Surgery UWorld

Question 1

Fat Embolism Syndrome

Answer 1

Fracture of bone
24-72hrs Triad:
-Respiratory Distress
-Neuro Disfunction (confusion)
-Petechial Rash

Question 2

GSW

Answer 2

Below 4th intercostal space: Abdomen exploratory Lapratomy

Question 3

Stress Fracture

Answer 3

Point Tenderness

XR negative for 6 weeks

Question 4

Shin Splints

Answer 4

No Point tenderness
Anterior Leg Pains
Overweight Individuals
Tx: Rest and Analgesics

Question 5

Aortoiliac Occlusion (Leriche Syndrome)

Answer 5

Bilateral HIp, thigh, buttock claudication, impotence, symmetric atrophy of bilateral lower extremities.

Claudication of bifurcation of the aorta

Question 6

Marjolin Ulcer

Answer 6

Squamous Cell Carcinoma associated with burn

Question 7

Pancreatic Cancer

Answer 7

Risk: Smoking, Hereditary, Obesity
Sx: Weight Loss, anorexia, abdominal pain/back pain: gnawing & worse at night, jaundice, recent onset diabetes, unexplained migratory superficial thrombophlebitis

Question 8

Venous Insufficiency

Answer 8

Lower extremity edema,

worsens throughout the day, better at night recumbent

Question 9

Spontaneous Pneumo

Answer 9

Tx: <2cm Observation and supplemental oxygen

Large and stable: Needle aspiration or chest tube

Question 10

Psoas Abscess

Answer 10

Subacute Fever, Abdominal Flank pain, radiating to the groin
Anorexia, weight loss
Abdominal pain with hip extension (psoas sign)
Dx: CT, cultures
Tx: Drain, Antibiotics

Question 11

Dumping Syndrome

Answer 11

Sx: GI (nausea, dirrhea, abdominal cramps) + Vasomotor (palpitations, diaphoresis)
Tx: Small frequent meals

Question 12

Acute Mesenteric Ischemia

Answer 12

Rapid onset of Pain out of proportion of exam.

Lab: Metabolic Acidosis (elevated lactate) elevated amylase, phosphate, leukocytosis

Question 13

AKI

Answer 13

Intravascular volume depletion, BUN:Cr >20:1

Administer IV fluid to restore renal perfusion

Question 14

Duodenal Hematoma

Answer 14

After Blunt Abdominal Trauma
Pediatric Patients
Epigastric Pain and vomiting 24-36hrs after injury
Tx: Gastric decompression and parenteral nutrition.

Question 15

Succinylchonline Side Effect

Answer 15

Depolarizing neuromuscular blocker - life threatening hyperkalemia

Question 16

Sphincter of Oddi dysfunction

Answer 16

biliary disorder due to dyskinesia or stenosis of sphincter of oddi. Episodic pain in RUQ or epigastric region, elevations of Aminotransferase & Alk Phos.

Worse by morphine.

Question 17

MCL Tear

Answer 17

Valgus Stress or twisting.

Tenderness to medial knee.

Question 18

Gallstone Ileus

Answer 18

Nausea, vomiting, air in biliary tree, hyperactive bowel sounds = Small Bowel Obstruction. Gallstone passes into small bowel.

Question 19

Parotid Surgery

Answer 19

Risk of facial nerve palsy = facial droop

Question 20

Acute Mediastinitis

Answer 20

Following surgery and present with fever, chest pain, leukocytosis & mediastinal widening.
Tx: Surgical debridement & antibiotics

Question 21

Anal Fissure

Answer 21

Pain and rectal bleeding on defecation

Tx: Fiber, Fluid, Stool Softeners, Sitz bath, topical anesthetics and vasodilators

Question 22

Acalculous cholecystits

Answer 22

Acutely ill patients

Question 23

Pulmonary Contusion

Answer 23

<24hrs after blunt trauma
Tachypnea, Tachycardia, hypoxia
Tx: Supplemental oxygen & pain control
Dx: CXR with patchy alveolar infiltrate

Question 24

Pilonidal Disease

Answer 24

Males age 15-30
Sedentary lifestyles
Deep gluteal clefts
Fluctuant mass 4-5cm

Question 25

Appendiceal abscess

Answer 25

>5 days of appendicitis +Psoas +obturator +Rectal exam

Question 26

Cardiac Tamponade

Answer 26

``` Sudden rise in ICP Blunt chest trauma Persistent JVD Tachycardia Hypotension despite fluid ```

Question 27

Gastric Outlet obstruction

Answer 27

``` Early satiety Nausea Nonbilious vomiting Weight loss Hx of Acid ingestion, ```

Question 28

Extraperitoneal bladder injury

Answer 28

Contusion or rupture of neck, or anterior wall of the bladder. Localized pain, gross hematuria and associated pelvic fracture

Question 29

Acute Adrenal insufficiency

Answer 29

Hypotension, vomiting, abdominal pain triggered by acute illness or surgery Tx Fluid support & dexamethasone