MTB3- Surgery Flashcards
Two consecquences of chest trauma?
- Hypovolemic shock
- Tamponsde
- Tension Pneumothorax
Management of the hemodynamicaly unstable patinet?
- getting 2 IV lines
- Blood & fluid
- blood type and screening
- Fuley Catheter
- Antibiotics
What are the two steps in the patients with open Fx of the head?
Tetanus toxoid and Antibiotics
Managemnet of the central line associated infection?
Culture form the site of catheter insertion/ culture from another vein/ start anti- staph Antibiotics
Management of catheter induced UTI?
-intermittent catheterizatins in long term catheterization/ Catheter removal / most accurate test in urine culture
How is the approach to diffuse axonal injury?
The cause of axonal injury?
No Tx, just prevent from other oxonal injury in future
Acceleration/ Decceleration injuries
Approach to increased ICP?
- Head elevation
- Hyperventilation
- Avoid fluid overload
- Mannitol
- Sedation or hypothermia to decrease brain demand
Mechanism o f Metronidazole?
It attaches to DNA and inhibits bacterial nucleic acidsynthesis.
Causes of perforation and abdominal pain ?
First initial step in perforation and peritonitis?
Tx for acute abdomen caused by peritonitis?
1- Diverticulitis2- Perforated peptic ulcer 3- Crohn’s disease
2- erect X-Ray or lateral decubitus
3- NPO/ IV fluid hydration
4- Antibiotics( metro & Cipro ) / 2nd generation cephalosporines/ Ampi-sulbactam/ Piperacilline-Tazobactam
How to Dx esophageal perforation?
It is usually iatrogenic and is associated with pain in chest or upper abdomen .
Dysphagia or Odynophagia.
The most important sign is Subcutaneous Emphysema.
How would you be suspeciouse about bowel obstruction?
DDXs in Bowel Obstruction?
- high pitched bowel sounds/ nausea and vomitting/ the patient is in constant moves to relieve the pain/ Absence of flatus or feces.
1- volvulus in an old patinet/ tumor in an old thin patient/ Diverticulitis/ Adheisionsrelated to prior surgeries/ history of hernia( incarcerated hernia)
What kind of contrast should be used in a patient with perforation
Gastrografin
How is AAA screening?
One time screening is necessary in all men 65-75 years old.
How is the approach to AAA?
If it’s painful => emergency surgery ( it shows that it’s already ruptured or gonna be ruptured very soon.
Aneurysms serial anuual imaging
Aneurysms >5 => Elective repair
RFs contributing to thr development of thoracic aortic aneurysm?
- Chronic HTN
- Marfan
- Smoking
- Hyperlipidemia
- Tertiary syphilis
How to manage arteriosclerotic occulsive disease of lower extremities?
Smoking cessation
Cilostazol/ ASA
How is doppler sono in peripheral A disease?
Ankle Brachial index
What is the ethiology of Arterial embolization of the extremities?
Emboli from the heart/ look for recent MI or Atrial fibrilation
What is subclavian steal syn.?
It’s an arteriosclerotic plaque at the origin of the subclavian A. It allows for enough blood to resch the hand at rest but there is lck of blood during exercise.
Patient has vascular symptoms with neurological signs.
In thorasic outlet syn., there is no neurological signs and symptoms.
Best diagnostic test for Acute diverticulitis?
CT with contrast
Signs and symptoms of hemorrhagic pancreatitis?
- very high WBC > 18.000
- low HCT that continues to fall the day after
- low Calcium
Cause of low Calcium in Hemorrhagic pancreatitis?
There are insoluble Ca salts in pancrease . Free fatty acids bind to these Calciums and that resultsin Ca deposition in retroperitoneum.
Consequences of Acute pancreatitis?
- Pseudocyst
- Abcess
- Chronic damage
When pseudocycts apear in acute pancreatitis?
- after 5 weeks
- if it’s painless do nothing/ if painful then if it’s > 6 weeks and > 6 cm then you should do surgical drainage
- if it’s infected then precutaneous external drainage
What IV antibiotics should be administered before appendectomy?
- Metronidazole/ Ciprofloxacin
- Ampi/ Sulbactam
- Levofloxacin and clindamycin
- Cefoxitin/ Cefotetan
Which on of the abdominal arteries is suceptible to ischemia?
Superior mesantric A.
What are the differences between Testicular torsion and Epididymitis?
Testicular torsion is very painful and the TX is Bilateral Orchiopexy with out pain or urinary symptoms.
Acute Epididymitis ha spain, fever and urinary symptoms. tx is tx pf UTI in males 35 Levofloxacin
What kind of diseases cause lytic leisions and which one cause bastic leisions?
Blastic leisions in prostatic cancer/ lytic leisions in kidney, thyroid , MM
Which diseases are associated with HLA-B27?
- Uveitis
- AS
- IBD
Ethilogies of CTS?
- Acromegaly
- Hypothyroidism
- RA
What is the rule to taking an X-Ray in Fxs?
- Always take an X-Ray of the sites at the line of the force of injury
- Always take 2 viwes at 90 degree to one another
What should you considered in any deep prenetrating deep wounds?
Gas gangrene, TX is IV Penicillin and Hyperbaric O2
What is the time frame to fix open FX?
6 hours
What is cole’s FX?
FX of the lower end of radius in wrist with backward displacement of the hand.
Most accurate test to DX Herpes encephalitis?
PCR
What is Gonioscopy?
When there is glucoma diagnosed by Tonometry we use this way to find the type of Glucoma , it shows us closed angle glucoma by measuring the angle between cornea and iris.
When should we start anti retroviral therapy?
When CD 4
First step in patient with trauma and altered mental status?
- secure the airway by orotracheal intubation
- patient has spinal injury then fix and immobalize the spine by flexible sigmoidoscopy
- facial bleeding and trauma => Cricothyroidectomy or precutaneous
Tracheostmoy
How is the charactristic of ruptured of the Achilles Tendon?
Tx of the Rupture of the Achilles Tendon?
It happens with overuse in tennis or basketball. It happens with sudden popping and limping.
TX is casting in equinus position or surgical repair.
Tibilal stress injury in?
- overuse it like marches.
Treat with cast order the patient not to bear weight and repeat film in 2 weeks.
Trigger finger charactristics?
Another name for Trigger finger?
Wakes the patient up at night withn flexed finger and snaps when hyperextend it.
De Auervain Tenosinovitis
Best Tx=> Steroids
How long does it take to see scaphoid Fx in xray?
Best TX option for scaphoid FX?
3 weeks
Spica cast of the thumb
Tx for femoral neck FX?
Tx for femoral shaft FX?
Tx of intertrochantric FX?
- Neck FX => femoral head replacement
- Intertrochantric Fx=> Open reduction and pin
- Femoral shaft FX=> intramedullary rod fixation
Tx for medial / Lateral collateral ligamnet injury?
Surgical if in multiple locations/ casting if only it’s in one location
Ant / Pos cruciate ligament injury TX?
Young atheletes => Arthroscopic repair
Older patients=> rehabilitation and immobalization
Tx of Miniscal injury?
Arthroscopic repair
Tx of acute cholecystitis?
- NG suction, NPO, IV fluids, Antibiotic ….. Followed by Antibiotics
When should we expect Biliary Atresia?
6-8 weeks
When should we expect Pyloric Stenosis?
3 weeks
When should we expect intussusception?
6-12 months
What will you see in an X-Ray in Meconium Ileus?
Multiple dilated loops / ground glass appearance
Teo pathogens involved in Necroziting Entrocolitis?
E.coli/ Klebsiella
Ethilogy of Ascending Cholangitis?
Obstruction of common bile duct which causes ascending infection there is high fever and high WBC and very high ALKP.
Tx of chlangitis?
Iv Antibiotics
ERCP
PTC(percutaneous transhepatic cholangiogram)
Cholecystectomy
Definition of fecal incontinence?
Dx?
TX?
Iinvoluntry passage for at least one month in a patient > 3 YO
The best initial test is sigmoidoscopy / the best accurate test is rectal manometry.
Combine Bulking agents with biofeedback techniques/ endoscopic injection of dextranomer- Hyaluronic and the last step in colorectal surgery
TX of congenital diapheragmatic hernia?
- endotracheal intubation/ low pressure ventilation/ NG suction
Ethilogy of esophageal Atresia?
Ventrally displaced location of the notochord in an embryo that can lead to a failure of apoptosis inthe developing foregut and cause esophageal atresia.
Etiologies of Gastrochisis and Omphalocele?
In gastroschisis the umbelical cord in normal and the defect is on the right side of the cord. Gastrochesis occur when the neural crest fails to migrate rsulting inthe absence of enteric neurons within myentric plexus and submucosal plexus.In Omphalocele the umbelical cord goes too the defect. Incomplete fusion during the fourth week of development results in defect that allows abdominal viscera to protrude through the anterior body wall whicn is made when the lateral body folds move ventrally and fuse in the midline.
