Monday 9/5/16: Surgery Exam 3

Question 1

What causes a medial collateral ligament tear?

Answer 1

Severe valgus stress (blow to the lateral knee) or twisting injury.

Question 2

What are some examination findings of a medial collateral ligament tear?

Answer 2

Ecchymosis and joint line tenderness at the medial knee.

Question 3

What is the valgus stress test?

Answer 3

Appreciable laxity when the leg is forced into abduction is helpful for diagnosis of a medial collateral ligament tear.

Question 4

What is the most sensitive test for MCL tear?

Answer 4

MRI but is reserved for patients considered for surgical intervention.

Question 5

How are patients with uncomplicated MCL tears treated?

Answer 5

1. Nonoperatively
2. Rest
3. Ice
4. Compression
5. Elevation

Question 6

How does injury to the anterior cruciate ligament present?

Answer 6

Tibia will show anterior rather than valgus laxity.

Question 7

How do injuries to the lateral collateral ligament present?

Answer 7

High velocity traumas. Knee will have varus laxity.

Question 8

How does medial meniscus injury present?

Answer 8

Shows a small joint effusion and crepitus, locking, or catching with range of motion.

Question 9

What is patellar tendinitis or jumpers knee?

Answer 9

Chronic overuse injury characterized by anterior knee pain and tenderness. Stress testing of the ligaments are normal.

Question 10

How do tibial plateau fractures present?

Answer 10

Contact sports, falls or MCV. But with fractures you are unable to bear weight on the knee.

Question 11

What are clinical features of peritonsillar abscesses?

Answer 11

1. Fever, earache
2. Sore throat, difficulty swallowing
3. Trismus
4. Muffled “hot potato” voice
5. Uvula deviation away from the enlarged tonsil.
6. Pooling of saliva

Question 12

What is a peritonsillar abscess

Answer 12

Acute bacterial infection of the region between the tonsil and the pharyngeal muscles.

Question 13

What are the series of events for peritonsillar abscess ?

Answer 13

1. Persistent tonsillitis/pharyngitis
2. progresses to cellulitis/phlegmon
3. Pus collecting into and abscess within a week of symptom onset

Question 14

Who normally gets peritonsillar abscess ?

Answer 14

Older adolescents and young adults, drug or alcohol use increases risks.

Question 15

What is the treatment for peritonsillar abscess ?

Answer 15

Needle aspiration or incision and drainage plus antibiotics to cover group A hemolytic strep and respiratory anaerobes.

Question 16

How does epiglottis present?

Answer 16

1. High-grade Fever
2. Severe sore throat
3. Odd phage that can progressively turn into airway obstruction

Question 17

How does tonsillitis present?

Answer 17

Tonsillar erythema and exudates
Tender anterior cervical nodes
Palatal petechia

Question 18

When do enlarged adenoids present?

Answer 18

Early childhood and regress with age

Question 19

What causes herpangina

Answer 19

Coxsackie A.

Question 20

How does herpangina present?

Answer 20

1. Fever
2. Sore throat
3. Odynophagia
4. Vesicles on the tonsils and soft palate

Question 21

How is infectious mononucleosis characterized?

Answer 21

1. Fever
2. Pharyngitis
3. Posterior cervical lymphadenopathy

Question 22

When should tetanus-diphtheria toxoid be given?

Answer 22

Individuals with severe or dirty sounds who received a booster more than 5 years ago and those with minor clean wounds who received a booster more than 10 years ago

Question 23

When should tetanus immune globulin be given?

Answer 23

Any individual with severe or dirty wound AND an unclear or incomplete immunization history. Or in someone who is severely immunocompromised

Question 24

What type of protection does tetanus immune globulin provide?

Answer 24

1. Passive
2. Temporary
   3 immediate immunity

Question 25

How does acute pancreatitis present?

Answer 25

1. Mid epigastric pain that radiates to the back 2. Nausea and vomiting 3. Elevated amylase and lipase

Question 26

What is the second most common cause of pancreatitis? And how can you determine that?

Answer 26

Gallstone pancreatitis if ALT>150 U/L

Question 27

What is the treatment for a resolved acute pancreatitis attack due to gallstones?

Answer 27

Early cholecystectomy

Question 28

What drugs cause drug induced pancreatitis?

Answer 28

1. Thiazides 2. ACE inhibitors Not calcium channel blockers

Question 29

When is ERCP recommended in gallstone pancreatitis?

Answer 29

Patients with gallstone pancreatitis who have cholangitis, visible common bile duct dilation or obstruction or increasing liver enzymes

Question 30

When are HIDA scans used?

Answer 30

Evaluating cholecystitis in patients with intermediate ultrasound findings.

Question 31

How does a AAA present?

Answer 31

1. Acute onset of severe back pain 2. Syncope 3. Hypotension

Question 32

What is the normal size of an abdominal aorta

Answer 32

1-3 cm

Question 33

How is a AAA different from a thoracic aortic aneurysm?

Answer 33

AAA involves all aortas layers and does not create an intimal flap or false lumen.

Question 34

AAA typical occur in what types of people?

Answer 34

Aged over 60. Smokers Men People with a history of coronary artery disease

Question 35

How are AAA found?

Answer 35

Incidental ultrasound or CT

Question 36

What is a physical exam finding in a AAA

Answer 36

Pulsatile abdominal mass at or above the level of the umbilicus.

Question 37

Where can a AAA rupture into

Answer 37

Into the retroperitoneium and can create a aortocaval fistula with the IVC, leading to venous congestion in retroperitoneal structures (bladder)- the fragile vessels can break causing hematuria

Question 38

How do you treat AAA?

Answer 38

Emergently taken to the OR.