Emma Holliday for Surgery: Part VIII Flashcards
Most frequent oral cancer and what we do about it
–Most freq squamous cell. In smokers & drinkers
–Tx w/ XRT or radical dissection (jaw/neck)
Laryngeal cancer is kids vs adults and what we do about it
–Laryngeal papilloma in kiddo w/ stridor or cough
–Squamous cell in adults.
–Tx w/ laryngoscope laser or resection
What is a pleomorphic adenoma?
–MC salivary glad tumor. Usually on parotid. Benign but recurs
What is a Warthlin’s tumor and how does it present?
–Papillary cystadenomalymphomatosum. Benign on parotid gland.
–Can injure facial nerve (look for palsy sxsin ? Stem)
Discuss the significance of mucoepidermoid carcinoma
–MC malignant tumor. Arises from duct. Causes pain and CNVII palsy
Diaphragmatic hernia presentation in a newborn besides the really obvious CXR
- Resp distress
- Scaphoid abdomen
Biggest concern of diaphragmatic hernia in a newborn?
Pulmonary hypoplasia
Best treatment for diaphragmatic hernia in a newborn
If dx prenatally, plan delivery at a place with ECMO, Let lungs mature for 3-4 days and then do surg
Baby is born with excess drooling and respiratory distress
TE fistula (remember the 4 million tpes in first aid way back when?)
Best diagnostic test for TE fistula
Place feeding tube, take x-ray, see it coiled in the thorax
Gastroschisis vs omphalocele (chem levels if applicable and where they are)
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.
Complications of gastroschisis?
Your bowel is sitting outside. Most likely gonna get infected.
May be atretic or necrotic requiring removal, leading potentially to short gut syndrome
Defect in the midline but not an omphalocele
Umbilical hernia
Umbilical hernias in the neonate is associated with what?
Congenital hypothyroidism. Potentially a big tongue
Treatment for neonatal umbilical hernia
Repair not needed unless it persists past age 2 or 3
Neonatal pyloric stenosis presentation
4 wk old infant with non bileous vomiting and palpable olive
Metabolic complications of pyloric stenosis
Hypochloremic, metabolic alkalosis
Treatment for pyloric stenosis
Immediate surg referral for myotomy
What if it is a 2 wk old instead of a 4 wk old and the pregnancy was complicated by polyhydramnios?
Intestinal atresia or annular Pancreas.
Associated with down syndrome (esp duodenal)
1 wk old baby with bileous vomiting, draws up his legs, had abd distension
Malrotation and volvulus
What embryologically causes malrotation and volvulus?
Doesn’t rotate 270 ccw around SMA
Explosion of poo on a DRE from a 3 day old newborn who hasn’t passed meconium
Hirschsprung’s
Bx of Hirschsprung’s
No ganglia from bx
Meconium ileus is linked with
CF if +FH.
Do gastrograffin enema for dx and treatment
Bloody diarrhea in a 5 day old who was born at 33 weeks
Necrotizing enterocolitis
Xray for necrotizing enterocolitis
Pneumocystis intestinalis (air in the wall)
Treatment for necrotizing enterocolitis
NPO, TPN if necessary, antibiotics and resection of necrotic bowel
Risk factors for necrotizing enterocolitis
Premature gut, introduction of feeds, formula
Detection and treatment for Prostate Cancer
–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.
Kidney stone treatment
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.
Avascular necrosis in kids vs adults
–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.
Where and what do we see with osteosarcoma
–Seen in distal femur, proximal tibia @ metaphysis, around the knee
–Codman’s triangle and Sunray appearance
What is a Ewing’s sarcoma, where do we see it and what do we see?
–Seen at diaphysis of long bones,
night pain, fever& elevated ESR
–Lytic bone lesions, “onion skinning”.
–Neuroendocrine (small blue) tumor
For organ transplant what is chronic rejection
–Occurs after years. Due to T-lymphocytes.
–Can’t treat it. Need re-transplantation.
When and what is happening with acute organ transplant rejection
–Organ dysfunction (incr GGT or Cr depending on organ) w/in 5days –3mo. Due to T-lymphocytes.
Two organ systems you look at closely with acute organ transplant rejection
–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.
Treatment for acute rejection
–Tx w/ steroid bolus and antilymphocyteagent (OKT3)
What’s the deal with hyperacute rejection?
–Vascular thrombosis w/in minutes
–Caused by preformed antibodies
Epi for anesthesia can’t go:
Fingers, nose, penis, toes
When do we do spinal subarachnoids for anesthesia?
–For ppl who can’t be intubated. Can’t give if incrI CP or hypotensive.
What about an epidural?
Epidural-(local + opiod)
–If “high block” - blocks heart’s SNS nerves and phrenic nerve.
Merperidine
Norperidine metabolite can lower seizure threshold esp in pts w/ renal failure.
What do we worry about with succinylcholine
Can cause malignant hyperthermia, hyperK (not for burn or crush victim)
