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Flashcards in Surgery Deck (528):
1

what's the most common fracture of the wrist

scaphoid

2

risk in scaphoid fracture

avascular necrosis

3

work for scaphoid fracture

plain xrays

4

particularity of plain xrays in scsphoid fracture(2)

can be normal
needs 10 days to show abnormalities

5

negative xray in susoect scaphoide fracture next step?(2)

thumb spica
xray in 10 days

6

clue for scaphoid scaphoid fracture

pain in anatomic snuffbox

7

cause of dermatitis in lower legs

venous stasis
venous hypertension

8

physio patho of venous satsis

vein insufficiency

9

minor traumatic brain injury next step

glasgow 15
discharge

10

management of mild TBI

glasgow 13-15 and vomiting'
discharge and sent home under surveillance
if normal ct

11

Management of moderate TBI

glasgow 9-12
sednt home under surveillance if normal CT

12

management of severe TBI

glasgow

13

cause of hematochezia(5)

diverticulosis
angiodysplasia
ischemia
infectious
neoplasm

14

first thing to di if you suspect lower GI bleeding

nasogastric tube

15

you suspect lower GI bleeding nasogastric tube has no blood next step

colonoscopy

16

in case of diverticulosis if colonoscopy is negative in a setting of hematochezia next step(2)

erythrocye scyntigraphy
or
angiography

17

technique to perfrom scintigraphy

technetium 99 labeled erytrocyte scynctigraphy

18

quid of lower GI bleeding

bhelow treitz ligament

19

patient with AFIB with abdominal pain and heme positive stools

bowel infarction

20

most common cause of acute mesenteric ischemia

embolus from the heart

21

quid of trendelenburg sign

drooping of controlateral pelvis occuring when the patient is standing

22

cause of trendelenburg sign(2)

gluteus medius muscle weakness
gluteus minus muscle

23

in case of gluteus medius mx weakness where is located the pain

in the knee

24

abdominal pain and bloody diarrhea following abdominal aortic aneurism repair

bowel ischemia

25

what to do to prevent bowel ischemia during aortic aneurism rapair surgery

check sigmoid perfusion following the placement of aortic graft

26

quid lugwig angina

cellulitis of submandibular and sublingual spaces

27

clinical clue for lugwig angina(3)

dysphagia
drooling
crepitus of submandibular area

28

most common cause of death in ludwig angina

asphyxia

29

what cause ludwig angina

infection in 2 et 3 e mandibular molar

30

rx of ludwig angina(2)

remove the infected teeth
antibiotics

31

led edema worst when the leg is dependent and improves with leg elevation

venous valve incompetence

32

could varice be unilateral

yes can be unilateral

33

pulastile mass in the groin

femoral artery aneurism

34

the most common peripheral aneurism

popliteal aneurism

35

what to do in front of peripheral aneurism

check abdominal aneurism

36

RLQ pain plus positive psoas sign

psoas abcess

37

scaphoid fracture management

plain xray

38

plain xray in scaphoid fracture

radioluscent line across the wrist

39

management of scaphoid fracture

wrist immobilization for 6-10 weeks

40

what to do if you suspect scaphoid fracture with negative Xray(2)

immobilize wrist
repeat xray in 7-10 jours

41

why immobilization in suspect scaphoid fracture

because of the risk of non union

42

management of spinal cord injury(4)

stabilize cervical spine
stabilize airway
hemodynamic stabilization
urine catheter in place

43

mechanism of spinal cord injury in traumatic patient

compression
contusion
shear injury
spinal cord edema leadig to hemorragic central necrosis

44

important step in teh management of spinal cord injury

bladder catherization

45

patient presenting whistling noise after rhinoplasty

nasal septal perforation

46

cause of septal of nasal septal perforation(6)

self inflicted trauma during picking nose
syphilis
TB
intranasal cocaine use
sarcoidosis
wegener(granulomatosis with polyangitis)

47

what cause the perforation in the case of rhinoplasty

septal hematoma

48

pale and cold arm after closed reduction of humerus fracture what complication you can have in the future

volkman contracture

49

rx of compartment syndrome

immediate fasciotomy

50

widened mediatinum in patient taking KCL pills

perforation esophagienne compliquee de mediastinitis

51

quid of hamman sign

crunching sound in the haert due to emphysema in esophageal perforation

52

confirmatory test in esophageal perforation

esophagography with water soluble contrast

53

cause of esophageal perforation(6)

trauma
pills esophagitis
Barret
caustic substance ingestion
infection a candida
Boherhave syndrome

54

clue for esophageal perforation

emphysema

55

patient presents with free peritoneal fluid the most likely finding during laparotomy

splenic laceration

56

traumatic injuric most common cause of intraabdominal hemorrage(3)

1-spleen 60%
kidney
liver

57

patient with dyspnea petechiae after tibial fracture dx

fat embolism

58

confirmatory DX of fat embolism(2)

fat droplets in urine
presence of intra arterial fat globule on fondoscopy

59

rx of fat embolism

respiratory support

60

after trauma patient present with only upper extremities weakness

central cord syndrome

61

mechanism trauma causing central cord syndrome(2)

hyperextension injury
degenerative cervical changes in spine

62

what position of spine is reached in central cord syndrome

central position of anterior spinal cord

63

clue for central cord syndrome

weakness more prononced in upper extremities than in lower extremities

64

why pain and temperature problem in central cord syndrome

damage of spino thalamic tract

65

what to do if you suspect cervical spinal cord injury

orotracheal intubation

66

when to suspect cervical spine

any patient with trauma with maxillofacial and neck edema

67

patient with unRX appendicitis develops ten days later tender boggy fluctuant mass in rectal examination DX (2)

perforated appendix with fluid in rectovesical pouch
it's a pelvic abscess formation

68

complication of ruptured appencitis

pelvic abcess

69

patietn develops pain and paresthesis below right elbow after full thickness burn Dx

compartment syndrome

70

rx for compartemnt syndrome induced by burne

escharotomy to relieve constriction

71

dx of compartment syndrome

doppler ultrasonography

72

what pressure during Dopler should mandate escharotomy

25-40 mm de Hg

73

if escharotomy fails next step in Rx compartment syndrome induced by burn

fasciotomy

74

child 5-7 ans with hip pain xray shows flatenned ofr fragmented left femoral head dx?

idiopathic avascular necrosis
or Legg calve perthes diseae

75

classic presentation of slipped femoral capital epiphysis

obese children with complaint of pain hip

76

clue for slipped femoral capital epiphysis

capital femoral epiphysis remains intact within the acetabulum

77

risk in patient with pelvic frasture

posterior uretral injury

78

clue post uretral injury(5)

blood at urertral meatus
high riding prostate
scrotal hematoma
inability to void
palpable distended bladder

79

cause of anterior uretral injury(3)

perineal tenderness
or perineal hematoma
no inability to void

80

why patient with post uretral injury can develop sepsis

because of risk of extravasation of urine in the scrotum peritonerum and abdominal wall

81

quid of anterior uretra

uretra distal to urogenital diaphragm

82

quid of post uretra

prostatic and membranous uretra

83

patient with eschar on the chest , consequence of that

respiratory failure

84

patient with hip pain and elevated ALP

paget

85

complication of Paget

hearing loss

86

athlete or military recruit with foot pain

stress fracture

87

rx of stress fracture

rest and pain control

88

the most common metatara involved in stress fracture

the second

89

management of 2e 3e 4e metatarsal fracture (2)

conservatively
or hard soled shoe

90

patients present with epigastric pain and vomiting after trauma

duodenal hematoma

91

why the duodenal hematoma is formed

collection of blood between submucosal and muscular layer

92

mamagement of duodenal hematoma(2)

nasogastric tube
and parenteral nutrition

93

after an accident patient developsn decreased breath sounds after chest tube placement patient stilll has air in pleural space and pneumodiastinum Dx

bronchial rupture

94

dx of bronchial rupture

ct of the chest

95

after an accident patient develops subcutaneos emphysema and pneumomediastinum

tracheobronchial rupture

96

after catherisation patient develops bacvk pain and hypotension dx

retroperitoneal hematoma

97

dx of retroperitoneral pain

ct scan of abdomen

98

major complication of heart catheterization(3)

MI
stroke
death

99

minor complication of cardiac catheterization(7)

hemostasis at access site
hematoma formation
AV fistula
pseudo aneurism
arterial thrombosis
perforation
contrast allergy

100

the most common cause of death in brain injury

diffuse axonal injury

101

ct scan of diffuse axonal injury

numerous punctuate hemorrage at gray white matter junction with blurring of gray white interface

102

hydrocele in newborn infant(2)

reassurance
observation

103

time limit for hydrocele to resove in children

12 months

104

why hydrocele should be remove if persistance after 12 months

because of risk of inguinal hernia

105

why the left Diapphragm is more susceptilble of trauma than the right

protective reffect of the liver

106

best test to Dx ruptured diaphragm

CT of chest and abdomen

107

cause of diaphragm rupture

vehicle accident

108

xray in diaphragm rupture(2)

shifting of mediastinum to the right
left lower lung opacity with obscure left hemidiaphragm

109

first step after central line placement

portable chest xray

110

why portable chest xray after central line placement

to rule out complications

111

complications of central line placement(6)

arterial puncture
pneumothorax
hemothorax
thrombosis
air embolism
sepsis
vascular perforation
MI leading to tamponade

112

before you administer drugs in central line placement next step

chest xray

113

clue for fat necrosis of breast

breast mass with biopsy revealing foamy macrophages with fat globules

114

cause of fat necrosis of breast(2)

breast trauma
surgery

115

characteristics of breast calcification in breast cancer

microcalcification

116

characteristics of breast calcification in fat breast necrosis

coarse calcifivcation

117

rx of fat breast necrosis

no rx

118

patient with marked limitation of extension of the wrist following a midshaft humerus fracture

radial nerve injury

119

patient with lupus develops hypotension hyponatremia

adrenal crisis

120

why lupus is important in this vignette

association entre lupus and prednisone intake

121

condition predisposing fro adrenal crisis

prednisosne >/ a 20 mg par jour pendant 3 semaines

122

clue for cushing features(4)

buffalo hump
central obesity
moon facies
weight gain

123

what happens to patient taking prednisone

risk for hypothalamic pituitary adrenal axis suppression(HPA)

124

if you suspect HPA suppresion during surgery what to give in term of medication

ETOMIDATE

125

patient with LLQ pain older with prior dx of diverticulitis develops perisigmoid fluid collection dx?

perisigmoid abcess

126

rx of perisigmoid abcess

percutaneous drainage

127

complication of diverticulitis(4)

abcess
perforation
0bstruction
fistula formation

128

first step in front of clavicular fracture(2)

angiogram
neurovascular exam

129

why in front of clavicular fracture angiogram and neurovascular exam are mandatory

because of proximity of subclavian artery and plexus brachial

130

patient with clavicle fracture presents loud bruit during auscultation beneath the clavicle

rapidly ask angiogram

131

clue for anterior cruciate ligament tear ACL(3)

popping sensation
followed by rapid hemarthrosis
instability in bearing weight on the affected side

132

dx of ACL tear

MRI

133

physical exam finding in ACL tear

laxity of anterior motion of tibia relative to femur

134

knee pain with valgus stress test positive

medial collateral ligament tear(MCL)

135

the most common ligament involved in knee trauma

MCL

136

best dx test for ligament tear of knee

MRI of knee joint

137

rx of MCL tear(2)

bracing
early ambulation

138

origin of torus mandibularis/palatinus

congenital

139

hard palate mass with bony hard consistence

torus mandibularis or palatinus

140

when to operate torus

when the mass interferes with eating or speaking

141

patient presenting with with crepitus in suprasternal notchafter effort of vomiting

esophagus perforation Known as boherhave syndrome

142

condition to have boherhave syndrome

when the patient is resisting the urge to vomit

143

complication of Boherhave

pneumomediastinum

144

meniscal injury

Knee pain
popping sensation under the examination fingers

145

work up of meniscal injury

MRI

146

rx of meniscal injury

surgery

147

worsening substernal chest pain and mild shortness of breath after endoscipy

esophageal rupture

148

next step if you suspect esophageal rupture

esophagoghraphy with water soluble contrast substance

149

common chest xray finding in in esophageal rupture(3)

left pleural effusion
pneumomediastinum
pneumothorax

150

test of choice to Dx esophageal rupture

esophagoghraphy with water soluble contrast substance

151

after surgery patient develops fever cloudy grey discharge and dusky friable subcutaneous tissue
decreased sensation on the edges of the woung dx?

necrotizing surgical infection

152

rx of necrotizing surgical infection

urgent surgical exploration

153

risk factor for necrotizing surgical infection

diabetics

154

cause of medial meniscus injury

twisting of the knee with fixed foot

155

clue for meniscal injury(2)

popping sensation
no effusion following the injury

156

why no effusion in meniscal tear

meniscus are not perfused

157

quid of murray sign

audible snap during slowly extending the leg at the knee from full extension while simultaneously applying tibial torsion

158

why the knee is locked at terminal extension in Murray sign

bucket handle tear

159

patient presenting one arm weakness after clonic tonic seizures

posterior shoulder dislocation

160

clue for posterior shoulder dislocation(2)

inability to externally rotate the right arm
or
arm is adducted and internally rotate

161

what cause the dislocation of shoulder during seizure

violent muscle contraction during tonic clonic seizure

162

popping sensation at the knee and knee swelling occuring 12-24 h later

meniscal tear

163

clue for ligamentous tear(2)

after the trauma immediate effusion
popping sensation

164

indicator in glasgow(3)

eye opening
speech
motor response

165

motor response

0bey =6
localizes pain=5
withdrawal=4
decortication=3
decerebration=2
no mvt =1

166

which is worst decortication or decerebration

decerebration

167

decerebration(3)

extension
3 E
you got 3 in glasgow

168

back pain plus hypotension plus syncope

ruptured AAA

169

physiopatho of hematuria in AAA rupture

blood in retroperitoneum creates aorto caval fistula leading to venous congestion in tretroperitoneal structure (bladder)
fragile the bladder can dbe distended and rupture

170

one YO patient comes with lesion of epidermolysis first thing to do

admit the patient and do a skeletal suvey

171

3 steps to tkae if you suspect child abuse(4)

physical examination
skeletal survey
report to care to child protective services
admit the patient

172

patient with brain trauma simple measur eto decrease high ICP(4)

head elevation
or sedation
or IV mannitol
hyperventilation

173

eye mvt in glasgow(4)

open spontanously=4
open a la demande=3
open with pain stimulation=2
closed eyes =1

174

speech in glasgow(5)

oriente=5
confuse=4
inapropppriate words=3
whisper incomprehensive words=2
say nothing=1

175

how elevation helps in decreasing high ICP

by decreasing venous flow from the head

176

how sedation helps in decreasing high ICP

by decreasing the metabolic demand
control of the hypertension

177

how iv mannitol helps in decreasing high ICP

extraction of free water out the brain tissue causing osmotic diuresis

178

how hyperventilation helps in decreasing high ICP

allowing co2 wash out leading to cerebral vasoconstriction

179

appropriate next step in penile fracture(2)

retrograd uretrogram
plus
surgical exploration

180

risk factor for penile fracture

woman on top of the man during sexual intercourse

181

pain of Mac Burney(1)


RLQ pain

182

rovsing sign

palpation of LLQ causes pain in RLQ

183

Dx of appendicitis(3)

it's clinic
if all the symptoms are present no image needed
surgery tet dwat

184

when asking sono or CT for appendicitis

whrn the typical features are absent

185

physiopatho of ombilical pain in appendicitis

it's visceral pain

186

physiopatho of RLQ pain in appendicitis(2)

it's somatic
irritation locale of parietal peritoneum

187

dx differentiel of appendicitis(3)

diverticulitis
ileitis
IBD

188

subluxation of radial head in kid cause(2)

risky behavior
lifting the child with with child's forearm

189

management of subluxation of radial head in kid

gentle passive elbow flexion and forearm supination

190

maneuver to reduce radial head subluxation(3)

extend the elbow and distract it
supinate the forearm
hyperflex the elbow with your thumb over the radial head in order to feel the reduction

191

patient with head trauma lost consciousness and has lucid interval followed by progressive deteriorationof consciousness DX?

epidural hematoma

192

dilated pupil in epidural hematoma why?

oculomotor compression in the side of the lesion

193

ct of epidural hematoma

biconvex hematoma

194

rx of epidural hematoma

emergent craniotomy

195

burn injury becoming chronically drained and painfull

SCC

196

condition favorising SCC(3)

skin over chronic osteomyelitis
radiotherapy scars
venous ulcers

197

all chronic wound with failure to heal next step?

biopsy

198

SCC from burn woung

marjolin ulcer

199

cause of paralytic ileus(3)

abdominal surgery
retroperitoneal hemorrage associated with vertebral fractures

200

radio of ileus paralytic(2)

air fluid levels
distended fas filled loops

201

history clinical of retroperitoneal hemorrage(2)

history of falling back
vertebral fracture

202

first thing to do if you suspect post yretral injury

retrograde uretrogram

203

what to not to if uretral injury is suspected

foley catheterization

204

why to not use foley catheterization if uretral injury is suspected

risk of abcess formation
worsen of uretral damage

205

why can you have atelectasia and pneumonia in rib fracture

hypoventilation

206

goal in rib fracture

ensure appropriate analgesia

207

patient hemodynamically unstable with sharp penetrating abdominal trauma and gunshot wound next step

exploratory laparotomy

208

why you should act emergently on unstable blunt abdominal trauma(2)

to prevent sepsis
to repair bleeding organ

209

patient begins to develop shortness of breath after placement of central venous catheter in the right subclavian vein dx

tension pneumothorax

210

rx of tension pneumothorax induced by placement of central venous catheter

needle thoracostomy

211

unstable patient after blunt ntrauma abdomen what to do

1-Fast

212

quid of fast

focused assessment with sono for trauma

213

Fast shows blood in the peritoneum next step

laparotomy

214

if fast is not available what to do in any patient with unstable blunt trauma

laparotomy

215

patient with blunt trauma with low TA first step

2 IV lines placement

216

Patient with blunt trauma TA stable FAST shows blood in spleno renal angle next step

CT of abdomen

217

blunt trauma abdominal in a patient unstable and fails to respond to hydration next step

Laparotomy

218

blunt trauma abdominal in a patient with low TA after rehydration SBP> ou egal a 100 mm de HG next step

CT is the best next step

219

what to do if perform splenectomy for a patient

immunization against encapsulated bacteria

220

patient with gastrectomy develops digestive symptoms 20-30 mn after eating:cramps,weakness,diaphoresis,light headedness Dx?

Dumping syndrome

221

physio patho of dumping syndrome

rapid emptying of gastric content into duodenum and small intestine

222

first thing to do in dumping syndrome(2)

dietary changes
small and frequent diet

223

second thing to do in dumping syndrome

octreoctide if failure of dietary changes

224

what to in refractory case of dumping syndrome

reconstructive surgery

225

clue for co poisonning(3)

wheezing
confusion
seizure

226

confirmatory dx of carbon monoxyde poisonning(2)

carboxyhemoglobin level >3% in non smoker
> 15% in smoker

227

Rx of carbon monoxyde poisonning

100% face mask oxygen

228

Rx of carbon monoxyde poisonning 100% face mask oxygen failure

hyperbaric oxygen

229

most commonly affected part of the colon following procedures on aortoilliac vessels

distal left colon

230

which procedure on artery can cause problem in colon

AAA procedure

231

what causes distal left colon ischemia during AAA procedure

prolonged clamping and impaired blood flow through the

232

Patient presents with enlarged breast with edema and erythema dx

inflammatory breasst carcinoma

233

pathognomonic sign of breast ca

scant bloody discharge in nipple

234

first step in breast ca

biopsy

235

patietn presents severe abdominal pain with hypotension suddenly

rupture of AAA

236

next step in AAA rupture(2)

bedside U/S
surgery

237

rarely patient with AAA rupture is stable next step

CT of abdomen

238

the first cause of acute biliairy pancreatitis

gallstones

239

other causes of acute pancreatitis(3)

alcohol
post ERCP
hypertriglyceridemia

240

clue for acute biliairy pancreatitis(4)

epigastric pain
high lipase
high ALP
high alanine amino transferase

241

first thing to to in acute biliary pancreatitis

right upper quadrant U/S

242

what to do in acute biliairy pancreatitis(2)

rx pancreatitis
schedule cholecystestomy

243

clue for tension pneumothorax(3)

trachea deviated to the left
decreased breath sound on the right
neck veins distended bilaterally

244

rx of tension pneumothorax

needle thoracostomy

245

where to place the needles in needle thoracostomy

between first and second ribs

246

dx of needle thoracostomy(2)

it's clinic
no image needed to make decision

247

patient with epigastric pain develops pneumoperitoneum dx?

viscus organ perforation

248

clue for viscus organ perforation

air blelow hemicoupole diaphragm in the right

249

penetrating abdominal trauma in unstable patient

surgery

250

patient with distal humerus fracture develops pain and paresthesia of fingers after close reduction dx

compartment syndrome

251

longterm complication of compartment syndrome

volkman ischemis contracture

252

most common fracture involved in compartment syndrome

supracondylar fractures

253

mechanism of volkman ischemis contracture

dead muscle is replaced by fibrous tissue

254

clue for splenic injury in a context of blunt abdominal trauma

epigastric or LUQ pain
shoulder pain in the left

255

quid of Kehr sign

shoulder pain in the left in a context of splenic injury

256

patient with blunt trauma abdomen develops later epigastric pain and hypotension

splenic injury with delayed onset

257

patient with blunt trauma abdomen develops later epigastric pain and hypotension in the USMLE next step

laparotomy

258

dx of splenic injury

CT of abdomen only in stable patient

259

dancer presenting with shin pain ,right leg and normal xray dx?

stress fracture

260

activities linked with stress fracture(2)

athletes
military recruits

261

zone of tibia invoved in stress fracture

distal third of tibia

262

cause of foot ulcer in diabetics

peripheral neuropathy

263

charcot joint

deformed foot seen in diabetics

264

3 main factors in diabetic foot in diabetics

1-Neuropathy causes painless trauma
2-Microvx insuffciency causes poor wound healing
3-immunosuppression causes infection

265

localisation of ulcer in diabetics foot and why

first metatarsal bone the head
zone of greater pressure

266

patient in ICU for brain trauma develops epigastric pain

cholecystitis

267

risk for cholecustitis(6)

hospitalizsed patient
severe trauma
multiorgan failure
prolonged parenteral diet
sepsis
burn

268

physiopatho of cholecystitis in hosptialized patient(2)

cholestasis
gallbladder ischemia

269

patient in ICU for brain trauma develops cholecystitis next step(2)

percutaneous cholecystostomy
cholecystectomy after stablization

270

clue for cholecystitis in hosptialized patient

pericholecystic fluid in U/S

271

patietn develops falccid paralysis after AAA repair

spinal cord ischemia

272

the most common cause of spinal cord ischemia or infarct

surgery to repair thoracic or thoracoabdominal aneurism

273

what artery is reached in cord ischemia following AAA repair

adamchiewics artery

274

quid of adamchiewics artery

it arises from the aorta
feed the anterior spinal artery in the T9-T12 level

275

vessel feeding the spinal cord(2)

anterior spinal artery ASA
two post spinal arteries PSA

276

origin of ASA and PSA

vertebral artery

277

artery feeding ASA(3)

radicular artery from
vertebral artery
intercostal arteries
aorta

278

why during cord ischemia after AAA surgery,proprioception and vibration are preserved

post circulation are preserved

279

other finding in cord ischemia after AAA surgery(2)

bowel
bladder dysfunction

280

first indicator of hypovolemia

pulse rate

281

after a fall patient develops paraplegia with loss of pain and T. in both legs

anterior cord syndrome

282

condition to have anteriod cord syndrome

burst fracture

283

clue for anterior cord syndrome(2)

motor problem below the level of lesion with loss of pain and T on both sides below the lesion
proprioception is intact

284

best test to DX anterior cord syndrome

MRI

285

after an accident patient presents with sensory problem over the medial side of the right lower thigh and leg what's nerve is involved

femoral nerve

286

motor role of femoral nerve(2)

hip flexion
knee extension

287

sensory role of femoral nerve(2)

anterior thigh
medial leg via saphenous branch

288

quid of leg flexion at the hip

hip flexion

289

quid of leg extension at the knee

knee extension

290

stress fracture tetrad(4)

female
amenorrhea
osteoporosis
poor eating habit

291

dx differentiel in in painful sore foot (4)

stress fracture
arthritis
bursitis
mortin neuroma

292

clue for stress fracture(2)

sharp and localised pain over bony surface
worse with palpation of taht area

293

clue for arthritis

all the metatarsal joints are involved

294

clue for Morton neuroma

pain in 3e et 4 e toe on plantar surface with clicking sensation

295

clue for mulder sign

when simultaneously palpate space of 3e and 4e and squeezing the metatarsal joints, you have a clicking sensation

296

risk of foot bursitis

poor fitting shoes during extended period leading to inflammation of the metatarsal heads

297

quid of trochanteric bursitis(2)

patient with hip pain when pressure is applied when sleeping on the affected side
pain with external rotation or resisted abduction

298

dx differentiel of unilateral pain(5)

infection
trauma
arthritis
bursitis
radiculopathy

299

after CABG patient develops small cloudy fluid in the sternal wound drain and widened mediastinum next step(2)

surgical debridement and drainage
antibiotherapy

300

after CABG patient develops small cloudy fluid in the sternal wound drain and widened mediastinum dx

post op mediastinitis

301

risk for mediastinitis

any sternotomies

302

patient with RLQ pain and absent bowel sounds present with normal WBC and urine sediment:15 rbc par HPf
examination shows needle shape crystals

kidney stones with paralytic ileus

303

best test to DX kidney stones

CT of abdomen

304

why ct abdomen is the best test now to Diagnose kidney stones

to see radioluscent stones
to ruleout appendix abcess

305

rx of stone

may pass with
liquid
analgesia

306

best way to evaluate acid uric stone (2)

abdomen CT
or
IV pyelography

307

breast mass work up in woman

U/S

308

breast mass work up in woman > 30 ans(2)

U/S +
mammo

309

patient

needle aspiration

310

patient

image guided biopsy

311

woman of > 30 ans with suspiscion of malignancy in U/s and mammo next step

core biopsy

312

quid of diverticulosis

mucosa and muscularis mucosa herniation through bowell wall

313

why bleeding in diverticula

diverticula can erode penetrating artery

314

most common site of diverticulosis

sigmoid

315

dx of diverticulosis(2)

CT abdomen
or
fluoroscopy

316

what to suspect in any appendix perforation

abcess formation

317

clue for appendix perforation and abcess formation

longer duration of symptom more than 5 jours

318

meaning of psoas sign (2)

retrocaecal appendix
abcess adjacent to psoas

319

quid of psoas sign

extension of hip against resistance elicits abdominal pain
RLQ pain with extension of right thigh

320

appendix abcess in stable patient(4)

rehydration
antibiotherapy
bowel rest and drainage
surgery in 6-8 weeeks---->appendectomy

321

obturator sign

RLQ pain with internal rotation of right thigh

322

meaning of obturator sign(2)

pelvic appendix
or
pelvic abcess

323

rovsign sign

pressure in LLQ elicits pain in RLQ

324

meaning of rovsign sign(2)

pelvic appendicitis
pelvic abcess

325

2 types of femoral neck fractures(2)

intracapsular
extracapsular

326

risk of avx necrosis

intracapsular fracture of femoral neck

327

older patient during a fall develops neck femoral fracture what's the next step) and why(5)

EKG
cardiac marker
chest Xray
raison:bilan cardio pulmonaire pre op
rule out a cardiac syncope responsable for the fracture

328

when the surgery will take place for the neck femoral fracture

delay surgery up to 72 h to evaluate heart and lung

329

older patient with femoral neck fracture why don't you pick crystalloid in vignette

because intracapsular fracture has low risk of bleeding and hypotension

330

amputation injury next step(2)

place the amputed finger in saline moistured gauze in a plastic bag
place the bag on a bed of ice and bring it along with the patient to the emergency department

331

clinical indication of thermal injury of the upper respiratory airway(8)

burn of the face
singing of eyebrows
oropharyngeal inflammation or blistering
oropharyngeal carbon deposits
carboneceous sputum
stridor
carboxyhb>10%
history of confinement in burning building

332

what to do if you have one indicator of thermal injury of upper respiratory airway

early intubation to prevent upper airway obstruction by edema

333

patient on endotracheal intubation with mechanical ventilation has a rate of c02 produced to the rate of 02 uptake of 1,05 why

carbon dioxyde excess in the diet

334

quid of respiratory quotient close 1.0

predominant oxydation of carbohydrates and net lipogenesis

335

respiratory quotient for protein

o,8

336

respiratory quotient for lipid

0.7

337

after accident patient develops hypotension ,flat veins neck tachycardia and cold extremities despite of IV fluid resuscitation why

hypovolemic shock

338

pulmonary post op complication in the first 24 h after surgery

atelectasia

339

why atelectasia in post op(3)

narcotic use in decreases the respiratory drive
anesthetics agent decreases mucociliary clearance
pickwikian like syndrome

340

cause of pickwikian like syndrome

patient is kept supine after surgery

341

what can be done to increase functionnal residual capacity FRC after surgery(4)

chest physiotherapy
incentice spirometry
coughing and frequent positionning
early ambulation

342

simple measure to increase the FRC de 20 a 35%

elevation of the head of the bed

343

patietn develops shortness of breath and chest pain after motor vehicle accident ,xray shows alveolar opacity dx?

pulmonary contusion

344

clue for pulmonary contusion

when you rehydrate these patients PO2 decreases

345

clue for flail chest(2)

inward motion of the right side ot the chest during respiration
also called paradoxical motion

346

rx of flail chest

positive pressure mechanical ventilation

347

clue for post op atelectasia(2)

hyperventilation
dense opactity in chest xray

348

gas sanguin in atelectasis(3)

hypoxie
hypocapnie
respiratory alkalosis

349

critical period for post op atelectasis

2 e jor post op a 5 e jour

350

rx preventive of post op atelectasis(4)

incentive spirometry
deep breathing exercices
epidural anesthesia instead of opiod
comtinuous positive airway pressure

351

pulmonary post op complications(4)

atelectasis plus infection
bronchospasm
exacerbation of COPD
prolonged mechanical ventilation

352

risk factor for pulmonary post op complication(7)

> 50 ans
emergency surgery
surgery duration more than 3 h
heart failure
COPD
poor general health
abdominal and thoracic surgery

353

strategies to reduce risk of post op atelectasis prior to surgery(4)

smoking cessation at least 8 weeks prior to surgery
control symptom of COPD
rx of any respiratory infection
patient education

354

clue for pulmonary contusion(2)

symptoms begin 24 h after he accident
patchy alveolar infiltrate on chest xray

355

after an accident patient develops hypotension dyspnea distension of neck veins and deviation of trachea

tension pneumothorax

356

best rx of tension pneumothorax

needle insertion in the second intercostal spacein the left midclavicular line (left pneumothorax)

357

3 types of pneumothorax

primary spontanoeus
secondary spontaneous
tension pneumothorax

358

primary spontaneous pneumothorax

no preceding event

359

quid of secondary spontaneous pneumothorax

complication of a lung disease COPD for instance

360

tension pneumothorax

lifethreatning trapped air wuth mediastinal shift and compromised cardiopulmonary function

361

rx of tension pneumothorax

depends on the size of the pneumothorax

362

small tension pneumothorax management(2)

observation
O2

363

large stable tension pneumothorax management(2)

urgent needle decompression
later chest tube placement

364

why to never use positive ventilation in tension pneumothorax

it will exacerbate it

365

quid of massive hemothorax

more than 1,5 l in pleural space

366

most common cause of massive hemothorax

traumatic laceration of the lung parenchyma

367

arteries damaged in massive hemothorax(2)

intercostal artery
or
internal mammary artery

368

clue for hemothorax(3)

hypotension
absent breath sounds
flat neck veins

369

patient in hemorragic shock develops cardiac arrest after being placed on mechanichal ventilation what measure would prevent that

volume resucitation

370

why mechanical ventilation could cause cardiac arrest in unstable patient(2)

positiv pressure mechanical ventilation increase intra thoracic pressure which decreases venous return to the haert and thereby decrease ventricular preload

in patient with hypovolemic shock this can cause circulatory collapse

371

evaluation of solitary nodule

first compare with old xray
followed by chest CT

372

from what depends the decision of biosy,abserve or resection of solitary nodule(3)

size of lesion
age of patient
smoking history

373

risk of cancer in solitary pulmonary nodule(4)

Diameter > ou egal a 2,3
age > 60
smoker > 20 paquets/day
corona radiate or spiculated appearance

374

when smoking cessation lowes risk of cancer

when you stop smoking > ou egal 7 ans

375

best way to decrease the incidence of of atelectasis in post op(2)

incentive spirometry
deep breathing exercices

376

in the vignette cause of atelectasis(2)

impaired cough
shallow breathing causes atelectasis in post op

377

patient from mexico develops hemoptysis with dense opacity inthe right upper lobe the first step?

respiratory isolation

378

first step in patietn with massive hemoptysis

place the bleeding lung in a dependent position

379

second step in massive hemoptysis

bronchoscopy to localize the bleeding site and attempt early therapeutic intervention

380

quid massive hemoptysis(2)

> 600 ml/24 h
or
100 ml/h

381

patietn with vehicle motor accident or fall > 10 feet with mediastinal enlargement dx?

rule out aortic injury

382

screening test for aortic injury

chest xray

383

eqivococal chest xray in aortic injury(2)

CT chest
or
angiography

384

how 's TA in aortic injury(3)

normal
or
HTA
or
hypotension

385

patient after accident with hypotension with high pulmonary capillary wedge pressure (12 mm)
after 1 l de liquide PCWP a 22

Myocardial contusion

386

type of shock in trauma

hypovolemia

387

patient with hypotension after accident ,aftee IV fluids ,failure to correct the hypotension and development of high PCWP

rule out myocardial contusion

388

dx of myocardial contusion(2)

EKG
positive cardiac markers

389

patient with intermittent claudication and pain in buttock,hip and thigh muscles dx

aorto illiac occlusion

390

additionnal finding in aorto illiac occlusion

impotence

391

quid of leriche syndrome(3)

hip and thigh buttock pain
impotence
symetric atrophy of bilateral loweer extremities

392

cause of leriche syndrome

aorto illiac occlusion

393

after accident patient develops hypotension and neck veins distended adn tachycardia dx

tamponnade

394

quantity of blood to cause tamponnade

100-200 ml

395

in chronic disease amount of fluid to cause acute cardiac tamponnade

1-2 l

396

chest ray in cardiac tamponnade post trauma

normal

397

clue ofro cardiac tamponnade

hypotension despite of rehydration

398

clue for aortic injury(4)

widened mediastinum
large sided hemothorax
deviation of the mediastinum to the right
disruption of the normal aortic contour

399

ABI

PAD

400

ABI > 1,33

calcified or uncompressed vessels

401

clue for arterial embolism(5)

pain
pulselessness
pallor
peresthesia
paralysis

402

casue of arterial embolism

emboli

403

PAD

chronic disease in artery

404

arterial occlusion

acute embolic event

405

origin of emboli(2)

ventricle from MI
atrium from AFIB

406

patient develops right calf pain after femoral artery embolectomy cause of the pain

soft tissue swelling

407

patient develops right calf pain after femoral artery embolectomy dx

ischemia reperfusion syndrome

408

quid of ischemia reperfusion syndrome

it's a compartment syndrome

409

condition predisposing to ischemia reperfusion syndrome

ischemia lasting more than 4 a 6 hours

410

quid of compartment syndrome

increased pressure within an enclosed facial space causing ischemia of muscles and nerves

411

indication of fasciotomy in compartment syndrome

pressure excess 30 mm de hg

412

what will happen after 4 a 6 hours of ischemia you reperfuse an area

both intra cellular and intersticial edema upon reperfusion

413

complication of pancreatic injury(2)

pancreatic abcesss
also called retro peritoneal abcess

414

accident causing pancreatic trauma

bicycle

415

best step in suspect pancreatic trauma and why?(2)

serial CT
because early CT less than 6 hours coul not show anything

416

complication of untreated pancreatic injury

pseudocyst formation

417

patient develops abdominal discomfort afterabdominal surgery with distended abdomen and decreased bowel sounds DX

post surgery ileus

418

cause of post surgery ileus

use of morphine

419

cause of post surgical ileus(3)

opiods use
penetrating cavity peritoneal
local relaese of inflammatory mediators

420

clue for pyloric stricture

succussion splash

421

cause of gastric outlet obstruction(6)

ca
PUD
chron
strictures
caustic agent
bezoar

422

patient with abdominal pain no bowel mvts for 2 days dx

small bowell obstruction

423

cause # 1 of small bowell obstruction

any surgery on abdominal wall

424

whyany surgery on abdominal wal can cause small bowell obstruction

adhesions

425

congenital adhesion causing obstruction of small bowell

Ladd's bands

426

xray for small bowel obstruction

dilated loops of bowel

427

most common etiology of small bowel obstruction

adhesions

428

patient presenting with pain and swelling over the coccyx dx?

pilonidal abcess

429

rx of pilonidal abcess(2)

drainage
excision of sinus tract

430

patient on warfarin with platelet 40000 develops acute abdomen what should be done prior entry to operating room

fresh frozen plasma

431

patient on warfarin with platelet 40000 develops acute abdomen what should be done prior entry to operating room why using fresh frozen plasma ti correct this problem(2)

the most common way to normalize the PF
and
restoration of vit K dependent factors

432

clue for pancreatic cancer(2)

epigastric pain
weight loss

433

trousseau sign in pancreatic cancer

migratory thrombophlebitis

434

pancreatic cancer with jaundice

head pancreas tumor

435

first thing in pancreas head tumor

U/S

436

localisation ca pancreatic with no jaundice(2)

body
and
tail

437

dx of body and tail pancreatic cancer

Ct scan of abdomen

438

incase of blunt trauma abdominal with hypotension what the first thing to do(2)

assess intraperitoneum free fluid
bedside ultra sonography

439

quid of FAST

focused assess sono for trauma

440

what you assess during FAST(2)

pericardium
peritoneum after trauma

441

if FAST equivococal next step

diagnostic peritoneal lavage (DPL)

442

patietn with positive FAST or positive DPL next step

laparotomy

443

hemodynamicaly stable patient with negative FAST next step

CT of abdomen

444

cause of syringomyelia(2)

prior spinal cord injury type whiplash
arnold chiari

445

what fibers are reached in syringomyelia

spinothalamic tract

446

manif of spinothalamic tract problem(2)

pain
Temperature are decreased

447

manif of syrigomyelie(2)

motor fiber s problem in upper extremities
Pain and T

448

physio patho of syringomyelia

csf drainage from the central canal of spinal cord is disrupted leading to a fluid filled cavity that compress surrrounding normal tissue

449

DX synringomyelia

MRI

450

Laps of tiem between the accident and beginning of syringomyelia

month to years later

451

risk in complete excision of parotid tumor

facial droop caused by facial nerve problem

452

cause of transtentorial herniation(uncal)

right sided epidural hematoma

453

artery rupture in epidural hematoma

middle menigeal artery

454

what nerve can be involed in transtentorial herniation

oculomotor nerve

455

manif of oculomotor problem(5)

ipsilateral hemiparesis
Mydriasis
strabismus
controlateral hemianopsia
altered mentation

456

quid of drop arm test

doctors abduct passively both arm above head end then ask to bring arm down slowly
in case of Rotator cuff tear, arm drops rapidly

457

signification of drop arm test

rotator cuff tear problem

458

Mx of rotator cuff tendon(4)

supra spinatus
infraspinatus
teres minor
subscpularis muscles

459

pain shoulder with arm in external rotation with resistance in internal rotation

axillary nerve is injured

460

pain shoulder with arm in external rotation with resistance in internal rotation

anterior dislocation of shoulder

461

arm in ant dislocation

external rotation

462

quid of oliguria(2)

463

first thing to do in patient with foley catheter developping prerenal azotemia

remove the catheter to see if it's not clogged

464

how' s K+ in prerenal azotemia

high

465

first thing to do in prerenal azotemia with high K+

bolus of IV fluids

466

indicator of prenal azotemia

BUN/Creat>20/1
FeNA

467

patient with pain in scrotumdevelops left sided scrotal swelling which increases with valsalva maneuver dx

varicocele

468

quid of varicocele

dilation of pampiniform plexus

469

why varicocle happens in the left

left testicular vein enters left renal vein inferiorly at a right angle thereby predisposing to impaired drainage

470

physical exam of varicocele

impression of bag of worms

471

why you can have shoulder irradiated pain during abdominal pain

intraabdominal pathology can cause peritonitis and irritation of diaphragm

472

patient with direct blow to the lower abdomen has pain in hypogastre radiated to the left shoulder

dome vesical rupture

473

the only part of the bladder covered by peritoneum

dome of bladder

474

cause of chemical peritonitis(5)

hemoperitoneum
spillage of bowel contents
bile pancreatic secretions
urine in peritoneum

475

most susceptible point of rupture of bladder

dome

476

why irritation of parietal peritoneum will cause shoulder pain (2)

peritoneur covers undersurface of diaphragm is innervated by C3 to C5 spinal levels
C3 to C5 also bring sensation to shoulder

477

best dx test for urolithiasis

CT of abdomen and pelvis without contrast

478

test for urolithiasis in pregnant women

US

479

cause of post op fever(5)

pneumonia
UTI
DVT
wound infection
drugs

480

cause of post op fever and chronology(5)

wind-----1 a 2 jours
water--------3 a 5 jours
walking-----4 a 6 jours
woung-----5 a 7 jours
wonder drugs --more than 7 days

481

fever with coagulase - in bacteria culture cause

indwelling catheter

482

femoral catheter infection

gram negative bacteria(enteric organism)

483

IV catheter or indwelling catheter

staph epidermidis

484

fever develops 1-6 months post op in a patient who has received blood products

febrile non hemolytic transfusion reaction

485

8 e day after surgery patient develops pain and swelling of the left angle of the jaw dx

post op parotiditis

486

what can prevent post op parotiditis(2)

adequate fluid intake
oral hygiene

487

bug causing of post op parotiditis

staph aureus

488

fever and knee swelling after right total knee replacement 6 months after the procedure

prosthetic joint infection

489

bugs in cause of prosthetic joint infection within 3 months after arthroplasty(3)

staph aureus
gram negative rods
anaerobes

490

bugs in cause of prosthetic joint infection more than 3 months after arthroplasty(3)

staph epidermidis
propionibacterium
enterococci

491

rx of prosthetic joint infection

remove the prothesis

492

patient 32 yo with intermittent bloody nipple discharge

intraductal papilloma

493

physical exam of intraductal papilloma

can be normal

494

size of tumor in intraductal papilloma

no larger than 2 mm

495

size of intraductal papilloma to be detected by US

greater than 1 cm

496

difference between intraductal papilloma and paget

in paget you eczematous changes in nipple

497

after thyroidectomy patietn develops mx cramps prolonged corrected qt interval(N

hypocalcemia caused by secondary hypoparathyroidism

498

why hypoparathyroidism after thyroidectomy

removal of 4 parathyroid glands

499

consequence of hypocalcemia(2)

tetany
seizure

500

patient with DVT and clot in distal portion of femoral vein CAT

Heparin

501

quid virchow triad(3)

stasis
endothelial injury
hypercoagulable state

502

guideline to prevent DVT after major surgery

stable patient begin anticoagulation 48-72 h after surgery

503

quid acute cholecystitis(2)

inflammation and distension of gallbladder
obstruction of cystic duct by calcul

504

Murphy sign

palpation on RUQ elicits shoulder pain

505

US of acute cholecystitis(3)

gallstones
thickened gallbladder with edema
normal common bile duct

506

management of acute cholecystitis(2)

rx conservatively
3 jours later laparoscopic cholecystectomy

507

vaccine in splenectomised patient

against encapsulated germs

508

most common encapsulated germs in sepsis chez les splenectomises(3)

S pneumoniae
meningoccoque
Hi flu

509

role of the spleen(4)

antigen uptake by dendritic cells in spleen
presentation to T cell
T cell activates B cells
b cell become plasma cells and form antibody

510

why you have sepsis in splenectomy

you need antibody to opsonise encapsulated gems to make phagocytosis effective

511

when to to give vaccine for encapsulated germs

before surgery on spleen

512

physiopatho of colicky pain in gallstones

fatty meal cause contraction of gall bladder
gallstone block the contraction causing intra gallbladder pressure to rise distend and cause the pain

513

how to differentiate acute cholecystitis from biliairy colic(3)

the second is intermittent
in relation with food
absence of fever

514

why the pain is intermittent in biliary colic

relaxation of the gallbladdder causes the gallstone to fallback from the duct

515

quid of bilairy colic

pain occurring when gallblader distends against an obstructed cystic duct

516

patietn burn 2e degree on day 3 develops hypothermia,hypotension and WBC >10000 dx

burn sepsis

517

clue for sepsis(5)

fever or hypothermia90/mn
resp>20/mn
wbc >12000 or

518

when to consider sepsis(6)

when you have ended organ damage
oliguria
hypotension
low platelet
metabolic acidosis
hypoxemia

519

quid of systemic inflammatory response syndrome(2)

you can have non infectious inflammatory response
can be infectious

520

cause of non infectious inflammatory response(4)

pancreatitis
Burn
vasculitis
autoimmune disease

521

quid of sepsis

systemic inflammatory response caused by infection

522

how's glucose in sepsis and why(2)

high
worsening insulin resistance

523

cause of death in patient with burn(2)

hypovolemic shock
later sepsis

524

clue for morton neuroma(2)

foot pain
mulder sign

525

quid of mulder sign

clicking sensation when simultaneously palapating 3e et 4 e metatarsal heads and squeezind

526

people at risk for morton neuroma

runners

527

rx of morton neuroma

bilateral shoe inserts

528

failure of bilateral shoe inserts in morton neuroma

surgery