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Surgery Shelf High Yield Cards > High Yield Surgery > Flashcards

High Yield Surgery Flashcards

1
Q

Blunt Abdominal trauma

A
  1. Gunshot to abdomen = anything below nipples = Ex-Lap
  2. Blunt abdominal trauma + guarding + rigidity + rebound tenderness + peritonitis = Ex-lap
  3. Blunt abdominal trauma + hypotensive + no signs for peritonitis = FAST (you can’t do Ex-lap yet because you don’t know where they are bleeding yet)
  4. Blunt abdominal trauma (stabbed/gunshot) + hemodynamically stable = CT-abdomen
  5. Blunt abdominal trauma (stabbed/gunshot) + hemodynamically unstable/ or signs of peritonitis = EX-lap
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2
Q

Cardiac tamponade

A
  1. Classified by beck’s triad: (hypotension + JVD + Distend (muffled) heart sound) + no signs for respiratory distress
  2. Initially: insert venous fluid (two large bores IV-lines 16 gauge needle)
  3. Diagnosed: clinically or FAST or Echo
  4. Treated: pericardiocenthesis
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3
Q

(Tension) Pneumothorax

A
  1. Classified as: hypotension + JVD + signs of respiratory distress/ or absent of breath sound at affected side + tracheal deviation + diaphragm pushed down + compression atelectasis ( collapsed lung because it cannot dilate)
  2. Pneu-mediastinum can lead to pneumothorax or vice-versa
  3. Diagnosis: clinically

Treat tension pneumothorax :

  1. needle decompression (needle thoracenthesis ) = mid-clavicle at 2nd intercostal space (between 2/3 ribs)
  2. thoracostomy tube ( chest tube) = anterior-axillary line at the 5th intercostal space

Treat pneumothorax:
1. Only chest tube

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4
Q

Widened mediastinum

A
  1. Anthrax ( bacteria inhalation)
  2. Aortic ( aneurysm, rupture, unfolding. Dissection)
  3. Cardiac ( cardiac tamponade, pericardial effusion)
  4. Esophageal rupture
  5. Mediastinum ( teratoma, thymoma, thyroid mass, lymphoma) or mediastinitis
  6. Thoracic Vertebral fracture (trauma)
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5
Q

Head trauma

A
  1. Head trauma + loss of consciousness = head CT without contrast
    * note = negative CT scan & patient is awake/alert/oriented (time 3; place, person, time) = patient can go home
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6
Q

Epidural hematoma

A
  1. Lucid interval: get knocked out, then wake up, then pass out again (blood take so much space, it displaces medulla)
  2. On CT-scan of head shows: lens shape
  3. Treat: emergency craniotomy
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7
Q

Increase ICP

A

Treat with:

  1. Elevating the head
  2. Hyperventilating
  3. Mannitol (osmotic diuretic, helps draw fluid into the vessels to alleviate edema in the brain)
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8
Q

Hemothorax

A
  1. Usually resolves by its own
  2. Decide if it needs OR intervention:
    * if there is >1.5 L increase in blood
    * > 200 mL/ hour for 4 hours
  3. If these criteria presents, then there is an intercostal artery injury ( rather than lung laceration) & surgical procedure is required ( video assisted thorascopic surgery = VATS)
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9
Q

Blunt trauma to the chest

A

Causes:

  1. Pulmonary contusion = occurs 24 hours after blunt chest trauma, associated with flail chest = Chest X-ray shows white outline = treated supportively.
  2. Myocardial contusion = trauma to the sternum, associated with sternal fracture = diagnosed by EKG & Troponin.
  3. Traumatic aortic transection (aortic rupture) = associated with high fall & MVC (sudden deceleration) (fracture of the 1st rib, scapula, sternum) = imprint of steering wheel= chest X-ray shows widened mediastinum = CT with angiography (two types: 1. Incomplete rupture = higher survival; 2. Complete rupture= death prior to arrival to hospital) (hemorrhagic shock= hypotension, tachycardia, pale/cool extremities, collapsed neck vein/flat), signs: 1. Widened mediastinum; 2. Abnormal aortic contour; 3. Left-sided effusion due to hemothorax; diagnosis: 1. Stable pt: CT angio; 2. Unstable pt: TEE (operating room)

Note:
1. Pulmonary contusion = decreasing perfusion/ ventilation gradient by increasing the pulmonary vascular resistance and decreasing pulmonary compliance

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10
Q

Blunt Bladder injury

A
  1. Diagnosed with retrograde cystogram
  2. If leakage into the peritoneal space = intra-peritoneal bladder injury = treat with surgery & close it with supra-pubic cystostomy tube
  3. If leakage is extra-peritoneal space, below peritoneum = treat with foley catheter
  4. Complications of untreated bladder injury: ileus, urinary ascites, intra-abdominal abscess, peritonitis, sepsis, vesicovaginal fistula
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11
Q

Renal injury

A
  1. Associated with lower rib fracture (11/12th rib which overlay the kidney)
  2. present with gross hematuria
  3. diagnoses: CT
  4. Treatment: self-resolving (leave it alone)
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12
Q

Urethral injury

A
  1. Present with blood at meatus, scrotal hematoma, inability to void, high-riding prostate
  2. Diagnosis: retrograde urethrogram
  3. Avoid applying foley catheter because this can worsen injury
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13
Q

Extremity injury (major concern is artery injury)

A
  1. Differentiate between hard signs vs. soft signs:
    * Hard signs (absent pulse, bruits/thrills, active hemorrhage, expanding hematoma, distal limb ischemia)
    * soft signs (no-expanding hematoma, history of hemorrhage, unexplained hypotension, peripheral nerve deficit)
  2. Diagnoses:
    * hard signs= go straight to OR
    * soft signs: MDCT angiography or duplex/doppler US
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14
Q

Developmental dysplasia of the hip

A
  1. Malformation of the acetabulum
  2. Present with clunking sound when moving the babies’s hip , asymmetric gluteal or thigh fold
  3. Diagnose: US
  4. Treat: Pavlik harness
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15
Q

Slipped capital femoral epiphysis

A
  1. Present in obese teenage (11 years old) with slippage of epiphysis
  2. Diagnosis: X-ray
  3. Treatment: surgery to stabilize the growth plate that slipped (screw fixation)
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16
Q

Genu varum vs genu valgum

A
  1. Reassurance of patient
  2. genu valrum = normal till 3 years old
  3. Genu valgum = normal till 8 years old
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17
Q

Legg-Calve-Perthes

A
  1. Avascular necrosis of femoral head
  2. Present in 6 year old kid, who is skinny
  3. Treated supportively
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18
Q

Osgood-schlatters disease

A
  1. Tibial tuberosity inflammation with little micro fracture
  2. Present with tenderness over tibial tuberosity in athletic kid
  3. Treat: conservatively
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19
Q

Tibial stress fracture

A
  1. Present in a kid, with low BMI who is athletic
  2. Present with point tenderness over the shin
  3. Diagnosis: X-ray is normal
  4. Treat: cast + no weight bearing + repeat x-ray in few weeks
20
Q

Compartment syndrome

A
  1. Associated with fracture (supra-condylar/distal humerus), re-vascularization, and compression due to cast
  2. Present with: pain, pallor, pulselessness, hypothermia, paresthesis, paralysis
  3. (Excruciating) Pain out of proportion with passive movement
  4. Diagnose with: clinically or needle manometry
  5. Treat: fasciotomy
21
Q

Blackberry thumb (De Quervain’s tenosynovitis)

A
  1. Repetitive thumb movement lead to inflammation/swelling of extensor pollicis
  2. Diagnose: put thumb and cover with rest of finger & ulnar deviate = positive, if illicit pain
  3. Treat: NSAIDs (Iv)
22
Q

Game-keeper thumb

A
  1. Ulnar collateral ligament (UCL) tear around MCP joint of the thumb
  2. Treat: casting
23
Q

Jersey finger

A
  1. Hyperextend of DIP at the flexor digitorum profundus
24
Q

Mallet finger

A
  1. When a ball hit the finger (index) & lead to tear in tendon
25
Q

Cuada equina syndrome

A
  1. Caused by disc herniation
  2. Present with LMN symptoms, urinary & bowel incontinence, decrease anal sphincter tone, perianal saddle anesthesia (can’t feel butt), paralysis
  3. Diagnosis: MRI & EMERGENCY
26
Q

Marginal ulcer

A
  1. Non-healing wound (that heal, break down, heal….) over many year
  2. Can progress to squamous cell carcinoma
  3. Need to do biopsy
27
Q

Acute gout

A
  1. Main location: metatarsal phalangeal joint of big toe
  2. Present with redness & inflammation
  3. Investigation: aspirate & analyze the fluid (shows: negatively birefringent crystal; yellow/needle shape)
  4. Treated with indomethacin (NSAID) or colchicine.
  5. Colchicine is contraindicated in patients with kidney diseases, instead use intra-articular steroid
28
Q

Chronic gout

A
  1. Treat with allopurinol or probenecid
29
Q

Meniscal injury

A
  1. Present with popping sound when someone extend the knee
30
Q

ACL injury

A
  1. Present with knee injury that gets swollen immediately

2. Diagnosis: anterior drawer test (tibia extend anteriorly more than it should)

31
Q

Contraindication to surgery

A
  1. EF < 30%
  2. Diabetic coma
  3. DKA
32
Q

If someone had recent MI, you should wait ?

A

6 months before any surgery

33
Q

When do you stop smoking before any surgery

A
  1. At least 2 months ( 8 weeks)

2. Smoking is bad for wound healing & act as vasoconstrictor

34
Q

Malignant hyperthermia

A
  1. Caused by general anesthesia
  2. Present with fever & rigidity
  3. Treat: supportively with dantrolene
35
Q

Neuroleptic malignant syndrome

A
  1. Caused by anti-psychotic use
  2. Present with fever & rigidity
  3. Treat: supportively with dantrolene
36
Q

Serotonin syndrome

A
  1. Caused by anti-depressant use (SSRI)
  2. Present with fever & rigidity
  3. Treat: benzodiazepines or cyproheptadine
37
Q

If PE or DVT patient on anti-coagulant

A
  1. drugs not working or increase bleeding

2. Second line treatment: install IVC filter (catch any ascending thrombus that might embolize to the lung)

38
Q

If a patient is confused or disoriented

A
  1. First: oxygen supplementation, to rule out hypoxia

2.

39
Q

Metabolic acidosis (low PH, low Bicarb, low CO2)

A

Elevated anionic gap:

  1. Poor tissue perfusion (lactic acidosis; sepsis)
  2. Diabetic ketoacidosis (DKA)
  3. Renal failure (uremia)
  4. Toxicities (methanol, ethylene glycol)

Normal anionic gap:

  1. Severe diarrhea
  2. Renal tubular acidosis (RTA)
  3. Excess normal saline infusion (chloride-bicarbonate ionic shift)
40
Q

Metabolic alkalosis (high pH, High Bicarb, High CO2)

A
  1. Nasogastric suctioning or severe vomiting (hypokalemia, hypochloremic, low urine Cl-/Na+ , low serum Cl-)
  2. Diuretic overdose
  3. Primary hyperaldosteronism ( HTN, Hypokalemia, high bicarb)
41
Q

Respiratory acidosis (hypoventilation, low PH, high bicarb, high CO2)

A
  1. Central respiratory depression (opioids overuse)
  2. Obesity hypoventilation syndrome, neuromuscular disease
  3. Chronic obstructive pulmonary disease (COPD)
42
Q

Respiratory alkalosis (hyperventilation, high PH, low bicarb, low CO2)

A
  1. Acute V/Q mismatch (PE, pneumonia)
  2. Anxiety, inadequate pain control
  3. High altitude, pregnancy
43
Q

Nephrolithiasis

A
  1. Flank pain, hematuria, vomiting

2. Caused by increase absorption of oxalate in the gut, due to fat malabsorption syndromes (Crohn’s disease)

44
Q

Urinary tract infection

A
  1. Caused by proteus —> struvite stones in renal pelvis —> staghorn calculi
45
Q

Crohn’s disease

A
  1. Increase absorption of oxalate in the gut (form oxalate stones)
  2. Decrease bile salt recycling & fatty acid absorption
46
Q

Renal cell carcinoma

A
  1. Weight loss, fever, anemia, hematoma, flank pain/mass

Surgery Shelf High Yield Cards (1 decks)

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