FMGE Surgery Flashcards

24 sample cards from the Surgery deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. State the components of the primary survey (ABCDE) in trauma management.

   A: Airway with cervical spine protection; B: Breathing/ventilation; C: Circulation with hemorrhage control; D: Disability (neurologic status/GCS); E: Exposure/Environment (undress, prevent hypothermia).

2. How is the Glasgow Coma Scale scored and what total indicates severe head injury?

   GCS = Eye opening (4) + Verbal response (5) + Motor response (6), range 3-15. Severe head injury is GCS ≤8 (also the threshold for intubation); moderate 9-12; mild 13-15.

3. What is the classic presentation and immediate treatment of a tension pneumothorax?

   Hypotension, distended neck veins, tracheal deviation away from the affected side, and absent breath sounds with hyperresonance. Immediate needle decompression (2nd intercostal space, midclavicular line) followed by chest tube — diagnosis is clinical, not radiographic.

4. Differentiate epidural from subdural hematoma on CT and mechanism.

   Epidural: biconvex (lens-shaped) hematoma not crossing suture lines, from middle meningeal artery injury, with a classic lucid interval. Subdural: crescent-shaped, crosses suture lines, from torn bridging veins, common in elderly/alcoholics.

5. What does the Cushing reflex (triad) indicate in head trauma?

   Hypertension (widened pulse pressure), bradycardia, and irregular respirations — a sign of raised intracranial pressure and impending brain herniation, requiring urgent intervention.

6. What is the FAST exam and which four areas does it assess in abdominal trauma?

   Focused Assessment with Sonography for Trauma detects free intraperitoneal/pericardial fluid at: hepatorenal recess (Morison's pouch), splenorenal recess, pelvis (pouch of Douglas), and pericardium (subxiphoid).

7. Which solid abdominal organ is most commonly injured in blunt abdominal trauma, and what determines operative versus non-operative management?

   The spleen is most commonly injured in blunt trauma. Hemodynamic stability determines management: stable patients can be managed non-operatively with observation/embolization; unstable patients require exploratory laparotomy.

8. What is the Salter-Harris classification used for, and what does Type II (the most common) involve?

   It classifies pediatric physeal (growth plate) fractures. Type I: through physis; Type II (most common): through physis and metaphysis; Type III: physis and epiphysis; Type IV: across metaphysis, physis, and epiphysis; Type V: crush injury of physis. (Mnemonic SALTR.)

9. What are the signs and the emergency management of compartment syndrome after a fracture?

   Pain out of proportion to injury, especially on passive stretch, plus the 5 Ps (paresthesia, pallor, pulselessness late, paralysis, pressure/tense compartment). Diagnosed by compartment pressure (>30 mmHg or within 30 mmHg of diastolic); treated by emergency fasciotomy.

10. Which hip fracture type risks avascular necrosis of the femoral head and why?

    Intracapsular (femoral neck) fractures, because they can disrupt the medial femoral circumflex artery supplying the femoral head; displaced neck fractures in elderly are often treated with arthroplasty rather than fixation.

11. What are the two main types of total hip replacement fixation and a leading long-term complication of joint replacement?

    Cemented (polymethylmethacrylate) and uncemented (press-fit/osseointegration) fixation. Aseptic loosening is a leading long-term cause of revision; periprosthetic infection and dislocation are other key complications.

12. What is cauda equina syndrome and why is it a surgical emergency?

    Compression of the lumbosacral nerve roots (commonly by a large central disc herniation) causing saddle anesthesia, bilateral leg weakness/sciatica, and bowel/bladder dysfunction (urinary retention). It requires emergency surgical decompression to prevent permanent deficits.

13. Differentiate spinal stenosis (neurogenic claudication) from vascular claudication.

    Neurogenic claudication: leg pain relieved by leaning forward/sitting (flexion) and worsened by standing/walking, with normal pulses. Vascular claudication: pain reliably reproduced by a fixed walking distance, relieved by rest (standing), with diminished pulses.

14. What is the most common composition of kidney stones and the classic presentation of renal colic?

    Calcium oxalate stones are most common (~75%). Renal colic presents with acute, severe, colicky flank pain radiating to the groin, with hematuria; non-contrast CT (KUB) is the diagnostic gold standard.

15. What stone size threshold favors spontaneous passage versus intervention, and what are common interventions?

    Stones <5 mm usually pass spontaneously; stones >10 mm rarely pass and need intervention. Options include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy with laser, and percutaneous nephrolithotomy (for large/staghorn stones).

16. What is the classic triad of renal cell carcinoma and its most common histologic subtype?

    Flank pain, hematuria, and a palpable abdominal mass (the full triad is now uncommon, seen in <10%). Clear cell carcinoma is the most common subtype; RCC characteristically invades the renal vein/IVC and may cause a left-sided varicocele.

17. Name three paraneoplastic syndromes associated with renal cell carcinoma.

    Polycythemia (erythropoietin), hypercalcemia (PTH-related peptide), and hypertension (renin); Stauffer syndrome (non-metastatic hepatic dysfunction) is also classic.

18. What is ureteropelvic junction (UPJ) obstruction, its most common cause, and how is function assessed?

    Obstruction of urine flow from the renal pelvis to the ureter, most commonly congenital (intrinsic narrowing or a crossing lower-pole vessel). Diuretic renography (MAG-3 scan) assesses differential function and degree of obstruction; pyeloplasty is the standard repair.

19. What is the most common cause of iatrogenic ureteral strictures, and which imaging best defines the stricture?

    Iatrogenic injury during pelvic/abdominal surgery (especially gynecologic) is the most common cause; retrograde or antegrade pyelography (or CT urography) best defines stricture location and length, guiding stenting versus reconstruction.

20. What is the most common cause of neonatal intestinal obstruction with bilious vomiting, and what is the dreaded surgical emergency to exclude?

    Bilious vomiting in a neonate is malrotation with midgut volvulus until proven otherwise — a surgical emergency due to risk of midgut ischemia. Upper GI contrast study (showing abnormal duodenojejunal junction position) is diagnostic; Ladd's procedure is the treatment.

21. Differentiate the typical bowel-gas findings of duodenal atresia from jejunoileal atresia on X-ray.

    Duodenal atresia: "double-bubble" sign (gas in stomach and proximal duodenum, no distal gas), associated with Down syndrome. Jejunoileal atresia: multiple dilated bowel loops with air-fluid levels, usually due to in-utero vascular accident.

22. What is the classic presentation and treatment of hypertrophic pyloric stenosis?

    Non-bilious projectile vomiting in a 3-6 week-old (more common in firstborn males), a palpable "olive" mass, and hypochloremic hypokalemic metabolic alkalosis. Ultrasound confirms (pylorus thickness >3-4 mm, length >15-17 mm); treatment is Ramstedt pyloromyotomy after fluid/electrolyte correction.

23. What is the most common cause of intestinal obstruction in infants 3 months to 2 years, and the classic findings?

    Intussusception (usually ileocolic, idiopathic at this age). Classic triad: intermittent colicky abdominal pain (drawing up legs), "currant jelly" stools, and a sausage-shaped abdominal mass; air/contrast enema is both diagnostic and therapeutic (reduction).

24. How is Hirschsprung disease diagnosed and what is the underlying pathology?

    Congenital absence of ganglion cells (aganglionosis) in the distal colon causing functional obstruction and failure to pass meconium within 48 hours. Rectal suction biopsy is the gold standard (absent ganglion cells, hypertrophied nerve fibers); contrast enema shows a transition zone.

What this deck covers

Surgery flashcards FAQ