General Pearls Flashcards
Pre-thoracotomy PFT
give FEV1 cutoffs for pneumonectomy/lobectomy/wedge resection?
What is minimum predicted postop FEV1?
FEV1 > 2L / 1L / 0.6L
Need predicted postop FEV1 > 0.8
Classically hamartoma CXR description
Popcorn lesion with calcifications
Thoracic outlet syndrome
most common symptom
rarely involves artery or vein (1-3%), generally ulnar n paresthesias
SVC syndrome
definition, symptoms, diagnosis and treatment
Lung Ca compressing SVC
flushing, cough, jvd
bronchoscopy
chemoradiation (no anti-coagulation)
Treatment for Massive hemoptysis
rigid bronchoscopy and airway packing
Acute lobar torsion
What is typical presentation?
post- RUL lobectomy; acute fever, tachycardia and opacification of RUL
Give three indications for a tissue valve replacement
- pregnant
- tricuspid replacements
- other contraindication to anticoagulation
Proctocolectomy cures most extracolonic manifestations of UC except: (2)
sclerosing cholangitis and arthritis
Treatment for Perianal abscess in Crohn’s
incision and drainage as with any abscess
Treatment for perforated esophageal cancer
- stable patient
- unstable patient
Should try to get GI to stent first.
never primary repair; OK to reconstruct if stable. Resect with delayed reconstruction if unstable
Indications and procedure
for esophageal Leiomyoma
if symptomatic or > 5cm excise by enucleation via thoracotomy (R if middle, L if lower esophagus). Do not biopsy on EGD.
Parotitis
typical presentation?
treatment?
Dehydrated elderly patient;
Observe with antibiotics alone.
Surgical drainage for abscess of failure to improve.
Tracheoinnominate fistula
Most common presentation?
How to avoid?
Present w/small heraldic bleed.
Avoid by making tracheostomy no lower than 3rd tracheal ring
Hydatid/Echinococcal cyst
preoperative tests? (2)
What operation?
+Casoni skin test, +indirect hemagglutination
resect (pericystectomy) cyst without spillage (causes anaphylaxis)
Diabetes Insipidus
two causes and mechanism:
Alcohol and head injury inhibit ADH
Diabetes Insipidus
UOP and lab findings
high urine output, low urine SG, high serum osmolarity/Na
CPP
formula and goal
MAP - ICP, want to keep ~70
Compartment Syndrome
three most common fractures
Calcaneous fx, tibia fx, supracondylar humerus fx
Ladd’s procedure for malrotation
take down bands, counterclockwise rotation, broaden the mesentery, do appendectomy.
Glomus cell tumor
definition and operation
painful, subungal tumor, benign, from glomic end organ.
Operation: enucleation
Wolk Chaikoff effect:
high I-doses (lugol’s, KI) inhibit TSH, useful in thyroid storm
Silvadene
risk of neutropenia. Good activity against Candida. Poor eschar penetration
Sulfamylon
painful; acidosis due to carbonic anhydrase inhibition (less H2CO3 -> H2O + CO2)
Silver Nitrate Side Effects as Burn Treatment
hypnatremia nd hypochloremia due to leeching of NaCl
Testicular mass:
operative approach
never biopsy orchiectomy via inguinal incision. Never trans-scrotal
Testicular torsion:
operative approach
bilateral orchiopexy
Natural complications of appendicitis in pregnancy
50% premature delivery, fetal mortality 2-8%, maternal 1%
Spigelian hernia
definition and operation
inferior to linea semicircularis, through linea seminlunaris; deep to ext oblique and therefore hard to diagnose Often incarcerates bowel, repair all
Triangle of pain nerves
lat cutaneous femoral nerve and genitofemoral nerve.
