Combo USMLE/ Shelf / PANCE/ EOR General Surgery Mega Review

What is the patency of the following conduits in CABG? 1. Internal mammary 2. Radial artery 3. Greater saphenous

1. 90-95% 10-year patency 2. 84% 5-year patency 3. 54% 10-year patency

In patients with hemothorax, what is the indication for thoracotomy in the OR?

1. > 1500 ml blood upon chest tube placement or 2. Continuous output of > 200ml/hr

What is the treatment for lower extremity rest pain?

1. Arteriography 2. Bypass surgery

Indicate results of a positive DPL

1. Aspiration of gross blood or 2. > 100,000 RBC/ml on laboratory exam of lavage fluid

List the key components of Airway assessment

1. Assess airway and patient's ability to protect airway 2. Use chin lift or jaw thrust to open airway 3. Keep low threshold for intubation

What 2 anatomical abnormalities must present in order for a patient to survive transposition of the great arteries?

1. Atrial septal defect 2. Patent ductus arteriosus

What are the radiographic components of the trauma triple?

1. C-spine 2. Portable chest x-ray 3. Pelvic x-ray

What 2 tubes should be placed in every trauma patient?

1. Foley catheter 2. Nasogastric tube (or orogastric for facial fracture)

List the phases of wound healing

1. Hemostasis, platelet plug and fibrin clot formation 2. Inflammation and recruitment 3. Fibroblast proliferation and granulation 4. Wound remodeling and contraction

List the criteria for CABG

1. Left main disease > 50% 2. Three vessel coronary disease 3. Failed medical management 4. Failed angioplasty 5. Decreased LV function 6. Complicated disease 7. Diabetes mellitus

What laboratory findings are consistent with cyanosis?

1. Low oxygen saturation 2. Elevated hemoglobin levels

List the criteria for unstable angina

1. New onset angina 2. Angina at rest 3. Crescendo angina 4. Not associated with exertion

List the components of Tetralogy of Fallot

1. Pulmonary stenosis 2. VSD 3. Overriding aorta (shift to right ventricle) 4. RV hypertrophy

List the key components of Exposure assessment

1. Remove all clothing 2. Treat/prevent hypothermia

List the indications for surgical intervention in PVD

1. Tissue loss 2. Rest pain 3. Lifestyle limiting claudication

What are the signs of tension pneumothorax?

1. Tracheal deviation away 2. Increased JVD 3. Decreased breath sounds 4. Tympany to percussion 5. Hypotension

Name the 2 anatomic R to L intracardiac/great vessel shunts in utero

1.Foramen Ovale 2. Ductus arteriosus

What percentage of cardiac tumors are benign?

75 %

Discuss the interpretation of ABIs

> 1 in normal patients 0.5 - 0.7 with intermittent claudication < 0.3 with rest pain

What does AMPLE stand for?

A - Allergies M - Meds P - PMH L - Last meal E - Events related to injury

List the ABCDEs of the primary survey for trauma patients

A. Airway B. Breathing C. Circulation D. Disability E. Exposure

What is an advantage that abdominal CT has over DPL?

Ability to evaluate retroperitoneum

What percentage of babies born annually have heart defects?

Approximately 1%

What is the gold standard for defining anatomy of carotid lesions?

Arteriography

What is Diagnostic Peritoneal Lavage (DPL)?

Aspiration of fluid from the peritoneal cavity to assess for intra-abdominal hemorrhage

What is an important site for the formation of atherosclerotic disease?

At bifurcations

What is the second most common congenital heart malformation?

Atrial septal defect

State the location of the foramen ovale

Atrial septum

How does one interpret blood flow in a Doppler ultrasound?

BART - blue away, red toward

What is the most common congenital heart malformation?

Bicuspid aortic valve

What physical exam finding is consistent with carotid vascular disease?

Carotid bruit on auscultation

What is the anatomical cause of coarctation of the aorta?

Complication due to closure of the ductus arteriosus

What is the prominent physical finding in a patent ductus arteriosus?

Continuous precordial murmur ("machinery")

What is the prominent physical finding in coarctation of the aorta?

Differential blood pressure and pulses, greater in upper extremities than lower

What is the diagnostic test of choice to screen for carotid artery disease?

Doppler ultrasound

What is the treatment for femoral head fracture?

Early traction and ORIF

How is the diagnosis of cardiac tumor made?

Echocardiogram

How is the diagnosis of pericarditis made?

Echocardiogram

What is the cause of amaurosis fugax?

Embolization of the retinal artery, resulting in a transient monocular blindness

Which intracranial injury is associated with a "lucid interval"?

Epidural hemorrhage

What diagnostic technique is indicated for penetrating trauma or for the unstable patient with obvious evidence of abdominal injury?

Exploratory laparotomy

What is the seat belt sign?

Fracture of the L2 vertebrae, resulting in injury to the duodenum

Which conduit is most commonly used in CABG?

Greater saphenous

State the location of an atrial septal defect (ASD)

Hole between the right and left atria

State the location of a ventricular septal defect (VSD)

Hole between the right and left ventricles

State the anatomical abnormality in tricuspid atresia

Hypoplasia of the R ventricle

What is the treatment for cardiac tamonade?

Immediate pericardiocentesis or sternotomy in OR

What is the treatment for an abscess?

Incision and drainage

What is the leading cause of postoperative mortality?

Myocardial infarcation

Which inflammatory cells migrate to the site of a wound?

Neutrophils and macrophages

What is a disadvantage of MRI?

Not best for defining anatomy

What are 2 important auscultatory findings in mitral stenosis?

Opening snap Apical crescendo diastolic rumble

Define rest pain

Pain in non-threatened limbs that occurs when the baseline demand for oxygen is greater than the inflow

What anatomical abnormality must be present for survival in Tetralogy of Fallot?

Patent ductus arteriosus

Define Eisenmenger's Syndrome

Phenomenom occurring with long-standing L to R shunts in which increasing pulmonary arterial pressures and flow rate result in shunt reversal to R to L

What is given to patients in order to maintain a patent ductus arteriosus?

Prostaglandins

Name the most common congenital obstructing lesion

Pulmonary stenosis

Definition of claudication

Reproducible pain in foot, calf or buttocks when the exercise-induced demand for oxygen is greater than supply

State the location of the ductus venosus

Shunt from the umbilical vein to the inferior vena cava, bypassing the liver

State the location of the ductus arteriosus

Small projection connecting the pulmonary artery to the aorta, bypassing the pulmonary ciruclation

What is the treatment for an open pneumothorax?

Sterile one-way "flutter valve" dressing

What is the treatment for a AAA rupture?

Surgical repair

Which the most common of the mixed shunts?

Transposition of the great arteries

List the three most common post-MI complications

VSD Acute mitral insufficiency LV aneurysm

Which is the most commonly diagnosed congenital cardiac defect?

Ventricular septal defect

What are two important late symptomatic findings in aortic insufficiency?

Water-hammer pulse (bounding) Widened pulse pressure

List the classic triad of symptoms associated with aortic stenosis

1. Angina 2. Syncope 3. CHF

What is the treatment for a75% symptomatic carotid stenosis?

Carotid endarterectomy

What is the initial imaging modality of choice in suspected congenital heart disease?

Echocardiography

During the physical exam, what must be maintained?

Midline immobilization

What is the most important lab test that should be ordered in a trauma patient?

Type and screen

What is the general rule for the secondary survey?

"A finger or a tube in every orifice"

What is Beck's triad?

1. Muffled heart sounds 2. JVD 3. Hypotension

The risk of stroke in patients with carotid stenosis depends on which two factors?

1. Degree of stenosis 2. Presence of symptoms

List the key components of Circulation assessment

1. Control hemorrhage 2. Obtain large bore IV access 3. Administer fluids as needed

Indicate the major signs and symptoms of congenital heart disease

1. Cyanosis 2. Dyspnea/tachypnea 3. Syncope 4. Failure to thrive 5. Edema/ascites

What are two of the earliest signs of hypovolemic shock?

1. Decreased pulse pressure 2. Orthostatic hypotension

What seemingly related symptoms are NOT associated with carotid disease?

1. Diploplia 2. Syncope 3. Paresthesias Vertebrobasilar arteries

Upon arrival, how should unstable patients with pelvic fractures be treated?

1. Emergent external fixation 2. Pelvic angiography with embolization if bleeding continues

List the key components of Breathing assessment

1. Evaluate breath sounds, percussion 2. Administer supplemental oxygen 3. Treat pneumothorax, hemothorax, flail chest

List the key components of Disability assessment

1. Evaluate level of consciousness, pupils, and ability to move extremities 2. Determine Coma Score

What is the treatment for tension pneumothorax

1. Immediate needle decompression 2. Chest tube placement

List three reasons to intubate a trauma patient

1. Impaired level of consciousness 2. Mechanically compromised airway 3. Inadequate ventilation (flail chest)

Define the following wound classifications 1. Clean 2. Clean-contaminated 3. Contaminated 4. Infected

1. Incision through prepped skin without violation of GI, GU or respiratory tracts 2. Incision through prepped skin and into GI, GU or respiratory tracts that have also been prepped 3. GI, GU or respiratory tract surgery with active infection somewhere else in the body 4. Existing infection at the site of operation

A Glascow Coma Score of ___ correlates with what? 1. > 13 2. 9 - 12 3. < 8

1. Mild brain injury 2. Moderate brain injury 3. Severe brain injury

How soon after wound formation do the following processes occur? 1. Migration of inflammatory cells 2. Reepithelialization 3. Collagen deposit 4. Increase in tensile strength

1. Minutes to 24 hours 2. 24-48 hours 3. 7-14 days 4. 6 months

What are the five "P's" of acute arterial occlusion?

1. Pain 2. Pallor 3. Pulselessness 4. Paresthesia 5. Poikilothermia

List the components of truncus arteriosus

1. Single trunk from the heart 2. VSD

List the 3 types of atrial septal defects

1. Sinus Venosus 2. Ostium Secundum 3. Ostium Primum

List important risk factors for atherosclerosis

1. Smoking 2. HTN 3. Diabetes 4. Hypercholesterolemia

Indications for aortic valve replacement

1. Symptoms, including DOE 2. Decreased LV function 3. Pressure gradient > 50 mmHg by cath

Definition of: 1. Concussion 2. Contusion

1. Temporary deficit without CT findings 2. Focal brain bruise

At what size is AAA repair indicated?

> 5cm in diameter

Definition of stable angina

Angina that is controlled by medication alone and unchanged in pattern for 4-6 weeks

What is the treatment for stable claudication?

Lifestyle modification, including smoking cessation, regimented exercise and medications, such as Pletal 100mg BID

Identify a device commonly used to stabilize pelvic fractures

Military Anti-Shock Trousers (MAST)

Which congenital heart disease is most rare?

Mitral Valve Disease

What is the best diagnostic screening test for aortic dissection?

Transesophageal echocardiogram (TEE)

Definition of flail chest

Two or more fractures in three consecutive ribs with paradoxical inspiration

What is the anatomical outcome in transposition of the great arteries?

Two separate closed systems