Miscellaneous Surgical Specialties Flashcards
what surgeries are high risk for urinary retention
rectal, inguinal, spinal, palvic
4 post op general conditions that can be altered to prevent urinary retention
opioids, fluid overload, immobility and pain
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
Depiction of hydrocele comm vs non comm
Between which two layers does a hydrocele form
parietal and visceral layers of the tunica vaginalis
4 history points for hydrocele
Gradual onset
Painless
Involved hemi-scrotum
Noncommunicating are nonreducible
Transilluminates
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
Hx differentiating comm from non comm hydrocele
fluctuation over time
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
test for testicular torsion
color doppler
two tests for epididymitis
urinalysis and doppler — thickened epidid
Goal tx time in testicular torsion and salvage rate
6h
5%
doppler or no for testicular torsion
only if no delay
op for testicular torsion?
mid raphe incision, detorse, pexy both
epididymitis tx
nsaids, supportt, ice
abx if urinalysis dirty
left vs right varicocele characteristics
left more common as left gonadal goes into left renal vein
right would be concerning for RP mass
varicocele grading
1 non palp unless valsalve
2 palp
3 visible
when to treat varicocele
low perm count
3 peaks for testicular cancer
PE pres
30m, 30y, 60y
painless mass
3 labs prior to orchiectomy
bhcg, afp and ldh
NEVER do what for testicular mass
bx through scrotum
staging for testicular mass
CT CAP
go to operation for testicular mass
radical inguinal
spermatoceles otherwise known as…
epididymal cyst
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
