Miscellaneous Surgical Specialties Flashcards by william hudson

what surgeries are high risk for urinary retention

rectal, inguinal, spinal, palvic

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4 post op general conditions that can be altered to prevent urinary retention

opioids, fluid overload, immobility and pain

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4 layers of the scrotum and importance of the 3rd deepest

Skin
Dartos muscle
Tunica vaginalis (parietal) hydrocele sac
Tunica vaginalis (visceral) and tunica albuginea of testis

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Depiction of hydrocele comm vs non comm

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Between which two layers does a hydrocele form

parietal and visceral layers of the tunica vaginalis

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4 history points for hydrocele

Gradual onset
Painless
Involved hemi-scrotum
Noncommunicating are nonreducible
Transilluminates

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10 ddx for painful swelling testicles

testicular torsion
epididymitis/orchitis
Fournier gangrene
torsion of the appendix testis
trauma
testicular rupture
testis cancer
inguinal hernia
IgA vasculitis (formerly Henoch-Schönlein purpura)
Mumps

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Hx differentiating comm from non comm hydrocele

fluctuation over time

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Mng of adult vs pediatric hydrocele

when is the time to operate for peds

Lord plication, plicate sac

Jaboulay -evert sac and sew behind cord

12m

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test for testicular torsion

color doppler

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two tests for epididymitis

urinalysis and doppler — thickened epidid

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Goal tx time in testicular torsion and salvage rate

6h
5%

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doppler or no for testicular torsion

only if no delay

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op for testicular torsion?

mid raphe incision, detorse, pexy both

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epididymitis tx

nsaids, supportt, ice

abx if urinalysis dirty

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left vs right varicocele characteristics

left more common as left gonadal goes into left renal vein

right would be concerning for RP mass

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varicocele grading

1 non palp unless valsalve
2 palp
3 visible

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when to treat varicocele

low perm count

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3 peaks for testicular cancer

PE pres

30m, 30y, 60y

painless mass

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3 labs prior to orchiectomy

bhcg, afp and ldh

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NEVER do what for testicular mass

bx through scrotum

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staging for testicular mass

CT CAP

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go to operation for testicular mass

radical inguinal

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spermatoceles otherwise known as…

epididymal cyst

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order of renal hilum

ureter and ureteral artery relative positions

artery anterior

3 ureteral layers

Mucosa: transitional epithelium Middle smooth muscle Adventitia

Majority of testicular tumors are .... more specifically

germ cell seminomas

2 types of germ cell tumors

seminoma and non

3 non germ cell tumors

leydig, sertol, gonadoblastoma

4 non sem tumors

teratoma, embryonal cell, choriocarcinoma and mixed

choriocarcinoma mets by ....

hem

risk factors for RCC who gets this

smoking, hypertension, obesity, chronic kidney disease, occupational exposure, and familial conditions such as von Hippel-Lindau syndrome. Men 60-80

bladder and ureteral cancer risks 2

smoking and arsenic

MC GU ca and 2nd leading killer in men 3 risk factors

prostate African-American race, older age (> 40 years), family history (first-degree relative diagnosed before age 65), and BRCA mutation.

screening for prostate ca

Although early screening in African-American men or men with a family history of prostate cancer is widely accepted (beginning at age 40-45 years), screening of all men is more controversial (beginning at age 50 years). Screening involves determining the prostate-specific antigen (PSA) value alone every 1 to 2 years. Men with a PSA level greater than 7 ng/mL should be referred to a urologist.

What is elevated in non sem sem?

afp and bhcg maybe bhcg

T staging for rcc

T1: ≤ 7 cm in largest dimension T2: >7 cm in largest dimension T3: extension into the renal vein or perinephric tissues but not beyond the Gerota fascia T4: extension beyond the Gerota fascia, including direct extension into ipsilateral adrenal gland

MC site of ectopic

fallopian tube 96%

normal bhcg increases what if it is slow

In normal pregnancy, hCG should increase more than 35% in 48 hours or double in 72 hours. ectopic

Rh neg women who are bleeding from ectopic need what

anti D

quick imaging modality for suspected ectopic rupture

FAST

discriminatory zone for bhcg what if no IUP visualized

2500 ectopic

MTX mech

folic acid antag

preferred tx for ectopic and indications contraindications

Indications include: Hemodynamic stability No contraindications to MTX Serum hCG less than 5000 mIU/mL No fetal cardiac activity detected by transvaginal ultrasound Patient ability to comply with posttreatment follow-up and access to emergency medical care in case of treatment failure and rupture Contraindications include: Co-occurring intrauterine pregnancy Ruptured ectopic pregnancy or hemodynamic instability Renal insufficiency Immunodeficiency Breastfeeding Hypersensitivity to MTX

operative ectopic preg

follow up for ectopic preg

hcg intervals Rh if needed

PID empiric treatmetn

cefoxitin plus doxy or clinda plus gent for 14 days

risk factor with PID

ovarian cancer

3 ovarian hereditary syndromes

BRCA and lynch

4 endometrial cancer RFs

Lynch/Cowden, obesity, unopposed estrogen

MC gyn cancer

endo

what is a classic presentation for endometrial cancer

uterine bleeding post men

BRCA 1 risk %s

breast 65 ovarian 40-60

besides surgery for brca1 what else can decrease ovarian risk

ocp

3 additional steps in ovarian tumor resection

peritoneum bx resection of omentum lymphadenectomy of pelvis

locally advanced cervical ca is treated with....

chemorads

what is a FAMM flap for

oral/nasal cavity

first line strategy for large facial defect from skin ca surgery 2nd line

partial primary with full thickness pec muscle flap

case control study starts with an ____ and looks back for _____

outcome; exposure

Observational studies, randomized controlled trials, and cohort studies begin with _____ and study the _____; in observational studies and cohort studies the exposures are _____ but measured; in randomized controlled trials, the exposure is ______ (interventional study).

exposure outcome natural assigned

levels of evidence quality by study type ranked

syst review rcts> rcts> cohort studies> case control

worst thing to have as hx for cardiac complications

aortic stenosis

is accepting a patients medical decisions as writing during ventilation ok?

sure

length time bias is for...

slow growing tumor screens

lead time bias is from early...

detection

dg delerium with CAM

he diagnosis of delirium requires the change in mental status to be of acute onset with a waxing and waning course and inattention. It also requires either disorganized thinking or an altered level of consciousness

what analysis is used for non compliance, withdrawal and crossover subject in an RCT

intention to treat analysis

mcc after lap hyterectomy

bladder injruy

2 components affecting the CI

sample size and SD

pressor support for withdrawal of care?

yes for palliative med circulation

what is the primary mechanism of PID

cervical mucus barrier breakdown

thoracic outlet structure order

SCV, phrenic, ant scalene, SCA, B plex, middle scalene

MC head and neck rfs

SCC ETOH smoking, hpv

Tx Stage 1 and 2 for HNN scc 3&4

rads +- surgery surgery with neck dissection then chemorads

order of malignancy for salivary glands

partid>submandibular>sublingual

MC malignant salivary gland tumor Tx

mucoepidermoid Radical resection +/- chemorads

adenocystic salivary tumor tx very senstive to

resection with nerve preservation -- less aggressive rads sens

MC benign salivary gland tumor Tx

pleiomorphic superficial parotidectomy

warthrin tumor tx -- other name?

watch papillary cystadenoma lymphomatosum,

2nd most common salivary tumor

warthrin

MC location of unknown hnn primary

tonsils then tongue

always do this investigation with your hnn w/u of unknown primary definitive tx if still cant find it

ipsilateral tonsillectomy bilateral tonsillectomy b/l rads ipsilateral neck

nasopharyngeal ca tx asoc virus

XRT EBV

gustatory sweating following parotidectomy caus3

frey auriculotemporal nerve injury and crossover