Flashcards in 15 Special surg Deck (65):
1
when is conjunctivitis an emergency?
varicella, shingles
-vesicles present
can lead to blindness
2
Testicular CA tumor markers and blood tests
Seminoma--LDH
Endodermal sinus--AFP
CC--B HCG
teratoma--malignant! (but not in females)
3
Scaphoid fx
-how tx (2)
-when to recheck xr
Clinical dx
-XR shows nothing, then cast. Recheck XR in 3 wks
-XR shows damage (bad enough to show), then ORIF
4
Long bone fx in child, cross growth plate
-tx
requires ORaIF to ensure growth plate realigned
5
Hip fx:
-what different txs? (4 to know)
Head: femoral prosthesis (risk avascular necrosis)
Intertrochanteric: Plates ORIF
Shaft: rods
Open: Emergent washout
6
newborn male with low/no urine output. Cr up.
-think what, do what
Posterior Urethral Valves (blockage)
-cath, relieve bladder pressure
-confirm dx with voiding cystourethrogram
-ablation/surgery of valves
7
retinoblastoma
-how dx
-what to be careful about
-assoc
-white reflex instead of red
-no radiation! 2nd hit.
-osteosarcoma, age 10
8
hypspadias and epispadias, what to remember
no circumcision
9
Child bone cancers to know: 3
-how to diff
1. Ewing's sarcoma--midshaft. Possible F/C/night sweats
2. osteosarcoma--prox/distal long bone, painful
3. osteochondroma--at growth plate, benign. Usu painless
10
Peds VSD
-when to do surgery
-why do surgery
-if asx, give 1 yr to allow closure
-Surgery if sx(CHF) or persistent to 1yr of age
-risk of Eisenmenger's later in life
11
Coarctation of aorta
-diff in dx between babies/adults
babies: echo
adults: CXR to see rib notching
12
premature baby with growths seen on retina
-think what
retinopathy of prematurity.
Also look for:
necrotizing enterocolitis
bronchopulm dysplasia
intraventricular hem
13
Peds brain tumor with cord lesions, think what
medulloblastoma
14
lesion suspicious for Melanoma:
how to dx
1. suspicion low: punch bx
2. small, or high suspicion: wide excisional bx
Looking for Breslow's depth
always check for lymph nodes
15
central retinal a occlusion
-tx (3)
painless unilat vision loss in elderly
-hyperventilate in bag (vasodilate)
-push on eye to move clot downstream (compromise smaller area of vision)
-intraarterial tpa possible
16
-most common cyanotic defect of newborn
-most common cyanotic defect of children
-Transposition
-Tet Fallot
17
Cyanotic heart diseases
which ones important?
Truncus arteriosus
Transposition of great arteries
Tricuspid atresia
Tet Fallot
TAPVR
Transposition and Tet-Fallot are the 2 important ones
18
dupuytren's contracture
-presentation
-pop (2)
-tx
can't extend hand flat, fasica tight
1. etoh
2. scandinavian
surgery
19
BCC and SCC skin CA:
-mets?
BCC: no mets
SCC: rare mets
20
SCC and BCC skin CA:
what tx (4)
small, not on face: excisional
large, not on face: wide excision
large aggresive, extremity: amputation
face: Mohs
21
When to suspect VUR (vesicoureteral reflux)
dx, tx?
Kid with
1. pyelo
2. recurrent UTI
Do a voiding cystourethrogram (dye should not enter ureters)
surgery or 'grow out of it' with empiric abx
22
SCC and BCC skin CA: what bx to do? (3)
small, not on face: excisional
large, not on face: incisional
on face: incisional
incisional: punch full thickness at ulcer edge
23
orbital vs periorbital cellulitis
extra-ocular paralysis,
get CT to confirm
24
amblyopia vs strabismus
-how to dx
-tx
amblyopia: permanent lazy eye
strabismus: lazy eye.
strabismus: light reflection is separate both eyes
If present at birth, surgery
If acquired, do glasses/patch.
Prevent amylopia!
25
Tet Fallot
Pulmonic stenosis
Overiding aorta
R Ventricle hypertrophy
VSD
26
Pt with painless vision loss, describes "veil/cloud" in vision. Think what?
Retinal detachment
Amaurosis fugax (if comes/goes)
27
corneal abrasion
-dx
fluorescein dye
28
Cushings reflex
HTN
bradycardia
irregular breathing
29
chalazion vs hordeolum
hordeolum: infection of eyelid gland, painful.
chalazion: sterile, chronic inflamm from blocked gland
"Chill" usu not painful.
hordeolum that heals can become chalazion
30
what is pink eye
conjunctivitis, viral. nonpurulent
usu adenovirus
make sure no vesicles, not varicella conjunctivitis
31
Down's: what murmur assoc
VSD
32
Peds ortho: what 4 hip pathology to remember? how to diff?
-dx
-tx
1. DDH (Newborn)--bartow/orlani click. U/S, harness
2. Leg-calve-perthes (age 6)--avascular necrosis, insidious onset, antalgic gait. XR, Cast
3. SCFE (age 13)--hip and knee referred pain. XR, Surgery
4. Septic hip and transient synovitis (any age). Aspirate, drain+abx
33
What fracture: person defending self from downward blow with forearm
Ulnar fx, radial d/l
Monteggia.
34
de quervain's tenosynovitis
-presentaiton
-tx
-tendonitis of thumb, from prolonged extension (cradle baby, lift weights)
-Dx: increased pain on ulnar deviation when fist
NSAIDs, splinting, then steroids
35
SAH:
when to tx
Clip/coil immediately.
If >48h, must wait 6 weeks before surgery
nimodipine to prevent vasospasm
36
acute glaucoma
-tx (4 categories to know)
constrict the pupil:
-B blockers (timolol)
-parasympathatomimetic (pilocarpine)
-CAI: acetazolamide (decrease fluid production)
-diruetics (eg mannitol) to decrease pressure
Never atropine
37
newborn conjunctivitis:
how to diff
how to tx
4 types by timing.
Chemical--24h from silver nitrate drops
Gonorrhea--Day 2-5, bilat. Intramusc ceftriaxone
Chlamydia--day 7-12, unilat. oral+topical erythromycin (risk PNA)
Viral
38
carpal tunnel
-dx
-tx, how progress
Clinical dx
1. splints, nsaids
2. surgery, but requires electromyography to confirm
39
Child that curls up into ball to relieve HA
-think what
obstructive hydrocephalus from ependymoma
-fetal position relieves
40
Boxer fx
metacarpal, from punching
cast it
41
SCC spectrum
-tx for each
actinic keratosis--imiquimod
Bowen's (CIS)--imiquimod, also possible radiation
SCC--excise
42
Stress fx
-what pop
-XR shows what
-tx
Think out-of-shape weekend warriors or soldiers on forced march.
Tibial point tenderness.
Takes 2 weeks to show on XR. Tx with crutches and if severe, cast.
43
Jersey and Mallet fingers
-what injured
-tx
Jersey: catching jersey, hyperextended.
Flexor tendon, so can't flex
Mallet: hit by ball when flexed.
Extensor tendon, so can't extend
Tx: Splint each first to heal. Then surgery
44
Osgood schlatter
-tx
1. tough it out (leaves palpable nodule), or
2. rest and cast
no permanent sequelae
45
cataracts in child: think what if:
-present at birth
-acquired
1. TORCH infection
2. galactokinase def
46
DRE in:
BPH
prostate CA
-smooth, rubbery
-firm, nodular
47
Pituitary apoplexy:
vignette to know
Young female comes to ED in coma. BP remains low even with 2L NS. Exam shows papilledema.
Boyfriends says she has had HA for months and having vision issues. She thought she was pregnant a few months ago b/c no more periods.
Do what? STEROIDS first, then CT
Pt had growing prolactinoma, outgrew its blood supply.
48
College student with colicky flank pain that resolved. 1st Etoh binge.
Ureteropelvic junction obstruction (ureteral stenosis)
-pyelogram IV to confirm dx, stent it
49
Fractures:
When to do ORIF (3 to know according to onlinemeded)
Do ORIF if:
-comminuted, angular, or open
Otherwise, closed reducation and casting
50
Blue newborn. Given 100% O2, but O2 sat does not increase.
Think what, do what
Likely Transposition, possible Tet Fallot (has murmur)
-keep PDA open (PGE1)
-then surgery
51
peds murmurs:
Tet fallot
VSD
ASD
PDA
coarctation
systolic (pulm stenosis)
holosystolic
fixed split s2
machine
none
52
BPH
-tx
-alpha blocker choice?
alpha blocker, then add finasteride
-tamsulosin--spec to bladder
-terazosin, doxazosin--also tx HTN
53
trigger finger
-presentation
-tx
can't flex middle finger. Pops if forced
steroids, surgery definitive (release fascia)
54
what is:
-Most common congenital heart dz dx
-most common after age 1
-VSD
-ASD
55
Girl with normal urine voiding but also constant leak since birth. Think what, do what?
What if adult female with new sxs, not since birth.
Low implantation of ureter
-dx IV pyelogram, surgical reimplantation
Adult female, think fistula
56
felon
-presentation
-tx
abscess in nail pulp, after injury. Tender.
drain it (abscess)
57
baby who refuses to walk
-think what, do what
claudication from coarctation of aorta
-get BPs on arms vs legs
-dx with echo
58
Potter sequence
Fetus has kidney problem. No urine production, so doesn't drink it. Bad lungs
Also limb hypoplasia and face deformed b/c no amniotic fluid, squished
59
Elderly man with UTI sxs, F/C, and low back pain.
-Think what, do what
-careful of what
Bacterial prostatitis. Looks like pyelo. Do DRE, will be tender
Check U/A, give IV Abx if +, then home FQs. If U/A has no bact, this is noninfectious prostatitis, just need NSAIDs
Don't do anymore DREs, can cause septic shock!
60
Melanoma breslow depth to know
<0.5mm--local resection
>1mm: wide resection, SLN dissection
>4mm: palliative chemo and rad. Mets already
61
Kidney tumors in kids (2)
difference?
Wilm's (age 2-5)
-flank, does not cross midline
Neuroblastoma (age<1)
-cross midline
62
cryptorchidism
-when to intervene
Allow boy 1 year, then surgery.
63
Painless testicular mass in young man. Do what in what order?
1. draw tumor markers before surgery
2. orchiectomy is the bx
64
old person + acute onset vision loss + pupil reflex lost + tense globe =
acute glaucoma
65