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2024 - Élo - Revision LMCC > High Yield: Surgery > Flashcards

High Yield: Surgery Flashcards

1
Q

With abdomen trauma, if they’re hemodynamically stable, what to do? Stab wound?

A

CT abdomen

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2
Q

What’s the next step if stab wound, unstable and have peritonitis?

A

Exploratory laparotomy

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3
Q

Describe: Tamponade

A

Beck’s triad

  • low blood pressure (weak pulse or narrow pulse pressure)
  • muffled heart sounds
  • raised jugular venous pressu
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4
Q

What’s the difference between tamponade and tension pneumothorax? (2)

A
  • cardio tamponade: no respiratory distress
  • tension pneumothorax: respiratory distress and trachyal deviation
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5
Q

What’s the dx of cardiac tamponade? (3)

A
  • Clinical
  • If insure: FAST echo
  • If dx clear: pericardiocentesis
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6
Q

What’s the dx of tension pneumothorax? What’s the management? (2)

A
  • Clinical dx
  • Management: Needle thoracentesis to alievate air escape, followed by chest tube.
    • key: trachial deviation
    • if normal pneumothorax, just chest tube
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7
Q

If trauma to the head with an unconscious period, what to do? (1)

A

Head CT without contrast

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8
Q

If CT head negative and orienté x 3, what to do?

A

They can go home

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9
Q

Identify. What’s the tx?

A
  • Epidural hematoma (lens shape)
  • tx: emergency craniotomy
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10
Q

Describe presentation: Epidural hematoma (lens shape) (3)

A
  • lucid interval
  • knocked out
  • wake up a bit, then pass out again
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11
Q

What’s the tx: Increased cranial pressure (3)

A
  • Elevating head
  • Hyperventilating
  • Mannitol (osmotic diuretic) which helps draw fluid into vasculature to alleviate edema
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12
Q

Describe tx: Hemothorax (2)

A
  • Usually resolves on its own
  • If > 1.5 L or > 200 ml/per hour for 4h -> intercostal artery injury, surgical procedure (video assisted thorascopic surgery VATS)
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13
Q

Name complications: Blunt trauma to chest (3)

A
  • Pulmonary contusion
  • Myocardial contusion
  • Transection of the aorta
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14
Q

Identify

A

L Pulmonary Contusion 24h after blunt trauma

tx: supportively

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15
Q

Describe: Myocardial contusion (3)

A
  • trauma to the sternum
  • EKG, troponin
  • associated with fx to sternum
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16
Q

Describe: Transection of the aorta (3)

A
  • Associated with high falls and motor vehicle crash with sudden deceleration
  • on x-ray: widened mediastinum
  • associated with first rib fx, scapula and sternum
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17
Q

Name 1st-line imagery: Transection of the aorta (1)

A

CT angio

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18
Q

Bladder injuries diagnosed with what?

A
  • Retrograde cystogram
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19
Q

In retrograde cystogram, if leakage in into peritoneum, what to do? (2)

A
  • = introperitoneal bladder injury
  • tx with surgery and close with suprabucic ostomy tube
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20
Q

Describe tx: Extraperitioneal injury of the bladder (bellow peritoneum)

A

Foley catheter

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21
Q

Describe: Renal injury (2)

A
  • Associated with lower rib fx (11th and 12th fx)
  • Gross hematuria
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22
Q

Describe dx and tx: Renal injury (2)

A
  • Dx: CT
  • Tx: self-resolving
23
Q

Describe: Urethral injury (3)

A
  • Blood at meatus
  • Possible scrotal hematoma, inability to void
  • High-riding prostate
24
Q

Describe dx: Urethral injury

A
  • dx: retrograde uretrogram
    • no foley catether bc can make injury worse
25
Q

What’s the major concern of extremity injuries?

A

Major injury injury

Different between soft and hard signs of arterial injury

26
Q

Differentiate between soft and hard signs of arterial injury (4)

A
  • Hard signs -> straight to OR
    • Pulsatile bleeding
    • Absent pulse
    • Expanding hematoma
    • Bruits/thrills
  • Soft signs -> Doppler
27
Q

Describe: Developmental dysplasia of the hip (4)

A
  • Malformation of the acetabulum (peds and ortho problem)
  • On E/P of baby: clunking sound when moving hip, asymmetrical gluteal or thigh folds
  • Imagery: Ultrasound
  • Tx: Pavlik harness
28
Q

Genu varum is normal until when? And genu valgum?

A
  • Genu varum: 3
  • Genu valgum: 8
29
Q
A
30
Q

How to tx: Compartment syndrome

A

Fasciotomy

31
Q

Describe presentation: Compartment syndrome (6)

A

6Ps

  • Pain
  • Palor
  • Pulseness
  • Paresthesia
  • Paralysia
  • Poikilothermia

Key: Excruciating pain with passive movement

32
Q

Describe: Quervain’s Disease (Blackberry thumb) (3)

A
  • Repetitive thumb movements -> inflammation of the extensor pollicis brevis tendon
  • sign: Finkelstein’s Test
  • tx: steroid injections
33
Q

Describe: Gamekeeper thumb

A
  • insufficiency of the ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint of the thumb
  • tx: casting
34
Q

Describe: Mallet finger

A

an injury to the end of your finger that causes it to bend inwards towards your palm. (often basketball)

35
Q

Describe: Jersey finger

A

rupture of flexor digitorum profundus tendon (grabbing someone’s jersey and they escaping -> force hyperextension)

36
Q

Describe: Cauda Equina Syndrome (4)

A
  • something compresses on the spinal nerve roots (often disc herniation)
  • sx: lower motor neuron sx, urination and bowel incontinence, overflow incontinence, decrease sphincter tone, perianal satal anesthesia, paralasis
  • emergy
  • dx: IRM
37
Q

Describe: Marjolin’s ulcer

A
  • patients who have chronic wounds that heals, and heals, then heals -> a non healing wound -> Squamous cell carcinoma -> biopsy
38
Q

Describe tx: Acute gout (2)

A
  • Indomethacin (NSAID) or colchicine
  • NSAID C-I in kidney disease -> intra-articular steroids
39
Q

Describe tx: Chronic gout (2)

A
  • Allopurinol
  • Probenecid
40
Q

Name main site of gout

A
  • Metatarsal phalangeal joint
41
Q

What to do before tx of gout?

A

First thing to do before tx -> aspirate and analyze fluid -> negative birefringence crystals (yellow needle shape)

42
Q

If someone has knee injury and you extend, makes popping sound, clicks while you extend, what to think of?

A

Meniscal injury

43
Q

If knee injury and supper swollen immediately, what to think of?

A

ACL injury

44
Q

Name C-I to surgery (2)

A
  • Ejection fraction < 35%
  • DKA
45
Q

If someone had a recent myocardial infarction, how long do you have to wait to do surgery?

A

6 months

46
Q

How early should someone stop smoking before surgery?

A

2 months, bc smoking really bad for wound healing (vasoconstrictor)

47
Q

Malignant hyperthermia should be different with what? (3)

A
  • Malignant hyperthermia
  • Neuroleptic malignant syndrome
  • Serotonin syndrome

all can have fever and rigidity

48
Q

Describe: Malignant hyperthermia (2)

A
  • follows a general anesthesia
  • tx supportively with dantrolene
49
Q

Describe: Neuroleptic malignant syndrome (2)

A
  • follows antipsychotic use
  • tx dantrolene
50
Q

Describe: Serotonin syndrome (2)

A
  • follows antidepressant antipsychotic
  • tx: benzodiazpeines ou cyproheptadine
51
Q

If you have a patient with PE or DVT and they’re on anticoagulants, and drugs didn’t work or have C-I (ex: increased risk of bleeding), what is the second line tx?

A

Instal Inferior vena cava filter

52
Q

What’s the first thing to do if the patient gets confused or disoriented?

A

Oxygen supplementation (R/O hypoexia)

53
Q

After surgery, patients can get low urine output. What to do first? (2)

A

Bladder scan

  • No urine means they’re not perfusing kidneys enough, give IV fluids
  • If a lot of urine, neurogenic bladder secondary to anesthesia use or surgery -> insert foley until bladder wakes up
54
Q

Describe: Paralytic ilesus (4)

A
  • Complication of surgery, small intestin and colon shuts down
  • Negative bowl sounds, no flatus, distension
  • hypokalemia worsens this
  • Ogilvie syndrome: Paralytic ileus of the colon only (small bowl active)
    • on abdominal x-ray -> distended colon
    • tx: colonoscopy suction with long rectal tube

2024 - Élo - Revision LMCC (6 decks)

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