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Flashcards in Surgery Deck (270):
1

T/F: Melanoma can be destructed by electrosurgical tech

F

2

What's Charcot triad?
Used for?

Fever, jaundice, RUQ

Dx cholangitis

3

MCC of cholangitis

Gallstone impacts bile duct => cholestasis + G-ve bacteria

4

Labs in cholangitis

High bilirubin
High ALP
WBC
Fever

5

Acute cholecystitis

Cystic duct obstruction by gall stone

RUQ + fever + N/V
+ Murphy sign (arrest of inspiration during palpation)

6

T/F: post CABG depression increases risk of subsequent cardiac disease

T

7

Would Rx post-CABG depression improves risk of subsequent events?

No
Just improve depressive Sx

8

Who is at haigher risk of post-CABG depression

Rapidly progressive / acute disease before surgery

9

What correlates best with pre-op risk of bleeding?

Hx of bleeding

10

Signs of cardiogenic shock

Low BP, urine, refill
High HR, CVP
Narrow pulse pressure

11

Is DVT prophylaxis recommended for hip surgery?

Yes.

12

Nerve involved in thumb abduction + addiction

Abduction: interosseous of radial

Adductor: ulnar

13

Sx of carpal tunnel

Median nerve
Pain and numbness in dorsal thumb and index

14

What's relation b/w insulin + anti-hyperglycemic and dupuytren's contracture

Use of DM increase risk of contracture

15

Would steroid injections help dupuytren's contracture

Multiple injections needed to regress disease if mild-moderate

16

When is surgery indicated in dupuytren's contracture

Metacarpal joints contracture reaches 30 degrees


Associated with PIP joint at any degree

17

What levels of ALT indicates acute pancreatitis

3x normal limit

18

Local anesthetic lasts 2-4 hrs

Bupivacaine

19

Loading dose of unfractionated heparin

1. Bonus dose 80U/kg in 6hr

20

Rx of torsades de pointes

Mg sulfate
Quinidine

21

Drugs contraindicated in torsades de pointes

Procainamide
Phenothiazide
Disopyramine
Tricyclics antidepressants

22

Tender breast lump
Cyclic changes
Young lady

Dx?

Fibrocystic changes

1st US = FNA

23

Post-op fever DDx

Wind 1, water 3, wound 5, walk 7

POD 1: atelectasis

POD 3: UTI

POD 5: wound infection

POD 7: DVT

24

How to reduce post-op resp complications

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