100 surgical vignettes - surgical recall Flashcards
elderly female, SBO, and air in biliary tract
gallstone ileus
elderly female with pain down inner aspect of thigh
obturator hernia (Howship-Romberg sign)
abdominal pain, hypotension, and abdominal pulsatile mass
ruptured AAA
abdominal pain “ out of proportion’ to abdominal exam
mesenteric ischemia
arm pain and syncope with arm movement
subclavian steal syndrome
increasing creatinine on ACEi
Renal artery stenosis
child with MIDLINE neck mass
thyroglossal duct cyst
child with LATERAL neck mass
Branchial cleft cyst
crush injury and dark urine
myoglobinuria
emesis, chest pain radiating to back, and mediastinal air
Boerhaave’s
Lower GI bleed + technectium pertechnetate scan
Meckel’s diverticulum
Flushing, diarrhea, and right-sided heart failure
carcinoid
pneumaturia and LLQ pain
colovesical fistula
Desmoid tumor, osteoma, and colon cancer
Gardner’s syndrome
Epigastric pain radiating to back and flank ecchymosis
Hemorrhagic pancreatitis
pancreatitis and palpable epigastric mass
pancreatic pseudocyst
Liver abscess with “anchovy paste’
Amebic abscess
RUQ pain, travel, and exposure to sheep
Hydatid cyst
Caput medusae
portal HTN, cirrhosis
45yo F with RUQ pain for 12 hrs, fever and leukocytosis
acute cholecystitis
elderly male with large nontender palpable gallbladder
pancreatic cancer (Courvoisier’s sign)
Female taking birth control pills with liver mass
hepatic adenoma
liver tumor with “central scar”
focal nodular hyperplasia
pancreatic mass, gallstones, DM, diarrhea
somatostatinoma
RUQ bruit and CHF in young adult
liver hemangioma
excruciating pain with bowel movement
anal fissue
abdominal pain, diarrhea, and anal fistulae
Crohn’s disease
EKG with “peaked” T waves
Hyperkalemia
Buccal Mucosa with pigmentation
Peutz- Jeghers syndrome
LLQ pain, fever, and change in bowel habits
diverticulitis
elevated urine 5-HIAA
carcinoid
institutionalized, abdominal pain, vomiting, and distention, with proximal colonic dilation
sigmoid volvulus
Infant with projectile vomiting
pyloric stenosis
newborn with failure to pass meconium in first 24 hours
Hirschsprung’s disease
infant with bilious vomiting
malrotation
Newborn with abdominal defect and umbilical cord on sac
omphalocele
teenager with knee pain and ‘onion skinning’ on x-ray
Ewing’s sarcoma
pulmonary capillary wedge pressure <18, CXR with B/L pulmonary infiltrates and PaO2: FiO2 ratio <300
ARDS
Increased peak airway pressure, low urine output, and urinary bladder>25mmHg
abdominal compartment syndrome
Newborn with inability to “pass an NGT”
esophageal atresia
Traumatic blinding in one eye followed bby blindness in the contralateral eye 2 weeks later
Sympathetic ophthalmia
miotic pupil, ptosis, and anhidrosis
Horner’s syndrome
Traumatic head injury, conscious in ER followed by unconsciousness, tearing of middle meningeal artery/branches, does not cross suture lines
Epidural hematoma (lucid interval)
“worst headache of my life”
subarachnoid hemorrhage
head trauma, crescent like CT scan, tearing of bridging veins, crosses the suture lines
subdural hematoma
hematuria, flank pain, and abdominal mass (palpable)
renal cell carcinoma
60 yo white male with painless hematuria
bladder cancer
RUQ pain, jaundice and fever
cholangitis
epigastric pain radiating to back with N/V
pancreatitis
“tearing” chest pain radiating to back
aortic dissection
40 yo male with tachycardia/HTN and confusion on postoperative day #2
alcohol withdrawal
pheochromocytomas, medullary thyroid cancer, Marfanoid body habitus, mucosal neuromas
MEN 2B
psammoma bodies
papillary thyroid cancer, papillary serous sporadic cystadenocarcinoma of the ovary, mesothelioma, meningioma
yellow sulfur granules, orofacial abscesses, abdominal abscess, possibly PID in women with IUD
Actinomyces
Thyroid tumor with AMYLOID tissue
medullary thyroid cancer
palpable neck tumor and hypercalcemia
parathyroid cancer
HTN, diaphoresis (episodic) and palpitations
pheochromocytoma
HTN, elevated liver enzymes, low-platelets, preeclampsia
HELLP syndrome
jejunal ulcers
Zollinger-Ellison syndrome
pituitary tumor, pancreatic tumor (gastrinoma), and parathyroid tumor
MEN-1
necrotizing migratory erythema
Glucagonoma
medullary thyroid cancer, pheochromocytoma and hyperparathyroidism
MEN-2A
hypoklaemia refractory to IV potassium supplementation
Hypomagnesemia
Necrotizing enterocolitis (NEC)
newborn with pneumatosis
child with abdominal mass that CROSSES midline
Neuroblastoma
Child <4 yo with abdominal tumor that does NOT cross midline
Wilm’s tumor
“currant jelly” stools and abdominal colic
intussusception
femur (long-bone) fracture, respiratory failure, petechiae, and mental status changes
fat embolism
hearing loss, tinnitus, and vertigo
Meniere’s disease
adolescent boy with nasal obstruction and recurrent epistaxis
juvenile nasopharyngeal angiofibroma
child <5 yo sitting upright and drooling with “hot potato” voice, no HIB vax
epiglottitis
angina, syncope, and CHF
aortic stenosis
tobacco use, asbestos exposure, and pleuritic chest pain
mesothelioma
supracondylar fracture and contracture of forearm flexors
Volkmann’s contracture
tibia fracture, “pain out of proportion’, pain on passive foot movement, and palpable pulses
compartment syndrome
25 yo male with liver mass with fibrous septae and no history of cirrhosis or hepatitis
fibrolamellar hepatocellular carcinoma
EKG with flattening of T waves and U waves
hypokalemia
Central pontine myelinolysis
too-rapid correction of hyponatremia
polydipsia, polyuria, and constipation
Hypercalcemia
Factor VIII deficiency
Hemophilia A
Abdominal pain, fever, hypotension, HYPERkalemia, and HYPOnatremia
adrenal insufficiency (Addisonian crisis)
massive urine output and HYPERnatremia
Diabetes insipidus
increased urine osmolality, HYPOnatremia, and low serum osmolality
SIADH
IV antibiotics, fever, diarrhea
C.diff pseudomembranous colitis
bleeding gums and wound dehiscence
central line infection
appendectomy followed by fever and abdominal pain on postoperative day #7
peritoneal abscess
advancing crepitus, fever, and blood blisters
necrotizing fasciitis
high Intraoperative fever
malignant hyperthermia
confusion, ataxia, and ophthalmoplegia
Wernicke’s encephalopathy
tracheal deviation, decreased breath sounds and hyperresonance
Tension pneumothorax
Hypotension, decreased heart sounds, and JVD
pericardial tamponade
Four ribs broken in two places and pulmonary contusion
flail chest
Otorrhea (clear) and Battle’s sign
Basilar skull fracture
Ulcer and decreased pain with food
Duodenal ulcer
vomiting, retching, and epigastric pain
mallory-weiss tear
Fever on post-operative day #1, with “bronze” weeping, tender wound
clostridial wound
hematochezia and tenesmus
rectal cancer
upper GI bleed, jaundice, and RUQ pain
hemobilia
gallstones, epigastric pain radiating to back, and nausea
gallstone pancreatitis
18 yo F with blood nipple discharge
ductal papilloma
irritability, diaphoresis, weakness, tremulousness, and palpitations
Insulinoma