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Surgery > Surg > Flashcards

Surg Flashcards

1
Q

Airway

A

Open if pt can talk

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2
Q

Epidural hematoma

A

Unconscious period and then lucid and then unconscious

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3
Q

Subdural hematoma

A

Craniotomy if midline deviation. If not, monitor ICP. Head of bed up, sedation, hypervent

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4
Q

Linear skull fractures

A

Leave alone if closed and there is no overlying wound

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5
Q

Urethral injury

A

Blood at meatus and pelvic fracture. Do retrograde urethrogram (NOT Foley)

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6
Q

Penetrating injury of extremities

A

If no vessels, just do tetanus prophylaxis. If major vessels are near, do CT angio or doppler. If there is obvious vascular injury, do surg exploration and repair

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7
Q

Limited severe burn (<20%)

A

Do early excision and grafting

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8
Q

Developmental dysphasia of hip

A

Hereditary - uneven gluteal folds, can be dislocated with jerk and click. Don’t x-ray (hip is not calcified). Abduction splint with harness

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9
Q

Broken clavicle

A

Place arm in a sling

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10
Q

Hip fracture

A

Shortened leg and externally rotated

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11
Q

Posterior hip dislocation

A

Shortened leg and internally rotated

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12
Q

Femoral neck fracture

A

Replace femoral head with prosthesis

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13
Q

Intertrochanteric fracture

A

Open reduction and internal fixation

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14
Q

Gamekeepers Thumb

A

Torn ulnar collateral ligament so thumb hangs limp with collateral laxity

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15
Q

Trigger finger

A

Wake up with flexed finger and have to snap it back

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16
Q

Jersey finger

A

Can’t flex finger (ruptured flexor tendon). Splint

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17
Q

Mallet finger

A

Can’t extend finger (ruptured extensor tendon) and finger looks like mallet. Splint

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18
Q

Felon (finger)

A

Abscess in pulp of fingertip. Surg drainage

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19
Q

Marjolin Ulcer

A

SCC of skin developing in chronic leg ulcer. Biopsy edge and do wide local excision and graft

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20
Q

Fistula of GI tract

A

Bowel contents leak through a wound or drain site. Can cause sepsis, fluid/electrolyte loss, nutritional depletion, and erosion of belly wall. Worse high in GI tract bc you lose more fluid. Nature will heal if there is no FRIENDS (FB, Radiation, Infection, Epithelialization, Neoplasm, Distal obstruction, Steroids). Protect ab wall, give nutrients, and fluids

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21
Q

Met Alkalosis

A

Give NS and KCl

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22
Q

GERD

A

Long standing history - do endoscopy and biopsies to look for Barrett’s

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23
Q

Acute Edematous Pancreatitis

A

Alcoholic or pt w gallstones. Epigastric pain radiating to back with nausea and vomiting. Elevated amylase or lipase. ELEVATED HCT. Tx w NPO, Fluids, NG Suction

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24
Q

Acute hemorrhagic pancreatitis

A

LOWER HCT. BUN goes up, met acid and low PO2. Abscesses develop and must be drained.

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25
Q

Fibroadenomas

A

Firm, rubbery mass that moves with palpation. FNA or sonogram to dx.

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26
Q

Fibrocystic changes

A

Related to period. No malignant potential or risk. Do mammogram to confirm. If there is a persistent mass (probably a cyst, but maybe tumor, do aspiration

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27
Q

Pagets Disease

A

DCIS that spreads to nipple and causes redness and itching

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28
Q

Phyllodes

A

Develop in connective tissue of breast - can be malignant. Biopsy and remove

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29
Q

Breast cancer in pregnancy

A

Diagnose normally and do surgery as necessary. No chemo in first trimester. No radiation during pregnancy

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30
Q

Thyroid nodules

A

FNA to dx. If malignant, do lobectomy

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31
Q

Types of green vomiting

A

Duodenal atresia, annular panc, malrotation, intestinal atresia, meconium ileus

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32
Q

Duodenal atresia

A

One bubble in stomach, one in duodenum

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33
Q

Annular pancreas

A

One bubble in stomach, one in duodenum

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34
Q

Malrotation

A

One bubble in stomach, one in duodenum, little ones throughout intestines. Dx w contrast enema

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35
Q

Intestinal atresia

A

Green vomit and multiple air fluid levels. Caused by vascular accident in utero

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36
Q

Meconium ileus

A

Babies with CF (look for mom with it). Feeding intolerance and bilious vomit. Dilated loops of small bowel. Do gastrografin enema (therapeutic and diagnostic)

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37
Q

Tracheomalacia

A

Just respiratory sx present in newborn

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38
Q

Vascular rings

A

Aorta surrounds trach and esophagus causing sx in both. Bronch and barium swallow to dx.

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39
Q

Operability of lung cancer

A

Min 800 mL FEV1 is necessary after operation. Tx w chemo and radiation

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40
Q

Arterial embolization

A

Clot busters if partial. Embolectomy with Fogarty catheter for complete obstruction.

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41
Q

BCC

A

raised waxy lesion on upper part of face. Excise with negative margins

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42
Q

SCC

A

Lower lip and can metastasize. Excise with wider margins or do radiation.

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43
Q

Thyroglossal duct cyst

A

On midline at level of hyoid bone and connected to tongue. Remove cyst, part of hyoid bone, and track to the tongue

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44
Q

Branchial cleft cyst

A

Anterior edge of sternocleidomastoid muscle

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45
Q

Cystic hygroma

A

Large mushy mass at base of neck. Can extend into mediastinum. Do CT before removing.

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46
Q

Mitral stenosis

A

RF. Dyspnea on exertion, orthopnea, PND, cough, hemoptysis. Rumbling diastolic murmur. Develop A fib over time. MV repair (by doing surgical commissurotomy or balloon valvuloplasty and if that doesn’t work, do MV replacement

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47
Q

Amblyopia

A

Vision impairment from interference with processing images. Fix ASAP if in first 6 or 7 years of life. Brain suppresses one of the images if eyes can’t focus on same thing.

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48
Q

Acoustic Nerve neuroma

A

Sensory hearing loss in one ear with no explanation

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49
Q

Cavernous sinus thrombosis

A

Development of diplopia from paralysis of extrinsic eye muscles in pt with frontal or ethmoid sinusitis (infection spreads and causes thrombosis). Hospitalize, IV abx, CT, and drain.

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50
Q

Trigeminal neuralgia

A

Extremely sharp pain by touching specific area. MRI to rule out organic lesions. Tx w anticonvulsants. Radioablation if that fails

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51
Q

Ureteropelvic Jxn Obstructon

A

Normal Urinary output wo difficulty, but large diuresis –> pain

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52
Q

Testicular cancer

A

Take alpha fetoprotein and B-HCG before then biopsy w radical orchiectomy. Very radio and chemosensitive (platinum-based chemo

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53
Q

Transplant complications

A

Most common cause of issues is plumbing. With liver check biliary obstruction (US) and vascular thrombosis (doppler). W heart, do ventricular biopsy.

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54
Q

Acute rejection

A

Steroid bolus (after checking to make sure it isn’t plumbing issue)

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55
Q

Cricothyroidotomy

A

Done if airway can’t be secured and running out of time

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56
Q

Tracheostomy

A

Only done in controlled setting

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57
Q

Base of skull fracture

A

Look for CSF or raccoon eyes. Indicates that very serious head trauma was sustained. Get CT of neck in addition to head

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58
Q

Penetrating trauma to neck

A

Surg exploration if there is hematoma, deteriorating vital signs, or clear signs of esoph or trach injury (coughing or spitting up blood). If not, do arteriography before surgery to decide approach.

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59
Q

Air embolism

A

Sudden death in chest trauma pt who is intubated and on vent. Can happen anytime subclavian vein is opened to air (CV line, disconnecting CV line). Put pt in trendelenburg when putting in CV lines to prevent

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60
Q

Blunt trauma to abdomen w signs of peritoneal injury

A

Ex lap

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61
Q

Blunt trauma to abdomen wo signs of peritoneal irritation

A

FAST to see if there is bleeding

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62
Q

Hematuria

A

Always work up for cancer except for trauma pt who has mild hematuria (to be expected)

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63
Q

Ex lap reasons

A

Blunt trauma w peritonitis or penetrating trauma

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64
Q

Breast mass

A

Mammo or sono guided core biopsy is best way to biopsy

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65
Q

Fibroadenomas

A

Can be confirmed with FNA or US

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66
Q

Fluid after burn

A

Start w 1L/hr Ringers Lactate and adjust to get hourly UO of 1-2 mL/Kg/hr

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67
Q

Genu varum (bowlegs)

A

Normal to age 3. After that is probably Blount disease and surgery is needed

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68
Q

Genu valgus (knock knees)

A

Normal bt 4 and 8 yo

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69
Q

DeQuervain Tenosynovitis

A

Mothers who flex wrist and extend thumb to hold baby’s head. Pain on radial side of wrist and first dorsal compartment. Splint and steroids.

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70
Q

Dupuytren contracture

A

Men of Norwegian ancestry. Contracture of palm of hand and palmar fascial nodules cna be felt

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71
Q

Surgery contraindications

A

Bilirubin above 2, Albumin below 3, PT >16, or encephalopathy

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72
Q

Post op Fever (in sequential time order)

A

Atelectasis (day 1), pneumo (3) UTI (day3), DVT (5), wound (day7), drugs

73
Q

SCC of anus

A

More common in HIV+ people. Fungating mass grows out of anus with metastatic infuinal nodes. Do Nigro chemo followed by surgery if there is residual tumor.

74
Q

Pyogenic liver abscess

A

Complication of biliary tract disease, usually acute ascending cholangitis. Pts get fever, leukocytosis, and tender liver. Dx with sonogram or CT and do percutaneous drainage

75
Q

Chronic constrictive pericarditis

A

Square root sigh, equalization of pressures, and signs of heart failure

76
Q

Foul smelling sputum in child

A

Foreign body

77
Q

Indomethacin

A

Prostaglandin antagonist used to tx PDA

78
Q

SCC of mucosa

A

Old men who smoke and drink with rotten teeth and AIDS pts. Shows up as nodes in the jugular chain. Dx with triple endoscopy (panendoscopy). Establish dx w biopsies and CT. Tx with resection and radiotherapy/platinum based chemo

79
Q

Meclizine

A

Antihistamine antiemetic

80
Q

Dizziness

A

Inner ear (room spinning) - Phenergan, diazepam, or meclizine or cerebral disease (patient is spinning but room is still) - neuro workup

81
Q

Cushing reflex

A

Sudden spike in Bradycardia and HTN done to maintain brain perfusion when a pt has a brain tumor. Visualize brain tumor with MRI or CT and tx ICP w high-dose steroids

82
Q

Brain abscess

A

Space occupying lesion but comes 1-2 wks after infection like mastoiditis or otitis media. Dx with CT

83
Q

Posterior urethral valves

A

Cause for newborn boy not to urinate. Voiding cystourethrogram to dx. Endoscopic fulguration (using electricity to remove tissue) or resection to tx.

84
Q

Prostatic cancer dx

A

Transrectal needle biopsy. Tx w surg and radiation along w orchiectomy and androgen ablation.

85
Q

Progression of getting a line

A

2 16s –> femoral or saphenous line –> intraosseous of prox tibia

86
Q

Salmon-colored fluid

A

Wound dehiscence –> go to OR

87
Q

Abdominal compartment syndrome

A

Fluids and blood that have been given during prolonged laparotomy cause swelling –> cant close incision –> put mesh over wound until it can be closed

88
Q

Bladder injuries

A

Dx with retrograde cystogram including postvoid films. If there are extraperitoneal leaks, just put a foley. If there are intraperitoneal leaks, do surgical repair and suprapubic cystostomy.

89
Q

Fractures involving growth plate

A

Closed reduction if epihyses and growth plate are in one piece. If growth plate is in two pieces, do open reduction and fixation to get precise alignment

90
Q

Fractured femur

A

Can cause significant blood loss, orthopedic emergency. Can also cause fat embolism if there are multiple fracture sites

91
Q

Fat emboli

A

Sx 2-3 days after injury. Look for petechiae, pulm, neuro sx. Multiple emboli get released so sx happen all over body

92
Q

Morton neuroma

A

inflamm of common digital nerve at 3rd interspace. Analgesics and wider shoes. Surgery if severe

93
Q

Malignant hyperthermia

A

Develops shortly after anesthesia. Ryanidine receptors activated by anesthesia –> release Ca2+ –> muscle contraction and use of ATP –> excessive heat and muscle death –> fever, Ca2+ release, acidosis, and myoglobinuria. Tx with IV dantrolene, 100% O2, correction of acidosis, and cooling blankets. Watch for myoglobinuria

94
Q

Dantrolene

A

Works on ryanadine calcium receptor to abolish excitation-contraction coupling and cures malignant hyperthermia

95
Q

Hypernatremia volume correction

A

Use D5W 1/2NS to rapidly correct volume without changing tonicity too much

96
Q

GERD

A

Resection if there are severe dysplastic changes. For minor dysplastic changes, do Nissen fundoplication

97
Q

Anal fissure

A

Examine under anesthesia and give diltiazem ointment (Ca channel blocker so it relaxes the sphincter)

98
Q

Obstructive jaundice from tumor

A

Gallbladder will be dilated by distal obstruction. Then do CT scan. CT allows you to localize tumor and then can do perq biopsy.

99
Q

Panc abscess

A

10 days after pancreatitis

100
Q

Pan pseudocyst

A

5 weeks elapses. Dx w CT or sonogram. Drain large or symptomatic cysts

101
Q

Cytosarcoma Phyllodes

A

Women in late 20s. Grow large and distort breast. Not fixed. Can become sarcomas. Core biopsy and remove.

102
Q

Mammary dysplasia

A

Same as fibrocystic disease. Grows with period

103
Q

Breast cancer

A

Should be suspected in any women with palpable breast mass. History of trauma does not rule out cancer. DX WITH CORE BIOPSY

104
Q

Congenital diaphragmatic hernia

A

Causes hypoplastic lung that still has fetal type circulation. Intubate and ECMO and give baby 3 to 4 days for lung to mature before operating

105
Q

Necrotizing enterocolitis

A

Feeding intolerance, abdominal distension, and dropping plt count in PREMATURE infants when first fed. Tx: stop all feedings and give ABx, IVF, and TPN. Surgery if there is abdominal erythema, air in portal vein, or air in intestines.

106
Q

Bromocriptine

A

Dopamine agonist used to tx prolactinomas

107
Q

Prolactinomas

A

Produce amenorrhea and galactorrhea in young women. Tx with bromocriptine and can do surgery transnasally

108
Q

Tumors at base of frontal lobe

A

Cause papilledema on other side, optic nerve atrophy on same side, anosmia, and behavior changes

109
Q

RCC

A

hematuria, flank pain, and flank mass. Hypercal, erythrocytosis, and elevated liver enzymes. Tx: surgery

110
Q

Cytoscopy

A

Only reliable way to rule out bladder cancer

111
Q

Perforation

A

Pain has sudden onset and is constant, generalized, and very severe. Free air under diaphragm in upright X-rays is found

112
Q

Intraabdominal bleeding

A

Dx w CT scan if pt is hemodynamically stable (responds to fluid resuscitation)

113
Q

Unstable intraabdominal bleeding

A

Doesnt respond to resuscitation fluid - FAST or DPL and then ex lap if blood is found

114
Q

Causes for ex lap

A

Penetrating ab injury, blunt ab injury with signs of peritonitis, blunt ab injury with hemodynamic instability and blood found on FAST/DPL

115
Q

Liver rejection

A

Usually technical problems, check biliary obstruction (US) and vascular thrombosis (doppler)

116
Q

Kidney rejection

A

Steroid boluses. Can try antilymphocyte agents after that

117
Q

Venous stasis ulcers

A

Chronically edematous, indurated, and hyperpigmented skin above medial malleolus. Ulcer forms. Dx with duplex scan and tx by keeping veins empty (support stockings, unna boots, etc.)

118
Q

Ogilvie Syndrome

A

Paralytic ileus of colon in elderly, sedentary pts who have become further immobilized. Causes dilated colon. Rule out mech obstruction with imaging or endoscopy and then give neostigmine to restore colonic motility.

119
Q

Neostigmine

A

Interferes with AChesterase –> increases ACh levels –> PS agonist

120
Q

Intermittent claudication

A

Doppler studies to look for pressure gradient. If something is found, do CT or MRI angio to identify stenosis and look for graft vessel.

121
Q

Primary peritonitis

A

Primary peritonitis (SBP) - child with nephrosis and ascites or adult with ascites who has mild acute abdomen. Culture of fluid will show single organism. Tx w abx!

122
Q

Airway necessary when

A

patient is unconscious, expanding hematoma in neck, inhalation injury, needs a respirator, or breathing is noisy or gurgly

123
Q

Cricothyroidotomy

A

if you can’t get intubation in the normal manner and running out of time

124
Q

Breathing is okay if

A

Normal BS bilaterally and pulse ox is good

125
Q

Trauma shock

A

Hemorrhagic, tamponade, or PTX (tamp and PTX due to blunt or penetrating trauma)

126
Q

Hemorrhagic shock in urban setting

A

Do surgery to stop bleeding first and then give fluids

127
Q

Hemorrhagic shock in non-urban setting

A

give 2 L LR and pRBC

128
Q

Pericardial tamponade

A

Dx w sonogram and clinically. Promptly evacuate pericardial sac

129
Q

Cardiogenic shock

A

High CVP (opposite of hypovolemic). DONT give fluids!

130
Q

Penetrating head trauma

A

Do surgery

131
Q

Skull fractures

A

If linear, leave alone. Tx in OR if not

132
Q

Loss of consciousness and head trauma

A

Get a CT. Can go home if negative

133
Q

Base of skull fracture

A

Get CT of cervical spine and no NG tubes

134
Q

Epidural hematoma

A

Do surgery

135
Q

Subdural hematoma

A

If no deviation, medically manage to keep ICP down. If deviated, do surgery

136
Q

Ways to keep ICP down

A

Hypervent, hypothermia, sedatives, sit head of bed up, diuretics

137
Q

Diffuse axonal injury

A

Severe trauma. Blurring of gray-white matter and small hemorrhages. Keep ICP down

138
Q

Chronic subdural hematoma

A

Tx with surgical evacuation

139
Q

Penetrating neck trauma

A

Surg exploration

140
Q

Blunt trauma to neck

A

Get CT if there is any pain in the neck

141
Q

Anterior cord syndrome

A

Burst fractures of vertebral bodies –> loss of motor and temp/pain on both sides below and preserved proprioception

142
Q

Hemothorax

A

Usually can just place a chest tube low. If bleeding is excessive, do thoracotomy

143
Q

Flail chest

A

Fluid restriction and diuretics to prevent pulm contusion. Look for traumatic transection of aorta. Put chest tubes in if you need to ventilate

144
Q

“white out of lungs”

A

Pulmonary contusion

145
Q

Sternal fractures

A

Watch for myocardial contusion

146
Q

Diaphragmatic hernia

A

Only on left side. Abdominal surg to correct

147
Q

Ruptured aorta

A

Look for it if there are hard to break broken bones (scapula, first rib) in deceleration injury and wide mediastinum

148
Q

CT angio

A

CT with IV dye

149
Q

Subq emphysema

A

Boerhaaves, ruptured trachea, or TPTX

150
Q

Air embolism

A

sudden death in chest trauma pt who is intubated and on respirator or when subclavian is open to air (CV lines)

151
Q

Below the nipple

A

Involves the abdomen

152
Q

Where blood can collect

A

Thighs, abdomen, and pelvis (lungs also but will show up on CT)

153
Q

Hemo stable

A

Do CT to look for blood

154
Q

Hemo unstable

A

Do DPL or FAST to look for blood

155
Q

Spleen injury

A

Try to repair it not remove it.

156
Q

Immunizations in splenectomy

A

H. flu, meningococcus (neisseria meningitidis), and pneumococcus (strep pneumo)

157
Q

Intraoperative development of coagulopathy

A

Give FFP and platelets. If there is also hypothermia and acidosis you have to terminate surgery

158
Q

Abdominal compartment syndrome

A

Following long surgery, may be impossible to close. Place mesh over incision until it can be closed. Can also cause a closed incision to re-open

159
Q

Pelvic hematoma

A

Interventional radiology has to embolize the internal iliacs

160
Q

Penetrating urologic injuries

A

Surgically explore

161
Q

Pelvic fractures

A

Can damage bladder and urethra

162
Q

Urethral injury

A

Blood at meatus (anterior), inability to void, and high riding prostate (posterior injury). DON’T place foley. Do retrograde urethrogram to Dx

163
Q

Bladder injury

A

Dx with retrograde cystogram with post-void films included

164
Q

Renal injuries

A

Rib injury. Look for AV fistula –> CHF or HTN if renal artery is stenosed

165
Q

Scrotal hematoma

A

Do US to look for ruptured testicle. If not ruptured, leave alone

166
Q

Penetrating injury of extremities

A

If no nearby vasculature –> tetanus and clean. If nearby vasc –> doppler or CT angio. If obvious vascular damage –> surg

167
Q

Combined bone, nerve, vessel injury

A

Bone first, then vessel (would be torn apart by fixing the bone if done first), then nerve

168
Q

Crush injuries

A

Hyperkal, Hypercal, myoglobinemia, renal failure, compartment syndrome. Tx with IVF, diuretics, and fasciotomy

169
Q

Chemical burns

A

Do intense irrigation. Alkali worse than acid

170
Q

Electrical burns

A

Massive debridement and amputations may be necessary. Give fluids, diuretics, and alkalinize the urine to prevent myoglobinuria renal failure

171
Q

CO poisoning

A

Give 100% O2

172
Q

Burn fluid resuscitation

A

Start w 1 L LR and titrate to 1-2 mL/Kg/hr

173
Q

Limited severe burns

A

Early excision and grafting

174
Q

Surface burns

A

Silver sulfadiazine. Triple antibiotic around the eyes

175
Q

Unprovoked animal bite

A

Rabies prophylaxis is mandatory

176
Q

Snake bites

A

Give antivenin (CROFAB)

177
Q

Black widow bite

A

IV Ca2+ gluconate

178
Q

Human bites

A

Extensive irrigation and debridement

Surgery (2 decks)

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