AMBOSS - Surgery Flashcards
Big mechanism of injury with mediastinal widening
Aortic injury
Hemothorax treatment?
Chest tube
Pneumobilia and s/sx of mechanical obstruction?
Cholecystoenteric fistula -> gallstone illeus
Mechanical SBO without clear cause on imaging?
Ogilvie syndrome
Tx = neostigmine
Blind loop syndrome
SIBO preventing absorption
H/o GI anatomy alteration (bypass etc) with s/sx malabsorption
Treatment for anal fissure
Sitz bath (reduce sphincter tone, increase blood flow) Nifidipine (increased blood flow for healing)
First line tx for internal hemorroids
Docusate (to soften stool)
Topical/suppository lido if painful
If fails -> rubber band, infrared coag, sclerotherapy
Glutamate dehydrogenase antigen tests for what?
C diff colitis
Also can do EIA for A/B tox, PCR, culture
Hamman’s sign
Crunch with heartbeat (d/t mediastinal emphysema)
Causes of postop hemorrhage
<24 hrs: Mechanical (slipped ligature, cessation of vasospasm) vs. hemostatic (undx’d coag dz)
<1 week: massive transfusion (dilution coag) vs. consumption coag
>1 week: surgical site infection, erosion of blood vessels
Diagnosing Boerhaave syndrome
Initial: CXR
Confirm: Gastrografin swallow
Unstable/uncooperative: CT
PBC marker and tx
AMA + (and ANA +)
1st line: Urodeoxycholic acid
Transplant if cirrhosis
Treat itching
Treatment of pancreatic head vs. body/tail carcinoma?
Whipple (pancreaticoduodenectomy)
Left sided resection with splenectomy
Double bubble on XR?
Duodenal atresia
H/o chron’s dz presenting with SBO. Tx?
Bowel sparing resection (strictureplasty) d/t likely postop formation of adhesions
Initial test for ZE (after ruling out h. pylori)
Fasting serum gastrin level
Dx of suspected pyloric stenosis
Ultrasound showing elongated and thickened pylorus
Target sign on transverse view
Lab findings in pyloric stenosis
Hypokalemic, hypochloridic metabolic alkalosis
Dx steps of achalasia?
Barium swallow
Manometry
NEED EGD with bx to rule out cancer (pseudo-achalasia)
Child with abd pain and concentric rings of bowel on US?
Intussusception (commonly caused by Meckle’s)
Carpal tunnel syndrome management
Mild/mod: 1st line = volar splint or GC injection
Severe or refractory = decompression
S/Sx of severe = thenar atrophy
Cushing triad
Hypertension, bradycardia, irregular respiration
Increased ICP -> Decreased brain perfusion -> increased sympathetic tone and HTN
Intermetatarsal neuroma (aka Morton’s neuroma)
Pain and burning in downstream digits
Often in pt who wears narrow/high-heeled footwear
Mulder’s sign
Pop or click + pain in patient with intermetatarsal neuroma
Who gets SCFE?
Obese males, 10-16 years old
PE: Flexed, ext rot hip (foot pointing at other)
XR: sclerotic epiphysis, joint widening (or nml early)
Surgical emergency, pinning
Legg-Calves-Perthes disease
Avascular necrosis of femoral head, idiopathic
Usually around 6 years old
Dx of developmental dysplasia of the hip
US NOT XR
Hip is not yet calcified
alpha angle <60
DDH treatment
Pavic harness (rigid harness)
Risk factors for DDH
Female
Breech presentation
Severe disk herniation symtoms
Urinary retention
Saddle anesthesia
Bilateral sx’s
Lidocaine injection test
Used in impingement
Dx and Tx
When is CRPP an option?
Generally with hand or distal radius fractures
Study of choice for suspected posterior shoulder dislocation?
Axillary radiograph
PE for posterior dislocation
Anterior flattening
Coracoid prominence
What kind of fluid do you give burn patients?
Crystalloid
Elbow fx vs. radial head sublux in a kiddo?
Inflammation vs. no-inflammation
Osteosarc vs. Ewings
Ewing = kiddos, onion skin, diaphysis Osteosarc = teens, sunburst, metaphysis
Palmar fibromatosis
Overproliferation of fibroblasts
Limit extension
Breast CA treatment in pregnancy
Always resect
Chemo after 1st tri
NO Rads
PDA treatment
Indomethacin (kill dem prostaglandins)
Cutoff for US vs. mammo in breast CA?
30 years old
Dx and tx for meconium ileus?
Gastrogaffin for both! Dx and osmotic pull
Different treatment for types of male germ cell tumors?
NSGCT = Bleomycin, etoposide, cisplatin (increased AFP, ßhcg) SGCT = Rads
