Surgery Specialty Flashcards
Adult with conjunctivitis
Pink eye
In adult usually viral (adenovirus)
Random cancer mets everywhere and can’t find the origin
Invasive melanoma can metastasize to anywhere
Only cancer that does that. It does not respond to chemo or radiation. It can be locally resected. It relapses and remits. It grows and shrinks
Treatment for BPH
Alpha-blockers to open the urethra and 5-alpha-reductase inhibitors to shrink the prostate.
Therapy begins with the alpha-blockers (Tamsulosin) and can escalate to combination therapy with Tamsulosin and Finasteride.
Presentation of coarctation of the aorta in child
A 1-year-old child who refuses to walk. He/she has claudication of his/her calves but is not able to communicate that pain in any other way other than crying.
Presentation of coarctation of the aorta in an adult
An adult (teenager to elderly) who has hypertension in the upper extremities and hypotension in the lower extremities. The older the person gets, the more difficult this is to separate from peripheral vascular disease, so the vignette will likely give you someone a little younger without atherosclerotic risk factors.
Work-up for coarctation of the aorta
Chest X-ray looking for rib notching
Diagnosis is then confirmed with some form of angiography of the aorta—CT scan chest with IV contrast, MRA, or regular angiogram.
Tx: Surgery w/ graft or anastomosis placed
Child with cyanotic heart
A child with cyanotic congenital heart disease not diagnosed at birth should prompt thorough evaluation for Tetralogy of Fallot.
Management of brain bleed
In any brain bleed, reverse anticoagulation (FFP) as the first step unless there are already signs of herniation (then choose craniotomy).
Scaphoid fracture management
Tenderness of the anatomic snuff box is pathognomonic for Scaphoid fracture, even if the x-rays are initially negative.
Tx with thumb cast and repeat xray in 3 weeks
Management of Abdominal Aortic Aneurysms
Surgery for AAA >5.5 cm
Surgery for AAA growing >0.5 cm/year, or those that are tender.
All others can be followed with serial Ultrasounds
Subarachnoid hemorrhage Diagnosis
Start with CT scan without contrast if (+) great
if Negative but high suspicion for SA hem then do LP and look for blood (xanthochromia)
The next step, after defining there is a subarachnoid hemorrhage is
An angiogram of the cerebral vessels
Either with direct catheterization (cerebral angiogram) or with a CT scan of the head with IV Contrast (CT Angiogram)
PAD Surgical treatment
Stenting is performed for femoral lesions less than 3 cm, all other lesions must be bypassed surgically.
Pituitary Apoplexy Management
The adenoma outgrew its vascular supply and died.
When you lose the pituitary all at once, you get a pan-hypopituitarism of sudden onset.
IV dexamethasone for the corticosteroid effect to regain blood pressure.
Femoral head fracture management
femoral head fracture require open reduction and internal fixation with replacement of the femoral head given its tenuous vascular supply
