Surgery Flashcards
(244 cards)
1
Q
Prostatic Valve Dysfunction Diagnosis
A
Echo
2
Q
Adolescent boy
Proximal Femur pain worse at night, relieved with NSAIDs, unrelated to activity
Small, round lucency (Xray)
A
Osteoid Osteoma
3
Q
Breast pain
Cyclic, bilateral diffuse
mass
Next Step
A
Imaging
4
Q
Breast pain
cyclic, bilateral, diffuse
No mass
A
observe
5
Q
Breast pain
noncyclic, unilateral focal
no mass
Abnormal imaging
A
biopsy
6
Q
Breast pain
noncyclic, unilateral focal
no mass
normal imaging
A
Observe
7
Q
Breast pain
noncyclic, unilateral focal
mass
A
biopsy, referral to breast surgeon
8
Q
Prior esophageal/gastric resection or reconstruction, Nissen fundoplication
Abdominal pain, diarrhea, nausea, hypotension, tachy, dizziness, AMS
15-30 minutes after meals
A
Dumping syndrome
9
Q
Dumping Syndrome management
A
clinical diagnosis
small, frequent meals, replace simple sugars with complex carbs, high fiber and protein rick foods
10
Q
Manage ureteral stone <10mm
A
Hydration
pain control
alpha blockers
strain urine
11
Q
Diagnosis of postop urinary retention
A
Portable bladder ultrasound
12
Q
Thunderclap headache, visual field defects, ophthalmoplegia
A
pituitary apoplexy
13
Q
Within minutes to 24 hours of transfusion
fever, chills, hypotension, hemoglobinura, flank pain
A
Acute hemolytic transfusion Reaction
14
Q
Lab findings of Acute hemolytic transfusion reaction
A
postive Coombs test
Hemolysis
15
Q
Complications of Acute hemolytic transfusion reaction
A
acute renal failure
DIC
16
Q
Diagnosis of open angle glaucoma
A
Tonometry
17
Q
Diagnosis of Zenker’s Diverticulum
A
contrast esophagography
18
Q
Hypotension, shock
nausea, vomiting, ab pain, fever, general weakness
A
Adrenal crisis
19
Q
Treatment of adrenal crisis
A
hydrocortisone
Dexamethasone
20
Q
Prolonged clamping of infrarenal aorta and iliac arteries complications
A
Metabolic acidosis via lactic acidosis
Increased bicarbonate reabsorption and increased H+ excretion, increased urinary Cl- excretion, increased excretion of ammonium
21
Q
Trauma in one eye, then blurry vision in opposite eye. Path…
A
Sympathetic ophthalmia
T cell sensitization of self antigens
22
Q
Brown Recluse Spider
A
eschar/ necrosis
clean wound and apply ice, supportive management
23
Q
acute pericarditis ECG findings and diagnosis
A
diffuse ST segment elevations and PR segment depression
D(x): echo
24
Q
Abrupt onset dyspnea, low grade fever, diffuse crackles/wheezes, infiltrate in dependent portion of lung
A
Chemical pneumonitis (from gastric acid) supportive care
25
Young patient with one sided headaches
| Nausea and vomiting
Ruptured arteriovenous malformation
26
Anesthesia, succinylcholine or excessive heat
Rigidity
tachy
Hypercarbia resistant to increased minute ventilation
Rhabdo
Hyperkalemia
Hyperthermia
Malignant Hyperthermia
27
Treatment for perforated bowel
Surgical exploration
28
Medial knee pain and focal tenderness
pes anserinus syndrome
| Manage with quadricep strengthening exercise
29
Hemodynamically stable patient with free fluid on FAST..next?
CT ab and pelvis
30
Hemodynamically unstable with free fluid on FAST
Laparotomy
31
Where is pelvic blood loss hidden?
retroperitoneum
32
Postop weakened dorsiflexion and diminished pinpoint sensation of big toe
common fibular N injury
| Reassurance and physical therapy
33
High protein Ascites
CHF, constrictive pericarditis, peritoneal carcinomatosis, TB, Budd Chiari, fungal
34
Low Protein Ascited
Cirrhosis, nephrotic syndrome
35
Treatment for radiculopathy
NSAIDs and avoidance of provocative maneuvers
36
Infections in solid organ transplants
Nosocomial infections
| CMV, PCP, Aspergillus
37
Local anesthetic complication
perioral numbness, metallic taste, tinnitus --> generalized tonic clonic seizures.
38
LUQ pain, left pleuritic chest pain and left pleural effusion
```
Splenic abscess
( via infective endocarditis- staph, strep, salmonella)
```
39
Unilateral frontal, parietal or temporal lobe lesion
| NO PUPILARY INVOLVEMENT
Subfalcine herniation
40
elderly FOOSH
Colles Fracture
| First step of management is closed reduction of fracture
41
head trauma or acceleration/deceleration
| GCS <8, impaired more than imaging MRI finidings
Diffuse Axonal Injury
Punctate hemorrhages in white matter, blurring of gray-white matter junction
42
Slipped capital femoral epiphysis X ray findings
posteriorly displaced femoral head
43
Fever, focal/severe back pain, neuro findings
Spinal epidural abscess
| Diagnosis with MRI of spine with contrast
44
Treatment for spinal epidural abscess
antibiotics (vanco + ceftriaxone)
| urgent aspiration/ surgical decompression
45
Bowel problem that is associated with erythema nodosum
Inflammatory bowel disease
| Crohns > UC
46
lytic lesion at epiphysis of distal femur
| Soap bubble appearance on X ray
Giant cell tumor
47
Night driving difficulty and halos around bright lights
| no pain
cataracts
48
Spinal abscess diagnosis
MRI with contrast
49
jaw pain and swelling exacerbated by eating
recurrent sialadenitis via sialolithiasis
50
ab pain and tenderness, hematochezia, diarrhea, lactic acidosis
colonic ischemia
51
Diagnosis of colonic ischemia
CT: colonic wall thickening fat stranding
Endoscopy: edematous and friable mucosa
52
Colonic Ischemia treatment
IVF and bowel rest
Abx with enteric coverage
colonic resection if necrosed
53
Patient >40
| painless hematuria, hydronephrosis and voiding symptoms
bladder cancer
| Do cystoscopy
54
Profuse watery diarrhea, liver inflammation and maculopapular rash after hematopoietic stem cell transplant
Acute graft vs host disease
D(x) with biopsy
55
snake bite treatment
limb immobilization and wound management
coag studies
antivenom
observe 12-24 hr
56
Most common pulmonary postop complication
Atelectasis (impaired cough and shallow breathing)
57
Diagnose Pulmonary embolism
CTA
58
ab/flank pain that radiates to groin or hip, ab pain with hip extension
Psoas abscess
59
Diagnose psoas abscess
CT scan of abdomen and pelvis
60
back pain, cachexia, high alkaline phosphatase and multiple osteoblastic/osteolytic vertebral lesion,
High AFP
hepatocellular carcinoma or testicular cancer
61
Treat priapism
aspirate blood fro the corpora cavernosa
62
Causes of priapism
cocaine, alcohol, testosterone, sickle cell disease, trazadone
63
blood products given in hemorrhagic shock
4 units FFP and 4 units platelets
64
Pleural effusions that can be managed with observation
small-moderate and not enlarging
early onset (1-2 days)
not associated with respiratory symptoms
65
Management of tender, purple bulge below the dentate line
external hemorrhoid
| excision
66
Chronic back pain, intermittent bilateral heel pain, impaired spinal mobility and limited chest wall expansion
Ankylosing spondylitis
67
Heart complication of ankylosing spondylitis
chronic aortic regurgitation
68
Nausea vomiting
No flatus
Abdominal distension
Decreased or absent bowel sounds
Ileus
69
Management of ileus
antiemetics, bowel rest, serial examinations
70
What decreases risk of infection in burn patients
Early wound excision and grafting
71
chest/back pain or epigastric pain, crepitus, Hamman sign, pleural effusion
widened mediastinum on CT
Esophageal perforation
| D(x): Esophagography with water soluble contrast
72
Treatment for UC
5-ASA agents (mesalamine, sulfasalazine)
73
How to prevent perioperative complications in patient with obstructive hypertrophic cardiomyopathy
ensure adequate IV hydration
74
```
Acute Infective Endocarditis
Preload
Afterload
Contractile function
EF
Forward stroke volume
```
```
Mitral regurgitation
Preload: HIGH
Afterload: low
Contractile function: no change
EF: HIGH
Forward stroke volume: low
```
75
Management of sigmoid volvulus
Endoscopic detorsion (flex sig) and elective colectomy
76
Young male with weak/spraying stream, incomplete emptying
Urethral stricture
Dx postvoid residual
Manage: dilation/ urethroplasty
77
flexed hip, adducted, internal rotation
posterior hip dislocation
78
Treat hip dislocation
reduction within 6 hours of injury
if no fracture: closed reduction
if fracture: open reduction
if limp ischemia: CTA
79
Reason for transfusion reaction within an hour
ABO compatibility
80
Abx for osteomyelitis in sickle cell patients
clindamycine and ceftriaxone
81
Abx for osteomyelitis in healthy children
clindamycin/vancomycin
82
Diagnostic test to identify cause of priapism in patient with hepatosplenomegaly
CBC
83
Male breast mass management
Mammography
84
Hemorrhagic shock- continuing normal saline fluid can cause what complication
Increased risk for coagulopathy
85
Boys insidious hip pain, limp, restricted hip abduction, internal rotation, positive trendelenburg
Normal X ray
legg Calve Perthes
| Avascular necrosis of femur
86
complications of nearsightedness
retinal detachment and macular degeneration
87
widened mediastinum prior falling from height
thoracic aortic injury
88
What type of hernia is more likely to be incarcerated
femoral hernia
89
History of alcohol and recent pancreatitis. Now progressive ab distension, nausea and vomiting.
CT round, well circumscribed, encapsulated fluid collection
Pancreatic pseudocyst
| T(x): endoscopic drainage procedure
90
Exudative effusion
pleural/serum protein >.5
Pleural/serum LDH > .6
Pleaural LDH > 2/3 upper limit of normal for serum LDH
91
postop unilateral back pain, nausea and vomiting
hydronephrosis
92
unilateral floaters and progressive vision loss.
candida endophthalmitis
93
new onset hypoxia by pulse ox due to anesthetic use
acquired methmoglobinemia
94
headache, nausea, vomiting, ipsilateral ataxia, dysarthria, vertigo, nystagmus
cerebellar hemorrhage
| Manage: surgical decompression
95
management of hidradenitis suppurativa
prolonged antibiotic
96
contraindication in cardioembolic stroke
thombolytics
97
diagnosis of meniscal tear
MRI
98
next step in management of infected foot ulcer
osteomyelitis (bone biopsy)
99
X ray: disruption of cortical contour, external rotation of distal fragment, shortening of neck, lucency or hazy sclerosis at fracture plane
femoral neck fracture
100
progressive sensorineural hearing loss, episodic vertigo with nystagmus due to changes in pressure in the inner ear (Valsalva)
Perilymphatic fistulas
101
Liver mass in women on long term OC, possible hemorrhage or malignant transformation
Hepatic adenoma
102
Liver mass with acute or chronic liver injury
Regenerative nodules
103
Most common place for colonic ischemia
splenic flexure
104
Complication of rhinoplasty
| whistling noise
nasal septal perforation
105
Hematuria, flack/abdominal pain, elevated LDH/AKI
| Enlarging kidney on imaging
Renal Vein thrombosis
106
Differentiate between level 1 axillary LN and Level 2
Pectoralis minor
107
```
Thyroid storm
SVR
Cardiac output:
venous-o2 content
pulm capillary wedge pressure
```
SVR: low
Cardiac output: high
venous O2 content: high
Pulm capillary wedge pressure: high
108
young patients with no tobacco exposure and multiple sexual partners.
enlarged firm neck mass and ulcerated tonsillar lesion
head and neck squamous cell carcinoma via HPV
109
First line treatment for high risk basal cell carcinoma
Mohs micrographic surgery
110
recurrent epistaxis and nasal crusting
CPAP usage
111
Brittle hair, skin depigmentation, neuro dysfunction, anemia, osteoporosis
What is deficient?
Copper deficiency
112
Risk factors of Euthyroid sick syndrome
severe acute illness
ICU admission
High dose glucorticoid therapy
113
Euthyroid thyroid labs
Low T3, normal TSH and T4
114
Aortic dissection patient
| Initial study of choice in hemodynamically stable patients with no evidence of renal dysfunction
CT angio
115
0-6 hours post op fever reasons
tissue trauma
blood products
malignant hyperthermia
T(x) symptomatic
116
Frostbite management
1. rapid rewarming
2. Analgesia and wound care
3. Angiography/ technetium 99m scan
4. thrombolysis in severe cases
117
ear pain with normal ear exam
| poor dentition
Referred otalgia via muscosal head and neck squamous cell carcinoma
118
Secretory diarrhea, bloating, abdominal cramps, umremarkable serum & stool studies
bile acid diarrhea
119
Treatment for bile acid diarrhea
choestyramine or colestipol
120
Unilateral, pruritic breast rash with breast erythema and edema, axillary LAD
Inflammatory breast cancer
121
Inflammatory breast cancer diagnosis
breast biopsy (core needle)
122
Management of venous air embolism
Left lateral decubitus positioning
| High flow/hyperbaric O2
123
Throbbing headache and nausea
Unilateral pronator drift
CT: calcifies extra axial mass
MRI: Homogenous, dural based
meningioma
124
Management of symptomatic meningioma
complete resection
125
post gastric surgery, bloating, flatulence, chronic water diarrhea, low B12 high folate
SIBO
126
Management for small bowel obstruction
nasogastric tube insertion and emergency laparotomy
127
dorsal penile plaque and pain/ curvature with erection
Peyronie disease
128
Weakness in upper and lower extremities, atrophy in hands with hyperreflexia in legs, electric shock pain with neck flexion
cervical spinal cord compression
129
First line therapy for burn wound infection
Meropenem and vanco
130
velcro inspiratory crackles
| CT: lower lobe subpleural honeycombing and reticular markings greatest and periphery
idiopathic pulmonary fibrosis
| Management: antifibrotic therapy (pirfenidone, nintedanib)
131
Management of HIT
stop heparin and start direct thrombin inhibitor (argatroban) or fondaparinux
132
First line therapy for IBD induced toxic megacolon
IV corticosteroids
133
fall with object in mouth, gradual onset hemiplegia, aphasia, neck pain and thunderclap headache
Carotid artery dissection
134
Management of acute limb ischemia
anticoagulation (heparin)
| Thrombolysis/surgery
135
Within first 3 months of transplant. Fever, malaise, LFT elevations
Histo: inflammatory infiltration
Acute cellular rejection
136
Management of acute cellular rejection
high dose corticosteroids
137
sudden onset severe unilateral ab pain right after strenuous activity
US: pelvic free fluid
ruptured ovarian cyst
138
Recommendation for medically stable patients who recover fro acute pancreatitis
Cholecystectomy
139
fracture of >3 adjacent ribs in >2 locations
| isolated chest wall segment that moves paradoxically
flail chest
140
High alk phos and bilirubin
| multifocal strictures of intrahepatic and extrahepatic bile ducts
PSC
141
CKD patient with femoral neck fracture what lab do you order?
parathyroid hormone level
142
small puncture wound appears minor initially
| septic arthritis
Clenched fist bite injury
143
Management of clenched fist bite injury
urgent surgical irrigation and debridement
| amp/sul or amp/clav
144
Complications of varicocele
infertility and testicular atrophy
145
Diagnosis of acute diverticulitis
CT abdomen
146
risk factors of avascular necrosis
```
femoral head fracture
glucocorticoids
excessive alcohol use
sickle cell
SLE
```
147
shortened internally rotated leg, hip flexed and adducted, knee flexed
unable to dorsiflex or straighten leg
posterior hip dislocation
148
liver abscess management
percutaneous aspiration
149
HIGH fever, tachy, hypertension, CHF, arrhythmia, agitation, delirium, goiter
postop
thyroid storm
150
Management of thyroid storm
B blockers
PTU
glucocorticoids
151
surgical indication in infective endocarditis
acute heart failure
extension of infection
difficult to eradicate organisms
persistent bacteremia on abx, large vagetation/ persistent septic emboli
152
shortened external rotation
femoral neck fracture
153
Pain out of proportion to injury, pain incrases on passive stretch, rapidly increasing and tense swelling, paresthesia
compartment syndrome
154
abx for acute bacterial prostatitis
Levofloxacin
155
complication of prolactinoma
bone loss
156
PAD diagnostic management
ABI
157
High pressure injection injury management
fasciotomy and debridement in the operating room
158
electrical injury complications
rhabdomyolysis
159
hard mass in the olecranon
tophaceous gout
160
indications for CT scan in orbital trauma
```
severe eye pain
evidence of fracture
painful extraocular movements
decreased visual acuity
suspected intraocular foreign body
inadequate examination
```
161
Diagnostic imaging of appendicitis
CT abdomen
162
Treatment of spiral fracture of toddler
immobilization and pain control
163
adolescent
proximal airway obstruction
recurrent pneumonia
hemptysis
bronchial carcinoid tumor
164
Path of flail chest
impaired generation of negative inspiratory pressure
165
imaging for intraabdominal organ injury
CT scan
166
abdominal distention, failure to pass flatus, absent bowel sounds.
X ray dilated gas filled loops with no transition point
paralytic ileus
167
unilateral, painless testicular mass
dull ache in lower abdomen
High AFP, BhCG, LDH
testicular cancer
168
Diagnose testicular cancer
scrotal US
labs
Radical inguinal orchiectomy
169
Colles Fracture Nerve compression
Median N
170
Salter III Fracture complication
limb length discrepancy
171
Parasite that causes SBO
ascaris lumbricoides
172
jaundice, pruritis, acholic stools, dark urine, weight loss, RUQ pain
high direct bilirubin ALP and GGT
CEA, CA19 and AFP
cholangiocarcinoma
173
Candida infection is lost likely from what?
Central venous catheters
174
contact lens abrasion management
topical antibiotic
175
gold standard for sphincter of oddi dysfunction
Sphincter of oddi manometry
176
Treatment for Zenkers
cricopharyngeal myotomy
177
post burn injury
hyperglycemia, increased body temp, increased muscle wasting
tachy and HTN
Hypermetabolic response to burn injury
178
Treatment of Hypermetabolic response in burn injury
early burn exciion and grafting
B blocker
Insulin
Nutrition and steroid
179
rapid progressive cellulitis of the submandibular and sublinguial spaces
Ludwig angina
180
Indications of worse prognosis in acute pancreatitis
elevated BUN
SIRS criteria
third spacing of fluid
181
Predictors of postop outcomes following lung resection
Preop FEV1 and DLCO
182
post gastric bypass, fever, ab pain, tachy and tachypnea
anastomotic leak
| D(x) oral contrast enhanced CT
183
stabbed in chest, respiratory distress, unilateral absent breath sounds, hypotension and distended neck veins
tension pneumothorax
184
TBI, episodic HTN, tachy, diaphoresis
paroxysmal sympathetic hyperactivity
185
most common opportunistic infection after renal transplant
CMV
186
Actively bleeding + DVT management
inferior vena cava filter
187
Right sided varicocele management
US abdominal
188
causes of sialadenosis
chronic alcohol use, bulimia, malnutrition
189
Type of dressing for venous stasis ulcers developed to cellulitis
wet to dry dressing
190
Cervical spine imaging necessary if
neuro deficit, spinal tenderness
AMS
intoxication
distracting injury
191
pain with ejaculation, many UTI
chronic bacterial prostatitis
192
valve issue that is most common cause of pregnancy related complications
mitral stenosis
193
Rectal prolapse with debilitating symptoms management
surgery
194
tumor that causes nasal congestion with epistaxis, headache, cranial nerve palsy, serous otitis media
nasopharyngeal carcinoma via EBV
195
treatment of plantar fasciitis
activity modification
stretching exercises
heel pads/ orthotics
196
blood thinner, acute ab pain, abdominal mass and anemia
rectus sheath hematoma
197
management of initial bloody output >1500mL via chest tube
emergent thoracotomy
198
Arterial embolism vs. arterial thrombosis
Arterial embolism= pain, pallor, paresthesia, pulseless, paralysis
arterial thrombosis= claudication
199
Most concerning of parotid malignancy
presence of facial droop
200
pelvic fracture + unstable patient
| first step in management
pelvic binder
201
local complication of cardiac catheterization
AV fistula (continuous bruit with palpable thrill)
202
Organisms that cause deep infections following puncture wounds
staph aureus
| pseudomonas
203
<24 hours after blunt thoracic trauma
tachypnea, tachy, hypoxia
CT: patchy, alveolar infiltrate not restricted by anatomic borders
pulmonary contusion
204
persistent hoarseness and fungating laryngeal mass
| smoker
laryngeal SCC
205
complication of succinylcholine
cardiac arrhythmia due to electrolyte derangement
206
progressive hearing loss, paradoxical improvement in noisy environments
reddish hue behind TM
otosclerosis
207
Treatment for c. diff
fidaxomicin or vanco
208
complication of C. diff
toxic megacolon
209
arm in extension and pronated
| no swelling, deformity or focal tenderness
Nursemaid elbow
| treat via hyperpronation or supination of forearm and flexion of elbow
210
post surgery, traumatic injury
Abdominal distension, pain, obstipation, vomiting
Xray: colonic dilation, normal haustra, nondilated small bowel
Oglivie syndrome
211
unilateral bloody nipple discharge with no breast mass or LAD
intraductal papilloma
212
treatment of small pneumothorax
supplemental oxygen
213
abdominal pain, RUQ mass, jaundice
| cystic dilation
biliary cyst
| treat with ERCP
214
posterior knee an calf pain with tenderness and swelling of the calf resembing DVT
arc of ecchymosis distal to medial malleolus
ruptured popliteal cyst
215
management of suppurative parotitis
US/CT
hydration and oral hygiene
abx
massage
216
bilateral hip, thigh, and buttock claudication
| absent/ diminished femoral pulses, impotence
leriche syndrome
217
post op fever, leukocytosis, high LFTs and RUQ pain
acalculous cholecystitis
218
nonhealing ulcer at the site of chronic burn scar
squamous cell carcinoma
219
CT well defined cyst with eggshell calcification
| dogs at home
hyadatid cyst
220
alopecia, pustular skin rash, hypogonadism, impaired wound healing, impaired taste, immune dysfunction
zinc deficiency
221
most common empyema organisms
strep pneumo, staph aureus
222
diagnostic of laryngomalacia
laryngoscopy
223
malignant pericardial effusion management
TTE
224
weeks to months after amputation
focal tenderness, altered local sensation
decreased pain with anesthetic injection
post traumatic neuroma
225
complication of cardiac surgery. mild chest pain or sensation of chest wall instability and clicking
sternal dehiscence
| T(x) surgical emergency sternal fixation
226
irregular exophytic growths in clusters on vocal cords
laryngeal papillomas
227
sudden sharp pain while pivoting ankle.
| Cannot move foot when calf is squeezed, cannot walk of tippy toes
Achilles tendon rupture
228
neuroendocrine malignancy from parafollicular cells
medullary thyroid cancer
| check calcitonin
229
bilateral renal infarcts and several abdominal arteries with microaneurysms and distal abrupt cutoffs
polyarteritis nodosa
230
Management of pheochromocytoma preop
alpha blockage prior to beta blockade
231
thyroid tumor marker
thyroglobulin
232
abdominal pain or nausea post cholecystectomy
| dilated common bile duct
postcholecystectomy syndrome
| ERCP
233
staging evaluation for rectal adenocarcinoma
CEA, CT scan, colonoscopy
234
Thyroid nodule evaluation
1. TSH and thyroid US
| 2. radioactive scintigraphy
235
posterior displacement of distal humerus
| nerve and artery damage
median nerve
| brachial artery
236
artery injured in knee dislocation
popliteal artery
237
anterior mediastinal mass high AFP and B hCG
mixed germ cell tumor
238
liver mass with arterial flow and central scarring
focal nodular hyperplasia
239
RUQ pain, jaundice, anemia and hyperbilirubinemia after liver biopsy, upper GI bleed
hemobilia
240
quick twisting motion around flexed knee, severe pain, popping noise
patellar dislocation
241
indurated, erythematous mass near anal orifice associated with severe constant anal pain and low grade fever
perianal abscess
| occlusion of an anal crypt gland
242
blunt abdominal trauma with billous emesis, gastric dilation and scant distal gas
duodenal hematoma
243
reduce intracranial pressure
hypertonic saline
244
post splenectomy abx if fever
amoxicillin- clav
