Missed Gen Surg Question

Front 1

You cannot operate if pts ejection fraction is less than _____

Back 1

35%

Front 2

what is the metabolic risk to surgery

Back 2

diabetic coma is an absolute c/i to surgery

Front 3

tx for malignant hyperthermia (due to anes) temp exeeds 104

Back 3

IV dantrolene, 100% o2, correction of acidosis and cooling blankets

Front 4

tx for atelectasis on first post op day

Back 4

incentive spirometry

Front 5

tx for post op pneumo day3

Back 5

cxr, sputum cx, abx

Front 6

tx for uti

Back 6

UA, cx and abx

Front 7

tx for dvt on day 5

Back 7

doppler, anticoag w. heparin

Front 8

wound infx

Back 8

on day 7, abx if cellulitis, I and D if abscess, use sonogram if cant distinguish

Front 9

hyponatremia 135- (water has been retained) tx

Back 9

slowly developing-water restriction
fast developing-NS, lac ringer

Front 10

hypernatremia 145+ tx

Back 10

D51/2 ns

Front 11

hyperkalemia 5+ ( slowly-renal failure)
(fast-K is dumped from cell in crushing injury)

Back 11

pushing it back into cell, by 50% destrose and insulin, sucking it out of GI (NG suction, exchange resin), neutralize its effect on cellular membrane (IV calcium)

Front 12

hypokelamia 3.5-

Back 12

10meq/hr replacement

Front 13

most common organ injured in BAT?

Back 13

1. Spleen
2. Liver

Front 14

most common organ injured in chest trauma form decel accident?

Back 14

aortic rupture (wide mediastinum in CXR)

Front 15

SYSBP <90 (shock), JVD, distant heart sound, next step and dx?

Back 15

FAST to dx Pericardial tamponade
tx-pericardiocentisis

Front 16

nerve injured in midshaft humerus fx?

Back 16

Radial N.

Front 17

Pt w. sx of acute appendecitis next step?

CT vs OR

Back 17

OR (dont wait for labs or imaging in case of appendecitis)

Front 18

Fx of long bone, dyspnea, petichea in upper body, dx?

Back 18

fat embolism

Front 19

any penetrating wound below nipple (4th ICS) abdominal, do __________ if pt is hemodynamically unstable

Back 19

ex lap it find cause of bleed

Front 20

breast mass, bx shows fat globule, foamy macrophages dx?

Back 20

fat necrosis

Front 21

suddent onset pain out of proportion to exam, bloody stool, N/V guarding rebound tenderness dx?

Back 21

mesenteric ischemia

Front 22

mesenteric ischemia is most commonly due to _______________

Back 22

1. emboli form heart
2. S/P AAA repair

Front 23

Acute back pain+profound hypotension (syncope)

Back 23

ruptured AAA

Front 24

epigastric pain radiate to back a/w gallstone, chronic alcoholism

Back 24

acute panceatitis

Front 25

Acute RUQ pain, fever, N/V

Back 25

Acute cholecystitis

Front 26

Periumbilical pain, then RLQ pain

Back 26

Acute appendecitis

Front 27

severe unilateral flank pain that radiates to groin, N/V
Order? dx?

Back 27

Ab CT (check for renal stone) , dx-Acute renal colic

Front 28

B/L hip thigh butt pain, impotence dx?

Back 28

aortoilliac occlusion (Leriche syndrome)

Front 29

sudden onset leg pain, asymmetric pulselessnes?

art emboli vs art thrombus

Back 29

art emboli

Front 30

leg pain for 3 mo, slowly progressing, pulse deminishin b/L

art emboli vs art thrombus

Back 30

art thrombus

Front 31

Dull achy pain, on Leg, on hosp pt, warm to touch?

DVT vs Septic arthritis

Back 31

DVT

Front 32

intermittent bllody d/c from one nipple in perimenopausal women dx?

Back 32

Intraductal papilloma (benign)

Front 33

Pt presents w. BAT, CT is clear (r.o Spleen, liver) pt comes back w. fever, chills, and deep ab pain?

Back 33

pancreatic abscess

Front 34

post op ataletasis manifest on day 2-3 as ?

Back 34

impaired cough and shallow breathing

Front 35

ABG of pt w. atalectasis shows?

Back 35

lo O2, lo CO2 (due to shallow breathing)

Resp alkalosis

Front 36

Post op day 3, ABG shows Resp acidosis? cause

ataletasis vs resp depression

Back 36

resp depression (due to analgesics)

Front 37

Post op ileus is caused by ?

Back 37

morphine (dec GI motility)

Front 38

Bowel sound in ileus?
Bowel sound in SBO?
Bowel sound in adhesion?

Back 38

ileus? absent
SBO? tinkling
adhesion? high pitched

Front 39

Imagaing in Ileus vs SBO

Back 39

ileus-air fluid level and dilation in SB+LB
SBO-air fluid level and dilation in SB,

Front 40

multiple rib fx, paradoxic motion during resp, reverss w. pos pressure mechanical vent dx?

Back 40

flail chest

Front 41

acute pain in coccyx?

Back 41

pilonidal cyst

Front 42

sh injury post drop arm sign dx?

Back 42

rotator cuff tear

Front 43

Pt has bicep tear, pop eye sign, weakness in ________

supination vs pronation

Back 43

supination (biceps inserts at radial tuborosity)

Front 44

s/p spinal injury, pt doesnt feel pain and temp

Back 44

syringiomyeloma

Front 45

distended neck vein, tachycardia, tachypnea, tracheal deviation dx? tx?

Back 45

tension pneumothorax, needle thoracostomy

Front 46

what defines oliguria? management

Back 46

Low urine output <400CC urine/day,
1. Ch foley (r.o obstruction)
2. Fluid

Front 47

when are TPA used?

Back 47

acute STEMI (w.in 3 hrs)

Front 48

early satiety, weight loss, nonbiliary vomit, hx of acid digestion dx>

Back 48

pyloric stricture (gastric outlet syndrome)

Front 49

Solitary pulm nodule is noted on CXR management?

Back 49

Chest CT
1. if small watch
2. if >2.5 cm biopsy

Front 50

dull pain, L testes, bag of worms, valsalva enlarges it dx?

Back 50

varicocele

Front 51

child limping dx?
obese teen limping?

Back 51

child>Legs Cales Perthes-avascular necrosis tx-cast
obese teen> SCFE,tx surgical pinning of femoral head

Front 52

Most common cause of LGI bleeding in older pt?
+painless
+hx of constipation
+not seen on Xray. order CT

Back 52

diverticulosis

Front 53

GCS assess what factors?

Back 53

eye opening 4pts
motor response-6 pts
verbal response-5 pts

Front 54

Pt w. smoke inhalation, O2 sat 96%, next step in management?

Back 54

100% O2 facemask, (CO poisoning, O2 sat is not sensitive to CO)

Front 55

Isolated dudoenal hematoma in child w. BAT tx?

Endocopy vs NG suction

Back 55

NG suction, TPN

Front 56

Tx for nursemaid elbow?

Back 56

Flex and supinate forarm

Front 57

Breast mass
Physical exam
1. Mobile->likely dx?
2. fixed-> likely dx?

Back 57

mobile-fibroadenoma , benign
fixed-malignant

Front 58

Breast mass management

Back 58

<30 do US
1. cyst->needle aspiration
2. mass->needle core bx

>30 do mammo and US
1. suspected malignancy-> needle core bx

Front 59

RLQ pain dissapears now pelvic mass on rectal exam dx?

Back 59

pelvic abscess

Front 60

snuffbox hurts, what bone?

Back 60

scafoid

Front 61

scafoid fx, tx?

Back 61

wrist immobilization 6-10 wks

Front 62

Tx for minor lig sprain?

Back 62

Rest, Ice, Compression, Elevation

Front 63

________ final sequel of compartment syndrome where dead muscle becomes fibrosed

Back 63

volkmanns ischemic contracture

Front 64

first indicatior of hypovolemia?

Back 64

pulse rate (tachycardia)

Front 65

LE edema, worse when leg is dependent (work)
improve w. elevation, most common cause of LE edema dx?

venous insuff vs arterial occlusion

Back 65

venous insuff

Front 66

LE edema, doppler +, pain, pale, paresthesia, pulselessness cool dx?

venous insuff vs arterial occlusion

Back 66

arteral occlusion

Front 67

twisting injury from fixed foot, POP heard, gradual swelling "day after injury" dx?

Back 67

meniscal tear, if persistent do MRI, tx Arthroscopy

Front 68

pop, rapid swelling due to hemarthrosis dx?

Back 68

lig tear

Front 69

foot pain over time, crepitus w. rom dx?

Back 69

osteoarthritis

Front 70

fx seen in runners 2nd to repeated stress

Back 70

stress fx

Front 71

HTN, bradycardia, resp depression are seen in ?

Back 71

uncal herniation (due to hi ICP)
ipsi hemiparisis
CN3 palsy- down and out

Front 72

femoral nerve provides sensation to?

Back 72

ant and medial thigh

Front 73

superficial unilat hip pain in adult exac by external pressure dx?

osteoarthritis vs trochanteric bursisits

Back 73

trochanteric bursisits

Front 74

what are peritonial sign/acute ab?

Back 74

rebound tenderness, ab guarding, lo bowel sound

Front 75

pt presents unconscious w. cervical spine injury to your trauma center what is the first step?

Back 75

orotrachial intubation if head is secured, or nasotrachial intubation

Front 76

pt in shock, neck vein is flat what is ur first ddx?

Back 76

hypovolemic shock

Front 77

pt in shock neck vein is distended what is ur ddx?

Back 77

pericardial tamponade
tension pneumothorax (resp distress)

Front 78

pt w. basilar fx should not get intubated by

nasotrachial vs orotrachial intubation

Back 78

nasotrachial intubation

Front 79

dec ICP, elevate head, hyperventilate, give mannitol and lasix

are tx for

acute epidural vs subdural hematoma

Back 79

subdural hematoma

(larger trauma, ICP monitoring is key)

Front 80

T or F

hypovolemic shock can happen from intracranial bleeding

Back 80

F

THere isnt anough space in head for amount of blood loss needed to produce shock (2L)

Front 81

Neck

Gunshot wound to upper zone

next step

Back 81

arteriogram

Front 82

neck

Gunshock wound to lower zone

next step

Back 82

the works

arteriogram, esophagram, bronchoscopy then decide on surgical approach

Front 83

neck

Gunshot wound to middle zone

next step

Back 83

surgery

Front 84

result of hemisection injury

Back 84

pain and temp to the left (contra)

proprioception (same)

Front 85

result of anterior cord injury

Back 85

due to burst fracture of vertebral body

proprioception ok
loss of pain temp (b/l)
loss of motor (b/l)

Front 86

result of central cord injury

Back 86

due to hyperextention (rear end collision)

paralysis and burning in UE

Front 87

Management of spinal cord injury

Back 87

1. High dose of corticosteroids
2. MRI (for precise diagnosis)

Front 88

rib fx can be deadly to elderly becasuse pain can lead to progression of hypoventilation to atelectasis to pneumonia, this can be avoided by tx elderly w.

Back 88

local nerve block and epidural cathather for pain control so they breath normally

Front 89

tx for plain pneumothorax
hemothorax
tension pneumothorax

Back 89

plain pneumothorax-chest tube high
hemothorax-chest tube low (to let blood out)
tension pneumothorax-needle decompression then chest tube

Front 90

myocardial contusion should be suspected if there is sternal fracture, monitor with _______ tx complication of myocardial contusion such as ________

Back 90

ekg, troponins,

tx-arrhythmias

Front 91

tx for sucking chest wound

Back 91

occlusive dressing (taped on 3 sides to allow air out)

Front 92

subcutaneous emphysema ddx

Back 92

1. rupture of trachea/main bronchus
tx-bronch-to id lesion, secure airway distal to lesion

2. rupture of esphagus (likely after an endoscopy procedure)

Front 93

Sudden death of chest trauma pt who was intubated and was on respiratior

cause?

Back 93

air embolism

Front 94

pt w. multiple trauma, long bone fx, presents w. petechial rash, fever, tachycardia, low plateletn and RESP distress dx?

Back 94

fat embolism

Front 95

man stabbed in R chest, , no breath sound on R, resonnant to percussion

what is it?
Tx

Back 95

plain pneumothorax
tx chest tube high in pleural cavity

Front 96

man stabbed in R chest, no breath sound on bottom of R side, dull to percussion

Back 96

hemothorax
tx chest tube low in pleural cavity

Front 97

tx for pulm contusion

Back 97

fluid restriction using colloid (preserve colloid osm pressure in blood) , diuretics, respt support (intubation, mech vent w. PEEP)

Front 98

pt w. motor vehicle accident, PE shows no breath sound over entire L chest, percussion is unremarkable cxr shows air fluid level in L chest dx?

Back 98

diaphragmatic rupture
(percussion unremarkable r/o pneumo/tension pneumo)

Front 99

pt w. MVA, currently stable, w. fractures 1st rib (or sternum, or scapula) and wide mediastinum on cxr?
Dx? managemnt?

Back 99

arteriogram (aortagram) to check for ruptured aorta

emergency surgery

Front 100

Pt w. internal bleeding, BP improves w. IV fluids do they need surgery (ex lap)

Back 100

no

Front 101

Prolonged laparotomy surgery. Pt develops coagulopathy, hypothermia, and acidosis next step?

Back 101

stop surgery, pack site, temporary closure
-resume operation later when pt has been warmed and coagulopathy treated

Front 102

Pelvic fractures w. expanding hematoma what is the next step?

Surgery vs pelvic fixators

Back 102

pelvic fixators

(opening the pelvis will lose tamponade effet, and often bleeding sites are inaccessible.

Tx-pelvic fixators (to stop hematoma from expanding) and IV radiololgy for embolization of bothe internal iliac artery

Front 103

Suspect renal injury in Traum w. _______

Back 103

lower rib fx

Front 104

what kind of sh injury is common in high voltage electrical burns?

Back 104

posterior dislocation of shoulder

Front 105

T or F

Tetanus proph for all bites

Back 105

T

Front 106

Dog bite managemnt

Back 106

if provoked (pt teased the dog) then less risk of rabies

if unproveked (dog is wild and may have rabies) then do rabies shot)
1. need to watch dog or kill the animal to check if they have rabies

Front 107

tx for bee stings

Back 107

epinephrine 1:1000

Front 108

tx for black widow spider bite

Back 108

IV Ca gluconate

Front 109

tx for brown recluse spider

Back 109

dapsone is helpful, Grafting

Front 110

Pt bitten by spider w. red houglass on belly, develos n/v/ muscle cramps

Black widow vs brown recluse

Back 110

black widow

Front 111

Pt bitten by spider develops ulcer w. necrotic center

Black widow vs brown recluse

Back 111

brown recluse

Front 112

Child w. uneven gluteal fold,
PE: hips easily dislocated posterorly w. a jerk, and a clicking is heard

Tx:

Back 112

developmental dysplasia of hip
tx w. pavlik harness for 6mo

Front 113

what is the most common bone tumor

Back 113

osteosarcoma (sunburst pattern on x ray

Front 114

Primary malignant bone tumor occur in


young vs old

Back 114

young

Front 115

Metastatic bone tumors occor in the

young vs old

Back 115

old

Front 116

Metastatic bone tumors come from ________ in men
_________ in women

Back 116

men-prostate (blastic bone lesion)
woment-breast (lytic bone lesion)

Front 117

old men w. fatigue, anemia, localized pain in specific places on several bone, x ray shows punched out lytic lesion, bence jones pronein in urine. dx

Back 117

multiple myeloma

Front 118

Most common shoulder dislocation


ant vs post

Back 118

anterior dislocation of shoulder

Front 119

suspected anterior dislocation of shoulder order

___________ views on x ray

Back 119

AP and latertal views

Front 120

Suspected posterior dislocation of shoulder (rare) in pt that was hit by lightning order

____________ views on x ray

Back 120

axillary view or scapular lateral view

Front 121

young teen fall on outstretched hands, CC: wrist pain
PE: tender over anatomical snuffbox
x ray is negative

dx
tx

Back 121

scaphoid fx (it takes 3 wks to show up on x ray)
tx -thumb spica cast

Front 122

What is the classical position of leg in hip fx pt

Back 122

leg is shortened, externally rotated

Front 123

Femoral neck fx tx

Back 123

replace w. prosthesis (to avoid avascular necrosis)

Front 124

knee injury WILL produce ________

Back 124

knee swelling

Front 125

T or F

Almost all cruciate injuries are sports related and require surgery

Back 125

T

Front 126

Pt recieves a sideway blow to knee they will have a
________ ligament injury

Collateral (MCL) vs cruciate (ACL)

Back 126

collateral (MCL)

Front 127

Pt w. collateral ligament injury shows positive valgus stress test has

MCL vs LCL

Back 127

MCL

Front 128

tx for lig tear
tx for meniscal tear

Back 128

lig tear-cast
meniscal tear-surgery

Front 129

TEEN w. tibial pain at very specific point on knee, x ray normal tx?

Back 129

tibial stress fx
tx; cast and repeat x ray in 2 weeks/ crutches

Front 130

pt is complaining of pain under their cast,

ignore vs remove cast to examine

Back 130

remove cast to examine (r.o compartment syndrome)

Front 131

pt has rupture of achilles tendon, you cast it in
____ position

plantar flexed vs dorsiflexed

Back 131

planter flexed (equineous position)

Front 132

Classical sign of compartment syndrome:

Back 132

severe pain with passive extension

Front 133

pt w. hip fx
pt w. posterior dislocation of hip (car accident)

presentation of foot

Back 133

hip fx-ext rot
posterior dislocation of hip-int rot

Front 134

pt had fall from height and landed on feet, look for hidden fx in _______

Back 134

spine

Front 135

Pt had head on collision w. injury to torso, look for hidden fx in _________

Back 135

posterior dislocation of hip

Front 136

pt w. facial fx/ closed head injury always eval _________

Back 136

c-spine

Front 137

pt presents with sx of distended bladder, flacid rectal paralysis and saddle anes dx tx?

Back 137

cauda equina syndrome (central disk (tumor, blood ect) herniation below L1)
tx-surgical decompression

Front 138

30 y.o complains of chronic back pain, xray shows "bamboo spine) dx?

Back 138

ankylosing spondylisis
tx: antiinflam, pt
f/u: HLA B27 (a.w uveitis and IBD)

Front 139

Diabetic foot ulcer tx

Back 139

control blood glucose
keep wound clean
elevate legs (dec pressure on heels)

Front 140

ulcer on tips of toes, hairless, dec pulse, scaly skin

arterial/venous insuff

Back 140

arterial

Front 141

ulcer above ankle, edema

arterial/venous insuff

Back 141

venous

Front 142

marjolin ulcer is due to _________ ca

Back 142

SCC

Front 143

swollen big toe, red, high uric acid in urine. dx and tx

Back 143

dx: gout
tx: indomethacin (nsaid) for acute attack

Front 144

a trauma pts Foley cathater shows hematuria but a cystogram is normal (bladder is ok),

where is the blood coming form? next step?

Back 144

Kidney
-order ab CT scan to make dx

Front 145

When is microscopic hematuria investigated in trauma setting?

adult vs kids

Back 145

kids- microscopic hematuria might be clue to congenital anomalie, esp if trauma isnt severe enough to cause it.

start w. sonogram,

Front 146

moist blister and painful describes ______ degree burn

Back 146

2

Front 147

white, leathery, painless describes ______ degree burn

Back 147

3

Front 148

When do burn pt starts rehab?

Back 148

REHAB STARTS at DAY 1

Front 149

Very small 3 degree burn (iron falls on lap) what is the next step?

IVF vs excision graft

Back 149

Excision and graft

Front 150

pt c.o human bite, you consult

ID vs orthopedic surgeon

Back 150

ortho-needs ortho exploration of bite to looks for bone infection

Front 151

older pt w. hx of sun exposure, presents w. skin lesion
dx? tx? f/u: mets? y/n

Back 151

Basal cell
tx: local resection
mets:no

Front 152

non healing ulcer lesion on skin, dx tx? mets?y/n

Back 152

Squamous cell carcinoma
tx: resect widely
mets:y

Front 153

lesion is described as asymmetric border color and diamter greater the .5 cm dx? mets? y/n

Back 153

melanoma
tx: resect local in <2cm
resect widely if >2cm
mets:Y

Front 154

any change in an hyperpigmented lesion is a tipoff for?

ex: man w. multiple nevi recently noticed one changing color/growth/ulcer ect.

Back 154

melanoma

Front 155

which skin cancer can go where no other tumor go?

Back 155

melanoma

-can mets after original tumor was removed to weird places

Front 156

pt w. mass on breast that is firm but moves easily
what is the next step?

Back 156

sounds benign=fibroadenoma
but still need to test, use least evasive of the choices
1. FNA
2. Core
3. Excisional

do not choose Mammo, thats only for screen

if pt is young <18, use sonogram (young breast are too dense for mammo)


fibroadenoma (benign)

Front 157

pt in late 20s, hx of mass growth over many years, no invasion, movable.

Dx? tx?

Back 157

dx: cystosarcoma phyllodes (benign)

tx: core/incisional bx (FNA is not sufficient)

Removal is mandatory (can become malignant)

Front 158

pt in 30-40s, w. bl breast tenderness related to menstrual cycle.

management?
if persistent mass?

Back 158

fibrocystic changes/ cystic mastitis (will go away w. menopause)

if cyst comes and goes then only mammogram is needed

persistant mass-do aspiration (not FNA but aspiration w. bigger needle)

Front 159

premenopausal woment w. bloody nipple discharge? dx?

Back 159

Intraduction papilloma
dx: mammogram (usually used to screen, but its the only way to detect cancer thats not palpable)
tx: galactogram my be diagnostic and guide surgicla resection

Front 160

Breast abscess in only seen in lactating women: what appears to abscess at other times are ______

Back 160

cancer until proven otherwise

Front 161

Breast cancer should be suspected in any women w. a palpable breast mass, A hx of trauma does not rule out cancer

T or F

Back 161

T

Front 162

Breast cancer during preggo tx:
no radiotherapy during _______
no chemo during ________ (which trimester)
termination?y/n

Back 162

no rads during preggo
no chemo during 1st tri
no termination needed

Front 163

A 49 year old has a firm, 2cm. mass in the right breast, that has been present for 3 months.

next step?

Back 163

What is it? - This could be anything. Age is the best determinant for Cancer of the breast. If she had been 72, you go for cancer. At 22, you favor benign. But they will not ask you what this is, they will ask what do you do.
Management: You have to have tissue. Core biopsy is OK, but if negative you don’t stop there: only excisional biopsy will rule out cancer.

Front 164

FNA-
Core needle biopsy-
Incisional bx-
excisional bx-

Back 164

FNA-very small needle
Core needle bx-bigger needle,
Tissue bx-
incisional-take part of mass
excisional-take out all of mass

Front 165

60 y.o F w. breast mass and eczema lesion under areola dx?

Back 165

pagets

Front 166

what is the radiological appearance of breast ca?
next step?

Back 166

mammo w. irregular inc density

Fine MICROCALCIFICATION not seen in prev study

Next step: Still need tissue to diagnose
1. stereotactic guided needle core bx
if unsatifactory then..
2. excisional biopsy (needed to dx)

Front 167

Pt dx w. Infiltrating ductal carcinoma (standard breast ca)

how do you choose between lumpectomy vs modified radial resection vs radical rescetion?

axillary nodes not palpable do u bx?

Back 167

lumpectomy-breast is big, tumor is small

modified radical resection: tumor is big breast is small

always do axillary nodes bx when dx w. breast ca, even if not palpable

Front 168

bleeding from breast + mass (huge, ulcerated, firmly attached to breast) dx? tx?

Back 168

Breast Ca (late stage)

Dx: still need bx (core or incisional)
Tx: Not operable (due to size)
1st line tx: chemo to reduce size
then maybe operable

Front 169

Pt had lumpectomy for infiltrating ductal carcinoma + axillary bx pos for mets, what adjuct therey is needed?

Premen gets -
postment gets-

Back 169

premen- chemotherapy
postmen-hormonal therapy

Front 170

Headache or backache+hx of breast cancer resection

dx?

Back 170

Mets
dx: head CT/ Bone scan

Front 171

Eyepain at night when watching movie+sees Halos


PE: pupil is dilated, does not respond to light, feels hard as rock
dx
tx

Back 171

dx: acute angle glaucoma
tx: EMERGENCY optho consult, while waiting give carbonic anhydrase inhibitor (DIAMOX)

Front 172

Chemical burn to body should immidiately be irrigated for ________ min prior to coming to ER

Back 172

30 min

Front 173

"Flash of light", Floaters in eye (snowstorm)+big dark cloud at top of visual field

dx?
tx?

Back 173

Dx: retinal detachment
Tx: optho consult (optho will spot weld the tear in retina)

Front 174

old pt w. sudden loss of vision from one eye dx tx?

Back 174

Dx: embolic occlusion of retinal artery
tx: Vasodilate and shake clot to a more distal area so smaller area becomes ischemia
have pt breath into paper bag and press on/off on eye to vasodilate the retianal artery as pt is on way to ER

Front 175

infant w. "huge, shiny eye" dx and path?

Back 175

congenital glaucoma
(congenital acute angle closure, eye are big due to increased pressure in the anterior chamber)

Front 176

swollen, red, hot, tender eyelids+fever+ leukocytosis. When prying the eyelids open, you can ascertain that her pupil is dilated and fixed and that she has very limited motion of that left eye.
dx?

Back 176

orbital cellulitis
tx: optho consult
if asked for next step: CT scan and surgical drainage

Front 177

Nonhealing perianal fistula, probable dx?

Crohns vs UC
management?

Back 177

Crohns

Perinal area has great vasc. supply so it should heal fast

Management: bx to r/o CA, and dx crohns

Front 178

anorectal management key? =R/o CANCER (answer how its done)

internal/ext hemorrhoids:
anal fissure:
Crohns:
fistula in anus:

Back 178

internal hemorrhoids: proctosigmoidosclopic exam
ext hemorrhoids: same
anal fissure: exam under anesthesia
Crohns: biopsy
fistula in anus: protosig exam

Front 179

Pt had hx of removal of pigmented skin lesion 20 yrs ago. Now presents w. an explosion of mets to many parts of body. What was the original dx?

SCC vs melanoma

Back 179

melanoma

Front 180

Hemorrhoids bleed when they are _______
internal vs external

Back 180

internal hemorrhoids

Front 181

Hemorrhoids hurt when they are ____

internal vs external

Back 181

external hemorrhoids

Front 182

young women+pain w. defication+blood streak covers stool+refuse exam due to pain
dx?
tx?

Back 182

anal fissure-due to tight sphincter
tx-stool softener
topical nitroglycerin, Ca ch blocker Deltiazam ointment 2% 90% success rate

Front 183

fissure/fistula/small ulceration+nonhealing+worse w. surgical tx
dx?
management

Back 183

Crohns,

management: Pick nonsurgical option, fistula should be drained w. seton while Remicade (infliximab) helps healing

Front 184

febrile+perirectal pain+cant sit, no BM+PE: hot, tender, red, fluctuant mass between the anus and the ischial tuberosity
dx:
tx:
F/u: if pt is DM w. ____

Back 184

ischiorectal abscess

tx: I&D under anes to r.o Ca.

F/U: if pt has DM-watch closely for necrotyzing fascitis

Front 185

Generally GI bleeding in young ppl occur in
Upper vs. lower GI

Back 185

upper GI

Front 186

define upper GI

Back 186

tip of nose to Lig of treitz (duodenum(

Front 187

Different words for blood in poop and their clinical significance
melena-
hematochezia-

Back 187

Melena-black tarry stool Digested blood!! (Upper GI bleed)
hematochezia-bright red bleeding per rectum (Can be either upper GI via very fast transit to avoid digestion, or lower GI)

Front 188

Management of Bright red blood per rectum->NG tube to aspirate gastric content, Interpret the following:
Blood is retrieved-
dx-
tx-

Back 188

Upper GI bleed

tx: Upper GI endoscopy

Front 189

Management of Bright red blood per rectum->NG tube to aspirate gastric content, Interpret the following:
No blood, fluid is white (aka no bile)-
dx- so what gets excluded?
tx-

Back 189

dx: nose to pylorus is excluded (still need to know about duodenum so...
tx: Upper GI endoscopy

Front 190

Management of Bright red blood per rectum->NG tube to aspirate gastric content, Interpret the following:
No blood, fluid is green (bile)-
dx-
tx-

Back 190

dx- Upper GI is excluded because it shows that NG tube went down full extent of upper GI (to lig treits aka duodenum) and no blood is seen
tx-
angiogram to locate source of lower GI bleed then angiographic embolization

Front 191

Active bleeding per rectum
exclude _______ 1st w. anoscopy

Back 191

hemorrhoids

Front 192

Bright red blood per rectum in child dx? tx?

Back 192

Meckels diverticulum (true diverticulum)
tx: Tech9 scan look for ectopic gastric mucosa

Front 193

massive bleeding in upper GI+stressed/multiple trauma/complicated post op pt dx?

Back 193

stress ulcer

Front 194

tx for stress ulcer

Back 194

angiographic embolization

Front 195

pt vomits blood/blood recovered in NG tube in pt w. bleeding per rectum
first step in management?

Back 195

Upper GI endoscopy

Front 196

Pt passing dark RED blood in stool what is the first diagnostic step?

Back 196

NG tube

Front 197

Pt had multiple complicated surgeries+ now has Massive upper GI bleed due to stress ulcer what is the best option for tx?

Back 197

angiographic embolization

Front 198

Pt had multiple complicated surgeries+ now has Massive upper GI bleed due to stress ulcer
How could this have been prevented

Back 198

keep gastric pH above 4
H2 blockers :
cimetidine Tagamet
famotidine Pepcid
nizatidine Axid
ranitidine Zantac

Front 199

Pt had multiple complicated surgeries+ now has Massive upper GI bleed due to stress ulcer what artery are you going to embolize to fix it?
left gastric vs right duodenal

Back 199

left gastric

Front 200

acute abdomen+hx of afib, recent MI dx?

Back 200

mesenteric ischemia

Front 201

acute abdomen+ sudden onset+free air under diaphragm

Back 201

perforation-emergency surg ex lap

Front 202

acute abdomen+ sudden onset+ colicky pain (comes and goes)

flank pain to groin-
epigastric pain to back-

Back 202

obstruction,

flank to groin-ureter stone-CT
epigastric pain to back-pancreatitis-serum amylase lipase, ct

Front 203

vague right upper quadrant discomfort+weight loss+ alpha fetoprotein is high dx

Back 203

hepatocellular carcinoma

Front 204

what is more common primary cancer to live vs mets to liver

Back 204

mets to liver

Front 205

birth control pills+ abdominal pain+blood loss in ab

dx, tx

Back 205

hepatic adenoma rupture
tx-emergency surgery

Front 206

Mexican+abscess in liver, management?

drain vs metronidazole

Back 206

amebic abscess of liver-give metronidazole, dont culture it because amaba doesnt grow in pus. send serologic study but dont wait for result

Front 207

obstructive jaundice caused by stones will have
distended thin vs nondistended thick walled gb

Back 207

nondistened thick walled gb

Front 208

obstructive jaundice caused by tumor will have
distended thin vs nondistended thick walled gb

Back 208

distended thin walled gb

Front 209

-when stones temporarily occlude cystic duct, pt presents w. colicky pain in RUQ, rad to sh, N/V, use U/S to dx gallstones, and do elective cholecystectomy

biliary colic vs acute cholecystitis

Back 209

Biliary colic

Front 210

-stone remains in cystic duct, causes an inflam rxn, pain is constant in RUQ, fever and leukocytosis U/S shows gallsones, thick walled GB, and pericholecystic fluid. If unclear do HIDA (radionucleotide uptake) to prove the HIDA(fake bile is not taken up by GB due to obstruction

biliary colic vs acute cholecystitis

Back 210

acute cholecystitis

Front 211

-stone in common bile duct, PARTIAL BLOCKAGE, pts w. high fever and chills, extremely high alk phos, start IV abx, and emergency decompression via ERCP

biliary colic vs acute ascending cholangitis

Back 211

acute ascending cholangitis

Front 212

which ab hernia does not need repair?

Back 212

-umbilical hernia in 2-5 yr old (close themselves)
esophageal sliding hiatal hernia

Front 213

T or F
Hernia the becomes irriducible need emergency surgery but hernias that have been chronically irreducible for years need elective repair

Back 213

T

Front 214

early satiety+deep epigastric mass+hx of acute pancreatitis/ab trauma wks ago dx? tx

Back 214

pancreatic pseudocyst, get CT to do CT guided drainage

Front 215

alcoholic+calcified pancreas+steatorrhea, DM. and constant epigastric pain radiate to back
dx?

acute pancreatitis vs chronic pancreatitis

Back 215

chronic pancreatitis

Front 216

5th post op day+wound dressing soaked in salmon colored fluid (serosanguinous/pink)
dx
path
tx

Back 216

dx-wound dehiscence
path-failur of fascia
tx: bind, limit straining, elective OR

Front 217

5th post op day+loops of bowel showing
dx
path
tx

Back 217

dx-eviceration
path-failure of fascia and skin
tx-warm saline dressing, OR NOW. (do not push bowel back in, u will push bacteria in too!!)

Front 218

what does a cold thyroid nodule mean?

Back 218

Radioactive Iodione scan was done. Thyroid didnt pick the iodine because its not functioning, do FNA to r.o cancer

Front 219

young, male, single nodule, history of radiation to the neck, solid mass on sonogram and cold nodule on scan. next step:

Back 219

FNA to dx, then surgery

Front 220

high calcium+asymptomatic pt+ PTH is high
test used to locatlize cancer?

sistimibi vs Tech9 scan

Back 220

sistimibi

Front 221

refractory peptic ulcer disease+diarrhea dx tx

Back 221

zollinger ellizon (gastrinoma)
tx- check gastrin level, the CT pancreas for tumor and resect

Front 222

migratory necrolytic dermatitis+mild Dm dx

Back 222

glucagonoma

check glucagon level, CT pancreas for tumor and resect

Front 223

repeated low glucose+ Cpeptide high (endogenous insulin)

Back 223

Insulinoma CT pancreas for tumor and resect

Front 224

fxn of aldosterone

Back 224

sodium in, potassium out,
sodium drives water in, inc blood pressure

Front 225

hyper aldosteronism presents with _________

Back 225

Hypertension and potassium out (LOW)

Front 226

episodes of headache, palpation+ but normal at clinic

Back 226

pheo

Front 227

what test do you order for pheochromocytoma?

Back 227

24 hr urine VMA and metanephrine. CT ab

Front 228

BP difference betn UE vs LE+rib notching on xray dx?

Back 228

coarctation of aorta
rib notching=body uses intercostal a. to bypass coarctaion

Front 229

HTN + bruit on upper abdomen dx+old men?

renal artery stenosis due to athrosclerosis vs fibromuscular dysplasia

Back 229

renal artery stenosis due to athrosclerosis

Front 230

HTN + bruit on upper abdomen dx+young women?

renal artery stenosis due to athrosclerosis vs fibromuscular dysplasia

Back 230

renal artery stenosis due to fibromuscular dysplasia

Front 231

first 24 hrs of birth+excessive salivation+coiled NG tube
dx-
f/u-

Back 231

dx-esophageal atresia
f/u-Vert-xray
Anus
Cardiac-echo
Tracheal
Esophageal
Renal-U/S

Front 232

first 24 hrs of birth+scaphoid ab+resp distress+bowel sound in L chest
dx-?
tx-Surgery now vs later why?

Back 232

Congenital diaphragmatic hernia
surgery in 3-4 days to allow the Hypoplastic lung to mature

for now give resp support

Front 233

first 24 hrs of birth+green vomit+double bubble
dx?

Back 233

duodenal atresia
annular pancreas

Front 234

first 24 hrs of birth+green vomit+dubble bubble,+ gas pattern beyond

Back 234

malrotation

Front 235

first 24 hrs of birth+green vomit+multiple gas pattern+mom did crack

Back 235

intestinal atresia

Front 236

3 wk old+projectile nonbilious vomiting+hypoCL,hypoK metabolic alkalosis
dx, tx

Back 236

pyloric stenosis
tx-1. correct lytes
2. myotomy

Front 237

premature+ab distension+pneumoperitonieum+feeding intolerence+dropping platelet level (sign of sepsis in baby)
dx
tx

Back 237

necrotizing enterocolitis
tx-NPO, IVF, abx

Front 238

6mo old+chubby kid+ colicky ab pain+current jelly stool

Back 238

intussusception
tx-barium/air enema is both diagnostic and theraputic

Front 239

fixed split S2, defect?

Back 239

ASD

Front 240

harsh holoSystolic murmur/loud pansystolic murmur , defect?

Back 240

VSD

Front 241

cont machine like murmur dx? tx?

Back 241

PDA
tx: INDomethacin-end PDA

Front 242

cyanosis at day one+mother had DM

Back 242

transposion of great vessels
tx-Prostaglandin kEEEEp pda open, and surgert

Front 243

harsh HoloSYStolic murmur

Back 243

VSD

Front 244

Systolic murmur
MR. Ass

Diastolic murmur
ARMS

Back 244

systolic-
mitral regurg
aortic stenosis
diastolic
aortic regurn (insuff)
mitral stenosis

Front 245

Coronary intervention is indicated when coronary vessels are ____% blocked

Back 245

70 or more

Front 246

tx for
small cell carcinoma
non-small cell (squamous cell carcinoma)

Back 246

small cell-give SMALL does of chemo and radiotion
squamou cell-operable if pt wil be left w. FEV of 800ml

Front 247

central hilar mass+bronch bx show squamous cell
FEV is 1000ml, ventilation-perfusion scan shows 80% comes from affected lung

next step

Back 247

FEV 1000ml (.80)=800ml comes from affected lung
1000-800=200ml will be the leftover fxn after pneumectomy, needs atleast 800ml to fxn. SO no further surgery workup, do chemo and rad

Front 248

arm claudication w. strenious work+neuro sx (vertidgo, blurred vision)
path
dx
tx

Back 248

subclavian steal syndrome
Path-plaque in origin of subclavian a. before the vertebral a. takeoff, during strainous work, blood goes to arm, from subclavian and vertebral
dx-duplex u/s
tx-bypass surgery
tx-

Front 249

6cm ab mass between xyphoid and umbilicus (AAA)
1. found of physical exam
2. mild pain
3. excruciating back pain

Back 249

1. needs elective repain 5.5cm+
2. vascular consult today
3. emergency surgery-rupturing now

Front 250

cant sleep due to to calf pain+better when he dangles feet off bed+leg is shiny, no hair, no peripheral pulse
dx, tx

Back 250

dx-Rest pain
tx:
1.Ankle Brachial index <.3
dopper-if he has significant gradient then arteriogram and bypass

Front 251

HTN+tearing chest pain radiating to back+cxr widened mediastinum+EKG and cardian enzymes neg (r.o MI)
next step? CTA vs angiogram

Back 251

CTA
(angiogram will pop the aortic dissection)

Front 252

management of ascending vs descending aortic dissection

Back 252

ascending=surgery
descending=medically control BP

Front 253

sudden loss of neurologic fxn without headache+resolves spontaniously w. sequeliae think?

sudden loss of neuroligic fxn w.o headeach+last more than 24hrs, leaves sequeliae thing?

Back 253

TIA-CT angio->carotid endarectomy
stroke-tPA w.in 3 hrs, supportive tx, rehab

Front 254

most common origin of TIA?
internal carotid vs vertebral artery

Back 254

internal carotid

Front 255

how do you differenciate between vascular occlusive vs vascular hemorragic neurosurgical cases

Back 255

vascular occlusive-neur sx+no headache
vascular hemorhagic-neuro sx+ha

Front 256

uncontrolled htn+very severe headache+neurological sx is classic case of ?

Back 256

hemorrhagic stroke (intracerebral bleed)
do CT to see extent of hemorrhage

Front 257

what caused subarachnoid hemorrhage?

Back 257

aneurysm rupture

Front 258

______ is universal exam to see blood in head

Back 258

head CT scan

Front 259

common sx of subarachnoid hemorrhage and managemnt?

Back 259

sentinal headache, goes home, comes back w. worse HA of my life, do CT , arteriogram, Clip it

Front 260

hx of progressively increasing HA+blurred vision+papilledema+projectile vomiting think of? order?

Back 260

Brain tumor
order MRI, while waiting for surg, reduce ICP w. high dose steroid (Decadron)

Front 261

teen small for age+bitemporal hemianopsia+calficiation above sell on head xray dx? tx?

Back 261

craniopharyngioma
get MRI to confirm and pituitary surgery

Front 262

Frontal lobe tumor+inappropriate behavior =___________syndrome

Back 262

Kennedy Foster syndrome (kennedy was known for inappropriate behaviors

Front 263

In tumor of frontal lobe optic nerve atrophy is on the ________ side , papilledema is one _________ side
same vs diff

Back 263

optic nerve atrophy same side
papilledema diff side

Front 264

loss of upward gaze+sunset eyes think?

Back 264

tumor of pineal gland

Front 265

signs and sx of tumor that occurs in 2 weeks (instead of months) and presents w. fever, and source of infection otitis media/ mastoiditis spells out? Order?

Back 265

brain abscess, CT is good enough, dont waste money on MRI

Front 266

sudden neurologic problem w.o headeach=

Back 266

vascular occlusive, get duplex/arteriogram, do endarterctomy

Front 267

sudden neurologic problem w. HA=

Back 267

vascular hemorrhagic, CT to see how bad

Front 268

Brain tumor have timetable w.in _______,
w. constant progressive HA, worse in morning, ICP inc, blurred vsion, projectile vomit

months vs weeks

Back 268

months

Front 269

Brain abscess have timetable w.in ______
months vs weeks

Back 269

weeks

Front 270

anterior cord syndrome is associated w. _________

hyperextension injury vs burst fx of vertebral body

Back 270

burst fx fo vertebral body

Front 271

central cord syndrome is associated w. _________

hyperextension injury vs burst fx of vertebral body

Back 271

hyperextension injury

Front 272

eldery+MVA+UE paralysis and burning pain

Back 272

central cord lesion

Front 273

CT shows burst fx of vertebral body+loss of pain and temp, propriociion is ok dx>

Back 273

anterior cord lesion

Front 274

teste pain+no fever=

Back 274

torsion, Surgical emergency

Front 275

teste pain+ fever

Back 275

epidimitis, give Abx

Front 276

if unsure about torsion vs epidimitis order?

Back 276

sonogram to r.o torsion (surgical emergency)

Front 277

teen boy gets flank pain aftering bing drinking
ureteropelvic juction obstruction vs low implantation ureter

Back 277

ureteropelvic juction obstruction

Front 278

little girls pee's normally but is also wet w. urine all the time

Back 278

low implantation of ureter-one is implanted into vagina which has no sphincter so, one ureter is always peeing