Pestanas- Specialties Flashcards
(122 cards)
1
Q
Excessive salivation shortly after birth + choking with feeds=
A
esophageal atresia
2
Q
Most common type esophageal atresia
A
upper atresia
lower fistula
3
Q
With esophageal atresia must r/o:
A
VACTER vertebral anal cardiac trachea esophageal renal/radial
4
Q
Management of imperforate anus
A
fistula nearby –> delay surgery but before toileting
high rectal pouch –> colostomy
low rectal pouch –> primary repair
5
Q
How to locate rectal pouch in IA
A
upside down xray
6
Q
CDH management
A
delay repair x 3-4 days
may need ET tube, ECMO, sedation
7
Q
Treatment of gastroschisis/omphalocele
A
small –> primary closure
large –> silo
*gastroschisis will need parenteral feeds x 1 month
8
Q
Bladder exstrophy must be repaired by ___
A
days 1-2 of life
9
Q
3 causes of green vomit + double bubble and how to dx
A
duodenal atresia
annular pancreas
malrotation
contrast enema/ upper GI
10
Q
green vomiting + multiple air fluid levels in baby=
A
intestinal atresia (vascular accident en utero)
11
Q
Hint to NEC
A
rapidly dropping platelet count
**will need abx and surgery if intestinal pneumatosis present
12
Q
Meconium ileus - what is dx and tx
A
gastrograffin enema
13
Q
Hypertrophic pyloric stenosis – typical age
A
3 weeks
14
Q
Jaundice at 6-8 weeks.. suspect? next step?
A
biliary atresia
do HIDA 1 week s/p phenobarb –> if no improvement do surgical exploration
15
Q
How to dx hirschsprungs
A
xrays (distended proximally)
full thickness bx rectum
16
Q
What may be mistaken for undescended testicle?
A
overactive cremasteric muscle –> can be PULLED DOWN (benign)
17
Q
Management undescended testicle
A
age 1 orchipexy
18
Q
Baby with abdominal mass- ddx?
A
liver: moves with respiration
otherwise- wilms vs neuroblastoma
19
Q
Age vs prognosis with neuroblastoma
A
younger better
20
Q
Newborn with stridor, difficulty swallowing, hyperextended position = what?
Next step in management?
A
vascular rings compressing both trachea & esophagus… –> confirm with barium/bronch then do surgery
21
Q
Key difference in presentation between vascular rings and tracheomalacia
A
tracheomalacia= just stridor, no difficulty with esophagus
22
Q
Which kiddo heart defect is assc with frequent colds?
A
ASD
23
Q
Two types of VSDs and their management
A
small, muscular –> will self resolve in most cases by age 3
large, membranous –> will likely need surgical closure due to FTT
24
Q
Which type of shunt has decreased vascular markings?
A
R –> L
25
How does truncus arteriosus kill?
overloading pulmonary circulation
26
Most common cyanotic anomaly in kids?
Tetralogy
27
Location of tet murmur
left 3rd intercostal space
| systolic ejection murmur
28
Dx/ tx tet
echo, EKG (RVH) --> surgical repair
29
Transposition requires _____
some sort of defect
30
Location of AR/AS murmur
right 2nd ICS/ LSB
31
When to replace valve in AR/AS
AS- symptoms or more than 50 mmHg gradient
| AR- LVD
32
When to replace valve in endocarditis
florid CHF
33
Valve disease that leads to hemoptysis
MS
34
MR/MS risk
afib --> clots
35
Vessel commonly used for grafts in CABG
internal mammary
36
Cardiac disease assc with square root sign
constrictive pericarditis
37
Progression in lung cancer dx
CXR --> CT and sputum sample --> bx (bronch, perc, VATS) --> tx
38
Which lung cancer cannot be treated surgically?
small cell
| mets except hilar
39
Requirement for lung cancer resection
residual FEV1 must be 800 mL
40
Claudication of arm, vision changes, altered equilibrium --> pathogenesis and management
plaque at origin of subclavian (subclavian steal syndrome)
duplex scanning --> bypass surgery
41
AAA when to observe and when to cute
4 cm or smaller observe
| 5-6 cm or growing more than 1 cm/ year --> surgery
42
Tender AAA - rupture is pending within ____ amount of time? Back pain- rupture is pending within ____?
Tender AAA- days
Back pain- minute to hours until rupture (this is retroperitoneal hematoma)
in both cases need immediate repair
43
Drug that provides symptom relief in PVD
cilostazol
44
Management of PVD
ABI --> if less than 1 cont to CT angio and plan revascularization
45
Appearance of PVD legs
hairless
shining
atrophic skin
lacking peripheral pulses
46
Cause of sudden cold/painful extremity
afib or postMI mural thrombus throwing clots
47
Incomplete/complete PV embolus management:
early incomplete- clot busters
complete- embolectomy w/ fogarty catheter
*consider fasciotomy if will take hours
48
Best option for AD dx
CT angio/ spiral CT
| though MRI/TEE do happen
49
Management of ascending vs descending AD
ascending- surgery
| descending- medical (risk loss of blood supply to spinal cord)
50
Two contraindications to FNA
testicular mass
| hemangioma
51
Incisional vs excisional bx on skin
incisional is for larger masses when you cannot just cut the whole damn thing out
excisional is for masses that are small enough to just remove
52
Margins needed for BCC, SCC, and melanoma
BCC 1mm
SCC 0.5-2 cm
melanoma 2cm
53
Contrast BCC and SCC locations
BCC above lip SCC below
54
Management of melanoma based on size
1-4 mm depth most benefit from aggressive therapy
| beyond 4 mm--> no hope
55
Chemotherapy for systemic melanoma mets
interferon
56
Management of strabismus
from birth --> surgery
| later --> may just need glasses
57
Acute angle glaucoma presentation
eyes dilated and nonreactive
seeing halos
eye is hard and painful
58
Drug therapy for acute angle glaucoma
a agonist
BBer
+/- Diamox
59
Orbital cellulitis management
emergent CT scan and drainage
60
RD presentation
flashes and floaters/ veil over visual field
| needs retina surgeon for spot welding
61
First aid for CRAO
breathe into paper bag; have someone press hard on the eye and release while in transit to ED
62
How long from dx of DM1 until retinal damage
20 years
63
Location of thyroglossal vs branchial cleft cysts vs cystic hygroma
thyroglossal- midline; moves with swallowing
brachial cleft- lateral; along SCM muscle
cystic hygroma- base of neck/ supraclavicular area
64
Lymphoma- presentation/dx/tx
young person with multiple nodes
must remove node and bx
chemo is tx
65
Where does met to supraclavicular nodes come from?
below clavicles --> not head and neck
66
SCC of neck dx
often just a node
must use triple endoscopy to find primary source
bx primary source (do not open bx node in neck, ruins surgical planning)
67
SCC of neck tx
resection, radical neck dissection, rads, plat based chemo
68
Acoustic neuroma:
| presentation and dx
unilateral sensorineural hearing loss
| MRI
69
Facial nerve tumor presentation vs Bells Palsy
it is gradual. (sudden in bells)
also note: will be upper and lower face
70
Most common parotid mass
pleomorphic adenoma
71
Signs that parotid mass is malignant (not pleomorphic adenoma)
hard, painful, producing paralysis
72
Management of parotid mass
no open biopsy
| excise whole gland
73
Cause of unilateral ENT problem in toddlers
foreign body
| will need endoscopy under anesthesia
74
Abscess on floor of mouth is caused ______ and poses risk of ______.
Ludwigs angina
| airway compromise
75
Management of Bells Palsy
antiviral
| steroids
76
Diplopia in sinusitis patient suggests...
Cavernous sinus thrombosis
77
Management of epistaxis in kids + location of bleeding
anterior septum
| phenylephrine + pressure
78
Management of epistaxis in teen + location of bleeding
cocaine; septal perforation --> posterior packing
| angiofibroma --> resection
79
Management of epistaxis in elderly or hypertensive pts
posterior packing +/- surgical ligation
80
Constrast presentation of inner ear dizziness; dizziness of neuro origin; Menieres
inner ear- room spins
brain- room stable
Menieres- vertigo, tinnitus, hearing loss
81
Management of menieres disease
diuretics
82
Management of vertigo 2/2 inner ear pathology
meclizine; promethazine; diazepam
83
Contrast presentation of ischemic vs hemorrhagic stroke patients
ischemic- painless
| hemorrhagic- painful
84
Characteristics of brain tumor pain
constant
85
Window for tPA in stroke
within 3 hours of symptoms
86
Cause of hemorrhagic stroke
uncontrolled HTN
87
How does surgical team manage SAH? radio?
surg- clips
| rads- coiling
88
Most common sources of brain mets
lung breast melanoma
89
How is increased ICP 2/2 brain tumor managed while awaiting surgery?
decadron
90
Vital signs- clues to ^^^ICP
bradycardia
| hypertension
91
Eye changes in frontal lobe tumors
ipsi side- CN2 atrophy
| contra side- papilledema
92
Workup for prolactinoma
TSH, pregnancy test, PRL --> MRI if ++
93
When to resect prolactinoma
pts who wish to get pregnant
| failed bromocriptine
94
Acromegaly management
somatomedin C levels --> MRI --> surgical removal
95
Bleeding into a pituitary tumor is termed ____.
| What must be done urgently?
pituitary apoplexy
| give steroids
96
Tumor that produces loss of upper gaze?
pineal gland
97
Which tumor causes children to prefer knee- chest position?
ependymoma in ventricle IV
98
Contrast brain abscess and brain tumor symptoms
abscess has more rapid onset
99
Crushing injury --> later cold and cyanotic extremity:
| cause? management?
causalgia --> successful sympathetic block is curative
treat with sympathectomy
100
Treatment of trigeminal neuralgia
carbamazepine --> radioablation --> separate nerve and vessel
101
Contrast testicular torsion and acute epididymitis
torsion: high riding testis w/ horizontal lie-- worse with elevation of scrotum
epididymitis: vertical lie-- relieved by elevation of scrotum
102
Management of testicular torsion vs epididymitis
torsion- surgery + orchipexy
| epididymitis- abx
103
When are stones a urologic emergency
anytime both obstruction ++ infection are present, must be treated emergently
104
Tx of stone + infection
stent or nephrostomy ++ abx ...cannot leave stone
105
When should IVP be avoided
Cr above 2
106
Dx of prostatitis
exquisitely tender prostate on DRE ONLY ONCE
| repeat DREs can lead to sepsis
107
Newborn boy cannot urinate at birth. Cause = _____
posterior urethral valves
108
The two --spadias: contast.
What should be avoided?
```
hypo= under= ventral
epi= top= dorsal
```
never circumcise
109
Little boy with repeat UTIs: dx
Vesicoureteral reflux
110
Little girl constantly dripping urine: cause and management
low implantation of ureter
vaginoscopy
corrective surgery
111
Three labs elevated in RCC
RBC
Ca
LFTs
112
management of bladder cx
CT --> cysto
| surgery and intravesicular BCG
113
Prostate cx:
| presentation & management
rock hard nodule on DRE
transrectal needle bx
surgery or radiation
114
Chemo type in testicular cancer
platinum based
115
Common cause of acute urinary retention
BPH patient gets cold and uses antihistamines + nasal drops --> will need bladder cath x3 days
116
BPG management
start with ablocker (tamsulosin) --> finasteride for 40+g glands --> TURP is final option (rare)
117
Most common type of incontinence seen in post-op patients
overflow incontinence from retention
118
At what size is a stone too large to pass spontaneously
7mm
119
Cause of pneumaturia
Fistula between bladder and GI tract
120
Only absolute contraindication to organ donation
HIV
121
Three types of transplant rejections
Hyperacute (minutes)
Acute (w/in 3 months)
Chronic (years)
122
Management of acute rejection (3 months)
Biopsy to confirm
| Can use tacrolimus/mycophenolate +/- prednisone
