it and treat wtih antibiotics

88
Q

what sx can hydronephrosis cause?

A

can lead to unilateral back pain and CVA tenderness

89
Q

what will UA look like in hydronephrosis secondary to ureteral injury?

A

will look normal, as will kidney function

90
Q

when do you excise hemorrhoids?

A

when they become thrombosed

91
Q

how do you know if external hemorrhoid is thombosed?

A

will be purplish and patient will have severe anorectal pain

92
Q

what type of hernia should be electively repaired?

A

femoral hernias

93
Q

why are femoral hernias repaired electively but indirect and direct inguinals are not?

A

because femoral has much higher risk of incarceration

94
Q

patient with traumatic brain injury has episodes of hypertension, fevers and diaphoresis, what is likely cause?

A

paroxysmal sympathetic overactivation

95
Q

who gets paroxysmal sympathetic overactivation?

A

patients with TBIs

96
Q

a breast mass with calcifications on imaging and fat globules and histiocytes on biopsy is most likely what?

A

fat necrosis of the breast

97
Q

what breast mass looks malignant but is benign?

A

fat necrosis

98
Q

what causes fat necrosis of the breast?

A

trauma and surgery

99
Q

does fat necrosis of the breast increase the risk of breast cancer?

A

No

100
Q

what is management of posterior hip dislocation?

A

reduction within 6 hours of injurty

101
Q

what is risk with giving loads of normal saline? why?

A

can cause metabolic acidosis due to high levels of chloride in normal saline

102
Q

a patient with severe burns should receive what fluids for resuscitation

A

lactated ringers

103
Q

what does imaging show in ovarian torsion?

A

complex adnexal mass without blood flow

104
Q

what is management of ovarian torsion?

A

laparoscopy

105
Q

what is managment options for abscess from diverticulitis?

A

if greater than 3cm then percutaneous drainage, if less than 3cm then IV abx and observation

106
Q

what is a perilymphatic fistula?

A

where endolymph leaks from semicircular canals and cochlea into surrounding tissue

107
Q

what causes perilymphatic fistula?

A

brain trauma

108
Q

what are sx of perilymphatic fistula?

A

sensorineural hearing loss, episodic vertigo

109
Q

what is a complication of roux en y surgery in couple days following surgery?

A

anastomotic leak

110
Q

what are sx of anastamotic leak from roux in y bypass?

A

abdominal pain, tachypnea and tachycardia

111
Q

what is rx of anastamotic leak from roux in y?

A

surgery

112
Q

what is a complication of cardiac cath that can happen at insertion site?

A

can get retroperitoneal hematoma if cath site is leaky

113
Q

how does retroperitoneal hemorrhage present

A

unilateral back or flank pain and hemodynamic instability

114
Q

what is imaging for retroperiotneal hemorrhage?

A

CT without contrast

115
Q

what is rx of retroperioneal hemorrhage?

A

intensive support and monitoring

116
Q

what is risk of using succinylcholine as anesthetic?

A

can lead to cardiac arrythmias due to release of potassium

117
Q

leydig and sertoli testicular tumors secrete what hormones?

A

testosterone or estrogen

118
Q

in testicular torsion, does it get bigger or smaller?

A

will get bigger

119
Q

why does a torsed testicle appear heterogeneous?

A

because of ischemia to the testicle

120
Q

what is hemobilia?

A

bleeding from liver

121
Q

what is usual cause of hemobilia?

A

iatrogenic liver injury from surgery or biopsy

122
Q

what are signs and sx of hemobilia?

A

ruq pain, melena, anemia, thrombocytosis and leukocytosis

123
Q

how does someone develop charcot arthropathy?

A

repetitive trauma to bone and joint due to impaired snesation and proprioception

124
Q

what is most common cause of charcot foot?

A

DM

125
Q

what can happen with chronic charcot arthropathy?

A

can get collapse of foot arch, subluxation and bone deformitites?

126
Q

what is management of charcot foot that has become chronic?

A

orthotics and surgical fixatio

127
Q

acute charcot foot can lead to what findings?

A

swelling and redness of foot, warmth and edema as well

128
Q

what is management of acute charcot foot?

A

put on foot cast

129
Q

if patient has trauma and has a bad pelvic fracture, what is a big concern/

A

retroperitoneal hemorrhage

130
Q

patient with bad pelvic fracture following trauma should receive what before further work up is completed?

A

pelvic binder to stabilize pelvis

131
Q

what is usual management of an SBO?

A

if not totally blocked then bowel rest pain management and NG tube

132
Q

what is management of SBO if totally blocked?

A

surgery

133
Q

when a patient is being intubated, what happens to intrathoracic pressure and venous system?

A

intrathoracic pressure goes up, can cause venous system collapse due to increase in pressure, can be an issue in patients with hypovolemic shock

134
Q

if patient has symptomatic hyponatremia, including sx of cerebral edema, what should be given?

A

hypertonic saline

135
Q

what are signs and symptoms of sigmoid volvulus?

A

slowly progressive abdominal discomfort along with potential nausea and vomiting

136
Q

what can contribute to development of sigmoid volvulus?

A

constipation

137
Q

how does pain progress/onset with sigmoid volvulus?

A

slowly over course of a couple days

138
Q

what is management of sigmoid volvulus?

A

emergency endoscopic detorsion

139
Q

patient with difficulty breathing following cervical trauma most likely has what?

A

diaphragm paralysis

140
Q

what should be done for patient with diaphragm paralysis from cervical spine injury?

A

oral intubation

141
Q

calcitonin is marker for which thyroid cancer?

A

medullary thyroid cancer

142
Q

what is management of papillary thyroid cancer?

A

surgical removal

143
Q

copper deficiency leads to what problems?

A

skin depigmentation
ataxia
anemia
brittle hair

144
Q

what two things are commonly elevated in acute mesenteric ischemia?

A

lactate and amylase

145
Q

what is an auricular hematoma?

A

tender blood collection on anterior pinna of ear

146
Q

who gets auricular hematomas?

A

ppl who play contact sports

147
Q

what should you do to an auricular hematoma?

A

drain it then give abx to prevent secondary infection

148
Q

what are sx of an auricular hematoma?

A

nothing….just fluctuant tender hematoma on ear

149
Q

patient with trauma to chest who now has stable vitals but has persistent shortness of breath, what should you consider?

A

diaphragmatic injury

150
Q

septic arthritis in a MCP joint requires what?

A

surgical drainage

151
Q

afp elevation is associated with what GI tumor?

A

hepatocellular carcinoma

152
Q

what are signs of complicated SBO?

A

fever, vital instability, metabolic acidosis

153
Q

what is a common risk factor for SBO?

A

previous abdominal surgery

154
Q

what is most important prognostic indicator for breast cancer?

A

TNMstaging

155
Q

if a patient falls with an object in their mouth, what can be a serious complication?

A

carotid artery dissection

156
Q

how does carotid artery dissection present?

A

gradual onset hemiplegia, aphasia,, neck pain and headache

157
Q

what is imaging for carotid artery dissection/

A

CT and MR angio

158
Q

what is most common cause of nosocomial bloodtsream infections?

A

central venous catheters

159
Q

what type of toe movement makes plantar fascitis hurt more?

A

dorsiflexion of toes

160
Q

retroperitoneal free air after blunt abdominal trauma to central abdomen should make you think what?

A

duodenal tear

161
Q

patient who is post transplant develops interstitial pneumonia but is taking bactrim, what bug is it?

A

CMV pneumonitis

162
Q

how long after blunt abdominal trauma can diaphragmatic injury present?

A

months to years…

163
Q

what is management if patient swallows a fish bone?

A

endoscopic removal

164
Q

what is dumping syndrome?

A

when patients have diarrhea and nausea along with tachycardia after meals after they had gastric surgery

165
Q

what is antibiotic choice for clean surgeries for surgical site inection prophylaxis?

A

cefazolin

166
Q

if patient cant have cefazolin, what is antibiotic choice for clean surgeries for surgical site inection prophylaxis?

A

Vancomycin

167
Q

3 symptoms of bladder rupture injury?

A

suprapubic fullness/tenderness
hematuria
difficulty with urination

168
Q

what is management of big cerebellar hemorrhage?

A

surgical intervention

169
Q

what can cause salivary gland enlargement that is non tender?

A

alcoholism

Surgery UWorld (3 decks)

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