Surgery Flashcards by Alex Hamidi

Pts that perform repetitive arm movement above shoulder height that present w/subacute pain on abduction have what?

What is a common characteristic?

Rotator cuff tendinopathy

Impingement syndrome

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What can Etomidate cause? How?

Propofol can cause what?

AI - bc it inhibits 11B-hydroxylase

severe HoTN d/t myocardial depression

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What causes herpangina?

Presents how?

Coxsackie A

Fever, sore throat, odynophagia

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Place ET tube in pt and it fills up w/more than 600 mL of blood, do what next?

Bronchoscopy

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What is the MC complication of supracondylar fracture of the humerus?

What is a v. Rare complication?

What else are they at risk for?

Brachial artery and median nerve entrapment

Compartment syndrome —> leads to Volkmann contracture

Cubitus Varus deformity

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What presents w/fever, chest pain, leukocytosis, mediastinal widening on CXR after cardiac surgery?

Treat how?

Acute mediastinitis

ABx and surgical debridement

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Pt w/respiratory distress after BAT w/dec breath sounds at left lung base can have what?

What is diagnostic?

Diaphragmatic injury

NG tube in lung field

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Pt that has a fall from > 10 feet or MVA, what must be ruled out in the upper chest area?

What is the initial screening test?

What finding is the most sensitive?

Blunt aortic trauma

CXR

Widened mediastinum

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Pt that has blunt GU trauma and is hemodynamically stable but has evidence of hematuria needs what?

Contrast CT of ABD and Pelvis

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What is described by b/L hip, thigh and buttock claudication; absent/diminished femoral pulses; and impotence?

What is ALWAYS present?

Leriche syndrome

Impotence

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Alcoholic that has poor wound healing due to what?

Nutritional deficiency (vitamin C)

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What presents w/neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx?

Can cause what?

Retropharyngeal abscess

Infection w/in superior mediastinum and cause acute necrotizing mediastinitis

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Pt w/BAT, left sided-ABD pain, anemia most likely has what?

Need to do what 1st?

Then what?

Splenic injury

FAST

CT ABD w/contrast

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Pt that has acute onset of HoTN, ABD or back pain, syncope with gross hematuria most likely has what?

Ruptured AAA

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Pt w/traumatic spinal cord injury needs to have what?

Urinary CATH to asses for urinary retention and prevent acute bladder distention and damage

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CT scan or CXR of pt after MVA that shows patchy, irregular alveolar infiltrate w/ABG that shows hypoxemia indicates what?

Pulmonary contusion

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SCC arising within a burn is called what?

Marjolin ulcer

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Respiratory distress, neurologic dysfunction, and a petechial rash 24 hours post op indicates what?

Fat embolism

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What is Cushing’s reflex (triad)?

Indicates what?

Bradycardia, dec respirations, INC systolic BP

Inc ICP

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Pt with DVT and ESRD, what is the treatment?

What is contraindicated

Unfractionated heparin bridge to Warfarin

Low molecular weight heparin and rivaroxaban (xarelto)

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NSAID use and episodic postprandial epigastric pain = ?

Perforated peptic ulcer disease

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What presents as an irregular genital mass that increases in size w/standing and valsalva?

Varicocele

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Any pt with knife trauma to ABD and peritoneal signs even if they are hemodynamically stable need what?

Ex Lap

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Pt w/fever, leukocytosis, and parotid inflammation in a post op pt has what?

MC agent?

Who is most prone to it?

Acute bacterial parotitis

S aureus

Elderly dehydrate pts

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What are conservative meds to give to a pt w/an anal fissure?

Lidocaine Nitroglycerin Nifedipine

What causes penile fracture?

Rupture of corpus cavernous d/t tear in tunica albuginea

What causes anterior knee pain, tenderness, erythema, and localized swelling and is common w/repetitive kneeling? D/t what?

Perpatellar bursitis S aureus

What presents w/flaccid paraplegia and loss of pain in the LE. Vibratory sensation remains intact and UE is ok? D/t what?

Anterior cord syndrome Spinal cord infarction

What is dumping syndrome? Occurs when? D/t what?

N/D/ABD cramps, palpitations, diaphoresis Postgastrectomy Loss of normal action of pyloric sphincter d/t surgical bypass

Pt that presents w/upper ABD pain that is constant and interferes with sleep, has poor appetite, weight loss, fatigue, and 30 year pack history has what?

Pancreatic adenocarcinoma

Blow to the head which causes uncal herniation is most likely what? What can uncal herniation cause?

Epidural hematoma CN 3 palsy and hemiparesis

What presents in children after BAT w/epigastric pain and vomiting 24-36 hours after initial injury? Manage how?

duodenal hematoma Gastric decompression and parenteral nutrition

How does hyperventilation decrease ICP? How does CO2 effect cerebral blood flow?

CO2 washout —> cerebral vasoconstriction As cerebral paCO2 rise, so does blood flow

Pt w/fever, HoTN, erythema and swelling after a cut on the leg and has a CT that shows air in the deep tissue has what? MC pathogen?

Necrotizing fasciitis grp A strep, but MC polymicrobial

GSW below what level requires Ex Lap in unstable pts? Bedside ultrasound shows what?

T4 (nipple) Equivocal

What does intraperitoneal bladder describe?

dome of the bladder - superior and lateral bladder walls and directly abuts the peritoneal space

How are fractures of the middle third of the clavicle treated? Distal third? Why?

Brace, rest, ice ORIF to prevent nonunion

What is tic douloureux?

Trigeminal neuralgia

What causes pooling of saliva and deviation of uvula from the affected side of throat pain?

Peritonsillar abscess

What can Succinylcholine cause in pts w/skeletal muscle trauma, burns or strokes? How?

Life-threatening HyperKalemia Binds to post-synaptic ACh-R’s which trigger influx of Na ions and Efflux of K+ ions

Pt w/a small (< 1.5 cm) congenital umbilical hernia is managed how? What about later in life?

Observation, they close spontaneously Need surgery if they do not close by Age 5

Pt w/recent cardiac catheterization, anticoagulation w/heparin, HoTN, tachycardia, flat neck veins and back pain has what? D/t what? Next step in management?

Retroperitoneal hematoma Bleeding from arterial access site NonCon CT ABD and Pelvis

Pt w/blunt head trauma has concern for what? 2/2 to what? May cause what?

Transtentorial (uncal) herniation Epidural hematoma CN 3 palsy, i/L hemiparesis, c/L hemianopsia

What does the CXR show in pericardial tamponade?

NORMAL cardiac silhouette w/out tension pneumothorax

What findings indicate a complicated SBO?

Fever Hemodynamical instability - HoTN, tachycardia Metabolic acidosis —> Look for LOW HCO3 Guarding

Pt that experiences recurrent episodic pain in the RUQ or epigastric region w/elevated LFTs and ALP after an inflammatory process (surgery, pancreatitis) has what? What can precipitate symptoms?

Sphincter of Oddi dysfunction Opioids

What nerve is responsible for knee extension and hip flexion? Innervates muscles of which compartment of the thigh?

Femoral Anterior

What presents w/a popping sound followed by acute pain and pt has reduced extension, a sensation of instability, and a knee effusion?

Medial meniscus tear

Pt w/complicated diverticulitis w/abscess formation should be managed how? What size fluid collection warrants this? If symptoms not controlled by when, what is recommended?

CT-guided percutaneous drainage > 3 cm 5th day, then do surgical I&D

Extraperitoneal bladder injury includes what? What is almost ALWAYS present? What other features?

neck, ant wall, anterolateral wall of the bladder pelvic fracture gross hematuria and urinary retention

Blunt chest trauma which causes hemorrhagic shock w/decreased breath sounds and dullness to percussion over 1 hemithorax and c/L tracheal deviation d/t what?

Large i/L hemithorax

Stable pt w/LARGE Pneumothorax needs what? Pt that is unstable needs what?

Needle decompression Tube thoracostomy (chest tube placement)

What causes peritonitis (diffuse ABD tenderness, guarding, rebound), referred pain to the i/L shoulder after a direct blow to the lower ABD and pelvis?

bladder dome rupture

What is a possible complication of AAA repair that presents w/bloody diarrhea and ABD pain?

Ischemia of the bowel

Acalculous cholecystitis occurs in whom? Imaging shows what? Treat how?

Critically ill pts GB wall thickening and distention, pericholecystic fluid ABx and percutaneous cholecystectomy

Pt that has been using lots of NSAIDs and presents w/ABD pain, fever, tachycardia w/ABD exam that shows rigidity, guarding, reduce bowel sounds and rebound tenderness has what? Dx how?

Perforated viscous d/t PUD Upright Xray of chest and ABD

Nonseminomatous germ cell tumors have what tumor markers?

Elevated AFP and elevated b-HCG

Pt w/extensive burns that develops an infection is most likely d/t what organisms?

G- Pseudomonas or Fungi

Pt w/N/V, pneumobilia (air in biliary tree), hyperactive bowel sounds, and dilated loops of bowel has what?

Gallstone ileus

needle thoracostomy should be placed where in tension pneumo? if it fails go where?

2nd ICS midclavicular line 5th ICS midaxillary line

Pt that presents w/N/V/ABD bloating and dilated loops of bowel on ABD xray has what? MC d/t what in history?

Complete SBO Adhesions from prior ABD surgery

Pt w/UE sensory deficits (pain/temp) and weakness after a whiplash injury has what? What is another common cause? Best way to diagnose?

Syringomelia Arnold Chiari MRI

What is psoas sign? Indicates what?

RLQ pain w/extension of the right thigh Abscess adjacent to psoas or retrocecal appendix

Pt that has IE and cardiac valve vegetation is at risk of getting what ABD event?

Acute mesenteric ischemia d/t embolism

What are the 4 T’s of anterior mediastinal masses?

Thymoma Terrible lymphoma Thyroid cancer Teratoma

Pt that has severe pain and parasthesia following a LE embolectomy just a few hours earlier most likely has what?

Compartment syndrome aka soft-tissue swelling

Myocardial rupture after MVA indicates what?

Immediate DEATH

What causes paradoxical respiration? D/t what?

Flail chest > 2 contiguous ribs fractures in 2 or more spots

What is the MC cause of LE edema? Classic symptoms?

Venous insufficiency (valve incompetence) Worse throughout the day, resolves overnight

What causes epidural hematoma anatomically?

Trauma to sphenoid bone —> tears MMA

Child w/blunt trauma or MVA that has left lower lung opacity, elevated hemidiaphragm and mediastinal deviation have what? Diagnose how?

Diaphragmatic rupture CT chest and ABD

Parotid surgery involves risk of injuring what? Causing what?

Facial nerve Facial droop

Acute knee pain assoc w/catching or reduced range of motion suggests what? Persistent symptoms should be evaluated how?

Meniscal injury MRI

Pneumomediastinum and subcutaneous emphysema after MVA indicates what?

Tracheobronchial rupture

What is the most frequent cause of nosocomial bloodstream infection in pts w/intramuscular devices?

Coagulase-negative Staph (epidermidis)

What is the management of a small spontaneous Pneumothorax? What is the MC pt?

Oxygen and observation Tall, thin man in early 20s

Pelvic fractures cause what in men? This includes what?

Posterior urethral injury Membranous and prostatic urethra

Gallstone pancreatitis presents how?

ALT > 150

Prosthetic joint infection that occurs w/in the 1st three months is d/t what? 3-12 months? After 12 months?

S aureus, pseudomonas S epidermidis, propionibacterium, enterococcus Hematogenous spread by distant infxn (uti)

What is a life-threatening form of acute cholecystitis that occurs more commonly in immunosuppressed pts (diabetes) that arises d/t infection of GB wall w/gas-forming bacteria? Treatment?

Emphysematous cholecystitis Emergent cholecystectomy

Widened mediastinum and left-sided hemithorax after MVA indicates what?

Aortic rupture