Surgery Rotation 4

Question 1

Treatment of hypernatremia

Answer 1

D5 1/2 NS - for slow development

D5 1/3 NS - for rapid development

Question 2

Treatment of hyponatremia

Answer 2

Water restriction - for slow developing

NS or Ringers lactate - for rapid developing

Question 3

Treatment for hypo and hyperkalemia

Answer 3

Hypo - IV potassium

Hyper - hemodialysis, insulin

Question 4

What is in cryoprecipitate

Answer 4

Used in coagulopathies

Fibrinogen, factor 8 and 13, fibronectin, VWF

Question 5

What does pronator drift test for

Answer 5

o Test:
♣ Patient outstretches the arms with palms up and eyes closed so that only proprioception is used to maintain arm position
♣ UMN lesions cause more weakness in supinator muscles compared to pronator muscles of the upper limb – so affected arm drifts downward and the palm turns (pronates) toward the floor

o Positive in UMN or Pyramidal/Corticospinal tract disease
♣ E.g. Multiple Sclerosis

Question 6

Initial management of patient with unprovoked first seizure

Answer 6

CT without contrast to rule out acute neuro problems (e.g. intracranial or subarachnoid bleed)

MRI is better than CT to identify structural causes of epilepsy in non-emergent situations

Question 7

Treatment of gas gangrene

Answer 7

Penicillin
Debridement
Hyperbaric chamber

Question 8

Review bone breaks and associated nerve/artery damage

Answer 8

Do it!!

Question 9

Artery damaged in posterior dislocation of knee

Answer 9

Popliteal artery

Important because there is very little collateral arteries back there

Must check if there is good blood supply to lower leg

Question 10

Management of carpal tunnel syndrome

Answer 10

Wrist xray
Splint and anti-inflammatories
If it needs surgery - precede by electromyography

Question 11

Management of trigger finger

Answer 11

Steroid injections

Question 12

Management of uncomplicated SBO

Answer 12

Bowen rest, NG tube suction, fluids

Question 13

Signs of complicated SBO

Answer 13

Changes in pain, fever, hemodynamic instability (tachycardia, hypotension), guarding, leukocytosis, metabolic acidosis

Increased risk of ischemia, strangulation, and necrosis

Question 14

Management of complicated SBO

Answer 14

Emergency exploratory laparotomy

Question 15

Management of acute mesenteric ischemia

Answer 15

Angiography of mesenteric vessels

Question 16

Ddx for anterior mediastinal mass

Answer 16

4 Ts

Thymoma, teratoma (and other germ cell tumors), thyroid neoplasm, terrible lymphoma

Question 17

Management of small and uncomplicated pneumothorax

Answer 17

Observation and O2

Question 18

Treatment of large but stable pneumothorax

Answer 18

Needle aspiration or chest tube

Question 19

Management of unstable pneumothorax

Answer 19

Chest tube or urgent needle decompression

Question 20

Management of uncomplicated diverticulitis

Answer 20

Bowel rest, oral abx, observation

Question 21

What is complicated diverticulitis

Answer 21

Diverticulitis associated with Abscess, perforation, obstruction, fistula

Question 22

Management of complicated diverticulitis with abscess

Answer 22

Percutaneous drainage guided by CT for fluid > 3

Surgical drainage if percutaneous drainage fails

Question 23

Most common organ injuries in blunt abd trauma

Answer 23

Hepatic and splenic laceration

Question 24

Major risk factor for pancreatic cancer

Answer 24

Smoking

Question 25

Presentation of pancreatic cancer

Answer 25

Systemic sx (weight loss), abd/back pain, jaundice, migratory thrombophlebitis, recent onset DM

Question 26

Test for MCL injury

Answer 26

Valgus stress test - one hand on medial leg and one on lateral thigh. Push lateral thigh inwards. Laxity indicates MCL injury

Question 27

Test for meniscal tear

Answer 27

McMurray test - passive knee flexion and extension while holding the knee in internal or external rotation. Pain, clicking, or catching indicates meniscal tear

Question 28

Causes of pre-renal AKI

Answer 28

* Decreased renal perfusion: - true volume depletion - decreased EABV (e.g. HF, cirrhosis) - displacement of IV fluid (e.g. sepsis, pancreatitis) - renal artery stenosis - afferent arteriole vasoconstriction (e.g. NSAID)

Question 29

How do you treat pre-renal AKI

Answer 29

Restoration of renal perfusion

Question 30

Management for fx of metatarsal

Answer 30

Middle metatarsals (2, 3, 4) - can usually heal with rest and analgesics 5th metatarsal has increased risk for nonunion - managed with casting or internal fixation

Question 31

Management of peritonsillar abscess

Answer 31

Needle aspiration or incision and drainage + abx

Question 32

Causes of post-op fever

Answer 32

``` Malignant hyperthermia (immediate) Bacteremia Atelectasis Pneumonia UTI (3 days later) DVT (5 days later) Wound infection ``` ``` Remember: 4 Ws for timing Wind - atelectasis Water - UTI Walking - DVT Wound - infection Wonder where - abscess ```

Question 33

What is dumping syndrome

Answer 33

Result of rapid emptying of food into the small bowel Hyperosmolality of food causes rapid fl ruin shifts from plasma into bowel, resulting in hypotension and sympathetic nervous system response Presentation = colicky abd pain, diarrhea, nausea, tachycardia

Question 34

Causes of severe post-op chest pain

Answer 34

MI or PE

Question 35

How soon after surgery will post-op MI occur

Answer 35

1-3 days

Question 36

How soon after surgery will post op PE occur

Answer 36

5-7 days

Question 37

In PE will you see hyper/hypxemia and hyper/hypocapnea

Answer 37

Hypoxia and hypocapnea Vs. respiratory failure which has hypercapnea because pt cannot blow off CO2

Question 38

What is the name of internal hernia after Roux-en-Y with small bowel herniating through mesenteric defect?

Answer 38

Petersen's hernia

Question 39

Contents of inguinal canal

Answer 39

Spermatic cord or round ligament Blood vessels Lymphatic vessels Ilioinguinal nerve

Question 40

Contents of the spermatic cord

Answer 40

``` Ductus deferens Testicular artery Pampiniform plexus Genital branch of genitofemoral nerve Cremasteric muscle ```

Question 41

What is Cooper's ligament?

Answer 41

Aka pectineal ligament Extension of the lacunar ligament that runs on the pectineal line of the pubic bone

Question 42

Boundaries of the femoral canal

Answer 42

1. Cooper's ligament posteriorly 2. Inguinal ligament anteriorly 3. Femoral vein laterally 4. Lacunar ligament medially

Question 43

What does TURP stand for?

Answer 43

Transurethral resection of the prostate

Question 44

What is the referred subscapular pain from gallstones called?

Answer 44

Boas sign

Question 45

What is Charcot's triad

Answer 45

For cholangitis Jaundice, fever, RUQ pain

Question 46

What is the pentad of sx associated with cholangitis

Answer 46

Reynold's pentad jaundice, fever, RUQ pain, hypotension, AMS