Absite Review

Front 1

What are the two options for repair of an extraperitoneal rectal injury?

Back 1

Primary repair of the injury or diverting colostomy

Front 2

What is the best management option in blunt injury of a renal artery

Back 2

Observation, particularly if the patient has other injuries

Front 3

What is the optimal treatment for a ureteral injury?

Back 3

Debride devitalized tissue, spatulate the two ends, perform an end-to-end anastomosis over a double J stent (ureteroureterostomy) using an absorbable monofilament

Front 4

What is a psoas hitch for ureteral repair?

Back 4

Mobilization of the bladder, which is then sutured to the iliopsoas fascia above the iliac vessels to perform a tension-free reimplantation of the ureter

Front 5

By what percentage do blood volume and red cell volume increase in a pregnant patient?

Back 5

Blood volume by 50%, red cell volume by 30%, creating a physiologic anemia

Front 6

What type of acid-base disorder is present in pregnant patients?

Back 6

Respiratory alkalosis, due to increased tidal volume and minute ventilation

Front 7

What happens to 2,3-DPG levels in a pregnant patient?

Back 7

They increase, thus facilitating release of oxygen to the fetus

Front 8

A trauma patient has gross hematuria, and CT cystography reveals air in the bladder and an accumulation of contrast in the right paracolic gutter. Management?

Back 8

Open repair of the intraperitoneal bladder injury with chromic catgut sutures and suprapubic cystostomy

Front 9

Which has a better prognosis, epidural hematoma or subdural hematoma?

Back 9

Epidural. Associated parenchymal brain injury is less frequent than with subdural hematomas

Front 10

What will ligation of the superior vena cava result in?

Back 10

Acute superior vena cava syndrome

Front 11

What will happen with ligation of the left renal vein close to the IVC?

Back 11

Nothing, as drainage can occur through the adrenal, gonal, and iliolumbar veins

Front 12

What will happen with ligation of the IVC just at the diaphragm?

Back 12

Acute Budd-Chiari syndrome

Front 13

Which arteries should always be repaired if possible in a trauma patients?

Back 13

Carotid, innominate, brachial, superior mesenteric, proper hepatic, iliac, femoral, popliteal, and aorta

Front 14

What are the criteria for blunt cardiac injury?

Back 14

Presence of shock in absence of hemorrhagic or spinal shock, arrhythmias on EKG, decreased cardiac index, structural abnormalities on Echo. Troponin levels are also highly sensitive and specific

Front 15

How is control of a right-sided arterial injury in zone 1 of the neck best achieved?

Back 15

A median sternotomy

Front 16

How is control of a left-sided arterial injury in zone 1 of the neck best achieved?

Back 16

A left anterolateral thoracotomy

Front 17

What is the Cattell maneuver?

Back 17

Medial visceral rotation of the cecum and ascending colon. Achieved by incision the line of Toldt. Exposes retroperitoneal structures such as the IVC and right ureter

Front 18

What is the Kocher maneuver?

Back 18

Mobilization and medial rotation of the duodenum. Exposes the suprarenal IVC below the liver. Not useful for celiac axis exposure.

Front 19

What is the Mattox maneuver?

Back 19

Medial rotation of the left colon at the line of Toldt, kidney, and spleen toward midline. Division of the left crus will expose the celiac plexus

Front 20

How is exposure obtained for injuries to the distal IVC and iliac vein bifurcation?

Back 20

Division of the right common iliac artery

Front 21

How is the junction of the SMA, the splenic vein, and the portal vein exposed in the context of massive bleeding?

Back 21

Division of the neck of the pancreas

Front 22

What are the indications of operative intervention of penetrating thoracic injuries?

Back 22

Caked hemothorax, large air leak with inadequate ventilation or persistent collapse of the lung, drainage of more than 1500cc on tube placement, 200cc output for more than 4 hours, esophageal perforation, cardiac tamponade.

Front 23

What is the optimal treatment for a through-and-through bullet wound to the right lower lobe of the lung with active air leak and ongoing bleeding?

Back 23

Pulmonary tractotomy with oversewing of bleeding vessels using a polypropylene monofilament.

Front 24

What does continued bleeding from a liver injury despite performing the Pringle maneuver suggest?

Back 24

Bleeding from the retrohepatic IVC or hepatic veins

Front 25

What is the treatment for severe luminal injury to the first or fourth portion of the duodenum?

Back 25

Duodenoduodenostomy

Front 26

What is the treatment for severe injury to the second or third portion of the duodenum without ampullary injury?

Back 26

Roux-en-Y duodenojejunostomy

Front 27

What does pyloric exclusion involve?

Back 27

Stapling or oversewing the pylorus and creating a gastrojejunostomy

Front 28

What does duodenal diverticulization involve?

Back 28

Repairing the duodenal injury, antrectomy, vagotomy, gastrojejunostomy, duodenostomy, choledocostomy, feeding jejunostomy.

Front 29

What is the treatment for neurogenic shock refractory to fluid resuscitation?

Back 29

A pure α-agonist such as phenylephrine

Front 30

What characterizes anterior cord syndrome?

Back 30

Ischemia to the anterior two thirds of the spinal cord from compression of the anterior spinal artery. Diminished motor function, pain and temperature sensation

Front 31

What characterizes Brown-Sequard syndrome?

Back 31

Hemisection of the the spinal cord. Ipsilateral hemiplegia with contralateral pain and temperature sensation deficits

Front 32

What characterizes central cord syndrome?

Back 32

Hyperextension injuries damaging the central part of the spinal cord. Diminished motor function and pain and temperature sensation in the upper extremities, lower extremity findings are normal

Front 33

What constitutes a positive diagnostic peritoneal lavage?

Back 33

10ml free blood, red blood cell count greater than 100,000 (blunt) or 50,000 (penetrating), bile or amylase, white cell count greater than 500

Front 34

What does the Cushing reflex consist of?

Back 34

Hypertension and bradycardia

Front 35

What is the preferred surgical treatment of a duodenal hematoma?

Back 35

Evacuation of the hematoma by a partial-thickness incision in the duodenal wall, followed by closure.

Front 36

What is the primary cause of respiratory failure in patients with flail chest?

Back 36

Pulmonary contusion. Paradoxical movement of the free-floating segment is typically not sufficient alone to compromise ventilation

Front 37

When should internal fixation of flail chest be considered?

Back 37

Flail chest without pulmonary contusion, noticeable paradoxical movement of a segment while a patient is being weaned, severe deformity of the chest wall, or if the patient is already undergoing a thoracotomy

Front 38

Hemotympanum and raccoon eye suggest what injury?

Back 38

Basilar skull fracture

Front 39

Marked swelling of the right eye, edema of the conjunctiva, double vision, and pulsatile exophthalmos after basilar skull fracture indicate what pathology?

Back 39

Carotid cavernous fistula. Treatment options include open neurosurgical approach or endovascular embolization

Front 40

Which compartment of the leg is typically affected first in compartment syndrome?

Back 40

The anterior compartment, affecting the deep peroneal nerve and manifesting as numbness in the first webspace of the tow

Front 41

What must be done to ensure proper decompression of the deep posterior compartment of the leg in compression syndrome?

Back 41

The soleus muscle must be detached from the tibia.

Front 42

What causes neurapraxia?

Back 42

Focal demyelination from mild stretch or compressions

Front 43

What is axonotmesis?

Back 43

Axonal damage with preserved neural connective tissue sheath, epineurium, and Schwann cell tubes. Associated with distal wallerian degeneration

Front 44

What is neurotmesis?

Back 44

Complete transection, damage, or disruption of a nerve. Regeneration cannot spontaneously occur, thus necessitating surgical intervention.

Front 45

What is the most commonly injured upper extremity nerve?

Back 45

The radial nerve due to humerus fracture.

Front 46

Posterior knee dislocation is associated with what type of injury?

Back 46

Popliteal artery injury and rarely tibial nerve injury

Front 47

What is the most commonly injured lower extremity nerve?

Back 47

The peroneal nerve

Front 48

What are the indications for a trauma whipple?

Back 48

Massive destruction of the head of the pancreas or massive devascularization of the duodenum

Front 49

What is the treatment for main pancreatic duct disruption to the left of the superior mesenteric vessels?

Back 49

Distal pancreatectomy

Front 50

What is the treatment for disruption of the main pancreatic duct to the right of the superior mesenteric vessels in the abscence of major pancreatic head disruption?

Back 50

Drainage with subsequent pancreaticoenteric anastomosis if an ensuing fistula fails to heal

Front 51

What is Beck's triad?

Back 51

Hypotension, distended neck, muffled heart sounds

Front 52

What is the first step in management of a stable patient with pericardial tamponade?

Back 52

IV fluids, which will help overcome the tamponade and lead to an improvement in hemodynamics

Front 53

Should the threshold for intubation increase or decrease in a patient with pericardial tamponade?

Back 53

Increase, as positive pressure ventilation can have a deleterious hemodynamic effect. Rapid surgical decompression should follow intubation

Front 54

How does PEEP increase arterial oxygen content?

Back 54

By increasing functional residual capacity which increases recruitment of alveoli in patients with decreased lung compliance.

Front 55

Where should blood samples for a mixed venous oxygen saturation (Svo2) level be drawn?

Back 55

The pulmonary artery

Front 56

What happens to plasma thromboxane levels in ARDS?

Back 56

They increase

Front 57

What is the risk of pneumonia in ventilated patients?

Back 57

5% per day and as high as 70% at 30 days

Front 58

What type of heart failure occurs in sepsis?

Back 58

High-output cardia failure (elevated cardiac index)

Front 59

What is calculation for free water deficit?

Back 59

(Serum sodium-140)/140 x total body water.
Total body water is 50% lean body mass (kg) for men and 40% for women

Front 60

For a patient with a free water deficit, how fast should the water be replaced?

Back 60

Half of the free water deficit in the first 24 hours, in order to avoid central pontine myelinosis

Front 61

What EKG changes are associated with hypokalemia?

Back 61

U waves, T-wave flattening, ST-segment changes, and arrhythmias

Front 62

What is the treatment for hypercalcemia of malignancy?

Back 62

Saline volume expansion, calcitonin, and bisphosphonates

Front 63

What is the treatment for symptomatic hyponatremia?

Back 63

Hypertonic saline, increasing sodium by no more than 1mEq/hr until the serum sodium levels reach 130 or neurologic symptoms improve. Beyond that free water restriction and isotonic saline can be used.

Front 64

What are some of the effects of hypophosphatemia?

Back 64

Cardiac dysfunction, muscle weakness, encephalopathy, and hemolysis of red blood cells

Front 65

What are the clinical findings for compartment syndrome?

Back 65

Pain, pain with passive stretch, numbness

Front 66

What is the likely cause of hypokalemia in trauma patients?

Back 66

Increased levels of circulating catecholamines. Typically no treatment is needed

Front 67

What is the only test necessary to exclude clinically significant blunt cardiac injury?

Back 67

EKG. Troponins have poor sensitivity and predictive value

Front 68

What measurements are used to determine the need for damage-control laparotomy?

Back 68

Acidosis (pH or base deficit), hypothermia, and coagulopathy

Front 69

What is the first step in managing a bile leak?

Back 69

Percutaneous drainage. Low output after drain placement can be managed conservatively. High output requires MRCP or ERCP with stent

Front 70

What is the optimal repair method for blunt aortic injury?

Back 70

Endovascular repair

Front 71

When is surgical exploration required for blunt pancreatic injury?

Back 71

In the setting of pancreatic duct injury, diagnosed by ERCP or MRCP

Front 72

What nerve is associated with mishaft humeral fractures?

Back 72

Radial nerve

Front 73

What nerve is responsible for arm flexion?

Back 73

Musculocutaneous

Front 74

Which nerve is most closely associated with the brachial artery within the antecubital fossa?

Back 74

Median

Front 75

What nerve is responsible for arm abduction?

Back 75

Axillary

Front 76

Which nerve innervates the interossei muscles of the hand?

Back 76

Ulnar

Front 77

What is the typical onset of type II HIT?

Back 77

5-14 days after initiation of heparin-based therapy

Front 78

What is the classic pentad associated with thrombotic thrombocytopenic purpura (TTP)?

Back 78

Fever, thrombocytopenic purpura, hemolytic anemia, neurologic manifestations, renal failure

Front 79

What is the most common functional neuroendocrine tumor of the pancreas?

Back 79

Insulinoma

Front 80

What type of neuroendocrine tumor presents with diabetes, mecrolytic migratory erythema, hypercoagulability, stomatitis, and glossitis?

Back 80

Glucagonoma

Front 81

What neuroendocrine tumor is associated with secretory diarrhea?

Back 81

VIPoma

Front 82

A secretin test is used to confirm the diagnosis of what neuroendocrine tumor?

Back 82

Gastrinoma

Front 83

What is the most common origin of a replaced right hepatic artery?

Back 83

The superior mesenteric artery