Monday 9/5/16: Surgery Exam 3 Flashcards
What causes a medial collateral ligament tear?
Severe valgus stress (blow to the lateral knee) or twisting injury.
What are some examination findings of a medial collateral ligament tear?
Ecchymosis and joint line tenderness at the medial knee.
What is the valgus stress test?
Appreciable laxity when the leg is forced into abduction is helpful for diagnosis of a medial collateral ligament tear.
What is the most sensitive test for MCL tear?
MRI but is reserved for patients considered for surgical intervention.
How are patients with uncomplicated MCL tears treated?
- Nonoperatively
- Rest
- Ice
- Compression
- Elevation
How does injury to the anterior cruciate ligament present?
Tibia will show anterior rather than valgus laxity.
How do injuries to the lateral collateral ligament present?
High velocity traumas. Knee will have varus laxity.
How does medial meniscus injury present?
Shows a small joint effusion and crepitus, locking, or catching with range of motion.
What is patellar tendinitis or jumpers knee?
Chronic overuse injury characterized by anterior knee pain and tenderness. Stress testing of the ligaments are normal.
How do tibial plateau fractures present?
Contact sports, falls or MCV. But with fractures you are unable to bear weight on the knee.
What are clinical features of peritonsillar abscesses?
- Fever, earache
- Sore throat, difficulty swallowing
- Trismus
- Muffled “hot potato” voice
- Uvula deviation away from the enlarged tonsil.
- Pooling of saliva
What is a peritonsillar abscess
Acute bacterial infection of the region between the tonsil and the pharyngeal muscles.
What are the series of events for peritonsillar abscess ?
- Persistent tonsillitis/pharyngitis
- progresses to cellulitis/phlegmon
- Pus collecting into and abscess within a week of symptom onset
Who normally gets peritonsillar abscess ?
Older adolescents and young adults, drug or alcohol use increases risks.
What is the treatment for peritonsillar abscess ?
Needle aspiration or incision and drainage plus antibiotics to cover group A hemolytic strep and respiratory anaerobes.
How does epiglottis present?
- High-grade Fever
- Severe sore throat
- Odd phage that can progressively turn into airway obstruction
How does tonsillitis present?
Tonsillar erythema and exudates
Tender anterior cervical nodes
Palatal petechia
When do enlarged adenoids present?
Early childhood and regress with age
What causes herpangina
Coxsackie A.
How does herpangina present?
- Fever
- Sore throat
- Odynophagia
- Vesicles on the tonsils and soft palate
How is infectious mononucleosis characterized?
- Fever
- Pharyngitis
- Posterior cervical lymphadenopathy
When should tetanus-diphtheria toxoid be given?
Individuals with severe or dirty sounds who received a booster more than 5 years ago and those with minor clean wounds who received a booster more than 10 years ago
When should tetanus immune globulin be given?
Any individual with severe or dirty wound AND an unclear or incomplete immunization history. Or in someone who is severely immunocompromised
What type of protection does tetanus immune globulin provide?
- Passive
- Temporary
3 immediate immunity
How does acute pancreatitis present?
- Mid epigastric pain that radiates to the back
- Nausea and vomiting
- Elevated amylase and lipase
What is the second most common cause of pancreatitis? And how can you determine that?
Gallstone pancreatitis if ALT>150 U/L
What is the treatment for a resolved acute pancreatitis attack due to gallstones?
Early cholecystectomy
What drugs cause drug induced pancreatitis?
- Thiazides
- ACE inhibitors
Not calcium channel blockers
When is ERCP recommended in gallstone pancreatitis?
Patients with gallstone pancreatitis who have cholangitis, visible common bile duct dilation or obstruction or increasing liver enzymes
When are HIDA scans used?
Evaluating cholecystitis in patients with intermediate ultrasound findings.
How does a AAA present?
- Acute onset of severe back pain
- Syncope
- Hypotension
What is the normal size of an abdominal aorta
1-3 cm
How is a AAA different from a thoracic aortic aneurysm?
AAA involves all aortas layers and does not create an intimal flap or false lumen.
AAA typical occur in what types of people?
Aged over 60.
Smokers
Men
People with a history of coronary artery disease
How are AAA found?
Incidental ultrasound or CT
What is a physical exam finding in a AAA
Pulsatile abdominal mass at or above the level of the umbilicus.
Where can a AAA rupture into
Into the retroperitoneium and can create a aortocaval fistula with the IVC, leading to venous congestion in retroperitoneal structures (bladder)- the fragile vessels can break causing hematuria
How do you treat AAA?
Emergently taken to the OR.
