Surgery UWorld Facts Flashcards
(44 cards)
1
Q
management of c-spine trauma
A
- prehospital
- spinal immobilization
- careful helmet removal if present
- airway oxygenation
- ED
- Orotracheal intubation (unless significant facial trauma)
- rapid-sequence intubation for unconscious patients who are breathing but need ventilatory support
- CT c-spine
- monitoring for neurogenic from spinal cord injury
2
Q
Causes of RUQ post-chole pain
A
- common bile duct stones
- RUQ pain + elevation of liver enzymes
- r/o w/US and ERCP
- sphincter of Oddi dysfunction
- RUQ pain + elevation of liver enzymes
- dx of exclusion if US/ERCP does not show stones
- tx = ERCP sphincterotomy
3
Q
Clinical presentation of tension pneumo
A
- Tracheal deviation to opposite side
- hyper-expanded chest w/decreased movement with respiration
- increased percussion
- elevated CVP
4
Q
Management of tension pneumo
A
- emergency needle thoracostomy in the 2nd intercostal space @ mid-clavicular line
- 14-16G IV cannula
5
Q
Ankle-brachial index measurement and use
A
- higher ankle systolic pressure/higher brachial systolic pressure
- <0.90 = abnormal ==> occulsive PAD
- .91 - 1.30 = normal
- >1.30 = suggests calcified and uncompressible vessel; consider other vascular studies
- used in work-up for claudication/presence of peripheral arterial disease
6
Q
Types of pediatric abdominal wall defects + characteristics
A
- umbilical hernia
- defect @ linea alba; covered by skin
- may contain bowel
- umbilical cord inserts @ apex of defect
- gastroschisis
- defect to right of cord insertion; not covered by membrane or skin
- contains bowel
- omphalocele
- midline abd. wall defect; covered by peritoneum
- contains multiple abdominal organs
- cord inserts @ apex of defect
7
Q
Pediatric/newborn umbilical hernia associations/risk factors
A
- african-american
- premature birth
- Ehlers-Danlos
- Beckwith-Wiedemann
- hypothyroidism
8
Q
Common result/management of pediatric umbilical hernia
A
- most close spontaneously (concentric fibrosis and scar tissue formation)
- spontaneously closure less likely in large (>1.5 cm) defect or those w/underlying medical problems
- surgery @ age 5 if not closed
9
Q
SBO cause and presentation
A
- adhesions = most common cause
- congenital vs. abdominal surgery/inflammation
- complete proximal obstruction ==>
- early vomiting, abdominal discomfort, abnormal contrast filling of xray
- mid/distal obstruction ==>
- colicky abdominal pain
- delayed vomiting
- prominent abdominal distension
- hyperactive bowel sounds
- dilated loops of bowel on xray
10
Q
Common cause and consequences of blunt abdominal trauma
A
- MVC ==> BAT
- most common solid organs injured =
- liver
- spleen
11
Q
Aortic dissection presentation + most common risk factor
A
- Chest pain that is sudden, tearing, radiating to back
- Decrescendo diastolic murmur = aortic regurg in dissection of aortic root
- widened mediastinum on xray
- HTN = most common risk factor
12
Q
Causes of aortic dissection
A
- HTN = 75% of cases
- older patient
- Connective tissue disease ==> aortic dissection @ younger patient
- Marfan’s
- Ehlers-Danlos
13
Q
Intermittent bloody nipple discharge w/out masses/lymph nodes ==> dx?
A
- intraductal papilloma = benign breast disease in perimenopausal women
- situated beneath the areola; small size (<2mm) and soft
14
Q
Presentation of compartment syndrome
A
- common features
- pain out of proportion to injury
- increased pain on passive stretch
- rapidly increaseing and tense swelling
- paresthesia
- uncommon features
- decreased sensation
- motor weakness (w/in hours)
- paralysis (late)
- decreased distal pulses (rare)
15
Q
Risks for compartment syndrome
A
- long operative/ischemic time
- limb revascularization
16
Q
Blunt trauma @ upper abdomen ==>
A
- pancreatic trauma
- early abdominal CT may fail to detect pancreatic injury
- presentation = upper abdominal trauma, nothing on CT, return with ~ 1wk later with abdominal pain, poor appetite +/- fever and chills
- injured tissue/pseudocyst from injury can become infection
- tx of pancreastic abscess = placement of percutaneous drain catheter, culture of drained fluid, immeadiate surgical debridement
17
Q
Common traumatic causes of small bowel injury
A
- more likely injured in penetrating (instead of blunt) trauma
- duodenum may be crushed in blunt tauma ==> duodenal hematoma and obstruction
18
Q
DDx for unilateral hip pain in adult
A
- infection
- trauma
- arthritis
- bursitis
- radiculopathy
19
Q
Presentation of trochanteric bursitis
A
- troch bursitis = inflamation of bursa surrounding insertion of gluteus medius onto femur’s greather trochanter
- caused by excessive frictional forces from overuse, trauma, joint crystals, or infection
- hip pain w/applied pressure, external rotation or resisted abductions
20
Q
Paget’s disease of bone characteristics
A
- bone turnover is accelerated in localized areas ==> focal bony hypertrophy
- affected bone is weak and prone to fx
- usually @ elderly pts, 75% asymptomatic
21
Q
Characteristics of aortoiliac peripheral vascular disease
A
- ==> buttok, thigh, hip pain and claudication
- may lead to erectile dysfuction
- pain is exercise-induced, relieved by rest
22
Q
Management of SBO
A
- if hemodynamically stable, w/out signs of strangulation:
- NPO
- NG tube
- pain control
- fluid resuscitation
- if signs of strangulation/hemodynamically unstable or failure of conservative measure
- urgent/emergent surgery
23
Q
Clavicular fx mechanism, presentation, and complications
A
- usually fx @ middle third of bone
- mechanism:
- athletic events
- fall on an outstretched arm vs. direct blow to shoulder
- presentation:
- opposite hand supports arm
- shoulder is posteriorly and inferiorly displaced
- complications:
- injury to subclavian artery
- bruit ==> angiogram
- injury to brachial plexus nerves
- **careful neurovascular exam
- injury to subclavian artery
24
Q
Interventions for lowering ICP
A
- Head elevation ==> increased venous outflow from brain
- Sedation ==> decreased metabolic demand & control of hypertension
- IV mannitol ==> extraction of free water from brain tissue/osmotic diuresis
- hyperventilation ==> CO2 washout ==> cerebral vasoconstriction
- Removal of CSF ==> reduction of CSF volume and pressure
25
Steroid doses ==\> adrenal insufficiency
* daily prednisone \>20mg for \>3weeks can lead to suppression of HPA axis
* Cushingoid features = increased risk for HPA suppression
* Patients w/HPA axis suppression need higher "stress" doses of glucocorticoids in acute stress such as surgery, infection, bleeding, MI
* pt.s on lower doses (\<5mg of prednisone) have no risk of HPA suppresion and do not need stress-dose steroids
26
Presentation of post-traumatic syringomyelia
* 3-4% of spinal cord injuries ==\> post-trauma syringomyelia
* whiplash = common cause
* sx develop months to years later
* CSF retention ==\> impaired strength and pain/temp sensation in upper extremities
* final dx with MRI
27
Causes of post-operative fever
* PO hours 0-2:
* prior trauma/infection
* blood products
* malignant hyperthermia
* POD#1-7:
* Nosocomial infection
* SSI (GAS or clostridium perfringens)
* Noninfectious: MI, PE\< DVT
* POD#7-30:
* SSI (not GAS or C. perfringens)
* Catheter site infection
* C. diff
* Drug fever
* PE/DVT
28
Common complication after gastrectomy procedures
* early dumping syndrome = rapid emptying of hypertonic gastric content into duodenum/small intestine
* ==\> abdominal cramps, weakness, lightheadedness, diaphoresis
29
Management of patients w/suspected spinal cord injury
* decreased sensation +/- decreased strength below a certain level of body bilaterally, e.g. @ legs ==\> suspicion of spinal cord injury
* as long as no obvious trauma to urethra, foley catheter should be placed to avoid bladder distention
30
Tetanus prophylaxis for wounds
* Clean or minor wound
* if \>3 tetanus vaccines: give tetanus vaccine only if last dose was \>10y ago; no TIG
* if unimmunized/unsure/\<3 vaccines: give tetanus vaccine; no TIG
* Dirty or severe wound
* if \>3 tetanus vaccines: give tetanus vaccine only if last dose was \>5y ago; no TIG
* if unimmunized/unsure/\<3 vaccines: give tetanus vaccine AND TIG
31
Dx and management?
* pneumoperitoneum
* exploratory surgery
32
"response to fluids" = ?
SBP \> 100mmHg
33
Pulsatile mass @ groin ==\> dx?
* pulsatile mass below inguinal ligament = femoral artery aneurysm
* ==\> anterior thigh pain
* second most common after popliteal aneurysm
34
Indirect vs. direct inguinal hernia
* indirect can ==\> scrotum
35
Presentation of ischemic bowel
abdominal pain + hematochezia
36
Pulmonary contusion presentation
* pulm cont = brusingo fl ung parenchyma
* may or may not be associated with rib fx
* usually w/in 24h of trauma (may develop within a few minutes):
* tachypnea
* tachycardia
* hypoxia
* chest wall bruising
* decreased breath sounds
* CXR: patchy, irregular alveolar infiltrate and CT scan
* ABG: hypoxemia
37
Pulmonary contusion vs. ARDS
* Pulmonary contusion =
* associated with trauma to lung
* w/in 24h of trauma
* ARDS
* 24-48h after trauma
* bilateral
38
Common presentation of postop cholestasis
* benign condition that develops after major surgery w/hypotension, high blood loss, massive blood replacement
* ==\> jaundice by POD2-3; bilirubin peaks @ 10-40 by POD10; alk phos possibly elevated; AST/ALT normal
* jaundice 2/2 increased pigment load (transfusion), decreased liver fxn (hypotension), decreased renal tubular excretion (ATN)
39
Lab results in Paget Disease of bone
* elevated alk phos
* normal Ca
* normal phos
40
Common presentation & possible consequences of Paget's disease of bone
* bowing or fx of long bones ==\> secondary OA of hip or knee
* skull bone enlargement ==\> frontal bossing, increased head size (hats no longer fit), HA, cranial n. palsy, \*\*hearing loss due to damage to cohlear nerve
41
Tx of penile fx
1. emergent urethrogram
2. emergent surgery to evacuate hematoma and mend torn tunica albuginea
42
Bladder portion covered in peritoneum
* bladder dome = only portion covered by peritoneum ==\> spillage of urine into peritoneum in setting of trauma
* segment most prone to rupture in setting of sudden increase in intravesical pressure
43
Hypoparathyroidism presentation
* low Ca + elevated phosphorous w/normal renal fxn
* causes:
* post-surgical
* parathyroidectomy
* thyroidectomy
* autoimmune destruction
44
