Flashcards in 15 Special surg Deck (65):
when is conjunctivitis an emergency?
can lead to blindness
Testicular CA tumor markers and blood tests
teratoma--malignant! (but not in females)
-how tx (2)
-when to recheck xr
-XR shows nothing, then cast. Recheck XR in 3 wks
-XR shows damage (bad enough to show), then ORIF
Long bone fx in child, cross growth plate
requires ORaIF to ensure growth plate realigned
-what different txs? (4 to know)
Head: femoral prosthesis (risk avascular necrosis)
Intertrochanteric: Plates ORIF
Open: Emergent washout
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
-what to be careful about
-white reflex instead of red
-no radiation! 2nd hit.
-osteosarcoma, age 10
hypspadias and epispadias, what to remember
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
-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
Coarctation of aorta
-diff in dx between babies/adults
adults: CXR to see rib notching
premature baby with growths seen on retina
retinopathy of prematurity.
Also look for:
Peds brain tumor with cord lesions, think what
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
central retinal a occlusion
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
-most common cyanotic defect of newborn
-most common cyanotic defect of children
Cyanotic heart diseases
which ones important?
Transposition of great arteries
Transposition and Tet-Fallot are the 2 important ones
can't extend hand flat, fasica tight
BCC and SCC skin CA:
BCC: no mets
SCC: rare mets
SCC and BCC skin CA:
what tx (4)
small, not on face: excisional
large, not on face: wide excision
large aggresive, extremity: amputation
When to suspect VUR (vesicoureteral reflux)
2. recurrent UTI
Do a voiding cystourethrogram (dye should not enter ureters)
surgery or 'grow out of it' with empiric abx
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
orbital vs periorbital cellulitis
get CT to confirm
amblyopia vs strabismus
-how to dx
amblyopia: permanent lazy eye
strabismus: lazy eye.
strabismus: light reflection is separate both eyes
If present at birth, surgery
If acquired, do glasses/patch.
R Ventricle hypertrophy
Pt with painless vision loss, describes "veil/cloud" in vision. Think what?
Amaurosis fugax (if comes/goes)
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
what is pink eye
conjunctivitis, viral. nonpurulent
make sure no vesicles, not varicella conjunctivitis
Down's: what murmur assoc
Peds ortho: what 4 hip pathology to remember? how to diff?
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
What fracture: person defending self from downward blow with forearm
Ulnar fx, radial d/l
de quervain's tenosynovitis
-tendonitis of thumb, from prolonged extension (cradle baby, lift weights)
-Dx: increased pain on ulnar deviation when fist
NSAIDs, splinting, then steroids
when to tx
If >48h, must wait 6 weeks before surgery
nimodipine to prevent vasospasm
-tx (4 categories to know)
constrict the pupil:
-B blockers (timolol)
-CAI: acetazolamide (decrease fluid production)
-diruetics (eg mannitol) to decrease pressure
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)
-tx, how progress
1. splints, nsaids
2. surgery, but requires electromyography to confirm
Child that curls up into ball to relieve HA
obstructive hydrocephalus from ependymoma
-fetal position relieves
metacarpal, from punching
-tx for each
Bowen's (CIS)--imiquimod, also possible radiation
-XR shows what
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.
Jersey and Mallet fingers
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
1. tough it out (leaves palpable nodule), or
2. rest and cast
no permanent sequelae
cataracts in child: think what if:
-present at birth
1. TORCH infection
2. galactokinase def
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.
College student with colicky flank pain that resolved. 1st Etoh binge.
Ureteropelvic junction obstruction (ureteral stenosis)
-pyelogram IV to confirm dx, stent it
When to do ORIF (3 to know according to onlinemeded)
Do ORIF if:
-comminuted, angular, or open
Otherwise, closed reducation and casting
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)
systolic (pulm stenosis)
fixed split s2
-alpha blocker choice?
alpha blocker, then add finasteride
-tamsulosin--spec to bladder
-terazosin, doxazosin--also tx HTN
can't flex middle finger. Pops if forced
steroids, surgery definitive (release fascia)
-Most common congenital heart dz dx
-most common after age 1
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
abscess in nail pulp, after injury. Tender.
drain it (abscess)
baby who refuses to walk
-think what, do what
claudication from coarctation of aorta
-get BPs on arms vs legs
-dx with echo
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
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!
Melanoma breslow depth to know
>1mm: wide resection, SLN dissection
>4mm: palliative chemo and rad. Mets already
Kidney tumors in kids (2)
Wilm's (age 2-5)
-flank, does not cross midline
-when to intervene
Allow boy 1 year, then surgery.
Painless testicular mass in young man. Do what in what order?
1. draw tumor markers before surgery
2. orchiectomy is the bx
old person + acute onset vision loss + pupil reflex lost + tense globe =