Surgical next step Flashcards
(102 cards)
1
Q
dx esophageal cancer
A
- endoscopy with biopsy
- barium swallow/upper GI series
- staging: CXR, CT chest/abd/pelvis, endoscopic US, - bronchoscopy
2
Q
Tx esophageal cancer
A
surgery if early stage
3
Q
dx upper GI bleed
A
EGD
NG lavage
angiography
- type and cross blood if needed
4
Q
tx upper GI bleed
A
- control bleeding (sclerotherapy or embolization)
- resuscitation (NS/LR, pRBC)
- correct any coagulopathies
5
Q
dx lower GI bleed
A
- colonoscopy
- tagged RBC scan
- angiography
- Tc99m scintigraphy
6
Q
dx SBO
A
- KUB (stepladder pattern of dilated small bowel loops and air-fluid levels, absence of colon gas
- CT abd/pelvis
- labs: leukocytosis = strangulation
- ABG: metabolic alkalosis due to vomiting
7
Q
tx SBO
A
MEDICAL: NPO, NG tube decompression, pain mgmt
SURGICAL: ex lap to lysis adhesions, resect necrotic bowel, running the bowel for stricture, tumor, IBD, hernias
8
Q
studies contraindicated in diverticulitis
A
colonoscopy and barium enema (risk of perforation)
9
Q
dx diverticulosis
A
barium enema and/or colonoscopy
10
Q
dx diverticulitis
A
CT is best
AXR (ileus, air-fluid levels, free air if perforated)
11
Q
tx diverticulosis
A
fiber, stool softeners, resuscitation if massive bleeding
12
Q
tx diverticulitis
A
IV fluids, bowel rest, antibiotics
- if emergent, resection of bowel and colostomy
- if elective, resection of bowel and primary anastomosis
13
Q
dx colorectal cancer
A
- fecal occult blood test/digital exam
- sigmoidoscopy/colonoscopy (+/- biopsy)
- barium enema
- CT abd/chest/pelvis for staging
- check for mets: LFT, CT, brain MRI
14
Q
tx rectal lesions (colorectal cancer)
A
abdominoperineal resection
- if near anal verge, remove rectum and anus and provide colostomy
- otherwise primary anastomosis
- adjuvant chemo (no rad)
15
Q
tx colonic lesions (colorectal cancer)
A
- resect lesion c 3-5 cm margins
- resect lymphatic drainage and mesentery at origin of arterial supply
- primary anastomosis of bowel
- adjuvant chemo (no rad)
16
Q
tx porcelain gallbladder
A
cholecystectomy and wedge resection of liver adjacent to GB (highly associated with malignancy)
17
Q
tx acute cholangitis
A
- antibiotics
- bile duct decompression via endoscopic sphincterotomy, percutaneous transhepatic drainage, or operative decompression
18
Q
dx chronic pancreatitis
A
CT is best
- KUB reveals calcifications
- ERCP shows ductal dilation/strictures
19
Q
tx hiatal hernias (both types)
A
1: antacids, small meals, head elevation
2: surgery (inc. risk of incarceration/strangulation)
20
Q
tx acute arterial occlusion
A
immediate anticoagulation, surgical balloon catheter embolectomy, amputation
21
Q
tx prostate cancer
A
- radical prostatectomy (+ seminal vesicles)
- radiation
- androgen ablation (refractory or extraprostatic)
22
Q
tx stage III lung cancer
A
chemo and rad, may be resected if down-staged
23
Q
tx superior sulcus tumors (pancoast)
A
radiation over 6 weeks followed by resection of lung and chest wall
24
Q
tx mesothelioma
A
unresponsive to therapy, most pts dead in 1 year
25
tx persistent pneumothorax
thoracoscopic excision of blebs and pleural abrasion (pleurodesis)
26
tx pharyngeal diverticulum
transection of cricopharyngeal muscle to relax esophageal entrance
27
tx achalasia
distal esophageal dilation
28
tx esophageal cancer
esophagectomy or palliation if severe
29
tx aortic dissection
```
control HTN (beta-blockers, etc.)
surgery if asc. aorta
```
30
tx small, uncomplicated pneumothorax
observation if no other injuries or hemothorax
31
tx tamponade
drain then OR for pericardial window to see if source of bleeding
32
tx abdominal gunshot wound
mandatory ex lap
33
dx hypotension in fractured pelvis
pelvic angiogram (OK because angiography suite has resuscitation capability if pt is unstable)
34
tx increased intracranial pressure
elevate head, hyperventilation to PCO2 26 (if blown pupils), slow administration of mannitol
AVOID MEDS THAT DEPRESS CNS FUNCTION
35
tx base of skull fracture
expectant management, assess C-spine c CT
| NO nasal ET intubation
36
tx epidural hematoma
emergency craniotomy
37
tx subdural hematoma
- ICP monitoring and tx if acute
| - surgical evacuation if chronic (in elderly)
38
dx spinal cord injury
MRI (CT if just for bone)
39
tx flail chest and pulmonary contusion
fluid restriction, diuretics
monitor blood bases for pulmonary dysfunction
posible chest tubes/respirator
40
tx myocardial contusions
tx possible arrhythmias
41
dx aortic rupture
CXR: widened mediastinum
| CTA
42
tx intraabdominal bleeding that responds to fluid resuscitation
surgery not required
43
tx non-expanding pelvic hematoma
monitoring but rule out associated injuries (do rectal exam, urethrogram)
44
tx penetrating urologic injuries
surgical exploration and repair
45
tx blunt trauma to kidneys
CT scan, surgery not usually needed, monitor for renal HTN
46
tx fracture of penis
emergency surgical repair to avoid impotence
47
tx crushing injury to extremity
fluids!, osmotic diuretics, alkalinize urine (to minimize myoglobinemia-myoglobinuria-renal failure)
48
tx inhalation injury
possible respiratory support/intubation
| 100% O2 if high carboxyhemoglobin
49
tx high-voltage burns
- debridement and possible amputation
| - fluid, mannitol, alkalinize urine (same reason as crush injury)
50
tx black widow bite
IV calcium gluconate (antidote)
| muscle relaxants
51
tx brown recluse
dapsone
| maybe surgical excision/grafting
52
tx human bites
irrigation/debridement in OR
53
tx developmental dysplasia of hip
abduction splinting with Pavlik harness for 6 mo
| NO X-RAYS (hip not calcified in newborn)
54
dx and tx slipped capital femoral epiphysis
ortho emergency
dx with x-ray
surgical pinning of femoral head back in place
55
dx septic hip
assertion of hip under general anesthesia
56
dx and tx acute hematogenous osteomyelitis
MRI, abx
57
tx Osgood-Schlatter
RICE
| extension or cylinder cast for 4-6 weeks
58
tx club foot
serial plaster casts starting in neonatal period
maybe Achilles tenotomy
surgery if no response
59
tx fractures involving growth plate
ORIF
60
tx multiple myeloma
chemo or thalidomide
61
tx sarcoma
WLE, rad, chemo
62
tx intertrochanteric fracture
ORIF
63
tx open fracture
OR cleaning and closure within 6 hours
64
imaging for knee injury
MRI
65
tx tib/fib fractures
intramedullary nailing
66
tx Achilles tendon rupture
casting heals in several months
| surgery gives faster healing
67
tx gas gangrene
IV pen
surgical debridement
hyperbaric O2
68
tx lumbar disk herniation
3 weeks bed rest
| nerve block
69
tx cauda equina syndrome
immediate surgical decompression
70
dx lumbar disk herniation
straight leg-raise test
| MRI
71
how to differentiate low urinary output in dehydrated pt vs. renal failure
- renal failure will not respond to fluids c incr. urine output
- urinary Na > 40 in renal failure
72
tx Ogilvie syndrome
neostigmine
73
tx GERD
- laproscopic Nissen fundoplication
| - surgery if refractory to meds, or complications (ulceration, stenosis)
74
tx Mallory-Weiss tear
photocoagulation (laser)
75
dx and tx Boerhaave syndrome
dx: contrast swallow
tx: emergency surgical repair
76
steps for dx active red blood per rectum
1. NG tube and aspiration (if blood = upper GI)
2. colonoscopy not helpful (blood obscures field)
3. exclude hemorrhoids
4. angiogram
5. tagged red-cell study
6. technetium scan if in kids
77
tx generalized acute abdomen
ex lap
78
dx ureteral stones
CT
79
tx diverticulitis
acute: NPO, IV, abx
chronic: surgery
80
tx esophageal atresia
- check for VACTERL
- surgical repair
- gastrostomy to protect lungs from reflux if surgery delayed
81
tx imperforate anus
high rectal pouch: colostomy then repair
- look for fistula
- rule out VACTERL
82
dx malrotation
contrast enema, upper GI study
83
dx/tx meconium ileus
gastrografin enema (both diagnostic and therapeutic)
84
tx biliary atresia
liver transplant
85
dx/tx intussusception
barium or air enema (both diagnostic and therapeutic)
86
tx Bell's palsy
antivirals, steroids
87
tx cavernous sinus thrombosis
IV axb, CT, drainage
88
stroke prophylaxis
CEA, ASA
89
dx and tx ischemic stroke
dx: CT to rule out hemorrhage/infarcts
tx: tPa quickly, rehab
90
tx subarachnoid bleeding from aneurysm
surgical clipping or endovascular coiling
91
dx brain tumor
MRI
92
tx pituitary apoplexy
steroids
93
tx testicular torsion
immediate surgery followed by orchiopexy
| DON'T waste time with tests
94
tx acute urinary retention
alpha-blockers
| 5-alpha-reductase inhibitors
95
tx acute organ rejection
steroids
96
tx wound dehiscence and evisceration
re-operation
| - until then, cover area and mobilize
97
tx hyperkalemia
- hemodialysis
- push K into cells: 50% dextrose and insulin
- suck it out of GI: NGT, exchange resins
- neutralize effects on cellular membrane: IV Ca
98
tx amebic abscess of liver
metronidazole, seldom drainage
99
tx asymptomatic gallstones
nothing
100
tx pancreatic pseudocyst
drainage if > 6 cm (risk of rupture or bleed)
101
dx rotator cuff tear
drop-arm test
102
tx abscess from diverticulitis
if 3 cm drain with CT guidance
