GenSurg Flashcards

1
Q

? is the name of the duodenal/jejunal feeding tube

How are positions verified

What are the E+ abnormalities seen w/ refeeding syndrome

A

Dobhoff tube

KUB films

Hypo K, Mg, Phos

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2
Q

What surveillance order is needed on Pts receiving TPN

Feeding tubes can be placed/started ? soon after surgery

Define Visceral vs Parietal pain

A

Weekly liver enzymes

Day 2 post-op

V: afferent fibers, pain MC midline d/t bilateral innervation
P: sharp/precise pain d/t peritoneal irritation

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3
Q

Sequence of x-ray assessment

What is a 3-way abdomen image and what is it used for

Abdominal x-rays normally show air in ? three areas

A

Adequacy Bones Calcifications Deformity/Density Extra air Foreign body/Fx

Flat, Upright, CXR for hemo/pneumo-peritononeum

Stomach Small bowel, Rectosigmoid

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4
Q

How are mechanical obstructions distinguished from ileus’

Ileus are more common after ? d/t ?

Sub-diaphragmatic air on x-ray suggests ? issue

A

Mechanical- more localized, severe pain
Ileus- diffuse and milder

Post-op d/t inc sympathetic nerve activity

Perforated viscous

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5
Q

Where does the appendix arise from

What land mark is used to locate it during removal

What causes this to become obstructed in adults/peds

A

Postero-medial cecum, 2cm inferior of IC valve

Taeniae of colon converging at base

Adult: fecalith Peds: lymphoid hyperplasia

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6
Q

What are the 3 PE tests performed to locate appendicitis

Mnemonic for Alvarado Score

A

McBurney: iliac fossa
Obturator- pelvis
Psoas- retroperitoneal/cecal

Migration to R iliac fossa- 2pts
Anorexia
N/V
Tenderness in R iliac fossa
Rebound pain
Elevated temp
Leukocytosis- 2pts (>75% neutrophils)
Shift to left of WBCs

5-6: compatible 7-8: probable 9-10: very probable

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7
Q

What ABX are used during appendicitis

Appendix are routinely removed even if not inflamed during ? GI surgery

What PE test is used for rectus sheath hematoma

A

Cipro+Metronidazole: Perf’d
Cefoxitin: non-perf’d

Meckels Diverticulum

Neg Fothergill sign

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8
Q

Where are Boerhaave perfs most likely to occur

What images are done

What lab result would be elevated from thoracentesis after Boerhave perfs

A

Left posterolateral wall- causes Hamman crunch

Cervical x-ray
Esophagogram w/ contrast
Chest CT to localize

Amylase

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9
Q

? is the most sensitive imaging study for suspected esophageal cancers

How are Pts managed

? is the most important prognostic factor

A

Endoscopic US w/ FNA of lymph nodes

Neoadjuvant chemo and rad

Stage of Dz

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10
Q

What are the 2 MC complications to occur within 30days after bariatric surgery

What is the most concerning early complication

? is the MC performed bariatric surgery

A

Dehydration, E+ imbalance

Anastomotic leak

LSG

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11
Q

? is the most accurate method to Dx gastric ulcers

When is a Dx of Zollinger Ellison Syndrome considered

What lab test is used for Dx

A

Endoscopy

Ulcer refractory to PPI
Ulcer in distal duodenum/jejunum
Recurrent ulcers despite Tx

Fasting gastrin, d/c PPI one week prior

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12
Q

? pre-op image is used to localize Zollinger Ellison tumors and all are Tx w/ ?

? triple therapy is used for Tx

Why is maintenance therapy done w/ Omeprazole

A

Somatostain receptor scintigraphy; Resection

Amox Clarith w/ PPI

Inhibits parietal cell ATP tor educe ulcer recurrence

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13
Q

Test of choice for post-gastric ulcer Tx eradication

What procedures done to Tx high risk Pts w/ gastric ulcers

How are perforated duodenal ulcers Tx

A

Urea breath test

Billroth I- gastroduodenal anastomosis
Bilroth 2- gastrojejunal anastomosis
Roux en-Y gastrojejunostomy

Omental/Graham patch

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14
Q

Complications after antrectomy

Complications after Truncal Vagotomy

? type of diet do Pts adopt to Tx Dumping Syndrome

A

Leakage from duodenal stump

Delayed emptying, Dumping syndrome, Diarrhea

Low carb, High fat/protein

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15
Q

What is the most sensitive and specific test for suspected Pyloric Stenosis and how is this Tx

? type of ulcer is not associated w/ Ca risk

These ulcers can be Tx by ? methods

A

US; Laparoscopic pyloromyotomy

Duodenal

EGD <24hrs if hermorrhaging, Selective vagotomy

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16
Q

? is the MC form of volvulus

How are these Dx

Pts w/ ? signs need immediate surgery or ? if no signs are present

A

Sigmoid then Cecal

Colonic- X-ray; Small bowel- CT

Toxic, Bloody d/c, Fever, Leukocytosis, Peritonitis- surgery
None- sigmoidoscopy

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17
Q

Define Rigler Triad

How is this Dx

How is this Tx

A

Abdominal radiograph findings for gallstone ileus: Pneumobilia Obstruction Gallstone

CT

Enterolithotomy- incision made proximal to obstruction for relief and removal

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18
Q

Meckel’s Diverticulum is d/t a remnant of ?

What is the Rule of 2s

A

Omphalomesenteric duct

2% of peds population
2 tissue types: gastric, pancreatic
2 feet from ileocecal valve

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19
Q

? are the MC benign tumors of the small bowel

? are the MC malignant tumors of the small bowel

? are the MC endocrine tumors of the small bowel

A

Leimyoma, Adenoma

Adenocarcinoma

Carcinoid tumor: hot flash, bronchospasm, arrhythmias

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20
Q

Define Bezoar

How are these conditions Dx by images

How are they Tx

A
Compacted, retained foreign material in GI tract:
Phyto- fiber
Lacto- milk
Pharma- meds
Tricho- hair

AP films

Endoscopy then surgery

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21
Q

? is the most sensitive and specific study to Dx acute cholecystitis

MCC of cholelithiasis

What are the RFs to develop this MCC

A

Cholescintigraphy: Hida scan

Cholesterol stones

Age Female Obesity Parity

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22
Q

What causes pigmented stones in the gallbladder

When are pigmented stones seen

What are the non-surgical Tx options for cholecystitis in Pts inelligible for surgery

A

Inc unconjugated bilirubin, turns into Ca bilirubinate

Sickle Thalassemia Spherocytosis

Ursodeoxycholic acid: stones <15mm
ESWL- breaks stones <2mm for passing

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23
Q

Optimum time for cholecystectomy or ? is performed

What is the MC complication that arises from acalculous cholecystitis

Choledocholithiasis leads to ? Dx

A

<72hrs from Sx onset; Percutaneous cholecystostomy

Gangrene > Perf, Empyema

Cholangitis

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24
Q

Common Bile Duct dilation more than ? suggest choledocolithiasis

What are the high risk features for suspected choledocholithiasis

How are mild or mod/sev cases of cholangitis Tx w/ ABX

A

> 10mm/1cm

Age >55y/o Bili >30mmol CBD >6mm Dx US w/ stone

Mild/Mod: Cefazolin/Cefoxitin
Sev/Deterioration: Aminoglycoside + Clinda or Metro

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25
Severe or unremitting cholangitis despite ABX are best Tx w/ ? How much gas is used to inflate the abdomen during lap procedures What is the name of the incision used for open cholecystectomy procedures
Endoscopic sphincterotomy then to laparotomy 15mmHg of CO2 Kocher's in RUQ
26
Post-cholecystectomy ABX are continued for how long When are Pts f/u w/ and when can they return to normal activity What system breaks up the liver into segments
Until afebrile and normal leukocytosis F/u 1wk, normal routine in 6-8wks Couinaud into 8 sections
27
Common hepatic artery arises from ? structure What structure marks the point of origin for the artery Why is vascular control within the abdomen difficult
Celiac axis Gastroduodenal artery Hepatic veins are very short prior to entering IVC
28
What 3 structures make up the portal triad These three structures enter the liver through ? Bile is composed of ? four components
Hepatic artery, Portal vein, Biliary duct Hepatic hilum Formed in hepatocytes out of: Conjugated bile acid, Cholesterol, Phospholipid, Protein
29
What are the Vitamin K dependent clotting factors MC injured organ w/ abdominal blunt trauma and w/ ? MC sequelae and ? is the Tx strategy for this injury What is a rare sequelae to liver trauma
2 7 9 10 Liver- biliary fistulae after central injury pattern: Non-op management Pneumobilia
30
# Define Bilioma How are these Tx if major leakage occurs MC type of liver cyst
Loculated collection of bile ERCP and spincterotomy Simple hepatic: anechoice lesion w/ smooth contours
31
What is the name of the pre-malignant liver cyst and how are they Tx Polycystic Liver Dz occur in Pts w/ ? MedHx How are the different types Tx
Cystadenoma- internal septae w/ irregular lining and papillary projections; Tx: resection PCKDz Type 1: cyst fenestration w/ <10 cysts >10cm Type 3: transplant d/t parenchymal involvement
32
? is the MC liver tumor How are these results different on imaging Hepatic adenomas are associated w/ ? RFs and managed how
Hemangioma d/t congenital vascular malformation T1: hypointense T2: hyperintense Cold: NucMed scan OCP/Androgen steroid use; <3cm: observe while d/c OCPs Resection: >5cm, expanding, malignant suspicion
33
Histologically, Hepatocellular Adenomas consist of ? How are Focal Nodular Hyperplasia growths of the liver ID'd w/ imaging What is the major RF for developing Hepatocellular Carcinoma
Benign hepatocytes Hot on NucMed imaging Chronic Liver Dz: Chronic hep B/C
34
How is Hepatocellular Carcinoma Dx After Dx of Hepatocellular Carcinoma, what f/u schedule do Pts have What are the 4 palliative options for these Pts
High resolution CT/MRI US w/ A-fetoprotein q6mon TACE TARE SBRT Sorafenib
35
What is the MC classification system used for liver failure How are Pts w/ Chronic Liver Dz Tx What is the name of the main/accessory duct in pancreas
Child-Pugh: Class C is c/i for hepatic resection TIPSS: shunt placed and BBs to reduce risk of first bleed Main Wirsung Accessory: Santorini
36
# Define Budd Chiari Syndrome When is this MC seen Initial Tx is ? followed by ?
Hepatic vein thrombosis Hypercoagulable female w/ RUQ pain, Ascites, Megaly TIPS then portal decompression before hepatic necrosis occurs (Fullament failure Tx w/ transplant)
37
Why does Acute Pancreatitis prominently present w/ N/V What are the 6 parts of the Ranson Criteria What scoring system is used as a bed side index of severity
Accompanying paralytic ileus GA LAW: Glucose>200 Age>55 LDH>350 AST>250 WBC>16K BASAP: BUN>25mg AMS SIRS Age>60 Pleural effusion
38
Pancreatic Pseudocysts form d/t and occur more commonly in Pts w/ ? What complication can occur as a result of severe pancreatic inflammation D/t fluid sequestration, how is hypovolemia Tx during acute pancreatitis
Acute pancreatitis fails to recover after 1wk of Tx; Duct abnormalities Pseudoaneurysm- acute exacerbation of abdominal pain 3-6L 9% NS or LR over first 24hrs
39
MCC of Chronic pancreatitis What is the clinical tetrad for this condition Name of Tx operation for large/small pancreatic duct chronic pancreatitis
Alcoholism Pain Weight loss Diabetes Steatorrhea: assess A1c, fecal elastase, check for HyperCa/Tglc Large: Puestow Small: Whipple, Beger
40
What is the traditional resection operation to Tx chronic pancreatitis MC type of pancreatic neoplasms What is the defining characteristic of this neoplasm
Pancreaticoduodenectomy- removed pancreatic head, duodenum and distal CBD (Whipple) Ductal adenocarcinoma (2nd MC GI tract malignancy), Bili levels average 18mg/dL Aggressiveness- early dissemination
41
How is pancreatic cancer Tx surgically What is the MC type of functional PNETs What triad is used for Dx of this MC
Pancreaticoduodenectomy- whipple procedure removing pancreatic head, duodenum, distal biliary system Insulinoma- Sxs of cerebral glucose deprivation Whipple Triad: Symptomatic fasting hypoglycemia w/ glucose <50 that is relieved w/ IV glucose
42
How are Insulinomas Dx ? is the MC PNET of MEN-1 These are MC found in ? anatomical triangle
72hr monitored fasting Gastrinoma- abdominal pain, diarrhea, refractory PUDz Pancreatic neck Junction of 2nd and 3rd duodenum Junction of cystic and common ducts
43
How are gastrinomas Dx All Pts w/ MEN-1 and gastrinomas should be screened for ? What is the most important determinant for Pt survival
Fasting serum gastrin >1000 Borderline: order secretin provocative test Parathyroid adenoma/hyperplasia/hyperCa Liver mets
44
Where are the majority of accessory spleens found What are the 3 zones and their function What are the two MC reasons for splenectomy
Splenic hilum- persistent dz if unrecognized Red: hematologic White: immunoglobulins Marginal: macrophages B-cells Sx relief of splenomeglay, ITP unresponsive to Pred
45
When are post-splenectomy Pts vaccinated What microbes are the vaccinated against and why are these needed Splenectomy can induce ? increase in heme results that is managed w/ ?
2wks prior to elective ectomy 2wks after emergent ectomy or at d/c if <2wks 3mon after chemo/rad H-flu Strep pneumo Meningococcus- avoid Overwhelming Post-Splenectomy Infection Thrombocytopenia induced risk for emoblisms- Tx w/ ASA and anti-platelet when Plt >600K
46
What are the 5 layers of the colon from in to out What are the only two parts of colon w/out taenia coli ? parts of the colon are retro/intra-peritoneal
Mucosa Submucosa Circle/Long muscle Serosa Longitudinal ribbons of smooth muscle outside of intestines: Appendix, Rectum Retro: ascending, descending Intra: transverse
47
What causes diverticulosis to bleed ? is the most optimal imaging modality for lower GI bleeds What are the indications for surgery
Thinning of out pouching of superficial vasa recta Colonoscopy Persistent/Massive hemorrhage Transfusion or >4units <24hrs Recurrent bleed
48
Colorectal polyps are classified per ? criteria ? tumor marker is used post-op for colorectal recurrence What Dx initiates colonoscopies regardless of age
Haggitt CEA UC- risk for Ca
49
Colonic obstruction d/t ? tends to be more localized and severe Pain from ? part of the colon is diffuse and milder ? image finding is highly suggestive of colon cancer
Mechanical obstruction Ileus Barium enema w/ apple core lesion- can be Dx and therapeutic
50
Crohns Dz causes ulcers in ? shape ? histology results will be seen How is UC surgically cured
Bear claw Non-caseating granulomas Total proctocolectomy
51
What are the 3 zones where hemorrhoids can develop Internal hemorrhoids are lined by ? External hemorrhoids are lined by ?
R-anterior, R-posterior, L-lateral Columnar mucosa epithelium Squamous epithelium
52
? med is a stool softener ? med is fiber Define Rectal Procidentia
Colace Metamucil Rectal prolapse- full thickness protrusion through anus
53
What are the 4 RFs for rectal prolapse Majority of cancers at the anal margin are ? type Neoplams of the anal margin appear as ?
Post-menopause Female Constipation Surgery SCC- well differentiated and rarely w/ distant mets Rolled, everted edges w/ central ulcerations
54
What is the best initial management strategy for malignant neoplasms at the anal margin Majority of anal fissures are found ? What type are more commonly found in females
Chemoradiation Posterior anal canal Anterior fissures
55
Why are lateral internal spincterotomys preferred over posteriors Why do Pts not experience incontinence after surgery ? type of anal abscess tend to be larger and complex
Avoid keyhole deformities Intact external sphincter Ischirectal- cryptoglandular infection w/in anal canal
56
? type of anal abscess have increased rates of fistulas Pilonidal dz is AKA ? Dz What is the name of the procedure for Pilonidal Dz
Horse shoe abscesses Jeep seat dz- hair follicles in gluteal cleft infected w/ keratin leading to infection/abscess formation Bascom
57
# Define the Chamberlain Procedure What procedure is used as an alternative MC indication for needle biopsy of the lung
Anterior mediastinotomy for biopsy x3 VATS Solitary pulm nodule
58
? form of imaging is particularly good for evaluating Pancoast Tumors ? image is used to detect cancer spread to mediastinal lymph nodes Define Infiltrate and Effusion
MRI PET In: fluid in lung; Eff: fluid in pleural space (meniscus sign on CXR)
59
? is the standard image to Dx Ptx Ptx are the MC ? problem ? are the MC Sxs of pleural Dzs
PA and Lat CXR w/ exhalation Pleural- no innervation to visceral layer Pain, Dyspnea d/t innervation from somatic intercostal/phrenic nerve
60
Pleural effusions develop d/t ? changes How much fluid does it take to blunt CV angles or an entire hemithorax on CXR How much fluid is needed on thoracentesis for evaluation
Inc hydrostatic press, capillary permeability Dec colloid oncotic press, intrapleural press, lymph drainage CVA: 300-500mL Hemi: 2-2500mL 20mL at least
61
Transudate and Exudates are caused by ? What lab results are seen in Transudate results Once full lung expansion is achieved after pleural effusions, ? is the next step
Trans: CHF, LF Ex: Ca, Pneumonia, PE Total protein <3g (ratio <0.5) LDH ration <0.6 SpecGrav <1.016 Pleurodesis w/ Doxy/Talc
62
? size tube are used for malignant effusion, hemothoraces Tx MCC of exudative pleural effusion is ? ? microbe is the MCC of empyema
Ca: 20-28F Heme: 32-36F Malignancy Staph A
63
? parasite can induce thoracic empyema ? is the most important non-invasive test for thoracic empyema All PTs need ? procedure and ? is the procedure of choice for Dx
Entamoeba histolytica CXR Bronchoscopy; Thoracentesis
64
? is the MCC of death in men and women in the US Pancoast tumors are more likely to be ? type ? is Horners Triad
Lung Ca Squamous cell Ca in apex SCC in apex causing Mitosis Anhydrosis Ptosis
65
? types of lung Ca are more likely to be peripheral or central Non-Small Cell Lung Ca is more likely to secrete ? while Small Cell Lung Ca is more likely to secrete ? substance ? nerve can become compressed by pancoast tumors in the apex
Peripheral: adenocarcinoma (painless) Central: Small Cell Non: PTH-like: HyperCa Small: ADH-like: SIADH, MSH, ACTH Ulnar
66
CT scans for lung neoplasms include the upper abdomen because of ? two common met sites ? lab result is essential because then ? tests are ordered ? is used for the staging test and is most effective for assessing distant/occult Dzs
Liver, adrenals AlkPhos- bone scan brain MRI/CT Fluorodeoxyglucose PET scan
67
Lung neoplasms are more likely benign w/ ? characteristics ? is the most predictive factor for successful surgical outcome in these Pts Difference between Neoadjuvant and Adjuvant chemo
<2cm, Concentric, Smooth, Solitary CardioPulm reserve, Fitness Neo: pre-op to shrink tumor, Adj: after Tx to prevent recurrence
68
TNM Staging What is the difference between Unresectable and Inoperable
T- 1: <3cm 2: 3-7cm 3: >7cm 4: invasive L: 0: none 1: ipsilat broncho/hilar 2: ipsilat mediastinal/subclavicular 3: contralateral M: 0: none 1: mets Un: invaded structures In: unstable Pt
69
MCC of arterial aneurysm What are the 3 types of pseudo-aneurysms ? is the MCC of pseudo-aneurysms
Atherosclerosis Saccular: out-pouch of vessel wall Fusiform: diffuse Mycotic: MCC Staph infection Trauma
70
? law of physics is applied to AAA MC Sx of AAA leak Image modality for tracking, Dx and elective planning
Law of Laplace: Back pain d/t leak in left posterior corner below L-renal artery origin Track: US Dx at rupture: CTA Elective: Aortogram
71
AAA characteristics at increased risk for rupture Repair is indicated in ? 3 conditions Define Blue Toe Syndrome
>5.5cm Expands >0.5cm/6mon Female > Male Saccular > Fusiform ASx and >5.5cm, Sx, Expands >1cm/yr Distal embolization from AAA
72
Aortic Transections are usually d/t ? mechanism and occur ? Pts can survive this injury if ? structure holds Best image for Dx and best method to control/dec shearing forces
Deceleration, Distal to subclavian artery Adventitia CTA; BBs then dilators
73
? is the MC catastrophic event involving the aorta Ruptures are more likely seen w/ ? Stanford type and have ? murmur Name of procedure to Tx mesenteric ischemia
Acute dissection- AR Type A Percutaneous Transluminal Angioplasty w/ stenting
74
? is the MCC of carotid related CVAs ? may be the first Sx of carotid artery dz ? is the most useful test for carotid artery dz assessment while ? is the gold standard but only used if surgery is planned
Emboli- MC Frank CVA Duplex US; Carotid arteriography w/ >75% occlusion= need for surgery (MRI/A- better for ischemic CVAs)
75
What medication is needed after carotid endarterectomy procedures Subclavian Steal Syndrome causes blood to be 'stolen' from ? Periphral Vascular Dz pain in calf, butt, groin means source is ?
Clopidogrel x 6wks Subclavian steals from vertebral artery Calf: femoral artery Butt/Thigh: iliac Impotence: aortic
76
What are 3 critical characteristics of limb ischemia AMI measurement below ? means occlusive Dz present What is the most important RF
Pain w/ rest Inc pain at night Hanging leg off bed/chair to dec pain <1.0 Smoking
77
What 3 meds are used for peripheral vascular dz and what are their MOAs What are the 6 Ps of acute arterial occlusions Which one indicates the beginning of irreversible ischemic changes
Cilostazol: PD-5 inhibitor to dilate vessels Anti-platelets: ASA Pentoxiphylline: dec blood viscosity Statins PooP Color Pulse Movement Temp Numb Sensory deficit
78
Arterial transections must be repaired within a few hrs to prevent ? How are arterial occlusions Tx ? type of knee injury leads to an arterial stretch injury
Gangrene Heparin- atraumatic Arteriorgram if light touch intact Thrombolytics or Embolectomy- emergent if neuro compromise present Anterior dislocation
79
What causes popliteal artery entrapments How does this entrapment present Thromboangiitis Obliterans is AKA ? Dz
Medial head of gastrocnemius w/ abnormal insertion causing medial deviation of artery ASx w/ rest, Ischemia w/ exercise Buerger Dz
80
What causes venous dilation in AV fistulas ? thyroid Ca follows a FamHx path Radiation during childhood puts Pts at risk for ? type of thyroid Ca
Arterial pressure Medullary carcinoma in MEN-2 Papillary- MC type of thyroid Ca MC d/t iodine deficiency
81
? is the first line investigation test for solitary thyroid nodules ? scintigraphy result means nodule is likely benign Toxic adenomas need to be removed if ? size
US guided FNA Hot- hormonally active (low TSH, high T3/4) >4cm
82
How are the two MC types of thyroid cancer spread MEN-1 is AKA while MEN-2 is AKA ? ? medication is used during thyroid tumors to suppress mets
Pap: lymph Foll: heme 1: Werner's 2: Sipple's Thyroxine
83
MC neoplasm in mediastinum MC neoplasm in mediastinum w/ clinical presentation What are the 2 MCC of thryotoxicosis
Thymoma Substernal thyroid Graves: hypersecretory goiter Plummer: toxic multi-goiter
84
Achilles DTR response to hyper/hypo-thyroidism How is Thyrotoxicosis Tx What study is used after Pt returns to euthyroid status after thyrotoxicosis
Hyper: shortened; Hypo: prolonged Methimazole/PTU Lugol iodine/Ipodate sodium BBs R-131
85
Where are Pts referred to after thyroid nodule work up Hyperparathyroid Pts are at ? risk ? type of acid-base d/o can hyperparathyroidism develop
IM- hyper/thyroiditis GenSurg/ENT- nodule/goiter/cyst Premature death d/t CV/malignancy Hyperchloremic metabolic acidosis
86
What other DDx need to be r/o w/ lab results consistent w/ hyperparathyroidism What type of rad findings may be seen during hyperparathyroidism ? advanced imaging is used for finding sub-sternal glands
Breast Ca Hands: osteitis fibrosa cystica, Mottled skull Sestamibi; Gamma probe for small nodes
87
Difference between Primary/Secondary hyperparathyroid growth Define Mondor's Dz
Primary: benign Secondary: malignant Chest wall trauma induced vein formation
88
MEN-1 Werner's Syndrome MEN-2a Sipple's Syndrome MEN-2b
Hyperparathyroid Gastrinoma>insulinoma Pituitary tumor Medullary thyroid Ca Pheo Hyperparathyroidism Medullary thyroid Ca Pheo GI ganglioneuromatosis Mucosal neuroma
89
What are the 3 layers of the adrenal cortex and what do they release What does the adrenal medulla produce What causes adrenal cortical hyperplasia
Glomerulus: aldosterone Fasciculata: cortisol Reticularis: testosterone Catecholamines- sympathetic stimulation Malignancy in fasciculate causing excess cortisol secretion (Cushing syndrome)
90
What is the next Tx step for pituitary adenomas if pituitary surgery fails What part of the kidney are pheo's found in and what do they secrete What is the classic Pheo Triad
Adrenalectomy Medulla- Epi HA, Palpitation, Diaphoresis
91
What are the two possible intra-operative complications during pheo removal What are the indications to remove hormonally inactive pheos What is the f/u procedure if surgery is not indicated for hormonally inactive pheos
Pheo: HTN d/t tumor handling HOTN after tumor devascularized Encroaching on surrounding structures >5cm <5cm= repeat CT in 3-6mon
92
What is the difference between lobe and duct of breasts ? is the MC carcinoma Rarely, ? meds are used to Tx fibrocystic breast changes
L: functional unit that produce milk D: store milk and connect to nipple Ductal Tamoxifen, Danazol w/ tenderness during luteal phase
93
What are the indications to excise fibroadenomas What are the two benign conditions that cause nipple d/c How are these Pts managed
>35y/o or Pt request Intraductal papilloma, Mammary duct ectasia F/u q 3mon w/ MMG and US
94
# Define Galactorrhea What PE test needs to be done How is this Dx and when are pts f/u
Bilat milk d/t in non-lactating women Visual field: Bitemporal hemianopsia Dx mammogram; F/u q3-4mon x12mon w/ MMG and US
95
Chronic breast abscesses normally arise from ? How are these Tx Where are supernumeray nipples found and how are they Tx
Duct ectasia Stop nursing, Admit w/ IV ABX, OR I&D Anywhere on milk line; Excision
96
What are the two views of a screening MMG How are findings classified
Craniocaudal, Mediolateral ``` BiRADs: 0- more images needed 1- neg/normal 2- benign finding 3- probably benign 4- suspicious, biopsy 5- suggests malignancy, definite biopsy 6- biopsy proven malignancy ```
97
What Pt population would receive pre-operative breast MRI ? is the MC lump found on self breast exams What is the worst pathological report for breast ca biopsy
Dense tissue, Implants Ca: painless, unilateral w/out d/c Triple negative: Tx w/ Chemo
98
How is HER-2 positive breast Ca Tx ? is the MC breast Ca type What is a pre-invasive marker of Ca
Poor prognosis 2/2 mets: Tx w/ monoclonal Abs Infiltrating ductal carcinoma Lobular Ca in situ
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MCC of bilateral breast Ca Define Paget Carcinoma How are these Pts managed/Tx
Primary lobular tumor Ductal carcinoma causing nipple itch/burn and crusted lesions ABX/Topical steroids x 7d then refer to GenSurg
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How does Inflammatory Breast Ca present How is this Tx Men w/ breast Ca present at ? age and w/ ? Medhx
Erythema/Edema w/out palpable mass in non-lactating female Neoadjuvant chemo, Surgery, Radiation 70y/o w/ prostate Ca
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What is an ominous finding for men w/ suspected breast Ca How are these Tx Difference between Modified Radical Mastectomy and Radical Mastectomy
Nipple d/c Modified radical mastectomy Mod: spares muscle w/ skin retention Rad: dec function of arm d/t structure removal
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What is the most important prognostic factor for breast ca Post-surgical drains are removed at ? point of recovery What two nerves can be injured during Modified Radical Mastectomy
Mets to axillary nodes <30ml/day Long thoracic: winged scapula Thoracodorsal: lat dorsi paralysis
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? type of radiation therapy is used for breast Ca Tx What structure is used to reconstruct breast mounds after mastectomy Difference between Femoral and Inguinal Hernias
Tangential: dec body irradiation Transverse Rectus abdominus muscle Inguinal: arises above inguinal ligament Femoral: arises below inguinal ligament
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Inguinal hernias develop laterally to ? structure Direct Hernias develop through ? structure What causes a congenital indirect hernia
Inferior epigastric artery Hesselbach Triangle: Medial: rectus muscle Lat: inferior epigastric artery Inferior: inguinal ligament Patent processus vaginalis (same as hydrocele)
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? is the MC hernia in both genders ? nerve may be prophylactically seperated during hernia repair ? type of repair makes the recurrence rate higher
Congenital indirect Ilioinguinal hernia Laparoscopic: usually done for bilateral hernias (open for unilateral hernia)
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? type of hernia is more common in women Epigastric hernias protrude through ? structural defect Umbilical hernias in infancy are repaired after ? age
Femoral: inferior to inguinal ligaments, medial to femoral vein Epigastric fat through linea alba 2y/o
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Post-hernia repair wound dehiscence appears as ? How are these managed? Untreated, this will progress to ?
Salmon colored peritoneal fluid Return to OR for fascial repair Acute: Evisceration Delayed: Incisional hernia
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Sports hernias are not true hernias but are result of microtears to ? This can also be a manifestation of ? Dx Define Hydrocele, Spermatocele, Varicocele
Femoris Adductor Rectus Hip flexor Obliques Psoas Osteitis pubis H: patent vaginalis allowing peritoneal fluid collection S: fluid filled mass on epididymis V: dilated pampiniforms (L > R)
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Smoking cessation ? long prior to surgery can help reduce atelecatsis development If intubation for post-op pneumonia is done, keep sats at ? level Aspiration pneumonia is avoided by Pts being NPO for ? long
>2wks PCO2 35-45 O2 >95% >6hrs prior for surgery
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What PE finding is associated w/ a suspected DVT PERC criteria Wells score criteria
Homan's sign HAD CLOTS: Hormone Age >50 DVT/PE Sxs Coughing blood Leg swelling O2 <95% Tachy >100bpm Surg/Trauma <4wks ``` EAT CHIPS: Edema/Leg pain/DVT Sxs: 3 Alt Dx less likely: 3 Tachy: 1.5 Cancer: 1 Hemoptysis: 1 Immobile >3 days: 1.5 Previous DVT/PE: 1.5 Surgery <30d: 1.5 ```
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How is C Diff Tx Mnemonic for trouble shooting catheters ? nerve injury can occur during hernia repair
PO Vanc or Metronidazole DOPE: Displace Obstructed Position Equipment Ilioinguinal- skin numbness
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? nerve injury can occur during mastectomy ? nerve injury can occur during para/thyroid surgery ? nerve injury can occur during carotid endarterectomy
Long thoracic- winged scapula Recurrent laryngeal- hoarseness Hypoglossal nerve- deviated tongue
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How is DIC Tx Why do blood transfusions result in HypoCa What is the lethal triad of hypothermia
FFP Citrate from banked blood binds to Ca Hypothermia Metabolic acidosis Coagulopathy
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What are the 4 stages of Decubitus Ulcers What is the criteria for Systemic Inflammatory Response Syndrome MOA of local anesthetics
1: Intact, non-blanching skin 2: shallow ulcer w/ red wound bed 3: adipose visible 4: underlying structures visible Temp >101.5* Tachy/Tachy Leukocytosis Na channel blocker to prevent AP
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What types of nerve fibers are easily blocked by local anesthetic Why do these not work well in infected tissues What are the two classifications
Thinner, Myelinated Inc acidity (normally pH 5.5-6.0 Amides: metabolized by liver (MC used) Ester: metabolized by cholinesterase into PABA- common allergen
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How are amides identified on visual assessment Four methods local tissue inflammation effects anesthetic activity What are the benefits of adding Epi
"i" before -caine Dec blood flow slows clearance Acidosis dec active anesthetic Macrophage inactivation Temp inactivated anesthetic Inc duration, Dec bleeding/volume needed
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What are the 3 disadvantages of adding lidocaine to local anesthetics Avoid Epi in Pts w/ ? MedHx What are the MC adverse effects
Tachy, THN, Dysrhythmias Cardiac dz HTN DM Hyperthyroid Urticarea Dermatitis Edema Erythema
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What PE finding suggests CNS toxicity from lidocaine w/ epi Max amount of lidocaine w/ and w/out epi How much lidocaine is in 1% lido
Tonic clonic activity- Tx w/ benzo 4mg/kg w/out, up to 300mg 7mg/kg w/, up to 500mg 1%= 10mg/ml, 2%= 20mg/ml
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Max dose of Bupivacaine Don't use in ? Pts How are toxicities Tx
2mg/kg up to 100mg <12y/o Hyperventilate dec pCO2, Benzo for seizure
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Malignant Hyperthermia MC occurs after ? How is this Tx What is the sequence of clinical anesthesia
Volatile agents, Succinylcholine Cooling, BiCarb, Dantrolene Dilation: loss of sympathetic tone Pain/Temp Pressure Motor
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# Define Spinal block What is this MOA What is the MC complication from use
Anesthetic in sub-arachnoid CSF Sympathetic/sensory/motor blockage Post-spinal HA; Tx w/ Blood Patch
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# Define Epidural Anesthesia What is the MOA This type of block is good for ? injury
Anesthesia injected to epidural space w/ catheter left in place Blocks sensory > motor Rib Fx
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C5, T4 and T10 are located at ? landmarks ? complication arises from central nerve blocks ? complication can arise from high spinal blocks
5: clavicle 4: nipple 10: umbilicus HOTN d/t neurogenic shock; Tx: pressor and fluid Bradycardia, HOTN, Arm tingling
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How are high spinal blocks Tx MC complication from central nerve blocks How are spinal HAs Tx
IV naloxone w/ ventilation Urinary retention Fluids, Caffeine, Blood patch from autotransfused blood into epidural
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What adverse complication arises from central nerve blocks in Pts on anticoagulants ? type of amnesia does conscious sedation create ? is the name of cricoid pressure
Epidural hematoma: compresses spinal cord causing loss of neuro function below injection site Antegrade Sellick
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? type of suture materials cause a more intense inflammatory reaction How is the tensile strength determined ? type of configuration has more infection risk
Natural fiber > Synthetic Larger integer= smaller diameter Braided
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Cutting needles are preferred for ? while tapered/round needles are used for ? Define swaged needles Define Double Armed needle
Cut: skin; Taper/Round: Vessel/Bowel Suture is pre-attached to needle Needles at both ends of suture for anastamoses
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Absorbable sutures Non-Absorbable sutures How are needle drivers loaded
Gut Monocryl Vicryl Ethilon Prolene Silk 50-75% past tip, perpendicular to driver w/ only first joint inserted in rings
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Difference Adsons and Debakeys Suture tension is inverse to ? When are simple interrupted used
Ad: outside body w/ rat tooth ends for traction Deb: inside body Spacing: more bites, less tension Almost all external closures, start in middle
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Most simple interrupted sutures are left in place for ? days w/ ? exception When are horizontal mattress sutures used and left in place for ? long When are vertical mattress sutures used
7-10 days; Face x 5d Larger lacerations x 7-10d Lacerations w/ poor eversion
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What type of knot is used to terminate a running suture ? type of suture is used to approximate deeper tissue prior to closure What are the 3 types of scalpels and their use
Aberdeen/Fishermen knot Subcuticular 10- large incisions, cut w/ hump of blade 15- small incision, smaller than 10 blade 11: puncture/cutting for suture removal
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Extensor surfaces are sutured in ? direction Flexor surfaces are closed in ? direction ? closing material has a higher tensile strength than sutures
Longitude Transversely Staples
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Pts classified as Immediate during triage
``` PART I CUT: Pending limb loss Amputation Retrobulbar hematoma Tension Ptx ``` Intracranial hemorrhage Compromised airway Uncontrolled hemorrhage Trauma w/ shock
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Pts classified as Delayed during triage Pts classified as Minimal during triage and why is this group so dangerous Pts classified as Expectant during triage
``` Globe injuries Trauma w/out shock Facial injury w/ airway intact Burns, non-life threatening Stable lacs/VS needing higher level of care ``` Minor lacs/burns, Small bone Fx; Overwhelm resources during MASCAL Severe burns High spine injuries Absent VS Transcranial w/ coma Shock
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OPAs are inserted w/ the tip pointing ? Flail chest can cause ? ventilation issue Size of needle decompression needle
Up, rotate 180* at posterior Inc pCO2, Dec pO2 14G, 3.25"/8cm
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How is systolic BP estimated during primary survey A Pts hemodynamic status is determined by ? During trauma, type specific blood should be avail w/in ? time
Radial= 80 Femoral= 70 Carotid= 60 Level of consciousness, Skin perfusion <20min
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During Primary Survey, dilated pupil correlates w/ ? A lateral gaze w/ dilated pupil indicates ? 9 line medevac
Ipsilateral injury Brain stem herniation through tentorium cerebelli 1: location 2: frequency 3: Pt type 4: equipment 5: Pt ambulation 6: security 7: LZ marking 8: nationality 9: NBC threat
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What are the components of the MIST report When is AMPLE done during triage ? is the MC error during the secondary survey
Mechanism of injury Injuries Sx/VS Tx given Secondary survey Failure to ID multiple injuries
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? is the most valuable test during a penetrating trauma work up What are the 3 zones of neck trauma What zone injury may be managed expectantly
Plain radiograph 3: lower lip and up 2: cricoid to lower lip 1: cricoid to clavicle Zone 2
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What are the indications for a thoracotomy Penetrating trauma can be d/c home as long as ? structure is not violated Most retroperitoneal injuries are identified how
Persistent output despite bilat tubes Initial output >1500ml Persistently >200ml x 3hrs Anterior fascia Extra luminal gas/fluid
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? type of Dx image is performed for suspected traumatic rectal injuries Best imaging to screen for intrathoracic bleeds while ? is the most reliable to find free intrabdominal blood Peritoneal cavity can hold ? much fluid
Sigmoidscopy CXR; EFAST 3L
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Life threatening hemorrhage from pelvic trauma means ? structure is damaged What do Pts need after external fixation What two presenting findings suggest need for emergency craniotomy
Posterior columns Angioembolization GCS <9 w/ lateralizing neuro exam
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Closed head trauma is rarely the cause of HOTN except for ? ? is the best imaging for blunt cerebral vascular injuries How are pericardial tamponades Tx
Final phase before herniation CTA Temporary: centesis OR: Sternotomy w/ repair
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What is the MC location for aortic injuries What two CXR findings aid w/ Dx Diaphragm ruptures MC occur on ? side w/ ? CXR finding as pathognemonic
Distal to LSCA Wide mediastinum >8cm, Obscured apex of chest- apical cap Left: Coiled gastric tube in chest
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? if the MC injured GU organ ? is the most reliable sign this MC has occurred Pelvic injuries need ? study prior to cannulation
Renal injuries Hematuria Cystogram
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What PE findings suggest a urethral injury is present What is the next step if these are found Define ECMO
High riding prostate Blood at meatus Hematochezia Retrograde urethrogram w/ fluoro Extra Corporal Membrane Oxygenation
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Initial imaging for blunt/penetrating chest trauma ? side of the diaphragm is most likely to be injured C-spine films need to encompass ? land marks and ? angle can help visualize this land mark
Portable x-ray L > R C7-T1; Swimmer's view
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What parts of the C-spine are evaluated for soft tissue edema Loss of the cervical lordotic curve can indicate ? Hangman Fx is AKA ?
C2: 6mm C6: 22cm Soft tissue swelling, Muscle spasms Traumatic spondylolisthesis- axial compression w/ hyperextension= bilat Fx of pars interarticularis
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? type of immobilization is used for Pts w/ C1-2 Fxs Jefferson Fxs are AKA ? Define Clay Shoveler's Fx
Halo-vest immobilization x 12wks Atlas Fx- d/t axial loading, usually w/out neuro injury Isolated spinous process Fx; unilateral lamina/pedicle Fx
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? type of cervical Fx usually leaves Pts as quadriplegics Hyperflexion injuries are usually from ? mechanism Hyperextension injuries are usually from ? mechanism
Tear drop- hyperflexion and posterior displacement compared to inferior vertebrae Flexion and Distraction- occiput blow Extension and Compression- forehead blow
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Hyperextension neck injuries most often have ? neuro complain ? part of the neck is MC Fx What are the 3 types of this Fx
Radiculopathy Odontoid Type 1: tip, uncommon Type 2: neck Type 3: junction and axis body
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What two types of neck injuries are most likely to be immediately fatal More than half of L-spine Fxs occur where Seat belt Fxs of the L-spine are AKA ? Fxs
Atlanto-occipital dislocaiton Atlanto-axial dislocation T12-L1 Chance Fxs
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L-spine compression Fxs can be Tx w/ pain and bed rest if ? two criteria are met All ? Fxs of the L-spine are unstable regardless of neuro exam What are the indications for surgical Tx
<50% loss of height, <30* angulation Burst >50% height Retropulsion narrows canal >50% Kyphotic angulation ≥25*
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? classification system is used for pelvis Fx
``` Young-Burgess- A: mechanically stable and MC type B: partial posterior (rotation unstable, vertical stable) B1: open book B2: lateral compression C: A/P instable ```
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Pts w/ intracapsular (femoral neck) pelvic Fxs will look like ? on PE How much blood can the abdominal cavity sequester Sequence for studying abdominal films
Shortened, externally rotated, abducted >3L 1: gas pattern 2: extraluminal air 3: calcifications 4: soft tissue masses
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What abdominal x-ray finding for the spleen is abnormal ? chest wall injuries are Tx w/ surgery MC injury from blunt chest wall trauma
Below rib 12 and/or displaced stomach bubble to midline >1L blood loss Diaphragm rupture Aortic transection Tamponade Rib Fx
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Ptx are dx w/ x-ray and ? breathing pattern Axial injuries to chest/spine can lead to ? thoracic issue Aortic transections may live to hospital if ? structure holds during injury
Exhalation Chylothorax Adventitia
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Great vessel injuries are most often exposed by ? procedure First test performed for Pts w/ high risk penetrating chest wounds Pts w/ obvious tamponade but no imminent arrest have ? next step
Median sternotomy eFAST Directly to OR for sternotomy
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Indications for resuscitative thoracotomy ? is the Triangle of Safety for chest tubes
Penetrating trauma CPR <15min Rapid deterioration Organized rhythm, even PEA Blunt trauma CPR <10min Medial: pec muscle Lat: lat dorsi Inferior: 4-5th ICS
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? is the insertion site for thoracostomy ? type of suture is used for securing What is the adverse outcome of placing a chest tube initially on wall suction
5th rib at anterior axillary line No 0-1 silk Pulmonary edema refractory to diuretics
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Indications to remove chest tubes ? organs are located retroperitoneum 3 main indications for Ex-Lap
No air leak on water seal <200ml drainage/24hrs No PTX Duodenum Pancreas Kidney Aorta Vena cava Peritonitis, Hemorrhage, Injuries
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? is the exception to gunshot wound Ex-Lap rule How are liver injuries graded
Tangental wounds= laparoscopy for peritoneal penetration 1: <10% surface area 2: 10-50% surface area 3: >50% surface area 4: 25-75% parenchymal disruption 5: >75% parenchymal disruption
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How are liver injuries managed after d/c ? type of drain is used after abdominal/pelvic trauma surgery What is another type of drain that may be used
Re-image 4-8wks after High grade: reimage at 3mon prior to returning to sports Jackson pratt- grenade shape, keeps area under pressure Penrose- prevent would healing, allows drainage
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What are the three sequential stages of wound healing Abnormal wound healing occurs when ? stage is prolonged What phase causes wound contraction What phase includes remodeling
Inflammation Migration/Proliferation Maturation Inflammation Migration and proliferation Maturation
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What are the 3 closure types Debris can lead to traumatic tattooing if not removed in ? time frame Pressure exceeding ? is Dx for compartment syndrome and Tx w/in ?
Primary: <8hrs of injury w/ suture/staple Secondary: self healing w/ packing Tertiary: delayed primary <48hrs >30mmHg; Fasciotomy <6hrs
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? type of fluids should be used during compartment syndrome ? type of venom do Elapids have ? type of venom do Vipers have
Mannitol-Alkaline Cobra/Mamba: neurotoxin Rattler/Viper: cytotoxin- can lead to compartment syndrome
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Secondary intention healing occurs through ? three mechansism Do not use ? item to cover healing tissue Difference between contraction vs contracture
Base granulation Edge contraction Re-epithelialization Cover sponges - ction: linear wound becomes shorter - cture: circle becomes smaller
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Best type of ulcer dressing for absorbency, comfort and hydrocolloids ? type of dressing is water resistant ? type can absorb alot of exudates
Foam Alginate Debridement Films Alginate
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? type of dressing can be changes w/ minimal pain ? type of dressing change can't be used on infected or exudative wounds ? type of dressing must be protected by a secondary dressing
Foams Hydrocolloid Hydrogel
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What 3 factors determine an infectious process What are the two MC microbes in surgical Pt infections
Organism Environment/local response Host defenses Gram Pos cocci > Gram neg bacilli
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? surgical infection microbe is MC enteroccoccal species ? surgical infection microbe is MC Vanc resistant How many brush stroked when scrubbing for surgery
Enterococcus epidermis Enterococcus faecium Finger tips: 30 strokes Finger/Palm/Wrist: 20 strokes
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What is the BBB of the OR ? type of burn injuries can heal w/out scars What are the names of the ridges found within the Basement Membrane Zone
Area between Anesthesia and Operative Field Pure epidermal injury Rete ridges- aid w/ protecting from shearing forces
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When looking at a burned area, ? area is most damaged What are the next two areas surrounding this most damaged area Rule of 9s
Center- zone of coagulation Stasis then Hyperemia Don't count 1st degree: Arm/Head: 9% each side Leg/Trunk: 18% each side
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Second Degree burns extend into ? layer What is the hallmark of this type of burn Deep Partial Thickness extend to ? layer
Papillary dermis Blisters Reticular layer of dermis
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Partial thickness burns that have not healed w/in 3wks need ? Tx ? ABX is used for burns but w/ ? s/e Third degree burns can only heal via ?
Excision and grafting Silvadine: silver sulfadiazine: leukopenia Contraction
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Second degree burns are Tx w/ occlusive dressings w/ ? exception ? type of ABX has no role in the Tx of burns What is the position that extremities are splinted in
Face: Tx open w/ ABX ointment Systemic ABX prophylaxis Function, not comfort
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# Define Autograft Define Allograft Define Xenograft
Skin graft from self Skin graft from same species Skin graft from another species
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Full Thickness graft are AKA ? Split Thickness graft are AKA ? What are the benefits of each
Sheet graft Meshed graft Sheet: dermis w/ superior cosmesis Meshed: max surface area allows egress of serum/blood
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UOP is used to guide burn resuscitation but only after ? long Why do burn Pts have so much edema How is fluid resuscitation determined
8hrs Hypoproteinemia Baxter/Parkland formula: 4ml x TBSA x Kg Half in first 8hrs, other half over 16hrs
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How are circumferential burns Tx How can the increased catabolism rate be decreased after burns What 3 meds have dec catabolism and incrased anabolism
Escharotomy BBs Insulin Growth hormones, T analogues
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Post-burn contractions are Tx via ? 3 kinds of electrical burns Acid burns lead to / while alkaline burns lead to ?
Z-plasty once healed Current Flame Thermal- arcing currents Acid: coagulation necrosis Alkaline: liquefaction necrosis
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Goal UOP after burn injuries Define Consciousness What are the two components
>0.5ml/kg/hr Subjective experience of environment and self Arousal/wake- defines level of consciousness Awareness/perception- defines content of consciousness
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What are the 5 terms used for defining levels of consciousness
Alert- awake, responsive Stupor- responds w/ stimulation Obtunded- asleep but responds to stimuli Vegetative- arousal w/out awareness Comatose- asleep, no response to stimuli
184
Scalp vessels are below hair follicles at the level of ? What is the acronym for structures of the SCALP First responder intervention can help reduce ? type of brain injury
Galea Skin CT Aponeuorsa Loose tissue Pericranium Secondary- brain injury from sequelae from primary injury
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Intubation is recommended for GCS <8 or motor score below ? What are the two worse secondary insults that occur after a TBI What is an independent predictor of mortality
4 or lower Hypoxia, HOTN In-hospital O2 desat <90%
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Brain injuries need SBP maintained <90mmHg w/ ? PE test indicating adequate MAP Equation for MAP Equation for CPP
Radial pulse 1/3 (SBP + 2DBP) CPP= MAP - ICP ICP measured w/ ventriculostomy
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ICP monitor is called ? Requirement prior to placement Head CT w/ midline shift indicates ? damage and will have ? PE finding
Bolt GCS 8 or greater and abnormal head CT Brainstem herniation; Pupil changes ipsilateral side
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What causes Diffuse Axon injuries What will be seen on CT What med can be used for BP control during ICP
Shearing force from acel/decel Normal Phenylephrine
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ICP w/ agitation is intubated w/ ? combo of RSI meds ? is used for seizure prophylaxis ? is the safest and most prudent Tx for TBI Pts
Propofol w/ Fentanyl Levetiracetam- Keppra Euvolemia w/ ICP <20
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What does a brain stem/uncal herniation look like What does a tonsillar herniation look like While intubated, keep Pts capnography between ?
Dilated, unresponsive pupils w/ lateral gaze Cushing Triad 35-45
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MCC of acute liver failure ? is a common complaint w/ no significance to a surgical Hx What is the MC error that occurs w/ hematochezia
Acetaminophen toxicity Changes in bowel habits Assumption of hemorrhoids
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True liver function is assessed w/ ? three labs Pre-op ABX are given ? far prior to surgery and redosed ? often ? perioperative stratification tool is used for risk assessment
Coagulation Albumin Total bili <1hr of surgery; q2 t1/2 lives ASA: 1: healthy 2: mild/mod systemic d/o 3: sev systemic dz 4: incapacitating 5: moribund/life expectancy <24hrs
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How is Mallampati classification done Pre-op serum creatinine higher than ? has inc M&M 6 Major Adverse Cardiac event criteria
Mouth open, Tongue out, No Ah sound >2.0mg DM insulin, RF, CHF, High risk surgery, Ischemic heart dz, TIA/CVA
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Chronically hyperglycemic Pts are more dehydrated and will be exacerbated while NPO for surgery, so use ? fluid How is their insulin dosage calculated Albumin <3g suggests while pre-albumin <16mg suggests ?
Dextrose solutions Sliding scale A: chronic malnutrition, P: acute malnutrition
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FENa equation How is a Pts hydration status assessed Colloid transfusion therapies include ? 5 fluids
100 x (Na.u x Cr.p/Cr.u/Na.p) Edwards EV1000 w/ serum lactate ``` FFP (30min thaw wait time) Whole blood PRBCs Albumin- LF, burns, nephrotic syndrome Platelets- bleeds w/ <50K Plt count ```
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IO infusions target ? structure Locations for central line placements ? is the femoral triangle landmarks
Medullary sinus Cephalic Jugulars Femoral Subclavian via Seldinger technique Medial: adductor longus Lat: sartorius Superior: inguinal ligament
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IV rehydration is good for ? long What 3 alternative methods of delivering nutrition are considered if this time line is met Pts receiving total enteral nutrition need ? daily lab and ? weekly lab
One week Peripheral parental nutrition Enteral G/J tube Total parenteral nutrition Daily: E+ Week: pre-albumin
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NG/OG tubes are used to decompress stomach in Pts that have eaten w/ ? time from surgery ? structures differ D1 from D2 Define Phleboliths
<6hrs Kerckring folds Calcified venous thrombi w/ lucent center in pelvic veins of women
199
What does the mnemonic ADC VAN DISMEL stand for
Admit to Dx Condition VS Activity Nursing ``` Diet IVF Studies Meds Allergies Labs ```
200
Appendectomy performed during pregnancy often lead to ? adverse reaction Open appendectomy uses ? incision ? artery supplies the appendix
Pre-term labor but not delivery McBurney's Mesoappendix
201
? is the MC rare pathology of appendicitis ? part of the small bowel is straight vasa recta Define Internal Hernia and what can cause these
Carcinoid Jejunum Strangulated bowel d/t bucket handle mesenteric defect; High speed MVCs
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Why does fertility increase risk for gallstones Hepatocytes conjugate bilirubin w/ ? for secretion in bile Liver metabolism of serum proteins provide the only source of ? two products
Estrogen- inc cholesterol secretion Progesterone- dec bile acid secrettion Glucuronide Albumin, Alpha globulin
203
What can cause splenomegaly What causes hypersplenism Why are vascular structures ligated as close to the spleen as possible during splenectomy
EBV, T-cell lymphoma Pancytopenia sequestration Avoid vascular injury to stomach/pancreas
204
Why are a majority of diverticula actually pseudodiverticula Colorectal screenings start at age ? and include ? tests Rectal cancer can present on DRE w/ mets in ?
Missing mucosal layer 50y/o w/ annual occult blood and Flex-Sig q5yrs Blumer shelf: pouch of douglas
205
Pt w/ hemorrhoids and Fe anemia need ? two examinations ? is the standard approach for open lung biopsy ? lung neoplasms causes clubbing and hypertrophic osteoarthropathy
Anoscopy and Proctosigmoidscopy Thoracoscopy Paraneoplastic syndromes d/t proliferation of growth factors