Surgery Flashcards

Question

Dehissence

Answer 1

Not that bad. Failure of the fascia, wound not open but underneath fasciae planes not closed Get a ventral hernia, see serosanguinous drainage that is salmon colored. Diagnose-Clinical Treat-prevent evisceration, use binders , reduce straining, and need to reoperate eventuall to close ventral hernia Don’t need to fix right away

Answer 2

Failure of whole wound. Skin and fascia beneath break down and looks of bowel pop out. Have person stand too early or strain too soon Diagnose clinical Treat surgical emergency yikes and apply warm saline dressings keep everything moist and never ever push it back in ...then get to the OR

Answer 3

``` Foreign body EPithelization Ttumour Irrigation/inflamed/inflammatory bowel (crohn) Distal obstruction ``` FETID Treat-resect fistula may need to do a diversion

Answer 4

Hemolysis and hematomas | Excess unconjugated indirect

Answer 5

Genetic Hepatitis Mixed

Answer 6

Obstruction Gallstones Cancer Strictures Increased conjugated

Answer 7

Dislodged in biliary tree choledectolithiasis Mild dilation and inflammation of biliary tree and gallbladder Expect to see increase temp and WBC and positive Murphy’s sign Acute painful jaundice wiht inflammation Diagnosis-RUQ US, MRCP bc can visualize with out ercp complication Treat ercp or cholecystectomy

Answer 8

No inflammation bc not acute, no temp no WBC and no Murphy sign, no pain Coursvier sign painless jaundice Diagnose-RUQ US, MRCP Treat-endoscopic US with biopsy, ERCP with biopsy may stent or resect dependent on underlying disease

Answer 9

Stricture or cancer Bili20-26 (so single digits in gallstone) Obstructive

Answer 10

Can’t get bilirubin into the stool Cancer by saying in addition weight loss Cancer Obstructive

Answer 11

Obstructive

Answer 12

CT scan if +pancreatic mass its pancreatic cancer look for migratory thrombophlebitis Diagnose pancreatic cancer with EUS with biopsy Treat whipple remove parts of liver, pancreas duodenum

Answer 13

Cholangiocarcinome Diagnose-ERCP and biopsy Treat resection

Answer 14

Ampulla of vater malignancy -FOBT positive and negative colonoscopy Diagnose-ERCP with biopsy can see malignancy Treat resection

Answer 15

Stenting and PSC

Answer 16

Weakened LES, acid reflux retro sterna burn Increased with flat and spices Better sitting up and antiacids Nocturnal asthma, gets up at night wheezing coughing acid comes up while laying on back Diagnosis-no alarm symptoms with lifestyle and PPI Avoid coffe peppermint chocolate and alcohol Alarm symptoms or 4-6 week failure PPI lifestyle...EGD with biopsy N/V, weight loss, anemia to biopsy first If better lifestyle PPI continue treat this way. But Barrett’s metaplasia treat with high dose PPI anytime undergo metaplasia Dysplasia now do ablation Adenocarcinoma-resect Nissen fundoplication-GERD surgery best test before this is 24 hr pH monitoring so want to do this before If Ph low and symptoms consider nissen..but if too tight can creat achlasia

Answer 17

LES wont relax Food gets stuck knot or call of food stuck at GE junction Dysphasia-first fo barium swallow See bird beak But best test is monometry Diagnosis -bird beek but next step is manometry Before treat must do EDG with biopsy to rule out pseudo achlasia to rule out cancer Treat-Botox temporary reserved for bad surgical candidates - dilation but risk perforation if cant take surgery - BEST WAY IS MYOTOMY remove muscle do too much get GERD

Answer 18

Squamous cellhot liquid, smoking

Answer 19

Adenocarcinoma | Related to gerd

Answer 20

Dysphagia to large substances and smaller food and then water progressive dysphagia 1. Barium swallow ass asymmetric fungating mass 2,. Confirm endoscopy with biopsy Always barium swallow first Treat resection

Answer 21

Superficial tear in mucosa in esophagus Self limiting bleed In someone vomiting as weekend warrior, Diagnosis no-but treat like GI bleed, IV PPI call GI, CBC Treat no

Answer 22

Trans mural tear esophageal perforation Career vomiter Bulemia or alcoholism Air in mediastinum not contained crepitus in chest when breath hear and feel it Hammands crunch from air around pericardium Mediastinitis-fever, cough, septic Diagnosis-1. Gastrograffin (bad for lung) swallow 2. If neg do barium swallow 3. If negative do endoscopy. Stop when positive Treat-surgical emergency to OR immediately

Answer 23

Adhesions if had surgery, hernia if not had surgery Pt: positive flatus and bowel movements but then have obstipation with colicky abdominal pain with distant ion Borborygmi->silent bowel sound Gas and fluid proximal to obstruction and abdominal distinction. DiagnoseL upright KUB look for air fluid levels follow that up with CT scan . If contrast material makes to rectum incomplete obstruction if non complete obstruction 1. KUB then CT Treat incomplete-contrast material reach rectum ...conservative NG tube decomression IV fluids if no improvement surgery, if become peritoneal get emergent surgery KUB must be upright look for air fluid levels If complete-surgery

Answer 24

Direct-adult, transversalis, i Guinean Indirect-babies, inguinal ring, intestine in scrotum, inguinal Femoral-female under inguinal ligament Ventral-iatrogenic, failure of fascia to close, post op Present as abdominal bulge-PE figure out what type.

Answer 25

Can push back in pops back out In and out Electively surgery

Answer 26

Can’t reduce SBO Risk strangulation Take care of it urgent surgery

Answer 27

Intestine dies, cuts off blood supply. Peritoneal signs Emergently to surgery

Answer 28

Feaclith Don’t need diagnostic steps bc clinical Periumbilical pain go away and return at McBurney’s point , anorexia, N/V CT scan-not needed for test but board service we like Treat surgery

Answer 29

Neuroendocrine tumor secretes serotonin only seen with Mets to liver to take effect Liver and lung Flushing, wheezing, diarrhea, heart R, fibrosisi Diagnosis 5-HIAA Treat CT scan and resect

Answer 30

Epigastric radiates through back Positiona;, N/V Lipase three times normal limit, amylase Symptoms Imaging CT US dont need it on day 1, but if person getting SICK hypotensive why r third spacing get CT scan bc worried about necrotizing fasciitis, WILL NEED NECROSECTOMY surgery after wait and conceal it dont go in too early ICU, do carbapenem antibiotics if FNA proven infection so need biopsy of necrotic tissue shows bug in order to give antibiotics so do FNA is nec p. OR 5 days to a week looks septic and ongoing fevers and leukocytosis might be abscess, so get CT scan and give antibiotics and tak them to surgery for IND, or early satiety weight loss and abdominal pain get CT scan might have pseudo cyst and size and time (<6 weeks and less 6 cm uncomplicated and watch and wait. If >6 weeks or greater 6 cm complicated high chance infection drainage how drain doesn’t matter. Just drain CT scan good for complications of pancreatitis NPO, Ivf, pain meds Triglyceride panel

Answer 31

Do not operate ! Pain-give pain meds, might need insulin and enzymes do not remove pancreas do not operate

Answer 32

Mixed cholesterol Fat female forty fertile Pigmented-hemolysis Present-colickyy RUQ pain radiates to shoulder worse with fatty foods Figure out if have gallstones Diagnosis-RUQ US see gallstones. Treat-cholecystectomy elective when pt wants -can use URODOXYCHOLIC ACID for old people not good surgical candidate

Answer 33

Gallstone pops out ends up in cystic duct Have some inflammation ..proximal to stone inflamed Gallbladder inflamed Caused by gallstones in cystic duct see pericholecystic fluid, thickened gallbladder wall and gallstones Present: constant RUQ pain with positive Murphy’s sign (if stop breathing bc of pain-arrest of inspiration) Inflammation Mild fever milld leukocytosis Diagnosis-RUQ US look for thickened gallbladder wall and pericholcystic fluid ...if not show what want get HIDA scan looking for perfusion after inject tracer if have will not fill up of gallbladder. Treat-NPO, IV fluids, IV antibiotics and cholecystectomy URGENT have to be done 72-96 hours or will get hard and hard to get out...higher conversion to open and bad outcome Cholecystostomy in non surgical candidate

Answer 34

Can get inflammation liver with increase AST ALT can get inflammation pancreas with increased lipase and amylase and bc liver continues to make bilirubin excreting conjugated so no where to go.....so first get dilation of duct and eventually bilirubin spill back over into blood and cause jaundice Gallstones in common bile duct. May have hepatitis, pancreatitis, WILL HAVE JAUNDICE Painful jaundice May have Murphy sign Have inflammation-mild fever and leukocytosis Diagnosis-RUQ US for obstruction and see dilated ducts wont see an obstructing stone. If US negative get MRCP not HIDA Treat-ERCP NPO give fluids and IV antibiotics, goal is ERCP Can also go straight to cholecystectomy ERCP urgent and then cholecystectomy electively Flu-can see ball valve effect-stone move up and down get better then worse then better then worse

Answer 35

Dilated ducts , gallstones in gallbladder and obstructing stone but have stagnant fluid and bacteria grow which ascends the biliary tree Gallstone in common bile duct with infection usually with gut flora (gram negative rods and anaerobes) RUQ abdominal pain, jaundice, and fever->charcots triad. If also have hypotension and altered mental status Reynolds pentad Diagnosis-RUQ US see dilated ducts like in choledocolithiasis wont see stone but effects, then Treat and diagnose-ERCP EMERGENT Then can do cholecystectomy usually urgently If spot want to jump to ercp but while get ready need IV fluid antibiotics and NPO

Answer 36

Cipro(gram neg) and metro(anaerobes) Ampicillin-gentamicin (gam neg) and metronidazole(anaerobes) WRONG IF PIP/TAZO bc expensive and covers both and covers gram positive like strep so over covering but done in hospital

Answer 37

Asymptomatic screening , postmenopausal man with iron defiency anemia, change in poop, bowel movement, and weight loss. Catch with colonoscopy where see cancer (CT scan to stage and chemo radiation), FAP(thousands of polyps in young give colesectomy), polyp

Answer 38

Good-small pedunculated, tubular Bad-sessile no stalk, large and Villous Look at polyp size a number and decide how soon should come back - few-come back 5 years - premalignant lesion-3 years - a lot or dysplasia-come back every year

Answer 39

Superficial mucosa of colon Patient bloody bowel movements rectal pain and weight loss Get colonoscopy and see continuously inflamed rectum superficial inflammation on biopsy no skip lesions treated medically until 8 years then need colon cancer screening every year and get a prophylactic colectomy . If resect colon they are cured

Answer 40

Not surgical unless fistula Trans mural. Skip lesions can connect to other things Fistula bc fecal soiling Fistula diagnosis-fistula Treat-fistulotomy Better to use meds bc if remove another spot will pop up

Answer 41

Internal -bleed dont hurt External-hurt and itch but dont bleed Diagnosis-visual inspection. Anoscopy in internal hemorrhoids, just peek in through hole Treat-surgical banding internal hemorrhoids and respecting external hemorrhoids. If remove too much can be left with a scar prevents ability to empty the rectum. BUT not gonna start with surgery start with sitz bath and preparation h

Answer 42

Tight sphincter Patient presents pain on delectation lasts for hours, so hold it in and get constipated and tears it even more Diagnosis-see it Treat-lateral internal sphincterotomy, nitroglycerin paste, sitz bath, then move to lateral internal sphincterotomy

Answer 43

HPV=seamen causes squamous cell carcinoma Patient-anoreceptive see especially men who have sex with men and HIV positive. Screen with anal pap. Diagnosis -use chemo and radiation. Usually works, nigro protocol

Answer 44

Abscess hair follicle Congenital disease have to have a hairy butt Diagnose-see Treat-IND then OR to resect the cyst.

Answer 45

Somatic-tissue pain prob with tissue , know where it is can point to it Visceral pain- hijack the nerves above the skin of embryologist origin, referred...no pain receptors so what organs feel is stretch and obstruction Neuropathic-damage to nerve, so thing it inner ages is bad and burning sensation pins and needles, nothing wrong. With the organ

Answer 46

Obstructive0must be holoviscous some sort of peristalsis which comes up on obstruction and passes. Colicky in nature and since only in obstruction no fever and no leukocytosis. Think about diseases like cholelithiasis and nephrolithiasis —no position will be comfortable writhe around Inflammatory pain-pain becomes constant with fever and can be leukocytosis, person writhing around in agony and no comfortable position , organ is inflamed so think about cholecystitis and pyelonehpritis Perforation-sick as shit, constant abdominal pain, motionless, moving will hurt, laying still, get an X RAY show free air have to do upright film think of cancer, penetrating trauma, or peptic ulcer dz Ischemic pain-patient present with pain out of proportion they will be soft and writhing, touch belly soft but bowel is dying and becoming toxic or bloody bowel movement or sepsis think of ischemic injury, ppl with risk factors are CAD, afib and mesenteric ischemia ,

Answer 47

Lung, diaphragm, liver, gallbladder

Answer 48

Lung, diaphragm, spleen,

Answer 49

Kidney, ureter, appendix , ovaries and testes, colon

Answer 50

Diverticulum, kidney, ureter, still have ovaries and testes

Answer 51

Bladder, uterus

Answer 52

Heart, aorta, esophagus, pancreases, stomach,

Answer 53

Constipation, DNA, MI

Answer 54

Compression, diabetic, arterial insuffiency, venous insuffiency, Marjolin ulcer,

Answer 55

Nonbloody erythema

Answer 56

Bone muscle

Answer 57

Pressure points if lay still putting pressure on the skin you’re going to get micro vascular ischemia and tissue die and get an ulcer. Happen to people bed ridden and wheelchair bound, CONSTITUTES AS ABUSE Diagnosis-Clinical Treat-also prevent-roll get out of bed and cushions and air mattress

Answer 58

Microvascular changes and neuropathy DM heels and balls of feet, if touch they dont feel Should do monofilament test Diagnosis-Clinical Treat0control DM, elevate leg, amputation and make sure have good shoes inspect feet loose shoes wont compress

Answer 59

Macro vascular Patient have peripheral vascular disease, look for hairless legs, shiny scaly skin and absent pulses especially in person who smokes a lot ,will get ulcer furthest from vascular supply If see ulcer tips of toes Diagnose-get ankle brachial index followed by US Doppler and angiogram Treat-stent or I pass graft, stent small lesion above knee, bypass large or popliteal

Answer 60

Can’t get blood out Pt have edema (CHF, cirrhosis) Hyperpigmentation can get indurated Medical malleolus-it is venous stasis ulcer Diagnosis-Clinical Treat-compression stockings to hel push fluid up, elevate legs, give diuretics

Answer 61

Squamous cell carcinoma Present-ulcer with sinus tract or one that breaks down and heals over and over Heaped up margins Biopsy Marjolin ulcer and treat with wide resection.

Answer 62

Estrogen-early menarche, late menopause, nulliparity, HRT (dont give it too long), OCP are safe. Radiation-person been treated with radiation for lymphoma leading to increased risk of cancer 3-BRCA1/2

Answer 63

Asymptomatic screen Breast lump Obvious breast cancer(skin dimpling , fixed a ill art nodes, large breast mass).

Answer 64

Don’t do self exams Physician exam NO Mammogram start at 50 and do every 2 years, MRI is best way though it is expensive so only use in people wiht high risk people with BRCA and previous radiaiton

Answer 65

Get mammogram then biopsy with core needle biopsy. ********* FNA and excision always biopsy when know its cancer

Answer 66

<30, just wait 1,2 cycles and goes away with cycle ignore but if come back and still there get US to tell different between mass and cyst <30 and cyst on US get FNA (bloody-cancer, pus-abscess, fluid-benign) <30 cyst and resolves you are done. >30 or had mass or bloody or recurred then go back to mammogram core biopsy

Answer 67

Based on stage Local therapy-procedures radiation, and surgery recast concerving lumpectomy and radiation and auxiliary lymph node dissection (always do sentinel lymph node biopsy before and its negative chances of spreading small not worth doing auxiliary node dissection, positive sentinel do auxiliary lymph node dissection) Systemic therapy-chemo (doxorubicinwith-cause CHF in dose dependent and irreversible way....get repeat echos. cyclophosphamide and paclitaxel)and targeted therapy look for HER2-Neu+ give trastuzimab-also causes CHF but nothing to do with dose and reversible still get echos Her2-Neu negative-bevecizumab ER/PR+ serms tamoxifen and raloxifen if premenopausal, use aroma tase inhibitors if post menopausal.

Answer 68

BRCA1/2 should have prophylactic mastectomy and salpingooopharectomy if not increased screening Tamoxifen-better, cause DVT and endometrial cancer, agonist in uterus Raloxifen-not as good but no risk DVT or cancer , estrogen receptor antagonist

Answer 69

Atresia and/or fistula multiple types Present: gurgling connection food and air hole and bubbling Diagnosis-coil NG tube get x ray and see coiling Treat-surgical repair but consider vacterl

Answer 70

Mild-close Severe-distant Patient present no butt hole Diagnose-Clinical look Need cross table x ray to see severity Treat-surgical mild fix now, if severe give colostomy, and reverse before fixing it before toilet training.

Answer 71

If find any one of them dont just go to surgery first look for ther features TEF , can INTUBATE? Echocardiogram can tolerate surgery or another before pick Look out for diagnostic steps for vacterl before proceed to surgery

Answer 72

Bachdalect posterior Anterolater morgangi Hole in diaphragm and bowel into chest See scaphoid abdomen Bowel sound in chest Diagnosis-x ray Treat-surgery Premature lung even though normal term may need to INTUBATE and give surfactant to expand lung MANAGE HYPOPLASTIC LUNG

Answer 73

Premature Present with bloody bowel movement Diagnosis:x ray and see air in the wall of the intestine -pneumatosis intestinalis -air in the wall of the intestine Treat-immediate bowel rest NPO->TPN bowel is dying not sterile put on IV antibiotics. Some babies can get through without surgery but if fail to improve surgery cut out bad segment Also recognize other diseases of premature infants that can arise Intracranila hemorrhage, bronchopulmonary dysplasia,retinopathy of prematurity.

Answer 74

Sudden onset ab pain, fetal position better knees to chest relieves the pain Sausage shaped mass Currant jelly diarrhea is infarcter bowel -want to intervene before that happens s Diagnosis-x ray Treat-air contrast enema both diagnostic and therapeutic.

Answer 75

No biliary tree worsening bili 2 weeks Diagnose US if neg Phenobarbital and HIDA Treat-surgery

Answer 76

Can’t get air from nose to pharynx Present-unlatch cant feed blue with feeding Pink while crying Hear snoring baby Diagnosis-passing a catheter can do a flexible scope not necessary Treat-surgical removal

Answer 77

1watch endocrine lectures

Answer 78

``` Primary hyperaldosteronism(conn)-HTN and hypoK Diagnosis-aldo/renin ratio>20, if positive follow up with salt suppression test, fail to suppress in Conn to then CT MRI, but want to so adrenal vein sampling Treat-resection ``` RAS-old man with atherosclerosis or young women with fibrovascular dysplasia, Renal artery stenosis decrease volume to kidney s increase renting and aldosterone . Aldo/renin<10. Do US with Doppler , best test is angiogram Treat-young woman should be stunted, old guy medically manage by blocking with ACE-I, ARB, or aldosterone antag like spironolactone

Answer 79

``` Catecholamines cause HTN and tachycardia 5Ps Paroxysms bc pulsation and random Pressure Pain Palpitations Perspire ``` Diagnosis-urinary VMA and metanephrines over 24 hours —then CT or MIBG to identify where it is, renal vein sampling as well Treat-resect but if poke get HTN crisis, have to reduce BP first catecholamines stimulate alpha and beta so stop both. First have alpha blockade then beta blockade then resection.

Answer 80

Cortisol up ACTH driven or not? Present: HTN, diabetic, woman, buffalo hump, striae, moon fancies, acne, Diagnose -low dose dexamethasone suppression test fail to suppress. Late night salivary cortisol or 24 our urine NEED ONE OF THOSE TWO to support....so Cushing need to know if acth or not. So not acth dependent and acth low it is primary adrenal tumor so get imaging (CT/MRI) Cain sampling ,and resect If acth elevated it is acth dependent so is it from pituitary or somewhere else. If pituitary can suppress high dose dexamethasone test CUSHING DISEASE PITUITARY ADENOMA GET MRI AND RESECT . If fails then coming from somewhere else and ectopic tumor usually lung cancer, get CT to identify.

Answer 81

Somewhere after the great vessels Torso HTN so legs hypotension Usually in kids with Claudia toon will refuse to walk bc hurts so stay crawling, arm warm, leg cold. Teenager or early twenties Adult-get collaterals or rib notching Diagnosis-angiogram Treat-resect and reanastomose

Answer 82

Murmurs grade 3 or higher or diastolic murmur investigate with echo Kids diagnose get echo

Answer 83

Path Calcifications Patient-old men with CAD, CP, syncope, CHG Heard intercostal space right eternal border, crescendo. Decrescendo in systole and radiates to carotid Diagnose with echo Treatment-replacement . Can’t do balloon! F/u TAVI/TAVR

Answer 84

Infection, infarction (papillary muscle**(more common or chordae tendinae rupture) Systolic murmur Heard best at cardiac apex Radiates to Avila Holosystolic Diagnose: echo Treatment replacement

Answer 85

Infection, infarction, dissection Acute presentation Or Chronic (insidious) Diastolic, heard best at 4th intercostal space left eternal border. Decrescendo, blowing Diagnosis confirmed by echo Treat-replacement F/u CABG

Answer 86

Path: rheumatic heart disease Heard during diastole at cardiac apex rumbling murmur with opening snap -occur earlier the worse the murmur is. May present with CHF or Afib Diagnose echo Treatment medical therapy, can do balloon valvotomy, replaced.

Answer 87

<10 years and dont need anticoagulation

Answer 88

10-20 years last Need anticoagulation Warfarin INR 2.5-3.5

Answer 89

Obese, HTN, DM female over 55, male over 45 Present: substernal chest pain , worse pain with exercise, improved with nitroglycerin and rest Diagnose-ekg->STEMI to cath emergently EKG normal troponins elevated ->cath urgently If no change get stress test and have symptomatic CAD->left heart cath Treat LIMA tether to most important artery. Every other vessel with saphenous vein graft and bypass other blockages you can find after put on bb, aspirin, ace-I and statin

Answer 90

Stent and clopidogrel

Answer 91

Product of atherosclerosis Male, smoker(d) Asymptomatic pulsating mass. Diagnose-men over 65 who ever smoke get one time screen Or get CT scan for ab pain and happen to identify but US is right. Treat >3.5 screen every year >4.5 cm get rescreened every 6 months >5 cm or growing .5 cm per 6months go to surgery Endovascular repair=open fix *person old smoke but tender pulsation mass and back pain means about to burst take to OR immediately

Answer 92

HTN , mar fans, syphilis 1. Tearing chest pain radiates to the back2. Asymmetric BP arm to arm 3. Widen mediastinum Ascending-A After great vessels-type B descending Diagnosis-CT angiogram looking for false lumen TEE=MRI if cant do CT angiogram Treat A-operate and replace the aortic valve Treat B-treat medically get BP and HR down with IV BB

Answer 93

CAD in a different place. Associated wiht Cholesterol, DM, HTN, smoker, women Present with leg claudication pain distal to obstruction. If butt pain aortic problem Or Non healing wounds If severe have pain at rest or change position)leg pale dangle purple ad blood return) Physical-shiny shins or loss of hair PVD. Problems with pulses and cooler temperatures especially left to right. ``` Diagnose-ankle brachial index .if>1.4 calcified have to. Go to toe brachial index 1-1.4 normal .9-1 equivocal-get exercise ABI .8-.9 mild .4-.8 mod ```

Answer 94

``` Path cholesterol following cath . Embolism-afib. thrombus form on top of PVD no time to get collaterals Pt Pulselessness Pallor Poikilothermia(cold limb) Pain Parasthesias Paralysis ``` Diagnosis-US Doppler angiogram Treat embolectomy or TPA NoteL assess compartment syndrome in anyone refer fused

Answer 95

Path: pressure after dilation Present low light causes pupils to dilate Flow out of chamber decreases Increased pressure=eye pain, HA, rigid eyeball Increased pressure=worsens condition dilated pupil that’s non reactive Diagnose-Clinical measure ocular pressures Treat-constricted pupil Activate alpha block beta and relieve pressure with laser drill hole in eyeball Never give atropine will precipitate acute crisis.

Answer 96

Inflammation around eye region Can they move their eye? If yes its a periorbital cellulitis just need antibiotics get CT scan and if find something treat with I and D, antibiotics. F/u DM/DKA consider mucor=amphotericin B

Answer 97

Path-something getting in the eye Pt hobby/job without goggles Pain, tear, red Treat-irrigate a lot Diagnosis-flarevn dye With or without surgery

Answer 98

Path-trauma=mva or HTN crisis. Floater-mild Curtain-severe Diagnosis-Clinical retina not attached Treat-spot weld with laser If floaters or curtain come and go it is anorasir fugox impending retinal artery occlusion

Answer 99

``` Path-eye stroke. Painless acute loss of vision 1.unilateral painless vision loss No other focal neurologic deficits Cherry red spot in the fovea ``` Diagnosis-Clinical Treat-stroke intra arterial TPA Hyperventilation, global pressure

Answer 100

Age and DM Present chronic, progressive vision loss Night vision White thing in anterior chamber Diagnosis clinical Treat resection

Answer 101

Wet (20%) dry (80%) Pt chronic progressive loss of central vision diagnose wet: blood/fluid Dry drusen and pigment changes Treat wet laser Treat dry nothing

Answer 102

Jobs in sun-navy and ships, outdoor labor, farmer, construction, landscaping Areas that get sun-face and hands, back of shoulders Sun people -people with fair skin and fair hair Bad burns previously Prevent with wide brim hate sun screen and avoidance of the sun

Answer 103

Cancer of basal layer Will not metastasize but locally invade Present-pearly lesion on sun exposed areas. But also described as lesion that fails to heal and bleeds easily. Diagnosis-excision always biopsy (incisional biopsy) Treat-face-mohs, limb-excision always biopsy, limb aggressive-amputate limb

Answer 104

Path-keratinocytes Can metastasis and locally invade Present-well definedred papules or like Marjolin ulcer that heals and breaks down over and over Lower lip hyperpigmentation. Do after squamous cell carcinoma. No paraneoplastic syndrome Diagnose same as BCC Treat BCC

Answer 105

Path-melanocytes Metastasize and can locally invade tiny lesion may kill you ``` Hey black lesion without any hair ABCDE Asymmetric Irregular borders Colors Diameter 5 mm Evolution over time ``` Diagnosis-punch biopsy=large lesions and los suspicion , excisional biopsy when small or high index of suspicion. BRESLOW depth Treat-how deep tumor went 4 mm-chemo and radiation. Already been metastasized and debulking for palliative care.

Answer 106

Aneurysm either leaks or bleed and got HTN generally (sex, exercise causes rupture) Thunderclap headache, may have history of sentinel bleed Neck stiffness to HA, FND, COMA Diagnosis-CT scan of the head if negative can get LP-looking for old blood xanthochronia Bleeding in meninges blood filling cisterns or ventricles Once make diagnosis look at vessels with MR/CT angiogram Treat-early(within 48 hours)-bleeding decrease MAP <140/90 with IV BB CCB then coiling or clipping -hydrocephalus do serial LP or VP shunt. . Late(5-7d)-seizures prophylactic with levetiracetam, increased ICP give hypertonic solutions like mannitol or hypertonic saline, elevate bed, hyperventilate. -vasospasm-CCB if it happens increase BP with vasopressin if fail not for test just for wards

Answer 107

Path-HTN, Present-FND< HA, N/V, coma Diagnosis-CT scan Treat-decrease CIP, craniotomy if need, evacuate hematoma Follow up with daily CT scans looking for expanding hematoma may crosss midline. Midline shift eventually herniate . Uncalled herniation through foramen magnum fixed dilated pupils and dead.

Answer 108

70% metastatic -lung, breast, GI, melanoma See multiple lesions stuck at the grey white junction 30% primary-never metastasize brain cancer doesn’t leave he brain Present-FND, seizure, HA, N/V Diagnosis-neuroimagine, MRI if contrast able yes>CT try to give with contrast Biopsy Best MRI, biopsy Treat-resection, radiation, chemo , steroids(palliative only), seizure prophylaxis for everyone with brain tumor

Answer 109

Asymptomatic pituitary tumor in kids Short stature bc consumes hormone producing centers Calcification of the sella on CT or xray Can resect

Answer 110

Anterior-adults | Posterior-peds

Answer 111

Prolactinoma, acromegaly, craniopharyngioma

Answer 112

Medulloblastoma, ependynoma Both hydrocephalus Meduloblastoma-highly malignantand seeds arachnoid space and spreads can get distal spinal cord lesions Do surgery and radiation with it to get after lesions. Ependymoma-4th ventricle obstructive hydrocephalus predominates look for kid that’s better int he fetal position, not distal lesions so just do resection

Answer 113

Meningioma-product of dura, can diagnose on CT and resection is curative and reverse FND Glioblastoma -in parenchyma, highly necrotic and mitotic can try to resect dismal prognosis of less than a year, ring enhancing lesion or bats wing deformity.

Answer 114

Posterior urethral valve, Hypo/epi spadias

Answer 115

Hematuria(non glomerular)

Answer 116

Ureteropelvic junction obstruction Ectopic ureter-low implantation Vesiculouretreal reflux

Answer 117

Malignancy(wilms) | Hematuria (glomerular)

Answer 118

U/A to see if micro or macro Micro-self limiting unless blunt trauma then do CT scan otherwise watch and wait.. Macro-need more-look at urine micro - dysmorphic cells or RBC cast-glomerular disease so get U/A and kidney biopsy - normal RBC and no casts have nonglomerular causes (in lumen for kidney to urethra, trauma, stones, cancer) first get US then cystoscopy versus systemic imaging like ct or MRI

Answer 119

1st step usually | Hydro or not-usually obstruction, but in kids can also be reflux so differentiate this with VCUG

Answer 120

Put cath in inject dye in dye should go out, but if ends up in ureters sign reflux. So reflux or no. AfterUS can show diverticula too Is hydro from reflux

Answer 121

Usually as last steps to investigate if bleeding/lesion is in lumen or on top of kidney CT-trauma also use IV contrast want to know if leaking. -if think there are stones use non contrast wanna see radioopaque stone and contrast is radiopaque Cystoscopy-intraluminal , access to ureters so can also fix

Answer 122

Baby cant get urine out of bladder from day 1 Redundant tissue causes a post o structure uropathy Present-oligohydramnios during pregnancy, no urinary output and a distended bladder, prenatal US, increased CR Diagnosis-US, show hydro then VCUG to rule out reflux, start catheter and get massive urinary output Treat-catheter

Answer 123

Path- Epi dorsal, hypo ventral Present-Clinical Diagnosis-Clinical Treat-never do a Circumscision!! Need the extra tissue to rebuild the urethra, will need to foreskin to reconstruct

Answer 124

Narrow lumen -normal for must of life but when have increased flow they simulate an obstruction. Present teenager been through life wiht no difficulty first alcohol binge and large diuretics gives colicky abdominal pain that spontaneously resolves Diagnosis US see hydronephrosis without hydroureter VCUG to rule out reflux, Treat-surgery may stent

Answer 125

Normal=bladder Abnormal-ectopic Boys completely asymptomatic Girls normal urinry behavior and have constant leak never have been dry Diagnosis US VCUG Radionucleotide Treat-reimplant

Answer 126

Path-retrograde flow Patient-diagnosed on prenatal US showing hydro Recurrent UTI if not diagnosed prenatal and pyelonephriritis (not good reason to have it in kids so have this) Diagnosis-US hydro VCUG-+ reflux Treat-suppressive antibiotics if not severe and grow out Or surgery

Answer 127

5-DHT Old men over 70 Screen if has family history Think about it when have obstructive symptom of BPH diagnosed on DRE find firm NODULAR prostate*** Diagnosis-if firm NODULAR prostate get PSA if elevated get a biopsy transrectal (usually cancer is posterior so rectal sample best or transurethral Gleesan score? Higher more likely prostate cancer Treat-resection=radiation=brachytherapy and can use anti androgens like flutamide, GNRH analogs like leuprolide, can do bilateral orchioectomy (if very old bc it is testosterone driven F/u with PSA if haverise in PSA but no signs it is biochemical evidence of recurrence and use antiandrogens. If symptoms and increased PSA use radiation and antiandrogens.

Answer 128

Transitional cell carcinoma associated with beta alanine dyes, and smoking. Present with painless hematuria may also see obstructive symptoms if just have hematuria: US, but best is cystoscopy!!!!**** bc look up and take a biopsy. Treat-remove transurethrally andgive intravesicular BCG or chemo Only remove bladder if invasive to muscular or a lot of recurrences(cystectomy)-if do chemo cisplatin based F/u cystoscopy regularly and remove

Answer 129

Germ cell Young male 18-35 Painless mass does not transiluminate (means solid mass not fluid) Diagnosis: US DO NOT DO VIOPSY..orchioectomy Treat-resect And separate into seminoma(cisplatin chemo and radiation) and non seminoma (endodermis sinus tumorAFP, choriocarcinoma bHCG, teratomas (being in women malignant in men) Just remove it do not biopsy

Answer 130

Flank pain, palpable mass, painless hematuria , paraneoplastic of erythrocytosis, anemia Diagnos-CT scan and nephrectomy to diagnose. Treat-resect

Answer 131

Prostate enlarges and closes urinary flow Over 50, lower urinary tract symptoms, DRE smooth rubbery prostate Diagnosis-UA, urinary culture which willl be negative. Treat-alpha blockers tamsulosin most bladder specific least orthostatic hypotension. Add 5-a reductive inhibitors like finasteride undo the BPH part willundo the blockade help down road while tamsulosin helps now If fail TURP-but can causes incontinence or ED F/u obstructive uropathy from BPH have put in catheter before TURP Never biopsy for BPH , dont do a PSA

Answer 132

Psych or organic Inability to acheive or maintain an erection Diagnose-night time tumescence take if breast its psych If not break then cant get erection and its an organic disease Organic treat-phosphodiesterase inhibitors , pumps, prosthesis F/u no nitrates with phsophodiesterase inhibitors

Answer 133

Testicle twists about pedicle Spontaneous pain horizontal lie, pain on elevation Diagnosis-US with Doppler shows no blood flow Treat untwist OR emergency if stay gross after surgery remove it Do bl orchiplexy if one does it other can do it too. If remove one tac down the other

Answer 134

Infection of epididymitis <35 STD, >55 E. coli Spontaneous scrotal pain testical in vertical lie and relief of pain on elevation Diagnosis US with Doppler to r/o torsion Treat-<45 ceftriaxone and azithromycin if >55 use ciprofloxacin (fluoroquionlone)

Answer 135

Bacterial or inflammatory? Must separate bc treatments are different Present old male with pyelo, urgency dysuria, frequency, vomiting but no CVA tenderness or casts in urine and DRE very tender. Treat never repeat the DRE bc increase chance of send to blood stres Diagnose-UA and urine culture Treat antibiotics if bacterial,NSAIDS if inflammatory

Answer 136

Calcium oxalate most common Colicky flank pain radiates to groin often with hematuria Diagnosis-UA, non contrast CT of abdomen ->US look for hydro if pregnant ofcant do CT Treat

Answer 137

Inflammatory disorder compression of median nerve Control sensation and move first three digits Ulnar digits four and five sensation and motor Pain progress to paresthesias->paralysis in first three digits Flexion make symptoms worse phablets sign , tap on median nerve tinsel’s sign worse, the air atrophy Hypothyroid, DM, ppl moving, pregnant Diagnosis-EMG Treat-1. Splinting and NSAIDS,2. Interarticular steroids. 3. Surgery F/u could be presenting symtpom of rheumatoid arthritis

Answer 138

Tear flexor tendon patient cant flex that finger . When make a fist that finger stays up open hand and try to close that finger remains extended Diagnosis clinical Treatment-splinting NSAIDS, steroids, surgery last resort

Answer 139

Catching some sort of ball. Tear extensor tendon . Can’t extend digit person makes fist fine try to open bad finger doesn’t go up. Can I’ve passively Diagnosis clinical Treat standard. 1 splint NSAIDS, steroids, surgery last

Answer 140

Can’t extend digit a stenosis tenosynovitis inflammation compresses the tendon when forced into extension there is a pop. Diagnosis clinical Treat standard splint NSAIDs, steroids, surgery.

Answer 141

Path: tendinitis Thumb pain -pregnant, men lifting weights Diagnosis: fist thumb twist test(thumb inside fist stretches tendon hurts Treat-splinting NSAIDs, steroids, then SURGERY IS NOT AN OPTION BC inflammatory dz

Answer 142

German and Scandinavian men Present: contracture fascia balls up and pulls fingers together, inability to extend and palpable fasciae nodules on palm and hand contracture Diagnosis-clinical Treatment-release surgically fasciae dz NSAIDs dont do anything

Answer 143

Abscess of pulp of the finger. Pain, fever, leukocytosis Usually from penetrating injury Diagnosis-Clinical Treat-IND...rarely may need antibiotics

Answer 144

Two x rays perpendicular to each other Pain, swelling Treat with open reduction internal fixation (open, angular, comminuted) OR casting (hope line up right way have to have closed wound with good approximation) Open-go to OR for emergent wash out

Answer 145

Any trauma Abducted and externally rotated as though shaking hands May have deltoid paresthesias bc of Szilard nerve Diagnosis-Clinical can get x ray Treat-relocate and sling

Answer 146

Massive trauma-MVA, seizures, lightening strike Abducted and internal rotated Diagnose x ray Treat relocate sling

Answer 147

Old lady fall on outstretched wrist common osteoporosis fracture radius and ulna dorsally displaced Diagnose x ray Treat cast or surgery

Answer 148

Upward block downward blow Ulna breaks, radius dislocated Diagnose x ray Treat cast vs surgery

Answer 149

Downward block Upward blow Breaks radius and displaces ulna Diagnose x ray Treat surgery vs cast

Answer 150

FOSH not old lady then pain at an atomic snuff box X ray-normal Cast anyways bc turns positive Don’t want a vascular necrosis

Answer 151

Punch against wall where fourth and 5th digits break

Answer 152

A lot of trauma or old lady wiht osteoporosis Leg shortened and externally rotated want make sure ok pulses below Femoral head had tenuous vascular supply so if have fracture of femoral head will have to do prosthesis Intratrochanteric fracture-use plates Shaft-use rods Open-emergency wash out in OR traction will help Rehabilitation

Answer 153

Locked leg with some sort of force Posterior trauma-ACL injury anterior drawer sign Anterior trauma=PCL injury posterior draw sign Diagnosis-MRI ``` Treat surgery(athletes) Casting (everyone else) ```

Answer 154

Valgus-MCL Varus-LLL Hit from lateral side injur MCL called valves stress and opposite ``` Diagnosis MRIsurgery(athletes) Hinge cast(everyone else) ```

Answer 155

Knee pain and click on extension Diagnosis MRI Treat arthroscopic repair

Answer 156

Weekend warriors or forced march Xray-normal probably Cast anyway with crutches Back in few days x ray positive

Answer 157

Usually both together Trauma-fall from height, pedestrian struck Diagnose-X ray Treat cast or surgery

Answer 158

Over eversion Over inversion Pain and swelling after and is non ambulatory (if can walk dont need x ray) Diagnosis x ray Treat surgery

Answer 159

Run hear pop then they limp reach back gap where tendon should be Diagnosis clinically Treat cast takes months to heal Surgery takes weeks

Answer 160

When reperfuse ischemic injury get edema and if get tense can shut off vascular supply Upon repercussion if get tense painful leg that is hard as rock if elevated compartment pressure do fasciotomy

Surgery Flashcards

(188 cards)