Surgery VI

Question 1

What nerve is responsible for flexion at the hip and extension at the knee?

Answer 1

Femoral nerve

Question 2

What nerve is responsible for foot eversion and dorsiflexion?

Answer 2

Peroneal (fibular) nerve

“PEDs”: Peroneal Eversion Dorsiflexion

Question 3

What nerve is responsible for foot inversion and plantar flexion?

Answer 3

Tibial nerve

“TIPs”: Tibial Inversion Plantarflexion

Question 4

What nerve provides sensation to the anterior thigh and medial leg?

Answer 4

Femoral nerve (saphenous branch)

Question 5

What nerve provides sensation to the area between the 1st and 2nd toes?

Answer 5

Deep peroneal (fibular) nerve

Question 6

What nerve provides sensation to the dorsum of the foot?

Answer 6

Superficial peroneal (fibular) nerve

Question 7

What nerve provides sensation to the medial thigh?

Answer 7

Obturator nerve

Question 8

What nerve provides sensation to the sole of the foot?

Answer 8

Tibial nerve

Question 9

What neurological pathology presents with pain/temperature loss and muscle weakness in the upper extremities?

Answer 9

Syringomyelia

“cape-like distribution”

Question 10

What pathology classically presents with periumbilical abdominal pain out of proportion to PE findings?

Answer 10

Acute mesenteric ischemia

Question 11

What post-gastrectomy complication presents with GI and vasomotor symptoms?

Answer 11

Dumping syndrome

e.g. nausea, diarrhea, abdominal cramps (GI) and palpitations, diaphoresis (vasomotor)

Question 12

What preventive measures are useful for preventing post-operative acute bacterial parotitis?

Answer 12

adequate fluid hydration and oral hygeine

Question 13

What rash in pictured in the image below?

Answer 13

Stasis dermatitis (secondary to venous insufficiency)

Question 14

What Staphylococcus species is typically the cause of delayed-onset (3-12 months) prosthetic joint infection?

Answer 14

S. epidermidis

infections are due to less virulent organisms and present with chronic pain

Question 15

What surgical intervention, if any, is recommended for patients with gallstone pancreatitis when medically stable?

Answer 15

Cholecystectomy

Question 16

What syndrome is characterized by a triad of respiratory distress, neurologic dysfunction, and petechial rash?

Answer 16

Fat embolism syndrome

typically develops following a latent period of 12 - 72 hours after the initial injury

Question 17

What testicular mass is a painless fluid-filled cyst at the head of the epididymis?

Answer 17

Spermatocele

Question 18

What testicular mass is easily transilluminated?

Answer 18

Hydrocele

Question 19

What three symptoms make up the Cushing’s reflex/triad?

Answer 19

hypertension, bradycardia, and respiratory depression

indicates elevated intracranial pressure

Question 20

What tissue pressure is diagnostic of compartment syndrome?

Answer 20

> 30 mmHg

Question 21

What trauma pathology occurs when > 3 continuous ribs are fractured in > 2 places?

Answer 21

Flail chest

Question 22

What type of bursitis is seen with repetitive kneeling?

Answer 22

Prepatellar bursitis (“housemaid’s knee”)

Question 23

What type of cholecystitis arises due to infection of the gallbladder wall with gas-forming bacteria (e.g. Clostridium)?

Answer 23

Emphysematous cholecystitis

treatment requires emergent cholecystectomy and broad-spectrum antibiotics

Question 24

What type of neuromuscular blocking agent should be used in patients with upregulated post-synaptic ACh receptors (e.g. skeletal muscle trauma, burn injury, stroke)?

Answer 24

Non-depolarizing agents (e.g. vecuronium, rocuronium)

Question 25

What type of surgical infection presents with intense pain in the wound, decreased sensitivity at wound-edges, cloudy-gray discharge, +/- crepitus?

Answer 25

Necrotizing infection

Question 26

What type of urethral injury (anterior or posterior) is typically caused by pelvic fractures in men?

Answer 26

Posterior urethral injury most commonly the membranous urethra at the bulbomembranous junction

Question 27

What type of urethral injury (anterior or posterior) is typically caused by straddle injuries in men?

Answer 27

Anterior urethral injury

Question 28

What vital signs (BP, HR) are concerning for hemorrhage following blunt abdominal or thoracic trauma?

Answer 28

hypotension and/or tachycardia

Question 29

What vitamin deficiency is characterized by swollen gums, petechiae, and impaired wound healing?

Answer 29

Vitamin C deficiency (scurvy) more common in patients with alcoholism, drug abuse, or psychiatric illness; diagnosis is made with plasma or leukocyte vitamin C levels

Question 30

When should older patients with hip fractures undergo definitive surgical correction?

Answer 30

As soon as reasonably possible may delay up to 72 hours to evaluate surgical risk and ensure medical stability

Question 31

When should patients with acute cholecystitis have a cholecystectomy?

Answer 31

Within 72 hours the same applies to other complicated gallstone diseases (e.g. choledocholithiasis, gallstone pancreatitis)

Question 32

When should patients with uncomplicated biliary colic have a cholecystectomy?

Answer 32

Electively

Question 33

Which metatarsal has an increased risk for non-union following a stress fracture, thus requiring more aggressive treatment?

Answer 33

5th metatarsal hus typically managed with casting or internal fixation

Question 34

Which metatarsal is most commonly injured by stress fractures?

Answer 34

2nd metatarsal second metatarsal is subjected to significant load during gait

Question 35

Which organs (2) are most commonly injured with blunt abdominal trauma?

Answer 35

liver and spleen

Question 36

Which region of the bladder may cause chemical peritonitis if ruptured?

Answer 36

Dome of the bladder this part of the bladder borders the peritoneal cavity, i.e. intraperitoneal bladder rupture

Question 37

Which side are varicoceles more common on?

Answer 37

Left due to drainage into the left renal vein, which is vulnerable to compression between the SMA and aorta ("nutcracker effect")

Question 38

Which Staphylococcus species is typically the cause of acute-onset (\< 3 months) prosthetic joint infection?

Answer 38

S. aureus infections are due to more virulent organisms and present with acute pain

Question 39

Which tibial pathology, shin splints or stress fracture, is more common in underweight individuals?

Answer 39

Stress fracture especially common in women with the female athlete triad

Question 40

Which tibial pathology, shin splints or stress fracture, presents with a diffuse area of tenderness on palpation?

Answer 40

Shin splints (medial tibial stress syndrome) important distinguishing feature from tibial stress fractures

Question 41

Which tibial pathology, shin splints or stress fracture, presents with a point tenderness on palpation?

Answer 41

Stress fracture important distinguishing feature from shin splints

Question 42

Which type of brain tumor typically appears as a well-circumscribed calcified extra-axial mass in a female?

Answer 42

Meningioma

Question 43

Which type of brain tumor typically appears as multiple ring-enhancing lesions at the gray-white junction?

Answer 43

Brain metastasis may do CT scan of chest, abdomen, and pelvis to look for primary tumor

Question 44

Which type of shock is characterized by decreased central venous pressure (CVP) and cardiac output?

Answer 44

Hypovolemic shock

Question 45

Which type of shock is characterized by increased mixed venous O2 saturation (MvO2)?

Answer 45

Septic shock

Question 46

Which type of skin cancer is most likely to arise from chronically wounded, scarred, or inflamed skin?

Answer 46

Squamous cell carcinoma SCC arising in chronic wounds tends to be more aggressive with an increased risk of metastasis; SCC arising from burn wound is termed a Marjolin ulcer

Question 47

[...] abscess often presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx (e.g. fish bone).

Answer 47

**Retropharyngeal abscess** often presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx (e.g. fish bone). may also have nuchal rigidity and bulging of the pharyngeal wall