Surgery UWorld QUESTIONS & ANSWERS VERIFIED 2022
- 3 compartments of brain
ii. brain parenchyma
iii. CSF
iv. C
BF (cerebral blood flow)
i.
v. t
hese determine ICP
-
- parenc hy m
-
a + CSF have constant pressures unless
- space
occupying
-I lesion or obstruction to CSF flow.
nterventions for lowering - CBF is
ICP influenced far more - impt target for tx
- mech of
hyperventilation - dec cerebral arterial
- paCO2 -
cause rapid vasoconstriction: thereby dec
ICP
***impt concept - ventilator rate affect arterial
pCO2>> >pO2 versus End Expiratory Pressure in
mech ventilated pt or concentration of inhaled O2
affect pO2>>> pC O2
,73 y/o m comes to ED. Fell + L A: ECG, cardiac markers, CXR
hip hurts a lot. Can't remember
falling. Over past several days,
has had SOB w/cough +
intermittent palpitations
attributed to "flu." PMH is HTN,
TIIDM< COPD< BPH. VSSAF.
Pulse Ox shows 95% on 2L/min
of O2 by nasal cannula. LLE
shortened + ext rotated. What
is next best step in pt?
- fractures are classified by anatomic location +
fracture type into either intracapsular (eg femoral
neck + head) or extracapsular (ie interrochanteric or
subtrochanteric)
i. intracapsular fractures - HIGHER RISK OF
AVASCULAR NEC
ii. extracapsular fractures - greater need for
IMPLANT DEVICES IE RODS/NAILS
Hip Fracture Type/Workup
- With Hip fracture - follow trauma protocol -
ABCDs but usually real concern is comorbidities.
i. in example above, pt somehow unknowingly fell +
had dec breath sounds on R side.
- DO ECG, CXR, CARDIAC MARKERS TO ENSURE
PT STABLE MEDICALLY
ii. CAN DELAY SURG UP TO 72 hours if needed to
address unstable medical comorbidity.
, - can progress to bowel infarction
- presents w/
i. Severe acute onset PERIUMBILICAL pain OUT OF
PROPORTION TO PE FINDINGS
ii. sudden onset severe poorly localized (DIFFUSE)
(visceral) mild abdominal pain accompanied by N/V
iii. if bowel infarction occurs - PERITONEAL SIGNS
ON ABD EXAM (i.e. tenderness to palpation
w/guarding + rebound tenderness); PASSAGE
BLOODY STOOL;
- most common cause - EMBOLIC OCCLUSION
ORIGINATING FROM HEART
i. LOOK FOR AFIB IN PT - NO P WAVES + RAPID
IRREGULAR PULSE
ii. LOOK FOR ATHEROSCLEROTIC RFS + HTN
- imaging: CT OR MRA (CT findings listed below);
MESENTERIC ANGIOGRAPHY - GOLD STD FOR
IMAGING
i. focal or segmental bowel wall thickening
ii. SMALL BOWEL DILATION
iii. MESENTERIC STRANDING
RFs
Acute Mesenteric Ischemia i. advanced age
ii. AFIB
iii. ATHEROSCLEROSIS
iv. CHF
v. Hypercoaguable disorders
Lab FIndings
i. Leukocytosis
ii. elevate d serum Lactate****** (META BOLIC
ACIDOSIS) - BICARB LOW + HYPERVENTILATION
iii. ELEVATED AMYLASE + PHOSPHA TE****
Surgery UWorld
https://quizlet.com/130600776/surgery-uworld-flash-cards/ 3/77
, 3/14/22, 9:07 PM Surgery UWorld Flashcards | Quizlet
Treatment
i. resuscitative measures
ii. broad spectrum antibiotics
iii. NG tube for decompression
iv. Surgery for bowel infarction or perforation
MOST COMMON SITE OF OCCLUSION = SMA
- ACUTE ABDOMINA or BACK PAIN followed by
SYNCOPE
Ruptured AAA presentation
- HYPOVOLEMIC SHOCK ensues***
- widened mediastinum on xray
Surgery UWorld
https://quizlet.com/130600776/surgery-uworld-flash-cards/ 4/77
- 3 compartments of brain
ii. brain parenchyma
iii. CSF
iv. C
BF (cerebral blood flow)
i.
v. t
hese determine ICP
-
- parenc hy m
-
a + CSF have constant pressures unless
- space
occupying
-I lesion or obstruction to CSF flow.
nterventions for lowering - CBF is
ICP influenced far more - impt target for tx
- mech of
hyperventilation - dec cerebral arterial
- paCO2 -
cause rapid vasoconstriction: thereby dec
ICP
***impt concept - ventilator rate affect arterial
pCO2>> >pO2 versus End Expiratory Pressure in
mech ventilated pt or concentration of inhaled O2
affect pO2>>> pC O2
,73 y/o m comes to ED. Fell + L A: ECG, cardiac markers, CXR
hip hurts a lot. Can't remember
falling. Over past several days,
has had SOB w/cough +
intermittent palpitations
attributed to "flu." PMH is HTN,
TIIDM< COPD< BPH. VSSAF.
Pulse Ox shows 95% on 2L/min
of O2 by nasal cannula. LLE
shortened + ext rotated. What
is next best step in pt?
- fractures are classified by anatomic location +
fracture type into either intracapsular (eg femoral
neck + head) or extracapsular (ie interrochanteric or
subtrochanteric)
i. intracapsular fractures - HIGHER RISK OF
AVASCULAR NEC
ii. extracapsular fractures - greater need for
IMPLANT DEVICES IE RODS/NAILS
Hip Fracture Type/Workup
- With Hip fracture - follow trauma protocol -
ABCDs but usually real concern is comorbidities.
i. in example above, pt somehow unknowingly fell +
had dec breath sounds on R side.
- DO ECG, CXR, CARDIAC MARKERS TO ENSURE
PT STABLE MEDICALLY
ii. CAN DELAY SURG UP TO 72 hours if needed to
address unstable medical comorbidity.
, - can progress to bowel infarction
- presents w/
i. Severe acute onset PERIUMBILICAL pain OUT OF
PROPORTION TO PE FINDINGS
ii. sudden onset severe poorly localized (DIFFUSE)
(visceral) mild abdominal pain accompanied by N/V
iii. if bowel infarction occurs - PERITONEAL SIGNS
ON ABD EXAM (i.e. tenderness to palpation
w/guarding + rebound tenderness); PASSAGE
BLOODY STOOL;
- most common cause - EMBOLIC OCCLUSION
ORIGINATING FROM HEART
i. LOOK FOR AFIB IN PT - NO P WAVES + RAPID
IRREGULAR PULSE
ii. LOOK FOR ATHEROSCLEROTIC RFS + HTN
- imaging: CT OR MRA (CT findings listed below);
MESENTERIC ANGIOGRAPHY - GOLD STD FOR
IMAGING
i. focal or segmental bowel wall thickening
ii. SMALL BOWEL DILATION
iii. MESENTERIC STRANDING
RFs
Acute Mesenteric Ischemia i. advanced age
ii. AFIB
iii. ATHEROSCLEROSIS
iv. CHF
v. Hypercoaguable disorders
Lab FIndings
i. Leukocytosis
ii. elevate d serum Lactate****** (META BOLIC
ACIDOSIS) - BICARB LOW + HYPERVENTILATION
iii. ELEVATED AMYLASE + PHOSPHA TE****
Surgery UWorld
https://quizlet.com/130600776/surgery-uworld-flash-cards/ 3/77
, 3/14/22, 9:07 PM Surgery UWorld Flashcards | Quizlet
Treatment
i. resuscitative measures
ii. broad spectrum antibiotics
iii. NG tube for decompression
iv. Surgery for bowel infarction or perforation
MOST COMMON SITE OF OCCLUSION = SMA
- ACUTE ABDOMINA or BACK PAIN followed by
SYNCOPE
Ruptured AAA presentation
- HYPOVOLEMIC SHOCK ensues***
- widened mediastinum on xray
Surgery UWorld
https://quizlet.com/130600776/surgery-uworld-flash-cards/ 4/77
