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Flashcards in General Surgery Deck (414)
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1

middle aged adult + superficial unilateral hip pain that is exacerbated by external pressure to the upper lateral thigh

trochanteric bursitis

2

how does trochanteric bursitis present?

hip pain when pressure is applied (as when sleeping) and with external rotation or resisted abduction.

3

what is trochanteric bursitis?

inflammation of the bursa surrounding the insertion of the gluteus medius onto the femur's greater trochanter

4

what population does slipped capital femoral epiphysis affect?

obese male children during late childhood or early adolescence

5

WHat nerves supply the upper lateral thigh causing superficial referred pain?

1. lateral femoral cutaneous
2. iliohypogastric

6

By what mechanism does the following lower ICP?
Head elevation

increased venous outflow from the head

7

By what mechanism does the following lower ICP?
Sedation

decreased metabolic demand and control of HTN

8

By what mechanism does the following lower ICP?
Intravenous mannitol

Extraction of free water out of the brain tissue -> osmotic diuresis

9

By what mechanism does the following lower ICP?
Hyperventilation

CO2 washout leading to cerebral vasoconstriction

10

Cerebral blood flow increases via what mechanisms?

1. Hypercapnia
2. Increased metabolic demand
3. Hypoxia through vasodilation

11

coag negative staph most commonly gains access to the blood via what??

indwelling femoral triple lumen catheter

12

femoral catheter infections are more commonly caused by what?

enteric organisms

13

how soon after the onset of a new drug do you see drug fever?

one to two weeks

14

drug fever is most commonly associated with what?

1. Anticonvulsants
2. TMP-SMX

15

what is the most common presentation of intraductal papilloma?

a form of benign breast disease presents w intermittent bloody discharge from one nipple

16

what are the common causes of paralytic ileus?

1. Exaggerated intestinal rxn after abdominal surgery
2. Retroperitoneal hemorrhage associated with vertebral fracturs

17

What does abdominal x-ray show in pts w paralytic ileus?

- air fluid levels
- distended gas-filled loops of both the small and large intesines

18

what is the tx of choice for paralytic ileus?

1. bowel rest
2. supportive care
3. tx of secondary cause of the ileus

19

What is the cause of nursemaid elbow?

subluxation of head of radius at the elbow joint

20

what is the tx of nursemaid elbow?

Closed reduction:
1. First extend and distract the elbow
2. Supinate the forearm
3. Hyperflex the elbow with your thumb over the radial head in order to feel the reduction as it occus

21

What is Kehr sign?

intraabdominal pathology causing peritonitis and irritation of the diaphragm
- irritation of the parietal peritoneum covering the undersurface of either hemidiaphragm can be referred to the ipsilateral shoulder bc the phrenic nerve originates from the C3-C5 spinal levels

22

what is the only part of the bladder covered by peritoneum and thus can cause peritonitis?

bladder dome

23

which part of the bladder is most susceptible to rupture and why?

- bladder dome
- the dome has a developmental hiatus where the urachus originates during embryonic life

24

what is the most common site of extraperitoneal bladder rupture?

bladder neck

25

What is the gold standard for evaluating mesenteric ischemia?

mesenteric angiography

26

what is the typical presentation of mesenteric ischemia?

severe abdominal pain after eating and relatively normal abdominal exam

27

what is the respiratory quotient?

the steady state ratio of carbon dioxide produced to oxygen consumption per unit time

28

what does a RQ close to 1 indicate? 0.8? 0.7?

1= carbohydrates are the major nutrient being oxidized
0.8 = proteins
0.7 = fatty acids

29

how is RQ important in mechanically ventilated patients?

- overfeeding, esp with carbs, causes excessive CO2 production and makes weaning from ventilation more challenging
- this is important in pts w preexisting lung disease as well

30

what is the RQ in sepsis? why?

less than 1, bc sepsis is a hypermetabolic hypercatabolic state where both fat and protein are broken down