Surgery Flashcards
(144 cards)
1
Q
Next step if FAST reveals free intraperitnoeal fluid in abdomen of hemodynamically unstable Pt?
A
Urgent laparotomy
2
Q
Management of hemodynamically unstable Pt with suspected intraabdominal trauma.
A
IV fluid resuscitation and FAST exam. If positive for intraabdominal hemorrhage, then laparotomy. If negative, then stabilize and look for signs of extra-abdominal hemorrhage (i.e. CT scan of abd).
3
Q
FAST acronym?
A
Focused assessment with sonography for trauma.
4
Q
Labs in Gilbert syndrome?
A
Elevated unconjugated bili (UDP glucuronosyltranferase enzeme deficient)
Normal liver ATs, etc.
5
Q
Name MC organisms to infect a new prosthetic joint (knee) under 3 months, 3-12 months, or >12 months after surgery.
A
<3 mo: Staph. Aureus or Pseudomonas
3-12: Coag negative staph (epidermidus) or propionibacterium
>12: Staph. Aureus (often hematogenous spread from distant infxn)
6
Q
A common postop complication resulting from shallow breathing and weak cough due to pain is?
A
Atelectasis. Most commonly shows up 2-3 days posop after abd surgery or thoracoabdominal surgery.
7
Q
Preoperative evaluation of what is required for a patient on long term steroid use (>5mg/day)?
A
Early-morning cortisol level. Study the risk of Addisonian crisis after surgery.
8
Q
Management of blunt abdominal trauma in hemodynamically stable patient?
A
If Alert and talking, do FAST exam. If not go right to CT. If Fast positive or negative gonna end up doing CT anyway.
9
Q
First step in dangerous hemorrhage?
A
2 large bore IVs.
10
Q
Management in suspected variceal hemorrhage in alcoholic?
A
2 large bore IVs. Fluids, IV octreotide, antibiotics (if cirrhotic). Urgent endoscopic therapy for varices.
11
Q
Fever, CP, leukocytosis, and mediastinal widening on chest Xray after cardiac surgery may indicate?
A
Acute mediastinitis. Requires drainage, surgical debridement, and prolonged antibiotic Rx.
12
Q
Epidural hematoma presentation on CT of head?
A
Hyperdense biconvex lesion that does not cross suture lines. Requires emergent hematoma evacuation.
13
Q
How is clavicle fracture managed?
A
Fractures of the middle third of the clavicle, which are the MC type of clavicle Fx, are treated nonoperatively with a brace, rest, and ice. If Fx occurs in the distal third it may require open reduction and niternal fixation to prevent nonunion. Careful neurovascular exam is required also and if damage to vasculature under the clavicle suspected then angiogram required.
14
Q
Management of umbilical hernia vs gastroschisis or omphalocele.
A
Hernia can be monitored for spontaneous resolution by age 5. Immediate surgery for the others.
15
Q
Contusion or rupture of the neck, anterior wall, or anterolateral wall of the bladder are considered what kind of bladder injury?
A
Extraperitoneal bladder injury. Often associated with pelvic Fx. Gross hematuria usually present and urinary retention may occur. Injury does not involve leakage of urine into peritoneal space (vs intraperitoneal bladder injury).
16
Q
Rupture of the dome of the bladder abutting the peritoneum is called what?
A
Intraperitoneal bladder injury. The dome of the bladder is composed of the superior and lateral bladde walls and directly abuts the peritoneal space. This results in intraperitoneal urine leakage and presents with chemical peritonitis.
17
Q
In what case are imaging studies needed in acute appendicitis?
A
Only in nonclassic cases. Otherwise, a classic clinical diagnosis (umbilical pain the moves to RLQ, sharp peritoneual pain, anorexia, NV, mild fever) can be made and laparoscopic surgery performed without need for imaging.
18
Q
What assessment must be made in a patient with penile fracture first, before surgery?
A
Urethral injury 2° to retrograde urethrogram. Evidence of urethral injury (blood at meatus, dysurea, retention), need urethrogram.
19
Q
Duodenal hematoma Rx?
A
Decompression via NG tube and parenteral nutrition for ~1-2 wks. until resolution.
20
Q
Placement of a central venous catheter must be confirmed immediately afterward with what method of imaging?
A
Chest Xray. Observation of tip placement proximal to angle between trachea and right mainstem bronchus confirms proper placement.
21
Q
Name 5 ways to decrease ICP in head trauma Pt.
A
Head elevation Sedation Mannitol Hyperventilation Remove CSF
22
Q
Stress fractures management of metatarsal 2-4 vs 5?
A
2-4: Requires rest and simple analgesia.
5: May require casting or internal fixation due to nonunion risk.
23
Q
What common risk presents after burn injury?
A
Gram+ infxn immediately after injury and gram- infxn more commonly occur after 5 days. A change in wound appearance or loss of graft often indicates infxn of burn wound. Hyperkalemia (EKG required and tele if abnormal) and compartment syndrome also possible (5Ps).
24
Q
Hypocalcemia and hyperphosphatemia in the presence of normal renal fxn indicates?
A
Hypoparathyroidism. Often due to post-surgery, autoimmune or non-autoimmune parayhroid destruction or defective calcium-sensing receptors (pseudohypoparathyroidism).
25
Causes of sphincter of Oddi dysfxn?
Dyskinesia and stenosis are more common. Appears as episodic colicky RUQ pain with AT and alk phos elevations. Opioids exacerbate problems.
26
Typical imaging and evaluation of a patient with blunt genitourinary trauma in stable/unstable Pt.
Focused Gu exam
Urinalysis --> hematuria and stable need contrast-enhanced CT of abd/pelvis to stage renal trauma. If unstable with renal trauma, then IV pyelograph.
27
Pt is post-op for partial distal gastrectomy and has intermittent cramping/diarrhea. Nausea, weakness, palpitations, dizziness, and diaphoresis occur about 25-30 minutes after eating. Dx?
Dumping syndrome. Characterized by GI symptoms and vasomotor symptoms, dumping syndrome is common after gastrectomy in about 50% of cases. Loss of pyloric sphincter results in hypertonic gastric content dumping into duodenum and fluid shift into intestine. This causes autonomic reflexes and intestinal vasoactive polypeptide release. Rx is dietary management including small meals/eating slowly/increase fiber/protein and stop eating sugar. VIP fxn includes "Its role in the intestine is to greatly stimulate secretion of water and electrolytes,[8] as well as relaxation of enteric smooth muscle, dilating peripheral blood vessels, stimulating pancreatic bicarbonate secretion, and inhibiting gastrin-stimulated gastric acid secretion."
28
Petechiae, follicular bleeding, gum bleeding/carries, arthralgias, weakness, impaired wound healing in a patient with poor nutritional risks. Dx?
Scurvy. Vitamin C is needed in healing (necessary for scarring).
29
Definitive Rx of perforated viscus suspicion (intrabdominal air on ray)?
Urgent exploratory lap.
30
MC organisms in necrotizing fasciitis?
```
Strep pyogenes
Staph aureus
C. perfringens
Polymicrobial
Bacteria spread under subQ/deep fascia, undermining skin leading to redness, swelling, edema, and pain out of proportion to exam findings.
```
31
Pt presents with acute-onset abdominal pain that is 9/10 in the midabdomen with few PE findings. She has A.fib. and found to have an elevated lactate. Dx?
Likely acute mesenteric ischemia. Rapid onset abd pain that is out of proportion to exam findings with an Hx of embolic risk (A. fib., IE, etc.) are classic. Metabolic acidosis, leukocytosis, elevated amylase or phosphate are lab findings that may be present.
32
Post operative day 2 with hyperventilation. Dx?
Atelectasis or PE likely. pH will be high, PO2 low, and PCO2 low in both. Atelectasis is ostruction due to retained airway secretions, decreased lung compliance, pain, or meds that interfere with deep breathing.
33
Subacute infxn with fever and lower right abdominal/flank pain. Pain is only present with deep abdominal palpation and extension of the leg with the Pt. in lateral recumbent position elicits pain. High WBCs and elevated platelets are present. Dx?
Psoas abscess. These are all classic signs of PA. Pain sometimes radiates to the groin, differentiating it from appendicitis. Psoas sign in appendicitis is generally rare, unless it is retrocecal. Appendicitis is also usually very acute with only low grade fever.
34
Time period in which C. diff will develop after antibiotics?
4-5 days.
35
Voluminous watery diarrhea at 4-5 POD with abdominal pain and fever. Dx?
C. diff.
36
Aneurysm of an infrarenal aorta and subsequent repair followed by abd. pain, tachycardia, mild distention of abd. Dx?
Ischemia of bowel. Sometimes pain is localized to LLQ, as in inferior mesenteric artery damage. Risk to the bowel is possible in AAA repair.
37
Penetrating trauma at or below the nipples requires what management?
Exploratory laparotomy in unstable patients. The diaphragm can reach up to the 4th IS on the right and 5th IS on the left on expiration and down to the 12th IS on inspiration. Any penetration below the nipples has potential to involve the abdomen.
38
3 components of the Glascow Coma Scale?
```
Eye opening (4 points)
- Spontaneous 4
- Verbal 3
- Pain 2
- None 1
Verbal response (5)
- Oriented
- Confused
- Inappropriate words
- Incomprehensible
- None
Motor response (6)
- Obeys commands
- Localizes
- Withdraws
- Flexion
- Extension
- None
```
39
What is an abdominal succession splash?
Placing the stethescope ober the upper abdomen and rocking the hips back and forth elicits a spalshing sound if gastric material is in the stomach. Retained material >3 hrs after a meal may indicate pyloric stenosis.
40
How are gallstones found incidentally without symptoms managed?
No treatment typically.
41
How are gallstones with typical biliary colic symptoms managed?
Elective lap chole. Could do ursodeoxycholic acid in poor surgical candidate.
42
How are gallstones with symptoms of acute cholecystitis, choledocholithiasis, gallstone pancreatitis managed?
Cholecystectomy within 72 hrs.
AC: US is best initial test. CT can find stones too, but also can find complications of stones. HIDA (hepatoiminodiacetic acid) scan is used if US inconclusive.
Choledocho: Labs show total/direct hyperbilirubinemia and elevated Alkphos. RUQ US usually initial study, though not very sensitive (~50%). ERCP is gold standard and follows US. ERCP is diagnostic and therapeutic.
Pancreatitis: ERCP is indicated if pancreatitis from stone. NPO, fluids, pain control, NG tube, TPN if it doesn't resolve.
43
Acute RUQ pain, tenderness, fever, and leukocytosis. Likely Dx?
Acute cholecystitis. Characterized by inflammation and distention of the GB due to obstruction of the cystic duct by a stone.
44
CT of patient shows round, well-circumscribed, encapsulated fluid collection in upper, mid abdomen. He has abdominal distention, nausea, and vomiting, with an Hx of alcohol use. Dx?
Pancreatic pseudocyst. Can leak amylase-rich fluid into circulation and increase levels. Infxn, duodenal or biliary obstruction, pancreatic ascites, and pleural effusion are possible. This may require drainage, but may require only expectant management if not symptomatic.
45
A post op Pt with pain, and erythema spreading beyond the surgical site and paresthesia at the edges of the wound with cloudy-gray discharge and mild crepitus in the surrounding area. Dx?
Necrotizing surgical site infxn. Requires ABx and debridement.
46
Men with pelvic fracture are at risk of injury to which portion of the urethra?
Posterior portion (prostatic urethra and membranous urethra, which both sit above the bulbomembranous jxn). An abrupt motion of the bladder and prostate can cause tearing of the urethra usually at the bulbomembranous jxn (separation point between the anterior and posterior urethra). Blood at urethral meatus, inability to void, scrotal/perineal hematoma, and high riding prostate on DRE indicate posterior urethral injury. Do Retrograde urethrogram to establish Dx before surgery to look for extravasation of contrast.
47
Blood at the beginning (initial hematuria) of voiding indicates?
Anterior urethral bleeding (urethritis, trauma).
48
Blood at the end of voiding (terminal hematuria) indicates?
Bladder problem (infxn, stone, cancer, BPH, prostate cancer). Eval with cystoscopy.
49
Blood throughout urination indicates?
Renal issue. Mass (benign/malig), glomerulonephritis, stone, PKD, pyelo, cancer, trauma. Needs cystoscopy. Clots usually not seen in renal causes.
50
A patient with chest trauma and signs of acute heart failure and shock requires what imaging modality immediately?
Echocardiogram.
51
Femoral nerve fxn and dermatomal pattern
Leg flexion at hip, extension at knee. Medial lower thigh and lower leg (via saphenous nerve) sensation.
52
Obturator nerve fxn and dermatomal pattern
Adduction of the thigh. Mid-thigh medial skin sensation.
53
Superficial peroneal nerve fxn and dermatomal pattern
Foot eversion. Anterolateral leg and dorsum of lateral foot from big toe.
54
Deep peroneal nerve fxn and dermatomal pattern.
Foot dorsiflexion, toe extension. Sensation on dorsum of foot webbing between big toe and 2nd metatarsal.
55
Appearance of pulmonary contusion on CXR?
Patchy, irregular alveolar infiltrate <24 hrs after chest insult.
56
A burn victim receives skin grafting, but has significant scarring. During Rx he has chronic draining at the wound site. Staff notice an enlarging nodule at the lesion site associated with pain and drainage. Biopsy will reveal?
Squamous cell carcinoma or a Marjolin ulcer (SCC 2° to burns).
57
Man presents with RUQ pain and imaging reveals gas in the gallbladder. Dx?
Emphysematous cholecystitis. Gas forming species (Clostridium, some E. coli) infect the GB resulting.
58
Diverticulitis management in comlicated vs uncomlicated cases?
Complicated: This refers to diverticulitis with abscess formation, perforation, obstrxn, or fistula. If <3cm, then IV ABx and obs. If >3cm then CT-guided percutaneous drainage. May require surgical debridement if not improved.
Uncomplicated: Outpatient bowel rest, oral ABx, observation. Hospitalization and IV ABx for immunocomp, elderly, or high fever/leukocytosis.
59
Management of individual with hemoptysis. Mild or massive?
MIld: Chest Xray, CBC, coag studies, renal fxn, etc. CT scan determines if bronchoscopy is needed for treatment.
Massive: Secure ABCs and place Pt with bleeding lung in dependent position. Follow mild pathway if bleeding stops or if bleeding continues do bronchoscope to stop bleeding.
60
Hypocalcemia results in what ECG changes?
Prolongs QT.
61
Hyperkalemia results in what ECG changes?
Peaks Ts and prolongs QT.
62
Thickening (edema) and air in the wall of the bowel are usually an indicator of?
Bowel ischemia.
63
Referred pain to the shoulder with a patient with abdominal injury may indicate?
Kehr sign. Indicates phrenic nerve irritation secondary to blood/urine/etc. spilling into the abdomen and irritating the lining of the left or right hemidiaphragm.
64
A patient has what he describes as bursts of excrutiating sharp pain into his face along the right cheek and jaw. Dx?
Trigeminal neuralgia with tic douloureux (Fr. painful tic).
65
Most common fracture in pediatric pop?
Supracondylar fractures of the humerus. This area just above the condyle is thin and weak due to remodeling in childhood. It can entrap the brachial artery or median nerve.
66
Classic meniscal tear findings
Small joint effusion, crepitus, locking or catching with ROM.
67
Knee injury presenting with acute hemarthrosis. Likely Dx?
ACL injury.
68
Valgus or varus laxity of knee. Dx?
Medial or lateral collateral ligament tear, respectively.
69
Anterior knee pain and tenderness with normal ligament testing. Dx?
Patellar tendonitis or "jumper's knee".
70
Tibial plateau fracture may not be able to?
Bear weight on the knee at all.
71
Free intraperitoneal air always warrants?
Exploratory lap.
72
What is the female athlete triad?
Low caloric intake
Hypo/amenorrhea
Low bone density (often leading to stress fractures)
73
Stress fracture diagnosis?
Mainly clinical (activity-related pain, swelling, point tenderness on palp), but Xrays are usually normal (especially first few weeks). Periosteal rxn may occur at the fracture later.
74
Achalasia suspicion best test?
Esophageal motility study then barium
75
First line Rx for achalasia?
Surgical Heller myotomy or dilation. Botox if non surgical candidate.
76
Initial management of tension pneumo?
Needle decompression followed by chest tube for definitive management.
77
After splenectomy, patients are more susceptible to what bugs?
```
Salmonella
S. pneumonia
H. influenza
N. meningitidis
All of these encapsulated species are usually eliminated by complement activation and opsonization in the spleen.
```
78
Prior to urgent splenectomy, what preventive measure is recommended?
Pneumococcal vaccine (PCV), meningococcal vax (MCV4), and H. influenza type b vaccine (HiB), especially if not previously vaccinated.
79
Initial testing in testicular torsion?
Doppler US
80
Nausea, vomiting, tender and swollen scrotum with absent cremasteric reflexes on the affected side are classic signs of?
Testicular torsion (spermatic cord torsion).
81
Surgical management of testicular torsion?
Exploration, detorsion, and scrotal orchiopexy. Both testis are fixed in the scrotum to the tunica vaginalis as the defect is usually bilateral. Surgical correction in under 6 hours is associated with 90% gonad survival rate.
82
Billroth reconstruction surgery and Roux-en-Y are for?
Gastric bypass
83
Hartmann operation is for?
Surgical resection of rectosigmoid colon with closure of rectal stump and formation of an end colostomy.
84
Whipple procedure is for?
Pancreaticoduodenectomy is a high risk procedure for pancreatic head neoplasm or periampullary structures (bile duct, ampulla, or duodenum).
85
Nissen fundoplication os for?
GERD. Passes the gastric fundus behind the esophagus to encircle the distal 6cm of esophagus.
86
Surgical management of toxic megacolon secondary to C. diff colitis?
Subtotal colectomy with end-ileostomy.
87
Epidural hematoma results from rupture of what artery?
Middle meningeal artery, a branch of the maxillary artery. May present with lucid interval after blow to temporal bone.
88
Anastamosis formation between two portions of bowel requires connecting what layers together?
Submucosa is most important as it contains the most tensile strength due to high collagen cross linking.
89
In a 40s female, a nontender, firm and fixated mass in the axilla or breast is most likely?
Breast cancer. Firm, fixed, and non-tender are classic cancer findings.
90
Fibroadenoma of the breast presents as?
Well-defined and palpable mass with rubbery texture and is mobile, unlike cancer which is firm, fixed, and nontender.
91
Fibrocystic changes of the breast present as?
Diffuse and tender breast tissue, changing with menstrual cycles.
92
Surgical management of type 1 and type 2 hiatal hernias?
1: Medical management. PPI.
2: Surical management actually needed in types 2-4.
93
Vitamin deficiency that occurs with carcinoid syndrome?
Niacin deficiency. Niacin and serotonin both produced from tryptophan, thus, in carcinoid syndrome pellagra can result (dermatitis, diarrhea, dementia).
94
Blind loop syndrome is a possibility in jejuno-ilial bypass that can lead to what vitamin deficiency?
B12 causing megaloblastic anemia. Think of bypassing the ilium where B12 is absorbed.
95
Amyand hernia management?
Appendectomy with hernia repair.
96
Ventral hernia repair?
Tension free method with mesh.
97
During surgery a women requires packed RBCs, but shortly after receiving them her BP decreases and her pulse increases. Blood is noted in the urine and she begins to ooze from her incisions. She dies of an arrythmia. Dx?
Acute hemolytic transfusion reaction. ABO incompatibility leading to DIC, renal failure and ATN, and shock. DIC may be the only presentation during surgery. Fever and chills may be the only manifestation after surgery.
98
Charcot's triad?
Sign of cholangitis.
| Fever, RUQ pain, jaundice.
99
Reynold's pentad?
Further signs of cholangitis. Charcot's triad (fever, RUQ pain, jaundice) with the addition of two more signs: AMS and shock (reduced BP).
100
Classic labs in cholangitis?
Elevated WBC
Elevated bilirubin in obstructive pattern
Elevated alk phos
+ Blood cultures
Dilated ducts often found on imaging also.
101
ABx for cholangitis?
Metronidazole and ciprofloxacin
| OR Metronidazole, ampicillin, and gentamicin
102
Procedure that utilizes the "bands of Ladd" to reduce a malrotation of the small intestine?
Ladd procedure.
103
Procedure in which the pylorus is incised longitudinally to reduce hypertrophic pyloric stenosis?
Ramstedt pyloromyomectomy.
104
Procedure used to correct malrotation of the sigmoid colon about the mesentary?
Sigmoidopexy.
105
Compartment syndrome presents in a circumferential burn patient and escharotomy is performed, but perfusion does not return. Next step?
Fasciotomy. The fascia underlay the eschar (overlying burned tissue) and may need to be cut to release pressure.
106
When is tetanus immune globulin used after puncture wound?
Only if the Pt has not had 3 tetanus toxoid vaccines in the past or if they are presenting with tetanus Sx.
107
When is tetanus booster required?
If the Pt has not had 3 tetanus toxoid vaccines before and has a puncture wound.
108
1st degree burn skin involvement, appearance, sensation, and healing?
Epidermis only, red on appearance with blanching, sensation intact with some pain, healing in 7 days no scar.
109
Superficial 2nd degree skin involvement, appearance, sensation, and healing?
Epidermis and superficial dermis (dermis has nerve endings). Skin is red with blisters, moist, elastic, blanching wound. Sensation intact largely and exquisitely painful. 1-3 week healing without scarring.
110
Deep 2nd degree skin involvement, appearance, sensation, and healing?
Epidermis and dermis involved with skin appendages destroyed. White with some red areas. Dry, waxy, less elastic and limited blanching. Decreased or less painful than superficial, but not anesthetic. Healing >3 weeks.
111
3rd degree skin involvement, appearance, sensation, and healing?
All epidermis and dermis involved with skin appendages destroyed. White or charred appearance and thrombosed vessels. Dry leathery skin without blanching. Limited sensation with surrounding areas of pain. Poor healing and heavy scarring with contractures.
112
4th degree skin involvement, appearance, sensation, and healing?
Deep burn down to fascia, muscle, bone.
113
HIDA scan produces a positive result for biliary obstruction (choledocholithiasis) if?
If there is absent filling of the intestines after 1 hour, a stone is present in the CBD. HIDA (hepatobiliary) scan causes the liver to secrete radiolucent dye into the bile duct that should, if the duct is clear, secrete through the liver, gallbladder, and CBD into the intestine, and if blocked will not.
114
In the case of a jaundiced patient who is 3 days post cholecystectomy presenting with RUQ pain, fever, abdominal distention, and diffuse tenderness, what is the first step in management?
US. If fluid is present in the GB fossa, aspiration and analysis would be done. If it is bile or enteric contents (poop), immediate laparotomy would be needed. ERCP or MRCP may be done to see where the leak is. If it is blood and stable, then watch/wait.
115
Seroma formation after laparoscopic surgery hernia repair requires?
Non-operative Rx, unless it is symptomatic or lasts >6-8wks.
116
Peutz-Jeghers syndrome is an autosomal dominant disease of the GI tract that results in what?
Many hamatomas in the GI tract (polyps), with mildly elevated cancer risk. They can cause bleeding and there is an intussusception risk (presents as stomach mass and bloody stool or currant jelly).
117
What is primary wound healing (primary intention)?
Suturing a wound closed.
118
What is secondary wound healing (secondary intention)?
Leaving a wound open or packing with damp gauze. Results in healing by wound contraction where myofibroblasts at the edges of the wound exert a centripetal force that draw the edges together.
119
What is tertiary wound healing (tertiary intention)?
Delayed primary closure or delayed suturing of a wound. People with delayed wound healing (diabetes, PAD, immunocomp.) may warrent this depending on wound age or site.
120
Is lobular carcinoma in situ considered cancerous or pre-malignant?
No. It is a marker or a RF that places the Pt at higher risk of cancer within 5-10 years. Tamoxifen should be given to decrease breast cancer risk.
121
What is the best ABx for known MRSA infxn after surgery?
Linezolid. If not available, vanco is probably the best choice.
122
ABx used for moderate to severe uncomplicated skin infxns due to MSSA or S. pyogenes?
Cefepime.
123
What nerve innervates the scrotum?
Genital branch of the genitofemoral nerve (T12-L1) and the ilioinguinal nerve (T12-L1) overlap to provide scrotal innervation.
124
What is the fluid of choice in the trauma patient?
Lactate ringers. The lactate is converted to bicarbonate in the body buffering any acidosis. 0.9% NS can be used also as a resuscitation fluid, but it does not buffer like LR.
125
If a trauma patient has not responded to 2-3 liters of crystalloid fluid (LR or NS), then what should be administered to continue resuscitation?
Colloid solution (albumin, dextran).
126
First line for Crohn's Rx?
5-ASA drugs. Sulfasalazine and mesalamine.
127
If remission is troublesome in Crohn's give?
6-mercaptopurine or azathioprine. Infliximab (anti-TNF alpha) is a last ditch effort.
128
Appendiceal carcinoid management?
>1.5cm --> hemicolectomy
| <1.5cm---> appendectomy
129
Management of symptoms of Schatzki ring?
Esophageal dilation.
130
Management of perianal abscess?
I&D. Usually do not need ABx.
131
Zinc deficiency leads to what Sx?
Hair loss and dermatitis.
132
Ruptured appendicitis requires what course of antibiotics?
Pre-op ABx and post-op ABx until afebrile with normal WBC, usually about 3-5days.
133
Billroth 1 and 2 procedures are indicated for?
PUD or gastric adenocarcinoma. Billroth 1 creates a gastroduodenostomy. Billroth 2 creates a gastrojejunostomy.
134
Contaminated and dirty infected wounds experience the lowest rate of postop infxn when allowed to heal by what method?
Secondary intention. Pack with wet gauze and replace several times a day.
135
A patient with multicentric breast cancer requires what management?
Simple mastectomy with sentinal node biopsy. If nodes are positive, axillary node dissxn performed.
136
Management of Zencker's diverticulum?
Cricopharyngeal myotomy.
137
What is the most effective way to manage acute cholecystitis in a poor surgical candidate?
Insertion of percutaneous cholecystostomy tube.
138
In the case that fecal contamination occurred in the gut while umbilical hernia repair was being done, how should the hernia be repaired?
Tension-free closure without mesh as mesh is contraindicated in fecal contamination.
139
If small bowel obstruction is suspected, what is the first imaging needed?
Abdominal Xray series. Upright chest radiogram (pneumoperitoneum), upright abdomen (air-fluid levels), supine abdomen (bowel dilation). Only if inconclusive clinically and via Xray are CT without contrast needed for SBO.
140
After clinical suspicion is established, what imaging is needed on meniscal tear?
Xray to rule out fracture, then MRI.
141
Treatment for Hemophilia A?
Factor VIII concentrate and DDAVP (desmopressin).
142
As a general rule in trauma, stable and unstable patients can be managed differently how?
Stable can get imaging before surgery. Unstable require exploratory surgery.
143
Second generation cephalosporins are unlike the other generations in that they have?
Anaerobic coverage. Cefotetan and cefoxitin are indicated as single-drug Rx for gram-negative and anaerobic coverage.
144
What medication is used to treat malignant hyperthermia?
Dantrolene. Due to hyperkalemia (from rhabdo), hypercalcemia, lactic acidosis, and myoglobinemia, the management of hyperkalemia and cooling of the patient are critical aspects.
