Arnce DSA

Question 1

Who most commonly get appendicitis?

Answer 1

10-19 yr old age group

Question 2

What imaging do you do for appendicitis in adults and kids?

Answer 2

adults: CT abdomen and pelvis w/ IV and oral contrast
Kids: US of RLQ first, if US negative need CT

Question 3

What can mimic early appendicitis?

Answer 3

GI or viral illnesss

*can have normal CBC or abnormal UA and still have appendicitis

Question 4

Where are physio spaces of narrowing of the esophagus?

Answer 4

upper eso sphincter
level of aortic arch
diaphragmatic hiatus

Question 5

What do you do if someone w/ esophagus food impaction is drooling and can’t swallow liquids?

Answer 5

emergent EGD w/in 6 hrs

most likely complete obstruction

Question 6

When should foreign bodies in the esophagus be removed?

Answer 6

within 24 hrs

Question 7

what happens to most foreign bodies in the stomach?

When would you do emergency EGD?

Answer 7

most pass in 4-6 days
do egd if sharp > 5 cm in length at or above proximal duodenum, magnets, > 2cm in diameter, batteries, or lead-containing

Question 8

What do you do for foreign object distal to ligament of treitz?

Answer 8

expectant management

resume normal diet

Question 9

What types of hernias are most common?

Answer 9

75% are inguinal

2/3 of all inguinal hernias are indirect

Question 10

What are direct and indirect inguinal hernias?

Answer 10

direct: passes directly thru weakness in transversalis fascia thru hesselbach triangle
indirect (most common): thru internal and external inguinal rings thru patent process vaginalis and then to scrotum

Question 11

When is an AAA diagnosed?

Answer 11

when the aortic diameter exceeds 3.0 cm

Question 12

What is the classic triad of a ruptured AAA?

Answer 12

abdominal/ flank pain
hypotension
pulsatile abd mass

Question 13

If someone has hx of AAA and is symptomatic, what do you do?

Answer 13

to OR without imaging

for other suspected AAAs, CT abd/pelvis

Question 14

When do you do conservative management of a AAA?

Answer 14

asymptomatic infrarenal < 5.5 cm

Question 15

What are the most commonly injured solid organs?

Answer 15

spleen and liver

Question 16

What type of injuries occur in an explosive injury?

Answer 16

blunt and penetrating
blast injury to lung and hollow viscus
inhalation

Question 17

What do you do in a primary trauma survey?

Answer 17

ABCDE
airway
Breathing
Circulation w/ hemorrhage control
Disability/neuro status
Exposure/ environmental control - completely undress pt, prevent hypothermia

Question 18

Where do diaphragm injuries occur most often and what do you NOT do to tx them?

Answer 18

most often on left
result from high impact MVC
DONT use trochar when putting in chest tube

Question 19

When do traumatic duodenal injuries often occur?

imaging?

Answer 19

unrestrained drivers frontal impact
bicycle handlebar injury
CT abd/pelvis w/ IV and oral contrast

Question 20

When do pancreatic lacerations occur?

Answer 20

direct blow to the pancreas that compresses it against vertebral column

Question 21

When do you suspect a GU trauma?

Answer 21

gross or microscopic hematuria
direct blows to back or flank
(suspect urethral disruption w/ anterior pelvic injuries)

Question 22

When do hollow viscus injuries occur?

Answer 22

sudden deceleration injuries or chance fracture

*early US and CT are often not diagnostic

Question 23

Why are pelvic fractures so dangerous?

Answer 23

can disrupt pelvic venous plexus/ splanchnic vessels and occasionally the internal iliac A system
ppl used to bleed out and die all the time before interventional radiology

Question 24

Who goes to surgery in an abdominal trauma?

Answer 24

hypotension, + FAST scan, or clinical evidence of bleed

blunt or penitrating injury w/ + DPL (diagnostic peritoneal lavage)

Question 25

What are the 4 parts of a FAST scan?

Answer 25

RUQ - liver and kidney, morrison’s pouch
LUQ - splenorenal pouch
subxyphoid cardiac view
bladder scan (longitudinal and transverse views)