surgery 2 Flashcards
27 yo immigrant from el salvador has long hx of growing 14x12x9cm mass in breast. firm rubbery and completely movable. no nodes. what is it? next steps?
cystosarcoma phyllodes. seen in late 20s. grow over many years, become very large, replacing and distorting the entire breast, yet not invading or becoming fixed. most are benign but they have potential to become malignant sarcomas. next steps: core or excision bx (FNA is not enough), removal is mandatory.
72 yo 5 days s/p ORIG for intertrochanteric fracture gets massively distended colon, distended tense contender abdomen, and X-rays that show the colon to be full of air, down to the level of the sigmoid. next/
fluid and electrolyte correction. rule out mechanical obstruction (large rectal tube) so that he can be given neostigmine (peripheral acetylcholinesterase inhibitor). this is ogilvies.
next step in workup of arterial insufficiency at rest
doppler studies looking for a pressure gradient. if significant different, do CT angio or MRI and to identify the specific areas of stenosis or complete obstruction and look for good distal vessels to which a graft could be hooked.
34 yo W deelops abdominal pain and shortly thereafter faints. HD unstable with low Hgb. she has been on BC since teenager.
hepatic adenoma. complication of BC pills. have a tendency to rupture and bleed massively inside the abdomen. CT scan is diagnostic and emergency surgery is required.
pt in car accident has decreased sensation to sharp and dull stimuli in medial side of right lower thigh and leg. knee extension on right is reduced when compared to left. what nerve is injured?
femoral nerve innervates muscles of anterior compartment of thigh. tibial nerve supplies muscles of postetio compartment of thigh. common perennial nerve gives rise to superficial and deep perennial nerves-> sensation to anterolateral leg and dorsum of foot.
pt s/p thyroid removal for graves disease has QT interval prolongation. also anxiety, muscle cramps, poor sleep. why?
removed parathyroids-> hypocalcemia and elevated phosphate in the presence of normal renal function.
