Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > gen surg > Flashcards

gen surg Flashcards

1
Q

treat malignant hyperthermia

A

o2
dantrolene
cold ivf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

dantroline
moa
and use in surgical context

A

uncouples excitation contraction by decreasing intracellular calcium by blocking ca release from sarcoplasmic reticulum

tx malignant hyperthermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which anesthetics cause malignant hyperthermia

A

volatile ones
inhaled halothane, fluranes
succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

mechanism of malignant hyperthermia

A

variant dihydropyridine or ryanodine ca receptors cause unregulated release of ca when certain volatile anesthetics bind (halothane, fluranes, succinylcholine) – sustained muscle contraction and hypercatabolic state, rhabdo when atp depleted, hyperthermia when heat generation outweighs dissipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

pyridostigmine moa

and use in tx of postop complication

A

blocks AchE
tx Olgilvie Syndrome – ileus of colon, commonly post-op in elderly
(more Ach, more ANS, more GI motility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

does hepatitis cause direct or indirect hyperbilirubinemia

A

mixed, intrahepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

is genetic hyperbilirubinemia typically direct or indirect?

A

mixed, intrahepatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

signs and symptoms of choledocolithiasis vs biliary stricture/cancer

A

choledocolithiasis:
-fever, leukocytosis, +murphy, pain

stricture/cancer
-afebrile, normal WBC, -murphy, wight loss
clay colored stool
painless jaundice
distended non-painful gallbladder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how to diagnose choledocolithiasis vs biliary stricture/cancer

A

RUQ US
MRCP
for both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

treat choledocholithiasis

A

ECRP (preferred)

cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

treat biliary stricture/cancer

A

depending on specific disease:
EUS + bx (pancreatic cancer) – whipple
ERCP + bx (cholangiocarcinoma) – resection
stenting (stricture not PSC (don’t stent PSC because need transplant…)
resection (ampulla of vater)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

s&s of obstructive jaundice not choledocholithiasis

A

wight loss
clay colored stool
painless jaundice
distended non-painful gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

signs of ampulla of vater as cause of painless obstructive jaundice
dx
tx

A

+FOBT
-colonoscopy
ERCP + bx
resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

sings of pancreatic cancer as cause of painless obstructive jaundice

A

migratory thrombophlebitis
EUS + bx
whipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

signs of cholangeocarcinoma as cause of painless obstructive jaundice
dx
tx

A

PSC (beads on string)
ERCP + bx
resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how to treat biliary stricture

A

stent

unless PSC.. will need… transplant..?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

simple definition of thrombophlebitis

A

venous clots associated w inflammation and pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

painless obstructive jaundice and migrating thrombophlebitis suggests

A

pancreatic cancer
dx EUS + bx
tx whipple

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

painless obstructive jaundice
+FOBT
-colonoscopy

suggests…

A

ampulla of vater issue..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

painless obstructive jaundice and PSC suggests…

A

cholangeocarcinoma
dx ERCP + bx
tx resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

2 biggest cardiovascular CIs to surgery

A

HFrEF v35% = moratility risk 75%

MI v 6 mos (40% mort at 3, 6% mort at 6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

goldman index

what is it

A

measure of cardiovascular CIs to surgery
most important factors are
HFrEFv35%
MIv6mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

CV preop screen

A

ECG (CI if MIv6mos)
echo (CI if HFrEFv35% - 75% mort)
stress test / left heart cath (CI if MIv6mos)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

surgical mortality risk if MI within
3 mos
6 mos

A

40% at 3

6% at 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

treat MI

A

stent (preferred)

CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

treat CHF

A

BB
ACEI
diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

pulm CIs to surgery

A

smoker
COPD/asthma
ILD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

preop pulm screen

A

PFTs
ABG
(for COPD, asthma, ILD… ^CO2, vO2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

preop liver screen
mortality risk
management

A 
MELD
Childs-Pugh
important factors include:
albumin v
pt/ptt ^
TBili ^
ascites
encephalopathy
--any 1 = 40% mort, all = 100% mort
--liver transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

why is nutrition screened preop?

A

affects healing ability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

preop nutrition screen
workup
management

A

20% weight loss in 3 mos
albumin v 3
skin anergy (not enough proteins for Igs for allergy)

prealbumin & CRP – other proteins body makes, to diff malnutrition from liver failure

PO nutrition preferred to parenteral IV
for 10 days preferred to 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

tf

prealbumin is made by the liver and turns into albumin

A

f
it comes before albumin when run on gel electrophoresis
it is another protein made by the body, screened eg to diff malnutrition from liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

preop metabolic screen

management

A

blood glucose
for DKA (glucose ^^ in DKA)
IVF and IV insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

preop screen consists of these tests for these diseases of 5 organs/systems

A

ECG, echo, stress test/LHC – HFrEF, MI
PFTs, ABG – COPD, asthma, ILD
alb, pt/ptt, tbili, ascites, encephalopathy - liver failure
20% weight loss 3 mos, alb, skin anergy, prealbumin, crp – malnutrition
blood glucose – dka

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

another name for prealbumin

A

transthyretin
called prealbumin because runs just ahead of albumin on gel electrophoresis, not a synthetic precursor to albumin, not synthesized by liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

overview of post-op fever and causes days 0-14

A 
0 intraop wonder drugs malignant hyperthermia
   postop day of surg bacteremia
1 wind atelectasis
2 wind PNA
3 water UTI
5 water DVT/PE
7 wound cellulitis
10-14 wound abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

intraop fever
dx
tx
ppx

A

clinical dx
malignant hyperthermia
O2; dantrolene, cool IVF
get family history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

postop fever day of surgery
dx
tx
ppx

A

blood cx
bacteremia
broad abx eg vanc piptazo
sterile precautions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

postop fever day 1
dx
tx
ppx

A

CXR
atelectasis
tx & ppx incentive spirometry, get out of bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

postop fever day 2
dx
tx
ppx

A

CXR
PNA
broad abx (HAP… vanc piptazo)
incentive spirometry, out of bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

postop fever day 3
dx
tx
ppx

A

UA Ucx
UTI
abx
remove foley ASAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

postop fever day 5
dx
tx
ppx

A

US bilateral LE
DVT/PE
heparin - warfarin
LMWH (can start postop), out of bed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

postop fever day 7
dx
tx
ppx

A

clinical, may be erythematous, not closed well
US negative for abscess, CT positive for cellulitis
Abx
sterile precautions and hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

postop fever day 10-14
dx
tx
ppx

A

US or CT shows abscess
abscess
abx; I&D
sterile precautions and hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

7 broad classes of postop complications to look out for

A 
fever
AMS
chest pain
abdominal distension
renal failure (v output)
wound non-closure
fistula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

ddx postop AMS and how to treat

A 
# DTs - 24-48hr hypot, tachyc, sweats; 48-72 hr tremors -- benzos
# hypoxemia: PE-anticoag; HAP-abx; ARDS-PEEP
# sundowning (elderly) - anipsychotics
# elytes - replete Na, Ca etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

brief definition of sundowning

tx

A

dementia-related agitation, confusion, hyperactivity building in late afternoon and evening
-antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

ddx postop chest pain
workup
tx

A 
# MI - ECG trops - PCI heparin NOT tPA POSTOP
# PE - US CT sprial - heparin--warfarin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

ddx postop dec urinary output
workup
tx

A

urge - bladder scan - obstruction - unkink foley, irrigate, in&out cath
no urge = renal failure - 500cc fluid bolus
inc output after bolus - prerenal - IVF
still no output after bolus - intrarenal - int med

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

ddx postop abdominal distension
workup
tx

A 
no stool no flatus
# day 1,2 - ileus / ogilvie - KUB - IVF, K+, out of bed for ileus -- rectal tube, stigmine, colonoscopy for ogilvie (colon ileus in elderly)
# day 5 - obstruction - KUB - SBO vs LBO - NG tube npo ivf for sbo... surg, lbo is surg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

SBO vs LBO appearance on KUB

A

SBO dilated proximal sb compressed distally

LBO dilated proximal lb compressed distally but normal sb because ileocecal valve prevents further backup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

wound dehiscence is a failure of what layer of a wound

A

the fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

wound dehiscence
s&s
dx
tx

A 
serosanguinous/salmon colored drainage
herniation
clinical dx
binders
avoid straining
elective reoperation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

difference betwen dehiscence and evisceration

A

dehiscence - failure of fascia

evisceration - failure of whole wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

wound evisceration
dx
tx

A

clinical dx - intestines are spilling out
apply warm saline dressing
emergent surgery
NEVER PUT SPILLAGE BACK IN w/o surgical setting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

postop fistula
ddx
tx

A

FETID
foreign body, epithelialization, tumor, inflammation/irradiation, distal obstruction
resect fistula
divert into ostomy while treating cause if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

most common complication of thyroidectomy

and assoc sx

A

hypoParathyroidism/hypocalcemia

from asymptomatic incidental lab finding
to non-specific fatigue anxiety depression
to severe tetany seizures qt prolongation (qtc v460 normal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

normal QTc

A

v460

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what electrolyte abnormality is seen with persistent hypothyroidism post-thyroidectomy

A

hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

tf

qt prolongation a result of hypothyroidism post thyroidectomy

A

f
not a result of hypothyroidism/hyponatremia

a result of hypoParathyroidism hypoCalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

how does vitamin D toxicity affect ekg

A

qt shortening from hypercalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

electrolyte disturbance in hypoparathyroidism

A

hypocalcemia
hyperphosphatemia
if renal function intact

63
Q

tf

rapid deceleration blunt chest trauama is high risk for airta injury

A

t

64
Q

s and s
workup
mgmt
for potential aorta injury after rapid deceleration blunt chest trauma

A

hypotension, evidence of external trauma, ams… if contained… if not contained usually death

stabilize abc’s airway breathing circulation

upright cxr (wide mediastinum, large left hemothorax, right mediastinum deviation, abnormal aorta contour)

confirm w chest ct

immediate operative repair…

65
Q

cxr findings consistent with aorta injury

A

wide mediastinum
large left hemothorax
right mediastinum deviation
abnormal aorta contour

66
Q

tf

esophageal rupture after blunt trauma like car accident is common

A

f

rare

67
Q

s and s
dx

esophageal rupture

A

pneumomediastinum
pleural effusion

water-soluble contrast esophagography

68
Q

tf

circulatory collapse with esophageal rupture

A

f

69
Q

immediate result of most myocardial ruptures

A

death

occasionally cardiac tamponade if contained by pericardium

70
Q

physical exam findings cardiac tamponade

A

hypotension
distended neck veins
muffled heart sounds

71
Q

ekg changes with myocardial contusion

A

tachycardia
new bbb’s
arrhythmia

72
Q

tf

sternal fx a common associated finding with myocardial contusiom

A

t

73
Q

s and s
xr findings
diaphragmatic rupture

A

abdominal pain
shoulder pain (referred)
sob
vomiting

abdominal cotents above diaphragm
loss of diaphragmatic contour

74
Q 
pneumothorax that does not resolve w chest tube
pneumomediastinum
subcutaneous emphysema
after blunt chest trauma
think...
A

bronchial rupture

rare after blunt chest trauma

75
Q

how does prerenal aki cause cr rise?

A

dec perfusion
dec cr filtration
inc serum creatinine

76
Q

bun/cr ^20:1 suggests…

A

prerenal aki

77
Q

quantitatively define oliguria

A

v500ml/24hrs

78
Q

urine sediment in prerenal aki

A

unremarkable
bland
no casts cells or protein

79
Q

tf

heart failure can cause prerenal aki in the setting of hypervolemia

A

t
dec Eabv
decreased Effective arterial blood volume

80
Q

treat prerenal aki

A

ivf isotonic fluid (normal saline)
to restore renal perfusion

as long as no signs of fluid overload (elevated jvp, lung crackles)

81
Q

differentiate prerenal from intrarenal aki in postop gi surg pt on piptazo

A

piptazo (beta lactams) can cause AIN acute interstitial nephritis… expect leukocytes in ua, skin rash

prerenal aki bland urine sediment no casts cells or protein

82
Q

how dose low dose dopamine affect renal blood flow

A

primarily d1 agonist
dilates afferent arteriole,
increasing rbf

83
Q

tf

give furosemide and mannitol to achieve urine output in pt w prerenal aki

A

F
loop diuretics and osmotic diuretics will further deplete eabf effective arterial blood volume, reduce renal blood flow, worsen prerenal aki, and potentially lead to atn acute tubular necrosis from low rbf

84
Q

for what is intravenous urography useful

A

eval for ureteral injury

85
Q

most pts w acute appendicitis will seek medical care within how long of start of sx?

A

within 24-48 hours

if delayed presentation w longer sx (^5days) think apendiceal rupture w contained abscess

86
Q

s and s
tx
acute apoendicitis

A

vague periumbilical to rlq pain
fever nv anorexia
parietal peritoneal irritation signs (rebound tenderness, involuntary guarding, ab rigidity) if rupture impending or completed with diffuse peritonitis
-urgent appendectomy

87
Q

what to suspect in delayed presentation of appendicitis (^5days sx)

and how to work up and manage

A

appendiceal rupture w contained abscess

fev leuk
unhelpful anterior ab exam
psoas sign (ext), obturator sign int rot), rectal exam more informative
ct confirms
ivabx npo, maybe percutaneous drainage, elective interval appendectomy at 6-8 wks (avoid immediate surgery as compx rate high w large surrounding inflammation friable debris and adhesions)

88
Q

psoas sign
what is it
ddx for + sign

A

pain on hip ext

abscess near psoas or retrocecal appendix

89
Q

obturator sign
what is it
ddx for + sign

A

rlq pain w internal rot of hip

pelvic appendix or abscess

90
Q

physical exam findings in appendicitis

A 
peritoneal signs (rebound tenderness, involuntary guarding, abdominal rigity) - rupture or impending
rovsing sign (rlq pain on llq palp), psoas sign (ext), obturator sign (int rot), rectal exam tenderness
91
Q

presentation of colon cancer

A

anemia
constipation
weight loss

92
Q

tf

psoas sign positive w pyelonephritis

A

f

93
Q

tf

atelectasis is common after abdominal surgery

A

t

94
Q

pathogenesis of postop atelectasis

A

pain and changed in lung compliance
cause shallow breathing and reduced cough reflex
limiting recruitment of alveoli at bases
and allowing small airway mucous plugging
resultant hypoxia stimulates respirstory rate and hypocapnea

95
Q

when is postop atelectasis most likely to manifest

A

day 2-3…-5

after postop night 2 (the start of day 2) to postop night 5, usually postop day 2-3

96
Q

decrease the incidence of postop atelectasis

A 
adequate pain control
deep-breathing exercises
incentive spirometry
directed coughing
out of bed (early mobilization)
97
Q

decreased breath sounds in the bases 2-3-5 days postop think…

A

atelectasis

98
Q

sudden onset
dyspnea cough fever ronchi/crackles
within hours postop before leaving perioperative unit
think…

A

aspiration
(of gastric contents)

due to impaired laryngeal defenses after postop anesthesia

99
Q

consequences of unilateral vs bilateral diaphragmatic paralysis

A

usually asymptomatic
vs
hypoxemia, rapid shallow breathing, orthopnea, sometimes respiratory failure

100
Q

pathogenesis of VAP ventilator-associated pneumonia

A

impaired lung defenses
after ^48 hours on ventilator
causing fever, hypoxia
suspect pseudomonas

101
Q

s and s

necrotizing surgical site infection

A
  • pain edema erythema beyond surgical site
  • fev tachyc hypot (systemic signs)
  • anesthesia paresthesia at edges of wound
  • “dishwater drainage” purulent cloudy gray
  • subq crepitus
102
Q

big risk factor for surgical site infection

A

diabetes

103
Q

bug in most surgical site infections

A

polymicrobial

104
Q

when is a surgical site infection considered an emergency

A

when it invades the fascial plain and becomes nec fasc

105
Q

manage necrotizing surgical site infection

A

EARLY SURGICAL EXPLORATION to eval extent and debride necrotic tissue
-broad abx, hydration, glycemic control are secondary

106
Q

tf

next step in mgmt of infected surgical wound is vac dressing broad abx and glucemic control

A

Fish tish
SURGICAL EXPLORATION to assess extent and debride necrotic tissue… if only cellulitis, abx dressing and glucose control appropriate
-appropriate dressing (don’t vac infected/necrotic wound immediately, reserved for healthy granulation tissue to accelerate healing), broad spectrum abx, glycemic control all important but not sufficient without surgical exploration for necrotizing infection

107
Q

differentiate necrotizing infection demanding surgical exploration from celullitis amenable to abx dressings and glycemic control

A

think when getting down to bottom 3 you have to suspect necrosis… also intensity of pain…

  • pain edema erythema beyond surgical site
  • fev tachyc hypot (systemic signs)
  • anesthesia paresthesia at edges of wound
  • “dishwater drainage” purulent cloudy gray
  • subq crepitus
108
Q

describe use of topical antimicrobial agents for surgical site infections

A

no clear use
may inhibit healing
and parenteral abx treat infection better

109
Q

person amputated a digit or limb, please advise

A

wrap in gauze
moisten with saline
put in plastic bag, on ice
send pt w limb to ed

(cool limb without freezing, will keep viable for reimplantation for up to 24 hours)

110
Q

best candidates for reimplantation of amputated limb

A

young
sharp cut not crush or avulsion
wrap in saline-moistened gauze and put on ice in plastic bag (don’t freeze) to preserve for up to 24 hours

111
Q 
tf
good ideas for amputated digit include
immerse in water
immerse in antiseptic solution or alcohol
put directly on ice
A

f
water immersion makes vessel repair more difficult
chemical injury may result from immersion in chemicals – the digit will be prepped appropriately with irrigation and abx for surgery in the hospital
frostbite injury can occure from direct placement on ice

112
Q

tf

varicocele transilluminates

A

f
hydrocele transilluminates
(peritoneal fluid collection between visceral and parietal tunica vaginalis)

varicocele does not transilluminate (dilation of pampiniform plexus)

113
Q

difference between hydrocele and varicocele

A

hydrocele transilluminates
(peritoneal fluid collection between visceral and parietal tunica vaginalis)

varicocele does not transilluminate (dilation of pampiniform plexus)

114
Q

presentation of varicocele

A

soft bag of worms in scrotum, size inc standing valsalva, dec supine
subfertility
testicular atrophy

115
Q

us findings in varicocele

A

dilation of pampiniform plexus
retrograde venous flow
tortuous anechoic tubules adjacent to testis

116
Q

treat varicocele

A

young men and boys with scrotal atrophy who desire fertility – scrotal vein ligation

old guys no more kids – scrotal support and nsaids…

117
Q

pres
dx
tx
varicocele

A

painful bag of worms in scrotum, inc w standing valsalva, subfertility testicular atrophy
us - dilated pampiniform plexus, retrograde venous flow
fertility desired - scrotal vein ligation.. if not, scrotal support and nsaids

118
Q

varicocele is more common on what side?

A

left

left gonadal vein drains into left renal vein, can get nutcracked between sma and aorta

119
Q

when can right varicocele present

A

mass effect eg from renal cell carcinoma or thrombus causing back up in gonadal vein into pampiniform plexus

120
Q

where do the left and right gonadal veins drain, respectively

A

left renal vein

ivc

121
Q

does the right renal artery cross ant or post to ivc

A

post

(remember left renal vein crossed ant to aorts for nutcrack under sma, so ivc shifted just ant to aorts at that level

122
Q

spermatocele
definition
presentation
does it change size with position or valsalva

A

fluid filled cist of head of epididymis
painless palpable mass at superior pole of testis
does not change size w standing valsalva etc

123
Q

tf

hydrocele changes w position

A

tish

Can change with position if communicating w peritoneum via patent processus vaginalis

124
Q

tf

a femoral hernia can protrude into scrotum

A

f

indirect inguinal hernia does this

125
Q

demo
pres
femoral hernia

A

older women

discomfort upper thigh, groin, pelvis

126
Q

where is the femoral ring relative to the inguinal ligament

A

below it

127
Q

borders of anatomkc snuffbox

A

(in anatomic position - vetruvian man)

medially extensor pollicus longus
laterally abductor pollicus longus

128
Q

what to do if scalhoid fx suspected but initial xr normal

A

get ct or mri or repeat xr after 7-10 days spica cast

129
Q

how to treat displaced scaphoid fx
vs
nondisplaced

A

surg
vs
thumb/wrist spica w fu xr

130
Q

etiology of bacterial tenosynovitis

A

penetrating injury eg cat bite to hand

hematogenous spread of distant inf (eg n. gonorrhoeae)

131
Q

etiology of fat embolism

A

long bone fracture

extensive soft tissue injury eg burn

132
Q

synovial cyst aka

A

ganglion cyst

133
Q

demo
etiology
synovial (ganglion) cyst

A

15-40yo

repetitive stress or inflammation

134
Q

tf

nerve injury is common w scaphoid fx

A

f

but lunate disloc next to it can cause median nerve compression in carpal tunnel

135
Q

etiologies of anal fissures

A

constipation, prolongued diarrhea, anal sex (trauma)
ibd
malignancy

136
Q

tf

skin tags associated w anal fissure

A

t

chronic fissure may have skin tag at distal end

137
Q

most common position of anal fissure

A

posterior midline…

138
Q

anal fissures relative to dentate line

A

distal to dentate line

139
Q

mechanism of chronic anal fissure

A

pain causes sphincter spasm which tears again/larger

140
Q

how does comstipation cause anal fissure

A

hard stools high pressures tears

141
Q

external skin tag at distal end of chronic anal fissure aka

A

sentinal pile

142
Q

what is a sitz bath

A

warm water dip for the perineum and/or anus
-sometimes with iodine, salt, baking soda, vinegar

warm water for blood flow, faster healing, itch irritation pain relief

143
Q

treat anal fissure

A

fiber diet, adequate hydration
stool softener
sitz baths
topical anesthetic (lidocaine) and vasodilator (nifedipine, nitroglycerin)

144
Q

why are topical vasodilators like nifedipine and nitroglycerin used to tx anal fissure

A

relieve sphincter pressure (dilate sphincter?)

increase blood flow for healing…

145
Q

tf

topical vasoconstrictors used to stem bleed of anal fissure

A

f
topical lidocaine used for anesthesia, topical nifedipine or nitroglycerin used for vasoDILATION to relieve sphincter pressure and inc blood flow for healing…

146
Q

when to consider fissure excision or lateral sphincterotomy for anal fissure
why
complications

A

when refractory to medical management (fiber, hydration, stool softener, sitz bath, lidocaine, nifedipine nitroglycerin)

to relieve pressure and/or interrupt spasm
but compx include incontinence and recurrent fissures

147
Q 
nausea
post prandial pain
vomiting of partially digested food
early satiety
weight loss
think...
A

gastric outlet obstruction

148
Q

etiologies of gastric outlet obstruction

A 
gastric malgnancy
pud peptic ulcer disease
crohn's
stricture with pyloric stenosis from caustic substance ingestion
gastric bezoar
149
Q

caustic means

A

able to burn or corrode organic tissue by chemical rxn

literally or figuratively eg sarcasm

150
Q

define abdominal succussion splash

A

splashing sounds heard with stethescope over upper abdomen while rocking hips

retained gastric material ^3hrs, liquid gas

151
Q

how long after acid ingestion to fibrosis eg pyloric stricture

A

6-12 wks

1.5-3 mos

152
Q

dx and tx pyloric stricture

A

upper endoscopy

surg

153
Q

tf

pancreatitis causes gastric outlet obstruction

A

f

may cause inflammation amd fibrosis and rarely obstruction of duod jeju transv colon, not usually stomach

154
Q

typical duration of diabetes before gastroparesis

A

a decade or longer

Surgery (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions