Emma Holliday for Surgery: Part VIII

Question 1

Most frequent oral cancer and what we do about it

Answer 1

–Most freq squamous cell. In smokers & drinkers

–Tx w/ XRT or radical dissection (jaw/neck)

Question 2

Laryngeal cancer is kids vs adults and what we do about it

Answer 2

–Laryngeal papilloma in kiddo w/ stridor or cough
–Squamous cell in adults.
–Tx w/ laryngoscope laser or resection

Question 3

What is a pleomorphic adenoma?

Answer 3

–MC salivary glad tumor. Usually on parotid. Benign but recurs

Question 4

What is a Warthlin’s tumor and how does it present?

Answer 4

–Papillary cystadenomalymphomatosum. Benign on parotid gland.
–Can injure facial nerve (look for palsy sxsin ? Stem)

Question 5

Discuss the significance of mucoepidermoid carcinoma

Answer 5

–MC malignant tumor. Arises from duct. Causes pain and CNVII palsy

Question 6

Diaphragmatic hernia presentation in a newborn besides the really obvious CXR

Answer 6

• Resp distress

- Scaphoid abdomen

Question 7

Biggest concern of diaphragmatic hernia in a newborn?

Answer 7

Pulmonary hypoplasia

Question 8

Best treatment for diaphragmatic hernia in a newborn

Answer 8

If dx prenatally, plan delivery at a place with ECMO, Let lungs mature for 3-4 days and then do surg

Question 9

Baby is born with excess drooling and respiratory distress

Answer 9

TE fistula (remember the 4 million tpes in first aid way back when?)

Question 10

Best diagnostic test for TE fistula

Answer 10

Place feeding tube, take x-ray, see it coiled in the thorax

Question 11

Gastroschisis vs omphalocele (chem levels if applicable and where they are)

Answer 11

Gastro looks terrible, complete evisceration of bowel and lateral to the midline. Sometimes see high maternal AFP. However, not associated with other disorders.

Omphalocele not so bad. Midline, covered. Associated with other conditions.

Question 12

Complications of gastroschisis?

Answer 12

Your bowel is sitting outside. Most likely gonna get infected.

May be atretic or necrotic requiring removal, leading potentially to short gut syndrome

Question 13

Defect in the midline but not an omphalocele

Answer 13

Umbilical hernia

Question 14

Umbilical hernias in the neonate is associated with what?

Answer 14

Congenital hypothyroidism. Potentially a big tongue

Question 15

Treatment for neonatal umbilical hernia

Answer 15

Repair not needed unless it persists past age 2 or 3

Question 16

Neonatal pyloric stenosis presentation

Answer 16

4 wk old infant with non bileous vomiting and palpable olive

Question 17

Metabolic complications of pyloric stenosis

Answer 17

Hypochloremic, metabolic alkalosis

Question 18

Treatment for pyloric stenosis

Answer 18

Immediate surg referral for myotomy

Question 19

What if it is a 2 wk old instead of a 4 wk old and the pregnancy was complicated by polyhydramnios?

Answer 19

Intestinal atresia or annular Pancreas.

Associated with down syndrome (esp duodenal)

Question 20

1 wk old baby with bileous vomiting, draws up his legs, had abd distension

Answer 20

Malrotation and volvulus

Question 21

What embryologically causes malrotation and volvulus?

Answer 21

Doesn’t rotate 270 ccw around SMA

Question 22

Explosion of poo on a DRE from a 3 day old newborn who hasn’t passed meconium

Answer 22

Hirschsprung’s

Question 23

Bx of Hirschsprung’s

Answer 23

No ganglia from bx

Question 24

Meconium ileus is linked with

Answer 24

CF if +FH.

Do gastrograffin enema for dx and treatment

Question 25

Bloody diarrhea in a 5 day old who was born at 33 weeks

Answer 25

Necrotizing enterocolitis

Question 26

Xray for necrotizing enterocolitis

Answer 26

Pneumocystis intestinalis (air in the wall)

Question 27

Treatment for necrotizing enterocolitis

Answer 27

NPO, TPN if necessary, antibiotics and resection of necrotic bowel

Question 28

Risk factors for necrotizing enterocolitis

Answer 28

Premature gut, introduction of feeds, formula

Question 29

Detection and treatment for Prostate Cancer

Answer 29

–Nodules on DRE or elevated/rising PSA means get a transrectal ultrasound and bx. Bone scan looks for blastic lesions.
–Tx w/ surgery, radiation, leuprolide or flutamide.

Question 30

Kidney stone treatment

Answer 30

CT is best test. If stone less than 5mm, hydrate and let it pass. If greater than 5mm, do shock wave lithotripsy. Surgical removal if more than 2cm.

Question 31

Avascular necrosis in kids vs adults

Answer 31

–In kids you see Leg-Calve-Perthe’s dz in 4-5 y/o w/ a painless limp and SCFE in a 12-13 y/o w/ knee pain or sickle cell pts
–In adults, steroid use, s/p femur fracture.

Question 32

Where and what do we see with osteosarcoma

Answer 32

–Seen in distal femur, proximal tibia @ metaphysis, around the knee
–Codman’s triangle and Sunray appearance

Question 33

What is a Ewing’s sarcoma, where do we see it and what do we see?

Answer 33

–Seen at diaphysis of long bones,
night pain, fever& elevated ESR
–Lytic bone lesions, “onion skinning”.
–Neuroendocrine (small blue) tumor

Question 34

For organ transplant what is chronic rejection

Answer 34

–Occurs after years. Due to T-lymphocytes.

–Can’t treat it. Need re-transplantation.

Question 35

When and what is happening with acute organ transplant rejection

Answer 35

–Organ dysfunction (incr GGT or Cr depending on organ) w/in 5days –3mo. Due to T-lymphocytes.

Question 36

Two organ systems you look at closely with acute organ transplant rejection

Answer 36

–Technical problems common in Liver. 1stcheck for biliary obstruction w/ U/S then check for thrombosis by Doppler.
–In heart, sxs come late, so check ventricular bx periodically.

Question 37

Treatment for acute rejection

Answer 37

–Tx w/ steroid bolus and antilymphocyteagent (OKT3)

Question 38

What’s the deal with hyperacute rejection?

Answer 38

–Vascular thrombosis w/in minutes

–Caused by preformed antibodies

Question 39

Epi for anesthesia can’t go:

Answer 39

Fingers, nose, penis, toes

Question 40

When do we do spinal subarachnoids for anesthesia?

Answer 40

–For ppl who can’t be intubated. Can’t give if incrI CP or hypotensive.

Question 41

What about an epidural?

Answer 41

Epidural-(local + opiod)

–If “high block” - blocks heart’s SNS nerves and phrenic nerve.

Question 42

Merperidine

Answer 42

Norperidine metabolite can lower seizure threshold esp in pts w/ renal failure.

Question 43

What do we worry about with succinylcholine

Answer 43

Can cause malignant hyperthermia, hyperK (not for burn or crush victim)