Neck Flashcards
1
Q
Describe the diagnosis and organism treatment of acute bacterial parotitis in a post-operative patient with FAHM.
A
ACUTE PAROTITIS:Cause…..bad oral hygiene and dehydration..vvvv imp Organism……staph
Cp……. Painful swelling and pus from the duct Preverntion………..hydration and oral hygiene TTT……antibiotic
If fulminant…..decompression by incision Do not wait for flactuation
2
Q
What is the first investigation for a suspected submandibular gland stone?
A
salivary gland stones:
Site:
submandibular……..most common Parotid…….. rare
Cp:
Swelling and pain increased by eating Pain referred to the ear Exam…..enlarged and tender gland
1st inv: intra-oral x-ray.
3
Q
Salivary gland tumours:
Most common malignant……….
A
mucoepidermoid carcinoma
4
Q
MC complication/ MC affected n. of parotid gland surgery:
A
facial n injury.
5
Q
Salivary gland tumours:Type bilateral or with hot spots
A
warthin tumour
6
Q
Explain the management of a submandibular gland stone if not revealed on x-ray. For duct and gland
A
TTT: If stone in the duct…… cutting directly over it
If the gland…….removal of the gland
7
Q
What is the diagnosis for a painful, rapidly growing swelling of the parotid gland with ipsilateral facial nerve palsy?
A
Dx: cancer parotid.
8
Q
What is the most common complication following parotid gland surgery?
A
MC complication: facial nerve injury.
9
Q
Define the most common benign tumor of salivary glands.
A
MC benign tumor: pleomorphic adenoma.
10
Q
If begnin…..Salivary gland tumours:
A
painless, slowly growing, well defined not affected
facial nerve
11
Q
If malignant..Salivary gland tumours:
A
painful, rapid growing , affecting facial nerve
12
Q
parotid
A
BIOPSY………..the main INV ……vvvv imp
Type of biopsy as breast cancer….the best is core biopsy CT…..for metastasis
If in superficial…. Superficial parotidectomy
If the deep part…… total conservative
13
Q
Main problem with pleomorphic adenoma…….
A
recurrence
14
Q
Main nerve affected during surgery
A
facial nerve…vvvv imp
15
Q
Describe the sequence of investigations for salivary gland swelling based on the nature of the mass.
A
If solid mass: 1st inv CT, Inv of choice: Biopsy.
Inv of choice………..Biopsy…..most accurate biopsy is excisional
If inflammation: 1st inv US. If stones: 1st inv X-Ray, Inv of choice: sialogram.
16
Q
Sequence of investigations in salivary gland swelling:..vvvvimpIf inflammation:
A
If inflammation: 1st inv US. If stones: 1st inv X-Ray, Inv of choice: sialogram.
17
Q
How is a pulp space infection typically treated?
A
TTT: incision & drainage (don’t wait for fluctuation).
18
Q
Explain the diagnosis and treatment of tenosynovitis presenting with pain, swelling, and limited movement at the radial side of the wrist.
A
Dx: tenosynovitis. TTT: mild cases - rest, NSAIDs. Resistant cases - cortisone injection.
19
Q
Describe the presentation and management of Dupuytren’s contracture.
A
Presentation: flexed finger with nodule at palmar fascia. Most common cause: alcoholism. Most important investigation: blood glucose level. Initial/most important investigation before surgery: US. or no treatment
20
Q
Define Volkman’s ischemic contracture and its treatment.
A
Permanent shortening/ contracture of muscle after supra-condylar dracture of humerus
Dx: volkman’s ischemic contracture. TTT: physiotherapy and surgery.
21
Q
What is the initial step for a patient with supracondylar fracture of the humerus experiencing severe pain after cast application?
A
1st step: cast removal.
22
Q
TTT of volkman’s ischemic contracture
A
: physiotherapy and surgery.
23
Q
If pain persist after cast removal:
A
immediate exploration.
24
Q
How is an ingrown toenail typically managed?
A
TTT: piece of gauze soaked with antiseptic solution, wearing proper size shoes. Wedge resection for resistant cases.
25
Describe the presentation and diagnosis of a thyroglossal duct cyst.
Treatment
Presentation: swelling at neck midline moving with swallowing & tongue protrusion.
MC fate: infection.
TTT: surgical removal.
26
Describe the main histological type of thyroid cancer.
Papillary carcinoma.
27
What is the next step if fine-needle aspiration biopsy (FNAB) shows follicular cells in thyroid cancer suspicion?
Biopsy to assess capsular infiltration.
28
What is the most fatal type of thyroid cancer, more common in males?
Anaplastic carcinoma.
29
Lateral aberrant thyroid…….
Enlarged deep cervical LN with normal thyroid gland
30
What is a bad sign in thyroid cancer indicating infiltration of the recurrent laryngeal nerve?
Hoarseness of voice.
31
What is the main line of treatment for thyroid cancer?
Total thyroidectomy (lymph nodes are only removed if affected).
32
What is the immediate step if a patient develops severe stridor a few hours after thyroidectomy?
Removal of all stitches (superficial & deep) and open the wound at the yard.
33
What is the diagnosis if a patient immediately after thyroidectomy develops tachycardia, hypertension, hyperpyrexia, and dyspnea?
Acute thyroid crisis.
34
How should acute thyroid crisis be managed?
Propranolol, IV fluids, ice packs, oxygen, cortisone.
35
What is the treatment for laryngeal edema after thyroidectomy?
Intubation.
36
Describe the consequences of unilateral injury of the recurrent laryngeal nerve after thyroidectomy.
Hoarseness of voice.
37
Describe the consequences of bilateral complete injury of the recurrent laryngeal nerve after thyroidectomy.
injury of RLN ……..
38
Describe the consequences of bilateral incomplete injury of the recurrent laryngeal nerve after thyroidectomy.
Aphonia and stridor.
39
What is the diagnosis for peri-oral numbness and tetany after thyroidectomy?
Hypoparathyroidism.
40
What is the cause of hypoparathyroidism after thyroidectomy?
Removal of all 4 parathyroid glands.
41
What is the emergent treatment for hypoparathyroidism after thyroidectomy?
Calcium gluconate 10% IV slowly.
42
What is the maintenance treatment for hypoparathyroidism after thyroidectomy?
Calcium and Vitamin D.
43
What is the treatment for progressive exophthalmos after thyroidectomy?
Tarsorrhaphy.
44
What is the recommended treatment for hyperthyroidism during pregnancy?
Short course of antithyroid drugs and propranolol until euthyroid, then surgery in second trimester
45
When is the best time for elective surgery during pregnancy?
2nd trimester.
46
What is the best treatment for thyrotoxicosis in children?
Antithyroid drugs.
47
What is the best treatment for thyrotoxicosis in cardiac patients?
Surgery.
48
What is the best treatment for thyrotoxicosis in pregnancy?
Surgery.
49
What is the treatment for malignant exophthalmos with abrupt toxic status change?
Antithyroid drugs first until euthyroid, then surgery.
50
What could be the cause of fever, agitation, and dyspnea in the first day post-operatively after thyroidectomy?
Atelectasis.
1st inv: pulse oximetry.
2nd inv: ABG then X-RAY.
1st step in TTT: O2.
Best TTT: breathing exercise.
Best way of prevention: incentive spirometry.
51
Fever, agitation, dysurea in 3rd d post-operative:
UTI.
52
Post op UTI
MC organism: E-coli.
Best ab TTT: TMP-SMX.
E-coli
TMP-SMX
53
Describe the first step in the treatment of a patient with a suspected urinary tract infection (UTI).
The first step in treatment is providing oxygen.
54
What is the best treatment for a patient with a UTI?
Breathing exercises are considered the best treatment.
55
Define incentive spirometry in the context of preventing UTIs.
Incentive spirometry is the best method for prevention.
56
How can urine samples be collected in pediatric patients?
For children over 4 years old, mid-stream collection is used. For younger children, especially under 1 year old, suprapubic aspiration is preferred. If these methods fail, catheterization may be necessary.
57
Describe the criteria for a positive urine sample in terms of white blood cells (pus cells) and E. coli count.
A positive sample includes more than 10 white blood cells (pus cells) and an E. coli count exceeding 100,000.
58
UTT - Further investigation to children…..US is a must
If recurrent UTI….
US
.micturiting cystourethrography
59
What is the main treatment for a patient with a suspected pulmonary embolism (PE)? 4- 5 days
The main investigation is a CT angiography, followed by treatment with LMWH (Low Molecular Weight Heparin) and warfarin with a target INR of 2-3 for 3-6 months.
60
Pain, red, swelling at site of surgical wound: wound inf; treatment
give abs.
61
MCC of hypovolemic shock:
bleeding.
62
1st sing of hypovolmia
pulse change.
63
Do you know the main treatment for hypovolemic shock?
The main treatment for hypovolemic shock is IV fluid resuscitation with normal saline (0.9% NaCl).
64
Worst sign of hypovolemia
hypotension (means loss of 20-25% of IV volume).
65
MCC of cardiogenic shock:
MI.
66
Define the main treatment for a patient in cardiogenic shock.
The main treatment involves using inotropes.
67
How should neurogenic shock be initially managed?
The initial steps in managing neurogenic shock include IV fluid administration followed by vasoactive medications.
68
Describe the primary treatment approach for septic shock.
The initial treatment for septic shock involves IV fluid resuscitation followed by antibiotics.
69
Main TTT of hypovolemic shock
IV fluid.
70
What is the recommended fluid for use in intestinal operations?
Hartman's solution is the best fluid for intestinal operations.
71
How should Hartman's solution be administered in relation to an operation?
Hartman's solution should be given before the operation, not during or after.
72
Define the daily post-operative fluid requirement in terms of dextrose and saline.
The daily requirement is 2L of 5% dextrose and 1L of normal saline.
73
If pt needs blood (e.g. hypotension):
packed RBCs (O- if must be given before cross matching).
74
Contra-indication of hartman’s solution
metabolic alkalosis
75
Daily post- operative fluid requirement
2L of 5% dextrose& 1L of normal saline.
76
Deficit therapy: given as normal saline.
given as normal saline.
77
What is the minimum daily potassium requirement for a patient?
The minimum potassium requirement is 60mmol/day, with a minimum level of 20mmol/L.
78
Describe the fluid management for an elderly patient with dehydration.
In elderly patients with dehydration, normal saline should be given to ensure urine output exceeds 2 ml/kg/h.
79
Do you know the most common cause of a discrepancy between input and output in medical settings? fluid
The most common cause is an error.
80
Define the most common reason for increased output compared to input on the 5th day post-operation.
The most common reason is the resolution of paralytic ileus.
81
Describe the first most common cause of post-operative oliguria.
Functional post-renal obstruction.
82
What is the second most common cause of post-operative oliguria?
Dehydration.
83
What is the first step in the management of post-operative oliguria?
Catheterization.
84
What is the first investigation done for post-operative oliguria?
Ultrasound (US).
85
What is the next step if there is no urine output after catheterization in a post-operative patient?
IV fluid administration (fluid challenge).
86
Define the most painful type of burn.
First degree burn.
87
Describe a painless, white burn.
Full thickness burn.
88
What is the recommended action if a burn patient has soot in the airway?
Intubation to prevent asphyxia and airway obstruction.
89
What should be done if a burn patient develops laryngeal edema?
Intubation.
90
What medication should be given to burn patients who have undergone major surgery or are in the ICU to prevent curling ulcer.?Burn pt, pt undergone major surgery or ICU pts
Proton pump inhibitor (PPI).
To prevent Curling ulcers in burn patients, those who have undergone major surgery, or ICU patients, the administration of acid-suppressive medications is recommended. The preferred medications include:
1. **Proton Pump Inhibitors (PPIs)**: These are effective in reducing gastric acid secretion and are commonly used as prophylaxis to prevent stress-related mucosal damage.
2. **Histamine-2 Receptor Antagonists (H2RAs)**: These also reduce stomach acid production and are an alternative to PPIs.
The use of these medications helps mitigate the risk of developing gastric and duodenal ulcers caused by the stress of severe burns or critical illness, which can lead to significant complications if not managed appropriately.
For more details, you can refer to the RACGP guidelines and other relevant sources such as the [World Journal of Surgery](https://link.springer.com) and [Vanderbilt University Medical Center](https://www.vumc.org/burn/sites/default/files/public_files/Protocols/Stress%20Ulcer%20Prophylaxis%20-%20March%202023.pdf).
91
Laryngeal edema in burn pt:
intubation.
92
What is the most common cause of death in burn patients, especially due to pseudomonas infection?
Infection.
The most common cause of death in burn patients, particularly those with Pseudomonas infections, is sepsis. Pseudomonas aeruginosa is a significant pathogen in burn wound infections due to its ability to thrive in moist environments and cause severe invasive infections. Burn wound sepsis can lead to systemic infections and multi-organ failure, which are major contributors to mortality in these patients.
For detailed guidelines on the management of thermal burns and associated infections, you can refer to the RACGP resource on thermal burns management [here](https://www.racgp.org.au/afp/2012/june/thermal-burns-assessment-and-acute-management).
93
What is the management approach for eschar in burn patients?
Escharotomy (not fasciotomy).
94
What is the most important prognostic factor in burn patients, focusing on the burn's extent rather than the degree?
Surface area.
95
What is the most common complication associated with peripheral or central line insertion?
Infection.
96
What is the most common organism causing infections related to central lines?
Staphylococcus.
97
What is the initial step in managing infection related to a catheter in a patient?
Remove the catheter followed by antibiotic administration.
98
What is the most common complication during central venous pressure (CVP) line removal?
Dislodgement of thrombus.
99
After CVP line removal, if a patient presents with marked congestion of the face and neck, what is the likely diagnosis and the preferred investigation?
Dislodgement of thrombus; CT with contrast.
100
What is the main treatment for necrotizing fasciitis?
Debridement.
101
What is the primary treatment for gas gangrene?
Debridement.
102
What is the most important vaccine recommended for patients with splenectomy?
Pneumococcal vaccine.
103
Why are patients with splenectomy at risk of septicemia from encapsulated organisms?
Due to the absence of spleen which plays a crucial role in fighting such infections.
104
What is the recommended management for serosanguineous discharge from a wound after abdominal surgery with just dehiscence?
Observation with abdominal strapping.
105
What is the appropriate action for serosanguineous discharge from a wound after abdominal surgery with evisceration?
Emergent surgery.
106
What is the initial step in the treatment of a lacerated deep wound?
Debridement.
107
Describe the vaccination and immunoglobulin administration protocol for a lacerated wound in a vaccinated individual.
Tetanus toxoid if last dose more than 5 years; no Tetanus Immunoglobulin (TIG).
108
What is the recommended protocol for vaccination and immunoglobulin administration in a lacerated wound for an individual who is not vaccinated or has an incomplete vaccination history?
Tetanus toxoid and Tetanus Immunoglobulin (TIG) administration.
109
What is the protocol for vaccination and immunoglobulin administration in a clean wound for a vaccinated individual?
No Tetanus Immunoglobulin (TIG) required; Tetanus toxoid administration.
110
What is the protocol for vaccination and immunoglobulin administration in a clean wound for an individual who is not vaccinated or has an incomplete vaccination history?
Tetanus toxoid and Tetanus Immunoglobulin (TIG) administration.
111
Describe the management for a patient with a lacerated wound who is not vaccinated or has an unknown vaccination status or has received less than 3 doses.
TIG is not recommended, Tetanus toxoid should be administered.
112
What is the recommended course of action if a patient received a booster dose of tetanus vaccine within the last 4 weeks?
For a lacerated wound: No treatment for vaccinated patients, TIG only for unvaccinated patients.
113
How should tetanus be managed in a child under 10 years old who is not fully vaccinated?
If not fully vaccinated, TIG and tetanus toxoid are not recommended, only DTPa should be administered.
114
Describe the management of tetanus in an old smoker presenting with any complaint related to the tongue until proven otherwise.
For an old smoker with a complaint related to the tongue, if cancer is suspected, the most important complaint is blood-stained saliva and otalgia.
Inv of choice of tongue cancer: biopsy.
115
White patch on tongue not removed by scraping
= oral leukoplakia (pre-malignant).
116
What is the next step for an old smoker presenting with new-onset hoarseness of voice?
The next step is laryngoscopy due to the risk of laryngeal cancer.
117
Old age male with dysphagia, regurge, halitosis and bulge in neck…
Dx: zenker diverticulum.
118
Inv of coice of zenker diverticulum:
barium swallow.
119
Timing to give antibiotics before the operation
one hour
120
Most imp sign after head injury
level of consciousness
121
Least cancer causing metastasis to the brain…
.prostate
122
Most imp inv in preoperative staging of gastric adenocarcinoma is ……..
PET scan.
123
If pt not improved after clindamycin: trans-pleural drainage.
lung abess
trans-pleural drainage.
124
Persistent symptoms of pneumonia after TTT with abs
… Dx: empyema.
125
What is the main treatment for a lung abscess?
The main treatment is clindamycin.
126
What is the recommended treatment if a patient with empyema does not improve after initial treatment?
For empyema, the treatment involves chest tube placement and continued antibiotics.
