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Surgery > Emma Holliday > Flashcards

Emma Holliday Flashcards

1
Q

First step if suspect PE

(a) Tx for PE

A

If suspect PE, immediately give heparin first
-then workup w/ V/Q scan

(a) PE: treat w/ heparin-warfarin overlap
- IVC filter is pt has contraindication to chronic anticoagulation

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2
Q

1-2 years s/p AAA pt presents w/ brisk GI bleed

A

Aortoenteric fistula

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3
Q

Mesenteric ischemia

(a) Diagnostic test
(b) Tx

A

(a) Workup = angiography
- aorta and SMA/IMA

(b) Tx = embolectomy
- or aortomesenteric bypass if thrombus

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4
Q

MEN1

A

MEN1- 3 Ps

  1. Pituitary adenoma (prolactinoma)
  2. Parathyroid hyperplasia (4 gland)
  3. Pancreatic islet cell tumor (gastrinoma)
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5
Q

1 wk old w/ bileous vomiting and abdominal distention

A

Malrotation and volvulus

  • Ladd’s bands kinking the duodenum
  • problem here is the small mesenteric base which makes it at high risk for volvulus
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6
Q

Child w/ neck mass

(a) Anterior to SCM
(b) Lateral to SCM

A

Non-midline neck mass

(a) Anterior to SCM = branchial cleft cyst
(b) Lateral to SCM = cystic hygroma
- associated w/ chromosomal abnormalities: Turner’s, Down’s, Klinefelters

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7
Q

Give tx for kidney stones based on size

A

Kidney stones

  • under 5mm: hydrate and let it pass
  • over 5mm: shock wave lithotripsy
  • over 2cm: surgical remoal
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8
Q

Differentiate which pts get the different types of esophageal carcinomas

(a) Squamous cell
(b) Adenocarcinoma

A

Esophageal cancer

(a) Squamous cell in smokers/drinkers in the middle 1/3 of the esophagus
(b) Long standing GERD => adenocarcinoma in the distal 1/3 of the esophagus

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9
Q

Name the type of fracture

(a) old lady falls on outstretched hand, distal radius is displaced
(b) young person falls on outstretched hand, tender anatomic snuff box

A

Fractures

(a) Colle’s fracture
(b) Scaphoid fracture

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10
Q

Genetic defect seen in ppl who get malignant hyperthermia

(a) Tx

A

Genetic defect causing malignant hyperthermia = ryanodine receptor gene defect

(a) Tx is dantrolene (blocks RYR)

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11
Q

Generalized etiology of neck mass that presents at

(a) 7 days old
(b) 7 mo old
(c) 7 yrs old

A

Neck mass

(a) 7 days old- inflammatory
(b) 7 mo old- cancer
(c) 7 yrs old- congenital

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12
Q

Lab abnormalities seen in acute mesenteric ischemia

A

leukocytosis, elevated Hgb, elevated amylase, metabolic acidosis (elevated lactate)

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13
Q

Why add epinephrine to lidocaine injections?

A

Larger doses of lidocaine can be used to increase duration

-epinephrine vasoconstricts arteries => delaying resorption of lidocaine and almost doubling the duration of anaestheisa

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14
Q

Dierticulosis vs. diverticulitis

A

Diverticulosis = just the outpuouching 2/2 low fiber diet (low fiber causes muscular hypertrophy of colon wall which narrows the lumen and therefore increases pressure)

Then when the outpouching becomes obstructed and forms abscess/perforates = diverticulitis

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15
Q

Differentiate Paget’s disease and inflammatory breast cancer

A

Paget’s disease: looks like eczema of the nipple

Inflammatory breast cancer- red, hot, swollen breast (not just the nipple)

  • orange peel skin
  • nipple retraction
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16
Q

Risk of BUN over 100 in the post-op period

A

Increased risk of post-op bleeding 2/2 uremic platelet dysfunction

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17
Q

Vent settings to manipulate

(a) PaO2
(b) PaCO2

A

Vent settings- evaluate vent management w/ ABG

(a) PaO2 correlates w/ FiO2
- if PaO2 is low, increase FiO2

(b) PaCO2 correlates w/ tidal volume and rate
- if PaCO2 is high (pH is low), increase rate or TV

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18
Q

Xray finding of necrotizing enterocolitis

A

Pneumocystis interstinalis = air in the intesitnal wall

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19
Q

Tx for nec in 5 day old

A

Bowel rest: NPO

  • abx and resection of necrotic bowel
  • TPN if necessary
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20
Q

When to use 3% saline in hyponatremic pt?

A

Symptomatic (seizures), or Na under 110

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21
Q

POD7 fever, pain at excision site w/

(a) edema and induration, no drainage
(b) induration with drainage
(c) salmon colored drainage

Give dx and tx

A

(a) Edema and induration w/o drainage = cellulitis
- Take BCx first, then start abx

(b) Induration w/ drainage = simple wound infection
- open wound and repack, no abx necessary

(c) salmon colored drainage = wound dehiscence
- immediately to OR, IV abx, primary closure of fascia (surgical emergency)

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22
Q

Tx for newborn w/ diaphragmatic hernia

A

Plan for birth in a hospital w/ ECHMO access- let lungs mature then do surgery on day 3-4

-biggest concern here is pulmonary hypoplasia 2/2 compression of lungs by abdominal contents

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23
Q

Most common oral cancer

A

Most common oral cancer = squamous cell

-seen in smokers and drinkers

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24
Q

Why do you not want to fix hyper/hyponatremia too quickly?

A

Don’t fix hyponatremia too quickly b/c of central pontine myolinolysis

Don’t fix hypernatremia too quickly (aka give free water) b/c of risk of cerebral edema

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25
Q

Tx for volvulus- first line

Last resort?

A

First line tx for volvulus = decompression from below (if not strangulated)

Last resort = surgical removal and colostomy

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26
Q

‘Small blue’ tumor of femur in pediatric pt with night pain and fever

A

Ewing Sarcoma

  • diaphysis of long bones
  • night pain, fever, elevated ESR
  • Xray: lytic bone lesion w/ onion skinning
  • small blue = neuroendocrine tumor
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27
Q

Benign liver tumor in F not on OCPs

A

Think focal nodular hyperplasia = 2nd most common benign liver tumor

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28
Q

General tx for DCIS/LCIS

A

Same outcome:

  1. modified radical mastectomy w/ SLN (w/o adjuvant RT)
  2. Lumpectomy w/ SLN + adjuvant radiation therapy
    - chemo if node +
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29
Q

62 yo M p/w severe epigastric pain x1 hr

  • episodic postprandial epigastric discomfort x2 wks
  • PMH: DM2, HTN, HLD, CAD
  • PSH: CABG
  • Meds: ASA for osteoarthritis
  • CXR shows air under right diaphragm

(a) Dx
(b) Next step

A

(a) Perforated peptic ulcer- acute onset epigastric pain w/ chronic NSAID use, intraperitoneal free air (pneumoperitoneum)
(b) Urgent ex lap

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30
Q

Give 2 ddx for 3 day old who has not passed meconium

(a) Give diagnostic test

A
  1. Meconium ileus
    (a) Gastrograffin enema is dx and tx
  2. Hirschspruing’s
    (a) Gold standard is biopsy of mucosa showing absence of ganglia
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31
Q

F/u for benign-appearing solitary lung nodule

A

CXR or CT scan q2mo to check for growth

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32
Q

How long before surgery should a smoker stop

A

8 wks

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33
Q

MEN2A

A

MEN2A

  1. MTC
  2. Pheo
  3. Parathyroid hyperplasia (4 gland)
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34
Q

POD1 pt develops 104F, very ill appearing

A

Nec Fasc

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35
Q

Pt dies suddently after removal of central line

A

Air embolism

36
Q

Baby born in respiratory distress w/ scaphoid abdomen

(a) Dx
(b) First step in dx

A

(a) Diaphragmatic hernia

(b) Xray to see abdominal contents in the thorax

37
Q

2 wk old infant w/ bileous vomiting

-pregnancy complicated by polyhydramnios

A

Intestinal atresia or annular pancreas

38
Q

Diagnostic test for TE-fistula

A

Place a feeding tube, then take Xray to see if it’s actually going into the stomach (or just stuck at blind pouch)

39
Q

2 parts of the colon that are most susceptible to ischemic colitis

A

The arterial watershed areas: splenic flexure and rectosigmoid junction, b/c they have the least collateral blood supply

40
Q

First step after

(a) Chemical burn
(b) Electrical burn

A

After

(a) Chemical burn- irrigate for 30+ minutes prior to ER
(b) Electrical burn- get EKG

41
Q

S/p trauma- pt has confusion, petechial rash in chest/axilla/neck, acute SOB

Dx

A

Dx = fat embolism

-suspect after a long bone fracture (esp. femur)

42
Q

Adverse effect of rocuronium

A

Possible allergic rxn in asthmatics

43
Q

Give brief standard of tx for

(a) Colon cancer
(b) Rectal cancer

A

(a) Colon cancer = remove affected segments + chemo if node is positive

(b) Rectal cancer:
Stage I/II
-upper/middle 1/3 get LAR (lateral anterior resection)
-lower 1/3 gets APR

Stage III/IV: neoadjuvant chemo/radiation

44
Q

What anal entity is treated w/ topical lidocaine and nifedipine?

A

Anal fissures

-give to posterior mucosal anal tear w/ skin tag, don’t need colonoscopy (more worried about lateral, not posterior, lesions)

45
Q

Gastrocschisis vs. omphalocele

(a) Elevated maternal AFP
(b) Associated disorders
(c) Covered by sac
(d) Relationship to midline

A

Newborn abdominal wall defects

(a) Gastrochiesis (no sac) is assocaited w/ elevated maternal AFP
(b) Omphalocele (yes sac) associated w/ cardiac abnormalities
(c) Gastrochiesis- no sac covering, omphalocele- yes sac covering
(d) Omphalocele (sac) midline, gastrochesis (no sac) lateral to umbilicus

46
Q

Tx for

(a) acute rejection
(b) Chronic rejection

A

Tx
(a) Acute rejection (5 days to 3 mo): steroid bolus and antilymphocyte agent (OKT3)

(b) Chronic rejection (after years): no tx, needs re-transplantation

47
Q

Huge facial trauma, blood obscuring oral and nasal airway, GCS of 7

Next step?

A

Cricothyroidotomy- don’t want blood in the tube for endotracheal intubation

48
Q

IBD associated w/

(a) terminal ileum vs. rectum
(b) PSC
(c) Fistulae
(d) Gramulomas
(e) Transmural inflammation
(f) Cured by colectomy
(g) Smoking
(h) Colon cancer risk
(i) p-ANCA

A

IBD: Crohn’s vs. UC

(a) Crohn’s = terminal ileum, vs. UC always involves the rectum
(b) UC and PSC (increased risk of cholangiocarcinoma)
(c) Fistulae in Crohn’s (give metronidazole)
(d) Granulomas and Crohn’s
(e) Transmural inflammation in Crohn’s
(f) UC is cured by cholectomy
(g) Smoking- decreased risk of UC, higher risk of Crohn’s
(h) Higher colon cancer risk in Crohn’s
(i) UC associated w/ p-ANCA

49
Q

Newborn w/ respiratory distress and excess drooling

A

Respiratory distress and excess drooling in newborn = TE fistula
tracheo-esophageal fistula

-think VACTERL association

50
Q

Tx for asymptomatic gastric varices

A

Beta-blockers

-don’t prophylactically band them if asymptomatic

51
Q

For a CKD pt on dialysis who needs surgery, when should they get dialysis pre-op?

A

Dialyze 24 hrs post-op

52
Q

(a) 4-5 yo kid w/ painless limp

(b) 12-13 yo w/ knee/thigh pain and sickle cell disease

A

Peds Ortho

(a) 4-5 yo w/ painless limp: think Leg-Calve-Perthe’s avascular necrosis of the femoral head
(b) SCFE

53
Q

ABI where you’d expect

(a) Claudication
(b) Limb ischemia
(c) Ulcers
(d) Gangrene

A

ABIs

(a) Claudication under .9
(b) Limb ischemia: 0.2-0.4 (surgery indicated)
(c) Ulcers w/ claudication at under .9
(d) Gangrene at under .2 (may require amputation)

54
Q

How should a chronic smoker be treated differently post-op?

A

Chronic smoking => chronic CO2 retention

-shouldn’t be given high O2 post-op b/c that could suppress respiratory drive

55
Q

Describe the metabolic complications seen in pyloric stenosis

A

Pyloric stenosis => lots of vomiting (non-bileous) => losing HCl => hypochloremic metabolic alkalosis

56
Q

2 anesthetic agents most commonly associated w/ malignant hyperthermia

A

Succinylcholine and halothane

57
Q

Pathophysiology of malrotation and volvulus

A

Embryologically, bowel doesn’t rotate 270 ccw around the SMA

58
Q

Clinical symptoms of

(a) hypocalcemia
(b) hypercalcemia

A

Clinical signs of

(a) Low Ca = numbness, Chvostek/Troussaeu, prolonged QT
(b) High Ca = ‘bones, stones, groans, psychiatric undertones’, shortened QT

59
Q

Blood at the urethral meatus w/ a high riding prostate

(a) Next best test

A

Think: urethral injury 2/2 pelvic fracture

(a) Next best test = retrograde urethrogram

60
Q

Management of adrenal nodule

(a) First step
(b) How size matters

A

Adrenal nodule

(a) First- check functional status
- high BP (pheo or primary aldo), cushingoid?

(b) Under 5cm and nonfunctional- can observe w/ CT scan q6mo
- if over 6cm (functional or not) => surgical removal

61
Q

Describe the pathophysiology of nec fasc

(a) Location
(b) Most common bugs
(c) Tx

A

Nec fasc = pt looks super sick, flesh eating bacteria of bound, super febrile (like 104) on POD1

(a) spreads along the fascial plane, in the subQ tissue (along Scarpa’s fascia

62
Q

34 yo M w/ severe pain in penis that started during intercourse
-grossly swollen penis deviated to the right

Tx?

A

Dx = penile fracture, due to tearing of the tunica albuginea which invests the corpus cavernosum

Tx = retrograde urethrogram (need to asses for urethral injury) + emergency surgery to evacuate hemoatoma and mend the torn tunica albuginea

63
Q

Characteristics of malignant lung nodules

A
  • new (not on old CXR)
  • smoker
  • over 40
  • over 3cm
  • calcified
64
Q

Most sensitive SCR finding for blunt aortic trauma

A

Mediastinal widening

  • see enlarged aortic bulge on superior cardiac silhouette
  • suspect aortic trauma in pt who suffers from blunt deceleration trauma (MVA or fall from more than 10 ft)
65
Q

39 yo M w/ r. hip pain that makes it difficult to lie on his right side while sleeping
-localizes pain to outer surface of his thigh

Dx

A

Dx for middle aged adult w/ unilateral hip pain exacerbated by external pressure to upper lateral thigh = trochanteric bursitis

= inflammation of the bursa surrounding the insertion of the gluteus medius onto the femur’s greater trochanter

66
Q

Contraindication to succinylcholine

A

Burn or crush victims b/c suc can cause hyperkalemia

67
Q

Name 3 fractures that go directly to the OR

A
  1. depressed skull fracture (broken bones are displaced inwards)
  2. any open fracture- bone sticking out needs cleaning
  3. femoral neck or intertrochanteric fx
68
Q

2 mo old w/ colicky abdominal pain and current jelly stool

A

Intussusception

-barium enema is dx and tx

69
Q

MEN2B

A

MEN2B

  1. MTC
  2. Pheo
  3. Marfanoid body habitus and neuromas
70
Q

What other concerns do you have when a newborn is diagnosed w/ TE-fistula?

A 
VACTERL association
Vertebral
Anal atresia
Cardiac abnormalities
TE- fistula
Renal/kidney defects
Limbs
71
Q

Meds to stop pre-op

(a) Name 3 meds to stop for 2 wks
(b) What to do w/ warfarin
(c) What to do w/ insulin

A

Pre-op meds to stop

(a) Stop for 2 wks: aspirin, NSAIDs, vit E
(b) Stop warfarin for about 5 days, goal is to drop INR below 1.5, can use vitamin K
(c) Take half the morning dose of insulin

72
Q

Spread of papillary vs. follicular thyroid cancer

A

Papillary thyroid cancer (most common) spreads via lymph nodes => can do lobectomy

Follicular thyroid cancer spreads via blood => must surgically remove entire thyroid

73
Q

Most common cancer in nonsmokers

A

Adenocarcinoma

74
Q

Midline neck mass that moves when pt sticks out tongue

(a) Tx

A

Midline neck mass in child that moves when tongue is protruded = thyroglossal duct cyst

(a) Remove surgically

75
Q

Tx for pyloric stenosis in 4wk old

A

Tx = immediate referral to surgery for myotomy

-cut/ligate the muscle around the pyloric sphincter

76
Q

Absolute contraindication to surgery

A

Diabetic coma, DKA

77
Q

2 other irregularities associated w/ umbilical hernia in newborn

A

Associated w/ umbilical hernia

  1. hyperglossia (large tongue)
  2. congenital hypothyroidism
78
Q

Salivary gland cancers

(a) Most common salivary gland tumor
(b) Most common malignant salivary gland tumor
(c) Warthlin’s tumor

A

Salivary gland cancers

(a) Most common salivary gland tumor = pleomorphic adenoma
- benign but recurs, usually on parotid

(b) Most common malignant salivary gland tumor = mucoepidermoid carcinoma
- pain and facial nerve palsy

(c) Warthlin’s tumor = benign parotid gland tumor, can injur facial nerve

79
Q

Utility of Goldman’s index?

(a) Name a few of the criteria

A

Goldman’s index- used to estimate a pt’s perioperative cardiac risk

(a) CHF, MI in the past 6 mo

80
Q

Adverse event associated w/ Merperidine

A

Seizures b/c merperidine lowers the seizure threshold, especially in pts w/ renal failure

81
Q

5 day old ex-33 weeker develops bloody diarrhea

Dx

A

Necrotizing enterocolitis

-often upon introduciton of feeds/switch to formula in a premature gut

82
Q

Name 4 contraindications to surgery

A
  1. Diabetic coma/DKA = absolute contraindication
  2. poor nutrition
    - albumin under 3, transferin under 200, wt loss of more than 20%
  3. severe liver failure
  4. current smoker
83
Q

1 cause of death s/p AAA repair

A

MI

84
Q

Diverticulitis

(a) Clinical presentation
(b) CT findings
(c) Tx
(d) F/u

A

Diverticulitis

(a) Presents w/ LLQ pain + constipation or diarrhea
(b) See free air on imaging (if perf), see abscess on CT
(c) Tx = bowel rest and decompression (NPO, NG tube), broad spec abx and pain
(d) F/u- do colonoscopy 4-6 wks later

85
Q

Enlarging nodule gradually growing over site of chronic draining wound from burn 4 years ago

A

Marjolin ulcer = squamous cell carcinoma that arises w/in a chronically wounded, scarred, or inflamed skin

86
Q

What cancer does Hashimoto’s thyroiditis predispose pt to?

A

Thyroid lymphoma

Surgery (10 decks)

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