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9 Surgery > UWorld - Surgery > Flashcards

UWorld - Surgery Flashcards

1
Q

Elevated amylase and abdominal pain In a cardiovascularly ill patient. Diagnosis? Procedure for diagnosis?

A

A cute mesenteric ischemia.

Diagnosed with mesenteric angiography

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2
Q

Air under the diaphragm. Next step and management?

A

Urgent exploratory laparotomy

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3
Q

What do Q waves mean on an ECG?

A

Old myocardial infarction

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4
Q

What is the most sensitive and specific test for acute pancreatitis?

A

Lipase

Amylase is less specific and sensitive.

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5
Q

First line treatment for anal fishers.

A

Increased fiber and fluid intake, stool softeners, sitz baths, topical anesthetics and vasodilators (lidocaine and Nifedipine)

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6
Q

Recent skin infection followed by abdominal pain radiating to the groin. Diagnosis?

A

Psoas major abscess

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7
Q

How to diagnose acute diverticulitis.

A

Abdominal CT scan

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8
Q

Treatment of diverticulitis associated with an abscess.

A

<3 cm IV Antibiotics

>3 cm CT guided percutaneous drainage

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9
Q

Bright red nodules in an HIV infected patient.

A

Bacillary angiomatosis caused by Bartonella (gram negative Bacillus)

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10
Q

Next step in management for patient with penetrating trauma

A

Exploratory laparotomy

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11
Q

Penetrating trauma below which intercostal space is considered an abdominal trauma until proven otherwise?

A

Fourth intercostal space

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12
Q

What type of intravenous fluid to use in burn victims and why.

A

Lactated Ringer solution
b/c It is isotonic
AND It contains a buffer (sodium lactate), which prevents hyperchloremic metabolic acidosis (which would occur if the patient were given normal saline)

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13
Q

Persistent pneumothorax despite chest tube placement. DDx?

A

Tracheobronchial perforation

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14
Q

What are the 3 categories assessed by the Glasgow Coma Scale?

A

1) Eye Opening
2) Verbal Response
3) Motor Response

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15
Q

Diagnosis when chest moves in a word on inspiration.

A

Flail chest is caused by rib fracture. More than three contiguous rib fractures.

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16
Q

Timeline for pulmonary contusion

A

Less than 24 hours after blut thoracic trauma

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17
Q

Management of Pulmonary contusion

A

Pain control, Pulmonary hygiene (nebulizer treatment, chest PT), supplemental oxygen and ventilatory support.

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18
Q

Elevation of AFP and Beta-HCG.

A

Nonseminomatous germ cell tumor

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19
Q

What is flail chest?

A

Facture of more than 3 consecutive ribs in more than 2 spaces.

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20
Q

Treatment of flail chest

A

Positive airway pressure will correct the paradoxical respiratory motion of the isolated segment of chest wall

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21
Q

Tension pneumothorax - side of deviation

A

Deviation away from affected side

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22
Q

Best step in management of a burn victim that exhibits oropharyngeal inflammation

A

Endotracheal intubation

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23
Q

What size of pneumothorax to treat with chest tube and what size to allow for observation and oxygen.

A

Small (less than 2 cm) - observation and oxygen

Large (more than 2 cm) - Needle aspiration or chest tube

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24
Q

What antihypertensives are associated with drug-induced pancreatitis?

A

Thiazides

ACEI

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25
Q

Jaundiced Patient

With Palpable Gallbladder that is NONtender

A

Courvoisier’s sign

Suggests malignancy of gallbladder or pancreas

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26
Q

Left supraclavicular adenopathy

A

Virchow’s node

Suggests malignancy in the abdomen

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27
Q

Fitz-Hugh Curtis syndrome

A

Perihepatitis in the setting of pelvic inflammatory disease. Infection and inflammation of the liver capsule and “violin string” adhesions of pertitoneum to liver. Chlamydia and gonorrhoeae.

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28
Q

How to treat an uncomplicated vs complicated small bowel obstruction (SBO)?

A

Uncomplicated SBO treat with conservative measures of bowel rest, IV fluids and NG tube.
Complicated SBO treat with surgical exploration

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29
Q

How to identify small bowel obstruction that is complicated and requires surgical exploration ASAP?

A

Small bowel obstruction will be accompanied by fever, hemodynamic instability, metabolic acidosis

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30
Q

Define oliguria

A

Less than 250 mL of urine production within 12 hours

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31
Q

Step in management for post operative oliguria

A

Bladder ultrasound scan and urinary catheterization

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32
Q

When to use oral ursodeoxycholic acid?

A

Used to treat symptomatic gallstones (when patients are having the typical symptoms of cholecystitis), but when these patients are poor surgical candidates.

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33
Q

What is volvulus?

A

When a loop of intestine twists around itself

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34
Q

Time-frame to suspect postoperative complication of: abscess

A

More than 10 days postoperatively

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35
Q

Time-frame to suspect postoperative complication of: Hospital Acquired Pneumonia

A

Less than 5 days postoperatively

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36
Q

What symptoms or signs do you look for to differentiate between acute cystitis vs choledocholythiasis.

A

Choledocholythiasis is accompanied by very high alk phos and can cause obstructive jaundice.

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37
Q

Boerhaave syndrome vs Mallory-Weiss syndrome

A

Boerhaave syndrome is transmural esophageal perforation. Mallory-Weiss syndrome is a partial mucosal tear. Boerhaave syndrome will be accompanied by crepitus in sternal notch.

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38
Q

What anabiotic‘s to use to treat a cat bite

A

Amoxicillin with clavulinate
This covers the two likely organisms from a cat bite:
Pasteurella multocida
Anaerobic Bacteria

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39
Q

Common cause of splenic abscess

A

Infective endocarditis

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40
Q

Nissan fundoplication

A

Surgery for refractory GERD

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41
Q

Liver cyst. Organism? Host?

A 
Organism = Echinococcus granulosus (tapeworm)
Host = Dog (sheep are intermediate host)
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42
Q

Liver cyst. How to diagnose and Next step in management.

A

Diagnose with ultrasound of liver.

Next step = Identify the organism Echinococcus granulosus with serology for Echinococcus granulosus IgG.

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43
Q

Liver cyst. Treatment.

A 
Small cyst (less than 5 cm) treat with antimicrobial against Echinococcus granulosus = albendazole
Large cyst (more than 5 cm) = percutaneous drainage or surgery
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44
Q

What is the most common cause of bloodstream infection in the hospital? With what organisms?

A 
Cause = Central venous catheters
Organisms = Staph aureus (majority) AND Candida (10%)
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45
Q

Chronic diabetic foot ulcer in which the bone can be palpated with a probe: Next step in management?

A

Biopsy and culture of affected bone.

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46
Q

Ureterolithiasis. What to do depending on size of stone.

A

Less than 5 mm = pass spontaneously. Recommend increased oral fluid intake (2L/day) and strain urine.
5 mm - 10 mm = Hydration, Pain control, Alpha blockers (e.g. tamsulosin) and strain urine.
More than 10 mm = Urology consult and consider lithotripsy

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47
Q

When is a urology consult and possible lithotripsy warranted?

A 
When stone is more than 10 mm.
OR
Any size stone WITH other symptoms such as:
Urosepsis (e.g. fever, altered mental status)
Complete obstruction (anuria)
Acute Kidney Injury
Refractory pain (pain meds don't work)
Nausea/Vomiting
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48
Q

Vibrio vulnificus
Causes what kind of infection?
Treatment?

A

Vibrio vulnificus causes a food-bourne illness from contaminated seafood.
ALSO causes wound infections from contact with contaminated water, which can be rapidly progressive (less than 12 hrs) and highly fatal.
Treatment = IV ceftriaxone and doxycycline.

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49
Q

These patients have increased risk of infection with Vibrio vulnificus

A

Patients with liver disease (cirrhosis, hepatitis, hereditary hemochromatosis)

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50
Q

Pasteurella infection. Source?

A

Dog/cat bites/scratch

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51
Q

Infection with what organism can occur from hot tub water?

A

Pseudomonas aerguinosa

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52
Q

Top organisms that cause cellulitis

A

Staph aureus

Strep pyogenes

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53
Q

Initial hematuria vs. Terminal hematuria vs. Total hematuria. Causes?

A 
Initial hematuria (at beginning of voiding) = Damage to Urethra
Terminal hematuria (at end of voiding) = damage to bladder/prostate
Total hematuria = damage to kidney/ureter
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54
Q

What part of the GI is affected by inflammatory bowel disease?

A

Depends on the type of inflammatory bowel disease.
Crohn’s disease = any part of GI, EXCEPT rectum. Crohn’s has skip lesions.
Ulcerative colitis = colon (colitis = colon). Continuous. ALWAYS rectum involved.

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55
Q

What type of disease affects colon transmurally and what type only mucosa and submucosa.

A

Transmural = Crohn’s

Mucosa and Submucosa = Ulcerative colitis

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56
Q

Treatment of Clostridium difficile

A

Oral metronidazole

If refractory then oral vancomycin

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57
Q

Small-bowel obstruction on imaging will show ________

A

Dilated loops of small bowel AND air-fluid levels

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58
Q

What is ileus?

Ileus on imaging will show _______

A

Ileus is intestinal hypomotility without obstruction.
On imagine ileus shows:
Dilation of BOTH small and large bowel.
NO air-fluid level

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59
Q

Small-bowel obstruction vs. Ileus. What kind of bowel sounds do you hear?

A

Small-bowel obstruction = high-pitched hyperactive bowel sounds
Ileus = HYPOactive bowel sounds

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60
Q

How to diagnose Acute Urinary Retension?

A

Bladder ultrasound demonstrating more than 300 mL of urine.

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61
Q

How soon after intubation does ventilator-associated pneumonia (VAP) occur? If suspected, how is VAP diagnosed? Treament?

A

VAP occurs more than 48 hrs after intubation.
Diagnose with lower respiratory tract endotracheal tube sample – gram stain and culture.
Treatment = empiric antibiotics

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62
Q

Diagnosis:
Anal pain PLUS fever
vs.
Anal pain NO fever

A

Anal pain PLUS fever = perianal abscess (caused by occlusion of anal crypt gland)
Anal pain NO fever = external hemorrhoid (hemorrhoid below dentate line)

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63
Q

1st and 2nd steps in a person with suspected esophageal variceal bleeding.

A

1) IV access: 2 large-bore IV catheters

2) Volume resuscitation, IV octreotide, antibiotics

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64
Q

How high is the temperature seen in malignant hyperthermia?

A

More than 40 C

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65
Q

If you suspect postoperative fever due to Clostridium difficile then what is the timeline?

A

Postoperative C diff = 1 week - 1 month after surgery

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66
Q

Why do alcoholics have poor wound healing?

A

Vit C deficiency causes impaired wound healing.

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67
Q

Why do alcoholics have gums that bleed easily?

A

Vit C deficiency causes gingivitis.

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68
Q

Why do patients with Crohn disease or other intestinal diseases that cause fat malabsorption develop nephrolithiasis?

A

Patient’s with Crohn’s disease or other fat malabsorption have increased oxalate absorption, which leads to oxalate stones.
Fat malabsorption causes calcium to remain bound to fat instead of oxalate – free oxalate is absorbed at higher rates.

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69
Q

Extraperitoneal bladder injury
vs
Intraperitoneal bladder injury
What anatomic region does each relate to?

A

Extraperitoneal bladder injury = injury of neck/anterior wall/anteriolateral wall of bladder. Associated with pelvic fracture
Intraperitoneal bladder injury = Rupture of dome of bladder, which is next to peritoneal space. Causes chemical peritonitis which presents as diffuse abdominal tenderness. Less likely with pelvic fracture.

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70
Q

Patient with RUQ pain. Patient receives morphine, but this worsens the pain. Diagnosis? Explanation.

A

Diagnosis = Sphincter of Oddi dysfunciton

Explanation: Opioid analgesics may cause sphincter contraction, worsening the symptoms of Sphincter of Oddi dysfunction

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71
Q

Pelvic fracture in a male. Next step in management.

A

Pelvic fracture in males is associated with Posterior Urethral Injury. Pt should undergo retrograde urethrogram to evaluate for the diagnosis.

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72
Q

What ankle brachial index (ABI) is considered normal. And what ABI value is diagnostic for Peripheral Artery Disease?

A

Normal = 0.91 - 1.30

Peripheral Artery Disease < 0.9

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73
Q

What valvular complication can arise after cardiac pacemaker or cardioverter-defibrillator placement?

A

Tricuspid valve regurgitation

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74
Q

Widened mediastinum on chest X-ray. Next step in management.

A

CT angiography

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75
Q

When does a pulmonary nodule require biopsy?

A

> 0.8 cm requires excision or biopsy, due to high probability for malignancy (>5%)

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76
Q

How does Zenker diverticulum develop?

A

Motor dysfunction of upper esophageal sphincter or esophagus, causes herniation though the cricopharyngeal muscle.

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77
Q

Sings and timeline of Transfusion-Related Acute Lung Injury (TRALI)

A

Fever, hypotension, noncardiogenic pulmonary edema within 6 hours of blood product administration.

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78
Q

Why can patients with ruptured aortic aneurysm develop hematuria?

A

AAA rupture can cause aortocaval fistula. Venous congestion backs blood up to the fragile veins of the bladder.

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79
Q

Post Myocardial infarction complications timeline within the 1st week after MI.

A

24 hrs = Cardiac arrhythmia
1-3 days = Pericarditis
3-5 days = Interventricular septal rupture
2-7 days = Papillary muscle rupture

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80
Q

Post Myocardial infarction complications timeline within 2 weeks of MI

A

5-14 days = Ventricular free wall rupture

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81
Q

Post Myocardial infarction complications after 2 weeks

A

Dressler syndrome = Autoimmune pericarditis

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82
Q

What is Kussmaul sign?

A

A rise in jugular venous pressure on inspiration. Normally, JVP decreases on inspiration because thoracic cavity expansion allows for more blood to return to the right side of the heart.
Kussmaul sign indicates Right Heart dysfunction.

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83
Q

Compare the timeline for post Myocardial Infarction complication of:
1) Interventricular septal rupture
vs.
2) Ventricular free wall rupture

A

Interventricular septal rupture = 3-5 days after MI

Ventricular free wall rupture = 5-14 days after MI

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84
Q

Compare the timeline for post Myocardial Infarction complication of:
1) Fibrous pericarditis
vs.
2) Autoimmune pericarditis

A 
Fibrous pericarditis = < 24 hrs after MI
Autoimmune pericarditis (Dressler syndrome) = > 2 wks after MI
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85
Q

If you see multiple liver lesions on CT scan then what is the next necessary diagnostic test? why?

A

Colonoscopy

because Colorectal cancer is the most common source of liver metastasis

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86
Q

Early post-op complication of abdominal aortic aneurysm repair.

A

Ischemia of the bowel

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87
Q

What is Pulmonary Capillary Wedge Pressure (PCWP) in the setting of trauma that caused myocardial contusion?

A

Myocardial contusion = Cardiogenic shock

Cardiogenic shock has elevated PCWP, due to backup from left ventricle dysfunction.

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88
Q

What is Pulmonary Capillary Wedge Pressure (PCWP) in tension pneumothorax?

A

Normal PCWP

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89
Q

Main risk factor for cholangiocarcinoma.

A

Primary Sclerosing Cholangitis

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90
Q

Malignant hyperthermia is caused by what?

A

Volatile anasthetics, succinylcholine

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91
Q

Neuroleptic malignant syndrome is caused by what?

A

Neuroleptic agents such as haloperidol, fluphenazine

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92
Q

In what part of the mediastinum is this structure?

Thymus

A

Anterior mediastinum

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93
Q

In what part of the mediastinum is this structure?

Esophagus

A

Posterior mediastinum

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94
Q

In what part of the mediastinum is this structure?

Trachea

A

Superior mediastinum

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95
Q

In what part of the mediastinum is this structure?

Heart

A

Middle mediastinum

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96
Q

Treatment of aspiration pneumonia

A

Clindamycin

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97
Q

Next step in management if you suspect pulmonary embolism.

A

CT angiogram of the chest

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98
Q

When to perform Rapid Strep Antigen Test

A

Group A Strep Pharyngitis Testing is performed when 2 or 3 of the Centor Criteria are met:
1) History of Fever
2) Tender anterior cervical lymphadenopathy
3) Tonsillar exudates
4) Absence of cough (NOT presence)
HOWEVER if all 4 are present then Rapid strep is not necessary – proceed to empiric penicillin or amoxicillin.

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99
Q

What labs help you to diagnose prerenal acute kidney injury?

A

Prerenal BUN/CR ration is > 20

100
Q

How to treat postsurgical acute kidney injury.

A

Intravenous Isotonic Fluid due to volume depletion.

101
Q

Next step in management after discovering a palpable breast mass.

A

Age over 30 = Mammogram

Age under 30 = Ultrasonogram

102
Q

What labs help you to diagnose prerenal acute kidney injury?

A

Prerenal BUN/CR ration is > 20

103
Q

How to treat postsurgical acute kidney injury.

A

Intravenous Isotonic Fluid due to volume depletion.

104
Q

Next step in management after discovering a palpable breast mass.

A

Age over 30 = Mammogram

Age under 30 = Ultrasonogram

105
Q

How does Crohn’s disease lead to Kidney Stones.

A

Crohn’s causes malabsorption of fat
Calcium binds to fat instead of Oxalate
= INCREASED Oxalate reabsorption by intestines
Results in Calcium Oxalate Kidney Stones

106
Q

Treatment of uric acid kidney stones

A

Alkalization of urine

potassium citrate OR potassium bicarbonate

107
Q

An asymptomatic hard mass on the hard palate.

A

Torus Palatinus (a benign bony growth)

108
Q

Complication that can occur by trauma to back of throat (e.g. fishbone)

A

Trauma to posterior pharynx

  • -> Retropharyngeal Abcess
  • -> Drain into Superior Mediastinum
  • -> Extend through alar fascia into Danger Space
  • -> Acute Necrotizing Mediastinitis
109
Q

Initial management of osteoarthritis.

A

Quadriceps strengthening exercises

110
Q

Treatment of heparin-induce thrombocytopenia

A

Stop Heparin

Switch to Argatroban

111
Q

Succinylcholine side effect, mechanism

A

Hyperkalemia: Succinylcholine is a depolarizing neuromuscular blocker that causes sodium influx and potassium eflux. Therefore succinylcholine should not be used in a patient with muscle injury. such patients have rhabdolysis, which places them at risk for hyperkalemia. Furthermore, skeletal muscle injury leads to upregulation of post synaptic acetylcholine receptors, which would make the effect of succinylcholine more dangerous. These patients should receive nondepolarizing neuromuscular blockers instead: e.g. rocuronium

112
Q

Halothane side effect, mechanism

A

Acute liver injury
Halothane is a general anesthetic, inhalation
Halothane makes hepatotoxic intermediary compounds

113
Q

Etomidate: side effect and mechanism

A

Adrenal insufficiency due to 11-beta hydroxylase inhibition.

Etomidate is an IV short acting anesthetic

114
Q

Nitrous oxide: Side effect and mechanism

A 
Peripheral neuropathy (neurotoxicity)
Nitrous oxide inactivates vitamin B12
115
Q

Propofol side effect

A

Propofol can cause myocardial depression and severe hypotension

116
Q

Supracgondylar fracture of the humerus: Arteries and nerves that may be damaged

A

Posterior displacement of the distal humerus
= Damage to brachial artery and median nerve (anterior structures)

Anterior displacement of the distal humerus
= damage to ulnar nerve
(Posterior structure)

117
Q

Injury to proximal humerus: damaged structures?

A

Axillary Artery

Axillary Nerve

118
Q

After anesthetic patient has pulse oximetry of 85%, but lab returns O2 Sat of 99%. Diagnosis? What anesthetic caused this?

A 
Diagnosis = Acquired methemoglobinemia (Iron is oxidized = Fe3+)
Anesthetic = Local anesthetic (benzocaine)
119
Q

What medications can cause methemoglobinemia?

A

Benzocaine = local anesthetic
Dapsone = antibiotic used to treat leprosy
Nitrites in infants

120
Q

Paget predisposes to __________

A

Osteosarcoma

121
Q

Pain on passive stretch in leg

A

Compartment syndrome

122
Q

Diagnosis: Wrist pain of new mothers who hold their infants.

A

De Quervain tenosynovitis (fibrous sheath at the radial styloid process)

123
Q

Skin finding on fat embolism

A

Petechial rash

124
Q

Diagnosis and treatment:

Most common cause of knee pain in young athlete, reproducible by compressing the patella

A

Patellofemoral Pain Syndrome

Tx = Quadriceps strengthening exercises AND NSAIDS

125
Q

What is the skin cancer that can develop within a burn wound?

A

Squamous Cell Carcinoma

on top of burn known as: Arjolin Ulcer

126
Q

What is the skin cancer that can develop after radiation therapy?

A

Angiosarcoma

127
Q

Treatment of Acute Bacterial Prostatitis

A

Most likely organism = E Coli

Tx = Lovfloxacin

128
Q

Infection in the submandibular space. Diagnosis? Mechanism?

A

Ludwig angina

- most cases arise from dental infections

129
Q

Pyoderma gangrenosum is associated with what conditions?

A

Pyoderma Gangrenosum associated with:
Inflammatory Bowel Disease (Crohn’s/UC)
Inflammatory arthropathies (e.g. rheumatoid arth.)
Hematologic conditions (acute myeloid leukemia)

130
Q

Ecthyma gangrenosum.
What is it?
What is it caused by?

A

Ecthyma Gangrenosum is a rapidly progressive necrotic cutaneous lesion, caused by pseudomonas aerguinosa

131
Q

Erythema nodosum.
What is it?
What is it associated with?

A 
Erythema nodosum = panniculitis (raised inflammatory lesions of subcutaneous fat, usually on anterior shins.
Associated with:
Sarcoidosis
Coccidiomycosis
Histoplasmosis
TB
Streptococcal infections
Leprosy
Inflammatory Bowel Disease
132
Q

What should you suspect if you see a lesion at the margin of a scar? And what is your next step in management?

A

Squamous Cell Carcinoma

Next step = Biopsy

133
Q

Treatment of symptomatic keloids

A

Intralesional glucocorticoids

134
Q

Premalignant lesions caused by sun exposure.
Diagnosis?
Treatment?

A 
Dx = Actinic Keratosis (can develop to Squamous Cell Carcinoma)
Tx = Fluorouracil cream
135
Q

On Physical Exam, how to distinguish between:
Epidermal inclusion cyst
and
Lipoma

A

Epidermal inclusion cyst = firm mobile nodule

Lipoma = soft to rubbery and irregular

136
Q

On physical exam, how to distinguish between:
Basal cell carcinoma
and
Squamous cell carcinoma

A

Basal cell carcinoma = pearly papule or plaque
(BCC = most common type of skin cancer, more likely above lip)
Squamous cell carcinoma = scaly papule or plaque
(SCC = 2nd most common, more likely below lip)

137
Q

Ropy mass in upper scrotum.

Diagnosis? Mechanism? Complication?

A 
Dx = Varicocele
Mechanism = dilation of pampiniform plexus
Complication = infertility
138
Q

Prosthetic joint infection timetable.

A

< 3 months = staph aureus, pseudomonas
3-12 months = staph epidermidis
> 12 months = hematogenous spread of a distant infection (e.g. UTI)

139
Q

What is Todd paralysis?

A

Transient unilateral weakness after a tonic-clonic seizure

140
Q

What do you see on physical exam for:
Anterior shoulder dislocation
vs
Posterior shoulder dislocation

A

Anterior shoulder dislocation = Arm is ABDucted and EXTernally rotated
Posterior should dislocation = Arm is ADDucted and INTernally rotated

141
Q

What tumor markers are elevated in testicular cancer?

A

AFP
beta-HCG
LDH

142
Q

What type of skin malignancy is most common in patients who are on chronic immunosuppressive therapy?

A

Squamous Cell Carcinoma

143
Q

Symptoms of bite from:
Brown Recluse Spider
vs
Black Widow Spider

A

Brown Recluse Spider = small painful erythematous ulcer that develops into necrosis and eschar.
Black Window Spider = Muscle pain, Abdominal rigidity, Muscle cramps

144
Q

Back pain and matastasis to lungs in a young man.
Dx?
Test?

A 
Dx = Testicular Cancer
Test = Scrotal ultrasound AND tumor markers (AFP, beta-HCG)
145
Q

What is Peyronie Disease?

Tx?

A

Peyronie Disease = Penile pain and curvature caused by fibrous plaques in the tunica albuginea, which result from repetitive blunt trauma.
Tx: Resolve spontaneously over 1-2 years.

146
Q

Dysuria, increased urinary frequency, pain on ejaculation in a young man. Examination reveals a nontender prostate. Urinanalysis shows Leukocyte esterase positive and Nitrites positive.
Dx?
Tx?

A 
Dx = Chronic bacterial prostatitis
Tx = Fluoroquinolones for 6 wks
147
Q

Does a patient with chronic bacterial prostatitis have to have a swolen and tender prostate on examination.

A

No, in fact prostatic tenderness and swelling is often absent in chronic bacterial prostatitis.

148
Q

What kind of testicular cancer produces excessive estrogen?

A

Leydig cell tumor

149
Q

Tumor marker testing in yolk sac tumor (testicle).

A

High AFP

150
Q

Tumor marker testing in choricarcinoma (testicle)

A

hCG

151
Q

Forceful flexion of the wrist with abduction of the thumb when a nurse is measuring blood pressure.

A

This is called Trousseau sign.

Characteristic of HYPOcalcemia

152
Q

Complication of circumferential burn.

A

Acute compartment syndrome

153
Q

Thyroid with many follicular cells arranged in microfollicles. DDx?

A

Either Benign Thyroid Adenoma OR Follicular Thyroid Cancer. Follicular Thyroid Cancer will also demonstrate invasion of the tumor capsule blood vessels.

154
Q

Thyroid with psammoma bodies

A

Papillary Thyroid Cancer

155
Q

How to differentiate between testicular torsion and epididymitis.

A

Epididymitis (e.g. gonorrhoeae or chlamydia) and testicular torsion can present similarly, with an elevated testicle with tenderness and swelling. To differentiate the 2:
Cremaster Reflex: No reflex (Negative) in testicular torsion, Yes reflex (Positive) in epididymitis
Prehn sign (elevation of testes): Does NOT relieve pain (negative) in testicular torsion, Relieves pain (Positive) in epididymitis

156
Q

Soft tissue crepitus is associated with infection with what organism?

A

Gas-forming organism

Most likely Clostridum perfringens

157
Q

Numbness and paresthesias at the toes and distal sole. Exacerbated when tapping on the medial maleolus. Dx? Mechanism?

A 
Dx = Tarsal Tunnel Syndrome
Mechanism = entrapment of posterior tibial nerve
158
Q

Pain on plantar aspect of heel and hindfoot. Worse on standing. Dx? Mechanism?

A 
Dx = Plantar fasciitis
Mechanism = Inflammation of plantar aponeurosis
159
Q

Pain in posterior heel, reproduced by passive dorsiflexion. Dx? Mechanism?

A 
Dx = Achilles tendionpathy
Mechanism = Inflammation of Achilles tendon
160
Q

Pain in heel. Worse on standing. Pain elicited upon squeezing heel. Dx? Mechanism?

A 
Dx = Calcaneal stress fracture
Mechanism = overuse injury to the bone
161
Q

Topical medication used to treat anal fishers.

A

Lidocaine, for pain

Topical vasodilators such as nitroglycerin and nifedipine.

162
Q

What’s skin finding is associated with inflammatory bowel disease?

A

Pyoderma gangrenosum

163
Q

Steatorrhea and foul smelling stools in alcoholic patient. DX?

A

Chronic pancreatitis

164
Q

Liver cysts. Cause? Treatment?

A

Echinococcus granulosus
- Dog tapeworm (sheep intermediate host)
- Usually acquired by humans through ingestion of food or water contaminated by dog feces
Tx = Albendazole

165
Q

Biliary disease caused by ingestion of what food? Organism? What is the biliary disease? Treatment?

A 
Food = Undercooked fish
Organism = Chlonorchis sinesis
Disease = Biliary tract inflammation with pigmented gallstones, associated with cholangiocarcinoma
Tx = Praziquantel
166
Q

Close contact with dogs in 3rd world countries can lead to infection with what organism? What disease does it cause? What is the treatment?

A 
Organism = Echinococcus granulosus
Disease = Multiple Liver Cysts
Tx = Albendazole
167
Q

Consumption of pork can lead to infection with what organism? What disease does it cause? Treatment?

A 
Organism = Taenia solium
Disease = tape worm, if eggs ingested from human feces then it can go to brain = seizures
Tx = Praziquantel. If Brain affected then Albendazole
168
Q

Consumption of what can lead to liver abscess? Other symptoms? Organism? Treatment?

A

Liver abscess can be caused by Entamoeba histolytica, which can be consumed as cysts in water. NOT to be confused with multiple liver cysts which are caused by Echinococcus granulosus, which is caused by consumption of food contaminated by dog feces. Entamoeba histolytica is treated with Metronidazole.

169
Q

What organism causes liver cysts? Liver Abscess? Treatment?

A

Liver cysts = Echinococcus granulosa (a tapeworm from food contaminated with dog feces). Tx = Albendazole
Liver abcess = Entamoeba histolytica (a protozoan from cysts in water). Tx = Metronidazole

170
Q

How to treat patient that is hyponatremic and with altered mental status after surgery?

A

Tx = Hypertonic (3%) saline

171
Q

Postoperative patient who is severely hypotensive and IV fluids do not help. Dx? Tx?

A 
Dx = Adrenal Crisis
Tx = IV hydrocortisone
172
Q

What diagnosis does a high-riding prostate suggest if a person has recently been in a traumatic accident?

A

Posterior Urethral Injury (PUI)

173
Q

Patient was in a motor vehicle accident. Blood is seen in the urethral meatus. Dx? Next step in management?

A

Dx = pelvic fracture with posterior urethral injury

Next step = retrograde urethrogram

174
Q

Hypoxia after blunt thoracic trauma. X-Ray shows alveolar opacities in right and left lower lobes. Dx?

A

Pulmonary contusion

175
Q

Next Step in Management if you suspect peptic ulcer disease with perforation.

A

Upright X-Ray to look for free intraperitoneal air under the diaphragm (pneumoperitoneum)

176
Q 
Central Cord Syndrome
vs
Anterior Cord Syndrome
vs
Posterior Cord Syndrome
A

Central Cord Syndrome = usually due to a hyperextension injury in the elderly. Causes weakness in upper extremities.
Anterior Cord Syndrome = Bilateral Spastic Motor Paralysis distal to the lesion
Posterior Cord Syndrome = Bilateral loss of vibratory and proprioceptive sensation. Often accompanied by urinary incontinence/retention.

177
Q

Brown Sequard Syndrome. Mechanism? Symptoms?

A 
Mechanism = Hemisection of spinal cord
Symptoms = Ipsilateral weakness, spasticity, loss of vibration and proprioception. Contralateral loss of pain and temp.
178
Q

Cellulitis of the submandibular space. Diagnosis? Cause?

A 
Dx = Ludwig angina
Cause = Usually a dental infection
179
Q

Most common causes of fever within 2 hours after surgery.

A
  • Febrile Nonhemolytic Blood Transfusion Reaction (due to cytokines released by leukocytes during blood storage)
  • Malignant Hyperthermia (+ muscle rigidity, due to inhaled anesthetic)
180
Q

Treatment for acute bacterial prostatitis.

A

If patient is not urinating then first place a suprapubic catheter, as use of a urethral catheter can lead to sepsis due to dislodging of bacteria from infected prostate.
Follow with antibiotic treatment = A fluoroquinolone (Levofloxacin) OR Trimethrorpim-Sulfamethoxazole (Bactrim)

181
Q

Any penetrating wound injury below _________ is considered to involve the abdomen and requires an exploratory laporotomy in unstable patients.

A

4th intercostal space (nipple line)

182
Q 
How to tell apart:
Inflammatory Breast Cancer
vs
Breast Abscess
vs
Clogged Lactiferous Duct
A

Inflammatory breast cancer = Solid (NOT fluctuant) mass with Axillary lymphadenopathy (+Peau d’orange skin)

Breast Abscess = Fluctuant (NOT solid) mas and Axillary Lymphadenopathy

Clogge Lactiferous duct = No axillary lymphadenopthy

183
Q 
Next step in management if suspecting:
Inflammatory Breast Cancer
vs
Breast Abscess
vs
Clogged Lactiferous Duct
A

Inflammatory Breast Cancer = Core needle and skin punch biopsy

Breast Abscess = Needle aspiration and antibiotics

Clogged lactiferous duct = warm compress and massage

184
Q

At what platelet level is platelet transfusion required?

A

When PLT is <50,000

185
Q

Medication given to patients preoperatively to prevent excessive bleeding if they have mild hemophelia A.

A

Desmopressin

increases factor VII levels by causing vWF factor release from endothelial cells

186
Q

Define postoperative oliguria

A

< 0.5 mL/kg/hr

187
Q

What anticoagulants are contraindicated in end-stage renal disease?

A

Low molecular heparin (eg Enoxaparin)
AND
Rivaroxaban

188
Q

Periodic epigastric pain relieved by meals

A

Peptic duodenal ulcer

189
Q

Femoral nerve area of sensation and muscle function

A

Sensation = Anterior thigh
and medial leg (via saphenous branch)
Muscle function = flexion at hip and extension at knee

190
Q

Common peroneal nerve area of sensation and muscle function

A 
Sensation = Lateral leg and foot
Function = Dorsiflexion (damage = drop foot)
191
Q

What nerve accompanies the spermatic cord through the superficial inguinal ring?

A

Ilioinguinal nerve

192
Q

Obturator nerve area of sensation and muscle function.

A 
Sensation = medial thigh
Function = Hip adduction
193
Q

Tibial nerve area of sensation and muscle function

A 
Sensation = sole of foot
Function = Plantarflexion
194
Q

Cause of most deep infections following puncture wounds. E.g. nail through shoe

A

Staph aureus and Pseudomonas aerguinosa

195
Q

Describe Factor V Leiden

A

Factor V Leiden is an autosomal dominant disease associated with venous thromboembolism (VTE), myocardial infarction, and stroke

196
Q

Antihypertensives that are associated with drug-induced pancreatitis

A

Thiazides

ACEI

197
Q

High PaCO2, low PaO2. Dx?

A

Dx = alveolar hypoventilation

198
Q

Fat embolism symptoms

A

Respiratory distress
Neurological abnormalities
Petechial rash

199
Q 
ONLY beta-HCG elevated
vs
ONLY AFP elevated
vs
BOTH beta-HCG and AFP elevated
A

beta-HCG = seminomatous germ cell tumor
AFP = Hepatocellular carcinoma
beta-HCG + AFP = non-seminomatous germ cell tumor

200
Q

Lid lag. Dx?

A

Hyperthyroidism

201
Q

Edema and purple papules appear on a patient’s skin years after radiation therapy for a cancer. Dx?

A

Angiosarcoma

tumor of the internal lining of blood vessels or lymphatic vessels

202
Q

Timetable for ventilator-associated pneumonia

A

more than 48 hours after endotracheal intubation

203
Q

Single liver mass and positive FOBT. Dx?

A

Dx = colorectal cancer with matastasis to liver

204
Q

Right upper quadrant pain and oral contraceptive use. Dx?

A

Hepatic adenoma

205
Q

Ewing sarcoma. When is the pain worse?

A

At night

206
Q

What are you worried about if a patient has low blood pressure withing 12 hours after cardiac cathetarization? Next step?

A

Femoral artery hematoma

Next step = diagnose with non-contrast CT of abdomen and pelvis

207
Q

If someone is having an MI what values do you expect for Cardiac Index and Pulmonary Capillary Wedge Pressure?

A
  • LOW Cardiac Index (LV dysfunction)

- HIGH Pulmonary Capillary Wedge Pressure (backup from LV dysfunction)

208
Q

If someone has a PE then what values do you expect for Cardiac Index and Pulmonary Capillary Wedge Pressure?

A
  • LOW Cardiac Index (low LV preload)

- Normal/Low PCWP

209
Q

Timetable for transfusion-related lung injury

A

Within 6 hours of giving blood product

210
Q

How does Syringomyelia present?

A

Loss of pain and temperature in upper extremities.
“Cape-like distribution”
Preserved touch, vibration, proprioception
May affect motor fibers (flaccid paralysis)

211
Q

After a pelvic injury. What symptoms can tell you what area of the bladder is injured if you find hematuria?

A

Intraperiotoneal bladder rupture (dome of bladder) presents with peritoneal signs (diffuse abdominal tenderness, guarding, rebound)
Extraperitoneal bladder rupture (NOT dome of bladder) presents without signs of peritonitis.

212
Q

What is furnuculosis?

A

A furnucle is a skin abcess that presents as a painful pustule or nodule typically draining purulent material. Usually staph aureus.

213
Q

What is intertigo?

A

Intertigo is skin infection with Candida. Presents as erythematous plaques.

214
Q

Next step in management if a patient has abdominal pain, bloody diarrhea plus high temperature, hypotension.

A

Suspect toxic megacolon (C diff)

Next step = X-ray (looking for colonic distension)

215
Q

Trachea is deviated towards diseased side. Dx?

A

Dx = Atelectasis

216
Q

Trachea is deviate away from diseased side. DDx?

A

DDx = Pneumothorax, Pleural effusion

217
Q

How to differentiate between pneumothorax and hemotorax on physical exam?

A

Both will present with decreased breath sounds on the affected side. However, percussion can be used to differentiate. Hemothorax will present with dullness to percussion. Pneumothorax will be hyperesonant to percussion.

218
Q

Next step in management depending on size of urethral stone.

A

Less than 5 mm - Discharge and instruct pt to drink more fluids
5-10 mm - alpha blocker
More than 10 mm = urology consult

219
Q

Pes anserinus pain syndrome. Where is the pain?

A

Medial aspect of knee

220
Q

Blunt abdominal trauma. Abdominal pain. Next step - next next step.

A

Next step = FAST exam
If FAST negative
Next next = CT abdomen

221
Q

How does an injury to axillary nerve occur?

A

Anterior dislocation of the humeral head. Caused by a blow to an arm that is externally rotated and abducted.

222
Q

How does an injury to radial nerve occur?

A

Humerus mid-shaft fracture

Improperly fitted crutches

223
Q

Crepitus in the suprasternal notch. Dx?

A

Suprasternal crepitus is a sign of subcutaneous emphysema of the neck (pneumomediastinum) caused by esophageal perforation.

224
Q

Tests used to diagnose esophageal perforation.

A

Water-soluble contrast esophogram

CT-scan/X-ray

225
Q

If you suspect esophageal variceal hemorrhage then what is the next step in management? Next next step? Next Next Next?

A

Next step = Place 2 large-bore IV catheters
Next next = Volume resuscitation, IV octreotide, Antibiotics
Next next next = Endoscopic therapy of esophageal varices

226
Q

Differential diagnosis for an anterior mediastinal mass.

A 
The 4 Ts:
Thymoma
Teratoma (germ cell tumor)
Thyroid Neoplasm
Terrible Lymphoma
227
Q

Atypical lymphocytes in blood smear.
Ulcers on colonoscopy.
Dx?
Risk Factors?

A

Dx = Cytomegalovirus

Risk factors = Immunosuppressed pt

228
Q

If someone develops Heparin Induced Thrombocytopenia, what drugs can they be switched to.

A

Direct thrombin inhibitor (Argatroban)

Factor Xa inhibitor (Fondaparinux)

229
Q

Diuretics used to treat hypokalemia.

A

Potassium sparing diuretics: spironolactone, eplerenone, amiloride, triamterene

230
Q

Diuretics used to treat hypocalcemia

A

Thiazide diuretics

231
Q

Diuretics used to treat hypercalcemia.

A

Loop diuretics

232
Q

Diretics used to treat hyperkalemia

A

Loop diuretics

233
Q

Always suspect __________ in a patient that is hypertensive and hypokalemic.

A

Hyperaldosternism

234
Q

What size adrenal adenoma to resect.

A

More than 6 cm

High risk of cancer

235
Q

Duodenal ulcer vs peptic ulcer causes.

A

Duodenal ulcer = H pylori OR Gastrinoma

Peptic ulcer = H pylori OR NSAIDs

236
Q

Diagnostic test for Meckel diverticulum

A

A radioisotope scan (technetium) looking for gastric mucosa in the lower abdomen.
What it will show if individual has Meckel = The abdomina scintigram, using technetium 99m petechnetate, shows uptake in the right lower quadrant separate from the activity in the stomach, kidneys and bladder.

237
Q

“currant jelly stool” Dx?

A

Intrussusception

238
Q

What do you see on ultrasound imaging in:
Chronic pancreatitis
vs
Pancreatic cancer

A

Chronic pancreatitis = pancreatic calcifications

Pancreatic cancer = intra- and extra- heptic biliary dilation

239
Q

Patient has acute bacterial endocarditis and midabdominal pain. What should you suspect?

A

Acute mesenteric ischemia

240
Q

Elevated pulmonary capillary wedge pressure should make you suspect what?

A

Cardiac dysfunction

241
Q

If you suspect temporal arteritis then what is the next step in management?

A

Prednisone and temporal artery biopsy TOGETHER, IMMEDIATELY

242
Q 
Serum markers for:
Pancreatic cancer
Hepatocellular Carcinoma
Cholangiocarcinoma
Colon Cancer
A

Pancreatic ca = CEA(normal); CA19-9(High); AFP(normal)
Hepatocellular ca = CEA(normal); CA19-9(normal); AFP (High 50% of cases)
Cholangiocarcionoma = CEA(High); CA19-9(High); AFP (normal)
Colon ca = CEA(High); CA19-9(High); AFP(normal)

243
Q

How to differentiate between breast abscess and clogged lactiferous duct? What are the different treatments?

A

Breast Abscess develops from untreated mastitis, so the inflammation can include the areola. Breast Abscess can include systemic inflammatory signs such as axillary lymphadenopathy and fever. Breast abscess is treated with needle aspiration and antibiotics (cover staph aureus with dicloxacillin, cephalexin)

Clogged lactiverous duct is usually subareolar and NOT associated with axillary lymphadenopathy. Treat with warm compress and massage.

244
Q

How to differentiate between the cause of liver abscess:
Protozoal infection
vs
Tapeworm infection

A

Protozoal liver abscess = Etamoeba histolytica. Symptoms include DIARRHEA. Diagnosis by stool ova and parasites. Treat with metronidazole.

Tapeworm (cestode) infection = Echinococcus granulosus. Symptoms do NOT include diarrhea. Treat with Albendazole.

245
Q

Non-tender solitary node in head or neck. Dx?

A

Head and Neck Cancer = most often Squamous Cell Carcinoma

246
Q

Prostatitis antibiotic treatment

A

Trimethorpim-sulfamethoxazole
OR
Fluoroquinolone

9 Surgery (3 decks)

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