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Emma Holliday Flashcards

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1
Q

First step if suspect PE

(a) Tx for PE

A

If suspect PE, immediately give heparin first
-then workup w/ V/Q scan

(a) PE: treat w/ heparin-warfarin overlap
- IVC filter is pt has contraindication to chronic anticoagulation

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2
Q

1-2 years s/p AAA pt presents w/ brisk GI bleed

A

Aortoenteric fistula

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3
Q

Mesenteric ischemia

(a) Diagnostic test
(b) Tx

A

(a) Workup = angiography
- aorta and SMA/IMA

(b) Tx = embolectomy
- or aortomesenteric bypass if thrombus

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4
Q

MEN1

A

MEN1- 3 Ps

  1. Pituitary adenoma (prolactinoma)
  2. Parathyroid hyperplasia (4 gland)
  3. Pancreatic islet cell tumor (gastrinoma)
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5
Q

1 wk old w/ bileous vomiting and abdominal distention

A

Malrotation and volvulus

  • Ladd’s bands kinking the duodenum
  • problem here is the small mesenteric base which makes it at high risk for volvulus
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6
Q

Child w/ neck mass

(a) Anterior to SCM
(b) Lateral to SCM

A

Non-midline neck mass

(a) Anterior to SCM = branchial cleft cyst
(b) Lateral to SCM = cystic hygroma
- associated w/ chromosomal abnormalities: Turner’s, Down’s, Klinefelters

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7
Q

Give tx for kidney stones based on size

A

Kidney stones

  • under 5mm: hydrate and let it pass
  • over 5mm: shock wave lithotripsy
  • over 2cm: surgical remoal
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8
Q

Differentiate which pts get the different types of esophageal carcinomas

(a) Squamous cell
(b) Adenocarcinoma

A

Esophageal cancer

(a) Squamous cell in smokers/drinkers in the middle 1/3 of the esophagus
(b) Long standing GERD => adenocarcinoma in the distal 1/3 of the esophagus

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9
Q

Name the type of fracture

(a) old lady falls on outstretched hand, distal radius is displaced
(b) young person falls on outstretched hand, tender anatomic snuff box

A

Fractures

(a) Colle’s fracture
(b) Scaphoid fracture

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10
Q

Genetic defect seen in ppl who get malignant hyperthermia

(a) Tx

A

Genetic defect causing malignant hyperthermia = ryanodine receptor gene defect

(a) Tx is dantrolene (blocks RYR)

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11
Q

Generalized etiology of neck mass that presents at

(a) 7 days old
(b) 7 mo old
(c) 7 yrs old

A

Neck mass

(a) 7 days old- inflammatory
(b) 7 mo old- cancer
(c) 7 yrs old- congenital

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12
Q

Lab abnormalities seen in acute mesenteric ischemia

A

leukocytosis, elevated Hgb, elevated amylase, metabolic acidosis (elevated lactate)

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13
Q

Why add epinephrine to lidocaine injections?

A

Larger doses of lidocaine can be used to increase duration

-epinephrine vasoconstricts arteries => delaying resorption of lidocaine and almost doubling the duration of anaestheisa

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14
Q

Dierticulosis vs. diverticulitis

A

Diverticulosis = just the outpuouching 2/2 low fiber diet (low fiber causes muscular hypertrophy of colon wall which narrows the lumen and therefore increases pressure)

Then when the outpouching becomes obstructed and forms abscess/perforates = diverticulitis

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15
Q

Differentiate Paget’s disease and inflammatory breast cancer

A

Paget’s disease: looks like eczema of the nipple

Inflammatory breast cancer- red, hot, swollen breast (not just the nipple)

  • orange peel skin
  • nipple retraction
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16
Q

Risk of BUN over 100 in the post-op period

A

Increased risk of post-op bleeding 2/2 uremic platelet dysfunction

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17
Q

Vent settings to manipulate

(a) PaO2
(b) PaCO2

A

Vent settings- evaluate vent management w/ ABG

(a) PaO2 correlates w/ FiO2
- if PaO2 is low, increase FiO2

(b) PaCO2 correlates w/ tidal volume and rate
- if PaCO2 is high (pH is low), increase rate or TV

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18
Q

Xray finding of necrotizing enterocolitis

A

Pneumocystis interstinalis = air in the intesitnal wall

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19
Q

Tx for nec in 5 day old

A

Bowel rest: NPO

  • abx and resection of necrotic bowel
  • TPN if necessary
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20
Q

When to use 3% saline in hyponatremic pt?

A

Symptomatic (seizures), or Na under 110

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21
Q

POD7 fever, pain at excision site w/

(a) edema and induration, no drainage
(b) induration with drainage
(c) salmon colored drainage

Give dx and tx

A

(a) Edema and induration w/o drainage = cellulitis
- Take BCx first, then start abx

(b) Induration w/ drainage = simple wound infection
- open wound and repack, no abx necessary

(c) salmon colored drainage = wound dehiscence
- immediately to OR, IV abx, primary closure of fascia (surgical emergency)

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22
Q

Tx for newborn w/ diaphragmatic hernia

A

Plan for birth in a hospital w/ ECHMO access- let lungs mature then do surgery on day 3-4

-biggest concern here is pulmonary hypoplasia 2/2 compression of lungs by abdominal contents

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23
Q

Most common oral cancer

A

Most common oral cancer = squamous cell

-seen in smokers and drinkers

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24
Q

Why do you not want to fix hyper/hyponatremia too quickly?

A

Don’t fix hyponatremia too quickly b/c of central pontine myolinolysis

Don’t fix hypernatremia too quickly (aka give free water) b/c of risk of cerebral edema

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25
Tx for volvulus- first line Last resort?
First line tx for volvulus = decompression from below (if not strangulated) Last resort = surgical removal and colostomy
26
'Small blue' tumor of femur in pediatric pt with night pain and fever
Ewing Sarcoma - diaphysis of long bones - night pain, fever, elevated ESR - Xray: lytic bone lesion w/ onion skinning - small blue = neuroendocrine tumor
27
Benign liver tumor in F not on OCPs
Think focal nodular hyperplasia = 2nd most common benign liver tumor
28
General tx for DCIS/LCIS
Same outcome: 1. modified radical mastectomy w/ SLN (w/o adjuvant RT) 2. Lumpectomy w/ SLN + adjuvant radiation therapy - chemo if node +
29
62 yo M p/w severe epigastric pain x1 hr - episodic postprandial epigastric discomfort x2 wks - PMH: DM2, HTN, HLD, CAD - PSH: CABG - Meds: ASA for osteoarthritis - CXR shows air under right diaphragm (a) Dx (b) Next step
(a) Perforated peptic ulcer- acute onset epigastric pain w/ chronic NSAID use, intraperitoneal free air (pneumoperitoneum) (b) Urgent ex lap
30
Give 2 ddx for 3 day old who has not passed meconium (a) Give diagnostic test
1. Meconium ileus (a) Gastrograffin enema is dx and tx 2. Hirschspruing's (a) Gold standard is biopsy of mucosa showing absence of ganglia
31
F/u for benign-appearing solitary lung nodule
CXR or CT scan q2mo to check for growth
32
How long before surgery should a smoker stop
8 wks
33
MEN2A
MEN2A 1. MTC 2. Pheo 3. Parathyroid hyperplasia (4 gland)
34
POD1 pt develops 104F, very ill appearing
Nec Fasc
35
Pt dies suddently after removal of central line
Air embolism
36
Baby born in respiratory distress w/ scaphoid abdomen (a) Dx (b) First step in dx
(a) Diaphragmatic hernia | (b) Xray to see abdominal contents in the thorax
37
2 wk old infant w/ bileous vomiting | -pregnancy complicated by polyhydramnios
Intestinal atresia or annular pancreas
38
Diagnostic test for TE-fistula
Place a feeding tube, then take Xray to see if it's actually going into the stomach (or just stuck at blind pouch)
39
2 parts of the colon that are most susceptible to ischemic colitis
The arterial watershed areas: splenic flexure and rectosigmoid junction, b/c they have the least collateral blood supply
40
First step after (a) Chemical burn (b) Electrical burn
After (a) Chemical burn- irrigate for 30+ minutes prior to ER (b) Electrical burn- get EKG
41
S/p trauma- pt has confusion, petechial rash in chest/axilla/neck, acute SOB Dx
Dx = fat embolism -suspect after a long bone fracture (esp. femur)
42
Adverse effect of rocuronium
Possible allergic rxn in asthmatics
43
Give brief standard of tx for (a) Colon cancer (b) Rectal cancer
(a) Colon cancer = remove affected segments + chemo if node is positive (b) Rectal cancer: Stage I/II -upper/middle 1/3 get LAR (lateral anterior resection) -lower 1/3 gets APR Stage III/IV: neoadjuvant chemo/radiation
44
What anal entity is treated w/ topical lidocaine and nifedipine?
Anal fissures -give to posterior mucosal anal tear w/ skin tag, don't need colonoscopy (more worried about lateral, not posterior, lesions)
45
Gastrocschisis vs. omphalocele (a) Elevated maternal AFP (b) Associated disorders (c) Covered by sac (d) Relationship to midline
Newborn abdominal wall defects (a) Gastrochiesis (no sac) is assocaited w/ elevated maternal AFP (b) Omphalocele (yes sac) associated w/ cardiac abnormalities (c) Gastrochiesis- no sac covering, omphalocele- yes sac covering (d) Omphalocele (sac) midline, gastrochesis (no sac) lateral to umbilicus
46
Tx for (a) acute rejection (b) Chronic rejection
Tx (a) Acute rejection (5 days to 3 mo): steroid bolus and antilymphocyte agent (OKT3) (b) Chronic rejection (after years): no tx, needs re-transplantation
47
Huge facial trauma, blood obscuring oral and nasal airway, GCS of 7 Next step?
Cricothyroidotomy- don't want blood in the tube for endotracheal intubation
48
IBD associated w/ (a) terminal ileum vs. rectum (b) PSC (c) Fistulae (d) Gramulomas (e) Transmural inflammation (f) Cured by colectomy (g) Smoking (h) Colon cancer risk (i) p-ANCA
IBD: Crohn's vs. UC (a) Crohn's = terminal ileum, vs. UC always involves the rectum (b) UC and PSC (increased risk of cholangiocarcinoma) (c) Fistulae in Crohn's (give metronidazole) (d) Granulomas and Crohn's (e) Transmural inflammation in Crohn's (f) UC is cured by cholectomy (g) Smoking- decreased risk of UC, higher risk of Crohn's (h) Higher colon cancer risk in Crohn's (i) UC associated w/ p-ANCA
49
Newborn w/ respiratory distress and excess drooling
Respiratory distress and excess drooling in newborn = TE fistula tracheo-esophageal fistula -think VACTERL association
50
Tx for asymptomatic gastric varices
Beta-blockers | -don't prophylactically band them if asymptomatic
51
For a CKD pt on dialysis who needs surgery, when should they get dialysis pre-op?
Dialyze 24 hrs post-op
52
(a) 4-5 yo kid w/ painless limp | (b) 12-13 yo w/ knee/thigh pain and sickle cell disease
Peds Ortho (a) 4-5 yo w/ painless limp: think Leg-Calve-Perthe's avascular necrosis of the femoral head (b) SCFE
53
ABI where you'd expect (a) Claudication (b) Limb ischemia (c) Ulcers (d) Gangrene
ABIs (a) Claudication under .9 (b) Limb ischemia: 0.2-0.4 (surgery indicated) (c) Ulcers w/ claudication at under .9 (d) Gangrene at under .2 (may require amputation)
54
How should a chronic smoker be treated differently post-op?
Chronic smoking => chronic CO2 retention | -shouldn't be given high O2 post-op b/c that could suppress respiratory drive
55
Describe the metabolic complications seen in pyloric stenosis
Pyloric stenosis => lots of vomiting (non-bileous) => losing HCl => hypochloremic metabolic alkalosis
56
2 anesthetic agents most commonly associated w/ malignant hyperthermia
Succinylcholine and halothane
57
Pathophysiology of malrotation and volvulus
Embryologically, bowel doesn't rotate 270 ccw around the SMA
58
Clinical symptoms of (a) hypocalcemia (b) hypercalcemia
Clinical signs of (a) Low Ca = numbness, Chvostek/Troussaeu, prolonged QT (b) High Ca = 'bones, stones, groans, psychiatric undertones', shortened QT
59
Blood at the urethral meatus w/ a high riding prostate (a) Next best test
Think: urethral injury 2/2 pelvic fracture (a) Next best test = retrograde urethrogram
60
Management of adrenal nodule (a) First step (b) How size matters
Adrenal nodule (a) First- check functional status - high BP (pheo or primary aldo), cushingoid? (b) Under 5cm and nonfunctional- can observe w/ CT scan q6mo - if over 6cm (functional or not) => surgical removal
61
Describe the pathophysiology of nec fasc (a) Location (b) Most common bugs (c) Tx
Nec fasc = pt looks super sick, flesh eating bacteria of bound, super febrile (like 104) on POD1 (a) spreads along the fascial plane, in the subQ tissue (along Scarpa's fascia
62
34 yo M w/ severe pain in penis that started during intercourse -grossly swollen penis deviated to the right Tx?
Dx = penile fracture, due to tearing of the tunica albuginea which invests the corpus cavernosum Tx = retrograde urethrogram (need to asses for urethral injury) + emergency surgery to evacuate hemoatoma and mend the torn tunica albuginea
63
Characteristics of malignant lung nodules
- new (not on old CXR) - smoker - over 40 - over 3cm - calcified
64
Most sensitive SCR finding for blunt aortic trauma
Mediastinal widening - see enlarged aortic bulge on superior cardiac silhouette - suspect aortic trauma in pt who suffers from blunt deceleration trauma (MVA or fall from more than 10 ft)
65
39 yo M w/ r. hip pain that makes it difficult to lie on his right side while sleeping -localizes pain to outer surface of his thigh Dx
Dx for middle aged adult w/ unilateral hip pain exacerbated by external pressure to upper lateral thigh = trochanteric bursitis = inflammation of the bursa surrounding the insertion of the gluteus medius onto the femur's greater trochanter
66
Contraindication to succinylcholine
Burn or crush victims b/c suc can cause hyperkalemia
67
Name 3 fractures that go directly to the OR
1. depressed skull fracture (broken bones are displaced inwards) 2. any open fracture- bone sticking out needs cleaning 3. femoral neck or intertrochanteric fx
68
2 mo old w/ colicky abdominal pain and current jelly stool
Intussusception | -barium enema is dx and tx
69
MEN2B
MEN2B 1. MTC 2. Pheo 3. Marfanoid body habitus and neuromas
70
What other concerns do you have when a newborn is diagnosed w/ TE-fistula?
``` VACTERL association Vertebral Anal atresia Cardiac abnormalities TE- fistula Renal/kidney defects Limbs ```
71
Meds to stop pre-op (a) Name 3 meds to stop for 2 wks (b) What to do w/ warfarin (c) What to do w/ insulin
Pre-op meds to stop (a) Stop for 2 wks: aspirin, NSAIDs, vit E (b) Stop warfarin for about 5 days, goal is to drop INR below 1.5, can use vitamin K (c) Take half the morning dose of insulin
72
Spread of papillary vs. follicular thyroid cancer
Papillary thyroid cancer (most common) spreads via lymph nodes => can do lobectomy Follicular thyroid cancer spreads via blood => must surgically remove entire thyroid
73
Most common cancer in nonsmokers
Adenocarcinoma
74
Midline neck mass that moves when pt sticks out tongue (a) Tx
Midline neck mass in child that moves when tongue is protruded = thyroglossal duct cyst (a) Remove surgically
75
Tx for pyloric stenosis in 4wk old
Tx = immediate referral to surgery for myotomy | -cut/ligate the muscle around the pyloric sphincter
76
Absolute contraindication to surgery
Diabetic coma, DKA
77
2 other irregularities associated w/ umbilical hernia in newborn
Associated w/ umbilical hernia 1. hyperglossia (large tongue) 2. congenital hypothyroidism
78
Salivary gland cancers (a) Most common salivary gland tumor (b) Most common malignant salivary gland tumor (c) Warthlin's tumor
Salivary gland cancers (a) Most common salivary gland tumor = pleomorphic adenoma - benign but recurs, usually on parotid (b) Most common malignant salivary gland tumor = mucoepidermoid carcinoma - pain and facial nerve palsy (c) Warthlin's tumor = benign parotid gland tumor, can injur facial nerve
79
Utility of Goldman's index? (a) Name a few of the criteria
Goldman's index- used to estimate a pt's perioperative cardiac risk (a) CHF, MI in the past 6 mo
80
Adverse event associated w/ Merperidine
Seizures b/c merperidine lowers the seizure threshold, especially in pts w/ renal failure
81
5 day old ex-33 weeker develops bloody diarrhea Dx
Necrotizing enterocolitis -often upon introduciton of feeds/switch to formula in a premature gut
82
Name 4 contraindications to surgery
1. Diabetic coma/DKA = absolute contraindication 2. poor nutrition - albumin under 3, transferin under 200, wt loss of more than 20% 3. severe liver failure 4. current smoker
83
#1 cause of death s/p AAA repair
MI
84
Diverticulitis (a) Clinical presentation (b) CT findings (c) Tx (d) F/u
Diverticulitis (a) Presents w/ LLQ pain + constipation or diarrhea (b) See free air on imaging (if perf), see abscess on CT (c) Tx = bowel rest and decompression (NPO, NG tube), broad spec abx and pain (d) F/u- do colonoscopy 4-6 wks later
85
Enlarging nodule gradually growing over site of chronic draining wound from burn 4 years ago
Marjolin ulcer = squamous cell carcinoma that arises w/in a chronically wounded, scarred, or inflamed skin
86
What cancer does Hashimoto's thyroiditis predispose pt to?
Thyroid lymphoma

Surgery (10 decks)

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