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USMLE Step 3 MTB > Surgery > Flashcards

Flashcards in Surgery Deck (95)
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1

If O2 sats are below 90, do

ABG

2

Normal bicarb =

24

3

Cardiac output =

Stroke volume x Heart rate

4

Stroke volume =

End Diastolic Volume - End Systolic Volume

5

Total peripheral resistance =

Mean arterial pressure - Mean venous pressure

6

Blood pressure =

Cardiac Output x Total Peripheral Resistance

7

Immediately perform __ in pericardial tamponade

Immediately place ____ into pleural cavity at ___ intercostal space 

pericardiocentesis

 

large bore needle or IV catheter; 2nd 

8

In preparation for immediate exploratory laparotomy in a abdominal trauma, do a bunch of things simultaneously:

2 large bore IV lines Type and cross Give fluids and blood Insert foley Administer IV antibiotics

Children <6 years old --> intraosseous cannulation in the proximal tibia 

9

Surgery is always done for ___ head injuries, even if the patient is asymptomatic!

comminuted or depressed skull fracture

10

All patients with open skull fractures should receive

tetanus toxoid and prophylactic antibiotics

11

Management of basal skull fracture =

CT scan of head/nec CSF leak sill stop by itself (NO Antibiotics needed) Facial palsy may occur 2-3 days later

12

All epidermal hematomas (Lens, biconvex; Middle meningeal artery; lucid interval) require

emergency craniotomy

13

Epidural hematoma = injury to

middle meningeal artery

14

Subdural hematoma = injury to

bridging veins

15

Only do an emergency craniotomy in case of subdural hematoma if

there are lateralizing signs and midline displacement

16

Surgery cannot help in this head injury that is caused by acceleration-deceleration injuries to the head

diffuse axonal injury

17

Gradual dilatation of one pupil and a decreasing responsiveness to light is an important sign of

elevating intracranial pressure (Medical emergency)

18

DO NOT EVER DO THIS

perform an LP before getting a head CT. If you perform a lumbar puncture on a person with increased intracranial pressure, you will HERNIATE THE BRAIN, KILL THE PATIENT, GET CHLAMYDIA AND DIE.

19

Hyperventilation causes vaso___ and decreased blood volume in the brain, causing ICP to ___

constriction; lower ICP

20

First line measures for high ICP are

elevated head of bed hyperventilation avoid fluid overload second line: mannitol, sedation/hypothermia

21

Anisocoria =

Ptosis of the left eye, Anisocoria, droopy left eyelid dx?

caused by? 

Best initial test ?

Tx?

unequal size of pupils

3rd CN palsy 

posterior communicating artery aneurysm 

MRI of the brain with Angio

embolization thru endovascular repain 

22

When is surgery the answer for acute abdomen?

Peritonitis (excluding primary peritonitis), Abdominal pain/tenderness plus sepsis signs, Pneumoperitoneum, Acute intestinal ischemia

Rule out pancreatitis first in all the above cases 

23

Treatment for spontaneous bacterial peritonitis is

immediate paracentesis; diagnosis is made when fluid contains neutrophils greater than 250 cells per cubed mm

24

Treat SBP with

ceftriaxone and albumin at 1.5g/kg on day 1 and day 3 of hospitalization

25

First study of choice for esophageal perforation is

gastrografin contrast esophagram

26

Most accurate test for adult with GI obstruction is

 

Volvulus (ex: sudden abdominal pain in elderly)Dx ? Tx?

CT scan of abdomen and pelvis with contrast

 

Proctosigmoidoscopy w/ rigid instrument 

Sigmoid resection

27

When diagnosing acute diverticulitis, don't forget to order

 

DX w/ 

a pregnancy test in women of reproductive age!

 

CT WITH contrast 

28

___ is absolutely contraindicated in acute diverticulitis

Colonoscopy

29

When palpation of the LLQ causes pain n the RLQ, think

acute appendicitis (Rovsing's sign)

30

It's important to administer ___ before appendectomy

IV antibiotics: -cipro and metronidazole -ampicillin/sulbactam -levofloxacin and clinda -cefoxitin or cefotetan