Surgery From Amboss Flashcards by Derin King

Diffuse weakness for past several months. Anterior medistisnal mass. What is most likely elevated in the Serum?

ACH!!!!

Thymoma is most common cause -> and patients typically have myaesthenia gravis

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Lower chest pain and shortbess of breath when taking a deep breath. Decreased breath sounds over right lung field. Táctile vocal fremitus is decreased with elevation of right hemidiaphragm. Opacification of right lower lung zone!!! (So not p.e which had no chest x ray findings). Most likely diagnosis?

ABG findings?

Post operative atelectasis!!

Hypoxemia -> hiperventilation -> respiratory alkalosis!!

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Diarrhea and perianal fístula. What type of IBD is this and what are you likely to see in histology.

Chrons

Transmural inflammation!!!

Contrast crypt abscesses seen in Chrons

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Chest pain, fever, widened mediastinum on chest x ray. Hamman crunch on auscultation. Following surgery. Next step in management?

Surgical debridemenr and IV antibiotics

= post operative mediastinitis

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Left inguinal repair. Restlessness and confusion. Abdominal exam shows mild distention and tenderness in the lower quadrants! Mildly erythematoys surgical wound in the left groin. Next step in management?

Perform bedside bladder scan!!!

Post operative urinary retention!!

Risk factors? = Inguinal hernia repair, anote tal surgery, Joint arthroplasty!!

Excessive IV fluids > 750 ml

Causes suprapubic discomfort and pain

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For a Patella dislocation. Manual reducción is management. However if recurrent dislocations occur or there is an osteochondral fracture. Management involves?

Arthroscopy!

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Management of posterior hip dislocation?

EMERGENCY closed reduction -> to prevent osteonecrosis

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Treatment resistent hypertension, high plasma renin and Hypokalemia. Bilateral carótid bruits.

Most likely finding in the abdomen?

Unilateral kidney atrophy!!!

Due to ischemic renal injury

MR angiography! To diagnose

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Fall in floor, hit head and has severe left hip pain. During examination. Her skin is cold and clammy and low BP. Home meds include aspirin and apixaban.
ECG shows absent P waves and non specific changes of the ST segment and the T wave. Most likely cause?

Blood loss!! -> hypovolemix shock -> cold clammy skin -> likely due to hip fracture

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Patient with TIA and concominant a fib on presentation. Treat with?

Rivaroxaban!!

Not aspirin

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Next step in diagnosis of hereditary hemachromatosis?

Genetic test! NOT liver biopsy or USS

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Biliary. Tests compicated by cholangitis. Billiary frainage and antibiotics performed. Next step in management?

Surgical cyst excision!!!

Decrease the risk of cholangicarcinoma

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Hydrocephalus in child (headache, dizziness, papilledema) and syringimelia (tingling of the arms and hands). Myelomeningocele at birth. Most likely cause of symptoms?

Chiari 2 malformation

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Nephrolithiasis first line investigartion?

CT scan!!!!

Not USS

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Cigarrete smoking is a key risk factor for osteoporosis! As is corticosteroid use

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Diverticulutis + >4cm fluid collection. Next step in management? In addition to antibiotics.

CT-guided percutaneous abscess drainage!!!

And if signs of peritonitis = emergency colectomy!

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With a Subdural hematoma. Hyperventilation can reduce cerebral blood flow!!

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Brain tumor
Siezures (meaning it’s most likely supratentorial)
Well circumsxribed mass and hyperintense to gray matter on T2. Most likely diagnosis?

Meningioma!!

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AXR Picture showing free intraperitoneal air in abdomen of baby with NECE. Next step in management.

Exploratorio laparotomy.

Look at AXR on phone!

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Carotid artery stenosis first line investigation?

Ultrasonography of the neck!

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Imáge identification -> retropharyngeal abscess

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Murmur. In 19month old. Right to left interstrial shunt that becomes apparent when the child coughs!!!

Next step in management?

No intervention!!!

PFO found in 25% of population and typically asymptomatic

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Duodenal ulcer symptoms. But now has fever leukocytosis and hypoechoic lesión with internal echoes in the liver. Most likely cause?

Penetrating duodenal ulcer!!

Caused liver abscess

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Hemolytic anemia + murmur.

Next step in management?

Aortic valve replecement!

Hemolytic anemia suggests severe aortic stenosis

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Neonatal clavicular fracture during delivery management?

Pin sleeve to shirt

Best way to decrease complications from central venous catheter placement?

Preparation of patients skin with chlorhexidine and alcohol

Hemophilia causes elevated PTT!!! Also k own as Factor VIII problem for hemophila A Contrast to VWD which would have prolonged bleeding time in addition

Hydatid cysts in liver treatment?

Oral albendazole Has daughter cysts. Contrast amebic liver abscess treated with metronidazole

Needle thoracostomy is used for pneumothorax. What is used for hemothorax?

Chest tube! But if more than 1500 ML after insertion then you do urgent thoracotomy!!!!!

In choledocolithiasis. The gallstone must be in the?

Common bile duct

PAD shiny leg with reduced hair growth. Absent dorsalis pedís pulse on the right with ABPI of 0.5 Next step in management?

Exercise therapy!! 0.5 and above still considered moderate PAD

Mesalamine is still first line immediate treatment for UC with bloody stools. For moderate = < 4 stools a day

Only use steroids for more Severe

Esophageal atresia in newborn and cardiac murmur. It is important to screen for what’?

Renal agenesis!!

Mechanism for envelopshaped crystals (calcium oxalate) in a patient with a history of Chrons?

Malabsorption of fatty acids!!

You always give Tdap only. When would You give Immunoglobulin as well?

Dirty injury and vaccination status is unknown

Osteoporosis mechanism?

Reduced osteoblastic activity

2 year old girl. Jaundice. Dark urine, pale stools. FUSIFORM dilación of the extraheoatic common bile duct. Most likely diagnosis? Japanese

Biliary cyst!! Or choledocal cyst. Surgical excision is necessary!!!

Temporal arteriris suspected. Next step in management?

Prednisolone!!! Comes before biopsy

Penetrating injury to subclavicular ñarasternal región caries the risk of?

Pneumothorax!!

Swollen painful leg, reduced pedal pulses and oaresthesia after undergoing left femoral artery embolism. Most likely diagnosis?

Reperfusion injury!!! -> causes compartment syndrome Not cholesterol embolism = live do reticularis, púrpura, necrosis

Penicilin prophylaxis if given DAILy after spleenectomy

Sudden onset paraparesis after abdominal aortic aneurysm. 1/5 muscle strenghr in lower limbs. What will be preserved?

Normalp propeioception and vibration!!! Anterior spinal artery syndrome

6 year old boy. Precocious puberty and left testicle mass. Most likely cause?

Leydig cell tumour

Acyclovir administración causing Aki. What is seen on urinalysis?

Crystals and white blood cells!!! Crystal induced Aki!!

Hypocalcemia following surgery is most likely due to?

Multiple blood transfusions

Pancreatic pseudocyts can present as a palpable epigastrix mass with Bilious or non Bilious vomiting. Complication of pancreatitis

In a Girl peripheral precocious puberty manufestinf as early mensturation and breast development. Suspected what?

Granulosa cell tumor!!! Or thecoma. Estrogen secreting

Features of heart failure in a newborn with patent ductus arteriousus (irritability, poor feeding, failure to thrive). Next step in management?

(I)buprofen!!!! Or indomethacin to close it Contrast to cyanosis at birth which you would need to temporarily keep it open with prostaglandin before you do surgery

Following a car accident, if all reflexes are absent and apnea test is positive. What does this mean?

Brain dead

Flank pain triggered by drinking diuresis inducig drinks like caffine and alcohol. Most likely cause?

Uretopelvic obstruction

Treatment of erysipelas?

Pencillin Or IV Cefazolin! Or IV penicilin if fevers and chills present Or

Mediastinal widening following Blunt trauma. Next step in management?

CT angiography

Posterior inferior cerebellar artery stroke presentation including facial droop, horners syndrome

Superficial thrombophlebitis in a pregnant woman. Next step?

Ultrasound lower limb to rule out concominanr DVT. Do if risk factors such as pregnancy, obesity, chronic venous insufficiency

Periosteal elevation Múltiple osteolytic áreas in the femoral metaphysis. Bone marrow edema. Fever. Next step in management after mri?

Bone Biospy

Headache vomiting tooth pain for 3 weeks. Papilledema bilaterally. Flexión if neck causes hip flexión. Most likely diagnosis?

Pyogenic brain abscess. +ve bruzindskis

Stumo ulcer warrants re-valuación of prosthetic fit

Absent bowel sounds, dilated bowel loops and uniform gas pattern = paralytic ileus. In a trauma patient with bilateral flank bruisws. Most likely cause is?

Retroperitoneal hemorrhage!!

Car accident. Weakness in upper limbs. And cape like distribución of sensory déficits. Diagnosis?

Syringomyelia

Distal humerus fractures distruot the Brachial artery and thus cause?

Absent radial pulse

First step in management of congenital diaphragmatic hernia?

Intubation and ventilation

Porcelain gallbladder image recignitkonn on CT abdomen!!

68 yo woman. Confusion and memory déficits for a month. Weakness in left leg. Can’t lift eyebrow or smile. MRI of head shoes several hyperintenze round lesions in frontal and temporal lobes. Significant smoking history. Most likely diagnosis?

Lung cáncer NOT MS as wouldn’t present at 68 years old and is relapsing and remitting

Post ERCP pancreatitis is mánaged with supportive care only eg IV fentanyl

Post cholexystextomy syndrome will have epigastric pain PLUS elevated LfTS, common bile duct may be too wide

Cut off for AAA repair in women vs men?

5 in women 5.5 in men. And also if it’s rápidlu expanding at 1CM a year

Ascites that is still not resolving despiste múltiple diuretics. Next step in management?

Large volume paracentesis! TIPs can also be used but risk of Heart failure

Colles fracture look. Typically caused by fall on to outstretched hand. Check image on phone

If back injury, and hypereflexia is present along with lower extremity weakness and bladder dysfunction, most likely cause?

Conus medullaris syndrome!!! NOT cauda equina as this is LWN signs only

Curativa treatment for MALT lymphoma of the stomach?

H pylori therapy!!!! Surgery is not needed

Diaphragmatic rupture suspected on CXR. Next step in management?

CT abdomen and pelvis!!

A non tender Cystic mass may be oalpsted in RUQ in pancreatic cancer

Metoprolol can be used for HCM. Just not used in heart failure

Acute compartment syndrome is diagnosed using?

Needle manómetro

Local anaesthetic of amide group with long duración of action?

Bupivicane

Hyperechogenic punctate regions (microcalcifications) and painless cervical lymphadenoathy + thyroid mass is most likely?

Papillary carcinoma of the thyroid

Newborn or infant with enlarging head, tense anterior fontanelle and eyes deviating inferiorly. Next step in management?

Ultrasound!!! Hydrocephalus signs NOT CT in infant

In graves opthalomology, glycosaminoglycan accumulates in the orbit

1 week after a TBI, now has sudden onset hypertension, tachycardia and contraction of muscles of his back. Most likely cause?

Paroxysmal sympathetic hypersctivity

Down syndrome can present with pyloric stenosis also or duodenal atresia. How do you differentiate?

Duodenal atresia = delayed meconium passage and distended abdomen in addition to vomiting!

Fibrosis is seen in what type of transolant rejection?

Chronic

Transphenoidal adenectomy used to remove pituitary gland adenoma

Where is a pilocytic astrocytoma typically located?

Cerebellar hemisphere!!! Broad based gait and disdiadocholekinesia

Massive PE. Given therapy then develops slurred speech decreased consciousness Most likely cause?

Intracerebral hemorrhage!!!! Complication of thrombotic therapy

Previous bowel resection for chrons, now notice 2 strictures during operation. Management?

Stricrueplasty of individual strictures No more bowel resection to prevent complications like short bowel syndrome. Post operative adhesions, fístulas

Patient has a traumátic hemothorax but now has fever, pleural split ring and thickening!!! And a dense fluid collectoon in the pleural space. Most likely diagnosis?

Hemothorax

DVT in 61 year old man. Hemoglobin normal. Last cancer screen over 10 years ago. Next step in management?

Colonoscopy!!

Surgery From Amboss Flashcards

(87 cards)