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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

skin CA key word descriptions
BCC
SCC

BCC: waxy, pearly

SCC: well-demarcated red papule, hyperpigmented, non-healing ulcer