Surgery Rotation 8

Question 1

What do you do for a pt with huge facial trauma, with blood obscuring oral and nasal airway

Answer 1

Cricothyroidotomy

Question 2

What are indications to take pt with a pneumothorax to the OR (vs. just chest tube)

Answer 2

If there is high output > 1.5L when chest tube placed

Or > 200cc/hour in first 4 hr of chest tube

Question 3

Tx for pulmonary contusion

Answer 3

No surgery

Make sure pt is taking deep breaths, coughing, and clearing secretions

Question 4

Management of flail chest

Answer 4

O2 and pain control

Question 5

How do you control pain in flail chest

Answer 5

NERVE BLOCK!

Don’t want to give drugs that will decrease respiratory drive

Question 6

Diagnose: pt involved in MCV with confusion, petechial rash in chest, axilla, and neck and acute SOB

Answer 6

Fat embolism

Question 7

Diagnose: pt dies suddenly after med student removes a central line

Answer 7

Air embolism

Question 8

Tx of pericardial tamponade

Answer 8

Needle decompression

Question 9

What are the max values of each component of Glasgow coma scale

Answer 9

Eyes 4
Verbal 5
Motor 6

Question 10

How can you tell acute vs. chronic subdural hematoma on CT

Answer 10

Acute blood = bright white

Old blood = dark/blackish

Question 11

Tx of increased ICP

Answer 11

Elevate head of bed, hyperventilate, Mannitol

Question 12

What are the 3 zones in the neck that you must be aware of for penetrating trauma

Answer 12

Zone III = above angle of mandible

Zone II = between angle of mandible and cricoid

Zone I = below level of cricoid

Question 13

Tx of penetrating trauma in zone III (above mandible)

Answer 13

Check aorta graph + triple endoscopy

Question 14

Tx of penetrating trauma in zone II (b/w mandible and cricoid)

Answer 14

2D doppler to check vessels

May want to do exploratory surgery

Question 15

Tx of penetrating trauma in zone I (below cricoid)

Answer 15

Aortography

Question 16

Tx of gunshot wound to abd

Answer 16

Exploratory laparotomy

+ tetanus prophylaxis

Question 17

Tx of abd stab wound with unstable pt with rebound, guarding, and rigidity

Answer 17

Exploratory laparotomy

Question 18

Tx of abd stab wound with stable pt

Answer 18

FAST exam, diagnostic peritoneal lavage

If either are positive = OR

Question 19

Tx of blunt abd trauma with hypotensive/tachy pt

Answer 19

Exploratory laparotomy

Question 20

Tx of blunt abd trauma with stable pt

Answer 20

CT

Question 21

Where do you expect damage in blunt abd trauma with handle bar sign

Answer 21

Pancreatic rupture

Question 22

Where do you expect damage in blunt abd trauma, stable pt, with epigastric pain and retroperitoneal fluid on CT

Answer 22

Consider duodenal rupture

Question 23

Next best test in a trauma pt with blood at urethral meatus and high riding prostate

Answer 23

Are considering pelvic fx with urethral or bladder injury

Want to do retrograde urethrogram

Question 24

If retrograde urethrogram is normal in a pt with blood at urethral meatus and high riding prostate, next step?

Answer 24

Evaluate bladder with retrograde cystogram

Question 25

What are you looking for in cystogram?

Answer 25

Dye extravasating from bladder

Question 26

What does location of extravasating dye tell you?

Answer 26

Extraperitoneal = anterior bladder

Intraperitoneal = dome of bladder

Question 27

Management of extra- vs intraperitoneal dye extravasation in cystogram

Answer 27

Extraperitoneal = bed rest + foley

Intraperitoneal = exploratory laparotomy and surgical repair

Question 28

Diagnose: should pain s/p seizure or electrical shock

Answer 28

Posterior shoulder dislocation

Question 29

Diagnose: Old lady FOOSH, distal radius displaced

Answer 29

Colle’s fracture (dinner fork fx)

Question 30

Diagnose: Young person FOOSH, anatomic snuff box tenderness

Answer 30

Scaphoid bone fx

X-ray will often be negative!

Question 31

Treatment of hypernatremia

Answer 31

D5 1/2 NS - for slow development

D5 1/3 NS - for rapid development

Question 32

IV fluids given to treat DKA

Answer 32

0.9% normal saline initially

Add dextrose 5% when serum glucose <200 mg/dL

Question 33

Treatment of hyponatremia

Answer 33

ater restriction - for slow developing

NS or Ringers lactate - for rapid developing

Question 34

What is in cryoprecipitate

Answer 34

Used in coagulopathies

Fibrinogen, factor 8 and 13, fibronectin, VWF

Question 35

Treatment of gas gangrene

Answer 35

Penicillin
Debridement
Hyperbaric chamber

Question 36

Management of carpal tunnel syndrome

Answer 36

Wrist xray
Splint and anti-inflammatories
If it needs surgery - precede by electromyography

Question 37

Management of trigger finger

Answer 37

Trigger finger = flexor tendon catches and finger may become locked in flexion

Steroid injections

Question 38

Management of uncomplicated SBO

Answer 38

Bowen rest, NG tube suction, fluids

Question 39

Management of complicated SBO

Answer 39

Emergency exploratory laparotomy

Question 40

What does pronator drift test for

Answer 40

o Test:
♣ Patient outstretches the arms with palms up and eyes closed so that only proprioception is used to maintain arm position
♣ UMN lesions cause more weakness in supinator muscles compared to pronator muscles of the upper limb – so affected arm drifts downward and the palm turns (pronates) toward the floor

o Positive in UMN or Pyramidal/Corticospinal tract disease
♣ E.g. Multiple Sclerosis

Question 41

Ddx for anterior mediastinal mass

Answer 41

4 Ts

Thymoma, teratoma (and other germ cell tumors), thyroid neoplasm, terrible lymphoma

Question 42

What is complicated diverticulitis

Answer 42

Diverticulitis associated with Abscess, perforation, obstruction, fistula

Question 43

Management of uncomplicated diverticulitis

Answer 43

Bowel rest, oral abx, observation

Question 44

Management of complicated diverticulitis with abscess

Answer 44

Percutaneous drainage guided by CT for fluid > 3

Surgical drainage if percutaneous drainage fails