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DIT Level 3 > Clinical questions - Surgery > Flashcards

Clinical questions - Surgery Flashcards

1
Q

Small bowel obstruction

A

abdominal distention
hyperactive, high pitched bowel sounds
air fluid levels on abd XR

MC cause - adhesions

Tx:
Initially: NPO, NGT + intermittent suction, IVF
If develop peritoneal signs -> laparotomy

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2
Q

Epidural hematoma

A

Head injury with LOC then lucid interval

CT head: lens-shaped (biconvex) hematoma with midline deviation

Tx:
EMERGENT CRANIOTOMY

Fatal within hours if untreated

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3
Q

Indications for emergent cholecystectomy

A

generalized peritonitis

emphysematous cholecystitis - concern for gangrene/performation

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4
Q

Best choice in management for clavicular fracture

A

sling or figure 8 bandage

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5
Q

Best choice in management for colles fracture

A
  • fall on outstretched hand, radial fx with distal radius segment pointing upwards
    tx: closed reduction and casting
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6
Q

Best choice in management for scaphoid fracture

A

fall on outstretched hand

-thumb spica cast

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7
Q

Best choice in management for femoral neck fracture

A

femoral head replacement - high risk for avascular necrosis

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8
Q

Best choice in management for intertrochanteric fracture

A

ORIF with pin

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9
Q

Best choice in management for femoral shaft fracture

A

intramedullary rod fixation

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10
Q

Best choice in management for trigger finger and de Quervain tenosynovitis

A

steroid injection

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11
Q

Compartment syndrome

A

crush injury with prolonged ischemia followed by reprofusion

Classic sign: severe pain with passive movement

Tx: emergency fasciotomy

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12
Q

Epididymitis

A

scrotal pain, fever, chills, likely new sexual partner

PE:
prinz sign: pain relieved with scrotal content manually elevated
cremasteric reflex present

US: normal testicular blood flow

Lab: UA + UCx
Cx discharge

Tx:
cover GC and chlamydia
-Cipro
-doxy

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13
Q

management of AAA and risk factor modification

A

asymptomatic and AAA less than 5.5 cm - observe with serial u/s
asymptomatic and AAA 5.5 cm or more - surgical repair
If symptomatic -> surgical repair

Risk factor modification: Stop smoking! #1 risk factor for development and progression of a AAA

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14
Q

Acute cholangitis

A

obstructed CBD with proximal infection
S/S: fever, RUQ pain, leukocytosis, elevated ALP, elevated Bili

Within 24 hr - IV abx, ESRP to decompress

If septic or life threatening:
-emergent ERCP to decompression CBD
IV abx: zosyn or ceftriaxone + flagyl
-> cholecystectomy

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15
Q

Nonsurgical management of achilles tendon rupture

A

casting in equines position

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16
Q

Presentation, Diagnosis and management of esophageal perforation

A

Presentation: pain in chest/upper abd, dysphagia, odynophagia, subQ emphysema after endoscopy

MC causes: iatrogenic (EGD), Boerhaave sn (excessive V), chest trauma

Dx:
CT chest OR gastrografin contrast esophagram

NO barium- can lead to mediastinal/pleural cavity inflammation

17
Q

Subclavian steal syndrome

A

narrowing of subclavian a. proximal to origin of the vertebral artery -> arm claudication
Neurologic sxs d/t brainstem ischemia -> disequilibrium, diplopia, ataxia

Dx:
Doppler US
MRA or CTA

Tx:
bypass surgery to bypass atherosclerotic lesion causing stenosis

18
Q

thoracic outlet syndrome

A

compression of brachial plexus or subclavian vessels d/t anatomic problem -> arm claudication
No brain stem symptoms

19
Q

Acute mesenteric ischemia

A 
acute onset n/v and severe periumbilical abdominal pain - 10/10.
Known history (MI, CAD) or significant risk factor for atherosclerosis

PE: pain out of proportion to exam, mild tenderness to palpation, no guarding

W/U: CTA abdomen - lock for arterial embolus or thrombosis

Consult surgery - sooner on cases

20
Q

Management of a patient with head trauma with CT showing cerebral edema and concern for impending herniation

A

Goal - preserve brain perfusion

Venticulostomy to relieve pressure
Elevate HOB 30 degrees
IV mannitol - cautiously - can decrease cerebral perfusion

2nd line:

  • hyperventilation
  • sedation
  • hypothermia
21
Q

Bone(s) involved in monteggia fracture

A

proximal ulna with dislocation of head of radius - fall on pronated arm

22
Q

Bone(s) involved in galeazzi fracture

A

radius with dislocation of radial/ulnar joint

23
Q

Bone(s) involved in boxer’s fracture

A

5th metacarpal

24
Q

Bone(s) involved in Jones fracture

A

5th metatarsal

25
Q

Bone(s) involved in Greenstick fracture

A

long bone fracture - incomplete
Result of bending that breaks one side of the cortex
suspect child abuse

26
Q

Plantar fasciitis

A

Pain with first steps that gradually improves with continued walking
Risk: obesity, flat feet, runners

PE: decreased dorsiflexion, point tenderness near medial process of calcanea tuberosity

Tx:
Self limited - lasts 12-15 months
Sxs tx: stretching exercises, avoid flat shoes and walking barefoot, shoe insert, NSAIDs
if no improvement within 6-12 months, local glucocorticoid injection
Surgical release

27
Q

Testicular torsion

A

sudden onset of severe groin pain with radiation to lower abdomen

PE: affected testicle oriented horizontally(transversely) in scrotum
Absent cremasteric reflex

Doppler US scrotum to evaluate

Tx: emergent surgery

28
Q

Diagnosis and management of claudication due to PVD

A

Confirm with ABI and doppler US to identify location of disease

ABI: ankle BP/arm BP - 0.9 or less = PVD

Tx:
exercise
angioplasty
surgical revascularization

Meds:
cilostazol - improve pain free walking distance

29
Q

Basillar skull fracture

A

trauma with resulting raccoon eye bruising

PE: ecchymosis around both eyes and behind ears
Continuous leakage of clear, watery fluid from nose - CSF

Mgmt:
Admit for obs
CSF leak self limited
CT head w/o con if AMS to r/o intracranial hemorrhage

if ICH -> NSx consult

30
Q

Esophageal atresia

A

1 day old neonate with choking when feeding, excessive drooling

NGT coiled in upper chest on XR

Tx:
Sx repair
-if Sx delayed - gastrostomy to protect lungs from acid refluxing via tracheoesophgeal fistula

31
Q

Knee injury associated with positive anterior drawer test and positive Lachman’s test

A

ACL - forced hyperextension of knee

Anterior force -> hyperextension -> ACL inj

32
Q

Knee injury associated with positive posterior drawer test

A

PCL - forced hyper flexion of knee

Posterior force -> hyper flexion -> PCL injury

33
Q

Knee injury associated with tibial joint line tenderness with clicking or locking and positive McMurray’s test

A

Meniscal tear

DIT Level 3 (32 decks)

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