2 Surgery Flashcards
When is surgery indicated for an abdominal aortic aneurysm?
More than 5 cm in size or growth >4 mm/year or if symptomatic
What is the classic triad of ruptured abdominal aortic aneurysm
Abdominal pain, hypotension, pulsatile abdominal mass
What is the name and treatment of the fracture of the fifth metacarpal that occurs after striking an object with a fist?
Boxer fracture; treat with closed reduction and ulnar splint. If skin broken, débride and give amoxicillin/clavulanate (Augmentin), cefuroxime (Ceftin) or doxycycline for human oral pathogens
What is the name and treatment of the fracture of the carpal bone that causes tenderness in the anatomical snuffbox?
Scaphoid fracture. Treatment is thumb Spica cast.
What is the most common fracture of the wrist that results from a fall on an outstretched hand and causes fracture of the distal radius with dorsal displacement of the distal fragment?
Colles’ fracture. Treat with closed reduction and cast.
What is the name and treatment of ulnar diaphyseal fracture and dislocation of the radial head?
Monteggia fracture (?nightstick fracture?). Treatment is closed reduction of the radial head and open reduction, internal fixation of ulna.
What is the name and treatment of radial head subluxation caused by forceful pulling by the hand?
Nursemaid elbow. Treatment is manual reduction by supination at 90 elbow flexion.
What is the name and treatment of the most common shoulder dislocation (95%)?
Anterior shoulder dislocation. Treatment is closed reduction, sling, rehabilitation.
What is the name and treatment of the most common fracture in school–aged children, which may also threaten the brachial artery?
Supracondylar fracture of the humerus. Treatment is closed reduction and pinning.
8 year old boy with involuntary tics, such as eye blinking, coughing, throat clearing, sniffing, and facial movements; coprolalia. What is the diagnosis?
Tourette’s syndrome
What are the signs of basilar skull fracture?
Hemotympanum, clear otorrhea/rhinorrhea, raccoon eyes, Battle sign (mastoid ecchymosis)
Ecchymosis of the lower abdomen from a seatbelt is a sign of what injury?
Small bowel perforation
What is Beck’s triad, which is seen in cardiac tamponade and tension pneumothorax?
Hypotension, jugular venous distension, decreased heart sounds
What are the signs of tension pneumothorax?
Unilateral absence of breath sounds, jugular venous distension, mediastinal shift
Difficulty swallowing liquids which is greater than difficulty with solids suggests what type of disorder?
Oropharyngeal dysphagia
Difficulty swallowing both liquids and solids occurs in what disorder?
Esophageal dysphagia
How does mechanical obstruction affect the ability to swallow solids and liquids?
Difficulty swallowing solids is greater than difficulty swallowing liquids when mechanical obstruction is the cause
How is Zenker’s diverticulum treated?
Myomectomy and excision of diverticulum
What are the causes of esophageal dysphagia?
Achalasia, esophageal stricture, esophageal web, scleroderma, esophageal cancer
What is achalasia?
Ganglionic loss causing inability of the lower esophageal sphincter to relax and loss of peristalsis; ?bird beak? appearance on barium swallow and increased pressure of lower esophageal sphincter.
What is Plummer–Vinson syndrome?
Iron–deficiency anemia, dysphagia, esophageal web, atrophic glossitis
What is Barrett’s esophagus?
Columnar metaplasia of squamous epithelium of distal esophagus, occurring because of acid injury from gastroesophageal reflux disease
What is the complication of Barrett’s esophagus?
Esophageal cancer
Which esophageal cancer is associated with alcohol and tobacco use?
Squamous cell cancer
What is the surgical term for esophageal perforation caused by severe vomiting?
Boerhaave’s syndrome
What are the signs of gastroesophageal reflux disease?
Substernal chest pain, heartburn, regurgitation, which are worse after meals and in the supine position
How is Barrett’s esophagus treated?
Antacids, H2 blockers or proton pump inhibitors; surveillance EGD and biopsies
List the complications of gastroesophageal reflux disease
Ulceration, strictures, Barrett’s esophagus, bleeding, aspiration
What are the common causes of epigastric pain?
Peptic ulcer disease, gastritis, pancreatitis, cholecystitis, coronary ischemia, gastroesophageal reflux disease
What is priapism?
Intractable, painful erection; caused by venous thrombosis, trazodone, sickle cell disease
What is balanitis?
Inflammation of the glans caused by poor hygiene
What is testicular torsion?
Twisting of the vasculature of the testicle; spontaneous or caused by trauma; usually rotates medial; therefore, detorsion is usually accomplished by twisting the testicle laterally.
What is a hydrocele testes?
Collection of fluid in the tunica vaginalis
What is a varicocele?
Palpable, ?bag of worms? dilation of veins of the spermatic cord
What are the complications of cryptorchidism?
5–10 times increased risk of germ cell tumors; atrophy, sterility, and inguinal hernias
What is the treatment for cryptorchidism?
Orchiopexy; will decrease the risk of sterility, but not decrease the risk of malignancy
What is the most common cause of orchitis?
Mumps virus; orchitis occurs 1 week after parotiditis
What organisms are the most likely cause of epididymitis in children?
Gram–negative rods
What is the cause of squamous cell carcinoma of the penis?
Human papilloma virus types 16, 18, 31, and 33
What category of testicular tumors accounts for 95% of all cases?
Germ cell tumors; peak incidence of 15–34 years of age
What is a seminoma of the testes?
Malignant, painless enlargement of testis; most common germ cell tumor, radiosensitive
What grading system is used to stage prostatic carcinoma?
Gleason system
Which prostate disorder commonly affects the peripheral zone?
Prostatic carcinoma
Which prostate disorder commonly affects the central zone?
Nodular hyperplasia
Which prostate disorder causes an increase in total prostate–specific antigen, with a decreased fraction fo free prostate specific antigen?
Prostatic carcinoma
Which prostate disorder causes an increase in total prostate–specific antigen, with a proportionate increase in the fraction of free prostate specific antigen?
Nodular hyperplasia
A patient with prostate cancer and an increased prostatic acid phosphatase is likely to have what complication?
Penetration of the prostate capsule by the prostate cancer
A patient with prostate cancer and an increased alkaline phosphatase is likely to have what complication?
Osteoblastic lesions from bony metastasis of the prostate cancer
What is the primary arterial supply to the gonads?
The testicular or ovarian arteries supply the gonads, which branch from the abdominal aorta
What is the primary venous drainage of the gonads?
The gonads on the left drain to the left testicular/ovarian vein, which drains to the left renal vein. The gonads on the right drain to the right testicular/ovarian vein, which drains into inferior vena cava
What is the lymph drainage of the gonads?
Deep lumbar nodes
What are the contents of the spermatic cord?
Genitofemoral nerve, ductus deferens, ductus deferens artery, pampiniform venous plexus, autonomic nerves (sympathetic and parasympathetic), cremasteric muscle and vessels, testicular artery, lymphatics.
What structures are found in the transverse cervical (cardinal) ligament of the uterus?
Uterine vessels
What structures are found in the suspensory ligament of the ovaries?
Ovarian vessels, lymphatics, autonomic nerves
What structures are found in the broad ligament?
Round ligaments of the uterus, ovarian ligament, ureters, uterine tubes, and uterine vessels
What is the anatomic relationship of the ureter and the uterine artery?
Ureter lies posterior and inferior to uterine artery. ?Water under the bridge?
What is an intestinal intussusception?
Telescoping of the intestines, resulting in intestinal obstruction
What is the most common location for volvulus?
Sigmoid colon; occurs most frequently in middle–aged and elderly men
What section of the colon is most frequently affected by diverticulosis?
Sigmoid colon
What type of neoplastic colonic polyp is the most common?
Tubular adenoma (75%); benign and pedunculated
What type of neoplastic colonic polyp is highly malignant?
Villous adenoma; sessile tumor >4 cm with finger–like projections