Day 8 - surgery Flashcards
1
Q
short arm cast goes over how many joints?
A
1
2
Q
long arm cast goes over how many joints?
A
2
3
Q
Which fractures get surgery?
A
- At joints w/ concern for AVN (humerus, hip, scaphoid, femoral, etc)
- Unstable fracture (ORIF)
- Fracture through the epiphysis extending into the joint surface
- through the skin
4
Q
long bone of body fracture treat?
A
intramedullary rod
5
Q
Imaging for soft tissue or tendon stuff?
A
MRI
6
Q
Unstable fractures treat how?
A
Open Reduction Internal Fixation (ORIF)
7
Q
Closed reduction Internal Fixation is or isn’t surgery?
A
is NOT surgery (ie casting, etc)
8
Q
Risk oc compartment syndrome treat?
A
w/ SPLINT not cast to allow space for swelling
9
Q
Traction is necessary when?
A
When by strong muscle groups –> prevent from pulling the reset joint/bone apart
10
Q
what is dentate line?
A
Line that is midpoint b/t anus and rectum
11
Q
what location is most typical for anal fissure?
A
6 o’clock, distal to the dentate line
12
Q
Rectum gets most common type of cancer?
A
Adenocarcinoma
13
Q
Most common type of anal cancer?
A
Squamous cell CA
14
Q
Anal CA will drain to what lymph nodes?
A
Inguinal LN
15
Q
Which hemorrhoids are painful?
A
external
16
Q
Rectal CA drain to what lymph nodes?
A
Mesenteric LN
17
Q
Anal fissures tend to be anterior or posterior?
A
Posterior! (six o’clock)
18
Q
Treatment of most anal disease (anal fissures, hemorrhoids, etc)?
A
WASH
- Warm water (Sitz bath)
- Analgesic
- Stool Softeners
- High Fibers
19
Q
Legg-Calve Perthes disease is?
A
avascular necrosis of the femoral head
20
Q
avascular necrosis of the femoral head is?
A
Legg-Calve Perthes disease
21
Q
Legg-Calve Perthes disease typical age?
A
6-8
22
Q
Slipped capital femoral epiphysis typical age?
A
> =12, usually obese
23
Q
Billroth 2 complications?
A
- Afferent loop syndrome (close to surgery, blockage at the inlet from aferrent loop to efferent loop connection (duodenum obstructed), bad)
- Dumping syndrome (right after surgery, food in-out right away –> diarrhea)
- Gastrojejunocolic fistula (takes months to dev, abnl connection b/t stomach and colon –> diarrhea )
24
Q
Billroth 2 antecolic gastrogegunostomy is?
A
Surgery that adjust connection so that the stomach attaches to jejunum (efferent loop) and keeps duodeum (afferent loop)
25
Hallitosis + diarrhea + many months - years after billroth 2 surgery = think?
Gastrojejuncolic fistula
26
3 main reasons for fistulas in abdomen?
1) Diverticulitis
2) Crohn's
3) Prior surgery
27
barium enema good for (2)?
- Hirschsprung
| - Obstructions
28
most likely to confirm fistula?
CT scan w/ contrast
29
IV contrast in CT for? (4)
- infx
- inflammation (ends in -itis)
- CA
- Blood vessels (something inside the BV, ie PE, PVD, mesenteric ischemia, etc)
30
lumbar spine injury usually happens post what injury?
a Fall
31
Knee into dashboard requires xray of what beyond the knees?
The HIPS!
32
Treatment of strangulated hernia?
Urgent surgical intervention
33
HIGH-PITCHED, HYPERACTIVE BOWEL SOUNDS = think?
obstruction
34
when do you workup prostate CA or not?
>70yo no workup
35
Workup of PVD if non-emergent?
1) Ankle brachial indices
2) U/S (w/ pulse vol recording)
3) Angiogram (really any, all same)
4) Treatment
36
Wound problems?
- Dehiscence
- Evisceration
- Infx
- Abscess
37
Wound evisceration is?
Wound open and stuff in abdomen coming out --> bring to OR
38
Would dehiscence is?
Wound ruptures along a surgical incision --> may see serous sanguinous drainage
39
Treatment of would dehiscence?
- Tape the wound securly
- Bind the abdomen
- Avoid sudden inc in intra-abdominal press (ie no walking around)
40
Treat wound evisceration?
SURGERY!
41
Crescent shaped hemorrhage in brain = think?
subdural hematoma
42
Lens shaped hemorrhage in brain - think?
Epidural hematoma
43
paradoxical breathing = think?
flailed chest
44
obstruction of bladder (ie CA) --> proximal or distal portion of urinary system dilates first?
Proximal - KIDNEYS
| - then ureters
45
Reflux of bladder (ie posterior uretheral valves) --> proximal or distal portion of urinary system dilates first?
Distal -- URETERS
| - then kidneys
46
smoking and alcohol inc risk of which esophageal cancer?
Squamous Cell CA
47
Pringle maneuver is?
clamping portal triad
48
Portal triad are?
- Hepatic Artery
- Portal Vein
- Common Bile Duct
49
Cushing triad?
- something going on in brain (lesion, hemorrhage, mass, etc)
- bradycardia
- hypertension
50
Cushing triad indicates?
Inc ICP
51
Treat intracranial HTN?
1) raise head of bed
2) HypERventilate
3) Mannitol (diuretic --> dec cerebral edema)
4) Sedate (propafol)
5) Surgery (if needed - burr hole, craniotomy)
52
Bloody nipple discharge in a young woman - think?
intraductal carcinoma
53
cartilage or ligament tear on MRI, generally on step 2 next step?
Arthroscopy
54
Fever post op day 1?
Atelectasis
55
Fever post op day 3?
UTI
56
Fever post op day 7?
Wound infx
57
Fever post op day 5?
DVT/PE
58
Fever post op day 2?
Pneumonia
59
Fever post op day 10-14?
Intrabdominal abscess
60
Fever during surgery?
Malignant hyperthermia
61
Breast mass what do?
small (4cm) - Mastectomy and axillary sampling
62
Radical mastectomy is?
mastectomy + removal of pectoralis m.
63
What do you always do w/ lumpectomy?
Radiation!
64
Fever immediately after surgery?
Bacteremia
65
Parotid tumor treatment?
Superficial parotidectomy sparing the facial nerve
66
Most common parotid tumor is what and is it malignant or benign?
Pleomorphic adenoma, benign
67
Parotid mass, do you biopsy?
NO
- don't want to damage facial nerve
- can cause fistulaes
- Most are benign, so just take it out
68
Why do parotid gland tumors recur?
b/c rarely cut out entirely (bc careful around facial nerve) --> leave some behind
69
phlegmon drainable or not drainable?
NOT drainable, bc w/o bacterial inflammation so nothing to drain
70
Phlegmon is?
a walled off inflammatory mass without bacterial infection
71
fluctuance = think?
Abscess
72
strictures and dilation of intrahepatic and extrahepatic ducts = think?
Primary sclerosing cholangitis
| - beads on a string
73
UC inc risk of what CA?
colon CA
74
Primary sclerosing cholangitis inc risk for?
Cholangiocarcinoma
75
indication for urgent hemodyalisis?
"FAKE Pee"
```
Fluid overload (acute)
Acidosis (metabolic)
K (potassium)
Encephalopathy (renal caused)
Pericarditis (uremic)
```
76
crunching sound over chest = think?
pneumomediastinum
77
Imaging of esophageal perforation
swallow study
78
young pt w/ positional swelling or losing pulse --> think?
thoracic outlet syndrome
79
thoracic outlet syndrome
Thoracic outlet syndrome (TOS) refers to a constellation of signs and symptoms that arise from compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle, within the confined space of the thoracic outlet.
80
Causes of thoracic outlet syndrome?
- Cervical rib (extra)
- Hypertrophed Anterior Scalene m. (weightlifter, etc)
-
-
81
Subclavian steal syndrome
The term "subclavian steal" refers to a phenomenon of flow reversal in the vertebral artery ipsilateral to a hemodynamically significant stenosis or occlusion of the subclavian artery
82
Older pt w/ atherosclerosis, arm pain/symp with using arm + dizziness/brain effect - think?
subclavian steal syndrome
83
contracted hand dev over time = think
Dupuytren contracture
84
inspiratory arrest on palpation of RUQ - think?
Murphy's sign --> cholecystitis
85
dulling of the femoral head - think?
Avascular necrosis
86
Imaging of AVN? initial v confirm?
initial - Xray
| Confirm - MRI
87
bi-malleoli fracture is stable or unstable?
UNstable
88
bi or tri malleoli fracture treat?
Splint initially --> ORIF a few days later
89
pituitary surgery --> high urine output --> ?
Central Diabetes Insipidus
| High serum Na, low urine Na
90
Central DI what are Na levels in serum and urine?
High serum Na, low urine Na
91
painless jaundice + palpable painless gallbladder + double duct sign (dilated bile ducts + pancreatic duct) = think?
Pancreatic CA
92
Couversier's sign?
Painless palpable gallbladder (think pancreatic CA)
93
double duct sign is and think?
Dilated hepatic bile ducts and pancreatic ducts --> think pancreatic CA
94
repetitive simultaneous contractions of esophagus w/ nL LES - think?
Diffuse esophageal spasm
95
8mm upper outer quadrant mass w/ estrogen receptor positive treatment?
Lumpectomy w/ sentinel node + tamoxifen + radiation
96
hirschsprung workup?
1) digital rectal
2) barium enema
3) biopsy
4) removal of diseased portion
97
dorsiflexion - means?
toes pointed up
98
BPH + distended bladder workup?
1) place foley catheter (may not be possible)
| 2) suprapubic catheter
99
Initial test for bladder CA?
Cystoscopy!
100
Primary melanoma found? (3)
- Skin
- Eyes
- Anus
101
Metastatic melanoma can go where and when?
Anywhere, Anytime! (weeks - decades)
