oncology surgery Flashcards
If a patient undergoing a surgical procedure has new onset hypoxia as shown on pulse oximetry but the Abg shows normal oxygen, huge difference in two readings. most likely cause?
Methemoglobinemia - caused by anaesthetic agents or dapsone - altered state of hemoglobin!
Discontinuation of causative agent and give methylene blue
Early large volume resuscitation with normal saline for trauma patient. Now what change must be made in continued treatment
Limit saline/crystalloids! -> risk of coagulopathy, hypothermia and mortality
Give blood products
Free fluid in abdomen can point to ongoing hemmorrhage
The work up of a suspicious breast mass in men, ie Firm, fixed, unilateral, nipple inversion, is the same as it is in women
Meaning ultrasound, mammography
Gynaecomastia typically mobile, bilateral, tender
For HIIT, after stopping heparin, what drug do you start?
Direct thrombin inhibitor! =argatroban or fondaparinux.
Patients can only be safely switched to warfarin once platelet count is above 150,000
Note skin necrosis can occur in hit at injection sites
Nontender solitary cervical lymph nodes concerning for?
Head and neck Scc
Mycobacteria’s lymphadenitis - the lymph node will become fluctuant and purple, more common in kids. Unlikely to cause ear pain
Smoking history , epigastric pain, weight loss, bleeding easily, leg pain consistent
with DVT. Most likely condition ?
CHRONIC DIC. on background of pancreatic cancer. This is very common with PC and other mucin producing tumours. Thrombosis and mucocutaneous bleeding can occur
A patient with chest discomfort, frequent URTIS and a middle mediastinal mass most likely has?
What masses are found in anterior chest?
Bronchogenic cyst!
Not thymoma as they are found in anterior chest
Anterior = 4Ts = thymoma, teratoma and other germ cell tumours , terrible lymphoma, thyroid neoplasm
In a patient with no limb threatening DVT and concurrent major bleeding elsewhere, how do you manage?
IVC filter instead of anticoagulation
Note in limb threatening DVT = thrombolysis or thrombectomy
Severe trauma can cause DIC = a consumptive coagulopathy v oozing from surgical sites etc
Rectus sheath hematoma risk factors?
Trauma to epigastric artery
Forceful contractions/ severe coughing
Anticoagulants
Associated with anemia and leukocytosis
21yo man with anterior chest mass. High levels of bhcg and alphafetorotein, most likely diagnosis?
Mixed germ cell tumour
Seminomas cause elevated bhcg only
Signs of hemorrhagic shock?
What blood products should be given with RBCs in this shock?
Hypotension, tachycardia, AMS, decreased cap refill
FFP, platelets AND rbcs in 1:1:1 ratio
69 YO woman, neck lump reveals SCC. Has mild hepatomegaly. Most useful investigation to determine origin of the cancer?
Laryngopharyngoscopy - head and neck cancer most likely
Thyroid biopsy. Develops expanding hematoma after. No personal or family history of bruising or easy bleeding. Most likely cause?
Insufficient hemostasis
Vitamin deficiency unlikely as no personal history of bleeding
Patient undergoes Colectomy, no enteral nutrition after, B-road spectrum antibiotics commenced, history of liver diseas. Bleeding noticed from site.
Prolonged PT and PTT normal platelet count. Most likelyv cause?
Vitamin k deficiency
Not DIC as reasons above and platelet count is normal
