Surgery Flashcards
1
Q
T/F: Melanoma can be destructed by electrosurgical tech
A
F
2
Q
What’s Charcot triad?
Used for?
A
Fever, jaundice, RUQ
Dx cholangitis
3
Q
MCC of cholangitis
A
Gallstone impacts bile duct => cholestasis + G-ve bacteria
4
Q
Labs in cholangitis
A
High bilirubin
High ALP
WBC
Fever
5
Q
Acute cholecystitis
A
Cystic duct obstruction by gall stone
RUQ + fever + N/V
+ Murphy sign (arrest of inspiration during palpation)
6
Q
T/F: post CABG depression increases risk of subsequent cardiac disease
A
T
7
Q
Would Rx post-CABG depression improves risk of subsequent events?
A
No
Just improve depressive Sx
8
Q
Who is at haigher risk of post-CABG depression
A
Rapidly progressive / acute disease before surgery
9
Q
What correlates best with pre-op risk of bleeding?
A
Hx of bleeding
10
Q
Signs of cardiogenic shock
A
Low BP, urine, refill
High HR, CVP
Narrow pulse pressure
11
Q
Is DVT prophylaxis recommended for hip surgery?
A
Yes.
12
Q
Nerve involved in thumb abduction + addiction
A
Abduction: interosseous of radial
Adductor: ulnar
13
Q
Sx of carpal tunnel
A
Median nerve
Pain and numbness in dorsal thumb and index
14
Q
What’s relation b/w insulin + anti-hyperglycemic and dupuytren’s contracture
A
Use of DM increase risk of contracture
15
Q
Would steroid injections help dupuytren’s contracture
A
Multiple injections needed to regress disease if mild-moderate
16
Q
When is surgery indicated in dupuytren’s contracture
A
Metacarpal joints contracture reaches 30 degrees
Associated with PIP joint at any degree
17
Q
What levels of ALT indicates acute pancreatitis
A
3x normal limit
18
Q
Local anesthetic lasts 2-4 hrs
A
Bupivacaine
19
Q
Loading dose of unfractionated heparin
A
- Bonus dose 80U/kg in 6hr
20
Q
Rx of torsades de pointes
A
Mg sulfate
Quinidine
21
Q
Drugs contraindicated in torsades de pointes
A
Procainamide
Phenothiazide
Disopyramine
Tricyclics antidepressants
22
Q
Tender breast lump
Cyclic changes
Young lady
Dx?
A
Fibrocystic changes
1st US = FNA
23
Q
Post-op fever DDx
A
Wind 1, water 3, wound 5, walk 7
POD 1: atelectasis
POD 3: UTI
POD 5: wound infection
POD 7: DVT
24
Q
How to reduce post-op resp complications
A
Incentive spirometer
Steroids in COPD only
25
IE in IV drug users affects which valve
IE affects mitral mainly
| But in IV users affects tricuspid.
26
Calcification in lung nodule
1. Central
2. Concentric
3. Popcorn
1. Central = tuberculoma / histoplastoma
2. Concentric = healed histoplasmosis
3. Popcorn = hamartoma.
27
Lung nodule > 1 cm
No calcification
Tuberculin / histoplasmosis / coccidiomycosis
Was negative.
Rx infection or biopsy to r/o cancer?
Biopsy!
No calcification
Size > 1.5 cm
28
MCC of death in bariatric surgery?
PE > anastomatic leak
29
Maxillary fracture Sx
Can't bite
Visual Sx
Nasal discharge
Raccoon eyes
30
Rx of carotid stenosis?
> 70% endarterectomy
31
Rx of compression fracture
Decrease activity
Vertebroplasty in 2 wks
No need for physical Rx
32
Female with RUQ mass
Otherwise healthy
On OCP
Hepatoceular adenocarcinoma
33
When is surgery indicated in hepatocellular carcinoma?
If lesion on surface of liver
Risk of bleeding + Ca transformation
34
Lisfranc fracture Sx
```
Hx of twist and fall
In athletics
Can't bear weight
Mid-foot swelling + pain
+/- bruising on dorsum
```
35
Lisfranc vs middle cuneiform fracture
Cuneiform is due to direct blow to foot
Lisfranc due to twist injury
36
Rx anal fissure
1. Conservative
Stool softener
Sitz baths
Nitroglycerin oint
2. Surgical (if medical failed)
Sphincteromy
37
Foot drop is sign of?
Peroneal nerve palsy
38
Marker for GI cancer?
Caecinoembryonic antigen CEA
39
```
Cancer antigens:
CA 125
CA 27-29
A-fetoprotein
PSA
```
CA 125: ovarian
CA 27-29: Breast
PSA: prostate
a-FP: hepatocellular carcinoma
40
MC site of venous ulcers
Medial malleolus
41
Origin of anorectal ulcer
Anal crypt
42
Rx of solitary brain met
Whole brain radiation + resection cancer
43
Asymptomatic hematuria Rx
Repeat sample in 1 wk
44
Bedside test for ACL tear of knee?
+ve Lachman test
"Forward subluxation of tibia"
Normal- Can't subluxate
Abnormal- forward movement
45
Most reliable test for ACL tear of knee?
Lachman test
46
Bleeding after massive PRBC transfusion?
Dilutional thrombocytopenia
47
Lachman vs anterior drawer test?
1. Lachman:
Knee flexed at 30
Femur stabilized
2. Anterior drawer
Knee at 90
No femur stabilization
48
Rx of painful ingrown toenail?
If shows granulation or nail dystrophy = lateral matricectomy.
Mild - no granulation or dystrophy:
Abx
Cotton wick elevation
Recurrent - permanent nail ablation
49
Location of incision in ER tracheotomy? Why?
Above cricoid cartilage
Through cricothyroid membrane.
Below vocal cords
By-pass laryngeal obstruction
50
Preferred tracheotomy site in OR/controlled situation?
Below cricoid cartilage at isthmus + 3-4 tracheal rings
51
Absolute indication for tonsillectomy
Airway obstruction
Dysphagia
Sleep disorders
Cardiopulmonary complications.
52
Risks for plantar fasciitis
Obesity
| Long standing
53
Plantar fasciitis Sx
Inferior heel pain on weight bearing
Pain: throbbing, searing or piercing
Pain in morning (first steps) or after inactivity.
Improves with walking.
Worse barefoot, on-toe walk, stairs.
Tenderness medial calcaneal tuberosity at plantar aponeurosis
54
Rx plantar fasciitis
NSAIDs
55
What causes pseudocyst in pancreatitis?
When do they appear?
Rx?
Pseudocysts lack true epithelium, they're duct leakage.
Appear > 2 wks of episode.
Resolves with time if persists or gets infected/necrotic surgery
56
Is barbiturate addictive?
Yes
57
Barbiturates withdrawal Sx
Hallucinations
| Seizures
58
Brachial neuritis Sx
AKA: neurologic amyotrophy.
M>F
Acute sever shoulder sharp pain esp. night.
Shoulder weakness
Not worsen by movement of shoulder
59
Dx brachial neuritis
EMG
| Nerve conduction
60
Glioblastoma multiforme Sx
At 50 Yrs
Rapid !
Mass effect Sx: N/V, headache, visual
Dx: MRI/CT irregularly enhancing mass
61
Temporal Fracture classic
Battle sign (post auricular ecchymosis)
Ear bleeding (hemotympanum or blue tympanic membrane).
CSF otorrhea
+/- vertigo, CN7 palsy
62
Complications of gastric bypass (early + late)
- Early:
GI bleed
Anastomotic leak
SBO
```
- Late:
Hernia
Stricture
Stones
Dumping syndrome
```
MC: anemia + B12 deficiency
63
What's anisocoria
Unequal pupil size
64
Anisocoria + sever headache
Intracranial hemorrhage
65
Outpatient diverticulitis Rx
Cipro 500 BID
+
Metro 500 TID
66
Impatient diverticulitis Rx
Cefoxitin IV
67
Unilateral absence of vas deference associate w/
Ipsilateral renal agenesis
68
When to check sperm count after vasectomy
6 wks
69
Patellofemoral pain syndrome
AKA runner's knee or anterior knee pain
Tenderness on medial retinaculum
Normal ROM
Normal tendon strength
Patellar deviation with knee flexion at 90
70
Rx of patellofemoral knee
Physical Rx
71
Lumbar radiculopathy Sx + Dx
Sever pain
Weak ankle jerk reflex
Spasm
Dx: MRI
72
CSF drainage
| Raccoon eyes
Anterior cranial fossa fracture
73
Snake bite Rx
Minutes: venom extractors
2-6 hrs: Antivenin (CroFab > horse-serum)
74
Traumatic iritis Sx
Consensual photophobia
Decreased acuity
Conjunctival injection
Change in intraocular pressure
75
Corneal abrasion Sx
```
Eye pain
Foreign body sensation
Pain w/ extraocular movement
Excessive tearing
+ve fluorescent
```
76
Retinal detachment Sx
Flashing light (photopsia)
Shower of floaters
Vision loss (cloudy / curtain like)
77
What incision used in felon?
Longitudinal (superficial w/ foreign body or discharge)
Mid-lateral (deep w/o foreign body or discharge)
78
Fishmouth incision in felon
Contraindicated
Lead to unstable pulp
79
Assess motor function of median nerve
Thumb opposition
| Thumb + 5th
80
Radial nerve injury Sx
Wrist drop
| No thumb extension
81
Rx of boxers fracture
Ulnar gutter splint
82
Pre-op assessment in cataract surgery
Not needed in asymptomatic patients.
83
Thyroid nodules algorithm
All thyroid nodules = TSH + US
Nodule > 5mm + micocalcifications = FNA
Nodule > 5mm + no calcification = Repeat in 6-12 mo
Nodule > 1cm = FNA
84
Size of renal stones need admission
Needs surgical intervention
> 4 mm
Surgery for > 5 mm
Hasn't passed in 2-4 wks
85
Aortic stenosis replacement indications
Aortic-valve gradient > 50
Valve area < 1 cm
86
Rotator cuff muscles
Infra + Supra spinatus
Subscapularis
Teres minor
87
Test Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Abdication of shoulder
Lateral rotation
Medial rotation
Lateral rotation
88
Test infraspinatus
Lateral rotation
89
How long can NGT used?
< month
90
Side effects of NGT
Diarrhea esp. c. Diff
Stricture
Ulceration
Aspiration
91
Signs of moderate - sever ingrown toe nail
Swelling
Seropurulent discharge
Infection
Ulceration
92
Rx of sever ingrown toe nail
Abx
Partial nail avulsion and phenolization
Or
Surgical excision of matrix
93
What's lateral epicondyltisi?
How is it Dx?
Tennis elbow
Pain with extension
Dx by history + PE
94
What's varicocele?
Dilated veins of pampiniform plexus of scrotum
95
Varicocele Sx
Sub-fertile men
Left sided
Cause reversible testicular atrophy
-ve trans illumination
96
Radial nerve dermatome
Dorsum of hands
97
Acute back pain following trauma / lifting
Due to lumbosacral MS strain
Normal neuro
Rx NSAIDs + bedrest 3 days
98
MCC of fat embolism
Long bone fracture
99
```
Diff eye surgeries
LASIK
Radial keratotomy
Photorefractive keratotomy
Laser thermal keratoplasty
Intrastromal corneal ring
```
1. LASIK:
Refractive for myopia + hyperopia
Corneal flap, ablation of corneal stroma w/ no sutures.
2. RK:
Radial incision to change corneal shape.
3. PRK:
No corneal flap needed
Laser directly to cornea
4. LTK:
Shrink cornea + change shape
5. ICR:
Plastic ring into cornea to change shape
100
Rx of foot tendinopathy
NSIADs
Immobilize in cast boot for 2-3 weeks.
Steroids inj contraindicated
101
Tendinopathy of foot?
Can't flex, invert or stabilize medial arch
Painful flat foot
Can't heel raise.
102
What must be tested in rheumatoid arthritis before surgery,
Atlantoaxial subluxation.
103
Sign of Achilles rupture
Thompson test
104
Rx of open fracture
Sterile dressing
Tetanus
Abx (aminoglycoside + 2G cephalosporin)
105
Rx of sigmoid volvulus
Scope
106
Ulnar nerve sensation
5th finger
1/2 4th finger
Motor: thenar + hypothenar
107
Median nerve sensory
Thenar muscle (motor)
Palmar side of thumb, index, middle and 1/2 ring fingers.
108
Radial nerve sensory
Dorsolateral thumb, index, middle + 1/2 ring fingers
109
What's Volkman's ischemia
Ischemia from increased pressure by cast!
Iatrogenic compartment syndrome.
Worsening pain even at rest, not relieved by meds.
110
Tibial nerve injury?
Loss of plantarflexion
Loss of toe flexion
Weak inversion
+ loss of sensation on posterior of leg and sole of foot
111
Patient on Abx develops high INR?
Vit K def
112
MCC of SBO
Adhesion > hernia > Ca
113
MCC of post op lung abscess
Aspiration of oral secretions
114
What's a ranula?
Pseudocyst of Mucin collection from a ruptured salivary gland duct
Caused by trauma
Asymptomatic + Rx with surgical excision (marsupialization)
115
When to stop BB in CHF/arryrhemia/HTN Before surgery?
Don't stop.
| Continue as scheduled
116
What explains urinary Hg without RBC?
Myoglobinuria
117
How does porphyria affect urine?
Makes urine burgundy in color
| But no hemoglobin in urine
118
How to judge adequacy of fluid replacement?
Urine output 1-2 ml/kg/hr
CVP 10-15
119
What's Parkland formula for burns?
Modified parkland?
4 x kg x BSA
1/2 in 8hr
1/2 in 16hr
Modified parkland:
Add 2000 ml to total for maintenance fluid.
4 x kg x BSA + 2000
120
Indications for bariatric surgery?
BMI > 35 + Co-morbidities
BMI > 40 even w/o morbidities
With failure lose weight
Alcohol use is contraindication
121
MC site of stress fracture in children?
Tibia
122
Sx of TMJ syndrome?
```
Headache
Tenderness of chewing ms
Stuffiness in ear
Disturbed sleep
Neck stiffness radiating to arm
```
123
What causes foot drop?
No dorsiflexion
Common peroneal branch of sciatic nerve
124
Rx of open (compound) lower leg fracture
Pain control
Irrigation
Sterile dressing
Tetanus prophylaxis
Abx (cephalosporin + aminoglycoside)
Closed > open reduction.
125
Scaphoid fracture Sx, Rx
Snuffbox tenderness
Fall on stretched hands
Rx:
1. XRay (repeat in 2wk in -ve)
2. Immobilization (thumb splint) 2 wks
126
Axillary nerve innervation
Teres minor
Deltoid
Sensation of glenohumeral joint and skin on deltoid.
127
Axillary nerve injury
Dysfunction of deltoid muscle.
Can't do forward elevation of shoulder (<30 degrees)
128
Rx of prostate with < 5% low grade tumor?
Observation.
129
How to asses for osteomyelitis in diabetic ulcer?
Look for palpable bone at base of ulcer.
130
What's Reynolds Pentad?
Septic shock from ascending cholangitis
1. Shock
2. RUQ pain
3. Jaundice
4. Fever
5. Altered mental status
131
Sign of rotator cuff injury
+ve impingement (Hawkin's)
Flex arm at 90
Flex shoulder at 90
Internal rotation of arm
Pain = +ve.
132
Dx anterior glenohumeral instability
+ve apprehension test
Abduct shoulder
Flex arm at 90
Externally rotate
Pain = +ve
133
Complication of undescended testis?
Lifetime risk of testicular cancer w/ undescended testis 9.7x higher.
Esp. Seminoma
134
Complication of cataract surgery
More in?
Prevented by?
Dx?
Rx?
1. Cystoid macular edema:
Breakdown of blood-retina barrier = fluid accumulation.
More in DM
Prevent with NSAIDs
Resolves spontaneously
Dx by fluorescein angiogram
135
Rx of hydrocele
Observe in 1st year
Surgery after 1 year if not resolved
136
Sx of orbital fracture
```
Double vision
Sunken eyeball
Eye stuck downward
Numbness on cheek / lip
Subcutaneous emphysema
```
137
Dx orbital fracture?
| Rx?
CT
```
Medical
Surgical if:
Ophthalmos or enophthalmos
Diplopia
Entrapment of nerve
Fracture > 50% floor
```
138
Rx of ankle sprain
Semi-rigid brace (air-cast)
139
Predictors of increased post-op cardiac disease
```
- Major:
Unstable MI, acute MI, recent MI
Sever valvular disease
Decompensated HF
Supra-ventricular arrhythmia.
```
- Moderate
CHF
DM
CKD
- Mild:
Elderly
Hx of stroke
Uncontrolled HTN
140
Dx anterior cruciate ligament?
Best: MRI
1st: anterior drawer test
Knees flexed 90 and leg pulled anteriorly.
141
Indications for ORIF?
1. Displaced intra-articular
2. Displaced epiphyseal
3. Avulsion fracture
4. Non union
In ankle:
+ Talar > 10 degree
142
Complication of mandibular fracture
Malocclusion of teeth
| Numbness
143
Rx of thrombosed external hemorrhoid
Excision under local
| + sitz baths
144
MCC of cellulitis post-breast resection
Lymphadema from Axillary LN resection.
MC bug: non-GAS
145
What's hamate fracture?
Fracture of hamate (MC bone)
Due to direct blow by handle of tennis racket/golf club.
End of racket forced into the palm
Direct pressure on hypothenar
146
Radial head subluxation ass with what fracture?
Pull of extended arm
| nursemaid fracture
147
Fall on hyper extended arms fractures? (3)
Lunate subluxation
Scaphoid fracture
Colle's fracture.
148
When to give pre-op Abx?
1hr prior to surgery
149
Rx of hammer toe
Surgical correction
If can't = weak pulses = costume made shoes
150
1st step in hypovolemic shock?
Samples
IVF
Before FAST
151
Facts on varicocele
Appear in teenage
Let > Rt
Dx clinically or US
152
T/F: Rt sided varicocele needs referral to uro
T
| Or child < 10
153
What's le Fort fracture?
Maxillary bone fracture
| Classic in facial trauma
154
What's pallidotomy?
Thalamotomy and pallidotomy
For disabling tremor / dyskinesia
155
Facial trauma + can't breath
| You've no tools?
Cricothyroid membrane opening via needle.
It's between anterior cricoid + thyroid.
156
LDL in aortic disease?
< 70
| < 2
157
Types of onychomycosis
1. Proximal
2. Distal
3. White superficial
158
Ottawa ankle and foot rules?
1. Ankle X-ray:
- Bone tenderness at posterior / tip lateral malleoulus
- Bone tenderness at posterior / top of medial malleolus
- can't bear weight
2. Foot X-ray:
- Tenderness at base of 5th metatarsal
- tenderness at navicular
- Can't bear weight
159
When to repair aortic aneurysm?
5.5 cm
160
Prognosis of prostate Ca
| Depends on?
Stage and Gleason grade
161
Gameskeeper/skier's thumb?
Avulsion of attachment of ulnar collateral ligament
Not associated with direct blow
162
What finger fracture associated with direct blow?
Baseball finger / mallet finger.
163
When does delirium termens starts?
2-10 days after alcohol
164
Sx of delirium termens?
```
Confusion
Sleeplessness
Nightmares
Sweating
Depression
+
Hallucinations esp. visual
Illusions
```
165
```
Frozen shoulder
Age?
Cause?
Risks?
Sx?
```
Idiopathic
MEN 40-60
Risk: DM
Sx: shoulder stiffness, loss of active + passive ROM, pain esp. night.
166
Frozen shoulder vs rotator tear?
Frozen = loss of ROM active + passive
Rotator cuff tear = loss of active, normal passive
167
Medial collateral ligament tear Sx?
Pain and swelling on medial knee
Knee abduction > 5 mm = tear.
168
Technetium-99 in lower GI bleed?
Not helpful
169
Vaccination after splenectomy
Pneumococcal
Meningococcal
HiB
2 wks before surgery
170
Tibialis stress
Tibilal posterior tendinitis
Pes anserine tendinitis
Tibialis stress = tenderness + pain w/ less activity.
Posterior tendinitis = pain extends to medial malleolus
Pos anserine = pain proximal to knee
171
Rx of Achilles tendinopathy
```
1. Conservative (3-6 mo)
Cryotherapy
Heel lift
Extracorporeal shock wave
Deep friction massage
Eccentric strength training
```
2. Surgery only if medical fails.
172
Role of NSAIDs in Achilles tendinopathy
No role? No inflammation
173
Sx of lumbar lordosis
Pain with spine extension = walking downhill
174
What's central extensor slip?
Cause?
Rx?
Complication?
Tear of extensor slip tendon.
- Passive flexion of PIP during active extension.
- Dx: hold joint at 15-30 degree flexion, patient can't actively extend finger, but passive flexion possible.
And tenderness on dorsal middle phalanx.
- Rx: split PIP in full extension 6 weeks.
- complication: boutonnière
175
What could follow aneurysmal subarachnoid hemorrhage? When?
Vasospasm
4-14 days
Dx: CT
176
What's Leriche Syndrome?
Triad of:
No femoral pulse
Pain w/ walking (claudication)
Impotence.
It's atherosclerosis of GI arteries.
177
P's of compartment syndrome
```
Pain
Pallor
Paresthesia
Pulselessness
Paralysis
```
178
Common scenario of anterior leg compartment syndrome
Compression during prolonged recumbency related to alcohol or drugs
179
Complication of slipped capital femoral epiphysis
A vascular necrosis
180
Contents of carpal tunnel?
Median nerve
Flexor policis longus
4 flexor digitorum profundus
181
Risk of peri-op MI is highest in which surgeries?
Aortic and peripheral vascular
182
MCC of anterior cruciate ligament tear?
Low-velocity non-contact injuries
Rotational injuries
Esp. Basketball, football, skiing.
183
T/F: Anterior cruciate ligament more in females
T
184
T/F: strength exercise prevent ACL tear
T
185
Dx and Rx of non-displaced forearm fracture
Dx: fat pad sign
Rx: posterior splint 1-2 wks w/ repeat X-ray
186
Effect of loss of one testis on fertility
No effect
187
Patient with biliary colic and no stones on US?
Mostly biliary dyskinesia
Dx w/ nuclear scan
188
Hoarseness after thyroidectomy?
Recurrent laryngeal nerve = vocal cord paralysis.
189
Dx acute pancreatitis
Contrast CT
190
```
Which ones show on X-ray?
Glass
Wood
Plastic
Urchin spine
```
```
Glass > 2 mm
Urchin spine (has Ca)
```
191
Most serious complication of supracondyl fracture
Compartment syndrome
192
Hesselbach triangle
Transversalis fascia defect
Direct inguinal hernia
- medial to inferior epigastric
- lateral to rectus
- superior to inguinal ligament
193
Indirect inguinal hernia anatomy
In deep inguinal ring
Lateral to inferior epigastric
Descend into scrotal sca / labia majora
194
Dx appendicitis
CT
195
T/F: stress fracture needs casting
F
196
Rx of foot stress fracture in runners
Rest 4-8 wks start activity as tolerated.
197
Different degrees of hemorrhoids and Rx
- 1st degree:
Bleed w/ defecation
No prolapse
Rx: diet (fiber), recurrent bleeding (sclerotherapy, coagulation, band)
- 2nd degree:
Prolapse w/ defecation + reduce spontaneously
Rx: band ligation
- 3rd degree:
Prolapse need Manual reduction
(Destroyed suspensory ligament)
Rx: band ligation or resection.
- 4th degree:
Prolapse and can't be reduced
Rx: resection
198
Sx of de quervain's tenosynvitis? Rx?
Pain at thumb side of wrist.
Pain worse w/ movement
Pain w/ opening and closing thumb
Finkelstein's test +ve
Rx: NSAISa early => steroids if constant Sx
199
Rx of enlarging hematoma in wound sit?
Remove suture and ligate
200
Elderly w/ mid-heel pain worse in evenings
Not better w/ NSAIDs
Normal PE + X-ray
Fat-pad atrophy
Fat-pad vs plantar fasciitis
Fat pad worse at night
Fasciitis worse in morning
201
Prevention of decubitus ulcer
Alternate Rt + Lt 30 degrees oblique positions
Well tolerated by elderly
202
Humeral shaft fracture palsy?
Radial nerve
203
Supracondylar fracture at distal humerus injures what nerve?
Median nerve
204
Fracture of humeral surgical neck injures what nerve?
Axillary nerve
205
Glasgow Coma Scale?
```
1. Eye
Spontaneous: 4
Speech: 3
Pain: 2
None: 1
```
```
2. Verbal:
Oriented: 5
Confused: 4
Inappropriate: 3
Incomprehensible: 2
None: 1
```
```
3. Motor:
Obeys command: 6
Localize pain: 5
Withdraw: 4
Flex: 3
Extend: 2
None: 1
```
206
Overuse of forearm extensors syndrome?
Tennis elbow (lateral epicondylitis)
207
Rx of massive / saddle shaped PE
1. No trauma or contraindication: tPA
| 2. Trauma: embolectomy
208
Patient w/ AFib for surgery.
| Need for anticoagulant
1. Lone Afib (no Hx thrombus)
Stop warfarin 3-4 days pre-op
Resume as indicated by surgeon.
2. Afib w/ Hx of thrombus:
Stop heparin 3-4 days pre-op
Give prophylactic heparin post-op
In high risk (prosthetic valve): give therapeutic in INR below normal.
209
Absolute contraindication to laparoscopy
1. Coagulation abnormalities
2. Shock
3. High ICP
4. Retinal detachment
210
What's malignant hyperthermia
Inherited myopathy in sarcoplasmic reticulum => high intercellular Ca => sustained contraction + hyper metabolic state.
211
Trigger of malignant hyperthermia
Inhalation anesthetics (halothane)
Succinylcholine
212
Sx of malignant hyperthermia
Fever
Tachycardia
Increases Ms tone + rigidity
213
Rx of malignant hyperthermia
Dantrolene + cooling
214
What's Dressler's syndrome?
Post-pericardiotomy syndrome
2 weeks after surgery = low grade fever + chest pain
215
What's osteitis pubis
Chronic lower abdominal pain + medial thigh w/ exercise.
216
Dx of osteitis pubis
Lower abdominal + medial thigh pain w/ exercise
Tenderness on pubis
Widened pubis on X-ray
217
What surgery has high risk of post-op DVT?
Neurosurgery
| Orthopedics esp. hip replacement.
218
Dx quada equine?
MRI w/ gadolinium
219
What's a jersey finger?
Tear of flexor digitorum profundus tendon of finger
Classically by catching finger in opponent's clothes
220
Rx of jersey finger?
Splint in slightly flexed position and refer to surgeon for tendon re-attachment
221
MCC of bowel obstruction in elderly
1. Adhesions
| 2. Groin hernia
222
What Morton's Neuroma
Tenderness in 3rd interspace between 3-4 toes.
No inflammation or redness.
223
What's the female athlete triad
Amenorrhea
Stress fracture
Eating disorder
224
Essential findings in brain death (3)
Coma
Absence of brain stem reflexes
Apnea
225
Dx brain death
- R/o hypotension, hypothermia <32, drugs, brain stem encephalitis, encephalopathy, low PO4
- GCS 3
- No pupillary reflex
- HR < 5 after atropine
- No resp. w/ high CO2
- +ve apnea test if no resp w/ PCO2 > 60 mmHg on 100 O2
226
Initial Rx in coma
ABC (airway, IVF, viral signs)
```
Coma cocktail:
Dextrose D50W
Flumazenil
Naloxone
Thiamine
```
227
Dx rotator cuff
Painful abduction > 90
| Weak external rotation (specific)
228
Who gets more than ECG in pre-op evaluation
1. Unstable MI
2. Sever VHD
3. Uncompensated CHF
4. Significant arrhythmia
229
Who gets ECG in pre-op
```
Males > 45
Females > 55
DM
Chest pain
NYHA 3
Cardiac disease
```
230
SE of spironolactone in men?
Gynecomastia (Uni > bi)
231
What's contraindicated in anesthesia of penile surgery / circumcision?
Epinephrine
232
What's penumocephalus? What does it indicate?
Air in cranium
Skull fracture, trans-sphenoidal surgery, tumors in base of skull
233
Serious complication of chronic calculous cholecystitis?
Gallbladder cancer
234
Shoulder pain after gall bladder surgery
Referred pain (C3-5)
235
Rx of buckle fracture of wrist
Removable splint
236
Patient high risk for DVT post-op
SubQ enoxaparain 1-2hr before surgery + 24hr after.
237
Bariatric surgery recommended BMI
1. BMI > 40
| 2. BMI > 35 + comorbidity
238
Effect of bariatric surgery on T2DM
Resolve disease in 75%
239
Pain in spinal stenosis vs herniated disk
Stenosis = improves w/ setting
Disk = improves by standing
240
Odds of having breast Ca? Die of breast ca?
1 in 8
1 in 30 dies of breast Ca
241
Physical / mechanical prevention of DVT?
Compression stockings
242
When do osgood-schlatter fracture resolve?
18-24 mo
243
Typical pain in Osgood-schlatter?
Confined to tibial tubercle.
244
T/F: Osgood-schlatter not ass w/ trauma
T
245
MC injured ligaments of knee
Medial CL
| ACL
246
When to refer varicocele to urology
If testicular volume 2ml less than normal
247
Primary closure after animal bite?
```
Face / scalp
W/in 6hr of injury
No devitalized tissue
No fracture
Immune competent
```
248
Femoroacetabular impingement pain
Worsening anterolateral hip pain
Sharp moving from seated position
Pain w/ ROM exam
249
Most sensitive test for femoroacetabular impingement
FADIR test
| Pain w/ hip Flexion, adduction, internal rotation
250
Rx of nursemaid's elbow
Manual reduction w/ supination-flexion techniques
251
Where's CN XI?
| Sx?
Posterior neck triangle
Innervates trapezius => dropped shoulder + can't raise hand above head.
252
Complication of scaphoid fracture / snuffbox?
A vascular necrosis
253
Risk of post-op delirium in elderly?
Dementia
254
Rx of closed colle's fracture
Slight flexion, full pronation, full ulnar deviation reduction
255
What improves Ca Oxalate stones?
High Ca diet
Low Fat
High Mg
Citrate
256
Imp risk of lung post-op?
Age > 80
257
Ogilvie's Syndrome?
Intestinal pseudo-obstruction with massive distention of colon or bowel after surgery.
No mechanical obstruction.
258
Herb to be stopped week before surgery
Ginseng = hypoglycemia + anticoagulant
259
When to start ROM exercise in ankle sprain
Early to maintain flexibility
260
Rx of femoral neck + intratrochanteric fracture
Femoral neck: internal fix
Intratrochanteric: compression screw + side plate
261
Diff dementia + delirium
Delirium = previously healthy + mental status fluctuates on successive visit.
262
Surgery for rotator cuff injury
Young + Active
| < 6wk of injury
263
MCC of fistula-in-ano?
Rectal abscess
264
Zanker's diverticulum (cricopharyngeal)
Difficult swallow
Gurgling noise
Spitting food swallowed hrs ago
Bad smell
265
Rx of choice in BCC
Mohs Surgery
266
BCC cure rate w/ mohs surgery
97-99%
267
How to decrease pain from inj local anesthetic
Add Na HCO3
Warm solution
Small needle
Slow inj
268
Proctalgia Fugax?
Episodes of sharp pain in rectum lasts minutes
Normal exam
269
T/F: Achilles' tendon rupture patient can't do single leg toe raise
T
270
Drug ass. w/ tendon rupture
Quinolone
