12 FEB 2017 1138 SURG

Question 1

how is perforated viscus diagnosed? what is observed?

Answer 1

• upright XR of chest and abdomen

- free air under diaphragm (pneumoperitoneum)

Question 2

when is diagnostic peritoneal lavage performed?

Answer 2

• hemodynamically unstable patients with blunt abdominal trauma
• inconclusive FAST exam

Question 3

what is dumping syndrome? what are the symptoms? what is the cause?

Answer 3

• postgastrectomy complication occurring in up to 50% of patients
• nausea, diarrhea, cramps, palpitations, diaphoresis
• caused by loss of normal action of pyloric sphincter due to injury or surgical bypass, leads to rapid emptying of hypertonic gastric contents into duodenum - fluid shift from intravascular space to small intestine

Question 4

how is dumping syndrome managed?

Answer 4

dietary modification:

• frequent small meals
• avoid simple sugars
• increase fiber and protein
• drink fluids between rather than during meals

Question 5

what is an adverse effect of etomidate?

Answer 5

inhibits 11B-hydroxylase - adrenal insufficiency

Question 6

what is an adverse effect of succinylcholine? why?

Answer 6

cardiac arrhythmia due to hyperkalemia

Question 7

how can NO lead to peripheral neuropathy?

Answer 7

NO inhibits vitamin B12, leading to inhibition of methionine synthase

*occurs in patients with pre-existing B12 deficiency

Question 8

what is Leriche syndrome?

Answer 8

triad of:

• bilateral hip, thigh, buttock claudication
• impotence
• symmetric atrophy of LE

due to chronic ischemia

Question 9

how is gallstone ileus diagnosed?

Answer 9

CT - bowel wall thickening, pneumobilia, obstructing stone

Question 10

what is the main goal of rib fracture management?

Answer 10

maintaining adequate ventilation

also pain management to maintain deep breathing and adequate cough