Pastana surgery Flashcards
(108 cards)
1
Q
Difference between tracheostomy and cricothyroidotomy?
A
Cricothyroidotomy is faster and easier to perform
2
Q
Base of the skull fracture management?
A
CT of the cervical spine/avoid nasal ET tube
3
Q
Pt who is on respirator suddenly died, what causes it?
A
Air embolism
4
Q
What to do for hemodynamically stable and unstable pt who you are suspecting of intraabdominal bleeding?
A
Stable - CT
Unstable - FAST scan - OR
5
Q
What happens if you give the pt too much fluid and blood in a long surgery?
A
Abdominal compartment syndrome - wound can be closed - use absorbable mash
6
Q
If an injury has occurred to the bone, vasculature and the nerve, whats the order of fixing it?
A
Bone - vessels - nerve
7
Q
How to manage circumferential burn?
A
Escharotomy
8
Q
What are the topical agents for burned pts?
A
Silver sulfadiazine/mafenide acetate (causes acidosis)
9
Q
Sign of envenomation?
A
Local pain/swelling/discoloration
10
Q
Meds for black widow and brown recluse spider bites?
A
Black widow - IV Ca gluconate
Brown recluse - dapsone
11
Q
What motion is limited in slipped capital femoral epiphysis?
A
Internal rotation
12
Q
When is genu valgus (knock knee) normal?
A
between age 4-8
13
Q
Old folks vs. young ppl who fall on out stretched hands?
A
Old folks - Colles fracture of the distal radius “dinner fork”
Young - scaphoid fracture - pain at “snuffbox”
14
Q
What post op caution should be taken for intertrochanteric fracture?
A
Anticoagulation for DVT ppx
15
Q
Tx for achilles tendon rupture?
A
Equinus cast/surgery (quicker)
16
Q
Sign for compartment syndrome of lower legs?
A
Excruciating pain with passive extension
17
Q
What is the tx for jersey and mallet finger?
A
Splinting
18
Q
The back pain from herniated disc is exacerbated by what?
A
Coughing/sneezing/pooping
19
Q
Which finding is the worst indicator for preoperative cardiac risk?
A
JVD
20
Q
How long should you stop smoking before a surgery?
A
2 months
21
Q
Pt is more difficult to “bag”/decrease BP/CVP goes up during surgery, what is it?
A
Tension pneumothorax
22
Q
What is the first thing to think for a post op pt that becomes confused?
A
Hypoxia - give O2
23
Q
Management of ogilvie syndrome?
A
NPO/NG tube/colonoscopic decompression
24
Q
Two causes of hyponatremia?
A
SIADH/loss of isotonic fluid (body retain water)
25
C Diff not responsive to tx, what's next step?
Total colectomy
26
What causes amblyopia?
Congenital impairment of one eye causes cortical blindness (e.g result of strabismus)
27
Topical tx for anal fissure?
Topical nitro/CCB
28
Anal fissure that fails to heal after surgical intervention suggests what?
Crohn's disease
29
Perirectal abscess can eventually leads to what?
Fistula
30
Test for active lower GI bleed?
Angiogram (large bleed)/tagged RBC study (intermediate)/wait till it stops (low amount of bleed)
31
Massive upper GI bleed from a trauma pt, what is it and what tx?
Stress ulcer/angiographic embolization
32
Tx for sigmoid volvulus?
Flexible sigmoidoscopy
33
Ascending cholangitis complication?
Pyogenic liver abscess
34
Tx for breast cancer during pregnancy
Surgery right away
NO radiationtherapy/hormone therapy
NO chemo first trimester
35
Total mastectomy equals lumpectomy + ____?
radiation therapy
36
What is nesidioblastosis?
Hyperinsulinemia in newborns
37
Appropriate postural response of aldosterone?
Standing up - increase RAAS - increase aldosterone
| Lying down decreases them
38
What is VACTER?
Congenital anomalies
| Vertebral/anal/cardiac/TE fistula/renal
39
What is the diagnosis with an infant whose testicle is in the canal and can be easily brought down?
Overactive cremasteric muscle (normal)
40
How soon should exstrophy of the bladder be fixed?
within 1 or 2 days
41
What is the diagnosis with a infancy whose testicle is in the canal and can be easily brought down?
Overactive cremastic muscle (normal)
42
Infant has respiratory difficulty relieved by hyperextension of the neck
Vascular ring
43
What kind of valve disease is associated with Austin Flint murmur?
AR
| Mid diastolic murmur heard best at cardiac apex
44
How do measure right and left atrial pressure?
Central venous pressure - right atrial pressure
| Pulmonary capillary wedge pressure - left atrial pressure
45
Tx for small cell lung cancer
Chemoradiation therapy only
46
What is subclavian steal syndrome?
Stenotic plaque at origin of subclavian artery - blood supply to arm is intact for normal activity but when exercise - arm steals blood from vertebral artery from the brain to supply arm - arm claudication and posterior neurological symptoms such as visual and equilibrium symptoms
47
What does it mean if a AAA is tender?
it is about to rupture in a day or two
48
Management of ascending and descending aortic dissection?
Ascending - surgical repaire
| Descending - medical management of HTN
49
What does a negative FNA result mean? and when can't we do FNA?
Negative FNA means nothing - mean better bx
| Two situation - hemangioma of the liver/testicular mass
50
What is the MC type of skin cancer?
Basal cell carcinoma (50%) and then SSC and then melanoma
51
What is Mohs surgery?
Take out cancer in the face layer by layer
52
Difference between basal and SSC of skin cancer?
Basal - local invasion
| SSC - spread to lymph nodes
53
What is it that a parent say his child didn't have strabismus from birth but got it later in infancy?
Exaggerated convergence caused by refraction difficulties
| Corrected by lenses right away
54
What to give pt with acute angel closure glaucoma while he is waiting for surgery?
Systemic carbonic anhydrase inhibitor
| Topical beta blocker/alpha 2 agonist
55
Zone of floaters, what is it?
Retinal detachment
56
Which neck cyst locates at the anterior edge of sternomastoid muscle?
Branchial cleft cyst
57
Tx for little kid with nose bleed
Anterior septum bleed
| Phenylephrine spray and local pressure
58
tPA can be used for up to how long of a stroke?
3 hours
59
What's another name for IGF-1?
Somatomedin C
60
If a kid is in a knee chest position whenever he's having a headache, what is it?
Ependymoma
61
New born boy that can't pee, what could be the problem?
Posterior urethral valve
62
Tx for kids with vesicoureteral reflux
Long term abx till they grow out of it
63
Workup for hematuria
CT (look for kidney problems) and cystoscopy
64
Pt have post op incontinence, what is it?
Post op urinary retention
65
Time line for hyperacute, acute and chronic transplant rejection
Hyperacute - right after organ is resupplied
Acute - within 3 months
Chronic - years
66
What cardiac complication can a young drug addict develop?
Aortic regurgitation (sudden HF)
67
What is vasomotor shock?
From anaphylactic or spinal transection injury
| CVP is low and pt is pink and warm and needs pressor
68
Linear skull fracture w/o scalp wound, what to do?
leave it alone
69
Management of acute subdural and epidural hematoma
Epidural - craniotomy
| Subdural - craniotomy only if midline shift - otherwise medical management
70
Rib fracture tx for elderly
Nerve block and analgesia by epidural catheter
71
Management for gunshot wounds
If below level of nipple - exploratory surgery
72
Management for pt who is bleeding a lot during prolonged trauma surgery
FFP/platelet transfusion
| If hypothermia then stop surgery and warm him up
73
extremity gun shot wound - no distal pulses, what to do next?
Surgery
74
Under what circumstances can you do immediate skin graft on a burn pt?
When the burn is limited and 3rd degree
75
Medical management of broken clavicle
Sling
76
How does GI fistula manifest after abdominal wound closure after abdominal surgery
Drain into a pool and cause sepsis
| Drain freely cause electrolyte/fluid loss/erode abdominal wall
77
Tx for meconium ileus
Gastrografin enema
78
Arterial embolization to extremity, what is the management for partial and complete obstruction?
Partial - tPA
| Complete - embolectomy (Fogarty catheter)
79
Surgical tx for mitral stenosis and regurg
Commissurotomy
| Annuloplasty
80
How to determine if pneumonectomy can be done?
Pul function evaluation
| Extend of metastasis
81
How long does amblyopia take to develop?
6-7 years
82
What kind of chemotherapy is for testicular cancer?
Platinum based (-platin)
83
Management approach to upper neck penetrating trauma
Arteriogram
84
Post op pt develops bilateral pul infiltrate and hypoxia. What is it and what is the tx
ARDS
| PEEP
85
Penetrating urologic injury causing hematuria, what is the next step of work up?
Surgical exploration
86
Infant with a palpable abdominal mass that moves up and down with inspiration, what is it?
Malignant liver tumor
87
Best way to bx breast masses?
Mammography or U/S guided core bx
88
What is the goal urinary output with burn pt?
1 or 2 ml/kg/hr
89
Old woman who has pathologic fracture (like lifting a heavy bag and then broke her arm) suspect?
Metastatic bone cancer
90
When does dehiscence typically occur post op
Day 5
91
Newborn with bilious vomiting, double bubble sign on x ray, what could it be? And what is it if I tell you that the rest of the bowel has normal gas pattern?
Annular pancreas/malrotation/duodenal atresia
| Malrotation
92
What's the purpose of Cushing reflex
Increase BP to overcome increased ICP to maintain brain perfusion
93
Pt who had otitis media mastoiditis later develop fever, headache, blurred vision and seizure, think?
Brain abscess
94
How small the kidney stone can be spontaneously passed?
Under 3mm
95
What can be caused by hyper extension of the neck and what is its symptoms?
Central cord syndrome
| Paralysis and burning pain upper extremities and no problem at lower extremities
96
What study is needed to assess bladder injury
Retrograde cystogram with post void film
97
What kind of fluid is used for pt with hypernatremia secondary to severe dehydration?
D5 1/2 saline
98
What kind of fluid is used for pt with hyponatremia from rapid water intoxication?
hypertonic saline (3 or 5%)
99
a late 20s woman has a mass in her breast that has been growing into a big mass over years, what is it? Is it malignant?
Cystosarcoma phyllodes
| Usually not
100
What management does very ill baby with congenital diaphragmatic hernia needs?
Extracoporeal (outside of the body) membrane oxygenation - like hemodialysis but for lungs
101
An infant with sudden drop in platelet count and air in portal vein, what is it?
Necrotizing enterocolitis
102
What should you put topically around the burn nears the eyes on a burn pt?
Triple abx ointment
103
Dx for appendicitis
CT
104
Tx for Oligivie syndrome?
Fluid and electrolyte correction/then colonoscopy to suck out all the air
105
Pt has GI bleed. NG has bloody gastric content and whats the next step?
Endoscopy
106
Doppler is the same as ___ when diagnosing peripheral artery disease
ABI
107
Child with a brain tumor is in a hands and knees position, what kind of tumor is it?
Posterior fossa tumor (meduloblastoma or ependymoma)
| Child is attempting to open up the CSF passage to relieve the headache
108
Dx for acute mesenteric ischemia
Angiography
