Pastana surgery Flashcards
Difference between tracheostomy and cricothyroidotomy?
Cricothyroidotomy is faster and easier to perform
Base of the skull fracture management?
CT of the cervical spine/avoid nasal ET tube
Pt who is on respirator suddenly died, what causes it?
Air embolism
What to do for hemodynamically stable and unstable pt who you are suspecting of intraabdominal bleeding?
Stable - CT
Unstable - FAST scan - OR
What happens if you give the pt too much fluid and blood in a long surgery?
Abdominal compartment syndrome - wound can be closed - use absorbable mash
If an injury has occurred to the bone, vasculature and the nerve, whats the order of fixing it?
Bone - vessels - nerve
How to manage circumferential burn?
Escharotomy
What are the topical agents for burned pts?
Silver sulfadiazine/mafenide acetate (causes acidosis)
Sign of envenomation?
Local pain/swelling/discoloration
Meds for black widow and brown recluse spider bites?
Black widow - IV Ca gluconate
Brown recluse - dapsone
What motion is limited in slipped capital femoral epiphysis?
Internal rotation
When is genu valgus (knock knee) normal?
between age 4-8
Old folks vs. young ppl who fall on out stretched hands?
Old folks - Colles fracture of the distal radius “dinner fork”
Young - scaphoid fracture - pain at “snuffbox”
What post op caution should be taken for intertrochanteric fracture?
Anticoagulation for DVT ppx
Tx for achilles tendon rupture?
Equinus cast/surgery (quicker)
Sign for compartment syndrome of lower legs?
Excruciating pain with passive extension
What is the tx for jersey and mallet finger?
Splinting
The back pain from herniated disc is exacerbated by what?
Coughing/sneezing/pooping
Which finding is the worst indicator for preoperative cardiac risk?
JVD
How long should you stop smoking before a surgery?
2 months
Pt is more difficult to “bag”/decrease BP/CVP goes up during surgery, what is it?
Tension pneumothorax
What is the first thing to think for a post op pt that becomes confused?
Hypoxia - give O2
Management of ogilvie syndrome?
NPO/NG tube/colonoscopic decompression
Two causes of hyponatremia?
SIADH/loss of isotonic fluid (body retain water)
C Diff not responsive to tx, what’s next step?
Total colectomy
What causes amblyopia?
Congenital impairment of one eye causes cortical blindness (e.g result of strabismus)
Topical tx for anal fissure?
Topical nitro/CCB
Anal fissure that fails to heal after surgical intervention suggests what?
Crohn’s disease
Perirectal abscess can eventually leads to what?
Fistula
Test for active lower GI bleed?
Angiogram (large bleed)/tagged RBC study (intermediate)/wait till it stops (low amount of bleed)
Massive upper GI bleed from a trauma pt, what is it and what tx?
Stress ulcer/angiographic embolization
Tx for sigmoid volvulus?
Flexible sigmoidoscopy
Ascending cholangitis complication?
Pyogenic liver abscess
Tx for breast cancer during pregnancy
Surgery right away
NO radiationtherapy/hormone therapy
NO chemo first trimester
Total mastectomy equals lumpectomy + ____?
radiation therapy
What is nesidioblastosis?
Hyperinsulinemia in newborns
Appropriate postural response of aldosterone?
Standing up - increase RAAS - increase aldosterone
Lying down decreases them
What is VACTER?
Congenital anomalies
Vertebral/anal/cardiac/TE fistula/renal
What is the diagnosis with an infant whose testicle is in the canal and can be easily brought down?
Overactive cremasteric muscle (normal)
How soon should exstrophy of the bladder be fixed?
within 1 or 2 days
What is the diagnosis with a infancy whose testicle is in the canal and can be easily brought down?
Overactive cremastic muscle (normal)
Infant has respiratory difficulty relieved by hyperextension of the neck
Vascular ring
What kind of valve disease is associated with Austin Flint murmur?
AR
Mid diastolic murmur heard best at cardiac apex
How do measure right and left atrial pressure?
Central venous pressure - right atrial pressure
Pulmonary capillary wedge pressure - left atrial pressure
Tx for small cell lung cancer
Chemoradiation therapy only
What is subclavian steal syndrome?
Stenotic plaque at origin of subclavian artery - blood supply to arm is intact for normal activity but when exercise - arm steals blood from vertebral artery from the brain to supply arm - arm claudication and posterior neurological symptoms such as visual and equilibrium symptoms
What does it mean if a AAA is tender?
it is about to rupture in a day or two
Management of ascending and descending aortic dissection?
Ascending - surgical repaire
Descending - medical management of HTN
What does a negative FNA result mean? and when can’t we do FNA?
Negative FNA means nothing - mean better bx
Two situation - hemangioma of the liver/testicular mass
What is the MC type of skin cancer?
Basal cell carcinoma (50%) and then SSC and then melanoma
What is Mohs surgery?
Take out cancer in the face layer by layer
Difference between basal and SSC of skin cancer?
Basal - local invasion
SSC - spread to lymph nodes
What is it that a parent say his child didn’t have strabismus from birth but got it later in infancy?
Exaggerated convergence caused by refraction difficulties
Corrected by lenses right away
What to give pt with acute angel closure glaucoma while he is waiting for surgery?
Systemic carbonic anhydrase inhibitor
Topical beta blocker/alpha 2 agonist
Zone of floaters, what is it?
Retinal detachment
Which neck cyst locates at the anterior edge of sternomastoid muscle?
Branchial cleft cyst
Tx for little kid with nose bleed
Anterior septum bleed
Phenylephrine spray and local pressure
tPA can be used for up to how long of a stroke?
3 hours
What’s another name for IGF-1?
Somatomedin C
If a kid is in a knee chest position whenever he’s having a headache, what is it?
Ependymoma
New born boy that can’t pee, what could be the problem?
Posterior urethral valve
Tx for kids with vesicoureteral reflux
Long term abx till they grow out of it
Workup for hematuria
CT (look for kidney problems) and cystoscopy
Pt have post op incontinence, what is it?
Post op urinary retention
Time line for hyperacute, acute and chronic transplant rejection
Hyperacute - right after organ is resupplied
Acute - within 3 months
Chronic - years
What cardiac complication can a young drug addict develop?
Aortic regurgitation (sudden HF)
What is vasomotor shock?
From anaphylactic or spinal transection injury
CVP is low and pt is pink and warm and needs pressor
Linear skull fracture w/o scalp wound, what to do?
leave it alone
Management of acute subdural and epidural hematoma
Epidural - craniotomy
Subdural - craniotomy only if midline shift - otherwise medical management
Rib fracture tx for elderly
Nerve block and analgesia by epidural catheter
Management for gunshot wounds
If below level of nipple - exploratory surgery
Management for pt who is bleeding a lot during prolonged trauma surgery
FFP/platelet transfusion
If hypothermia then stop surgery and warm him up
extremity gun shot wound - no distal pulses, what to do next?
Surgery
Under what circumstances can you do immediate skin graft on a burn pt?
When the burn is limited and 3rd degree
Medical management of broken clavicle
Sling
How does GI fistula manifest after abdominal wound closure after abdominal surgery
Drain into a pool and cause sepsis
Drain freely cause electrolyte/fluid loss/erode abdominal wall
Tx for meconium ileus
Gastrografin enema
Arterial embolization to extremity, what is the management for partial and complete obstruction?
Partial - tPA
Complete - embolectomy (Fogarty catheter)
Surgical tx for mitral stenosis and regurg
Commissurotomy
Annuloplasty
How to determine if pneumonectomy can be done?
Pul function evaluation
Extend of metastasis
How long does amblyopia take to develop?
6-7 years
What kind of chemotherapy is for testicular cancer?
Platinum based (-platin)
Management approach to upper neck penetrating trauma
Arteriogram
Post op pt develops bilateral pul infiltrate and hypoxia. What is it and what is the tx
ARDS
PEEP
Penetrating urologic injury causing hematuria, what is the next step of work up?
Surgical exploration
Infant with a palpable abdominal mass that moves up and down with inspiration, what is it?
Malignant liver tumor
Best way to bx breast masses?
Mammography or U/S guided core bx
What is the goal urinary output with burn pt?
1 or 2 ml/kg/hr
Old woman who has pathologic fracture (like lifting a heavy bag and then broke her arm) suspect?
Metastatic bone cancer
When does dehiscence typically occur post op
Day 5
Newborn with bilious vomiting, double bubble sign on x ray, what could it be? And what is it if I tell you that the rest of the bowel has normal gas pattern?
Annular pancreas/malrotation/duodenal atresia
Malrotation
What’s the purpose of Cushing reflex
Increase BP to overcome increased ICP to maintain brain perfusion
Pt who had otitis media mastoiditis later develop fever, headache, blurred vision and seizure, think?
Brain abscess
How small the kidney stone can be spontaneously passed?
Under 3mm
What can be caused by hyper extension of the neck and what is its symptoms?
Central cord syndrome
Paralysis and burning pain upper extremities and no problem at lower extremities
What study is needed to assess bladder injury
Retrograde cystogram with post void film
What kind of fluid is used for pt with hypernatremia secondary to severe dehydration?
D5 1/2 saline
What kind of fluid is used for pt with hyponatremia from rapid water intoxication?
hypertonic saline (3 or 5%)
a late 20s woman has a mass in her breast that has been growing into a big mass over years, what is it? Is it malignant?
Cystosarcoma phyllodes
Usually not
What management does very ill baby with congenital diaphragmatic hernia needs?
Extracoporeal (outside of the body) membrane oxygenation - like hemodialysis but for lungs
An infant with sudden drop in platelet count and air in portal vein, what is it?
Necrotizing enterocolitis
What should you put topically around the burn nears the eyes on a burn pt?
Triple abx ointment
Dx for appendicitis
CT
Tx for Oligivie syndrome?
Fluid and electrolyte correction/then colonoscopy to suck out all the air
Pt has GI bleed. NG has bloody gastric content and whats the next step?
Endoscopy
Doppler is the same as ___ when diagnosing peripheral artery disease
ABI
Child with a brain tumor is in a hands and knees position, what kind of tumor is it?
Posterior fossa tumor (meduloblastoma or ependymoma)
Child is attempting to open up the CSF passage to relieve the headache
Dx for acute mesenteric ischemia
Angiography
