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Surgery > Surgery Final Exam > Flashcards

Surgery Final Exam Flashcards

1
Q

best management to reduce risk of thromboembolic complications

A

subcut LMW heparin

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2
Q

primary goal of postop fluid management

A

maintain at euvolemia

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3
Q

pregnant with hard, non-tender upper outer quadrant mass of breast

A

excisional biopsy of mass

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4
Q

components of MELD score

A

bilirubin, INR, creatinine

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5
Q

MI decrease risk of cardiac complications

A

postpone surgery for 6 months post MI

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6
Q

increase risk of perioperative cardiac complications

A

audible S3 gallop

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7
Q

perioperative glucose management in insulin dependent DM

A

half usual dose of long acting insulin morning of surgery

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8
Q

agent most likely to produce hyperkalemia after hemodialysis

A

succinylcholine

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9
Q

informed consent

A

patient and surgeon decide on a plan

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10
Q

patients with pre-op EKG

A

HTN evaluation for CEA

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11
Q

tingling and numbness s/p total thyroidectomy with additional finding

A

carpopdeal spasm

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12
Q

s/p total parathyroidectomy with muscle cramps and confusion

A

severe hypocalcemia

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13
Q

appropriate fluid for replacing fluid loss from fistula

A

lactated ringers

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14
Q

electrolyte composition of bile-colored fluid

A

Na 130
Cl 100
K 4
Bicarb 25

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15
Q

bilious drainage s/p gastric resection

A

bilairy leak from duodenal stump

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16
Q

hypertrophic pylorus metabolic derangement

A

hypochloremic hypokalemic metabolic alkalosis

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17
Q

proximal muscle weakness s/p refeeding anorexic d/t

A

hypophosphatemia

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18
Q

hyponatremia and hyperglycemia

A

measured serum sodium decreased as a result of dilution in response to osmolar gradient created by increase in serum glucose

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19
Q

treatment of SIADH

A

water restriction to less than 1000mL/day

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20
Q

N/V in ED most assistance in diagnosis and treatment from

A

serum electrolytes

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21
Q

obese nutrtional classification

A

high risk of nutrtional deficiency

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22
Q

microcytic anemia resection

A

jejunum

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23
Q

lab measurement that reflects recturn to normal protein anabolism

A

pre-albumin

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24
Q

kilocals from lowest to highest

A

lipids, proteins, carbs

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25
Q

oral meds absorbed in

A

duodenum

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26
Q

anemia and respiratory distress from

A

re-feeding syndrome

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27
Q

major cause of cachexia in patient with short bowel syndrome

A

malabsorption

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28
Q

diarrhea from tube feedings

A

high osmolarity feedings

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29
Q

PN stopped when EN reaches what percent of PN

A

66%

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30
Q

body weight and caloric needs

A

160 lbs/1545 kcal

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31
Q

cause of elevated PT and PTT

A

vitamin K deficiency

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32
Q

greatest risk following transfusion

A

hep B

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33
Q

best treatment option for bleeding vW patient

A

cryoprecipitate (8, vWF, 13)

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34
Q

patient temp to 39C during transfusion

A

stop transfusion and go to ward to assess patient

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35
Q

increased bleeding from OTC

A

garlic

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36
Q

EKG after blood transfusion and muscle cramps

A

prolonged QT secondary to ST elevation

d/t citrate toxicity

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37
Q

blood clot after 3 hr plane ride d/t

A

factor V neutralization impairment

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38
Q

best lab test to assess bleeding in patient with LMWH and nosebleed

A

anti-Xa activity

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39
Q

distended abdomen after administration of heparin post op d/t

A

inadequate surgical hemostasis during first operation

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40
Q

optimal use of blood product transfusion

A

red cells, FFP and platelets in 1:1:1 ratio

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41
Q

EKG with ischemia, sudden onset of agitation and hypertension d/t

A

cardiogenic hypoperfusion

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42
Q

principle value of lactic acid measurement marker of

A

response to circulatory resuscitation

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43
Q

65 yo aortofemoral bypass

A

euvolemic, normal perfusion

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44
Q

ongoing HoTN d/t

A

decreased venous return

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45
Q

edematous pancreas therapy

A

three liters of isotonic crystalloid

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46
Q

35 yo after gallstone pancreatitis

A

hyperdynamic perfusion

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47
Q

distended neck veins, crackles in lungs and gallop

A

cardiac contractility

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48
Q

increase in hgb is plasma volume depletion from

A

diffuse interstitial fluid accumulation

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49
Q

20 yo after car accident with distended neck veins

A

venous return

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50
Q

65 yo perforated diverticulitis

A

hypovolemic hypoperfusion

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51
Q

hyperglycemia increases

A

infectious complications

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52
Q

intervention can help prevent ventilator associated pneumonia

A

keeping head of bed elevated

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53
Q

diagnosis of thyroid storm

A

nearly nondetectable TSH levels, elevated T3, T4 and glucose levels

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54
Q

urgent indication for renal replacement therapy

A

hyperkalemia

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55
Q

most common cause of death in acute liver failure

A

cerebral edema

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56
Q

patient with HIT and PE

A

argratroban

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57
Q

alcohol abuse pt with confusion and agitation

A

diazepam

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58
Q

ventilator mode in pt with respiratory failure

A

assist control ventilation

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59
Q

improve oxygenation

A

increase PEEP

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60
Q

hyponatremia in 45 yo

A

administer hydrocortisone

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61
Q

small bowel resection and poor wound healing

A

d/t decreased fibroblast proliferation, decreased collagen synthesis, and impaired overall wound strenght

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62
Q

most effective next step to reduce bacterial load

A

debride necrotic tissue from wound

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63
Q

granuloma with refractive material

A

suture granuloma

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64
Q

2 wks after inguinal hernia repair biopsy

A

predominanty collagen with scarce inflammatory cells

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65
Q

small ulcerated nodule on midline draining serous fluid

A

excision of lesion and tract with pathologic analysis

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66
Q

chronic leg ulcer with thickening

A

biopsy wound edges

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67
Q

supplementation in obese patient before hernia repair

A

vitamin C

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68
Q

safest maximum volume of 1% lidocaine for local anesthesia

A

40 mL

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69
Q

postoperative antibiotic for colon resection

A

no need for antibiotics

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70
Q

raised, red, and thick beyond confines of original incisions

A

keloids

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71
Q

periprocedural prophylactic ABX for patients

A

patient who requires open repair of an abdominal aortic aneurysm

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72
Q

C diff management

A

oral vancomycin therapy

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73
Q

IV prophylactic ABX in patient with sessile polyp

A

administer one hour prior to operation

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74
Q

decreased hearing acuity from ABX

A

vancomycin

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75
Q

purulent drainage from old IV site

A

excision of IV site

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76
Q

acceptability for organ donation

A

latent HTLV is documented by ELISA and confirmed by NAT

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77
Q

best management of patient with peritoenal tap showing 500 leukocytes and G+ cocci

A

admit to hospital for IV ABX therapy

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78
Q

subhepatic abscess on CT

A

image guided percutaneous drainage

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79
Q

ABX for insulin dependent DM

A

administer one hour prior to incision

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80
Q

E coli blood cultures-source

A

UTI

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81
Q

protocol for tetanus prevention

A

0.5mL absorbed tetanus toxin

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82
Q

smoker with erythema at base of nail that dos not extend beyond DIP

A

excision of overlying nail plate

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83
Q

motor weakness of both arms but able to move lower extremities

A

central cord syndrome

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84
Q

blunt trauma, FAST negative

A

CT of abdomen and pelvis

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85
Q

convex collection of blood

A

epidural hematoma

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86
Q

tense calf and numbness of toes

A

operative fasciotomy

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87
Q

tender abdomen and respiratory acidosis

A

abdominal compartment syndrome

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88
Q

opens eyes to pain, decorticate, moans GCS

A

7

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89
Q

shot to left umbilicus

A

ex lap

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90
Q

stab to left anterior neck

A

emergent operative neck exploration

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91
Q

pericardial fluid, undetectable BP

A

left thoracotomy and cardiac repair

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92
Q

hemorrhage shock clasification

A

III

HR>120, confusion, UOP 5-15cc/h

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93
Q

appropriate rehab for 60% burn patient

A

directed to restoring patients to functional status by preventing scar contraction and immobility

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94
Q

best choice for preventing burn wound sepsis

A

excision and grafting within 5-7 days of injury

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95
Q

burns from house fire

A

intubate patient and administer 100% O2

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96
Q

correct sequence for patient

A

secure airway, obtain 2 large bore IVs, bolus 2L LR, examine CT scan, calculate TBSA, treat burns with silvadine

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97
Q

size of burn-half anterior trunk, right thigh, upper extremity

A

45%

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98
Q

burn injury least painful

A

hands

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99
Q

best pain management partial thickness burn

A

IV narcotics, transition to oral narcotics and NSAIDs

100
Q

no pulse in burn patient

A

confirm presence of vascular compromise, perform lateral and medial escharotomies of lower extremity from hip to ankle

101
Q

allograft

A

skin graft taken from human cadaver

102
Q

treatments functional cosmetic outcome

A

tangential excision and full thickness grafting

103
Q

camper fascia, next layer

A

external oblique aponeuroses

104
Q

follow scarpa medially to turn into

A

Dartos fascia

105
Q

obturator hernia symptoms

A

symptoms of intermittent bowel obstruction

106
Q

no bulge in external ring

A

femoral hernia

107
Q

Ricter’s hernia finding at first repair

A

non-circumferential incarceration of bowel wall

108
Q

ASIS and parallel to external oblique

A

McBurney

109
Q

relative contraindication in man with left sided inguinal hernia

A

total extraperitoneal laproscopic repair

110
Q

large abdominal wall veins

A

high blood pressure portal vein blood is diverted to lower pressure veins of the abdominal wall via paraumbilical veins

111
Q

bulge in epigastrum below umbilicus

A

diastasis recti

112
Q

greatest risk for incisional hernia formation

A

wound infection

113
Q

initial priority after ingesting drain cleaner

A

endotracheal tube

114
Q

treatment of Zenker diverticulum

A

diverticulectomy with cricopharyngeal and lower esophageal mytomy

115
Q

management Barrett’s with low grade dysplasia

A

repeat endoscopy in 6 months with repeat 4 quadrant biopsy of the Barretts

116
Q

large type II paraesophageal hernia

A

observant management

117
Q

dysphagia and elevated lower esophageal sphincter

A

combined Heller myotomy and Nissen fundoplication

118
Q

Stage I esophageal adenocarcinoma bilateral pulmonary emphysematous disease s/p bilateral thoracotomy

A

transhiatal esophagectomy with gastric pull-up

119
Q

smooth mass in muscularis best approach

A

enucleation of the lesion with reapproximation of muscle layer

120
Q

gastroesophageal reflux not controlled surgical approach

A

Collis gastroplasty with Nissen fundiplication

121
Q

fishbone most likely

A

posterior mediastinum

122
Q

adenocarcinoma diagnostic procedure to T stage

A

endoscopic ultrasound

123
Q

sibutramine

A

serotonin and NE uptake inhibitor; SE-HTN

124
Q

initial acid secretion

A

Ach

125
Q

nonhealing gastric ulcer with signet rings work up

A

diagnostic laproscopy

126
Q

persistent type III ulcer negative for malignancy

A

antrectomy with trunacal vagotomy

127
Q

considered potential contraindication for surgical intervention to assist with weight loss

A

colon cancer

128
Q

projectile vomiting resuscitation

A

normal saline

129
Q

rapid urease testing negative and corkscrew submucosal vessels

A

cholestyramine

130
Q

milkshake after bilroth I

A

somatostatin

131
Q

gastrin 1200, calcium 11.3

management

A

parathyroidectomy

132
Q

deficiency after Roux-en Y

A

iron

133
Q

small intestinal absorptive function

A

linked to Na-coupled absorption

134
Q

malrotation after falling off bicycle

A

midgut volvulus

135
Q

migrating motor complex

A

helps prevent stasis and bacterial overgrowth

136
Q

ileocolic Crohn’s disease

A

vitamin B12 deficiency

137
Q

fistulous complications of Crohn’s requires surgery

A

enterovesical

138
Q

extracolonic malignancy FAP

A

periampullary duodenum

139
Q

NG tube thick green fluid next best step

A

schedule an emergent laprotomy

140
Q

postsurgical scenarios most consistent for short bowel syndrome

A

less than 60cm small intestine preserved

141
Q

Meckel’s diverticulum test

A

technetium pertechnetate scan

142
Q

APUD from cells

A

carcinoid tumor

143
Q

LLQ tender to palpation

A

order CT scan of abdomen and pelvis

144
Q

hematochezia best choice for identification of bleeding site

A

tehnetium labeled RBC scan

145
Q

episodic bleeding with hemorrhoid

A

increase dietary fiber and fluids and reevaluate in 2-3 months

146
Q

dilated colon loops and no free air diagnosis

A

colonic volvulus

147
Q

RLQ pain

A

appendectomy

148
Q

sigmoid diverticulosis

A

CT

149
Q

air filled loops interpreted as sigmoid volvuls

A

sigmoidoscopic attempt at reduction

150
Q

external hemorrhoids

A

surgical hemorrhoidectomy

151
Q

fluctant swelling at right anterior perianal skin

A

operating room and exam under anesthesia and abscess drainage

152
Q

colonoscopy with ulcerations but normal terminal ileum

A

ulcerative colitis

153
Q

recommendation for obs without surgery

A

asymptomatic gallstones

154
Q

fever, jaundice, pain treatment

A

resuscitation, IV ABX, urgent ERCP to relieve bile duct obstruction

155
Q

ALK, bili, AST and ALT

A

choledocholithiasis

156
Q

RUQ with guarding

A

cholecystitis b/c patients with cholangitis are often jaundiced

157
Q

Cr 0.7 to 1.3, amylase

A

ask office staff to call patient to ER

158
Q

biliary tree is dilated proximal, common bile duct distal is not dilated

A

Mirizzi syndrome

159
Q

gallstone formation in native american

A

cholesterol

160
Q

benefits of laproscopic

A

safely performed in patients who have already had open abdominal surgery

161
Q

GS since last pregnancy with elevated amylase, alk phos, bili

A

ERCP with sphincterotomy and gallstone removal if lab values do not improve

162
Q

highest risk of gallstones

A

female gender

163
Q

most likely cause of recurrent pancreatitis

A

pancreas divisum

164
Q

place to find her gastrinoma

A

descending duodenum

165
Q

tumor does not involve vascular structures-pancreatic cancer

A

surgical excision

166
Q

ERCP shows cyst communicates with main pancreatic duct

A

pancreatic cyst gastrostomy

167
Q

fasting blood sugar is 40

A

insulinoma

168
Q

in addition to gastroduodenal artery must be ligated and divided

A

inferior anterior pancreaticoduodenal

169
Q

risk for developing complication of chronic pancreatitis

A

diabetes

170
Q

best indication for surgical intervention in severe pancreatitis

A

gastric outlet obstruction

171
Q

DM after surgery

A

islets of langerhans are more abundant in the tail than the head and uncinate

172
Q

adeno of pancreas best procedure

A

pancreaticoduodenectomy

173
Q

no extravasation of contrast

A

observation only

174
Q

hepatic colorectal mets

A

evaluation for surgical resection

175
Q

7 cm mass on liver

A

liver resection

176
Q

portal HTN

A

transjugular intrahepatic portocaval shunt

177
Q

diagnosis and management

A

cystadenoma, resection

178
Q

not candidate

A

severe pulmonary disease

179
Q

most appropriate next step without peritonitis

A

interventional radiology with selective hepatic artery embolization if a bleeding site is identified

180
Q

21 yo after MVC RLL contusion

A

observation with close monitoring

181
Q

diagnosis and management

A

hepatic adenoma, arterial embolization

182
Q

pharmacologic agents for treatment of chronic hepC with asterixis

A

lactulose

183
Q

pain and swelling behind nipple

A

antibiotics followed by excision of subareolar ducts and fistula tract

184
Q

22 yo needle biopsy with fibroadenoma

A

observation

185
Q

29 yo with breast mass

A

breast ultrasound

186
Q

contraindication to lumpectomy

A

pregnancy

187
Q

44 yo with cancer

A

stage III

188
Q

next 3 years

A

history and physical exam every 6 months, annual mammogram

189
Q

numbness and tingling on posterior aspect of upper left arm

A

intercostal brachial nerve

190
Q

hypoechoic

A

aspirate lesion

191
Q

greatest risk for BC

A

family histroy

192
Q

adverse effect of whole breast radiation

A

fibrosis

193
Q

blood test prior to distal pancreatectomy

A

calcium

194
Q

Hurthle cells

A

thyroid lobectomy

195
Q

HTN

A

serum metanephrines

196
Q

rising calcium

A

autonomous parathyroid gland function

197
Q

FNA shows papillary carcinoma

A

total thyroidectomy

198
Q

hypercalcemia worsened by

A

hydrochlorothiazide

199
Q

calcitonin elevated thyroid cancer

A

urinary catecholamine levels

200
Q

25 yo with HTN

A

primary hyperaldosteronism

201
Q

borders of mass are defined

A

repeat adrenal CT scan

202
Q

thyroid enlarged with palpitations

A

circulating IgG antibody that stimulates TSH receptors on follicular cells

203
Q

increased megs and purpuric lesions

A

observation

204
Q

polyvalent pneumococcal vaccine

A

2 weeks before splenectomy

205
Q

nonoperative management of splenic trauma

A

4 yo fell from swing, CT shows subcapsular splenic hematoma involving 10% of splenic surface

206
Q

transfuse platelets

A

after splenic artery has been clamped

207
Q

enlarged spleen, neutropenia

A

splenectomy

208
Q

noncaseating granulomas

A

sarcoidosis

209
Q

benefit of splenectomy in thal major

A

decrease transfusion requirements

210
Q

FNA near angle of jaw

A

carcinoma

211
Q

spleen infarcts

A

increased Howell-Jolly bodies

212
Q

optimal timing for polyvalent pneumococcal vaccine

A

on day of d/c from hospital

213
Q

5.6 cm AAA

A

endovascular repair since it is assoc with improved survival compared to open AAA

214
Q

most appropriate way to assess for vascular anatomy prior to revascularization

A

CT angio of pelvis and LE

215
Q

highest risk for developing AAA

A

personal history of an elective popliteal aneurysm repair

216
Q

indication to intervene in symptomatic right leg PAD

A

on medical leave from her job as a letter carrier

217
Q

diagnosis in woman

A

fibromuscular dysplasia of a renal artery

218
Q

largest decrease in pressure gradient across a stenosis

A

radius of lesion

219
Q

CT confirms type A dissection

A

urgent operative repair

220
Q

smoking cessation, leg claudication

A

bilateral aortobifemoral bypass

221
Q

if left untreated

A

ankle ulceration

222
Q

most consistent with PAD

A

aching foot pain exacerbated with leg elevation

223
Q

best immunosuppression regimen

A

no immunosuppression because of lack of immune reactivity to donor graft isoantigen

224
Q

onset of HTN, tremors, LFTs

A

tacrolimus

225
Q

1 yr survival for cardiac transplantation

A

80%

226
Q

most useful in maintaining BP until organ donation

A

dopamine

227
Q

cause of leukopenia

A

increased cellcept dose (mycophenolate mofetil)

228
Q

longest optimum time liver can be kept on ice

A

18 hrs

229
Q

MOA of alemtuzumab

A

depletes T and B lymphocytes

230
Q

determines cessation of brain function for organ donation

A

absence of spontaneous respirations

231
Q

best immunologic test to detect Ags from cellular arm

A

mixed lymphocyte culture

232
Q

higher place on waiting list

A

44 yo with acute liver failure secondary to Wilson disease

233
Q

mores suitable for lung transplant than isolate heart transplant

A

severe pulmonary hypertension

234
Q

most likely cause of intolerance

A

tacrolimus

235
Q

most likely effect of oral fluconazole

A

elevated serum creatinine

236
Q

obliterative bronchiolitis

A

chronic rejection

237
Q

six antigen match immunosuppression strategies

A

combination of agents

238
Q

pathologist stain for

A

ckit

239
Q

TMN melanoma left calf

A

T1bN0M0

240
Q

most appropriate step in management

A

wide local excision of forearm scar with sentinel lymph node biopsy

241
Q

nontender mass, possible sarcoma

A

incisional biopsy

242
Q

decrease risk in BRCA

A

bilateral mastectomy

243
Q

Mohs therapy

A

specialized surgical technique used to excise skin cancers

244
Q

no lymphadenopathy and 1 cm lesion

A

biopsy with 1-2mm margin of normal skin

245
Q

PET avid lesion in left upper lobe

A

video assisted thoracoscopic resection of the lesion

246
Q

chemotherapy after lumpectomy

A

adjuvant

247
Q

left neck mass

A

FNA of neck lesion

Surgery (6 decks)

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