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Surgery > USMLE > Flashcards

USMLE Flashcards

1
Q

clinical presentation and Ba swallow suggest achalasia.. what next?

A

endoscopy to r/o esophageal cancer

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2
Q

hordeolum is what?

A

a stye, usually caused by staph aureus

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3
Q

brain tumor with CT/MRI butterfly appearance

heterogenous and serpiginous contrast enhancement

A

GBM

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4
Q

target cells usually seen with what?

A

thalassemia, not so much iron deficiency anemia

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5
Q

what to do if you suspect toxic megacolon?

A

abd xray to confirm dx

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6
Q

how to tx toxic megacolon

A

conservative management: NPO, NG, steroids (if caused by IBD) or abx (if caused by infection)
-if that doesn’t work, then emergency surgery

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7
Q

patient with jaundice should be worked up with what dx test first?

A

US

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8
Q

recurrent bouts of upper abd pain, diarrhea/steatorrhea, weight loss

A

chronic pancreatitis

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9
Q

how to dx chronic pancreatitis

A

CT scan

amylase and lipase may be normal

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10
Q

if you suspect pancreatic cancer, what study should you get?

A

CT scan

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11
Q

arthralgias, weight loss, fever, diarrhea, abdominal pain, chronic cough, cardiac and valvular problems, pigmentation, lymphadenopathy
PAS positive stuff in lamina propria of small intestine

A

whipple’s disease

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12
Q

you are likely to form cholesterol gallstones during ______

A

pregnancy

effects of estrogen and progesterone

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13
Q

most common cause of iron deficiency anemia in old ppl is _________. what do you do next?

A

GI blood loss

perform colonoscopy. if negative, then EGD

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14
Q

asymptomatic diverticulosis is tx with what

A

increased fiber in the diet

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15
Q
  • back pain, anemia, renal dysfunction, elevated ESR

- constipation, weakness, renal tubular problems, neurologic sxs, anorexia

A

multiple myeloma causing hypercalcemia

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16
Q

always look for __________ as a cause of constipation

A

hypercalcemia

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17
Q

old patients with new onset dyspepsia
young patients with new onset dyspepsia and weight loss/vomiting/dysphagia

what to do?

A

upper endoscopy

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18
Q

young pts with new onset dyspepsia and w/o alarm sxs. what to do? (2)

A

PPI trial

H Pylori testing

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19
Q
  • old person with tea and toast diet is deficient in what

- macrocytic anemia

A

folic acid

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20
Q

vegans often deficient in what

anemia + CNS problems

A

vitamin B12

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21
Q

perifollicular hemorrhage, swollen gums, poor wound healing

A

scurvy (vitamin c deficiency)

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22
Q

osteomalacia and hypocalcemic tetany in adults caused by ______ deficiency

A

vitamin D

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23
Q

RBC fragility, hyporeflexia, muscle weakness, blindness caused by ______ deficiency

A

vitamin E

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24
Q

crypt abscesses are characteristic of ___________

A

ulcerative colitis

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25
Q

causes of bloody diarrhea

A

E Coli
Shigella
Campylobacter

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26
Q

explain the D-xylose test

A

normal: D-xylose is absorbed in the proximal small intestine and excreted in the urine
small intestine disease: D-xylose is not absorbed and instead, excreted via the feces

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27
Q

elevated BUN/Cr ratio means what (3 things)

A
  • prerenal renal failure
  • GI bleeding (due to reabsorption of blood from GI tract)
  • steroid administration
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28
Q

first indicator of hypovolemia

A

pulse rate

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29
Q

post-prandial abdominal cramps, weakness, light-headedness, diaphoresis after having a partial gastrectomy

A

early dumping syndrome

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30
Q

how to tx early dumping syndrome

A

dietary modification
octreotide
reconstructive surgery

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31
Q

rectangular enveloped shaped crystals in urine

A

ca oxalate crystals

often due to ethylene glycol poisoning

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32
Q

how to calculated serum osmolarity

A

2*Na + glucose/18 + BUN/2.8

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33
Q

elevated osmolar gap metabolic acidosis indicates (3 things)

A

methanol, ethanol, or ethylene glycol poisoning

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34
Q

hypokalemia, hyponatremia with increased urinary Na and K

A

diuretic abuse

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35
Q

main causes of metabolic alkalosis

A
  • administration of alkali
  • removal of acidic gastric secretions via vomiting and NG tube
  • renal H+ loss due to mineralocorticoid excess
  • contraction alkalosis
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36
Q

in pts requiring multiple transfusions during surgery, they are at risk for _________
-hyperactive DTRs, muscle cramps, rarely convulsions

A

hypocalcemia

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37
Q

muscle weakness, cramps, flaccid paralysis, U waves on EKG

A

hypokalemia

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38
Q

muscle weakness, flaccid paralysis, peaked T waves, asystole

A

hyperkalemia

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39
Q

decreased DTRs, muscle paralysis, apnea, cardiac arrest

A

hypermagnesemia

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40
Q

causes of nephrogenic DI

A

hypercalcemia
severe hypokalemia
tubulointerstitial renal disease
meds: Li, amphotericin, cidofovir

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41
Q

common meds that cause hyperkalemia

A 
nonselective beta blockers
K sparing diuretics (ex. triamterene, trimethoprim) 
ACEIs
ARBs
NSAIDs
digoxin
cyclosporin
heparin
succinylcholine
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42
Q

glucose range for DKA

A

250-600

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43
Q

how to shift K from extracellular to intracellular

A

insulin and glucose
Na bicarb
albuterol (beta 2 agonist)

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44
Q

when not to use succinylcholine

A

when risk for hyperkalemia

  • crush injuries
  • demyelinating syndromes
  • tumor lysis syndromes
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45
Q

potential side effects of loop diuretics

A

hypokalemia
metabolic alkalosis
prerenal renal failure

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46
Q

2 classes of metabolic alkalosis

A
  1. chloride sensitive (hypochloremic, saline responsive)
    - urinary Cl < 20
    - ECF volume depletion –> mineralocorticoid –> bicarb retention, H+ loss, K+ loss
    - causes: thiazide/loop diuretics, vomiting/NG suction
    - tx with volume repletion via saline
  2. chloride resistant (normochloremic, saline unresponsive)
    - urinary Cl > 20
    - ECF volume expansion
    - causes: primary hyperaldosteronism, Bartter’s, Gitelman’s, licorice ingestion
    - not corrected by saline infusion
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47
Q

COPDers with chronic respiratory acidosis treated with diuretics are at risk for ______

A

prerenal renal failure due to drop in cardiac output

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48
Q

anorexia, fatigue, GI complaints, weight loss, hypotension, hyponatremia, hyperkalemia, hyper pigmentation or vitiligo, anemia, eosinophilia

A

Addison’s (adrenal insufficiency)

-causes: autoimmune, TB, HIV, fungi, metastatic cancer, hemorrhagic infarction

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49
Q

acute symptomatic hyponatremia: correct with ________ at no more than _______

A

3% saline

0.5 mEq/L/hr

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50
Q

pt with h/o GERD now has difficulty swallowing solids. endoscopy shows symmetric circumferential narrowing

A

peptic stricture

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51
Q

tissue transglutaminase antibodies are diagnostic of what?

A

celiac disease

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52
Q

mono-like syndrome consisting of fever, night sweats, LAD, arthralgias, and diarrhea should make you suspicious for ____

A

HIV

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53
Q

what is cryoprecipitate used for?

A

to treat patients with fibrinogen, vWF, or factor VIII deficiency

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54
Q

pRBC transfusion threshold

A

hgb < 7 for pts who are otherwise stable

hgb < 9 for unstable pts related to anemia or ACS with active ischemia

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55
Q

______ = dietary deficiency of niacin
often found in ppl with a ___-based diet in Asia
what are the 3 D’s?

A

pellagra
corn
3 Ds- diarrhea, dermatitis, dementia

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56
Q

SLE can cause diarrhea (t/f)

A

F

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57
Q

UC extra-intestinal manifestations include:

A

uveitis
arthritis
erythema nodosum
pyoderma gangrenosum

58
Q

worsening post-prandial pain that leads to avoidance of food is usually suggestive of _____

A

abdominal angina (atherosclerosis of the mesenteric arteries)

59
Q

IBS can lead to weight loss (t/f)

A

F

60
Q
  • diarrhea

- modified acid fast stain showing oocysts in stool is highly suggestive of ____________

A

cryptosporidium parvum

  • self limited in immunocompetent
  • persistent clinical course in immunocompromised
61
Q

corkscrew esophagus on esophagogram
high amplitude esophageal contractions on manometry
chest pain and dysphagia

A

diffuse esophageal spasm

-tx with antispasmodics, dietary changes, psychiatric counseling

62
Q

esophageal smooth muscle atrophy (loss of distal esophageal peristalsis) and incompetent LES

A

scleroderma

63
Q

foot gets stuck in throat… male with halitosis and regurgitation but no pain

A

zenker’s diverticulum

64
Q

absent peristalsis and super tight LES tone

A

achalasia

65
Q
  • alopecia, abnormal taste, bullous pustulous lesions surrounding body orifices and/or extremities, impaired wound healing
  • IBD patient on TPN
A

zinc deficiency

66
Q

selenium deficiency highly associated with _________

also not in TPN

A

cardiomyopathy

67
Q

triad of carcinoid syndrome

A

flushing
valvular heart disease
diarrhea

68
Q

patients with carcinoid syndrome are at risk for ____ deficiency

A

niacin

69
Q

________ decreases the renal clearance of digoxin, causing ________ issues

A 
verapamil 
GI issues (anorexia, N/V)
70
Q

multiple duodenal ulcers and a jejunal ulcer are almost pathognomonic for _______

A

ZES

71
Q

elevated transferrin saturation and ferritin levels suggest _____
bronze diabetes, fatigue, elevated hepatic enzymes

A
  • iron overload

- maybe due to hereditary hemochromatosis (increased Fe absorption), which causes liver cirrhosis and eventually HCC

72
Q

suspect ________ in a patient with cirrhosis and ascites presenting with fever or altered mental status
to to dx and tx?

A

SBP

  • dx with paracentesis (positive culture or PMN > 250)
  • tx with abx
73
Q

what to do if someone comes in with a classic presentation of appendicitis?

A

immediate surgery

74
Q

when should you image before surgery in suspected appendicitis?

A
  • pregnant women should get ultrasound
  • suspected appendicitis with atypical presentation should get US or CT
  • pts with symptoms > 5 days should be managed conservatively with IV abx, bowel rest, and delayed appendectomy
75
Q

_______ most common cause of LGIB in elderly

A

diverticulosis

76
Q

_______ most common solid organ to be injured in blunt abd trauma

A

spleen

77
Q

how to approach acalculous cholecystitis (usually occurs in very sick patients)

A

US shows gallbladder distention, thickening of gallbladder wall, pericholecystic fluid
-tx with percutaneous cholecystostomy followed by cholecystectomy when the patient’s medical condition improves

78
Q

undifferentiated carcinoma of SCC origin seen in the nose of Mediterranean or Far East ppl

A

nasopharyngeal carcinoma

79
Q

what is nasopharyngeal carcinoma highly assoc with?

A

EBV infection

80
Q

how to tx duodenal hematoma

A

NG suction and parenteral nutrition

it will resorb spontaneously over time

81
Q

opening snap assoc with what heart issue?

A

mitral stenosis

82
Q

eggshell calcification of a liver cyst

A

most likely hydatid cyst

83
Q

how to tx hydatid cyst

A

not aspiration due to risk of anaphylaxis

tc: surgically resect with albendazole

84
Q

cysticercosis

A

cysts in the brain or muscle

taenia solium

85
Q

management of blunt abdominal trauma in hemo unstable pts

A

FAST

  • positive –> exlap
  • inconclusive –> DPL
  • negative –> look for other areas of hemorrhage and stabilize –> then get a CT
86
Q

recurrent pneumonia in the same area of the lung should make you suspect ________. Therefore, get a ____

A
  • cancer or some sort of obstruction

- CT

87
Q

proteinuria, easy bruisability, restrictive cardiomyopathy (thickened ventricular wall, normal ventricular dimensions, slightly reduced systolic function)

A

amyloidosis

88
Q

capillary pulsations in fingers and lips may be assoc with ____

A

aortic regurgitation

89
Q

parathyroid adenoma
pituitary tumors
enterohepatic tumors (pancreatic islet cell tumor)

A

MEN I

90
Q

medullary thyroid cancer
pheochromocytoma
parathyroid hyperplasia

A

MEN IIA

91
Q

medullary thyroid cancer
pheochromocytoma
other: mucosal and intestinal neuroma, marfanoid habitus

A

MEN IIB

92
Q

exudative pleural fluid

A

Light’s criteria

  • fluid protein/serum protein > 0.5
  • fluid LDH/serum LDH > 0.6
  • pleural LDH > 2/3 the upper limits of normal serum LDH
93
Q

dementia pts are at risk for pneumonia due to ______

A

impaired epiglottic function

94
Q

lots of blood on U/A but not many RBCs on urine microscopy…

A

suspect myoglobinuria, which is often caused by rhabdo, which frequently leads to acute renal failure

95
Q

murmur increases in intensity during valsalva

A

most likely HOCM

96
Q

what to do with solitary pulmonary nodule…

A 
low risk: serial CT scans
medium risk: 
     -if small --> serial CT
     -if large --> PET followed by either serial CT or surgery
high risk: surgical excision
97
Q 
positive breath hydrogen
positive stool for reducing substances
low stool pH
increased stool osmotic gap 
NO steatorrhea
A

lactose intolerance

98
Q

what does S4 mean?

A

stiff LV due to restrictive cardiomyopathy or LVH from longstanding HTN

99
Q

mid systolic click and late systolic murmur over cardiac apex

A

mitral valve prolapse

100
Q

cor pulmonale is often caused by ______

you see JVD, right sided S3, RV heave, hepatomegaly, ascites, dependent edema, but NOT pulmonary congestion

A

COPD

101
Q

chronic malabsorption can cause vitamin D deficiency which presents as:
_____ Ca
_____ phosphate
_____ PTH

A

low
low
high

102
Q

________ is a potential complication of bronchiectasis

A

hemoptysis

NOT malignancy, LV failure, ptx, or PE

103
Q

how to approach esophageal perforation

A

water soluble contrast esophagography

tx with abx, parenteral nutrition, surgical repair

104
Q

suspicion for psoas abscess. what next?

A
  • get a CT
  • if clinical suspicion is high but CT is negative, you can do a laparoscopy
  • tx with percutaneous drainage and abx
105
Q

runners with pain between 3rd and 4th toes reproducible with palpation, clicking sensation when squeezing the metatarsal joints

A

morton neuroma

-tx with bilateral shoe inserts

106
Q

fx of bone around the ankle

burning, numbness, aching of the distal plantar surface of the foot or toes that sometimes radiates up the calf

A

tarsal tunnel syndrome

107
Q

female who exercises a lot and doesn’t weigh very much

sharp and localized pain over a bony surface that is worse with palpation

A

stress fracture

108
Q

needle shaped crystals on U/A indicate ______

A

uric acid stones (radiolucent)

109
Q

ureteral colic can cause ileus (t/f)

A

yep

110
Q

enteroclysis

A

used to dx small bowel tumors and other pathology

111
Q

RQ ratios for:
carbohydrates
protein
lipid

A

1

  1. 8
  2. 7
112
Q

how to dx breast mass

A

under 30

  • ultrasound
    • -> simple cyst- needle aspiration if patient desired
    • -> complex cyst/mass- image guided core biopsy

over 30

  • mammogram and ultrasound
    • -> suspicious for malignancy –> core biopsy
113
Q

fat malasorption can cause _______ oxalate absorption

this causes ______

A

increased

kidney stones

114
Q

if you suspect boerhaave, you should get _____ to dx it for sure

A

gastrograffin swallow

115
Q

how to tx stress fracture of metatarsal

A

rest and analgesics

116
Q

someone has symptoms of claudication.. what’s the first test?

A

ABI

117
Q

how to dx kidney stones

A

noncontrast CT

118
Q

hemo unstable blunt abdominal trauma… after fluid resuscitation, what do you do?

A

FAST before possible exlap

119
Q

if you see a carotid artery intimal flap, what do you do?

A

surgical repair

120
Q

palpable breast mass in pts over 35… what’s the first test?

A

mammogram

121
Q

unstable pt with blunt abdominal and pelvic trauma… FAST and DPL are negative… what do you do next?

A

pelvic angiography

122
Q

how to dx and tx developmental dysplasia of the hips

A

if < 4 months, dx with US (after physical exam of course)

tx with spica cast or hip harness

123
Q

trauma patient with nosebleed, what do you get before getting a head CT?

A

spine xray

OR you could get head and cspine CT

124
Q

SBO with lactic acidosis, what do you do next?

A

laparotomy

125
Q

penis fx… what to do?

A

RUG then surgery

126
Q

how to tx femoral neck fxs?

A

in young ppl- ORIF

in old ppl- primary arthroplasty

127
Q

tetanus: <3 doses and clean

A

toxoid

128
Q

tetanus: at least 3 doses, clean

A

toxoid only if last dose was > 10 years ago

129
Q

tetanus: <3 doses, dirty wound

A

toxoid and immunoglobulin

130
Q

tetanus: at least 3 doses, dirty wound

A

toxoid if > 5 years since last dose

131
Q

how to tx closed femoral shaft tx

A

closed intramedullary fixation

132
Q

how to approach airway of an apneic pt with head injury

A

orotracheal intubation or cricothyroidectomy

133
Q

how to tx pancreatic pseudocyst?

what if there’s an infection?

A
  • observe for 4-6 weeks and drain if it doesn’t resolve

- if it’s infected, drain immediately

134
Q

O2 and CO2 of the following:

  • PE and atelectasis
  • asthma/COPD and hypoventilation
A
  • hypoxia, hypocapnea

- hypoxia, hypercapnea

135
Q

what abx for perforated appendix? (gram - and anaerobes)

A

cefotetan

136
Q

teen with knee pain, no systemic sxs, sunburst radiology pattern, increased ALP

A

osteosarcoma

137
Q

blue cells, fever, weight loss, onion skin in diaphyses of long bones/spine/pelvis

A

Ewing’s

138
Q

adults with knee problems and soap bubble appearance on xray

A

osteoclastoma

139
Q

after cardiac surgery…. fever, leukocytosis, tachycardia, chest pain but NO widened mediastinum
-tx?

A

postcardiotomy syndrome

-tx: pericardial puncture if tamponade, aspirin or steroids

140
Q

how to tx acute mediastinitis and what does it often look like on CXR

A

widened mediastinum

tx wit drain, debride, abx

Surgery (5 decks)

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