Flashcards in UW - Surgery Deck (61)
What is acute mediastinitis and how do patients usually present? what is the proper treatment?
-Complication of cardiac surgery from wound complication
-Fever, tachycardic, chest pain, leukocytosis, sternal wound drainage/purulent discharge
Tx: surgical debridement and antibiotics
What is the treatment for a patient presenting with scaphoid fracture (radiolucent line across bone on xray)? when would this treatment change?
Wrist immobilizaiton for 6-10 weeks
Open Red and IF if initial xray shows >2mm fracture displacement
What are common causes of gastric outlet obstruction and how can you ascertain this?
-Malignancy, PUD, crohn's, strictures (w/ pyloric stenosis) 2/2 ingestion of acid or other caustic agents, gastric bezoars
-May hear abdominal succussion splash
-confirm with endoscopy
How long can hemiarthroplasty for femoral neck fractures be delayed, and what me a reason for doing this?
Delay up to 72 hours, if other medical comorbidities (e.g. MI) need to be investigated
What is the cause of atelectasis post-op?
Pain and changes in lung compliance may cause impaired cough and shallow breathing --> limited recruitment of alveoli at lung bases
how can you distinguish tension pneumothorax vs. diaphragmatic hernia from blunt abdominal injury?
TPX - pt would be hypotensive, pulmonary vasculature less prominent on CXR
Hernia - usually left side, resp distress or delayed n/v, NGT in pulmonary cavity on CXR
What is the cause of volkmann's contracture?
compartment syndrome, leading to ischemia and infarction
What are the most common complications of supracondylar fractures of the humerus?
entrapment/injury to brachial artery or median nerve
less likely: cubitus varus deformity and volkmann contracture
When should sodium bicarbonate be used for treating acidosis?
Severe cases, where pH is
What are the two most common causes of syringomyelia?
-Arnold chiari malformation and previous spinal cord injury
What are worrisome signs of ruputured AAA?
acute onset severe back pain, syncope, hypotension,
-possible formation of aortocaval fistula with IVC leading to venous congestion in retroperitoneal structures (e.g. bladder, causing gross hematuria)
What are signs of a retroperitoneal abscess?
Fever, chills, and deep abdominal pain
What is sphincter of Oddi dysfunction and how do you treat?
Elevated sphincter pressure causing post -cholecystectomy pain
Treat with ERCP and sphincterotomy
How can you differentiate the bacteria involved for prosthetic joint infection? What is the management of each?
Early onset infection - 3 months; Coag - staph, propionibacterium, enterococci; remove/replace implant
What abdominal injury/disease can cause referred pain to the shoulder and why?
Peritonitis (as from leaked gastric, bowel, or bladder contents) which will irritate the hemidiaphragm whose phrenic nerve branches refer pain to shoulder
Who are prone to form duodenal hematomas and where do these occur? How do you treat?
-Blunt abdominal trauma to peds
- forms from blood collecting between submucosal and muscular layers of duodenum causing obstruction
-NGT and TPN, will resolve in 1-2 weeks
What is included in the Ddx of anterior mediastinal mass?
The 4 T's : Thymoma, teratoma, thyroid neoplasm, and terrible lymphoma
What is a respiratory quotient and what does this number tell you?
Steady-state ratio of CO2 produced to O2 consumed per unit time
Makes assesments on metabolism in the body, close to 1 = mostly carb diet, 0.8 = mostly proteins, 0.7 = mostly fatty acids
What do patients with medial meniscus tears usually complain of?
Popping sound followed by severe pain at time of injury
What test can confirm medial collateral ligament injury?
valgus stress test
What is an absolute contraindication to surgery?
DKA - sky high glucose
What are major contraindications to surgery?
DKA, poor nutrition (albumin 20% weight loss, transferrin
What is the most optimal way to provide patients with nutrition preop?
Where should O2 be kept for patients with COPD or smokers getting surgery/coming out of anesthesia?
Keep relatively low, because these patients are chronic CO2 retainers and you don't want to suppress respiratory drive
What are the most important risk factors in the Goldman's Index?
1. CHF (biggest predictor of preop mortality) - get EF
2. Recent MI (w/in 6 mo) - get EKG, stress test, CABG
4. Age (>70)
5. Emergent operation
6. Aortic stenosis - LISTEN FOR MURMUR
What is Leriche syndrome?
Chronic ischemia of both LEs causing bilateral claudication of hip thigh and buttocks, impotence and muscle atrophy
What conditions will cause paralytic ileus?
Exaggerated intestinal rxn after abdominal Surgery, retro peritoneal hemorrhage after vertebral fractures,
What are the main priorities in managing patients with rib fractures?
Pain management and respiratory support, to prevent hypo ventilation which would lead to atelectasis and PNA
What should be the next step once perforated peptic ulcer is discovered?
Immediate surgical intervention