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Other Books > Dr. Pestana's Surgery Notes > Flashcards

Dr. Pestana's Surgery Notes Flashcards

1
Q

What are the different ways to intubate someone?

A

orotracheal
nasotracheal
cricothyroidotomy

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2
Q

What way to you intubate someone with a suspected cervical spine injury?

A

nasotracheal or orotracheal

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3
Q

What are the signs of shock?

A 
low urinary output
sweating
pale
fast feeble pulse
low BP
shivering
thirsty
apprehensive
cold

shows 20-30% of blood volume lost

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4
Q

What is considered low urinary output?

A

less than 0.05 mL/kg/hr

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5
Q

What are the common causes of shock in a trauma setting?

A

hemorrhage
pericardial tamponade
pneumothorax

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6
Q

In a trauma what is the preferred route of fluid resuscitation?

A

2 peripheral IV lines

16 gauge

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7
Q

What are nontrauma causes of shock?

A 
intrinsic cardiogenic (MI, fulminating myocarditis)
vasomotor
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8
Q

What are signs that a fracture is present at the base of the skull?

A

ecchymoses
rhinorrhea
racoon eyes
ottorrhea

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9
Q

If a pt has a modest trauma with loss of consciousness, lucid interval, then gradual lapses into a coma again with a fixed dilated pupil and contralateral hemiparesis with decerebrate (wrists flexed, arms adducted, feet plantar flexed) what does this describe?

A

acute epidural hematoma

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10
Q

How does a subdural hematoma present differently than an epidural hematoma?

A

has a bigger trauma, pt doesn’t fully regain consciousness, pt is much sicker

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11
Q

How do you tx an acute subdural hematoma?

A 
hyperventilate
monitor ICP
elevate head
avoid fluid overload
give mannitol or furosemide

Hyperventilation causes decreased PaCO2 which subsequently leads to arterial vasoconstriction thus lowering cerebral blood flow (CBF), cerebral blood volume, and ICP. This effect is mediated my pH changes in the extracellular fluid which cause cerebral vasoconstriction or vasodilation depending on the pH.

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12
Q

What is the progression of rib pain in the elderly?

A

chest pain => decreased breathing => atelectasis => pneumonia

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13
Q

A contused lung is susceptible to what?

A 
fluid overload
(fluid restrict use diuretics)
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14
Q

A big deceleration injury makes you look for what?

A

aortic dissection

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15
Q

Layers of the blood vessels?

A

intima
media
adventitia

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16
Q

Long bone fractures, petechial rashes on the neck and axilla, tachycardia, fever, and respiratory distress points to what?

A

fat emoblism

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17
Q

Where could 1500 mL of blood hide?

A

abdomen
pelvis
thigh

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18
Q

In circumferential burns what do you have to worry about?

A

blood supply being cut off

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19
Q

If a burn exceeds 20% in a child how fast do you infuse fluid?

A

20 mL/kg/hr and fine tune to urinary response

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20
Q

Difference between Legg-Calve-Perthes disease and slipped capital femoral epiphysis

A

LCP (avascular necrosis): 6 yo, insidious dev of limping, decreased hip motion, hip or knee pain

Slipped C F E: chubby 13 yo boy, knee or groin pain, limping,

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21
Q

An EF less than what is bad for surgery?

A

< 35%

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22
Q

What do you look at for cardiac risk?

A

JVD distention
MI in last 6 months
> 5 PVCs per minute/ other than sinus rhythm
> 70 yo
emergency surgery
aortic valve stenosis/poor health/surgery in chest or abd

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23
Q

What factors do you look at to assess hepatic risk factors?

A 
Albumin <3
PT >16
bilirubin >2
encephalopathy
ascites
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24
Q

tx for malignant hyperthemia?

A

dantrolene
oxygen 100%
cooling blankets
correct acidosis

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25
Q

Causes of post-op fever?

A 
atelectasis - Day 1
pneumonia- Day 3
UTI- Day 3
DVT- Day 5
wound infection- day 7
wound abscess- day 10-15
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26
Q

What are causes of abdominal distention post-op?

A 
ileus
obstruction (adhesions)
ogilvie syndrome (nursing home)
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27
Q

What is the speed limit of replacing K?

A

10 mEq/hr

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28
Q

How does cancer of the right colon present?

A

anemia

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29
Q

How does cancer of the left colon present?

A

bloody stool

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30
Q

What types of colonic polyps are there?

A 
hyperplastic
adematous
from familial syndromes (Lynch
villous adenoma
juvenile
peutz-jegers
isolated inflammatory
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31
Q

tx of c diff

A

metronidazole

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32
Q

Where does most GI bleeding come from?

A

upper Gi tract (90%)

lower MC in elderly

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33
Q

a massive upper GI bleed in the context of trauma or complicated post-op is probably from what?

A

stress ulcer

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34
Q

what combine abdominal pain and blood in the lumen of the gut?

A

ischemia

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35
Q

what mimics an acute abdomen?

A 
mi
pancreatitis
pe
kidney stones
lower lobe pneumonia
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36
Q

mesenteric ischemia has what hx?

A

afibb or recent MI

throwing a clot

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37
Q

pyogenic liver disease is mostly a complication of what?

A

ascending cholangitis

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38
Q

What are the 3 processes of jaundice?

A

obstruction
liver problems
hemolysis

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39
Q

moderate elevation of liver transaminases and bilirubin, very elevated ALP points to what source of jaundice?

A

obstruction

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40
Q

stones, bones, and abdominal groans means what?

A

hyperparathyroidism

classic presentation

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41
Q

a baby with salivation at birth and choking with first feeding probably has what?

A

esophageal atresia

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42
Q

what does VACTER stand for?

A 
Vertebral
Anus
Cardia
Tracheal
Esopagheal
Renal

abnormalities associated together at birth

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43
Q

what side is a congenital diaphragmatic hernia always on?

A

the left

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44
Q

gastrochisis vs omphacele

A

both are a protrusion of the bowel at birth

gastrochisis the defect is not the umbilical chord
omphacele the defect is the umbilical chord

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45
Q

what color vomiting in an infant is bad

A

green

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46
Q

what conditions cause green vomiting in an infant

A

intestinal atresia
annular pancreas
malrotation

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47
Q

Where are brachial cleft cysts?

A

ant edge of SCM

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48
Q

What is a congenital, large, mushy mass that occupies the entire supraclavicular area?

A

cystic hygroma

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49
Q

A recently dx lymph node mass has what FU timetable?

A

3-4 week re-check to see if its gone

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50
Q

Lymphoma is typical in what population?

A

young people

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51
Q

What is a triple endoscopy and what is it used for?

A

bronchoscopy
esophagoscopy
direct laryngoscopy

SCC of the neck

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52
Q

dx SCC of the neck?

A

biopsy for patho

CT shows extent

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53
Q

Hoarseness + painless ulcers of the mouth + ear ache =

A

SCC of neck mucosa

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54
Q

sensory HL in one ear of adult suspect what?

A

acoustic neuroma

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55
Q

How do you biopsy a parotid?

A

FNA

DON’T open it up

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56
Q

Why is ludwig angina an emergency?

A

threatens airway

abscess on the floor of the mouth

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57
Q

Sudden paralysis of the facial n vs gradual? (etiology)

A 
sudden = bels palsy
gradual = cancer
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58
Q

Frontal or ethmoid sinusitis + diploplia developing = what are we worried about? How do you manage?

A

cavernous sinus thrombosis

hospitalize, IV fluid/antibiotics, CT/MRI, drainage

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59
Q

tx for ant nosebleed of kid?

A

phenylephrine

compression

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60
Q

18 yo with nosebleed suspect what?

A

cocaine

61
Q

Room is spinning vs pt is spinning (what etiology)

A 
room = inner ear
pt = brain problem
62
Q

tx for inner ear dizziness?

A

meclizine
phenergen
diazepam

63
Q

nature of vascular problems in brain (ie presentation)

A

sudden onset
no HA is occlussive
HA if hemorrhagic

64
Q

time table of brain tumors ie beginning

A

months

65
Q

MC origins of cause of TIA?

A

carotid stenosis

ulcerated plaque at carotid bifurcation

66
Q

Timeframe of tPA?

A

90 min - 3 hours

67
Q

pt has unc. HTN + a severe HA suspect

A

hemorrhagic stroke

68
Q

blood in spinal tap comes from a bleed where?

A

subarachnoid

69
Q

What does the course of a brain tumor look like?

A

1) progressive HA, increase ICP, blurred vision, papilledema, projectile vomiting
2) extreme end: bradycardia and HTN

70
Q

A tumor causes problems with 1) speech or 2) behavior is located where?

A

1) lateral lobe

2) frontal lobe

71
Q

Prolactinomas cause what symptoms?

A

amenorrhea

galactorrhea

72
Q

bromocriptine is what? used to tx what?

A

dopamine agonist

used to tx prolactinoma

73
Q

acromegaly has what presentation

A 
enlarged jaw, tongue, hands
HA
diabetes
sweating
hx of rings not fitting
74
Q

What is pituitary aploplexy?

A

bleeding in a pituitary tumor

75
Q

What tumor has “sunset eyes” + loss of upper gaze

A

pineal gland tumor

76
Q

Where are most brain tumors in children

A

posterior fossa

77
Q

an unshaven area of the face may represent what?

A

trigeminal neuralgia

78
Q

dx reflex sympathetic dystrophy? (ie causalgia)

A

a successful nerve block of burning pain over previous crush injury

79
Q

where are the testes in a testicular torsion?

A

elevated ie high riding

epididymitis is normal

80
Q

UT obstruction and infection needs what?

A

decompression surgically

81
Q

poss dx for kid with burning urine, frequency, low abd pain, perineal pain/flank pain and fever/chills

A

vesicoureteral reflux

voiding cystourethrogram

82
Q

In girls the low implantation of a ureter causes what?

A

urine drips into the vagina and leaks out

83
Q

How does UT cancer show up?

A

hematuria

84
Q

Who needs work-up for hematuria?

A

everybody except adult with recent major trauma

85
Q

first thing for work-up of hematuria?

A

CT

86
Q

dx prostate cancer

A

transrectal needle biopsy

87
Q

testicular cancer is painful T/F

A

false

88
Q

2 blood markers of testicular cancer?

A

alpha fetoprotein

beta HCG

89
Q

dx testicular cancer

A

radical orchiectomy

almost all testicular tumors are malignant

90
Q

for acute Urinary retention in males how long is catheter left in?

A

3 days

91
Q

life/meds causing acute urinary retention?

A

over hydration
cold
antihistamines
nasal drops

92
Q

fistulization between bladder and GI tract causes what?

A

pneumaturia

93
Q

only absolute CI to being an organ donor?

A

HIV

94
Q

what heart defect is likely to close in 2-3 yrs on its own?

A

small VSD low in septum

95
Q

a “failure to thrive” pansystolic @ LSB and increased pulmonary markings is a murmur of what congenital defect

A

VSD

96
Q

bounding peripheral pulses + a machine like murmur + newborn

A

patent DA

97
Q

MC cyanotic abnormality

A

tetrology of fallot

98
Q

dx of malrotation in infant?

A

contrast enema

99
Q

signs of sepsis in a baby?

A

dropping platelets

100
Q

what causes a meconium ileus? Associated with what?

A

too thick a stool causes obstruction

cystic fibrosis

101
Q

dx for hypertrophic pyloric stenosis without feeling olive?

A

US

102
Q

what drug is a powerful cholertic? ie promoting bile secretion

A

phenobarbitol

103
Q

dx of hirschprungs?

A

full thickness biopsy

104
Q

colicky abd pain x1min followed by full recovery and then repitition, kids double up and squat during the episodes (name of problem)

A

intussusception

105
Q

incomplete obliteration of the vitelline duct causes what?

A

meckel’s diverticulum

106
Q

lower GI bleeding in kids could be what?

A

meckle’s diverticulum

107
Q

vascular rings produce what symptoms?

A

stridor
resp distress
hyperestended neck

(vascular rings around neck, congential)

108
Q

ASD has what murmurs

A

systolic (faint)

fixed split S2

109
Q

What are the 4 parts of the tetrology of fallot?

A

1) VSD
2) outflow obstruction
3) right ventricle hypertrophy
4) overriding aorta

110
Q

what keeps transp of the great vessel kids alive?

A

ASD
or
VSD

111
Q

a harsh, midsystolic @ right ICS

A

aortic stenosis

112
Q

when does aortic stenosis need a new valve?

A

50 mmHg gradient

113
Q

high pitched diastolic @ left LSB

A

aortic insufficiency

114
Q

cause of acute aortic insufficiency

A

endocarditis

115
Q

which lung cancer is non-operable?

A

small cell

116
Q

minimum FEV1 for lung resection?

A

800 mL

117
Q

pt has a cold limb, tingling, muscle pain + visual/equilibrium problems with exercise the arm

A

subclavian steal syndrome

118
Q

< what size AAA is ok

A

< 4 cm

119
Q

a tender AAA means what?

A

it’s going to rupture

120
Q

life/drugs that help PVD?

A

exercise
no smoking
cilostazol

121
Q

ultimate stage of PVD?

A

rest pain leading to lack of sleep, dangling leg from bed

then ulceration and gangrene

122
Q

arterial embolization and clog leads to what symptoms?

A 
pain
pallor
cold
pulselessness
paresthesias
paralysis
123
Q

tx of embolus

A

clot buster

124
Q

dyspnea with exertion, orthopnea, paroxysmal nocturnal dyspnea, a cough, hemoptysis, and afibb comes from what heart problem?

A

MS

125
Q

ms has what sort of murmur?

A

low-pitched rumble heard at the apex

126
Q

systolic murmur of AR lasts for how long of the heart cycle?

A

pansystolic

127
Q

3 vessel disease leads to what?

A

bypass

128
Q

what do you need to pay attention to in post-op heart surgery?

A

cardiac output

129
Q

a dissecting thoracic aorta occurs in who?

A

uncontrolled HTN

130
Q

best imaging for dissecting thoracic aneurysm?

A

spiral CT

131
Q

preferred place of basal carcinoma?

A

upper face

line across lips

132
Q

preferred place for SCC?

A

lower face

line across lips

133
Q

met melanoma metastasizes where?

A

anywhere and everywhere

134
Q

“square root sign” with equalization of pressures comes from what?

A

chronic constrictive pericarditis

135
Q

a coin lesion is 80% malignant after what age?

A

50 yo

*find previous xray

136
Q

suspected lung cancer do what?

A

sputum culture and CT

137
Q

3 factors after dx lung cancer and considering work-up?

A

1) likelihood its cancer (age, previous xray, noncalcified)
2) ability to surgically fix (PFT)
3) if surgery can be curative (ie no metastasis to lymph nodes, liver mass)

138
Q

strabismus in kids can lead to what?

A

amblyopia (ie impaired vision of one eye)

139
Q

white pupil in a baby =

A

retinoblastoma

140
Q

how is the pupil in acute glaucoma?

A

fixed mid-dilated ie unreactive to light

141
Q

time length of irrigating chemical burn of the eye

A

30 minutes before ER then continue in ER

142
Q

“flashing lights” + floaters =

A

retinal detachment

143
Q

youngsters with type 1 diabetes have how long before eye problems?

A

20 yrs

144
Q

neck mass: how do you differentiate between neo and inflammatory?

A

time.. neo comes over months and inflammation over days/weeks

145
Q

what level is the thyroglossal duct at?

A

hyoid bone

146
Q

what EF is prohibitive for non cardiac surgery?

A

35%

147
Q

worst finding predicting heart failure risk?

A

JVD

148
Q

If a post op pt is confused what is the first thing to suspect?

A

hypoxia

149
Q

what happens to k in diabetic ketoacidosis?

A

k moves into the cells=> hypokalemia

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