Dr. Pestana's Surgery Notes Flashcards
(149 cards)
1
Q
What are the different ways to intubate someone?
A
orotracheal
nasotracheal
cricothyroidotomy
2
Q
What way to you intubate someone with a suspected cervical spine injury?
A
nasotracheal or orotracheal
3
Q
What are the signs of shock?
A
low urinary output sweating pale fast feeble pulse low BP shivering thirsty apprehensive cold
shows 20-30% of blood volume lost
4
Q
What is considered low urinary output?
A
less than 0.05 mL/kg/hr
5
Q
What are the common causes of shock in a trauma setting?
A
hemorrhage
pericardial tamponade
pneumothorax
6
Q
In a trauma what is the preferred route of fluid resuscitation?
A
2 peripheral IV lines
16 gauge
7
Q
What are nontrauma causes of shock?
A
intrinsic cardiogenic (MI, fulminating myocarditis) vasomotor
8
Q
What are signs that a fracture is present at the base of the skull?
A
ecchymoses
rhinorrhea
racoon eyes
ottorrhea
9
Q
If a pt has a modest trauma with loss of consciousness, lucid interval, then gradual lapses into a coma again with a fixed dilated pupil and contralateral hemiparesis with decerebrate (wrists flexed, arms adducted, feet plantar flexed) what does this describe?
A
acute epidural hematoma
10
Q
How does a subdural hematoma present differently than an epidural hematoma?
A
has a bigger trauma, pt doesn’t fully regain consciousness, pt is much sicker
11
Q
How do you tx an acute subdural hematoma?
A
hyperventilate monitor ICP elevate head avoid fluid overload give mannitol or furosemide
Hyperventilation causes decreased PaCO2 which subsequently leads to arterial vasoconstriction thus lowering cerebral blood flow (CBF), cerebral blood volume, and ICP. This effect is mediated my pH changes in the extracellular fluid which cause cerebral vasoconstriction or vasodilation depending on the pH.
12
Q
What is the progression of rib pain in the elderly?
A
chest pain => decreased breathing => atelectasis => pneumonia
13
Q
A contused lung is susceptible to what?
A
fluid overload (fluid restrict use diuretics)
14
Q
A big deceleration injury makes you look for what?
A
aortic dissection
15
Q
Layers of the blood vessels?
A
intima
media
adventitia
16
Q
Long bone fractures, petechial rashes on the neck and axilla, tachycardia, fever, and respiratory distress points to what?
A
fat emoblism
17
Q
Where could 1500 mL of blood hide?
A
abdomen
pelvis
thigh
18
Q
In circumferential burns what do you have to worry about?
A
blood supply being cut off
19
Q
If a burn exceeds 20% in a child how fast do you infuse fluid?
A
20 mL/kg/hr and fine tune to urinary response
20
Q
Difference between Legg-Calve-Perthes disease and slipped capital femoral epiphysis
A
LCP (avascular necrosis): 6 yo, insidious dev of limping, decreased hip motion, hip or knee pain
Slipped C F E: chubby 13 yo boy, knee or groin pain, limping,
21
Q
An EF less than what is bad for surgery?
A
< 35%
22
Q
What do you look at for cardiac risk?
A
JVD distention
MI in last 6 months
> 5 PVCs per minute/ other than sinus rhythm
> 70 yo
emergency surgery
aortic valve stenosis/poor health/surgery in chest or abd
23
Q
What factors do you look at to assess hepatic risk factors?
A
Albumin <3 PT >16 bilirubin >2 encephalopathy ascites
24
Q
tx for malignant hyperthemia?
A
dantrolene
oxygen 100%
cooling blankets
correct acidosis
25
Causes of post-op fever?
```
atelectasis - Day 1
pneumonia- Day 3
UTI- Day 3
DVT- Day 5
wound infection- day 7
wound abscess- day 10-15
```
26
What are causes of abdominal distention post-op?
```
ileus
obstruction (adhesions)
ogilvie syndrome (nursing home)
```
27
What is the speed limit of replacing K?
10 mEq/hr
28
How does cancer of the right colon present?
anemia
29
How does cancer of the left colon present?
bloody stool
30
What types of colonic polyps are there?
```
hyperplastic
adematous
from familial syndromes (Lynch
villous adenoma
juvenile
peutz-jegers
isolated inflammatory
```
31
tx of c diff
metronidazole
32
Where does most GI bleeding come from?
upper Gi tract (90%)
| lower MC in elderly
33
a massive upper GI bleed in the context of trauma or complicated post-op is probably from what?
stress ulcer
34
what combine abdominal pain and blood in the lumen of the gut?
ischemia
35
what mimics an acute abdomen?
```
mi
pancreatitis
pe
kidney stones
lower lobe pneumonia
```
36
mesenteric ischemia has what hx?
afibb or recent MI
| throwing a clot
37
pyogenic liver disease is mostly a complication of what?
ascending cholangitis
38
What are the 3 processes of jaundice?
obstruction
liver problems
hemolysis
39
moderate elevation of liver transaminases and bilirubin, very elevated ALP points to what source of jaundice?
obstruction
40
stones, bones, and abdominal groans means what?
hyperparathyroidism
| classic presentation
41
a baby with salivation at birth and choking with first feeding probably has what?
esophageal atresia
42
what does VACTER stand for?
```
Vertebral
Anus
Cardia
Tracheal
Esopagheal
Renal
```
abnormalities associated together at birth
43
what side is a congenital diaphragmatic hernia always on?
the left
44
gastrochisis vs omphacele
both are a protrusion of the bowel at birth
gastrochisis the defect is not the umbilical chord
omphacele the defect is the umbilical chord
45
what color vomiting in an infant is bad
green
46
what conditions cause green vomiting in an infant
intestinal atresia
annular pancreas
malrotation
47
Where are brachial cleft cysts?
ant edge of SCM
48
What is a congenital, large, mushy mass that occupies the entire supraclavicular area?
cystic hygroma
49
A recently dx lymph node mass has what FU timetable?
3-4 week re-check to see if its gone
50
Lymphoma is typical in what population?
young people
51
What is a triple endoscopy and what is it used for?
bronchoscopy
esophagoscopy
direct laryngoscopy
SCC of the neck
52
dx SCC of the neck?
biopsy for patho
| CT shows extent
53
Hoarseness + painless ulcers of the mouth + ear ache =
SCC of neck mucosa
54
sensory HL in one ear of adult suspect what?
acoustic neuroma
55
How do you biopsy a parotid?
FNA
| DON'T open it up
56
Why is ludwig angina an emergency?
threatens airway
| abscess on the floor of the mouth
57
Sudden paralysis of the facial n vs gradual? (etiology)
```
sudden = bels palsy
gradual = cancer
```
58
Frontal or ethmoid sinusitis + diploplia developing = what are we worried about? How do you manage?
cavernous sinus thrombosis
hospitalize, IV fluid/antibiotics, CT/MRI, drainage
59
tx for ant nosebleed of kid?
phenylephrine
| compression
60
18 yo with nosebleed suspect what?
cocaine
61
Room is spinning vs pt is spinning (what etiology)
```
room = inner ear
pt = brain problem
```
62
tx for inner ear dizziness?
meclizine
phenergen
diazepam
63
nature of vascular problems in brain (ie presentation)
sudden onset
no HA is occlussive
HA if hemorrhagic
64
time table of brain tumors ie beginning
months
65
MC origins of cause of TIA?
carotid stenosis
| ulcerated plaque at carotid bifurcation
66
Timeframe of tPA?
90 min - 3 hours
67
pt has unc. HTN + a severe HA suspect
hemorrhagic stroke
68
blood in spinal tap comes from a bleed where?
subarachnoid
69
What does the course of a brain tumor look like?
1) progressive HA, increase ICP, blurred vision, papilledema, projectile vomiting
2) extreme end: bradycardia and HTN
70
A tumor causes problems with 1) speech or 2) behavior is located where?
1) lateral lobe
| 2) frontal lobe
71
Prolactinomas cause what symptoms?
amenorrhea
| galactorrhea
72
bromocriptine is what? used to tx what?
dopamine agonist
| used to tx prolactinoma
73
acromegaly has what presentation
```
enlarged jaw, tongue, hands
HA
diabetes
sweating
hx of rings not fitting
```
74
What is pituitary aploplexy?
bleeding in a pituitary tumor
75
What tumor has "sunset eyes" + loss of upper gaze
pineal gland tumor
76
Where are most brain tumors in children
posterior fossa
77
an unshaven area of the face may represent what?
trigeminal neuralgia
78
dx reflex sympathetic dystrophy? (ie causalgia)
a successful nerve block of burning pain over previous crush injury
79
where are the testes in a testicular torsion?
elevated ie high riding
epididymitis is normal
80
UT obstruction and infection needs what?
decompression surgically
81
poss dx for kid with burning urine, frequency, low abd pain, perineal pain/flank pain and fever/chills
vesicoureteral reflux
voiding cystourethrogram
82
In girls the low implantation of a ureter causes what?
urine drips into the vagina and leaks out
83
How does UT cancer show up?
hematuria
84
Who needs work-up for hematuria?
everybody except adult with recent major trauma
85
first thing for work-up of hematuria?
CT
86
dx prostate cancer
transrectal needle biopsy
87
testicular cancer is painful T/F
false
88
2 blood markers of testicular cancer?
alpha fetoprotein
| beta HCG
89
dx testicular cancer
radical orchiectomy
| almost all testicular tumors are malignant
90
for acute Urinary retention in males how long is catheter left in?
3 days
91
life/meds causing acute urinary retention?
over hydration
cold
antihistamines
nasal drops
92
fistulization between bladder and GI tract causes what?
pneumaturia
93
only absolute CI to being an organ donor?
HIV
94
what heart defect is likely to close in 2-3 yrs on its own?
small VSD low in septum
95
a "failure to thrive" pansystolic @ LSB and increased pulmonary markings is a murmur of what congenital defect
VSD
96
bounding peripheral pulses + a machine like murmur + newborn
patent DA
97
MC cyanotic abnormality
tetrology of fallot
98
dx of malrotation in infant?
contrast enema
99
signs of sepsis in a baby?
dropping platelets
100
what causes a meconium ileus? Associated with what?
too thick a stool causes obstruction
| cystic fibrosis
101
dx for hypertrophic pyloric stenosis without feeling olive?
US
102
what drug is a powerful cholertic? ie promoting bile secretion
phenobarbitol
103
dx of hirschprungs?
full thickness biopsy
104
colicky abd pain x1min followed by full recovery and then repitition, kids double up and squat during the episodes (name of problem)
intussusception
105
incomplete obliteration of the vitelline duct causes what?
meckel's diverticulum
106
lower GI bleeding in kids could be what?
meckle's diverticulum
107
vascular rings produce what symptoms?
stridor
resp distress
hyperestended neck
(vascular rings around neck, congential)
108
ASD has what murmurs
systolic (faint)
| fixed split S2
109
What are the 4 parts of the tetrology of fallot?
1) VSD
2) outflow obstruction
3) right ventricle hypertrophy
4) overriding aorta
110
what keeps transp of the great vessel kids alive?
ASD
or
VSD
111
a harsh, midsystolic @ right ICS
aortic stenosis
112
when does aortic stenosis need a new valve?
50 mmHg gradient
113
high pitched diastolic @ left LSB
aortic insufficiency
114
cause of acute aortic insufficiency
endocarditis
115
which lung cancer is non-operable?
small cell
116
minimum FEV1 for lung resection?
800 mL
117
pt has a cold limb, tingling, muscle pain + visual/equilibrium problems with exercise the arm
subclavian steal syndrome
118
< what size AAA is ok
< 4 cm
119
a tender AAA means what?
it's going to rupture
120
life/drugs that help PVD?
exercise
no smoking
cilostazol
121
ultimate stage of PVD?
rest pain leading to lack of sleep, dangling leg from bed
then ulceration and gangrene
122
arterial embolization and clog leads to what symptoms?
```
pain
pallor
cold
pulselessness
paresthesias
paralysis
```
123
tx of embolus
clot buster
124
dyspnea with exertion, orthopnea, paroxysmal nocturnal dyspnea, a cough, hemoptysis, and afibb comes from what heart problem?
MS
125
ms has what sort of murmur?
low-pitched rumble heard at the apex
126
systolic murmur of AR lasts for how long of the heart cycle?
pansystolic
127
3 vessel disease leads to what?
bypass
128
what do you need to pay attention to in post-op heart surgery?
cardiac output
129
a dissecting thoracic aorta occurs in who?
uncontrolled HTN
130
best imaging for dissecting thoracic aneurysm?
spiral CT
131
preferred place of basal carcinoma?
upper face
| line across lips
132
preferred place for SCC?
lower face
| line across lips
133
met melanoma metastasizes where?
anywhere and everywhere
134
"square root sign" with equalization of pressures comes from what?
chronic constrictive pericarditis
135
a coin lesion is 80% malignant after what age?
50 yo
| *find previous xray
136
suspected lung cancer do what?
sputum culture and CT
137
3 factors after dx lung cancer and considering work-up?
1) likelihood its cancer (age, previous xray, noncalcified)
2) ability to surgically fix (PFT)
3) if surgery can be curative (ie no metastasis to lymph nodes, liver mass)
138
strabismus in kids can lead to what?
amblyopia (ie impaired vision of one eye)
139
white pupil in a baby =
retinoblastoma
140
how is the pupil in acute glaucoma?
fixed mid-dilated ie unreactive to light
141
time length of irrigating chemical burn of the eye
30 minutes before ER then continue in ER
142
"flashing lights" + floaters =
retinal detachment
143
youngsters with type 1 diabetes have how long before eye problems?
20 yrs
144
neck mass: how do you differentiate between neo and inflammatory?
time.. neo comes over months and inflammation over days/weeks
145
what level is the thyroglossal duct at?
hyoid bone
146
what EF is prohibitive for non cardiac surgery?
35%
147
worst finding predicting heart failure risk?
JVD
148
If a post op pt is confused what is the first thing to suspect?
hypoxia
149
what happens to k in diabetic ketoacidosis?
k moves into the cells=> hypokalemia
