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Surgery general Flashcards

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1
Q

Signs of cardiogenic shock

A

JVP, crackles, EKG changes

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2
Q

findings fat embolism

A

petechiae

respiratory distress

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3
Q

Legg Calve Perthes

A

avascular necrosis of femoral head causing deformity
intermittent pain causing antalgic gait
young children who are short in stature confirmed with xray

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4
Q

Malignant pleural effusion

A

Fluid buildup between parietal and visceral pleura due to cancer
Decreased pulse ox
Friction rub over the lungs
Dullness to percussion

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5
Q

Signs of atrial myxoma

A

weight loss,
Majority in LA
Tumor “plop” and mid diastolic rumble that change when patient changes position

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6
Q

Paraneoplastic syndromes associated with lung cancers

A

Small cell: SIADH, Lambert Eaton

SCC: PTHrP

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7
Q

ITP

A

anti-platelet antibiodies

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8
Q

hiatal hernias

A
  1. sliding: displacement of GE junction above the diaphragm; asx or GERD; Tx is mx of GERD
  2. paraesophageal: true hernia with a hernia sac and is characterized by an upward dislocation of the gastric fundus through a defect in the phrenoesophageal membrane; tx is surgery in sx pts
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9
Q

Sx VIPoma

A

tumor in pancreas
flushing, weight loss, loose stools
arises in young children of adults

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10
Q

Sx testicular tumor

A

does not transilluminate
firm nodule
grows with time
painless

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11
Q

Sx lymphoma

A

B sx

chylothorax

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12
Q

labs nephrolithiasis

A

gross or microscopic hematuria

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13
Q

Diabetic joint

A

Charcot neuropathy loss of sensation to a joint may result in a chronic, progressive, and destructive arthropathy
Causes change in foot architecture

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14
Q

Sx ovarian cancer

A

advanced disease can spread to omentum or bowel, leading to abdominal distension, nausea, early satiety, ascites (+fluid wave)

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15
Q

Slipped capital femoral epiphysis

A 
obese teens
displacement of femoral neck causes fx at epiphysis 
knee or hip pain; limping
dx: xray
tx: surgery; fixation
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16
Q

mechanism of AV fistula causing high output heart failure

A

acute decrease in systemic vascular resistance and a secondary increase in cardiac output
tachycardia, edema, JVD, wide PP, an enlarged apical impulse, a midsystolic murmur (caused by increased ventricular filling), S3 and S4, pulmonary crackles, peripheral edema, and warm extremities as a result of low systemic vascular resistance

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17
Q

Bloody nipple discharge in premenopausal woman

A

Intraductal papilloma

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18
Q

most common premenopausal breast mass

A

fibrocystic change; benign

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19
Q

fibroadenoma

A

most common benign tumor; well circumscribed rubbery

estrogen sensitive–grows during pregnancy

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20
Q

DCIS

A

incidental microcalcifications on mammogram
malignant cells that have not yet invaded BM
not usually palpable on PE

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21
Q

Invasive ductal carcinoma

A

firm, immobile, discrete mass with nipple retraction

malignant cells with stromal invasion and microcalcifications

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22
Q

invasive lobular carcinoma

A

malignant cells infiltrating breast lobules; sensitive to hormonal therapy

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23
Q

nipple retraction cause

A

suspensory ligaments are infiltrated by cancer cells.

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24
Q

test used to determine perioperative cardiac risk

A

dipyridamole thallium imaging

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25
varicocele
dilatation of pampiform plexus causing bag of worms feel; more common on left; associated with male infertility; does not transilluminate
26
ovarian torsion
acute onset of severe pain, adnexal mass, h/o cysts
27
toxic adenoma
solitary nodule on thyroid that overproduces T4 Usually benign Looks hot on thyroid scintigraphy
28
cerebral hyperperfusion
risk of CEA in which severe post-op HTN causes headaches, neuro defects, or seizures leading to intraparenchymal hemorrhage
29
Post-op risk CEA
cerebral hyperperfusion (HTN) causing intraparenchymal hemorrhage
30
Drugs that reduce stroke in patients undergoing CEA
statin and ASA
31
Unhappy triad
medial meniscus, ACL, MCL
32
presentation meniscal tear
clicking/locking of knee especially with extension, delayed swelling, pain along medial joint line Can't see on X-ray; do MRI
33
diverticulitis signs
fever, leukocytosis, peritoneal irritation in LLQ, sometimes palpable mass middle age
34
sx insulinoma
SNS activation sweating, nervousness, tremors, tachycardia, hunger worse w fasting
35
gallstone ileus CT
Gallbladder wall thickening Pneumobilia Intestinal obstruction Obstructing gallstone
36
mesenteric ischemia risk factors
source of clot: afib, recent MI
37
mesenteric ischemia presentation
old person w/ acute abdomen with GI bleed | very old may not present until acidotic and septic
38
signs of hemolytic transfusion reaction
fever, flank pain, and red or brown urine
39
detecting adequate resuscitation
best indicated by urine output of > 0.5 to 1 mL/kg/h. (30-40 mL/hr)
40
basal cell carcinoma of skin characteristics
upper lip waxy, pearly, raised does not metastasize excision
41
squamous cell carcinoma of skin characteristics
lower lip and rest of body metastasis to lymph nodes excision; radiation sometimes
42
torus platinus
bony benign mass on hard palate of mouth most frequently found in women of Asian descent. tx is obs unless it is symptomatic inwhich it can be surgically removed
43
complications of parotidectomy
injury to CN VII causing facial droop or cervical plexus causing numbness around earlobe
44
most common salivary gland tumor
pleiomorphic adenoma
45
Screening guidelines for child born with APC
flexible sigmoidoscopy beginning at 10.
46
colon cancer screening guidelines for UC patient
screen 8 years after disease onset and every 1-2 years after. Do random biopsies.
47
Ogilvie's syndrome
pseudoobstruction of colon associated with bedridden, neurologically impaired or older patients, opiate use, surgery, trauma, or infection.
48
findings on laparoscopy with normal appendix on pathology
Crohn's (regional enteritis)--mimic's appendicitis
49
factors that prevent fistulas from spontaneously closing
``` High output Inflammation Short Foreign body Radiation Infection Epithelialization Neoplasm Distal obstruction ```
50
signs of sigmoid volvulus
bent inner tube | coffee bean
51
triad epidural abscess
focal back pain, abnormal inflammatory markers, neurologic deficits
52
slipped capital femoral epiphysis
obese teenage males | Trendelenberg sign due to gluteus muscle weakness
53
signs of suppurative tenosynovitis
flexor tendon sheath tenderness, sausage shaped fingers, pain w passive extension, semi flexed posture of digit
54
legg calve perthes disease
avascular necrosis of the hip causing pain most commonly in children between 4-10
55
drop arm test
evaluate a tear in supraspinatus muscle. shoulder to 90 and flex to 30 while keeping thumb pointed down.
56
most commonly injured rotator cuff muscle
supraspinatus
57
Tinel sign
for carpel tunnel: percuss over median nerve and feel tingling in first 3 digits
58
Phalen sign
for carpel tunnel: placing elbow on table and flexing wrist for 60s causes numbness in first three digits
59
imaging posterior dislocation of shoulder
axillary and lateral view radiographs. if equivocal, then CT.
60
signs of biliary atresia
6-8 wk old babies with worsening juandice
61
dx biliary atresia
HIDA with phenobarbital to look if bile reaches duodenum
62
febrile non-hemolytic transfusion rxn
fever and chills within 1-6 hours of transfusion caused by cytokine accumulation in blood storage
63
acute hemolytic transfusion rxn
fever, flank pain, hematuria, renal failure, DIC within an hour of transfusion caused by ABO incompatibility
64
delayed hemolytic transfusion rxn
mild fever within 2-10 days caused by Ab response; postive direct coombs testa and positive new ab screening test
65
anaphylactic transfusion rxn
rapid onset of shock, angioedema, urticaria within a few seconds of transfusion due to anti IgA Abs
66
urticarial transfusion rxn
flushing, angioedema, pruritis within 2-3 hours of transfusion caused by recipient IgE abs and mast cell activations
67
transfusion related acute lung injury
respiratory distress and signs of noncardiogenic pulmonary edema within 6 hours of transfusion caused by donor anti leukocyte Abs
68
silver sulfadiazine SE
leukocytosis
69
mafenide acetate SE
acidosis
70
silver nitrate SE
methemoglobinemia
71
clinical picture intussusception
squatting kid 6-12 mo. with vague R mass, current jelly stool
72
surgical candidate for lobectomy must have
FEV1>800
73
findings on barium enema for Crohn's
string sign
74
presentation ATN
recent surgery, hypotension, sepsis, necrosis | NSAIDs, aminoglycosides, cisplatin
75
central venous catheter complications
``` infection thrombosis stenosis vascular injury PE air embolus ```
76
presentation ruptured trachea or bronchus
subq emphysema in chest, neck, face and air leak from chest tube
77
dd of subq emphysema
ruptured trachea or bronchus, tension pneumo, ruptured esophagus
78
PE developmental dysplasia of hip
uneven gluteal folds, easily dislocated hips with jerk and clip
79
septic hip
toddlers post febrile illness who refuse to move hip | dx is aspiration
80
presentation of osgood schlattter
persistent pain over tibial tubercle without swelling; aggravated with quad contraction
81
risk following tx supracondylar fx of humerus in child
Volkmann contracture (claw like deformity)
82
osteogenic sarcoma on xray
sunburst
83
multiple myeloma imaging
multiple punched out lesion on Xray
84
rules for xrays
2 views 90 degrees from one another of one joint above and one below
85
presentation anterior shoulder dislocation
holding arm close to body and rotated outward
86
xray views to see posterior shoulder dislocation
axillary and scapular lateral
87
colles fx is of
distal radius
88
presentation of posterior hip dislocation
leg is shortened, adducted, and internally rotated
89
presentation of broken hp
leg is shorted and externally rotated
90
assessing hepatic risk in surgery
encephalopathy, ascites, serum albumin, INR, bilirubin
91
blood gases PE`
hypoxemia and hypocapnia
92
sx PE
``` sudden pleuritic pain SOB anxiety and diaphoresis JVP tachycardic ```
93
presentation of air embolus
sudden death while on ventilator and respirator
94
distinguishing between adrenal hyperplasia vs adrenal adenoma
postural change response: hyperplasia adjusts to lying down by secreting more aldosterone where adenoma does not
95
causes of intracranial hemorrhage in children, adults, and elderly
children: AV malformation adults: hypertension elderly: amyloid angiopathy

Surgery shelf (2 decks)

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