High Yield: Surgery Flashcards
1
Q
With abdomen trauma, if they’re hemodynamically stable, what to do? Stab wound?
A
CT abdomen
2
Q
What’s the next step if stab wound, unstable and have peritonitis?
A
Exploratory laparotomy
3
Q
Describe: Tamponade
A
Beck’s triad
- low blood pressure (weak pulse or narrow pulse pressure)
- muffled heart sounds
- raised jugular venous pressu
4
Q
What’s the difference between tamponade and tension pneumothorax? (2)
A
- cardio tamponade: no respiratory distress
- tension pneumothorax: respiratory distress and trachyal deviation
5
Q
What’s the dx of cardiac tamponade? (3)
A
- Clinical
- If insure: FAST echo
- If dx clear: pericardiocentesis
6
Q
What’s the dx of tension pneumothorax? What’s the management? (2)
A
- Clinical dx
- Management: Needle thoracentesis to alievate air escape, followed by chest tube.
- key: trachial deviation
- if normal pneumothorax, just chest tube
7
Q
If trauma to the head with an unconscious period, what to do? (1)
A
Head CT without contrast
8
Q
If CT head negative and orienté x 3, what to do?
A
They can go home
9
Q
Identify. What’s the tx?
A
- Epidural hematoma (lens shape)
- tx: emergency craniotomy
10
Q
Describe presentation: Epidural hematoma (lens shape) (3)
A
- lucid interval
- knocked out
- wake up a bit, then pass out again
11
Q
What’s the tx: Increased cranial pressure (3)
A
- Elevating head
- Hyperventilating
- Mannitol (osmotic diuretic) which helps draw fluid into vasculature to alleviate edema
12
Q
Describe tx: Hemothorax (2)
A
- Usually resolves on its own
- If > 1.5 L or > 200 ml/per hour for 4h -> intercostal artery injury, surgical procedure (video assisted thorascopic surgery VATS)
13
Q
Name complications: Blunt trauma to chest (3)
A
- Pulmonary contusion
- Myocardial contusion
- Transection of the aorta
14
Q
Identify
A
L Pulmonary Contusion 24h after blunt trauma
tx: supportively
15
Q
Describe: Myocardial contusion (3)
A
- trauma to the sternum
- EKG, troponin
- associated with fx to sternum
16
Q
Describe: Transection of the aorta (3)
A
- Associated with high falls and motor vehicle crash with sudden deceleration
- on x-ray: widened mediastinum
- associated with first rib fx, scapula and sternum
17
Q
Name 1st-line imagery: Transection of the aorta (1)
A
CT angio
18
Q
Bladder injuries diagnosed with what?
A
- Retrograde cystogram
19
Q
In retrograde cystogram, if leakage in into peritoneum, what to do? (2)
A
- = introperitoneal bladder injury
- tx with surgery and close with suprabucic ostomy tube
20
Q
Describe tx: Extraperitioneal injury of the bladder (bellow peritoneum)
A
Foley catheter
21
Q
Describe: Renal injury (2)
A
- Associated with lower rib fx (11th and 12th fx)
- Gross hematuria
22
Q
Describe dx and tx: Renal injury (2)
A
- Dx: CT
- Tx: self-resolving
23
Q
Describe: Urethral injury (3)
A
- Blood at meatus
- Possible scrotal hematoma, inability to void
- High-riding prostate
24
Q
Describe dx: Urethral injury
A
-
dx: retrograde uretrogram
- no foley catether bc can make injury worse
25
What's the major concern of extremity injuries?
Major injury injury
Different between soft and hard signs of arterial injury
26
Differentiate between soft and hard signs of arterial injury (4)
* Hard signs -\> straight to OR
* Pulsatile bleeding
* Absent pulse
* Expanding hematoma
* Bruits/thrills
* Soft signs -\> Doppler
27
Describe: Developmental dysplasia of the hip (4)
* Malformation of the acetabulum (peds and ortho problem)
* On E/P of baby: clunking sound when moving hip, asymmetrical gluteal or thigh folds
* Imagery: Ultrasound
* Tx: Pavlik harness
28
Genu varum is normal until when? And genu valgum?
* Genu varum: 3
* Genu valgum: 8
29
30
How to tx: Compartment syndrome
Fasciotomy
31
Describe presentation: Compartment syndrome (6)
6Ps
* Pain
* Palor
* Pulseness
* Paresthesia
* Paralysia
* Poikilothermia
Key: Excruciating pain with passive movement
32
Describe: Quervain's Disease (Blackberry thumb) (3)
* Repetitive thumb movements -\> inflammation of the extensor pollicis brevis tendon
* sign: Finkelstein's Test
* tx: steroid injections
33
Describe: Gamekeeper thumb
* insufficiency of **the ulnar collateral ligament** (UCL) of the metacarpophalangeal (MCP) joint of the thumb
* tx: casting
34
Describe: Mallet finger
an injury to the end of your finger that causes it to bend inwards towards your palm. (often basketball)
35
Describe: Jersey finger
rupture of flexor digitorum profundus tendon (grabbing someone's jersey and they escaping -\> force hyperextension)
36
Describe: Cauda Equina Syndrome (4)
* something compresses on the spinal nerve roots (often disc herniation)
* sx: lower motor neuron sx, urination and bowel incontinence, overflow incontinence, decrease sphincter tone, perianal satal anesthesia, paralasis
* emergy
* dx: IRM
37
Describe: Marjolin's ulcer
* patients who have chronic wounds that heals, and heals, then heals -\> a non healing wound -\> Squamous cell carcinoma -\> biopsy
38
Describe tx: Acute gout (2)
* Indomethacin (NSAID) or colchicine
* NSAID C-I in kidney disease -\> intra-articular steroids
39
Describe tx: Chronic gout (2)
* Allopurinol
* Probenecid
40
Name main site of gout
* Metatarsal phalangeal joint
41
What to do before tx of gout?
First thing to do before tx -\> aspirate and analyze fluid -\> negative birefringence crystals (yellow needle shape)
42
If someone has knee injury and you extend, makes popping sound, clicks while you extend, what to think of?
Meniscal injury
43
If knee injury and supper swollen immediately, what to think of?
ACL injury
44
Name C-I to surgery (2)
* Ejection fraction \< 35%
* DKA
45
If someone had a recent myocardial infarction, how long do you have to wait to do surgery?
6 months
46
How early should someone stop smoking before surgery?
2 months, bc smoking really bad for wound healing (vasoconstrictor)
47
Malignant hyperthermia should be different with what? (3)
* Malignant hyperthermia
* Neuroleptic malignant syndrome
* Serotonin syndrome
all can have fever and rigidity
48
Describe: Malignant hyperthermia (2)
* follows a general anesthesia
* tx supportively with **dantrolene**
49
Describe: Neuroleptic malignant syndrome (2)
* follows antipsychotic use
* tx **dantrolene**
50
Describe: Serotonin syndrome (2)
* follows antidepressant antipsychotic
* tx: **benzodiazpeines ou cyproheptadine**
51
If you have a patient with PE or DVT and they're on anticoagulants, and drugs didn't work or have C-I (ex: increased risk of bleeding), what is the second line tx?
Instal Inferior vena cava filter
52
What's the first thing to do if the patient gets confused or disoriented?
Oxygen supplementation (R/O hypoexia)
53
After surgery, patients can get low urine output. What to do first? (2)
Bladder scan
* No urine means they're not perfusing kidneys enough, give IV fluids
* If a lot of urine, neurogenic bladder secondary to anesthesia use or surgery -\> insert foley until bladder wakes up
54
Describe: Paralytic ilesus (4)
* Complication of surgery, small intestin and colon shuts down
* Negative bowl sounds, no flatus, distension
* hypokalemia worsens this
* Ogilvie syndrome: Paralytic ileus of the colon only (small bowl active)
* on abdominal x-ray -\> distended colon
* tx: colonoscopy suction with long rectal tube
