General Surgery

Question 1

Timing of suture removal for adults

Answer 1

Face: 4-5 days
Scalp: 6-7 days
Trunk, arm, leg: 7-10 days
Joints, extensor surface: 8-14 days
Joints, flexor surface: 8-10 days
Dorsum of hand: 7-9 days
Palm: 7-12 days
Sole of foot: 7-12 days

Question 2

Timing of suture removal for children

Answer 2

Face: 3-4 days
Scalp: 5-6 days
Trunk, arm, leg: 5-9 days days
Joints, extensor surface: 7-12 days
Joints, flexor surface: 6-8 days
Dorsum of hand: 5-7 days
Palm: 7-10 days
Sole of foot: 7-10 days

Question 3

Hemorrhage class II

Answer 3

750-1500mL blood loss
(15-30%)
HR>100
Orthostatic hypotension

Question 4

Hemorrhage class III

Answer 4

1500-2000mL blood loss
(30-40%)
HR>120
Hypotension

Question 5

First-line tx of ITP

Answer 5

Corticosteroids, longer courses
IVIG, 1g/kg one-time dose (may be repeated as necesary)
[table 4-2]

Question 6

Febrile NHTR

Answer 6

MOA: preformed cytokines, host Ab to donor lymphocytes
Prev: use leukocyte-reduced blood, store plt <5days

Question 7

Allergic transfusion reactions

Answer 7

MOA: soluble transfusion constituents
Prev: provide antihistamine prophylaxis

Question 8

TACO

Answer 8

Transfusion-assoc’d circulatory overload
MOA: large volume of blood transfused into an OLDER patient with CHF
Prev:
1. Increase transfusion time
2. Adminsiter diuretics
3. Miinimize assoc’d fluids

Question 9

TRALI

Answer 9

MOA: anti-HLA or anti HNA Ab in transfused blood attacks circulatory and pulmonary leukocytes
Prev: limit female donors

Question 10

Guidelines for referral to a burn center [table 8-1]

Answer 10

Partial thickness burns greater than 10% TBSA
Burns involving the face, hands, feet, genitalia, perinium, or major joints
3rd degree burns in ANY age group

Electrical burns, including lightning injury
Chemical burns
Inhalational injury

Comoribidities
Concomitant trauma in which the burn is the greatest risk
Burned children
Px who will require special social, emotional, or rehabilitative intervention

Question 11

BURNS: 4 crucial assessments in initial evaluation

Answer 11

1. Airway
2. Other injuries
3. Burn size
4. CO and cyanide poisoning

Question 12

BURNS: preferred method for securing the airway

Answer 12

Orotracheal intubation

Question 13

BURNS: When is two large-bore IV ideal?

Answer 13

When the burn is >40% TBSA

Question 14

Burns and antibiotics

Answer 14

Patients with acute burn injuries should never receive prophylactic antibiotics. This intervention has been clearly demonstrated to promote development of fungal infections and resistant organisms and was abandoned in the mid-1980s

Question 15

Acid that causes liquefactive necrosis

Answer 15

Hydrofluoric acid

• may also cause hypocalceia
• mgt: topical / IV calcium gluconate

Question 16

Formic acid

Answer 16

Known to cause hemolysis and hemoglobinuria

Question 17

BURNS: Dupuytren classification (1832), as per Schwartz, 2019

Answer 17

1st degree: superficial
2nd degree: partial-thickness (BLISTERS)
3rd degree: full-thickness (LEATHERY)
4th degree: affects underlying soft tissue
5th degree: muscle to bone
6th degree: charring bones

Question 18

BURNS: Zones of tissue injury

Answer 18

“Jackson’s 3 zones”
Zone of coagulatiotn
Zone of stasis
Zone of hyperemia

Question 19

Remarks on 2nd and 3rd degree

Answer 19

Superficial partial thickness: will heal with nonoperative mgt
Deep partial thickness and 3rd degree: will benefit from excision and skin grafting

Question 20

BURNS: formulas in nutrition

Answer 20

Harris-Benedict equation
-uses factors such as gender, age, height, weight
-may be inaccurate in burns <40% TBSA
Curreri formula
-25kcal/kg/day + 40kcal/%TBSA/day

Question 21

BURNS: fluid resuscitation

Answer 21

Parkland / Baster formula:
3-4mL LRS / kg / %TBSA
ABA formula:
2mL LRS / kg / % TBSA

Question 22

CHOLEDOCHAL CYSTS: Type I mgt

Answer 22

Cholecystectomy + excision of extrahepatic biliary tree + R en Y HJ

Question 23

CHOLEDOCHAL CYSTS: Type II mgt

Answer 23

Same as type I (Cholecystectomy + excision of extrahepatic biliary tree + R en Y HJ)
Or
Diverticulecctomy

Question 24

CHOLEDOCHAL CYSTS: Type III mgt

Answer 24

Sphicterotomy

• if small: sphicterotomy
• if large: transduodenal excision

Question 25

CHOLEDOCHAL CYSTS: Type IV mgt

Answer 25

Same as type I (Cholecystectomy + excision of extrahepatic biliary tree + R en Y HJ)

• for extrahepatic part: same as type I
• for intrahepatic part: partial hepatectomy

Question 26

CHOLEDOCHAL CYSTS: Type V mgt

Answer 26

If confined: hepatic resection

If bilobar / complex / portal HTN: liver transplant

Question 27

Esopageal blood supply

Answer 27

Cervical: inferior thyroid artery
Thoracic: bronchial arteries (1 right-sided and 2 left-sided branches
*2 esophageal branches arise directly from aorta
Abdominal: ascending branch of the LEFT GASTRIC ARTERY and from INFERIOR PHRENIC ARTERIES

Question 28

Esophagus venous drainage

Answer 28

Cervical: inferior thyroid vein
Thoracic: bronhical, azygos, or hemoazygos veins
Abdominal: coronary vein (LEFT gastric vein)

Question 29

Insulinoma: ___% are malignant, ___% are associated with MEN1 syndrome

Answer 29

10%, 10%

INSULINOMA
Most common functional pancreatic endocrine neoplasm
Presents with WHIPPLE’S TRIAD (Schwartz)
90% benign, solitary, and sporadic
*10% are malignant, 10% are assoc’d with MEN1 syndrome (morelikely to be multifocal; higher rate of recurrence)
EVENLY distributed throughout head, body, tail
Tx: simple enucleation, EXCEPT if close to main pancreatic duct and is >2cm