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Surg Flashcards

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1
Q

hypoCa, hyperK, normal renal fx –> condition?

A

hypoPTH

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2
Q

pt w classic presentation of acute appendicitis –> next step?

A

appendectomy, NOT imaging

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3
Q

small (<2cm) pneumothorax –> next step?

A

observation & supplemental O2

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4
Q

UE –> muscle weak, sensory loss –> dx?

A

syringomyelia

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5
Q

syringomyelia: pathophys

A

spinal cord –> central canal –> CSF drainage disrupted –> cyst –> compress surrounding neural tissue

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6
Q

syringomyelia: 2 most common cause

A
  • Arnold-Chiari malformation

- prior spinal cord injury –> ie whiplash

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7
Q

syringomyelia: most commonly affected which spinal tracts?

A
  • spinothalamic tract (pain & temp)

- corticospinal tract (UE motor)

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8
Q

syringomyelia: PE findings

A
  • decreased strength, pain/temp in arms/hands or cape-like distribution
  • dorsal column fx preserved –> normal light touch, vibration, position sense
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9
Q

syringomyelia: how dx?

A

MRI

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10
Q

SBO + hemodynamic instability –> next step?

A

urgent surg exploration

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11
Q

SBO –> when require immed surg (3)?

A
  • clinical/hemodynamic instability
  • fail to improve after initial conservative measures
  • dev ssx of ischemia/necrosis
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12
Q

ileus –> classic XR finding?

A

small & large intestine –> gas-filled, uniformly distended w no transition pt

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13
Q

traumatic injury –> abd pain –> most likely dx?

A

paralytic ileus

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14
Q

ileus –> causes (4)

A
  • # 1 abd surg
  • retroperitoneal/abd hemorrhage/inflamm
  • intestinal ischemia
  • electrolyte abnormal
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15
Q

arm –> full thick burn –> circumferential –> eschar formation –> leads to what condition?

A

eschar –> restrict venous/lymph drain –> acute cmpt synd

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16
Q

acute cmpt synd –> clinical features

A
  • pain out of proportion to injury
  • pain increase w passive stretch
  • rapid & tense swell
  • paresthesia (early)
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17
Q

twisting injury w foot fixed –> what condition?

A

medial meniscus tear

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18
Q

meniscus tear –> clinical presentation

A
  • reduced knee extend
  • sensation of instability
  • effusion
  • palpable lock/catch when extend jt while under load
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19
Q

meniscus tear –> how confirm dx?

A

MRI or arthroscopy

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20
Q

meniscus tear –> tests?

A
  • Thessaly test

- McMurray test

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21
Q

what is Thessaly test? Positive test indicates?

A

stand on 1 leg –> flex knee 20deg –> int/ext rotate on flexed knee –> pain/click/catch –> meniscal tear

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22
Q

what is McMurray test? Positive test indicates?

A

hold knee in int/ext rotate –> passive knee flex/ext –> pain/click/catch –> meniscal tear

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23
Q

clavicle fx –> next step? why?

A

careful neurovasc exam –> r/o injury to brachial plexus, subclavian A

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24
Q

1 measure to prevent postop pulm comp

A

incentive spirometry –> promote lung expansion

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25
what is Kehr's sign
acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated
26
diffuse abd pain + guarding + pain in shoulder --> condition?
peritonitis
27
acute chem peritonitis --> what part of bladder ruptured?
dome
28
peritonsillar abscess --> tx
needle aspiration/I&D + abx
29
peritonsillar abscess --> clinical presentation
- fever - pharyngeal pain - earache - trismus - muffled voice - swelling of peritonsillar tissues w uvula deviation
30
varicocele --> clinical presentation
- soft scrotal mass "bag of worms" --> decrease in supine, increase w stand/valsalva - subfertility - testicular atrophy
31
meniscal tear --> tx?
mild ssx, older pt: - rest - modify activities persistent ssx, impaired activity: - surg
32
postop fever --> blood cultures reveal coag-neg staph --> seen most often in what kind of pts?
pts w intravasc devices
33
stress fracture --> RF (5)?
- repetitive activies (running, gymnastics) - abrupt increase in physical activity - inadeq Ca, vitD - inadeq calories - female athlete triad: inadeq calories, hypo/amenorrhea, low bone density
34
stress fracture --> tx?
- reduce wt-bearing for 4-6wk | - if at high risk for malunion (anterior tibial cortex, 5th metatarsal) --> refer to ortho
35
blunt trauma to chest --> pneumothorax --> chest tube --> persistent pneumothorax --> condition?
tracheobronchial rupture
36
tracheobronchial rupture --> clinical findings
- persistent pneumothorax despite chest tube placement - pneumomediastinum - subcut emphysema
37
gunshot at 6th intercostal space --> pt unstable --> next step?
exploratory laparotomy
38
penetrating wound below what level is considered to involve abd?
4th intercostal space (level of nipples)
39
postop atelectasis --> when after postop?
postop day 2
40
postop atelectasis --> RF (4)?
- airway obstruction from retained airway secretions - decreased lung compliance - postop pain - meds that interfere w deep breathing
41
postop atelectasis --> ABG results? why?
hypoxemia, hypocapnia, resp alk lung collapse --> decrease lung vol --> V/Q mismatch --> hypoxemia --> tachypnea --> hypoCO2 & resp alk
42
massive hemoptysis --> initial management?
estab adeq patent airway
43
massive hemoptysis --> in what position should pt be placed?
lat position w bleeding lung in dependent position --> avoid blood collection in opp lung
44
massive hemoptysis --> initial procedure of choice? why?
bronchoscopy - localize bleeding site - provide suction ability to improve visualization - other therapeutic interventions possible (balloon tamponade, electrocautery)
45
severe burn --> wound infect & sepsis --> what org if soon after injury? If after 5days?
soon after burn --> G+ | after 5day --> G-, fungus
46
burn wound infect --> 1st sign?
- change in burn wound appearance | - loss of skin graft
47
burn wound infect --> dx?
- quantitative wound culture | - bx for histopath
48
young pt --> midline hard palate --> fleshy immobile mass --> condition?
torus palatinus
49
torus palatinus --> tx?
asymptomatic: none symptomatic, interfere w speech/eat: surg
50
flail chest --> pathophys?
>3 contiguous ribs fractured in >2 locations
51
ischemic colitis --> CT findings?
- thickened bowel wall | - pneumatosis coli
52
ischemic colitis --> colonoscopy findings?
- cyanotic mucosa | - hemorrhagic ulcerations
53
hematuria --> indicates damage to what? - during initial part of voiding - at end of void - continuously thru void
- initial: urethra - terminal: bladder, prostate - total: kidney, ureter
54
ant shoulder dislocation --> cause?
glenohumeral jt --> forceful abduct & ext rot
55
ant shoulder dislocation --> can damage what N? Leads to what signs?
Axillary: - deltoid: weak shoulder abduct - lat shoulder: sensory
56
GI perforation --> next step?
exploratory laparotomy
57
blunt abd trauma --> GI perforation --> pathophys?
blunt trauma --> damage mesenteric blood supply --> necrosis --> GI perforate
58
blunt trauma to abd & chest --> tachycardia, hypotension --> condition?
splenic laceration
59
splenic injury --> ssx?
- abd pain - tachycardia - L shoulder pain
60
blunt trauma to abd & chest --> what happens to: - preload - cardiac output - ejection fraction
massive internal hemorrhage --> hypovol shock: decreased venous return --> decreased preload --> decrease cardiac output --> activate sympathetic --> increase SVR & HR --> increase ejection fraction
61
ant spinal cord infarct --> potential comp of what procedure?
thoracic aortic aneurysm surg
62
ant spinal cord synd --> ssx
- spinal shock: bilat flaccid paralysis, loss of pain/temp - days-wks --> UMN: spastic, hyperreflex - normal vibrate, proprioception
63
umbilical hernia --> assoc w?
- black - premature - Beckwith-Wiedemann - hypothyroid
64
pt w renal dz --> surg --> DVT --> tx? for how long?
- unfractionated hep for acute | - warfarin for 3 mo
65
pilonidal dz --> pathophys
intergluteal region --> hair follicle occlude --> edema, infect --> abscess --> rupture --> sinus tract --> sit, stand --> hair/debris into sinus tract --> recur infect
66
pilonidal dz --> who?
- 15-30yo M - obese - sedentary - deep gluteal cleft
67
pilonidal dz --> presentation?
interglut region --> 4-5cm cephalad to anus --> painful, fluctuant mass --> mucoid/purulent/bloody discharge
68
acute adrenal insuff --> etiology?
- adrenal hemorrhage/infarct | - chronic adrenal insuff, glucocorticoid use --> acute illness/injury/surg
69
acute adrenal insuff --> tx?
- hydrocortisone, dexamethasone | - IVF
70
acute adrenal insuff --> ssx
- hypotension - vomit - abd pain - fever
71
rhinoplasty --> whistling noise during respiration --> condition?
septal hematoma --> nasal septal perforation

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