Surgery Shelf Flashcards
(143 cards)
1
Q
What is the ABG consequence of post-op atelectasis?
A
ventilation-perfusion mismatch –> hypoxemia –> increased WOB –> patients hyperventilate –> respiratory alkalosis
2
Q
What can be used to rapidly reverse warfarin?
A
fresh frozen plasma
3
Q
What factors mitigate hernia formation/enlargement/ recurrence?
A
- weakened tissue: smoking, age, steroids, immunosuppressive meds, collagen disorders, surgical wounds
- force applied to tissue: heavy lifting, obesity, constipation, cough, trouble urinating
4
Q
A ____________ hernia enters through a weak point in the fascia of the abdominal wall and its sac is medial to the inferior epigastric vessels
A
direct hernia
5
Q
What is Hesselbach’s triangle?
A
- rectus abdominus
- inguinal ligament
- inferior epigastric artery
6
Q
Direct inguinal hernias exit through the (superficial/deep) inguinal ring and (can/cannot) extend into the scrotum
A
- superficial inguinal ring
- cannot extend into the scrotum
7
Q
A __________ hernia occurs from failure of embryonic closure of the deep inguinal ring after the testicle has passed through
A
indirect hernia
8
Q
Which type of polyp has a greater risk of becoming colon cancer?
hyperplastic or adenomatous
A
adenomatous
9
Q
What polyp factors should prompt consideration of total colectomy?
A
- poorly differentiated histology
- lymphovascular invasion
- cancer at the resection or stalk margin or margin <2mm
- invasion into muscular propia of bowel wall
- invasive carcinoma in a sessile (flat) polyp
- invasive carcinoma with incomplete polypectomy
10
Q
What is used to treat anal fissures and why?
A
- topical lidocaine: comfort
- nifedipine: vasodilator –> increases blood flow to fissure –> enhances healing
11
Q
Best treatment options for a blunt trauma patient with pneumoperitonium include all of the following except…
- ABG
- serum lactate
- exploratory laparotomy
- CT CAP
- exploratory laparoscopy
A
CT chest, abdomen, pelvis
12
Q
What do scaphoid fractures carry a significant risk for?
A
osteonecrosis
13
Q
What complication occurs when too much normal saline is given?
A
hyperchloremic acidosis
14
Q
Is LR or NS preferred for large-volume resuscitation?
A
LR (because normal saline causes hyperchloremia)
15
Q
What fluids do you give for each of the following Na+ problems?
- hypernatremia: hypovolemic, euvolemic, hypervolemic
- hyponatremia: hypovolemic, euvolemic, hypervolemic
A
- hypernatremia: hypovolemic (NS), euvolemic (water), hypervolemic (lasix)
- hyponatremia: hypovolemic (NS), euvolemic (water restrict), hypervolemic (water restrict)
16
Q
What is a local vascular complication of cardiac catheterization that presents with sudden hemodynamic instability?
A
retroperitoneal hematoma
17
Q
How do you treat hyperkalemia?
A
calcium, glucose + insulin, bicarb, beta-agonists
18
Q
N/V, hyporeflexia, weakness, quadraparesis, coma, bradycardia, and respiratory failure are all signs of what electrolyte disturbance?
A
hypermagnesium
19
Q
How does hyperphosphatemia present?
A
seizures and tetany from low calcium
20
Q
What is the effect of the following receptors?
- alpha 1
- beta 1
- beta 2
A
- alpha 1: peripheral squeeze
- beta 1: cardiac contractility
- beta 2: peripheral dilation
21
Q
What receptors does epinephrine act on?
A
alpha 1 and beta 1
22
Q
What receptors does phenylephrine act on?
A
pure alpha
23
Q
What receptors does milrinone act on?
A
PDE inhibitor
24
Q
What antibiotics should be given for a patient with epididymitis?
A
CTX, doxycycline, FQs
25
What does a CT scan with diffuse blurring of the gray-white matter interface and multiple small punctate hemorrhages suggest?
diffuse axonal injury
26
Trauma --> deteriorating blood gases, "white out" of the lungs on CXR
pulmonary contusion
27
If a patient undergoes splenectomy, what vaccines must be given postoperatively?
- pneumococcus
- H influenza B
- meningococcus
28
What is the standard topical agent used to treat patients with burns?
silver sulfadiazine
29
What does rabies prophylaxis consist of?
immunoglobulin + vaccine
30
What is the antidote for a black widow spider bite?
IV calcium gluconate
31
What is Ogilvie syndrome?
paralytic ileum of the colon
32
From where do each of the following originate?
- epithelial tumor
- sarcoma
- adenocarcinoma
- epithelial tumor: ectoderm
- sarcoma: mesoderm
- adenocarcinoma: endoderm
33
Severe migratory necrolytic dermatitis, DM, anemia, glossitis, and stomatitis are suggestive of...
glucagonoma
34
In a baby, green vomiting and a "double-bubble" picture in x-rays (large air-fluid level in stomach, smaller one to its right in 1st portion of duodenum) are found in...
- duodenal atresia
- annular pancreas
- malrotation
35
What should a patient receive for antibiotics who has been bitten by a cat?
amoxicillin-clavulonate
36
What is the difference between treatment for subdural and epidural hematoma?
- epidural: emergency craniotomy
| - subdural: ICP monitoring, elevate head of bed, hyperventilate, avoid fluid overload, give mannitol or furosemide
37
Failure to thrive in an infant, pansystolic murmur best heard at L sternal border, and increased pulmonary vascular markings on CXR are suggestive of...
VSD
38
What does development of diplopia (from paralysis of extrinsic eye muscles) in a patient suffering from frontal or ethmoid sinusitis suggest?
cavernous sinus thrombosis
39
What should be the urgent treatment for pituitary apoplexy?
steroid replacement (eventually other hormones will need to be replaced)
40
What it the utility of IVP (intravenous pyelogram)?
- excellent view of kidneys, collecting system, ureters, bladder
- provides help with idea of function of renal parenchyma and for ureters and bladder
41
Only _____________ can look at the bladder mucosa in detail and aid in detecting early cancers
cystoscopy
42
What causes pneumaturia?
fistulization between the bladder and GI track, most commonly the sigmoid colon, and most commonly from diverticulitis
43
Vascular thrombosis that occurs within minutes of re-establishing blood supply to a transplanted organ is a...
hyperacute rejection
44
What causes hyper acute rejection?
preformed antibodies
45
What suggests acute organ rejection and when does it occur?
- liver function deterioration (rising GGT, alk phase, bilirubin)
- 5 days to 3 months post-transplant
46
What is first line therapy for acute organ rejection?
steroid bolus
47
What type of fluid resuscitation should patients with burns get?
LR
48
What is the worry if a BUN is >100?
increased risk of post-op bleeding 2/2 uremic platelet dysfunction
49
What are the most common causes of a non-anion gap metabolic acidosis?
diarrhea, diurectic, renal tubular acidosis
50
A metabolic alkalosis with a low urine chloride is caused by...
vomiting/NG, antacids, diuretics
51
A metabolic alkalosis with a high urine chloride is caused by...
Barreter's, Gittleman's
52
Paralysis, ileus, ST depression, and U waves are suggestive of...
hypokalemia
53
How do you treat a circumferential burn?
escharotomy
54
What should you think of when you see a post-op patient with decreased platelets and clots?
HIT
55
A patient has confusion, a petechial rash in the chest, axilla, and neck, and acute SOB. Dx?
fat embolism
56
When a patient presents with muffled heart sounds, JVD, electrical alternans, and pulses paradoxus, what is the confirmatory test for the diagnosis?
- pericardial tamponade
| - FAST scan
57
What test should be done if blood is seen at the urethral meatus and patient has a high-riding prostate?
retrograde urethrogram
58
How do you treat lung abscesses?
IV clinda or PCN
59
Patients with constipation, kidney stones, malaise, low PTH, and central lung mass
squamous cell carcinoma (paraneoplastic syndrome)
60
CXR showing peripheral cavitation and CT showing distant mets
large cell carcinoma
61
Elevated AFP is associated with what type of cancer?
hepatocellular carcinoma
62
Carcinoid tumor occurs most commonly at __________ and presents w/ sxs of...
- appendix
| - diarrhea, wheezing
63
When should a hemicolectomy be done for a patient with carcinoid tumor?
- >2cm
- at base of appendix
- with +nodes
64
What test is done to work up the following...?
- pheochromocytoma
- primary aldosteronism
- adrenocortical carcinoma
- cushing
- pheochromocytoma: urine or plasma-free metanephrines
- primary aldosteronism: plasma aldo to renin ratio
- adrenocortical carcinoma: urine 17-ketosteroids
- cushing: overnight dexamethasone suppression test
65
A systolic-diastolic abdominal bruit is specific for...
renovascular HTN
66
What type of shock affects vagal tone and what type affects cardiac afterload?
- vagal tone: neurogenic shock
| - cardiac afterload: septic shock
67
________ cysts are located on the midline, at the level of the hyoid bone, and seem somehow connected to the tongue
thyroglossal duct cysts
68
________ cysts occur along the anterior edge of the sternomastoid muscle
brachial cleft cysts
69
How should adrenal insufficiency be worked up?
8am cortisol and plasma ACTH
70
What further workup should be done for a simple renal cyst?
none
71
How do you distinguish between painless thyroiditis and Graves disease?
- painless thyroiditis has decreased radioiodine uptake, suggesting release of preformed thyroid hormone
- Graves has increased radioiodine uptake, suggesting increased synthesis of thyroid hormone
72
What is the primary screening test for hyperaldosteronism?
plasma aldo:renin ratio
73
An elderly, sedentary, immobilized person with abdominal distension and a dilated colon
ogilvie syndrome
74
Young patient with HTN in the arms w/ normal pressure in the lower extremities and scalloping of the ribs
coarctation of the aorta
| -spiral CT is diagnostic
75
HIV+ patient with perforated cecum and CD4 <200. What bug caused the bloody diarrhea and perforated cecum?
CMV
76
What is the difference between a paraesophageal and sliding hiatal hernia?
- paraesophageal: defect in diaphragm, normal GE junction
| - sliding: dilation of the hiatus, associated with GERD
77
What lab abnormality can be seen with fibromuscular dysplasia?
increased serum aldosterone concentration
78
Young woman with headaches, hypertension, and hypokalemia
aldosteronoma
79
What is the most common hip disorder in adolescence?
slipped capital femoral epiphysis
80
What artery do nosebleeds come from?
sphenopalatine artery
81
What study is most appropriate to predict a patient's risk for preoperative MI?
radionuclide scan with thallium and dipyridamole
82
How do you confirm carpal tunnel?
nerve conduction studies
83
What is the difference in RAIU between Graves and a toxic thyroid adenoma?
- Graves: diffuse uptake
| - toxic thyroid adenoma: uptake in only one spot
84
Apocrine glands are found in the...
skin, breast, eyelid, ear
85
Sebaceous glands are found in the...
skin, hair
86
A rapid and significant increase in transaminases is the hallmark of...
ischemic hepatopathy
87
_________ should be considered in a patient with hemolytic anemia, cytopenia, and a hypercoagulable state
paroxysmal nocturnal hemoglobinuria
88
What acid-base disturbance can be seen with atelectasis?
respiratory alkalosis
89
The most common cause of painless bleeding associated with lightheadedness and hemodynamic instability is...
diverticular hemorrhage
90
transudate = ______ SAAG
-high SAAG (hydrostatic pressure)
91
exudate = ______ SAAG
-low SAAG
92
Anti-thyroid peroxidase and antithyroglobulin are 90% specific for...
Hashimoto's thyroiditis
93
How do you treat hospital-acquired PNA?
vancomycin, pip/tazo
94
How do you treat a catheter-associated UTI?
CTX
95
What two cardiac risk factors are absolute contraindications to (non-cardiac) surgery?
- EF <35%
| - MI within the last 6 months
96
MRCP with "beads on a string" and ERCP with "onion-skin fibrosis" are suggestive of...
PSC
97
Patients with a puncture would to the foot are at risk for...
pseudomonas
98
A baby with bilious emesis and a "double bubble" sign likely has _________ based on...
- normal gas distally
- no gas
- multiple air-fluid levels
- normal gas distally: malrotation
- no gas: duodenal atresia, annular pancreas
- multiple air-fluid levels: intestinal atresia
99
How is diverticulitis diagnosed?
CT
100
A coiled GI tube with normal gas below is suggestive of...
esophageal atresia with fistula
101
What is the murmur of endocarditis?
mitral regurg or aortic regurg
102
What is the murmur of rheumatic fever?
mitral stenosis
103
How is a seminoma treated?
platinum-based chemo
104
What is the first thing to do when someone has a chemical burn?
wash it
105
A double bubble sign with otherwise normal gas pattern is suggestive of...
malrotation
106
How should BRBPR be worked up in a child?
radioactively-labeled technetium scam
107
HTN and rib scalloping are suggestive of ________ and the next step in the workup includes __________
- coarctation of the aorta
| - CT angio
108
Diffuse thyroid uptake from radioactive iodine scan suggests...
hyperthyroidism
109
A chest tube with a persistent air leak may be caused by...
ruptured bronchus
110
A reaction two hours after a blood transfusion is due to...
preformed Abs to leukocyte antigens
111
A child with black, shiny stools and an abdominal mass has...
meckel diverticulum
112
What is biliary atresia and how does the patient present?
- abnormally narrow, blocked, or absent bile ducts in a child
- child with jaundice (~3 weeks of life)
113
What is the next step when someone has non-palpable pedal pulses?
arteriography
114
Dense hemiparesis and early decerebrate posturing is suggestive of...
a ruptured intracerebral aneurysm
115
Anti-thyroid peroxidase and thyroglobulin antibodies are suggestive of...
Hashimoto's thyroiditis
116
What are the EKG findings associated with hyperkalemia?
- gradual prolongation of PR interval
- prolonged QRS complex
- ST segment elevations
- peaked T waves
117
In what patient population is calculus cholecystitis seen?
severely ill patients in the ICU with multigrain failure, severe trauma, surgery, burns, sepsis, or prolonged TPN
118
How do you work up Hirschsprung's disease?
biopsy the rectal mucosa
119
If a patient has an esophageal tear, what is the next step?
exploratory thoracotomy
120
What is the fluid replacement equation?
4mL x kg x %body burned
121
What artery is affected with a temporal bone fracture?
middle meningeal artery
122
How do you manage acute kidney rejection?
antithymocyte serum and steroid bolus
123
An acute drop in Na+ after surgery is likely due to...
water retention
124
How do you treat paralytic ileum of the colon?
1st: fluid and electrolyte correction
2nd: colonoscopy (suck out all the air) and rectal tube
125
What type of cancer causes multiple pelvic masses, ascites, and omental masses?
ovarian adenocarcinoma
126
What is the most commonly found organism causing ascending cholangitis?
e coli
127
How do you manage esophageal perforation?
exploratory thoracotomy
128
How do you treat H. pylori?
- PPI
- amoxicillin
- clarithromycin
129
Which describes ileum and which describes abdominal obstruction?
- post-op day 1-2: no stool or flatus
- post-op day 5: no stool or flatus
- ileus: post-op day 1-2, no stool or flatus
| - obstruction: post-op day 5, no stool or flatus
130
Migratory thrombophlebitis is characteristic of...
pancreatic cancer
131
What is important about antitrypsin III deficiency?
heparin won't work
132
What are the most common bugs causing necrotizing fasciitis?
- group A beta hemolytic strep
| - clostridium perfringens
133
blowing diastolic murmur
aortic regurg
134
wide, fixed, split S2
ASD
135
Patient with bleeding gums, petechiae, nosebleeds, decreased platelet count, increased megakaryocytes; no splenomegaly
1st time: steroids for ITP
| relapse: splenectomy
136
What is the mainstay of treatment for squamous cell anal cancer?
chemo
137
Bleeding + isolated decrease in platelets...
ITP
138
Normal platelets but increased bleeding time and PTT...
vWD
139
Low platelets, increased PT, PTT, bleeding time, fibrinogen, d-dimer, schistocytes...
DIC (caused by gram- sepsis)
140
What is the first step in treating an electrical burn?
EKG
141
Alcoholic --> big meal --> vomiting = ?
edematous pancreatitis
142
If blood at the urethral meatus and a high-riding prostate, consider...
pelvic fracture w/ urethral or bladder injury
143
Patient with shoulder pain, ptosis, constricted pupil, and facial edema has...
superior sulcus syndrome from small cell cancer of the lung
