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rotations > Surgery > Flashcards

Surgery Flashcards

1
Q

Management of increased ICP due to acute subdural hematoma (7)

A
  1. ICP monitoring***
  2. elevate head
  3. hyperventilate
  4. avoid fluid overload
  5. mannitol or furosemide
  6. sedation
  7. hypothermia
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2
Q

tx of rib fracture

A

**esp impt in elderly

local nerve block + epidural catheter

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3
Q

pulmonary contusion on CXR

A

white out of lungs

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4
Q

gunshot wound to abdomen management

A

exploratory laporatomy

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5
Q

management of intraoperative development of coagulopathy

A

platelet packs + FFP

**if hypothermia and meta acid –> stop laparotomy

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6
Q

penetrating injury of extremities management

A

** determine if vascular injury based on anatomic location
if no –> tetanus prophylaxis + cleaning
if yes and asym–> Doppler/CT angio +/- surgery
if yes and sx –> surgery

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7
Q

circumferential burns

A

** edema can cutoff blood supply

tx + escharotomies

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8
Q

GI fistula

A

if all contents don’t leak outside, can cause sepsis
if draining freely with no fever or peritoneal irritation, can cause 1) fluid and lytes loss, 2) nutritional depletion, 3) erosion/digestion of belly wall **worse the higher the fistula is in GI tract

Tx = fluid/lyte replacement, nutritional support, protect abdominal wall (with suction, ostomy)

Nature will heal the fistula if no FETID (foreign body, epithelialization, tumor, infection/ irradiated tissue/IBD, distal obstruction

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9
Q

int vs ext hemorrhoids

A

internal - bleed, tx = rubber band ligation (if prolapsed can become itchy and painful)

external - painful, tx = conservative or surgery

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10
Q

workup of SCC of HEENT mucosa

A

triple (pan) endoscopy to look for primary
biopsy establishes dx
NO open biopsy

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11
Q

acute epididymitis

A

men old enough to be sexually active
severe sudden onset testicular pain + fever + pyuria
testis is swollen and tender, in normal position, cord is tender
tx = abx (US to rule out testicular torsion)

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12
Q

uretopelvic junction obstrtuction

A

normal urine flow is fine, but with large diuresis (e.g. after beer binge) the area is too narrow –> colicky flank pain

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13
Q

testicular cancer workup

A

biopsy with radical orchiectomy
preop serum markers: alpha fetoprotein, beta HCG
platinum based chemo *very radio and chemo sensitive

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14
Q

scaphoid fracture

A

fall on outstretched hand
wrist pain + tenderness over snuffbox
initial xrays negative but postive 3 weeks later
tx = thumb spica cast (ORIF if displaced)

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15
Q

wound dehiscence

A

~POD 5
wound looks intact, but there is large amounts of pink/salmon colored fluid soaking dressings (peritoneal fluid)
tx = securely tape and bound abdomen, re-operation for closure

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16
Q

SCC of anus

A

HIV+, receptive anal sex
fun gating mass grows out of anus, +/- metastatic LNs
Dx = biopsy
Tx = nigro chemoradiation +/- surgery

17
Q

tx of resectable breast cancer

A

if small lesion and away from nipple/areola –> lumpectomy + rad
if large tumor or laying below nipple/areola –> mastectomy

18
Q

chronic constrictive pericarditis

A

exertion dyspnea + hepatomegaly + ascites
cardiac Cath shows square root sign and equalization of pressures
tx = surgical

19
Q

morton neuroma

A

inflammation of common digital nerve of the third interspace between 3rd and 4th toes
palpable tender spot
common cause is pointed high heels or cowboy boots
tx = analgesics, better shoes, +/- surgical excision

20
Q

zero urinary output?

A

usually mechanical prob - kicked or blocked catheter

21
Q

correcting hypernatremia

A

start with D51/2NS

every 3 meq/L that Na is above 140 equals 1.L of fluid lost

22
Q

anal fissure

A

young women with super painful, blood streaked stools
fear of pain causes constipation
exam under anesthesia
cause = tight sphincter
tx = stool softeners, topical nitroglycerin, botox, forceful dilatation, lateral internal spincterectomy , diltiazem ointment

23
Q

obstructive jaundice caused by tumor

A

thin walled dilated gallbladder
CA: pancreas head adenocarcinoma, ampulla of vatar adenocarcinoma (jaundice + anemia + occult blood in stool), cholangiocarcinoma
do CT scan then ERCP if necessary, endoscopy of ampullary suspected

24
Q

full blown renal cell CA

A

hematuria + flank pain + flank mass
hypercalcemia, erythrocytosis, elevated LFTs
workup = CT –> heterogenic solid tumor (can grow into renal vein or vena cava
tx = surgery

25
Q

transitional cell cancer of the bladder

A 
*smokers
hematuria, irritated voiding
dx = CT, cystoscopy
tx = surgery, intravesical BCG
high rate of local recurrence *lifelong F/U
26
Q

topicals for burns

A

silver sulfadiazine
mafenide acetate for deep penetrations (thick eschar, cartilage)
triple abx cream for burns near eye

27
Q

obstruction AND infection of urinary tract

A

emergency!! can lead to kidney death, sepsis, death within hours
can happen while someones waits to spontaneously pass ureteral stone
tx = IV abx, immediate decompression of urinary tract (ureteral stent or percutaneous nephrostomy)

28
Q

Ogilvie syndrome

A

paralytic ileus of the colon seen in elderly sedentary patients that are further immobilized because of surgery elsewhere
large abdominal distention (tense, not tender), massively dilated colon
tx = fluid and late correction, colonoscopy to suck out air/decompression, place long rectal tube

29
Q

primary peritonitis

A

classic: child with ascites and nephrosis or adult with ascites and mild generalized abdomen
+/- fever, leukocytosis
tx = abx

30
Q

diagnostic and therapeutic enema for meconium ileum

A

gastrogaffin

31
Q

management of arterial embolization of extremitiy

A

doppler to locate site of obstruction
incomplete obstruction –> clot busters
complete –> embolectomy w/ Fogarty catheter (+ fasciotomy if several hrs pass before revascularization)

32
Q

brachial cleft cyst vs cystic hygroma

A

brachial cleft cyst: anterior edge of SCM, several cm +/- opening and blind tract

cystic hygroma: base of neck, large and mushy ill defined mass, occupies entire supraclavicular area and extend deeper into chest *CT before surgical removal

33
Q

penetrating neck trauma

A

upper zone gunshot: arteriogram
GSW at base of neck: arteriogram + esphagogram + esophagoscopy + bronchoscopy before surgery
surgical exploration if expanding hematoma, deteriorating vital signs, clear signs of esophageal or tracheal injury

34
Q

dx of intraabdominal bleeding

A

stable –> CT

unstable –> FAST exam

35
Q

tx of acute organ rejection

A

steroid bolus 1st line
antithymocyte serum
anti lymphocyte agents (OKT3) have high toxicity

36
Q

leg ulcers

-diabetic vs arterial insufficiency vs venous stasis vs marjolin ulcer

A

diabetic ulcer: pressure points

art insufficiency: tips of toes (as far from heart as possible), look dirty, no granulation tissue, pt with other CAD signs, workup = doppler, angio

venous stasis: chronic edema, indurated and hyperpigmented skin above medial malleolus, painless with granulating bed, varicose veins and cellulitis bouts, workup = duplex scan

marjolin ulcer: SCC develops in chronic leg ulcer *untreated 3rd degree burns or chronic draining sinuses from osteomyelitis, dirty looking deeper ulcer develops with heaped up tissue growth around the edges, biopsy, wide local excision and grafting

rotations (6 decks)

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