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Uworld 2 > Surgery > Flashcards

Surgery Flashcards

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1
Q

Bladder Cancer 65 yo smoker @ trigone, expected finding?

A

Bilateral Hydronephrosis via prolonged urinary retention

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2
Q

Beaten up in the face, decreased facial sensation over lower chin and jaw

A

Mandibular fracture distal to inferior alveolar nerve (3rd branch of trigeminal n.)

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3
Q

Hypovolemic/ hypotensive post surgery, decreased urine outflow

A

3rd spacing vs. renal failure -> bolus fluid challenge -> improve BP vs no improvement, or UNa <10-20 hypovolemic v >40 renal

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4
Q

Signs of vascular injury requiring immediate surgery

A

absent pulses, bruit, thrill, active hemmorrhage/hematoma expanding, distal ischemia (cold/pale, paresthesia, pain, paralysis)

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5
Q

Signs of stable vascular injury but require vessel imaging

A

hx of hemmorrhage at scene, stable hematoma, decreased pulses / asymetric, proximal to major vessel, associated nerve deficit, ABI < 0.9

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6
Q

Steroid use, pneumoperitoneum (air under diaphram)

A

Ulcer hx, perforated, immediate abdominal laparotomy

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7
Q

Age >40, hematochezia, constipation, weight loss, stool caliber change

A

Colon cx, Left side

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8
Q

Pt w glass eye, or missing toe (surgical), presents w liver mets

A

Melanoma: marker Tyrosinase

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9
Q

Pneumoturia

A

Colovesicular fistula (via crohns, diverticulitis, iatrogenic, foreign body, cancer) -> CT abdomen/pelvis

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10
Q

Pringle Maneuver: clamps portal triad… still bleeding?

A

Hepatic vein (to IVC) is not blocked and bleeds, blocked triad (portal vein, hepatic artery, common bile duct)

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11
Q

Nausea Vomiting, Abd distention? –> SBO workup? Mng?

A

Abd Xray: dilated loops of bowl. NPO, NG tube decompression. Surg for severe/ worrisome ischemia

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12
Q

hypotensive /pale 28yof on birth control w vomiting anddistended/ tender abdomen

A

Rutpured hepatic adenoma, benign, a/w OCP use, glycogen storage dz 1, bleed into abdomen

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13
Q

Painless obstructive jaundice (dilated biliary duct/ high alk phos). Dilated thin walled gallbladder w/o stones

A

Malignancy ie. Cancer of the head of the pancreas -> CT Scan

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14
Q

Flank pain, radiating to thigh and scrotum, Hematuria

A

Nephrolithiasis -> CT non contrast

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15
Q

RUQ pain, cholecystites w/ stones, 1 week later: bilious vomiting, air in biliary tree, dilated bowel loops

A

Gallstone Ileus -> Fistula between biliary tract and bowel-> Pneumobilia

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16
Q

Fat, Female, Forty, Fertile, colicky abd pain a/w fatty foods

A

Gallstones: confirm w/ R upper abd ultrasound, Rx: Antibiotics, IVF for cholecystitis (+fever, leukocytosis)

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17
Q

Post op abd pain / distended, nausea, constipation, dilated large bowel

A

Oglivie syndrome - colonic pseudo obstruction: Rx IV Neostigmine 2m over 10min

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18
Q

High spinal anesthetic -> hypotense / flushed, 0 central venous pressure

A

Sympathetic block -> vasodilation -> vasomotor shock Rx. Peripheral vasoconstrictor alpha agonists and IVF

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19
Q

Intra-op tachycardia, hypotensive, low urine output, decreased cardiac output, increased vascular resistance

A

Cardiogenic shock -> Rx Dobutamine (beta1 agonist) -> increased contractility and output

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20
Q

Pituitary adenoma resection -> lethargic, confused, comatosed, increased urine, dry mucosa

A

Central diabetes insipitus -> hypernatremia -> CNS pathology, Rx: IVF, Desmopressin

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21
Q

Hx chronic hepatitis B/C, cirrhosis, hepatotoxins + sx wt loss, RUQ discomfort

A

Hepatocellular carcinoma (HCC) -> monitor AFP (alpha feto- protein)

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22
Q

Inspiratory arrest w/ palpation of RUQ abd

A

Murphy’s sign: acute cholecystitis

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23
Q

Shortened leg, externally rotated -> displaced fx neck of R femur Mx?

A

Arthroplasty (prosthetic replacement) given the risk of avascular necrosis, tenuos blood supply to femoral head

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24
Q

Kid falls on outstretched arm -> supracondylar humeral fx -> closed reduction -> pain/palor/cold forearm -> ?

A

Compartment sx -> untreated (faschiotomy) -> ischemic injury: Volkman’s contracture: necrosed muscle replaced by fibrotic tissue

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25
Boy 4-10 hip/groin/knee pain + antalgic gait
Legg-Calve-Perthes Avascular necrosis of femoral head
26
Boy 10-15 groin knee pain, chubby, hip flexed/thigh external rotated, internal rotation difficult
Slipped capital femoral epiphysis (SCFE) - Rx. pin femoral head
27
Hypotension w pulsatile abdominal mass
Ruptured AAA -\> emergent laparotomy / surgical repair
28
MVC midshaft femoral fx Mx?
Closed intramedullary fixation of the femoral shaft
29
Airway for apneic pt w head n neck injury
Orotracheal intubation or cricothyroidectomy
30
AAA repair, next day febrile, LLQ pain, bloody diarrhea, leukocytosis
Ischemic Bowel: CT: thickening of bowel wall, colonoscopy cyanotic mucosa w hemorrhagic ulceration; surgical rx colon resx colostomy
31
Palpable crepitus at mediastinum, protracted vomiting
Pneumomediastinum, perforated esophagus (Boerhaave's sd.)
32
Valgus stress test: increased laxity, tender medial knee
Medial Collateral Ligament tear
33
Varus stress test: increased laxity, tender lateral knee
Lateral Collateral Ligament tear
34
Sudden onset diffuse abdominal pain, air under diaphragm
Perforated gastric ulcer
35
Unilateral hip pain, middle aged adult, exacerbated by external pressure to upper lateral thigh
Trochanter bursitis
36
Abdominal trauma, adolescent, duodenal hematoma with obstruction Mx?
NG suction + parenteral nutrition (isolated hematoma)
37
Pt febrile RLQ pain, 5 days post appendicitis sx presentation
Perforated / complicated appendicites: Rx IVF + Cefotetan (enteric G-, anaerobes)
38
Abd trauma, epigastric pain, N&V, air in retroperitoneum
Duodenal Rupture: CT w contrast
39
Popping sound on passive flexion/extension of knee joint
Meniscal tear -\> MRI / arthroscopy
40
MVC Deceleration chest trauma, decreased breath sounds, palpable mediastinal crepitus (subQ emphesyma), pneumothorax despite chest tube
Tracheobroncial injury / rupture -\> high resolution CT -\> surgical repair
41
Post trauma, decreased breathing / chest pain / discomfort, lower, mediastinal deviation, lower lobe atelectasis
CXR: mediastinal deviation, hemidiaphrag, bowel gas above L diaphragm -\> CT contrast / barium swallow : perforated diaphragm w herniation -\> surgical repair
42
Grand-mal seizure, shoulder pain, arm adducted and internally rotated
Posterior dislocated shoulder
43
Bone pain, diabetic, elevated ESR and leukocytosis
Chronic osteomyelitis
44
Teen, bone pain, afebrile, joint swelling erythema, normal ESR, elevated AlkPhos, metaphysis of long bones
Osteogenic sarcoma (osteosarcoma), destructive lesions w periosteal formation & elevation (Codman's triangle), sunburst pattern
45
Teen, bone pain, systemic fever/wt loss, diaphysis of long bones (spine, pelvis)
Ewing sarcoma: small round blue cell malignancy, osteolytic onion skin pattern
46
Excess hair/easy bruisablitiy, elevated cortisol, High dose dexamethasone -\> ACTH still elevated
Small Cell Cancer of the Lung -\> chemo / radiation
47
Infiltrating ductal cx breast mass \>4cm
Mastectomy w axillary sampling
48
Herniation felt in the lateral aspect w examiner's finger in the external inguinal ring
Direct inguinal hernia: direct through floor/posterior wall of inguinal (Hesselbach’s) triangle (inferior epigastric laterally, rectus abdominis medially, inguinal ligament inferiorly)
49
Herniation felt by examiner's finger in the external inguinal ring
Indirect inguinal hernia: defect in deep inguinal ring, incomplete closure of processus vaginalis, contents into scrotum/labia
50
Progressive dysphagia solids&liquids, bird's beak barium study
Achalasia: loss of inhibitory neurons in LES -\> fail to relax: endoscopic pneumatic dilation, surgical myotomy / fundoplication
51
Ranson's criteria: 3 or more - severe pancreatitis
WBC\>16000, Glu\>200, AST\>250, LDH\>350, Age\>55 (non-gallstone) WBC\>18000, Glu\>220, AST\>250, LDH\>400, Age\>70 (stone)
52
Alcoholic, steatorrhea, intermittent intense epigastric pain, diabetes
Chronic pancreatitis! most accurate test: Secretin -\> bicarb rich pancreatic secretion (- test) if functional; CT best initial
53
Male w trauma to perineum / unstable pelvis (fx), unable to void, possible blood at meatus/ penile/ scrotum, high riding prostate
Trauma to urethra: must get retrograde urethrogram before foley!
54
Distended, diffusely tender abd, mitral stenosis + irregular pulse, acidotic
Afib -\> mesenteric thromboembolism -\> bowel ischemia -\> metabolic acidosis: emergent exploratory laparotomy, (mesenteric angio if stable w/o signs of ischemic bowel)
55
Tender painful spot in 3rd interspace of foot between 3rd/4th toes
Morton's neuroma, avoid high heels, surgical removal
56
Obese old man, blood in stool, anemic, increased AlkPhos & bilirubin, dilated intra & extra -hepatic ducts
Duodenal cx obstructing common bile duct @ ampulla of Vater -\> abd US -\> endoscopy w/ biopsy
57
Crushing injury, months later intense constant burning pain
Causalgia: reflex sympathetic dystrophy - sympathetic block relieves sx/ dx -\> sympathectomy
58
Incidental finding: dilated distal ureter
Megaureter: more common in males -\> asymptomatic / hydronephrosis -\> kidney failure
59
Increased parathyroid hormone in postmenopausal femal, increased Ca
Parathyroid adenoma, Rx. Surgical removal, or Estrogen/progesterone, Raloxifen, Bisphosphonates -\> decreased Ca
60
Postsurgical sx hypothyroid w low T4
Potential adrenal insufficiency, give Steroids, before T4. ACTH if pituitary insufficiency is the cause
61
Jaundiced, pruritis, wt loss, RUQ pain, conjugated hyperbilli, transaminases, hx sclerosing cholangitis, hepatomegaly
Obstructive jaundice 2/2 cholangiocarcinoma @confluence of hepatic ducts: US inconclusive-\> CT or MRCP: ductal dilation/ small gallbladder -\> ERCP cytologic dx
62
Asymptomatic Bacteriuria, pregnant, E Coli, Rx?
Nitrofurantoin, Cephalosporin (cefpodoxime), Sulfisoxazole, Amoxicillin, Amoxicillin-Clavulanate, Fosfomycin
63
8 yo w/ melena, RLQ pain, intussusception, volvulus, or obstruction near the terminal ileum
Meckel's Diverticulum: dx: Techtenium Pertechtinate, sx: 2 inches long., 2 feet from the ileocecal valve., 2% of population, first 2 years of life. 2 types of epithelia (gastric/pancreatic).
64
Pt w/ (infection/surgery/trauma/stroke/tumor) sx. Hyponatremia, increased FENa, hypo-osmolality; fluid restriction ineffective
SIADH: if can't tolerate loop diuretics, sodium tablets, give ADH antagonist: Demecocycline or Lithium
65
Pt (critically ill/ post op/ hypovolemic/ sedated) abd pain, vomiting, leukocytosis, fever
Acalculous cholecystitis via bile stasis; US: distended gallbladde, thickened wall; Percutaneous Cholecystostomy, or if possible/stable Cholecystectomy
66
High fever, jaundice, RUQ pain (charcot's triad), high AlkPhos, mental status changes
Acute Cholangitis: Choledocholithiasis (stone in common bile duct), distended C bile D. on US; ERCP dx & rx
67
Intermittent crampy abd pain/ bloody diarrhea; US: dilated intra/extra hepatic ducts, high AlkPhos, jaundice
Primary Sclerosing Cholangitis, a/w: IBD, Ulcerative Colitis, increased risk of colonic cx and cholangio cx
68
Urinary frequency, dribbling, hesitancy, large prostate, distended bladder
Overflow incontinence: alpha antagonist (tamsulosin, doxazosin, terazosin), 5alpha-reductase inhibitor (finasteride) for BPH
69
Pain, edematous arm, worst with raising arm above head, recent hx weight lifting
Thoracic Outlet Sd: venous-\>edematous; neuro TOS-\>paresthesia, muscular atrophy, Arterial TOS-\> pulseless, ischemic
70
Cold tingling muscle pain, visual & equilibrium rpoblems, maybe syncope
Subclavian steal sx
71
LLQ abd mass, neuro deficits in L leg, increased urine epi/norepi metabolites, café au lait lesions
Adrenal gland pheochromocytoma -\> MRI confirms (Type 1 Neurofibromatosis) v. Extra-adrenal pheo: only epi metabolite in urine
72
Gunshot wound bellow 4th intercostal / nipple
Exploratory Laparotomy
73
Post-op CABG day 10: Chest pain, fever, leukocytosis, widened mediastinum
Acute mediastinitis: throacotomy for drainage/debridement, antibiotics
74
MVC LE weakness, loss of pain temp, proprioception is intact
Anterior cord sx: immediate rx w/ methylprednisone. Confrimed on CT
75
MVC blunt chest trauma, increased PCWP, hypotensive, tachycardic
Cardiogenic shock (MI, arrhythmia, contusion, compression) -\> IVF to increase PCWP to 15-20, Ionotropics Dobutamine / Dopamine
76
MVC deceleration, hypertense UE, hoarse voice
Aortic rupture -\> hematoma -\> compressing: vessels - pseudocoarction & L recurrent laryngeal
77
MVC blow to pelvis, full bladder, abd pain referred to L shoulder
Intraperitoneal rupture of bladder dome -\> peritonitis -\> irritating diaphragm w shoulder pain (Kehr's sign)
78
Blunt trauma to abdomen, intial CT negative. 1 week later: chills, fever, deep abd pain
Pancreatic laceration/contusion/crush injury -\> pseudocyst -\> retroperitoneal abcess -\> percutaneous drainage/culture -\> surgical debridement
79
Mexican w atraumatic severe hemoptysis, cxr opacity in R lower lobe
M. Tuberculosis -\> rigid bronchoscopy -\> control bleeding / airway
80
Chest trauma, JVD, tachy, hypotensive despite fluids
Pericardial Tamponade -\> cardiogenic shock; rx. Pericardiocentesis / pericardiotomy
81
Swollen painful calf post femoral artery embolectomy
Ischemic-Reperfusion sx -\> interstitial/ intracellular edema -\> tissue swelling -\> compartment sx (pain, pallor, pulseness, paresthesia, paralysis); fasciotomy
82
MVC, hours later develops tachycardia, tachypnia, hypoxia; cxr patchy uni/bilateral alvolar infiltrates
Pulmonary contusion; tachypnea, decreased CO2 & alkalosis; monitor, intubation /ventilation if severe
83
Senior w cervical spondylosis post MVC hyperextension injury, w/ UE weakness
Central cord sx: damage to central portions of corticospinal pathway
84
Petechia in upper body, dyspnea, confusion, fracture of long bones
Fat Embolism: petechial rash, dyspnea, tachypnea, severe respiratory distress, subconjuctival hemorrhage, fever, pulmonary infiltrates on cxr
85
Severe onset substernal pain, widened mediastinum, medistinal air / crepitus, taking K/Cl, hx HIV
Esophageal perforation: Gastrograffin (H2O sol contast) study; Hamman's sign - crunching sound on heart auscultation (pneumomediastinum); atibiotics, surgery
86
MVC, pelvic, rib fx, hypotense 80/40 post fluids, FAST/ peritoneal lavage: no intraperitoneal blood/ organ damage
Pelvic Angiography: for dx and repair of retroperitoneal bleeds
87
MVC, hypotense, distended abd, no bowel sounds
Hemorrhagic abdomen -\> exploratory laparotomy
88
Colicky/periodic abd pain/ constipation 3 days, N&V 6h, episodic high pitched bowel sounds, increased amylase, mildly acidotic
Complete SBO: requires surgical corrections; metabolic acidosis: ischemic strangulated bowel loop -\> lactic acidosis
89
Acute flank pain, hematuria, vomiting, hx Crohn's dz, abd pain
Nephrolithiasis - Calcium Oxylate stones; fat malabsorption - Ca binds fat in lumen, increased unbound Oxalate absorption in blood -\> stones
90
Asian w recent neck swelling, mass on posterior nasal cavity, undiff cx.
Nasopharyngeal carcinoma; strong a/w EBV (epsteinbarvirus), smoking, nitrosamines
91
Supracondylar fx Humerus, post reduction -\> forarm pain, palor, cold
Acute compartment sx needs fasciotomy, may progress to Volkman's ischemic contracture - dead muscle replaced by fibrous tissue

Uworld 2 (2 decks)

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