Surgery Flashcards
(150 cards)
1
Q
Best treatment for patient with subdural hematoma without midline shift?
A
Hyperventilation, Diuretics, Fluid restriction
2
Q
Post-traumatic HA is more common in patients with HX of …
A
Depression
3
Q
NML intracranial pressure?
A
< 15
4
Q
When do symptoms of elevated intracranial pressure develop?
A
> 20
5
Q
Which CN is most commonly affected by elevated intracranial pressure?
A
CN 6
6
Q
Why is CN 6 most commonly affected by elevated intracranial pressure?
A
Long intracranial course
7
Q
DOC for prevention of cerebral vascular spasm following SAH?
A
Nimodipine
8
Q
Zone 1 of neck trauma?
A
Thoracic outlet»_space; Cricoid cartilage
9
Q
Zone 2 of neck trauma?
A
Cricoid cartilage»_space; Angle of mandible
10
Q
Zone 3 of neck trauma?
A
Angle of mandible»_space; Skull base
11
Q
Best management of neck trauma to Zone 1?
A
Conservative
12
Q
Best management of neck trauma to Zone 2?
A
Surgical
13
Q
Best management of neck trauma to Zone 3?
A
Conservative
14
Q
32 yo male presents with R chest pain after MVC; L hemithorax is hyper-resonant to percussion, without breath sounds; Pulse Ox shows O2 sat = 88%; Vitals are otherwise NML - diagnosis?
A
Simple PNX
15
Q
32 yo male presents with R chest pain after MVC; L hemithorax is hyper-resonant to percussion, without breath sounds; Pulse Ox shows O2 sat = 88% - best initial treatment?
A
CXR + chest tube placement
16
Q
Which tendon flexes the DIP?
A
Flexor digitorum profundus
17
Q
Which tendon flexes the PIP?
A
Flexor digitorum superficialis
18
Q
Which muscles flex the MCP joints?
A
Lumbricals + interossei
19
Q
Most common fatal complications of acute compartment syndrome?
A
Rhabdomyolysis, Renal failure
20
Q
Best next step of management for patient who sustains 3rd degree burn?
A
Monitor peripheral pulses and capillary refill
21
Q
According to Rule of 9s – surface area of head?
A
9%
22
Q
According to Rule of 9s – surface area of each arm?
A
9%
23
Q
According to Rule of 9s – surface area of each leg?
A
18%
24
Q
According to Rule of 9s – surface area of anterior torso?
A
18%
25
According to Rule of 9s – surface area of posterior torso?
18%
26
According to Rule of 9s – surface area of perineum?
1%
27
Parkland formula?
(4 mL) * (% of body surface) * (kg)
28
How quickly should fluid be replaced in Parkland formula?
Half of fluid in first 8 hours; Half of fluid in first 16 hours
29
6 criteria for transferring burn patients to burn center?
Electric burn, Respiratory injury, Circumferential burn, Genital + Face involvement. Partial thickness > 10%, Full thickness > 5%
30
Etiology of J waves on EKG?
Hypothermia
31
Appearance of J waves on EKG?
Camel’s hump following QRS complex in V2-V6
32
Which 2 post-exposure prophylactic vaccines should be given to patients after sexual assault?
HIV, Hepatitis B
33
Best treatment for black widow spider bite?
Antivenin
34
Diagnostic test for Pseudotumor Cerebri?
Head CT or MRI … (to rule out other cause of elevated ICP)
35
70 yo male with T2DM presents with sudden R eye vision loss; Eye exam shows train-tracking of retinal arteries, very pale, except for 1 focal area of redness (cherry red spot)?
Central Retinal Artery Occlusion
36
Next step in CRAO?
Carotid Duplex US
37
Quality of vision loss in CRAO?
Painless vision loss
38
Difference between CRAO and Retinal Vein Occlusion?
RVO = polycythemia (causing vein thrombosis), fundoscopy also looks much angrier than CRAO train-tracking
39
Clinical presentation of retinal detachment?
Brief flashes of light in peripheral eye fields + floaters + night shade
40
Next step of management for retinal detachment?
Urgent ophthalmology consult
41
59 yo female presents for HTN follow-up; Reports blurry vision R>L; Fundoscopic exam shows increased optic disk ratio – diagnosis?
Glaucoma
42
Which type of glaucoma is associated with painful red eye?
Closed angle
43
Appearance of macular degeneration on fundoscopic exam?
Yellow drusen spots
44
Pattern of vision loss in macular degeneration?
Loss of CENTRAL vision
45
Painful sudden vision loss that presents with decreased red reflex?
Endophthalmitis
46
Painful sudden vision loss that presents with NML red reflex?
Retrobulbar neuritis
47
Condition associated with Retrobulbar neuritis?
MS
48
26 yo HIV patient presents with floaters in visual therapy; CD4 count is 26 – diagnosis?
CMV retinitis
49
Most common ocular infection in HIV patients?
CMV retinitis
50
CD4 count associated with increased risk for CMV retinitis?
CD4 < 50
51
45 yo male presents with unilateral ocular pain, redness, vomiting; Reports blurry vision with halos around lights – diagnosis?
Closed angle glaucoma
52
Most common ocular manifestation of RA?
Scleritis
53
38 yo male presents with personality changes, jaundice, joint pain; PE shows Kiser-Fleischer ring – diagnosis?
Wilson Disease
54
Inheritance pattern of Wilson Disease?
AR
55
Value of D-penicillamine in treatment of Wilson Disease?
Increases excretion of copper in urine
56
Value of zinc in treatment of Wilson Disease?
Inhibits intestinal copper absorption
57
Colles fracture affects which bone?
Radius
58
Direction of distal radius displacement in Colles fracture?
Dorsal
59
Best management of suspected scaphoid fracture, even if initial XR shows no fracture?
Casting
60
Boxer’s fracture affects which bone?
5th metacarpal
61
Alternate name for Tennis elbow?
Lateral epicondylitis
62
Alternate name for Golfers elbow?
Medial epicondylitis
63
Which nerve is typically injured during anterior should dislocation?
Axillary nerve
64
Motion of proximal fragment during clavicle fracture?
Upward
65
Motion of distal fragment during clavicle fracture?
Downward
66
Motion of leg after femoral head fracture?
ER
67
Terrible triad of lateral knee injury?
ACL, MCL, Lateral meniscus
68
Best test for suspected trauma to Terrible Triad?
MRI
69
Most common medial meniscus injury?
Bucket handle tear
70
PE finding for medial meniscus tear?
Knee locking with extension
71
Description of Lachman Test?
Knee flexion to 30° … Leg is pulled forward … Increased displacement of patient’s knee
72
Typical event leading to PCL tear?
Dashboard injury
73
Description of Pott’s Fracture?
Transverse avulsion of medial malleolus
74
What accounts for medial malleolus damage in Pott’s Fracture?
Strength of medial (deltoid) ligament
75
Event that leads to Pott’s Fracture?
Severe foot eversion
76
Addition fracture that affects Pott’s Fracture?
Oblique fibula fracture
77
2 benign bone tumors?
Osteochondroma, Giant cell tumor
78
Most common benign bone tumor?
Osteochondroma
79
Complication of Osteochondroma?
Chondrosarcoma
80
Classic XR appearance of Giant cell tumor?
Soap bubble appearance in epiphysis
81
3 malignant bone tumors?
Osteosarcoma
82
Location of Osteosarcoma in bone?
Metaphysis
83
4 RFs for development of Osteosarcoma?
Fibrous dysplasia, Paget’s disease, Familial retinoblastoma, Bone radiation
84
2 characteristics of Osteosarcoma on XR?
Sunburst appearance; Periosteal elevation
85
3 most common sites of metastasis for Osteosarcoma?
Brain, Lung, Liver
86
Lab result associated with Osteosarcoma?
Elevated alkaline phosphatase
87
Location of bones affected by Chondrosarcoma?
Pelvic bones, Proximal femur
88
Appearance of Ewing Sarcoma on XR?
Onion skinning + Lytic lesions
89
Bone location of Ewing Sarcoma?
Medulla of long bones
90
Histologic appearance of Ewing Sarcoma?
Pseudorosettes
91
Spinal roots affected by Erb’s Palsy?
C5-C6
92
Clinical presentation of Erb’s Palsy?
Intact grip strength; Upper arm is IR + Extended
93
2 nerves affected by Erb’s Palsy?
Musculocutaneous, Axillary
94
Which 2 muscles undergo atrophy in setting of Erb’s Palsy?
Brachialis, Deltoid
95
Spinal roots affected by Klumpke’s Palsy?
C8-T1
96
How can you distinguish Klumpke’s Palsy from Erb’s Palsy?
Klumpke = diminished grip strength; Erb = intact grip strength
97
Patient presents with inability to oppose thumb + weak wrist flexion – which nerve was damage?
Median nerve
98
Which 2 arteries are likely injured during surgical neck fracture?
Anterior + posterior circumflex humeral arteries
99
2 motions completed by Median nerve?
Thumb opposition, Wrist flexion
100
Which nerve + vessel run in the radial groove of humerus?
Radial nerve + Deep brachial artery
101
Hand motion completed by radial nerve?
Wrist dorsiflexion
102
Spinal roots of long thoracic nerve?
C5-C6-C7
103
Clinical presentation of damage to long thoracic nerve?
Winged scapula
104
Event that may lead to damage to long thoracic nerve?
Mastectomy
105
3 muscles that are innervated by musculocutaneous nerve?
Biceps brachii, Brachialis, Coracobrachialis
106
2 actions completed by musculocutaneous nerve?
Elbow flexion, Forearm supination
107
Event that leads to ulnar nerve damage?
Injury to medial epicondyle of humerus
108
2 systemic conditions that may lead to Carpal Tunnel Syndrome?
Pregnancy, Hypothyroidism, Acromegaly, Hemodialysis
109
Deposition of ___ results in Carpal Tunnel Syndrome
b2 microglobulin
110
b2 microglobulin is a component of …
Amyloid
111
Which nerves are associated with development of foot drop?
Common fibular nerve; L5 radiculopathy
112
How can you distinguish between L5 radiculopathy causing foot drop vs. Common fibular nerve causing foot drop?
L5 = BOTH inversion + eversion lost; Common Fibular Nerve = inversion intact, eversion lost
113
Spinal roots associated with pudendal nerve?
S2-S3-S4
114
Which structure does the pudendal nerve run with through the greater sciatic foramen?
Pudendal artery
115
Value of pudendal nerve block during labor?
Decreased perineal pain; No effect on contraction pain
116
Best strategy for obtaining tissue for diagnosis of testicular CA?
Radical inguinal orchiectomy
117
Most common LNs involved in metastasis of testicular CA?
Para-aortic
118
Location of Para-aortic LNs?
Retroperitoneal
119
Skin of scrotum drains into which LN … (significant if you do a trans-scrotal biopsy)?
Superficial Inguinal LN
120
Which type of testicular CA presents with elevated AFP?
Non-Seminoma
121
3 types of Non-Seminoma testicular CA?
Embryonal, Teratoma, Choriocarcinoma
122
Which type of testicular CA has better prognosis?
Seminoma
123
Which tumor marker may be present in seminomatous testicular CA?
b-HCG
124
Treatment of stage 1 seminoma?
Radiation
125
Treatment of stage 1 non-seminoma?
Observation
126
Treatment of stage 2 seminoma?
Radiation
127
Treatment of stage 2 non-seminoma?
Chemotherapy
128
Treatment of stage 3 seminoma?
Chemotherapy
129
Treatment of stage 3 non-seminoma?
Chemotherapy
130
Pathology report shows testicular CA, seminomatous type; Labs show elevated AFP – best management?
Treat as non-seminoma
131
Most significant RF for bladder CA?
Smoking
132
What type of bladder CA is caused by Schistosoma infection?
Squamous Cell Carcinoma
133
Next best step of workup for patient with firm nodule on prostate?
TURP
134
What are do factors that do NOT pose a risk for Prostate CA?
Smoking, BPH
135
What is the survival benefit of PSA screening?
None
136
69 yo male with PMHX of Prostate CA treated with XRT; PSA today is 12.0, was undetectable about 1 year ago; Bone scan shows multiple mets in T/L spine – what is next best step of management?
Leuprolide + Flutamide; Orchiectomy
137
MOA of Leuprolide + Flutamide in treatment of asymptomatic metastatic prostate CA?
LHRH agonists
138
Distinct odor of Arsenic poisoning?
Garlic breath
139
Best treatment for Arsenic poisoning?
Dimercaprol
140
Which type of RTA is associated with Fanconi Syndrome?
Type 2
141
Etiology of Fanconi Syndrome?
Impaired resorption of glucose, uric acid, phosphate, HCO3-
142
Type of peripheral neuropathy associated with Fanconi Syndrome?
Wrist drop + Foot drop
143
Best treatment for acute lead poisoning?
EDTA
144
Best treatment for iron poisoning?
Deferoxamine
145
Oil of Wintergreen contains a high concentration of which toxic substance?
Salicylates
146
Which acetaminophen metabolic is responsible for liver toxicity?
NAPQI
147
Best treatment of acetaminophen poisoning?
N-acetylcysteine … Increases hepatic supply of glutathione
148
Best antidote for benzodiazepine toxicity?
Flumazenil
149
Which medication should be avoided in setting of cocaine toxicity?
b blockers
150
Which 2 NTs are responsible for development of cocaine addiction?
Dopamine, Norepinephrine
