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Flashcards in surgery uworld Deck (63):
1

Characteristics of pain of bursitis

shar, swelling, erythema, pain with active but not passive motion

2

Knee pain associated with repetitive kneeling

prepatellar bursitis

3

patella fracture

welling, tenderness, inability to extend knee; caused by sudden forse like falling from a height

4

Patellar tendinitis

episodic pain and tenderness at the inferior patella and patellar tendon; seein athletes in jumping sports

5

Patellofemoral pain syndrome

most common in women; presents with peripatellar pain wosrse with activity or prolonged sitting

6

Tx of supracondylar fracture

analgesia and immobilization

7

terminal hematuria

suggests bleeding form the prostate, bladder or posterior urethra

8

initial step in workup for bladder cnacer

cystoscpy

9

men with pelvic fractures are at significant risk for

posterior urethral injury

10

First step in patients with suspected urethral injury

retrograde urethrogram

11

Men with straddle injury are at risk for

anterior urethral injury

12

Signs of pelvic fracture, gross hematuria, possibly voiding difficulty; next step

retrograde cystogram to assess for bladder rupture

13

Diffuse axonal injury

traumatic acceleration/deceleration -> diffuse damage of axons presenting in coma with CT findings of small bleeds in the grey-white matter jct

14

uncal hernia

ipsilateral hemiparesis; compression of ipsilateral oculomotor nerve (mydraiasis, ptosis and down and out gaze; compresion of ipsilateral posterior cerebral artery (contra homonymous hemianopsia) altered level of consciousness and coma

15

Cushings triad

hypertension, bradycardia and respiratory depression)

16

Acute popping sensation in knee, catching and locking sensation; how do you dx

MRI looking for meniscal tear

17

short vs long term tx meniscal tear

short term NSAIDS and rest; if >3-4 weeks surgical intervention

18

pain with abduction, external rotation; subacromial tenderness; normal range of motion with positive neer and hawkin signs

rotator cuff impingement or tendiopathy

19

pain with abduction; weakness external rotation age >40

rotator cuff tear

20

anterior shoulder pain; pain with lifting, carrying or overhead reaching, weakness less common

biceps tendinopaty/rupture

21

respirtory distress, neurologic dysfunction and petechial rash

fat embolism

22

recent history of skin infection, fever, abd pain that radiates to groin

psoas abscess

23

abd pain with hip extension

psoas sign

24

tx psoas abscess

drainage and blood and abscess cultures

25

immediate fever post op

prior infection, blood products, malignant hyperthermia

26

post op fever within 1-7 d

sirgical site infection, MI, PE< DVT, nosocomial infection

27

post op fever 1-4 wks

catheter infection, c diff, drug fever, PE/DVT

28

PE findings pneumothorax

hyperresonance over affected side and tracheal deviation to opposite side

29

Signs of tracheobronchial tear

dyspnea, hemoptysis, subcut emphysema,, audible crepitus on cardiac auscultation

30

indications for a urgent laparotomy

free intraperitoneal fluid in abd of a hemodynamically unstable patient

31

indication for contrast andiography

unstable patient with pelvic fracture disrupting pelvic vessels and for patients with hemorrhage d/t spleci or hepatic lacerations

32

signs of myocardial rupture

muffled heart sounds, hypotension and distended neck veins

33

Dx of myocardial rupture

US with emergent surgical repair

34

preferred wat to establish an airway in a cervical spinal injury if there is no significant facial trauma

orotracheal intubation

35

fever, leukocytosis, parotid inflammation

bacterial parotitis most commonly cause bby S aureus

36

best way to prevent bacterial parotitis post op

adequate fluids and oral hygience

37

extra axial well circumscribed or round homogenously enhancing dural based mass on MRI suggest

meningioma

38

tx meningioma

resection

39

indications for an airway

severe inhalation injury (breathing smoke), cervical spine injury

40

indication for fiberoptic bronchoscope securing of airway

subcut emphysema in the neck

41

indication for cricothyroidotomy

intubation cannot be done in usual manner and time becomes an issue

42

clinical signs of shock

low BP (<90), fast feeble pulse, low UO (<0.5 mL/kg/h), pale, cold sweating, thirsty

43

causes of shock in the trauma setting

bleeding (hypovol), pericardial tamponade, tension pneumo

44

trauma with low CVP (empty veins) vs high

low-bleeding-> hypovol
high- tamponade or tension pneumo

45

respiratory distress, no breath sounds on right and hyperresonant to percussion and mediastinum displace to left

right sided pneumo

46

preferred route of fluid resuscitation in trauma

2 16 gauage PIV if not possible femoral vein cath; if under 6 yo intraosseus cannulation of prox tibia

47

management pericardial tamponade

clinical dx (no Xray needed maybe sonogram); pericardiocentesis, tube, pericardial window or open thracotomy; fluid and blood

48

management tension pneumo

clinical dx; needle or cath into pleural space; follow with chest tube to underwater seal

49

non trauma causes of hypovol shock

burns, peritonitis, pancreatitis, massive diarrhea

50

causes of cardiogenic shock

massive MI, fulminating myocarditis

51

tx penetrating head trauma

surgical intervention

52

tx linear skull fractures

closed- leave
open- wound closure
comminuted or depressed- OR

53

Anyone with head trauma who has become unconscious

get a CT to look for intracranial hematoma

54

signs of fracture affecting the base of the skull

raccoon eyes, rhinorrhea, otorrhea

55

head trauma, unconsciousness, lucid interval and gradual relapse into coma, fixed dilated pupils, and contralateral hemiparesis. CT finding

epidural hematoma shows biconvex hematoma

56

tx epidural hematoma

emergency craniotomy

57

ICP monitoring

elevae head, hyperventilate, avoid fluid overload, and give mannitol or furosemide

58

ALS deficits

upper and lower motor neuron with no loss of sensory

59

cervical spondylosis

neck pain and stiffness; spinal stenosis-> neuro defects

60

herniated cervical disc

unilateral radiculopathy

61

risk factors emphysematous cholecystitis

DM, vascular compromise immunosuppression

62

tx emphysematous cholecystitis

cholecystectomy emergently and broad spectrum abx

63

Sodium bicarb in the management of metabolic acidosis

severe with pH <7.1