Surg

Question 1

hypoCa, hyperK, normal renal fx –> condition?

Answer 1

hypoPTH

Question 2

pt w classic presentation of acute appendicitis –> next step?

Answer 2

appendectomy, NOT imaging

Question 3

small (<2cm) pneumothorax –> next step?

Answer 3

observation & supplemental O2

Question 4

UE –> muscle weak, sensory loss –> dx?

Answer 4

syringomyelia

Question 5

syringomyelia: pathophys

Answer 5

spinal cord –> central canal –> CSF drainage disrupted –> cyst –> compress surrounding neural tissue

Question 6

syringomyelia: 2 most common cause

Answer 6

• Arnold-Chiari malformation

- prior spinal cord injury –> ie whiplash

Question 7

syringomyelia: most commonly affected which spinal tracts?

Answer 7

• spinothalamic tract (pain & temp)

- corticospinal tract (UE motor)

Question 8

syringomyelia: PE findings

Answer 8

• decreased strength, pain/temp in arms/hands or cape-like distribution
• dorsal column fx preserved –> normal light touch, vibration, position sense

Question 9

syringomyelia: how dx?

Answer 9

MRI

Question 10

SBO + hemodynamic instability –> next step?

Answer 10

urgent surg exploration

Question 11

SBO –> when require immed surg (3)?

Answer 11

• clinical/hemodynamic instability
• fail to improve after initial conservative measures
• dev ssx of ischemia/necrosis

Question 12

ileus –> classic XR finding?

Answer 12

small & large intestine –> gas-filled, uniformly distended w no transition pt

Question 13

traumatic injury –> abd pain –> most likely dx?

Answer 13

paralytic ileus

Question 14

ileus –> causes (4)

Answer 14

• # 1 abd surg
• retroperitoneal/abd hemorrhage/inflamm
• intestinal ischemia
• electrolyte abnormal

Question 15

arm –> full thick burn –> circumferential –> eschar formation –> leads to what condition?

Answer 15

eschar –> restrict venous/lymph drain –> acute cmpt synd

Question 16

acute cmpt synd –> clinical features

Answer 16

• pain out of proportion to injury
• pain increase w passive stretch
• rapid & tense swell
• paresthesia (early)

Question 17

twisting injury w foot fixed –> what condition?

Answer 17

medial meniscus tear

Question 18

meniscus tear –> clinical presentation

Answer 18

• reduced knee extend
• sensation of instability
• effusion
• palpable lock/catch when extend jt while under load

Question 19

meniscus tear –> how confirm dx?

Answer 19

MRI or arthroscopy

Question 20

meniscus tear –> tests?

Answer 20

• Thessaly test

- McMurray test

Question 21

what is Thessaly test? Positive test indicates?

Answer 21

stand on 1 leg –> flex knee 20deg –> int/ext rotate on flexed knee –> pain/click/catch –> meniscal tear

Question 22

what is McMurray test? Positive test indicates?

Answer 22

hold knee in int/ext rotate –> passive knee flex/ext –> pain/click/catch –> meniscal tear

Question 23

clavicle fx –> next step? why?

Answer 23

careful neurovasc exam –> r/o injury to brachial plexus, subclavian A

Question 24

1 measure to prevent postop pulm comp

Answer 24

incentive spirometry –> promote lung expansion

Question 25

what is Kehr's sign

Answer 25

acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated

Question 26

diffuse abd pain + guarding + pain in shoulder --> condition?

Answer 26

peritonitis

Question 27

acute chem peritonitis --> what part of bladder ruptured?

Answer 27

dome

Question 28

peritonsillar abscess --> tx

Answer 28

needle aspiration/I&D + abx

Question 29

peritonsillar abscess --> clinical presentation

Answer 29

- fever - pharyngeal pain - earache - trismus - muffled voice - swelling of peritonsillar tissues w uvula deviation

Question 30

varicocele --> clinical presentation

Answer 30

- soft scrotal mass "bag of worms" --> decrease in supine, increase w stand/valsalva - subfertility - testicular atrophy

Question 31

meniscal tear --> tx?

Answer 31

mild ssx, older pt: - rest - modify activities persistent ssx, impaired activity: - surg

Question 32

postop fever --> blood cultures reveal coag-neg staph --> seen most often in what kind of pts?

Answer 32

pts w intravasc devices

Question 33

stress fracture --> RF (5)?

Answer 33

- repetitive activies (running, gymnastics) - abrupt increase in physical activity - inadeq Ca, vitD - inadeq calories - female athlete triad: inadeq calories, hypo/amenorrhea, low bone density

Question 34

stress fracture --> tx?

Answer 34

- reduce wt-bearing for 4-6wk | - if at high risk for malunion (anterior tibial cortex, 5th metatarsal) --> refer to ortho

Question 35

blunt trauma to chest --> pneumothorax --> chest tube --> persistent pneumothorax --> condition?

Answer 35

tracheobronchial rupture

Question 36

tracheobronchial rupture --> clinical findings

Answer 36

- persistent pneumothorax despite chest tube placement - pneumomediastinum - subcut emphysema

Question 37

gunshot at 6th intercostal space --> pt unstable --> next step?

Answer 37

exploratory laparotomy

Question 38

penetrating wound below what level is considered to involve abd?

Answer 38

4th intercostal space (level of nipples)

Question 39

postop atelectasis --> when after postop?

Answer 39

postop day 2

Question 40

postop atelectasis --> RF (4)?

Answer 40

- airway obstruction from retained airway secretions - decreased lung compliance - postop pain - meds that interfere w deep breathing

Question 41

postop atelectasis --> ABG results? why?

Answer 41

hypoxemia, hypocapnia, resp alk lung collapse --> decrease lung vol --> V/Q mismatch --> hypoxemia --> tachypnea --> hypoCO2 & resp alk

Question 42

massive hemoptysis --> initial management?

Answer 42

estab adeq patent airway

Question 43

massive hemoptysis --> in what position should pt be placed?

Answer 43

lat position w bleeding lung in dependent position --> avoid blood collection in opp lung

Question 44

massive hemoptysis --> initial procedure of choice? why?

Answer 44

bronchoscopy - localize bleeding site - provide suction ability to improve visualization - other therapeutic interventions possible (balloon tamponade, electrocautery)

Question 45

severe burn --> wound infect & sepsis --> what org if soon after injury? If after 5days?

Answer 45

soon after burn --> G+ | after 5day --> G-, fungus

Question 46

burn wound infect --> 1st sign?

Answer 46

- change in burn wound appearance | - loss of skin graft

Question 47

burn wound infect --> dx?

Answer 47

- quantitative wound culture | - bx for histopath

Question 48

young pt --> midline hard palate --> fleshy immobile mass --> condition?

Answer 48

torus palatinus

Question 49

torus palatinus --> tx?

Answer 49

asymptomatic: none symptomatic, interfere w speech/eat: surg

Question 50

flail chest --> pathophys?

Answer 50

>3 contiguous ribs fractured in >2 locations

Question 51

ischemic colitis --> CT findings?

Answer 51

- thickened bowel wall | - pneumatosis coli

Question 52

ischemic colitis --> colonoscopy findings?

Answer 52

- cyanotic mucosa | - hemorrhagic ulcerations

Question 53

hematuria --> indicates damage to what? - during initial part of voiding - at end of void - continuously thru void

Answer 53

- initial: urethra - terminal: bladder, prostate - total: kidney, ureter

Question 54

ant shoulder dislocation --> cause?

Answer 54

glenohumeral jt --> forceful abduct & ext rot

Question 55

ant shoulder dislocation --> can damage what N? Leads to what signs?

Answer 55

Axillary: - deltoid: weak shoulder abduct - lat shoulder: sensory

Question 56

GI perforation --> next step?

Answer 56

exploratory laparotomy

Question 57

blunt abd trauma --> GI perforation --> pathophys?

Answer 57

blunt trauma --> damage mesenteric blood supply --> necrosis --> GI perforate

Question 58

blunt trauma to abd & chest --> tachycardia, hypotension --> condition?

Answer 58

splenic laceration

Question 59

splenic injury --> ssx?

Answer 59

- abd pain - tachycardia - L shoulder pain

Question 60

blunt trauma to abd & chest --> what happens to: - preload - cardiac output - ejection fraction

Answer 60

massive internal hemorrhage --> hypovol shock: decreased venous return --> decreased preload --> decrease cardiac output --> activate sympathetic --> increase SVR & HR --> increase ejection fraction

Question 61

ant spinal cord infarct --> potential comp of what procedure?

Answer 61

thoracic aortic aneurysm surg

Question 62

ant spinal cord synd --> ssx

Answer 62

- spinal shock: bilat flaccid paralysis, loss of pain/temp - days-wks --> UMN: spastic, hyperreflex - normal vibrate, proprioception

Question 63

umbilical hernia --> assoc w?

Answer 63

- black - premature - Beckwith-Wiedemann - hypothyroid

Question 64

pt w renal dz --> surg --> DVT --> tx? for how long?

Answer 64

- unfractionated hep for acute | - warfarin for 3 mo

Question 65

pilonidal dz --> pathophys

Answer 65

intergluteal region --> hair follicle occlude --> edema, infect --> abscess --> rupture --> sinus tract --> sit, stand --> hair/debris into sinus tract --> recur infect

Question 66

pilonidal dz --> who?

Answer 66

- 15-30yo M - obese - sedentary - deep gluteal cleft

Question 67

pilonidal dz --> presentation?

Answer 67

interglut region --> 4-5cm cephalad to anus --> painful, fluctuant mass --> mucoid/purulent/bloody discharge

Question 68

acute adrenal insuff --> etiology?

Answer 68

- adrenal hemorrhage/infarct | - chronic adrenal insuff, glucocorticoid use --> acute illness/injury/surg

Question 69

acute adrenal insuff --> tx?

Answer 69

- hydrocortisone, dexamethasone | - IVF

Question 70

acute adrenal insuff --> ssx

Answer 70

- hypotension - vomit - abd pain - fever

Question 71

rhinoplasty --> whistling noise during respiration --> condition?

Answer 71

septal hematoma --> nasal septal perforation