Usmle Ck - Surgery 2

Front 1

pt s/p acid ingestion

Back 1

- esophogeal stricture: dysphagia
- pyloric stenosis: eating fine i.e. no dysphagia but throwing up afterwards = gastric outlet obstruction, succussion splash on epigastrium

Front 2

midshaft humerus fx

Back 2

- radial nerve injury = wrist drop = limited extension
- ulnar nerve = claw hand

Front 3

barium enema bird beak

Back 3

- sigmoid volvulus

Front 4

tx of pseudocyst

Back 4

- when pt becomes bacteremic = pseudocyst infx and need to drain

Front 5

paralytic ileus

Back 5

- trauma pt s/p retroperitoneal associated with vertebral fx => decreased bowel sounds, no stool, KUB = air fluid levels in gas filled large intestint

Front 6

esoph perf

Back 6

- pt with hx of esophagitis whether pill induced (KCL) or infx (candidiasis) now with widened mediastinum and pneumomediastinum
- do gastroraffin esophagram; NEVER BARIUM which causes mediastinal inflammation

Front 7

solitary pulm nodule

Back 7

- <3 cm in diameter by xray
- do CT
- benign if doubles in 1.5 yrs, if doubles in <30 days = infx

Front 8

glascow coma

Back 8

- eye: spontaneous 4, verbal 3, pain 2, none 1
- verbal: oriented 5, disoriented 4, inappropriate 3, incomprehensible 2, none =1
- motor: obeys = 6, localizer 5, withdraws 4, flexion (decorticate) 3, extension posturing (decerebrate) 2, none =1

Front 9

humeral shaft fx with decreased strength and pulse

Back 9

- injury to radial nerve, will heal
- attempt to align humerus

Front 10

bronchial vs esoph rupture?

Back 10

- rarely esoph from trauma, only 2/2 esophagitis
- trauma = bronch
- will see pneumomediastinum in both

Front 11

syringomyelia?

Back 11

- spinothalamic = pain and temp
- upper motor neuron injury
- above are located near center of cord
- hx: whiplash

Front 12

pt with diverticulitis now with abscess formation?

Back 12

- now complicated, do CT guided drainage, lap if fails
- noncomplicated = cipro and metronidazole

Front 13

hypoglossal nerve injury

Back 13

- surgery below mandible => tongue palsy

Front 14

winged scapula

Back 14

- long thoracic nerve injury e.g. axillary dissection

Front 15

breast pathology

Back 15

- intraductal papilloma: benign, intermittened d/c from one niiple
- fibrocystic: bilateral breast pain with cystic change
- fibroadenoma: firm, painless, mobile lump, 15-25 y.o., benign
- ductal carcinoma: incidental finding on mammography, asympt, abnormal ductal epithelium, no BM involvement

Front 16

lower brachial cuff injury

Back 16

- sudden upswing of arm
- C8,T1
- Klumpke's palsy: weakness, atrophy of hypothena and interosseous muscle, claw hand

Front 17

hydrocele

Back 17

- fluid collection in processus or tunica vaginalis
- ddx testicular mass by transillumination, hydrocele will transluminate
- resolves in 12 mo

Front 18

pancreatic vs splenic rupture

Back 18

- both 2/2 abd trauma
- CT would have spot spleen; if neg CT but sx 1 wk later of sepsis then pancreatic trauma that formed pseudocyst

Front 19

psoas abscess

Back 19

right of left lower quadrant pain but elicited on DEEP palpation, no rebound/guarding to suggest peritoneal signs e.g. appendicitiis
- hx of skin infx (furuncles) as infx by continguous spread
- MC pathogen s. aureus

Front 20

ischemia reperufsion syndrome

Back 20

- ischemia => embolectomy => reperfusion => swelling, compartment syndrome

Front 21

septic synovial fluid

Back 21

- WBC >= 2000 often 50,000
- neutrophil 75%, glucose <25, +gram stain

Front 22

SCFE tx?

Back 22

- surgical pinning of slipped epiphysis where it lays (in situ) to decrease risk avascular necrosis

Front 23

anserine bursa

Back 23

- gracillis and semitendinosus muscle tendon => medial knee tenderness

Front 24

nerve of lower limb

Back 24

- femoral: anterior compartment => knee extension, hip flexion, saphenous branch
- tibila: posterior compartment => knee flexion and plantar flexion, sensation to leg except medial side and plantar
- obturator = medial compartment => adduction, medial thigh sensation
- common peroneal = sensation to anterolateral leg, dorsum foot

Front 25

MCL, ACL, PCL

Back 25

- MCL: + vlagus stress test
- ACL: forceful hyperextension or torsional injury during deceleration => Lachman's test, anterior drawer test, pivot test
- PCL = dashboard injury => Posterior drawer, reverse pivot, post sag test

Front 26

indications for transfusion?

Back 26

- lose 25-30% of blood volume ~1500ml
- start with crystalloid infusion, then blood

Front 27

xray shows diaphragm rupture, next step?

Back 27

- barium swallow or CT with oral contrast => operation

Front 28

irritation of diaphragm

Back 28

- pain radiating to shoulder 2/2 peritonitis or rupture = Kehr sign

Front 29

bladder injury

Back 29

- MC is dome, additional evidence is peritonitis b/c only dome leaks into peritoneum, so see chemical irritation of diarphgram
- MC extraperitoneal injury = bladder neck

Front 30

raccoon eyes, rhinorrhea, otorrhea?

Back 30

BASILAR FX OF SKULL

Front 31

svc catheter placed, pt now hypoT, tachy

Back 31

- cause of 1/4 of iatrogenic PTX
- pt has tension PTX

Front 32

FNA vs excisional biopsy

Back 32

- if high suspicion of malignancy e.g. fixed and irregular do excisional
- FNA for palpable lesion

Front 33

fluid in spleno-renal area by U/S

Back 33

- do CT, grade the injury => surgery vs conservative tx

Front 34

follicular occlusion?

Back 34

- suppurative hidradenitis = painful nodules and pustules of axillae and groin
- pilondial disease - coccyx pain 2/2 infx of hair follicles in that area
- dissecting folliculitis of scalp
- acne conglobata

Front 35

Bowen's dz?

Back 35

- SCC in situ of skin - thin erythematous plaque with scale and crust

Front 36

Aortic injury

Back 36

- rapid decl blunt chest trauma => can have incopmlete or contained rupture => no immeidate death but large hemothoradx
- antiHTN therapy and surgery
- myocardial rupture = insta death

Front 37

codman's triangle

Back 37

- metaphysis = osteosarcoma
- diaphyses = Ewing

Front 38

scaphoid fx

Back 38

- MC fx, fall on outstretched hand, tenderness at anatomical snuffbox
- note: must do multiple views of hand to catch the fracture, but even if you dont' see fx and still highly suspect, cast it
- cast immobilization, surgery if displacement

Front 39

appendicitis

Back 39

- if woman, do U/S to r/o gyne processes
- if man and obvious, APPY
- if signs of abscess or phlegmon = conservative tx with abx

Front 40

acute cholecystitis

Back 40

- manage conservatively with observation, pain meds, abx, followed by elective chole during same admission
- ERCP if gallstone in CBD
- perQ drainage if C/I to surgery
- emergent chole if biliary gangrene or perf

Front 41

tonic clonic seizure, which shoulder dislocation?

Back 41

- posterior - adducted, internally rotated
- if externally rotated = anterior shoulder d/c

Front 42

burn inhalation

Back 42

- non rebreather, but low threshold for intubation

Front 43

head injury

Back 43

- low risk: no LOC, mild HA => go home
- mod risk: LOC, emesis, severe HA, seizure => CT => if neg, go home

Front 44

osteosarcoma

Back 44

- young kid, osteolytic lesion at end of long bones
- MC primary bone malignancy, occurs at growth areas, see normal ESR but high alk phos
- codman and sunburst, no systemic sx

Front 45

onion skin

Back 45

- ewings; onions = ew
- blue cell, systemic sx, diaphyses, spine, pelvis

Front 46

soap bubble

Back 46

- osteoclastoma = giant cell, epiphyses of distal femur, prox tibia

Front 47

post op fevers

Back 47

1-2d = PNA
3-5 = UTI
4-6 = DVT
5-7 = wound
>7 = drug

Front 48

pt with ileus and UA suggesting renal stones?

Back 48

- ileus 2/2 ureteral colic
- do CT to dx renal stones

Front 49

clavicle fx

Back 49

careful with subclavian artery and brachial plexus
- tx: brace, rest, ice
- if distal fx then open reduction, fixation

Front 50

pt with head and neck injury but also apneic?

Back 50

- do orotracheal intubation, benefits outweigh risk of cervical injury
- needle cricothyroidectomy only in kids
- surgical cricothyroidectomy if orotrach fails
-0 tracehsotomy is no longer done

Front 51

fluctuant mass palpable on tip of rectal exam?

Back 51

- abscess! 2/2 gyne in women and appendicitis in men
- drainage
- anorectal abscess = perineal pain with mass on perineum

Front 52

carotid artery injury

Back 52

-intimal flaps? MUST REPAIR

Front 53

SIRS

Back 53

- systemic inflammatory response
- fever or hypothermia, tachypnea, tachy, leukocytosis, leukopenia, or bandemia
- need 2 of 4
- if 2/2 infx = sepsis
- severe end organ damage = hypotension, thrombocytopenia, met acidosis, hypoxia

Front 54

fibrocystic nodule

Back 54

- must do FNA b/c cannot r/o carcinoma
- if serous (Green) and non bloody and cyst disappears then reexamin in 6 wks for reccurence
- OCP bad b/c estrogen may be cause