Surgery, Trauma, Subspecialties For Step 3

Front 1

Best test to evaluate head trauma

Back 1

Noncontrast CT (better than MRI in emergent situations)

Front 2

Management of blunt abdominal trauma where pt is awake and stable and initial exam is benign

Back 2

Admit and observe with serial abdominal exams

Front 3

Management of blunt abdominal trauma where pt is hemodynamically unstable and does not respond to fluid challenge

Back 3

Proceed directly to laparotomy

Front 4

Management of pt with blunt abdominal trauma where pt had AMS and abd is unexaminable or tender or there is no obvious source for blood

Back 4

CT scan of abdomen and pelvis with oral or IV contrast

Front 5

Mgmt of GSW to the abdomen

Back 5

laparotomy

Front 6

Mgmt of sharp instrument to abdomen and pt is unstable

Back 6

laparotomy

Front 7

Mgmt of sharp instrument to the abdomen and pt is stable

Back 7

CT scan and if results are positive then laparotomy; if negative, observe and repeat exam later

Front 8

Si/Sx of tension pneumothorax

Back 8

1. Trachea and mediastinum are shifted to OPPOSITE side of chest
2. absent breath sounds
3. hypertympanic or hyperresonant to percussion on AFFECTED side
4. hypotension or distended neck veins

Front 9

Mgmt of tension pneumothorax

Back 9

Needle thoracentesis to anterior 2nd ICS followed by insertion of a chest (thoracostomy) tube

Front 10

DX: penetrating trauma to left chest resulting in hypotension, distended neck veins, muffled heart sounds, pulsus paradoxus and normal breath sounds

Back 10

Cardiac tamponade

Front 11

Mgmt of cardiac tamponade

Back 11

If stable, Echocardiogram to confirm dx; If unstable then catheter insertion in pericardial sac via subxiphoid approachto aspirate blood or fluid

Front 12

Initial mgmt of massive hemothorax

Back 12

IVF &/or blood BEFORE chest tube placement. If bleed stops then CXR &/or CT and treat supportively. If bleeding does not stop then emergent thoracotomy.

Front 13

The most common (MC) cause of immediate death after an automobile accident or fall from a great height

Back 13

Thoracic aortic rupture usu at the aortic isthmus

Front 14

Classic CXR finding with aortic dissection

Back 14

widened mediastinum

Front 15

Most immediate life-threatening risk with electricity exposure and burns

Back 15

cardiac arrhythmias; order an EKG

Front 16

Mgmt of 1st degree burns--epidermis only; painful, dry red areas WITHOUT blisters

Back 16

keep clean

Front 17

Mgmt of 2nd degree burns involving epidermis and some dermis; swollen with blisters and open weeping surfaces

Back 17

Remove blisters and apply abx ointment (silver nitrate, silver sulfadiazine, neomycin) and dressing

Front 18

Mgmt of 3rd degree burns involving all layers of the skin incl nerve endings; skin is dry and PAINLESS

Back 18

Surgical excision of eschar and skin grafting is required. Watch for compartment syndrome which is treated with escharotomy.

Front 19

What vaccine should burn victims receive?

Back 19

Tetanus

Front 20

The most impt thing to monitor in pts with hypothermia

Back 20

EKG for arrhythmias; Classic but rare finding on EKG is J wave, small positive deflection following QRS complex.

Also monitor electrolytes, renal function and acid-base status

Front 21

Immediate threats to life in pts with hyperthermia

Back 21

Convulsions (Rx: Diazepam) and cardiovascular collapse

Front 22

Classic culprits for pts with malignant hyperthermia? Treatment?

Back 22

Succinylcholine and halothane exposure
Tx with Dantrolene

Front 23

Mgmt of near drowning pts

Back 23

If pt unconscious--intubate; If pt conscious--monitor ABGs

Front 24

Acute abdomen localized to RUQ you should think:

Back 24

GB (cholecystitis), bile ducts (cholangitis) or liver (abscess)

Front 25

Acute abdomen localized to LUQ you should think:

Back 25

slpeen (rupture w/blunt abd trauma and rarely abscess)

Front 26

Acute abdomen localized to RLQ you should think:

Back 26

appendix (appendicitis) or OB/Gyn problem

Front 27

Acute abdomen localized to LLQ you should think:

Back 27

sigmoid colon (diverticulitis) or OB/Gyn problem

Front 28

Findings assoc with cholangitis?

Back 28

RUQ pain, fever, or shaking chills and jaundice

Front 29

Mgmt of cholangitis?

Back 29

Blood cultures 1st then prophylactic abx and cholecystectomy once the pt is stable

Front 30

Best 1st test for suspected GB disease

Back 30

Ultrasound; HIDA scan clinches a difficult dx
(+) scan==>nonvisualization of the GB

Front 31

DX: Pt with blunt abd trauma with hypotension or tachycardia, shock and Kerr sign (pain referred to left shoulder)

Back 31

Splenic rupture

Needs splenectomy; Don't forget immunizations against encapsulated organisms

Front 32

MC Dx in pt >50YO with localized LLQ pain?
Mgmt?

Back 32

Diverticulitis; confirm with CT scan abdomen with oral and IV contrast

Tx: broad-spectrum abx and NPO

Front 33

Complications of acute pancreatitis

Back 33

pseudocyst and pancreatic abscess

Dx by CT scan and may require surgical intervention

Front 34

Which narcotic should be avoided in pts with pancreatitis

Back 34

Morphine which causes sphincter of Oddi spasm and can worsen ssx. Use opiates instead, usu. meperidine

Front 35

Most likely dx and mgmt for pt with mildly elevated amylase & normal lipase with small amt of free air under the diaphragm on Xray

Back 35

Perforated peptic ulcer

Laparotomy

Front 36

MCC od SBO in adults is

Back 36

adhesions from previous abdominal surgeries

Front 37

Si/Sx SBO

Back 37

bilious vomiting (early)
abd distention
constipation
hyperactive bowel sounds (high-pitched, rushing sounds)
poorly localized abd pain
multiple air-fluid levels in small bowel loops

Front 38

In a child with SBO what is MC etiology?

Back 38

Think incarcerated inguinal hernia or Meckle's Diverticulum

Front 39

Mgmt of SBO

Back 39

NPO
NG tube
IVF

If ssx do not resolve or if pt develops peritoneal ssx then laparotomy is needed to relieve the obstruction

Front 40

In a child with LBO consider

Back 40

Hirschsprung's disease

Front 41

Common causes of LBO in older adults and mgmt

Back 41

Diverticulitis, volvulus, colon cancer

Tx: NPO, NGT; Sigmoid volvulus can be decompressed with endoscope; If refractory may require surgery

Front 42

MC hernia in both sexes and all age groups

Back 42

INDIRECT

Front 43

Protrusion of this hernia begins lateral to the inferior epigastric vessels due to a patent processus vaginalis

Back 43

INDIRECT

Front 44

This hernia is more common in women

Back 44

Femoral

Front 45

This hernia is due to defect in abdominal wall, Hasselbach's triangle

Back 45

DIRECT

Front 46

This hernia is most susceptible to incarceration and strangulation

Back 46

Femoral

Front 47

Protrusion of this hernia is MEDIAL to the inferior epigastric vessels and NOT into the labia or scrotum

Back 47

DIRECT

Front 48

Best preoperative test to assess pulmonary function

Back 48

Spirometry

Front 49

MCC of post-op fever in the 1st 24hrs

Back 49

Atelectasis

Front 50

Fascial/wound dehiscence typically occurs ________ days post-op

Back 50

5-10 dd post-op
Look for leakage of serosanguinous fluid w/Valsalva
Tx: Abx (if 2/2 infxn) and reclosure of incision

Front 51

Cause of acquired hearing loss in children

Back 51

Meningitis or recurrent OM

Screen for hearing loss after meningitis

Front 52

Classical physical findings and bacterial cause for infectious myringitis?

Back 52

Otoscopy reveals vesicles on TM and classic cause is Mycoplasma spp. Also Strep pneumo and viruses

Rx: abx

Front 53

MCC of sensorineural hearing loss in adults

Back 53

presbyacusis---nml part of aging

Tx: hearing aid if needed

Front 54

MCC of progressive conductive hearing loss in adults

Back 54

Otosclerosis

Tx: hearing aid or surgery

Front 55

What is Beck's triad?

Back 55

--decr systemic arterial pressure
--incr CVP
--small quiet heart
**signifies acute cardiac tamponade

Front 56

Post-op hypotension, hypoglycemia, and change in mental status---you should suspect____

Back 56

Adrenal insufficiency

Front 57

Lung white out 2 days after flail chest or rib fractures---dx and mgmt?

Back 57

pulmonary contusion--fluid restriction, diuretics, respiratory support

Front 58

Blood in meatus and high riding prostate after trauma--dx & mgmt?

Back 58

Posterior urethral injury
Do posterior urethrogram, suprapubic catheter, repair delayed 6 months

Front 59

Blood in meatus and scrotal hematoma--dx & mgmt?

Back 59

Anterior urethral injury
Do retrograde urethrogram and immediate surgical repair

Front 60

What tumor classically affects both the 7th and 8th CNs?

Back 60

Acoustic schwannoma which is located in the cerebellopontine angle. If present consider---neurofibromatosis

Front 61

MCC of BILATERAL facial nerve palsy

Back 61

Lyme disease

Front 62

Most likely dx in pt with hx of head trauma w/LOC followed by lucid interval of minutes to hours then neurological deterioration. Tx?

Back 62

Epidural hematoma--biconvex on xray
Tx: surgical evacuation

Front 63

Worst HA of pt's life with si/sx of meningitis except NO fever

Back 63

Subarachnoid hemorrhage (SAH)

Front 64

SAH is usually 2/2

Back 64

Rupture of aneurysm (usu berry)--blood in ventricles but NOT in brainstem or brain

Front 65

Treatment for SAH

Back 65

Support, anticonvulsants and observation; once pt is stable, do a cerebral angiogram to look for aneurysms or AVMs which are usu treated w/surgical clipping or ligation

Front 66

Causes of bleed in brain parenchyma

Back 66

MCC is HTN; AVMs, coagulopathies, tumor and trauma are other causes

Front 67

Classic and MC location of HTN-related bleeds

Back 67

Basal ganglia (2/3)
Pt often presents in coma. If awake, may have contralateral hemiplegia and hemisensory deficits

Front 68

4 classic signs of basilar fracture

Back 68

1. periorbital ecchymosis (raccoon eyes)
2. postauricular ecchymosis (battle sign)
3. hemotympanum (bld behind TM)
4. CSF otorrhea/rhinorrhea

Front 69

After trauma pt has unilat dilated unreactive pupil---pt most likely has

Back 69

epidural bleed causing impingement of ipsilat CN III and impending uncal herniation due to incr ICP

Front 70

Normal ICP range

Back 70

5-15mmHg

Front 71

What is Cushing's triad and what does it's presence suggest?

Back 71

Incr BP
bradycardia
resp irregularity

**suggests very high ICP

Front 72

How to treat HTN in setting of incr ICP?

Back 72

Do NOT treat
Cerebral perfusion pressure = BP-ICP

Front 73

Si/sx of spinal cord (SC) trauma

Back 73

spinal shock--loss of reflexes and motor fxn and hypotension

Front 74

Mgmt of SC trauma

Back 74

Immediate IV corticosteroids and surgery for incomplete neurologic injury

Front 75

Pt with local spinal pain and neuro deficits below the lesion (e.g. hyperreflexia, +Babinski, weakness or sensory loss) likely has____?

Back 75

Subacute SC compression---can be due to metastatic CA, primary neoplasm, subdural or epidural abscess or hematoma (esp after spinal tap)

Front 76

In what condition of the elderly is the classic triad of ataxia, dementia, and urinary incontinence seen?

Back 76

Normal pressure hydrocephalus

Tx: ventricular shunt

Front 77

Bilat loss of pain and temp sensation below lesion in SC in the distribution of a cape--dx?

Back 77

Syringomyelia---central cavitation of the SC
Dx w/MRI
Tx: Surgery--create shunt

Front 78

Type of glaucoma that is a painless gradual progressive visual field loss

Back 78

Open-angle glaucoma---accts for 90% of cases
Usu 2/2 HTN

Front 79

Medications for open-angle glaucoma

Back 79

beta blockers
prostaglandins (latanoprost)
acetazolamide
pilocarpine

Front 80

Si/sx of closed-angle glaucoma

Back 80

sudden ocular pain
halos around lights
red eye
very high intraocular pressure (>30mmHg)
N/V
sudden decr in vision
fixed, mid-dilated pupil

Front 81

Treatment for closed angle glaucoma

Back 81

Immediately with pilocarpine drops, and oral glycerine and acetazolamide to break the attack then surgery to prevent other attacks (peripheral iridectomy)

Front 82

6 Causes of sudden unilateral, painless vision loss

Back 82

1. Central retinal artery occlusion
2. Central retinal vein occlusion
3. Retinal detachment
4. Vitreous hemorrhage
5. Optic neuritis/papillitis
6. Stroke or TIA

Front 83

MC Dx in pt with branching ulcer over his cornea with terminal bulbs that stain green with fluorescein. Usu starts with vesicular eruption on lid and conjunctivitis.

Back 83

Ocular herpes keratitis

Refer to ophthalmologist promptly for antiviral tx (idoxuridine)

Front 84

Mgmt for a pt with CC of floaters and flashes of light and "veil or curtain coming down in front of eye"

Back 84

Dx---likely retinal detachment

Immediate referral to ophthalmologist, as prompt surgery (reattachment) may save pt's vision

Front 85

4 causes of sudden, unilateral painful vision loss

Back 85

Trauma
Closed-angle glaucoma
optic neuritis
migraine HA (rare)