General Pearls

Question 1

Pre-thoracotomy PFT
give FEV1 cutoffs for pneumonectomy/lobectomy/wedge resection?
What is minimum predicted postop FEV1?

Answer 1

FEV1 > 2L / 1L / 0.6L

Need predicted postop FEV1 > 0.8

Question 2

Classically hamartoma CXR description

Answer 2

Popcorn lesion with calcifications

Question 3

Thoracic outlet syndrome

most common symptom

Answer 3

rarely involves artery or vein (1-3%), generally ulnar n paresthesias

Question 4

SVC syndrome

definition, symptoms, diagnosis and treatment

Answer 4

Lung Ca compressing SVC
flushing, cough, jvd
bronchoscopy
chemoradiation (no anti-coagulation)

Question 5

Treatment for Massive hemoptysis

Answer 5

rigid bronchoscopy and airway packing

Question 6

Acute lobar torsion

What is typical presentation?

Answer 6

post- RUL lobectomy; acute fever, tachycardia and opacification of RUL

Question 7

Give three indications for a tissue valve replacement

Answer 7

1. pregnant
2. tricuspid replacements
3. other contraindication to anticoagulation

Question 8

Proctocolectomy cures most extracolonic manifestations of UC except: (2)

Answer 8

sclerosing cholangitis and arthritis

Question 9

Treatment for Perianal abscess in Crohn’s

Answer 9

incision and drainage as with any abscess

Question 10

Treatment for perforated esophageal cancer

1. stable patient
2. unstable patient

Answer 10

Should try to get GI to stent first.

never primary repair; OK to reconstruct if stable. Resect with delayed reconstruction if unstable

Question 11

Indications and procedure

for esophageal Leiomyoma

Answer 11

if symptomatic or > 5cm excise by enucleation via thoracotomy (R if middle, L if lower esophagus). Do not biopsy on EGD.

Question 12

Parotitis
typical presentation?
treatment?

Answer 12

Dehydrated elderly patient;
Observe with antibiotics alone.
Surgical drainage for abscess of failure to improve.

Question 13

Tracheoinnominate fistula
Most common presentation?
How to avoid?

Answer 13

Present w/small heraldic bleed.

Avoid by making tracheostomy no lower than 3rd tracheal ring

Question 14

Hydatid/Echinococcal cyst
preoperative tests? (2)
What operation?

Answer 14

+Casoni skin test, +indirect hemagglutination

resect (pericystectomy) cyst without spillage (causes anaphylaxis)

Question 15

Diabetes Insipidus

two causes and mechanism:

Answer 15

Alcohol and head injury inhibit ADH

Question 16

Diabetes Insipidus

UOP and lab findings

Answer 16

high urine output, low urine SG, high serum osmolarity/Na

Question 17

CPP

formula and goal

Answer 17

MAP - ICP, want to keep ~70

Question 18

Compartment Syndrome

three most common fractures

Answer 18

Calcaneous fx, tibia fx, supracondylar humerus fx

Question 19

Ladd’s procedure for malrotation

Answer 19

take down bands, counterclockwise rotation, broaden the mesentery, do appendectomy.

Question 20

Glomus cell tumor

definition and operation

Answer 20

painful, subungal tumor, benign, from glomic end organ.

Operation: enucleation

Question 21

Wolk Chaikoff effect:

Answer 21

high I-doses (lugol’s, KI) inhibit TSH, useful in thyroid storm

Question 22

Silvadene

Answer 22

risk of neutropenia. Good activity against Candida. Poor eschar penetration

Question 23

Sulfamylon

Answer 23

painful; acidosis due to carbonic anhydrase inhibition (less H2CO3 -> H2O + CO2)

Question 24

Silver Nitrate Side Effects as Burn Treatment

Answer 24

hypnatremia nd hypochloremia due to leeching of NaCl

Question 25

Testicular mass:

operative approach

Answer 25

never biopsy  orchiectomy via inguinal incision. Never trans-scrotal

Question 26

Testicular torsion:

operative approach

Answer 26

bilateral orchiopexy

Question 27

Natural complications of appendicitis in pregnancy

Answer 27

50% premature delivery, fetal mortality 2-8%, maternal 1%

Question 28

Spigelian hernia

definition and operation

Answer 28

inferior to linea semicircularis, through linea seminlunaris; deep to ext oblique and therefore hard to diagnose Often incarcerates bowel, repair all

Question 29

Triangle of pain nerves

Answer 29

lat cutaneous femoral nerve and genitofemoral nerve.