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Flashcards in Surgery Deck (50):
1

For patients with an obstruction caused by volvulus what procedural management is indicated? What if recurrent episodes?

Rigid proctosigmoidoscopy

Recurrent: consider sigmoid resection

2

For abdominanl hernias in patients

Elective

3

What is the most accurate diagnostic test for diverticulitis?

CT abdomen with contrast to look for fat stranding, abscess, or free air

4

What is appropriate treatment in the following cases of diverticulitis?

No peritoneal signs
Abscess
Perforation
Recurrent diverticulitis

No peritoneal signs: OP with antibiotics
Abscess: NPO IVF, antibiotics, CT-guided aspiration
Perforation: emergent surgery
Recurrent: elective surgery

5

What are lab value warning signs of hemorrhagic pancreatitis?

Lower Hct which continues to fall
WBC > 18000
Hypocalcemia

6

How are pseudocysts managed in pancreatitis? Hint, it depends on pain.

Painless: do not drain
Painful: If > 6cm and lasting > 6weeks then drainage. If infected though do a MIS drainage (i.e. percutaneous)

7

What lap value has the highest specificity for pancreatitis? Highest sensitivity?

Specific: Lipase (SPIN)
Sensitive: Amylase (SNOUT)

8

What should be done before appendectomy in acute appendicitis?

Administer antibiotics

9

Is chronic ulcerative coliltis managed surgically?

Generally no, medical management.
Only surgical if severe and refractory cases with complications

10

You suspect acute mesenteric ischemia in a patient and you emergently take them to the operating room. You confirm the dx. What do you do in the OR?

Embolectomy and revascularization with potential resection

11

You suspect acute mesenteric ischemia and take a patient to angio right away. You confirm the dx in the angio suite. What do you do next?

Give vasodilators and thrombolysis

12

What is the first step in the diagnosis of obstructive jaundice caused by gallstones? What can be used to confirm the dx?

Sonogram (ultrasound)

Can confirm with endoscopic ultrasound or MRCP

13

What is treatment of obstructive jaundice due to gallstones?

ERCP and/or cholecystectomy

14

How is biliary colic due to gallstone obstruction of cystic duct managed?

Elective cholecystectomy

15

How is acute cholecystitis managed?

NPO, IVF, NG suction, antibiotics
Elective cholecystectomy 6-12 weeks later

16

When is an emergent cholecystectomy done for acute cholecystitis?

When peritoneal signs or due to generalized peritonitis or emphysematous cholecystitis (i.e. d/t perforation or gangrene)

17

What causes acute ascending cholangitis? How is it managed?

Gallstone obstructing common bile duct leads to ascending infection

NPO, IVF, NG suction, antibiotics
Emergent decompression via ERCP or percutaneous transhepatic cholangiogram (PTC)

Cholecystectomy should follow down the line

18

What is the best initial test for fecal incontinence? What is the most accurate test?

Initial: Anoscopy
Accurate: Anorectal manometry

19

How is fecal incontinence managed?

Combine bulking agents (e.g. fiber) with biofeedback techniques. If doesn't work can consider endoscopic injections of dextranomer/hyaluronic acid as a pseudo-sphincter

20

How long after an MI should you defer surgery?

6 months

21

How long before surgery should smoking be stopped? What FEV1 threshold is a marker of higher surgical risk?

Stop smoking 8 weeks prior
FEV1

22

Describe the "4 W's" mneomic for post-op fevers

Wind: POD1, atelectasis (CXR)
Water: POD3, UTI (UA)
Walking: POD5, DVT (US)
Wound: POD7, wound infection (PE, CT r/o deep infection)

23

Your patient is 16hrs post-op and becomes very disoriented. What should you acquire right away and why?

ABG because if patient hypoxic that is one of the lethal causes in the early post-op period

24

How is a fecal fistula generally managed?

Observation, as long as draining on outside. If draining on inside then it'll probably cause infection and fever

25

How can you confirm esophageal atresia?

Place NG tube and see it get coiled up on CXR

26

How long after birth is congenital diaphragmatic hernia repaired?

3-4 days, usually after hypoplastic lung has had time to mature (you intubate the patients and keep on low-pressure ventilation prior to repair; also NG suction)

27

Distinguish gastroschisis from omphalocele

Gastroschisis does not have a covering

Omphalocele has a covering

28

What trisomies are associated with gastroschisis and omphalocele?

Trisomy 18 (Edward's)
Trsiomy 13 (Patau's)

29

How does the size of the defect affect the operative plan for gastroschisis and omphalocele?

Small defects can be closed primarily

Large defects require a silo to be placed over with a small portion being replaced intra-abdominally each day

30

What presents with double-bubble sign?

Duodenal atresia, BUT ALSO annular pancreas and malrotation

31

When should exstrophy of the bladder be repaired?

First 1-2 days of life. Patient needs to be transferred to a facility which does these

32

What is generally the cause of intestinal atresia?

Vascular accident in utero

33

What is treatment of gas gangrene?

Large doses of IV penicillin and hyperbaric oxygen

34

You suspect a fracture but the original X-ray does not show one. What is your next image of choice?

Repeat X-ray of the joint at 90 degrees to the original

35

A patient presents with facial bruising and injuries after a fight where he was tossed around. What additional imaging do you want to obtain?

Cervical spine radiographs

36

Figure-eight sling is the best choice in the management of which fracture?

Clavicular fractures

37

How should a Colles' fracture be managed?

Closed reduction and casting

38

Diaphyseal fracture of the ulna requires what kind of mgmt?

Open surgical reduction and fixation

39

When a patient presents with pain in the "anatomic snuffbox" what fracture is this indicative of? What should be done for immediate mgmt?

Scaphoid fracture

Place in thumb spica cast to prevent nonunion bc these fractures often don't appear on X-rays right away (may take 3 weeks or more)

40

Femoral neck fractures in the elderly are treated with ...

Femoral head replacement (d/t tenuous blood supply)

41

Intertrochanteric fractures are treated with ...

Open reduction and pinning

42

How are femoral shaft fractures treated?

Intramedullary rod fixation

43

What is the best initial therapy in patients with either trigger finger or DeQuervain tenosynovitis?

Steroid injections

44

What is Dupuytren contracture and how is it managed?

Palm contracture with palmar fascia nodules
Collagenase or surgery

45

A shortened and internally rotated leg may be due to what injury?

Posterior hip dislocation (commonly from a MVC with knees hitting dashboard)

*Emergency reduction is needed to avoid avascular necrosis

46

If only a single ligament is involved then how is an MCL or LCL injury managed? What if multiple are injured?

Single: Casting
Multiple: Surgical

47

How are ACL or PCL injuries managed? How does it differ by age?

Young athletes often need arthroscopic repair
Elderly may be immobilized and require rehab

48

How are meniscal injuries managed?

Arthroscopic repair

49

How are tibial stress injuries managed?

Cast
Don't bear weight
Repeat films in 2 weeks

50

How are achilles tendon ruptures managed?

Casting in the equine position or surgical repair