Step 2 surgery 12-18-2015 rapid review

ruhland1's version from 2015-12-18 11:31

Section 1

Question Answer
F old SBO air in BTGStone ileus
trusssupport hernia
simple mastectremoves alll but not LN
radical mastectremoves alll and axillary LN
abd pain dn bp abd pulsatile massruptured AAA
pain out of proportionmesenteric isch
mesenteric ischmesenteric angiography
papervineacute mesenteric isch
arm pain and syncope w arm mvmtsubclavian steal synd
subclav steal syndreversed vertebral flow due due stenosis of subclav a
use ACEi get up creatininerenal a stenosis makes sense...
child midline neckthyroglossal cyst
child lateral neckbranchial cleft
trauma and dark urinemyoglobinemia excretion
emesis chest pain rad to back and mediastinal airboerhaves
Meckel Divert dxTc-99 Scan
right sided HFcarcinoid because massive pulmonary congest
pneumaturia and LLQ paincolovesicular fistual
demoid, osteoma, colon cxgardner
epig pain to back and flank ecchyhemmoraghic pancreatitis
panc and palp epig mass and persistent hyperamylasemiapanc pseudocyst
panc psuedocyst2-3wks post acute panc or steering wheel trx
anchovie pasteamebic abscess
RUQ travel sheephydatdid cyst
45 F RUQ 12 hr F and WBCacute chole

Section 2

Question Answer
large nontender palp GB and oldCourvoisiers sign (panc cx)
purlent urethra and G- coccigonn
vomitdn K Cl Na
Clfollows K
N V ud F no eat loose stools periumbpain 24 hrgastroenteritis
unil 1 duct bloody premenopintraductal papiloma
CDiff txPO metro > vanco
53 F R breast mass onlythink LCIS (lobular cx insitu) will become invasive in 10 yr, often bil, need to do mammography contra breast
colon dzalways r/o cx
breast massr/o cx unless young
non palp breast massfirst do mammo
anal fissureLIS
F on OCP riskhepatic adenoma
central scarfocal nodular hyperplasia
panc mass, gallstone, diabetes, diarrheasomatostatinoma
somatostatinomadn insulin dn cck * dn bile dn gastrin * achlorhydria
achlorhydriadn HCl production in GI
RUQ bruit CHF youngLiver hemangioma
pain with BM gets worse bc afraid to poopyanal fissure
abd px rrhea anal fistCDz
peaked T waveshyperK
Peutz JeghersBenign polyp
LLQ px F change bowel habitsdiverticulitis
mental ill, abd px, V, dist, prox colon dilsigmoid volv
no meconium 24 hrhirschsrpung
infant with bilious Vmalrot
malrotationinfant with bilious V
baby abd def and umbical cord on sacomaphalocele
onion skin bone11 22 Ewing
sarcomaconnective tissue that infuses interstitium
wedge pressurewedging a pulm cath into small pulm artery
dn wedge P, CXR bil infiltARDS
PaO2:FiO2 <200ARDS
up peak airway p, dn urine Oput, bladder >25mmhgabdominal compartment synd
abd compartment syndup up abd compartment P dn GI perfusion, dn peeing cause cant be pissed over the pressure, occurs when fluid within perit or retroperit accum
cant pass NG tube in babyesph or choanal atresia

Section 3

Question Answer
trx blind one eye then in 2 wks blind contrasymp ophthalmia
symp opthal pathophystrx one eye immune see new Ag therefore now attacks both eyes via T4 HSN
ptosis, miosis, anhydrosishorner (pancoast tumor, non-small cell lung cx)
luicd intervalepidural biconvex
worst HASAH
hematuria, flank pain, palp abd massrenal cell cx
60 M painless hematbladder cx
RUQ Jaundice FCholangitis (charcot) or ascending cholang
reynoldcharcot + dn bp + d mind
epig pain to back, N and Vpanctitis
chest pain "tearing" to backaortic dissect
Debakeyaortic dissect, I is heart to desending aorta, II is ascending aorta, III desending aorta to L subclave
StanfordType A= ascending aorta need srx, B= no ascending involvment no srx
40 M tachy htn confusion post op day 2
mucosal neuroma and MarfanoidMEN II b
MEN Ipit pth panc (diamond) prolactin growth horm Zollinger VIPoma gastric ulcer kidney stone due to up PTH
sippleMEN II a Medullary thyroid cx (secrete calcitonin) pheo and PTH
MEN IIA and B sharemed thy cx(calcitonin), pheo, ret gene assoc
sulfgranuleacintomyces israllei, heat dz, dental abscess
ABCactinomyces, bactreotrides, clostridoum
thyroid tissue AMYLOID tissuethyroid medullary cx (calcitonin MEN II)
Pheohtn, diaphor, palp, episodic
jejunal ulcerthink Zollinger Ellison massive gastrin
stress ulcermultiple srx and ICU admission, goal keep pH >4
glucagonomanecrotizing migratory erythema
alpha cellsglucafon
necrotizing migratoy eythermaareas of focal massively concentrated glucagon cause massive lipolysis and catabolic processes
migratory thrombophlebitis panc / gastric cx areas of massive focal conc trypsin
cant correct K despite IV K+ supplehypomagnesium
K+ and Mg++opposite direction relationship

Section 4

Question Answer
Fever post op day 0-1systemic response, pre-existing inf
Fever post op day 1-3atelectasis
Fever post op day 3-7pneum, wound ix, UTI, intraperit sepsis (etio are sepsis / anamostic leak)
Fever post op day 7-10DVT and PE
large blood transfusiondilutional and consumptive coagulopathy
psammomas bodiesorphan annie eyes and concentric things in papillary thyroid cx

Section 5

Question Answer
newborn pneumatosisnecrotizing enterocolitis
pneumatosisgas cysts in bowel wall
premature infantup pneumatosis bc up nec enterocolitis bc dn BF to GI bc underdeveloped
child abd mass crosses midlineneuroblastoma
child abd mass not cross midlinewilms tmx (WAGR)
WAGRwilms aniridia GU issue retard
currant stool and abd colicintuss
fat embolifemur frx, Resp F, petechiae, d mind
Male teen nasal obstruct and recurrent epistaxisjuvenile nasopharyngeal angiofibroma
child <5yo drooling hot potatoepiglottis
angina syncope CHFaortic sten
bobbing headaortic regurg (demussels)
tobaacco, asnestos, pleuritic chest painmesothelioma
supracondylar frx and contracture forearm flexureVolkman contaracture
tibia frx, up pain, pallor, paresthesia, poikilothermia, parylysis, 0 pulse, tensecompartment
pin and needlesparesthesia
dx compartment synd>30mmhg and delta pressure <30mmhg (diastolic p- compartment p)
25 M, liver mass, fibrous septae, no liver dz hxFIBROLAMELLAR hepatocelluar cx
flat T wavedn K
U wavesdn K
constip, poly dip, poly uriaup Ca, dn motility up peeing to excrete Ca
dn Factor 8Hemophilia A (PTT)
addisonian crisisadrenal insuff and abd pain F, dn BP, up K dn Na
up piss and up Nadiabetes insipid
Na proportional tovolume status dont forget this
dense urine, dn Na, dn stuff in bloodSIADH
SIADHsmall cell cx, dn Na because up vol
dn Na and urine >300 osmolSIADH

Section 6

Question Answer
IV abx, F ,DC Diff due to Ampicillin / Clindamycin, tx metro>vanc
bleeding gum and wound dehiscences
primary intention wound healedges approx, grafts and flaps
2nd intention wound healwound left open and allowed to fill in
tertiary intention wound heal left open allowed to granulate then approximated (aka delayed closure)
crepitus F and blood blisternec fascitis
confusion ataxia wild eyeswernickes enceph
tracheal devia, dn breath sound, hyper restension pneumo
pneumatosisgas cysts in GI tract due to necrotizing GI in immature newborn
Battlesignraccon eye, mastoid eccy, due to basilar skull frx
duod ulcerdn pain w food
V retch epig painmallory weis
F on post op d 1 "bronze" weep and tender woundClostridial wound inf
heamtochezia and tenesmusrectal cx
recurrent continual inclination to evac bowelsaka tenesmus due to rectal d/o
UGI bleed, jaudice, RUQ painhematobilia
18 F bloody nip dischductal papilloma
irrit, diaphor, wk, tremulous, palpsx of hypoglycemia think insulinoma