Surgery Shelf Prep Flashcards by Victoria Brennan

What is the most commonly used antibiotic regimen in prophylaxis of endocarditis (e.g. prior to dental procedure in post-valve replacement pts)?

Oral Amoxicillin - administered 60 min. prior to high risk procedure. [Clindamycin is 2nd line agent if allergic to penicillin]

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Which antibiotic regimen is ideal in prophylaxis of endocarditis in patients with penicillin allergy (e.g. prior to dental procedure in post-valve replacement pts)?

Clindamycin. Clindamycin is 2nd line agent if allergic to penicillin. Oral Amoxicillin is first line w/o allergy.
Either administered 60 min. prior to high risk procedure.

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What type of medication is Cabergoline?

Long acting Dopamine agonist and prolactin inhibitor

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What is the initial treatment for a Prolactinoma

Dopamine agonist therapy e.g. Cabergoline

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What is the treatment for Peritonsillar Abscess

Airway management.
IV anitbiotics gram + & anaerobic coverage - Clindamycin or ampicillin-sulbactam
I&D or needle aspiration if risk of airway obstruction, complications or immunodeficiency
Tonsillectomy if unresponsive to prior tx, recurrent, + complications, or airway obstruction

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What are the potential complications of Peritonsillar abscess

Airway compromise
Spread of infection
Aspiration pneumonia
Internal jugular vein thrombosis or thrombophlebitis
Bacteremia/sepsis

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The term synechiae is equivalent to the term “____”

Adhesions

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What are the common clinical signs of a Gastrinoma (Zollinger-Ellison Syndrome)

Recurrent peptic ulcer disease - multiple ulcers & jejunal ulceration, refractery ulcers to PPI
Hx of MEN1
Thickened gastric folds on Endoscopy

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What is the initial medical treatment for Dermatitis Herpetiformis

Dapsone

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What is the main difference between Type 1 and Type 2 Heparin Induced Thrombocytopenia (HIT syndrome)

Type 1 is non-immune mediated and platelet counts decrease only mildly (usually stay >100,000)
Type 2 is autoimmune mediated w/ autoantibody against endogenous Platelet Factor 4 complexed with heparin and results in significant platelet drops often >50% w/in 5-10 days

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The presence of what in the CSF is specific for HIV associated primary CNS Lymphoma

EBV DNA in the CSF

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Progressive multifocal leukoencephalopathy lesions (in HIV + pts) are ring _____(enhancing/nonenhancing)

Non-enhancing

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Primary CNS lymphoma lesion(s) in HIV+ pts are ring-____ (enhancing/nonenhancing)

weakly ring enhancing

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In pts w/ AIDS dementia complex, imaging studies reveal…

cortical and subcortical atrophy & secondary ventricular enlargement

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What are the common clinical features of compartment syndrome?

Pain out of proportion to injury
Increased pain on passive stretch
Rapid increasing/tensing swelling
Paresthesias

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What are some uncommon clinical features of compartment syndrome

decreased sensation
motor weakness
paralysis
decreased distal pulses

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What is the treatment of choice for compartment syndrome

Fasciotomy

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What are the common complications of a rhinoplasty

-pt dissatisfaction
-nasal obstruction
-epistaxis
Less commonly a nasal septum perforation may occur secondary to septal hematoma or septal abscess

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Rapid correction of warfarin-induced elevated INR prior to emergent surgery is achieved by administration of …?

Fresh Frozen Plasma to replace vitamin K dependent clotting factors

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______ is given pre-operatively to patients with Hemophilia A to reduce bleeding risk. Why?

Desmopressin in order to indirectly increase factor VIII by increasing vWF release from endothelial cells

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The most specific test for diagnosing osteomyelitis is…?

Bone biopsy & culture

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Which organisms are most commonly responsible for deep infections following a puncture wound

Staph aureus and Pseudomonas aeruginosa.

P. aeruginosa is especially common after puncture wound through the shoe

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Pasteurella multocida, common microbe following cat bite, is an _____ bacteria

Gram negative coccobacilli

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What is the Management for Cat bites

Copious irrigation & cleaning
Prophylactic amoxicillin/clavulanate
Tetanus booster
Avoid closure of wound

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Tetanus boosters should be considered with injury in children if last dose was __ years ago

What is the cause of Zenker Diverticulum

Upper Esophageal sphincter dysfunction and esophageal dysmotility

What skin pathology starts as small pustule/papule/nodule that develops into an ulcer and is associated with IBD

Pyoderma gangrenosum

Porcelain gallbladder is associated with an increased risk of what cancer

Gallbladder Adenocarcinoma

What are the local vascular complications (e.g. in the groin) of a cardiac catheterization

- Hematoma - Pseudoaneurysm - Arteriovenous Fistula

How do the local vascular complications of cardiac catheterization differ on physical exam

- Hematoma: +/- mass, no bruit - Pseudoaneurysm: Bulging, pulsatile mass, Systolic Bruit - AV Fistula: No mass, Continuous bruit, +/- palpable thrill`

What is the "Ugly Duckling Sign"

A skin lesion that is different from the surrounding lesions, i.e. the ugly duckling, is most likely melanoma (90% Sensitivity)

What is the criteria for a diagnosis of a solid testicular mass

Painless hard mass in testicle + suggestive ultrasound

Pancreatic tumors in the head of the pancreas are most likely to present with what symptoms

jaundice, weight loss, steatorrhea

Pancreatic body and tail tumors are most likely to present with what symptoms

dull upper abdominal pain radiating to the back, weight loss

What are the most likely pathologies given the location of a mass in the mediastinum (anterior, middle, & posterior)

Thymomas in the anterior mediastinum Bronchogenic cysts in the middle mediastinum Neurogenic tumors in the posterior mediastinum

Cardiac Index is a measure of what

Cardiac Output

How are Cardiac Output, PCWP, and PVR affected by hypovolemic shock

Cardiac Output decreased PCWP decreased PVR increased

How are the Cardiac Output, PCWP, and PVR affected by Cardiogenic shock

Cardiac Output decreased PCWP increased PVR increased

How are Cardiac Output, PCWP, and PVR affected by Distributive Shock (e.g. sepsis, anaphylaxis, SIRS, neurogenic)

Cardiac Output increased PCWP decreased PVR decreased

Pulmonary Capillary Wedge Pressure (PCWP) is a measure of what

An estimation of the left atrial pressure

How are Cardiac Output, PCWP, and PVR affected by obstructive shock (e.g. cardiac tamponade, tension pneumothorax, massive PE)

Cardiac output decreased PCWP increased PVR increased

What muscles does the axillary nerve innervate

Teres Minor and Deltoid

What nerve innervates the Teres Minor and Deltoid muscles

Axillary nerve

Which nerve is most likely to be compromised in an anterior shoulder dislocation

Axillary nerve

What is the clinical triad of fat embolism syndrome

- Respiratory Distress - Neurologic dysfunction - Petechial rash

Respiratory distress, neurologic dysfunction, and petechial rash following orthopedic injury or pancreatitis suggest _____

Fat embolism syndrome

Describe the characteristics of a typical meningioma

Intracranial lesion w/ Extra-axial well-circumscribed or round homogenously enhancing dural-based mass on MRI

What is the treatment for acute viral pericarditis

NSAIDs + Colchicine + Activity restriction | Use lowest dose of steroids only if NSAIDs contraindicated

Describe the physical exam findings for a lung consolidation

- Increased Breath Sounds - Increased Tactile Fremitis - Dullness to percussion

Describe the physical exam findings for a pleural effusion

- Decreased Breath Sounds - Decreased Tactile Fremitis - Dullness to percussion - Mediastinal shift away from effusion

A Giant Cell Tumor of the bone has what appearance on X-ray

eccentric lytic lesion, aka "Soap Bubble"

Where are Giant Cell Tumors of the bone most commonly located

The epiphysis of long bones

Eccentric lytic lesions of long bones that has a Soap Bubble appearance on X-ray is suggest of ______

Giant Cell Tumor of the bone

What is the most common X-ray appearance of an osteoid osteoma

Small round lucency

Night pain and a small round lucency on X-ray is suggestive of what

Osteoid osteoma (benign bone tumor)

What are the major risk factors for Aortic Dissection

Hypertension (most common) Marfan Syndrome Cocaine use

What is a Marjolin ulcer

A squamous cell carcinoma arising within a burn

What are the risk factors for acalculus cholecystitis

- Severe trauma or recent surgery - TPN or prolonged fasting - Critical illness (sepsis, ICU, etc.)

What are the secondary endocrine causes of osteoporosis

- Hyperparathyroidism - Hyperthyroidism - Hypercortisolism - Hypogonadism

How does celiac disease contribute to secondary osteoporosis

By causing malabsorption of vitamin D

What is the gold standard for diagnosis of sphincter of Oddi malfunction

Sphincter manometry

What is the basic difference between cellulitis and necrotizing fascitis

Cellulitis is pretty much just in the skin | Necrotizing fascitis causes patients to be sick with systemic symptoms and rapid spread

An Ankle Brachial Index of =0.9 is significant for what

Diagnosistic for occlusive PAD, 90% sensitive, 95% specific in pts w/ symptoms

What are the components of the Glascow Coma Score

- Eye Movement - Verbal Response - Motor Response

Secondary polycythemia without signs of chronic hypoxia is worrisome for

EPO producing tumor such as renal cell carcinoma

what is the male to female incidence ratio for imperforate anus

1. Occurs equally in both (1 in 20,000 live births)

Imperforate anus is due to what

Failure of the urorectal septum to descend

Low cases of imperforate anus typically have rectal termination in the ______

Perineal fistula

High cases of imperforate anus typically have rectal termination in the _____

prostatic urethra or vagina

What is the most common serious complication of an end ostomy

Parastomal herniation (skin irritation/breakdown is not considered serious)

What is the 5 yr survival for pancreatic adenocarcinoma following a whipple procedure for cure

5-20% (according to PreTest Surgery book)

How does achalasia affect the risk of esophageal cancer

7 times increased risk of Squamous Cell Carcinoma (even after treatment)

Where are Meckel's diverticula usually located relative to the ileocecal valve

50-70 cm proximal

Meckel's diverticula may contain ______

gastric and/or pancreatic tissue

Which is the more common complication of Meckel diverticula: hemorrhage/obstruction or acute inflammation?

Hemorrhage/obstruction

What is the best indicator that a splenectomy is beneficial in the management of Immune (Idiopathic) Thrombocytopentic Purpura (ITP)

75% increase in platelet count following corticosteroid therapy. Most cases of ITP do not need surgical intervention

True or False: Peutz-jeghers syndrome increases risk of malignancy

False: Peutz-Jeghers syndrome is associated w/ intestinal polyposis, typically harmartomas, and melanin spots of oral mucosa

How is H. pylori diagnosis established

Serologic & urea breath tests. | Endoscopy biopsy/scrapings can also be used but is impractical given necessary culture requirements

What is the initial treatment for Hirschsprung's

Diverting colostomy in neonates to allow the bowel to grow in length and decompress before re-anastamosis with the rectum

Surgery Shelf Prep Flashcards

(79 cards)