Flashcards in Surgery Deck (50)
For patients with an obstruction caused by volvulus what procedural management is indicated? What if recurrent episodes?
Recurrent: consider sigmoid resection
For abdominanl hernias in patients
What is the most accurate diagnostic test for diverticulitis?
CT abdomen with contrast to look for fat stranding, abscess, or free air
What is appropriate treatment in the following cases of diverticulitis?
No peritoneal signs
No peritoneal signs: OP with antibiotics
Abscess: NPO IVF, antibiotics, CT-guided aspiration
Perforation: emergent surgery
Recurrent: elective surgery
What are lab value warning signs of hemorrhagic pancreatitis?
Lower Hct which continues to fall
WBC > 18000
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)
What lap value has the highest specificity for pancreatitis? Highest sensitivity?
Specific: Lipase (SPIN)
Sensitive: Amylase (SNOUT)
What should be done before appendectomy in acute appendicitis?
Is chronic ulcerative coliltis managed surgically?
Generally no, medical management.
Only surgical if severe and refractory cases with complications
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
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
What is the first step in the diagnosis of obstructive jaundice caused by gallstones? What can be used to confirm the dx?
Can confirm with endoscopic ultrasound or MRCP
What is treatment of obstructive jaundice due to gallstones?
ERCP and/or cholecystectomy
How is biliary colic due to gallstone obstruction of cystic duct managed?
How is acute cholecystitis managed?
NPO, IVF, NG suction, antibiotics
Elective cholecystectomy 6-12 weeks later
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)
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
What is the best initial test for fecal incontinence? What is the most accurate test?
Accurate: Anorectal manometry
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
How long after an MI should you defer surgery?
How long before surgery should smoking be stopped? What FEV1 threshold is a marker of higher surgical risk?
Stop smoking 8 weeks prior
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)
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
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
How can you confirm esophageal atresia?
Place NG tube and see it get coiled up on CXR
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)
Distinguish gastroschisis from omphalocele
Gastroschisis does not have a covering
Omphalocele has a covering
What trisomies are associated with gastroschisis and omphalocele?
Trisomy 18 (Edward's)
Trsiomy 13 (Patau's)
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
What presents with double-bubble sign?
Duodenal atresia, BUT ALSO annular pancreas and malrotation
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
What is generally the cause of intestinal atresia?
Vascular accident in utero
What is treatment of gas gangrene?
Large doses of IV penicillin and hyperbaric oxygen
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
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
Figure-eight sling is the best choice in the management of which fracture?
How should a Colles' fracture be managed?
Closed reduction and casting
Diaphyseal fracture of the ulna requires what kind of mgmt?
Open surgical reduction and fixation
When a patient presents with pain in the "anatomic snuffbox" what fracture is this indicative of? What should be done for immediate mgmt?
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)
Femoral neck fractures in the elderly are treated with ...
Femoral head replacement (d/t tenuous blood supply)
Intertrochanteric fractures are treated with ...
Open reduction and pinning
How are femoral shaft fractures treated?
Intramedullary rod fixation
What is the best initial therapy in patients with either trigger finger or DeQuervain tenosynovitis?
What is Dupuytren contracture and how is it managed?
Palm contracture with palmar fascia nodules
Collagenase or surgery
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
If only a single ligament is involved then how is an MCL or LCL injury managed? What if multiple are injured?
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
How are meniscal injuries managed?
How are tibial stress injuries managed?
Don't bear weight
Repeat films in 2 weeks