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$$MS3 > Surgery > Flashcards

Surgery Flashcards

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1
Q

What is Charcot’s triad and reynold’s pentad and what is its indication? tx?

A

RUQ pain/jaundice/fever
all 3 plus HoTN/AMS
Ascending cholangitis
ERCP with cipro + metro

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2
Q

Tx for follicular, medullary, papillary thyroid carcinoma?

A

Follicular/medullary - total thyroidectomy
Papillary - lobectomy
Follicular - I2 ablation

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3
Q

What electrolyte abnormalities would you see from mineralocorticoid deficiency?

A

Hyponatremia and hyperkalemia

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4
Q

Under what GCS score do you intubate? what does GCS evaluate?

A

8

Eye opening/motor/verbal

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5
Q

Management of abdominal gunshot wound?

A

Exploratory laparotomy

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6
Q

A patient who has a fake eye of missing toe from a cancer 20 years ago now have multiple masses in the liver, what is it?

A

Metastatic melanoma (metastasize 20+ years after the onset)

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7
Q

Management of Colle’s fracture?

A

Closed reduction and short arm cast

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8
Q

Difference seen on barium swallow in pt with achalasia vs. cancer?

A

Achalasia - massive dilation (bird’s beak)

Cancer - no massive dilation/just focal narrowing

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9
Q

What is the criteria for lumpectomy vs. mastectomy for breast cancer?

A

Size of 4cm
Under 4 - lumpectomy
Over 4 - mastectomy

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10
Q

Dx of mesenteric ischemia?

A

CT

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11
Q

What is cushing’s triad? and its management?

A

Increase ICP
Irregular breathing/HTN/bradycardia
Elevate head of the bed/give mannitol/hyperventilate/craniotomy

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12
Q

When do you do an endoscopy for GERD pt?

A

anyone with alarming symptoms such as dysphagia/bleeding/odynophagia
Or pt>50 with more than 5 years of GERD

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13
Q

What would you worry about a pt post brain surgery with AMS?

A

DI - hypernatremia

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14
Q

Elderly pt with hx of atherosclerosis/recent hypotension complains of sudden abdominal pain, what is it and what do you see on angiography?

A

non occlusive mesenteric ischemia from vasoconstriction

“string of sausages”

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15
Q

What would a penetrating trauma to the groin cause?

A

AV fistula causing venus HTN — edema and varicose veins

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16
Q

What test is used first for peripheral vascular disease? and how to interpret it?

A

ABI
normal 1 - 1.3
Under 1 - ischemia
Over 1.3 - calcified (DM or vasculitis)

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17
Q

What are afferent loop and dumping syndrome?

A

Post gastrojejunostomy
Dumping syndrome - too much food in small intestine too fast - nausea/vomiting/diarrhea/dizziness/fatigue tx - smaller meals and less fat
Afferent loop syndrome - mechanical obstruction of the afferent loop - abdominal pain 1-2 hours after eating, relieved by vomiting

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18
Q

Difference between incarcerated and strangulated bowel hernia

A

Incarcerated - just tender

Strangulated - tender/fever/elevated WBC - urgent surgery

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19
Q

What is the bacteria number in u/c for bacteriuria?

A

over 100,000

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20
Q

What score system is used to grade prostate cancer?

A

Gleason score

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21
Q

What does CVP measure and what is its normal range?

A

Venous filling pressure aka volume level

2- 6 mm Hg

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22
Q

What does contrast highlight?

A

Blood vessels

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23
Q

What causes nephrogenic DI?

A

Demeclocycline and Li+

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24
Q

Normal value of BUN/Cr, FENa and urine osm? what happens in intrarenal disease?

A 
BUN/Cr = 15
FENa <1%
Urine osm >500
BUN/Cr <15 (decrease reabsorption)
FENa >2% (decrease reabsorption) 
Urine osm <500 (can't concentrate)
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25
What causes hypokalemia?
Loop/thiazide/Bartter's syndrome
26
What electrolytes abnormalities does diarrhea and vomiting cause?
They both cause hypokalemia Vomiting cause alkalosis Diarrhea cause acidosis
27
Why does aldosterone cause alkalosis?
Aldosterone increase Na reabsorption and K/H+ secretion
28
Why does aortic regurg causes widen pulse pressure?
Pulse pressure = systolic - diastolic pressure Aortic regurg - blood flows back into ventricles during diastole - increase ventricular volume thus systolic pressure - decrease aortic volume thus diastolic pressure
29
How does beta blocker increase K+?
It blocks renin | Prevent cellular uptake of potassium
30
What electrolyte abnormalities do VIPoma cause?
Hyperglycemia/hypercalcemia/hypokalemia
31
What other electrolyte is affected by low Mg?
Low Mg -- low PTH--- low Ca
32
When cant you do endocraft to fix AAA?
When the neck is <15mm | such as juxtarenal/suprarenal AAA
33
When cant you do endocraft to fix AAA?
When the neck is <15mm
34
Which IBD has nonceasating granuloma?
Crohn's
35
Which use Mg2+ for acute asthma?
Inhibit smooth muscle contraction/ACh release
36
What are the 3 signs for appendicitis?
Rovsing/Psoas/obturator
37
Appendicitis is dx with contrast or noncontrast CT?
Contrast CT
38
What size of the carcinoid tumor that we dont care about?
<2 cm
39
Common etiology of big bowel obstruction?
Volvulus/diverticulitis
40
How to decompress sigmoid volvulus?
Sigmoidoscopy
41
Biliary air in liver with signs of SBO, what is it?
Gallstone ileus
42
What would be urine pH be with dehydrated patients?
Aciduria | Caused from aldosterone reabsorbs Na and excrete K and H+
43
A breast cancer mass is tend to feel rubbery or hard?
It is hard
44
Which biopsy method is preferred for breast cancer?
Core needle biopsy
45
What kind of adjuvant therapy should triple negative breast cancer pt receive?
Chemotherapy
46
What is Marjolin's ulcer?
SSC of the skin with previous trauma or burn
47
What kind of feeding method is used for pt with a large burn or pancreatitis?
Enteral feeding vis either NG or NJ (nasojejunal) tubes
48
What kind of feeding method is used for pt with a large burn?
Enteral feeding
49
Frostbite limb with no pulse, what is happening?
Thrombosed arteries, need tPA
50
You found a bulb at the carotid bifurcation, what could it be and what's the tx?
Carotid body tumor | take it out
51
What is acute peripancreatic fluid collection and when does it become pseudocyst?
Fluid around the pancreas in a sack (wait till it becomes pseudocyst) If it's over 4 weeks then it's pseudocyst
52
80% of stenosis at external carotid, what to do next?
Wait and see | External carotid stenosis does not cause stroke
53
What should be the diet for CKD pt?
Restrict protein/K/Mg/Ph cuz kideny get filter them out thus lead to accumulation in blood stream
54
What is ACE inhibitor's effect on kidney and why is it used for CKD patients?
Decrease efferent arterial constriction/decrease GFR/lessen hyperfiltration/decrease protein filtration thus proteinuria
55
Difference between stye and chalazion?
Stye is infection of a hair follicle and chalazion is blockage of sebaceous gland Both can be tx with warm compresses to increase drainage
56
Tx for CO and cynaide poisoning?
100% O2/cobolamine and thiosulfate
57
Signs of diverticulitis with what else would make it a complicated one?
UTI - might be a fistula
58
What could the pt do to alleviate the pain from pancreatitis?
lean forward
59
Does the presence of gallstone enough to establish the dx as gallstone pancreatitis?
If there are no other factors then yes
60
What is acute peripancreatic fluid collection and when does it become pseudocyst?
Fluid around the pancreas in a sack | If it's over 4 weeks then it's pseudocyst
61
MRI findings of PML/Toxo/CNS lymphoma
PML - multiple non enhancing lesions Toxo - multiple ring enhancing lesions CNS lymphoma - solidary ring enhancing lesion
62
Why hyperventilation decreases cerebral edema?
Hyperventilation -- decrease PaCO2 --- arterial vasoconstriction -- decrease cerebral blood flow ---- decrease cerebral edema
63
The only STD ulcers that is painful? and the only STD ulcer associated LAD that is not painful?
Painful STD ulcers - HSV/chancroid | Nonpainful STD LAD - syphilis
64
Why does rhabdomyolysis causes hypocalcemia?
Release phosphate --- phosphate precipitates Ca --- decrease Ca
65
What does Prussian blue stain?
Iron
66
When do you have target cells?
Post splenectomy/beta or alpha thal minor
67
Tx for SIADH
ASX - water restriction/NS + loop/Li/demeclocycline | SX - hypertonic saline
68
What's in Lactated ringer that is not in NS? and why does surgeons prefer LR and medicine prefer NS?
LR has K that is not in NS Large amount of NS infusion can cause acidosis but not LR You use a lot of fluid in surgery thus you dont wanna give pt acidosis so LR is better Medicine ppl dont wanna volume overload pt so they wont give large amount of fluid so LR is not needed (besides K in LR can worsen CKD or heart failure)
69
What are the two condition with increased MCHC? and what should be giving to these pt?
Sickle cell/herediatry spherocytosis | Folate
70
what are the three conditions that have spherocytes?
Herediatry spherocytosis/warm autoimmune hemolytic anemia/G6PD def
71
What is the triad in PNH and what is the tx?
Anemia/pancyotpenia/venous thrombosis | Eculizumab - against factor C5
72
Hypothyroidism causes?
Joint pain/increase lipid/macrocytic anemia
73
Symptom and causes of central cord syndrome? prognosis?
Hyper extension of the neck Loss of motor function and burning pain in upper extremities Eventually recovery on its own
74
What causes warm autoimmune hemolytic anemia? and what kind of hemolysis?
Cancer/drug/SLE | Extravascular
75
Medical management of pul contusion
Use diuretics/fluid restrict
76
What's the cause of aortic rupture and what's the dx?
Deceleration injury | Spiral CT aka CT angio
77
What is the complications of HIT?
PE and DVT
78
Why liver disease causes coagulopathy?
Decrease clotting factor/cholestasis decrease Vit K absorption/hyperslenishm (from portal HTN) - thrombocytopenia
79
Adverse effect of heparin
Osteoporosis/alopecia
80
Subtypes of Hodgkin's and Non-Hodgkin's lymphoma?
Hodgkin's - ones like lymphocyte depleted | NHL - Burkitt's/Mycosis fungoides
81
What kind of bladder rupture can be fixed, intra or extraperitoneal?
Intraperitoneal
82
What is alpha blocker's role in kidney stone?
Relax the smooth muscle of distal ureter
83
What mimics testicular torsion?
Appendages torsion
84
What to do next with a young guy with ball mass?
Take it out, don't bx
85
Phimosis vs. paraphimosis?
Phimosis- can't pull back foreskin - seen normally in young boys Paraphimosis - foreskin pulled back too long - emergency - reduce it back
86
What kind of inguinal hernia can be sliding hernia and what is the risk of repairing it?
Indirect inguinal hernia usually on the left side/colonic injury
87
What is the MC type of hernia in men and women?
Indirect inguinal hernia
88
What is femoral hernia associated with and where is it located?
Multiple births | Empty space in NAVEL (nerve, artery, vein, empty and lymphatics)
89
What drug is associated with post op ileus?
Opioid
90
What is Richter's hernia?
Only one wall of bowel is strangulated or incarcerated | without associated symptoms
91
When should we fix an infant's umbilical hernia? and what size can it usually be healed by itself?
Delayed till 4 years old | If under 2cm then it usually heal on its own
92
What causes ischemic orchitis and what is the tx?
Thrombosis of pampiniform plexus | Self limited
93
What does the genital and femoral branch of genitofemoral nerve innervate and what about ilioinguinal?
Genital branch of genitofemoral - scrotum and cremastic reflex Femoral branch - proximal medial thigh Ilioinguinal - lower abd and medial thigh
94
What is closed loop SBO?
A segment of bowel is obstructed both proximally and distally
95
Management of postop NSTEMI?
Medical management
96
What is dressler syndrome?
Post MI pericarditis
97
What is the access hormone in pheo?
Epi/norepi
98
Found a 8cm mass on adrenal gland, what to do next? and what if its 3cm?
Take it out Any adrenal tumor that is over 6cm - take it out and don't bx 3cm - check biochemical marker to see if the tumor is functional or not, if not observe
99
see laryngeal cancer, think what other cancer?
Lung cancer
100
What is the MC organism that causes otomycosis and what populations are most susceptible?
Aspergillus | Pt with hx of AML and DKA pts
101
What can causes mastoiditis and what is the dx and tx?
Otitis media | CT/surgery
102
Tx for acalculus cholecystitis
Abx and percutaneous cholecystectomy if critically ill
103
What to do with pt with ASX gallstones?
Observe
104
What is the complication of AAA repair and what is the dx?
Ligate IMA - ischemic colitis | Flexible sigmoidoscopy
105
What is the screening for kids with FAP?
Sigmoidoscopy since the age of 10
106
What does diffuse axonal injury results in?
Unconsciousness and then vegetative state
107
MC site of PE?
Left common iliac vein
108
Fever, painful, purple swollen leg, increased RR and HR, what is it?
Necrotizing fasciitis
109
What kind of shock causes vasodilation?
Septic and anaphylactic
110
Tx for ITP?
Steroid and then IVIG
111
If pt is likely on Well's criteria, can you give heparin before confirm the diagnosis?
Yes
112
What are the 4 classes of wounds?
Class I - clean (not entering cavities) Class II - clean contaminated (entering but do so surgically like c section) Class III - contaminated - trauma Class IV - dirty infected (like abscess, perforation)
113
What area of bleeding can't FAST detect?
Retroperitoneal
114
Management of pancreatic injury with duct disruption
Surgery
115
Management of blunt carotid injury?
Heparin only
116
Hemodynamically stable GSW pt, what to do?
Get a CT first to assess

$$MS3 (8 decks)

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