Casebased Surgery Flashcards
What should you think if persistent ab pain, fever, nausea beyond a few days after lap cholecystectomy?
think bile duct injury or leak
do CT to look for fluids
What is first step in working up pancreatic leak?
test drained fluid for amylase
if high –> make pt NPO
How do you dx ischemic colitits after AAA? presentation?
present: LLQ pain, fever, diarrhea, bloody stool
dx: flexible sigmoidoscopy
What is surgical tx of internal hemorrhoids?
lateral internal sphincterotomy
What is tx for sigmoid volvulus?
if uncomplicated –> decompression w/ colonoscopy / rectal tube
complicated (fever, tachycardia, hypotension, peritonitis, WBCs) –> ex lap w/ sigmoid resection and prox colostomy
How do you dx pheo? in pregnancy?
dx w/ contrast CT
in pregnancy w/ MRI
WHat is presentation of osteosarcoma?
local pain, worse at night, metaphysis of long bones, distal femur, sunburst pattern
What is presentation of ewing?
onion peal, periosteal reaction
What should you think if pain on leg palpation w/ edema of surrounding skin after change in activity or long period of standing?
tibial stress fracture
What is work up for pts w/ clavicle fracture?
do neurovascular exam on everyone
do CTA if thrill or bruit, fracture of 1st rib, mediastinal widening, or diminished pulse
What are two markers of instrinsic AKI?
FeNa > 1%
urine Na > 40
What is tx of brain abscess?
open drainage and empiric abx
What is presentation of plummer vinson?
dysphagia, esophageal webs, iron deficiency anemia
What is tx for blunt carotid injury?
anticoagulation (heparin)
What is presentation of neurogenic shock?
hypotension w/ inappropriately normal HR, decreased SVR, normal/high CO, sympathetic blockade
