Surgery Flashcards

Question

T/F the Aa gradient is elevated in patients with hypoventilation

Answer 1

False - it is **normal**

Answer 2

True - it increases with age, but an Aa \>30 is considered to be elevated regardless of age

Answer 3

PE atelectasis pleural effusion/pulmonary edema ^{(all of these cause V/Q mismatch and subsequently elevations in Aa gradient)}

Answer 4

\>38C (100.4F)

Answer 5

prior infection or trauma inflammation due to surgery malignant hyperthermia medications (anesthetics) transfusion reaction/blood products given during or prior to surgery

Answer 6

nosocomial infections (PE, UTI) non-infectious (PE)

Answer 7

drug fever surgical site infection PE

Answer 8

infection (viral infection from blood products, infective endocarditis)

Answer 9

caused by **residual plasma or leukocytic cells **in PRBC taht release cytokines during storage; when transfused it can cause transient fevers, chills, and malaise (w/o hemolysis) **within 1-6 hours of transfusion** mgmt: stop transfusion; r/o other causes of fever (acute hemolytic rxn) and anti-pyretics (aspirin)

Answer 10

**laparoscopy** = hemodynamically stable pts; assess injury to hollow viscus or other organs that cannot be readily determined clinically **laparotomy** = hemodynamically **un**stable patients; used to diagnose and treat source of bleeding as well as any perforation of any abdominal viscus in an effort to prevent sepsis

Answer 11

when US is not available for a FAST exam OR when a FAST exam is inconclusive

Answer 12

axillary n. physical exam: * prominent acromion with abnormal sub-acromial space (where humeral head normally resides) * paralysis of deltoid and teres minor muscles * loss of sensation over the lateral upper arm

Answer 13

wrist-drop sensory loss on the posterior arm, forearm, and lateral dorsal hand

Answer 14

claw hand (secondary to paralysis of intrinsic muscles of hand) sensory loss on the dorsal- and ventral- medial hand)

Answer 15

dome of bladder - this region is attenuated because it's where the urachus atttaches to the bladder

Answer 16

venous insufficiency (valvular incompetence) edema that worsens throughout the day and resolves overnight when the patient is recumbent

Answer 17

innervates muscles of **anterior** compartment of thigh (quads, satorius, pectineus) sensation to anterior thigh/medial leg via saphenous branch

Answer 18

innervates medial compartment of thigh (gracilis, adductor longus/brevis/magnus) sensation over medial thigh

Answer 19

branch of common peroneal nerve aka fibular nerve

Answer 20

branch of common peroneal nerve aka fibular nerve

Answer 21

**immediate appendectomy** - classic presentation (migratory pain, N, V, F, leuokcytosis, McBurney's point, Rovsing sign); no further imaging before surgery is necessary **further imaging (US/CT)** - atypical presentation or there are other potential causes of RLQ pain (diverticulitis, ileitis, IBD)

Answer 22

**cyst or abscess near/on buttock cleft; often contains hair and skin debris** **infection of hair follicles** with sub-cu spread & abscess formation that then ruptures to form a pilonidal sinus tract; accumulation of hair/skin debris can subsequently cause infection/foreign body reactions, resulting in pain, swelling, and purulent discharge in the midline post-sacral intergluteal region develops following **chronic sweating/friction** of skin overlying coccyx within the superior gluteal cleft -\> promotes growth of **anaerobic bacteria** Tx: **I&D and excision of sinus tracts**

Answer 23

Crohn's disease within 3 cm of the anal margin

Answer 24

Squamous cell carcinoma in situ of the skin typically presents as a gradually **enlarging, well-demarcated erythematous plaque** with **irregular borders** and **crusting/scaling**

Answer 25

**bladder catheterization -** in absence of obvious pelvic injury and blood at the urethral meatus, patients should have a urinary catheter placed to assess for urinary retention and prevent possible bladder injury from acute distension and damage

Answer 26

Complications (**Ba**rry's **Mn**emonics broke his fall) * median n. injury * brachial a. injury * cubitus varus deformity * compartment syndrome/Volkmann ischemic contracture Fractures are comon in children as the supracondylar area is thin/weak due to physiologic remodeling in childhood

Answer 27

structures affected and presentation: * **contralateral crus cerebri against tentorial edge** * ipsilateral hemiparesis * **ipsilateral CN III (oculomotor)** * loss of parasympathetic innervation -\> mydriasis (early) * loss of motor innervation -\> ptosis and down/out gaze of ipsilateral pupil due to unopposed CN4/6 activity (late) * **ipsilateral posterior cerebral artery** * contralateral homonymous hemianopsia (due to ischemia of visual cortex) * **reticular formation** * ∆ level of consciousness; coma

Answer 28

Cushing's reflex - indicates increased ICP Also present with ipsilateral oculomotor n. dysfunction (mydriasis, ptosis, down-and-out gaze) secondary to uncal herniation

Answer 29

think **septic shock**, which is managed with **IV NS (without vasopressor therapy) **to maintain intravascular pressure **IV antibiotics **to correct underlying infection _{(bicarb in treatment of lactic acidosis is controversial; only used in severe acute acidosis pH<7.2)}

Answer 30

retropharyngeal abscess Get **CT Neck** to fully evaulate the extent of the infection ^{note: lateral X-rays of the neck show lordosis of cervical spine with gas + swelling in the retropharyngeal space} Trmt: **IV broad spectrum abx + I&D of abscess** to prevent spread into mediastinum

Answer 31

diphtheria low grade fever, unilateral nasal discharge, pharyngitis, cervical lymphadenopathy

Answer 32

coxsackie A virus (vesicles on tonsils and soft palate, typically in children) sore throat, fever, pain with swallowing

Answer 33

malignancy affecting the upper GI or associated solid organs (liver, GB, pancreas

Answer 34

smoking hereditary pancreatitis non-hereditary chronic pancreatitis obesity/lack of physical activity

Answer 35

periodic pain that is **relieved by food** PPI/H2 blockers provide some relief

Answer 36

Easy! If the patient is jaundiced (head tumors), get US if the patient is not jaundiced (body + tail tumors), get CT

Answer 37

**common symptoms**: insidious onset of constant and gnawing epigastric pain, often worse at night, anorexia + weight loss, fatigue, migratory thrombophlebitis (Trousseau sign) Other symptoms depends on the location of the tumor: * **head**: painless jaundice (CBD obstruction), steatorrhea (inability to secrete fat-digesting enzymes/blockage of main pancreatic duct) * **body/tail: jaundice ** don't confuse with peptic duodenal ulcer, which typically causes periodic epigastric pain that is relieved by meals

Answer 38

FIRST establish access wtih two large bore IV needles or central line ^{(don't worry about management of the esophageal varices, as they usually ceases bleeding eventually without further intervention; medical management (terlipressin, octreotide, or somatostatin) can be used to control bleeding comes later). Can also use NG tube to minimize risk of aspiration)}

Answer 39

**colonic ischemia and infarction (usually distal L colon)** symptoms & radiological findings: * LLQ pain with bloody diarrhea * CT - thickness of bowel wall * colonoscopy - discrete segment of cyanotic and ulcerated bowel cause: inteference of blood flow to L distal colon secondary to: * loss of collateral circulation * mainpulation of vessels with surgical instruments * prolonged aortic clamping and impaired blood flow through IMA

Answer 40

diarrhea rectal bleeding tenesmus incontinence later, strictures and fistulas may form

Answer 41

**duodenal hematomas** (forms in the submucosal and muscular layers of duodenum, thereby preventing gastric secretions from moving down the GI tract) causes obstruction-like symptoms: **epigastric pain with vomiting** **NG tube with parenteral nutrition** (most resolve in 1-2 weeks); **surgery** **to evacuate the hematoma** is considered if the more conservative method fails

Answer 42

ensure appropriate pain control (opiates, NSAIDs, or intercostal nerve blocks) because rib pain can cause hypoventilation that may ultimately result in atelectasis and pneumonia

Answer 43

hypovolemic shock ## Footnote severe hemorrhage - \> decreased VR -\> decreased EDV and CO - \> increased sympathetic activity -\> constrict venous capacitance vessels -\> improved VR

Answer 44

positive pressure mechanical ventilation - \> increases intrathoracic pressure during inspiration - \> increases RA pressure -\> decreases systemic VR to RA (preload) and subsequently decreased pulmonary blood flow -\> acute circulatory failure and death _{normally, (-) pressure created by inspiration assists with VR, and alleviates pressure on the pulmonary capillary system to encourage flow. On expiration, the intrathoracic pressure returns towards zero/atmospheric so that VR will increase.} **prevent by IV fluid resuscitation BEFORE mechanical ventilation is attempted!**

Answer 45

**compartment syndrome** - soft tissue swelling caused by reperfusion following an arterio-occlusive ischemia, usually \> 4-6 hrs (edema causes increased pressure within an enclosed fascial space, ultimately leads to muscle and nerve ischemia secondary to compromised blood flow) other sx: pain out of proportion to injury, rapidly increasing and tense swelling, paresthesias Tx: **fasciotomy**

Answer 46

**_DVT_**: calf tenderness with **vague, aching** pain worsened by **passive dorsiflexion** of the calf with the knee extended (Homan) **_Compartment_**: **pain-out-of-proportion-to-injury** increased on **passive extension**

Answer 47

post-op cholestasis - usually develops after a major surgery characterized by hypotension, extensive blood loss into tissues, and massive blood replacement; pathophysiology involves * increased pigment load caused by transfusion * decreased liver function caused by hypotension * decreased renal bilirubin excretion (caused by ATN secondary to hypotension)

Answer 48

* **fluid resuscitation** - first step always in a patient with hypotension/tachycardia * **fast scan** - first step after IVF to determine if there is intraperitoneal free fluid or hemorrhage * **DPL** - if FAST if unequivocal * **CTs** - done only in hemodynamically stable patients * **head CT** - in patients with closed head injury coinciding with BAT * **Chest CT** - in pts with multisystem injury ad suspected injury to aorta, CXR showing mediastinal abnormalities * **abdominal CT** - in pts with negative findings and FAST to determine need for laparotomy

Answer 49

nasal septal perforation (septum is poorly vascularlized and has poor regenerative capacity following trauma or surgery)

Answer 50

give FFP to restore the vitamin K dependent clotting factors

Answer 51

**DDVAP** - increases factor VIII by causing vWF release from endothelial cells

Answer 52

1. elevate head - increase venous outflow from the brain 2. sedation - decreased metabolic demand and control HTN 3. mannitol - osmotic diuresis (cannot cross BBB) 4. hyperventilation - cerebral vasoconstriction 5. CSF removal via therapeutic LP's - reduces volume/pressure

Answer 53

**Reynold's pentad** (confusion + hypotension *in addition to* Charcot's triad of fever, jaundice, RUQ pain) get **ERCP** because urgent biliary decompression (either sphincterotomy w/ stone removal and/or stent placement) is imperative

Answer 54

12-72 hours

Answer 55

All in the presentation! pulmonary contusion -\> **hours **(cxr shows patchy, irregular infiltrates fat emboli -\> **12-72 hours**

Answer 56

squamous cell carcinoma arising from burn wounds

Answer 57

**inflammation + distension of the GB** (usually due to obstruction of the cystic duct by a gallstone) RUQ pain, fever, leukocytosis cholecystectomy **within 72 hours**

Answer 58

percutaneous transhepatic gallbladder drainage

Answer 59

detecting intracerebral hemorrhage

Answer 60

when determining the etiology of TIA or strokes

Answer 61

limb ischemia due to arterial thrombi occlusion secondary to afib - note the 5 P's (pain, pallor, pulselessness, paresthesias, paralysis) in the question stem get heparin infusion + vascular surgery consult for intra-arterial thrombolysis or surgical embolectomy

Answer 62

increase splanchnic nerve sympathetic tone due to violation of the peritoneum local release of inflammatory mediators post-op narcotic (opiate) use, which causes disordered peristalsis

Answer 63

depends on how much hemoptysis one is having, but **bronchoscopy is the initial choice** because it can localize the bleeding site, provide suctioning ability to improve visualization, and include therapeutic interventions, such as embolization, or resection when indicated if **mild/moderate --\> work up** (CXR, CBC, coag, CT +/- _bronchoscopy_) if **massive (\>600cc/24h or 100cc/hr) -\> secure ABCs**; if bleeding continues, then _bronchoscopy_

Answer 64

rest and analgesics

Answer 65

pain and changes in lung compliance can cause: * impaired cough -\> small airway mucus plugging * shallow breathing -\> limit recruitment of alveoli at the basesza

Answer 66

think AAA rupture and take to the OR AAA can rupture into the retroperitoneum and create an aortocaval fistula with the IVC, leading to venous congestion in retroperitoneal structures (bladder). The fragile and distended veins in the bladder can rupture and cause gross hematuria

Answer 67

\<400 cc/day or \<6 cc/kg/day

Answer 68

first - change the foley to ensure it's not clogged next - if pre-renal azotemia is suspected, a fluid challenge (IVF bolus) is indicated

Answer 69

Arnold Chiari malformations and prior spinal cord injuries (s/p MVA, whiplash, neck hyperflexion) strength + sensory loss in upper extremities - damage involves the crossing fibers of the spinothalamic tract (pain/temp) and upper extremity motor fibers due to their medial locations within the corticospinal tra

Answer 70

diaphragmatic injury blunt abdominal trauma causes sudden increase in intraabdominal pressure that causes large radial tears in the diaphragm, allowing leakage of intra-abdominal contents into the chest, lung compression, and mediastinal deviation (also shows a NG tube in the lung cavity) Mgmt: surgical repair

Answer 71

because the mechanical ventilator induces (+) intrapleural pressure (ie it replaces the normal (-) intraplaural pressure) during spontaneous ventilation, thereby causing the previously paradoxical moving flail segment of the thoracic cage to move out normally normally with the rib cage during inspiration

Answer 72

intraductal papilloma usually difficult to palpate because it is usually \< 2mm and soft; US is usually negative as well ^{(US is best at detecting masses >1 cm)}

Answer 73

gastric outlet obstruction caused by mechanical obstruction post-prandial pain and vomiting with early satiety causes: gastric malignancy, PUD, Crohns, pyloric stricture/stenosis, ingestion of caustic agents (acid, etc), and gastric bezoars

Answer 74

developing a **pyloric stricture -** acid causes fibrosis 6-12 weeks after the resolution of the acute injury.

Answer 75

in patients who have had diabetes for \>**10** years

Answer 76

20 mg daily for \>3 weeks patients may not respond appropriately to "stress" (surgery, infection, bleeding, MI) and will require "stress doses" of short-term steroids during the acute condition

Answer 77

endotracheal intubation because of the physical evidence of thermal damage to the upper airway. Reason for early intubation is that progressive airway edema may preclude intubation later in the patient's clinical course

Answer 78

N-acetylcysteine

Answer 79

steady state ratio of **CO2 produced** to **O2 consumed** per unit time. Used to assess the body's metabolism, as this ratio depends mainly upon the major fuel being oxidized for ATP production RQ 1 = carbs is the major nutrient being oxidized RQ 0.8 = proteins " " RQ 0.7 = fatty acids " " impt when trying to wean patients off mechanical ventilation since overfeeding (esp with carbs) can cause excess CO2 production and make weaning more challenging

Answer 80

post-op pain (promotes shallow, rapid breathing) narcotics (decreases respiratory drive, deep inspirations, and coughing abnormal mucociliary clearance obesity + supine position

Answer 81

femoral artery aneurysm associated with anterior thigh pain due to femoral n. compression that runs lateral to the artery

Answer 82

depends on the hemodynamic status of the patient and their response to IV fluids: * if hemodynamically **un**stable + **un**responsive to fluid administration --\> emergent exlap * if hemodynamically unstable +** **responsive to fluid administration (SBP \>100mmHg) --\> CT abd

Answer 83

diastolic decrescendo murmur /aortic regurgitation - usually heard if the dissection involves the aortic root

Answer 84

suspect bleeding/hematoma with retroperitoneal extension most form within 12 hours, esp if the arterial puncture site is above the inguinal ligament diagnose with non-con CT or US mgmt: supportive w. bed rest, intensive monitoring, IVF, and blood transfusion if necessary

Answer 85

MRI - able to detect complete and partial tears, the exact site of the ligamentous injury and associated injuries to other ligaments/meniscus

Answer 86

early dumping syndrome - rapid emptying of hypertonic gastric content into the duodenum/small intestines results in: fluid shift from intravascular -\> small intestines release of vasoactive polypeptides stimulation of autonomic reflexes management: **diet ∆s,** octreotide for resistant cases, reconstructive surgery for intractable cases

Answer 87

**psoas abscess**: fever + lower abdominal pain elicited with deep palpation; source of infection include hematagenous spread from the skin (ie furuncles) or contigious spread from nearby bone or bowel abscess * mgmt: abx + drainage (percutaneous drainage tube, laparotomy, or laparoscopy) **appendicitis**: vague periumbilical pain that localizes to RLQ * mgmt: appendectomy

Answer 88

damage to radial nerve (passes through the radial groover on the posterior side of teh humerus) results in a limitation of extension at the wrist, aka **"wrist drop"**

Answer 89

Note mediastinal widening on CXR, which is the most sensitive finding for **aortic injury**, which commonly ocurs after blunt deceleration trauma (MVA or fall \>10 ft)

Answer 90

48-72 hours

Answer 91

severely ill patients ^{(ex: ICU, multi-organ failure, severe trauma, surgery, burns, sepsis, prolonged TPN)} likely due to cholestasis and GB ischemia, which can lead to secondary infection by enteric organisms and resultant GB edema and necrosis. Can lead to sepsis and death if undetected **antibiotics + percutaneous cholecystostomy** under radiologic guidance initially, followed by cholecystectomy when the medical condition stabilizes

Answer 92

rotator cuff tear falling on an outstretched hand commonly causes injury to the supraspinatous muscle, where the patient has severe shoulder pain and edema and is unable to abduct the arm past 90˚.

Answer 93

2nd intercostal space, midclavicular

Answer 94

wrapped in saline-moistened gauze, sealed in a plastic bag, placed on ice and brought to the ED with the patient do not place directly on ice because this could result in frostbite injury to the amputated tissue and loss of viability

Answer 95

arterial occlusion at the level of the aortic bifurcation into the common iliac arteries; characterized by the triad of ^{bilateral claudication of the hip, thigh, and buttock} ^impotence ^{symmetric atrophy of bilateral lower extremities due to chronic ischemia} most common in men with a predisposition for atherosclerosis, such as smokers

Answer 96

ruptured aorta with blood collection in the adventitial layer if the patient is unstable --\> OR for surgical repair if the patient is stable --\> CT

Answer 97

abdominal surgery retroperitoneal hemorrhage associated with vertebral fracture

Answer 98

patients should proceed emergently for ex lap if * they do not improve with conservative measures * develop signs/symptoms of strangulation * hemodynamically unstable _{conservative measures: complete bowel rest, NG tube, pain control, fluid resuscitation, correction of metabolic derangements} _{sx of strangulation: fever, tachycardia, leukocytosis, and metabolic acidosis, peritonitis (occurs only if there is frank bowel necrosis}

Answer 99

**acute mediastinitis**, likely secondary to intraoperative wound contamination (the cloudy fluid is actually pus in the mediastinum) Mgmt: drainage, debridement with immediate closure, and prolonged antibiotic therapy

Answer 100

normal; self-limited and usually resolves in \< 24 hrs. anticoagulation +/- cardioversion is indicated if it doesn't resolve within 24 hours

Answer 101

**ligamentous: rapid swelling** due to hemarthrosis (ligaments have greater vascular supply than menisci, which rely on diffusion for nourishment) **meniscal: gradual joint swelling** over 12-24 hr **BOTH are often associated with a popping sensation**

Answer 102

**bronchial rupture** - persistent pneumothorax despite CT placement + pneumoediastinum ^{(don't confuse wtih esophageal rupture, which can also present with pneumomediastinum in addition to pleural effusions; also esophageal rupture secondary to blunt trauma is rare - usually it's secondary to iatrogenic causes)}

Answer 103

* hernia - covered by skin * omphalocele - covered with peritoneum without overlying skin * gastroschisis - no membrane

Answer 104

yes, large hernias are less likely to close spontaneously, so surgery is recommended around age 5 for persistant hernias, or sooner.

Answer 105

retrograde urethrogram

Answer 106

urinary diversion via suprapubic cathether while the primary injury and associated hematomas are allowed to heal, after which assessment/repair of residual damage (ie strictures) is done.

Answer 107

since a bruit is heard, get an **angiogram** to rule out injury to the underlying vessel

Answer 108

motor response verbal response eye opening

Answer 109

place thumb in a spica cast and repeat the x-ray in 7-10 days because the initial x-rays may not show anything if it is a minimally displaced or compressed fracture if there is a non-displaced fracture --\> wrist-immobolization for 6-10 weeks to minimize the risk of non-union since the scaphoid bone is at high risk of avascular necrosis

Answer 110

bowel ischemia - results from inadequate colonic collateral arterial perfusion to the L and sigmoid colon after loss of the IMA during aortic graft placement prevent by checking sigmoid colon perfusion following placement of the aortic graft

Answer 111

**adhesions** secondary to inflammatory processes or abdominal operations (ie appendectomy)

Answer 112

GI bleed that originates above the ligament of Treitz PUD, gastritis, esophagitis, Mallory-Weiss tear

Answer 113

hyp**O**calcemia

Answer 114

usually with blunt trauma with pulmonary injury that can result in communications between the airways and vessels - air emboli (esp when positive pressure mechanical ventilation is used) can form

Answer 115

**clinically**: severe periumbilical pain that is out of proportion to exam findings, leukocytosis, elevated amylase, and metabolic acidosis (from increased serum lactate levels) **diagnosis**: mesenteric angiography **trmt**: supportive (IVF, abx, NG tube)

Answer 116

get a colonoscopy cancer until proven otherwise!

Answer 117

urgent needle decompression in the second intercostal space, L mid-clavicular line followed by chest tube placement (tube thoracostomy) in the 5th intercostal space mid-axillary line

Answer 118

liver and spleen

Answer 119

medial colalteral ligament injury valgus stress test

Answer 120

lateral collateral ligament varus stress test

Answer 121

**anterior cord syndrome,** likely due to spinal cord infarction anterior spinal artery supplies the anterior 2/3 of the spinal cord, which includes the motor tracts (corticospinal) and sensory tracts (spinothalamic). it the ASA derives its blood supply from the **radicular arteries** that originate from the thoracic aorta. thus thoracic aortic surgery can result in reduced blood flow through the radicular arteries (cross-clamping, systemic hypotension), and lead to anterior spinal cord infarction

Answer 122

spinal shock - abrupt onset of **bilateral flaccid paralysis** and **loss of pain/temperature** sensation below the level of the spinal injury vibration and proprioception are preserved

Answer 123

hypoxemia hypocapnia respiratory alkalosis large areas of atelectasis cause VQ mismatch, leading to **hypoxemia** and increased work of breathing (dyspnea, tachypnea) to compensate for the hypoxemia, patients usually ventilate and develop **respiratory alkalosis** and **decreased PaCO2/hypocapnia**

Answer 124

anti-HTN and immediate operative repair

Answer 125

thymoma teratoma thyroid neoplasm terrible lymphoma

Answer 126

seminomas = usually just elevated ßhCG + normal AFP non-seminomatous = elevated ßhCG + AFP

Answer 127

typically \>5 days after the onset of symptoms of appendicitis (when the appendix has perforated and an abscess has formed) if they are clinically stable -\> IV abx, bowel rest, and/or percutaneous drainage of the abscess can return in 6-8 weeks for interval appendectomy

Answer 128

escharotomy - incision of only the eschar layer fasciotomy - incision through all fascial layers (after escharotomy, patients are evaluated for clinical signs of adequate perfusion, and if there is no relief, a fasciotomy should be performed)

Answer 129

Paget's disease of the bone (osteitis deformans) disordered bone remodeling resulting in structurally inferior woven bone may have **hearing loss** due to cochlear nerve compression from enlargement of temporal bone

Answer 130

T \> 38.5˚C (101.3) or \<35˚C Pulse \>90/min RR \> 20/min WBC \>12K, \<4K, or \>10% bands

Answer 131

**hypovolemic shock** **hypermetabolic response** (hyperglycemia, muscle wasting, protein loss, hyperthermia, increase energy expenditure) ^{there is an increase in catecholamines+cortisol s/p burns, which can cause significant protein losses as muscle degradation is used for gluconeogenesis} **infection** (pneumonia/wound infections) leading to sepsis and septic shock

Answer 132

worsening hyp**er**glycemia (due to worsening insulin resistance) leukocytosis thrombocytopenia mild hypothermia (T \<36˚) Tachypnea tachycardia

Answer 133

tearing of tunica albuginea, which invests the corpus cavernosum. This results in a rapidly-forming hematoma that causes bending of the shaft of the penis at the site of the fracture. urgent urethrogram to assess for urethral injury and emergency surgery to evacuate the hematoma and to mend the torn tunica albuginea

Answer 134

splenic injury if the patient is stable -\> get a CT with contrast, as this is the best diagnostic study to determine if there is a need for surgery if patient is hemodynamically unstable despite IV resuscitation -\> urgent laparatomy

Answer 135

splenic injury (sometimes the stem will indicate L rib fractures as well) if pt is stable -\> get a CT w/ contrast, as this is the best diagnostic study to determine if there is a need for surgery if pt is hemodynamically unstable despite IV resuscitation -\> urgent laparatomy

Answer 136

twisting injury with the foot in a fixed position symptoms: * GRADUAL swelling and pain **usually within 12-24 hrs** * symptoms of popping, catching, knee giving out, and locking (inability to extend the knee) **usually develops weeks later** **MRI**

Answer 137

ankle-brachial index (=SBP in ankle / SBP in arm) ABI \<90 is diagnostic of occlusive peripheral artery disease

Answer 138

abdominal US

Answer 139

arterial occlusion of an extremity

Answer 140

thrombus embolus trauma

Answer 141

retropharyngeal space

Answer 142

infection in the submandibular space typically begins in the floor of the mouth and extends through the submandibular and sublingual space into tissues surrounding the airway

Answer 143

wrist-immobolization for 6-10 weeks to minimize the risk of non-union since the scaphoid bone is at high risk of avascular necrosis

Answer 144

sphenopalatine artery | (MCC posterior nosebleeds)

Answer 145

**lack of normal joint sensation (Charcot foot)** progressive degeneration of a weight-bearing joint, a process marked by bony destruction, resorption, and eventual defomity; commonly due to diabetic neuropathy or any condition resulting in decreased peripheral sensation, proprioception and fine motor control

Answer 146

Low Ca levels can cause Prolonged QT -\> give Ca gluconate

Answer 147

CMV colitis - inflammation of the colon

Answer 148

LR - needs to be fluid resuscitated

Answer 149

atrial myxoma - primary heart tumor derived from multipotential mesenchymal cells and may cause a ball valve-type obstruction; causes a **mid-diastolic rumble** (secondary to mitral stenosis caused by the tumor) **that changes when the patient changes position**

Answer 150

**needle localized open biopsy -** performed when there is an abnormality seen on a mammogram that cannot be palpated. ^{Note that this is NOT a FNA!!}

Answer 151

gastric bypass ^{Panniculitis is a group of diseases whose hallmark is inflammation of sub-cu adipose tissue.}

Answer 152

ovarian adenocarcinoma ^{As the cancer becomes more advanced, it can cause an accumulation of fluid in the abdomen} ^{ovarian cancer risk factor: Not having children, obesity, HRT, increased age} ^{OMENTAL THICKENING: typically caused by metastatic infiltration by tumors arising from the stomach, ovary, or colon (OT-SOC).}

Answer 153

microscopic hematuria (\> 3/hpf)

Answer 154

water soluble contrast upper GI study to look for perforation

Answer 155

**HIT** - predisposes to thrombosis because IgG form a complex with heparin + PF4 and the tail of the antibody then binds to the FcγIIa receptor on platelets. This results in platelet activation and the formation of platelet microparticles, which initiate the formation of blood clots; the platelet count falls as a result, leading to thrombocytopenia.

Answer 156

femoral hernia key words: **female**

Answer 157

15 L of LR calculate using Parkland Formula: **V = 4\* mass (kg) \* % area burns**

Answer 158

Fat emboli - classically presents with 1) **respiratory changes** - first to present; usually dyspnea, tachypnea, and hypoxemia 2) **neurological ∆s** - early stages, ranges from confusion, drowsiness, and seizures 3) **petechial rash** - due to embolization of small dermal capillaries leading to extravasation of erythrocytes; most common in the axillary NOT alcohol withdrawal, since these do not present with axillary petechiae, which is pathognomonic for fat emboli

Answer 159

rapid infusion of IV saline - get the patient stabilized first, then figure out the bleeding source

Answer 160

**bronchial rupture** - persistent pneumothorax w/ chest tube, pneumomediastinum, _sub-cu emphysema_ **esophageal rupture** - pneumonmediastinum + _pleural effusions_; diagnose with gastrofin contrast esophagogram

Answer 161

anterior = abducted + externally rotated (ant a**bd** **e**x) posterior = adducted + internally rotated (post a**dd** **i**n)

Answer 162

**2nd part of duodenum** it is retropertioneal and is the least mobile, perforation occurs when the bowel is compressed between the spine and external solid structure (ie steering wheel, seat belt)

Answer 163

osteosarcoma "osteo = bone pain" * sites of rapid bone growth (metaphyses, proximal tibia/humeus) * (+) persistent bone pain that is worse at night ewing's sarcoma "eww...symptoms" * typically at diaphysis * (+) systemic features (malaise, fevers, wt loss)

Answer 164

**gun shot wound -** to the abdomen (below the 4th intercostal space/nipple) requires **ex lap** to ensure that there is no life threatening injury. Why? because of the *blast effect* of the bullet **stab wounds -** observed and treated conservatively in cases where the patient is hemodynamically stable

Answer 165

high dose IV steroids - should be given asap (ie administration should not be delayed for CT/MRIs) (though its use is controversial)

Answer 166

reassurance + observation because **hydroceles** typically resolve within 12 months; those that do not resolve should be surgically removed due to increased risk of inguinal hernias

Answer 167

**fibrocystic condition of the breast** * classically presents with breast pain that worsens around the time of menses * cysts are tender + mobile Get ******FNA** to r/o malignancy - usually yields serous / thin, greenish, non-bloody fluid with resolution of the mass after aspiration. a breast mass that produces a non-bloody aspirate and disappears completely w/ aspiration does not need further evaluation other than observation for recurrence

Answer 168

indirect measure of LA pressure normally 6-12 mmHg

Answer 169

LV failure/cardiogenic shock

Answer 170

contrast study avoid endoscopy because insufflation with CO2 may exacerbate the injury

Answer 171

ruptures into rectovesical pouch PE: tender fluctuating mass palpable with tip of fingers on rectal exam

Answer 172

CT guided percutaneous drainage

Answer 173

**intact scaphoid** = analgesics + repeat xrays in 2 weeks **radiolucent line across the R scaphoid bone** = cast immobolization **displaced scaphoid fracture** = ORIF

Answer 174

neck exploration + repair of the flat failure to do so will result in complete obstruction with emboli formation

Answer 175

Paget's disease/Osteitis deformans - disordered bone remodeling

Answer 176

angiogram - consider a retroperitoneal bleed

Answer 177

\< 4 yo = Ultrasound \> 4 yo = XRay

Answer 178

it remains the same/near normal blood levels in the time period immediately following hemorrhage

Answer 179

antibiotics, analgesics, and continue breast feeding

Answer 180

external drainage of the cystic lesion

Answer 181

replacement of the large herniated contents into the peritoneal cavity increases the pressure in the peritoneal cavity and results in: * decreased VR to heart -\> hypotension * impaired motion of the diaphragm due -\> hypotentilation -\> decr. pH, incr PCo2, hypoxemia

Answer 182

bupivacaine short acting (**chloroprocaine**, 45-90 minutes) intermediate duration (**lidocaine**, mepivacaine, **prilocaine** 90-180 minutes) long acting (**bupivacaine**, levobupivacaine, ropivacaine, 4-18 hours)

Answer 183

Esophagogastroduodenoscopy (EGD) - diagnostic endoscopicprocedure that visualizes the upper part of thegastrointestinal tract up to the duodenum; indicated when there is: * Unexplained anemia (usually along with a colonoscopy) * Upper GI bleed * **Persistent dyspepsia in patients \> 45 years** * Heartburn and chronic acid reflux - this can lead to Barrett's esophagus * Persistent vomiting * Dysphagia * **Odynophagia** * Persistent nausea * IBD (Inflammatory Bowel Diseases)

Answer 184

**nerve conduction studies** - two electrodes are taped to your skin and a small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel

Answer 185

**apocrine glands** sweat glands found in teh axillae, areola, nipples, ear canal, eyelids, nostril wings, perianal region, and external genitalia

Answer 186

surgical procedure involving a large incision through theabdominal wall to gain access into theabdominal cavity. It is also known a laparotomy.

Answer 187

serum **IL-2** and **TNF-a** are associated with advanced gastric cancer and that these cytokines might be a useful tumor marker for gastric cancer, being associated with poor prognosis.

Answer 188

thyroidectomy - high suspicion for cancer in this gentleman given his history of neck radiation

Answer 189

COX inhibition with increased NE release

Surgery Flashcards

(219 cards)