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Surgery > Pastanas 1 > Flashcards

Pastanas 1 Flashcards

1
Q

Most common brain tumor in children

A

Medulloblastoma

-arises from cerebellum => classic cerebellar symptoms (stumbling, truncal ataxia)

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2
Q

Ddx of subcutaneous emphysema

A

Subcutaneous emphysema = air trapped in the layer (subQ) under the skin

  • Boerrhaves (esophageal rupture)
  • tension pneumothorax (lung bursts…)
  • tracheal or major bronchus rupture
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3
Q

Features indicative of cauda equina syndrome

A
  • perineal saddle anesthesia

- urinary incontinence

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4
Q

Post-op management of splenectomy

A

Vaccination against encapsulated bacteria

  • H. influenza B
  • pneumococcus
  • meningococcus
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5
Q

Name the common brain tumors in adults

A

Most are mets (50% of which are from the lung)

Of primary brain tumors:
50% gliomas (w/ glioblastoma multiforme as the malignant counterpart)
20% meningiomas (usually benign)

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6
Q

When do you stop giving burn victims fluids?

A

Around day 3- you expect the plasma at the burn edges to resorb and then have a large diuresis

Why you give fluids- need to maintain intravascular space while tons of fluids escapes to the burn site

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7
Q

Differentiate tx for

(a) femoral neck fracture
(b) intertrochanteric fracture
(c) femoral shaft fracture

A

(a) Femoral neck fracture- often replace femoral head w/ prosthesis 2/2 risk of ischemia
- displacement of femoral head gives high risk of compromising blood supply

(b) Intertrochanteric fracture- ORIF and immobilization (therefore post-op anticoag is indicated)
- less likely than femoral neck fracture to lead to avascular necrosis => can ORIF instead of replacing w/ prosthesis

(c) femoral shaft fracture- intramedullary rod

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8
Q

MRCP vs. ERCP

A

MRCP- noninvasive, pt fully awake, detailed view of both ducts and surrounding parenchyma

ERCP- sedation, more invasive, risk of pancreatitis, but not just diagnostic also therapeutic
-sphincterotomies, retrive stones, deploy stents, biopsy tumors

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9
Q

First step in workup of suspected Cushings syndrome

A

Overnight low-dose dexamethasone suppression test

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10
Q

Why are fluids needed in treatment of burn victims?

A

Huge internal fluid shift from intravascular space into space below the burn- fluid accumulates below the burn

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11
Q

Common finding seen in these 2 populations:

  • young F w/ fibromuscular dysplasia
  • old M w/ atherosclerotic occlusive disease
A

Renovascular hypertension, 2/2 renal artery stenosis

-faint bruit over flank or upper abdomen

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12
Q

Adjuvant systemic therapy in pre vs. post menopausal F for ER+ breast cancer

A

Premenopausal = Tamoxifen

Postmenopausal = Anastrozole

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13
Q

Which fluid is best for resuscitation in hypernatremic pt

A

D5 1/2NS- want to give rapid volume w/o hypertonicity (b/c of cell lysis…)

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14
Q

Deep abdominal mass in child that is nonmobile

A

Thinking Wilm’s (nephroblastoma) or neuroblastoma (adrenal tumor)

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15
Q

Tx for the most common types of gastric cancer

A

Gastric cancers

Gastric adenocarcinoma- tx w/ surgery
-seen in the elderly

Gastric lymphoma- tx w/ chemo/radiation
-if low grade, first eradicate H. pylori

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16
Q

Differentiate FeNa values for prerenal vs. renal oliguria/AKI

A

FeNA = fractional excretional sodium

  • in renal failure, FeNa is over 1
  • if prerenal, FeNa is under 1
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17
Q

Pt presents w/ severe eye pain, frontal headache in the evening
-seeing halos around lights

(a) Dx
(b) Tx

A

(a) Acute angle closure glaucoma = acute buildup of intraocular fluid in the anterior chamber
(b) Opthamologic emergency- emergent laser hole to release the fluid trapped in the anterior chamber

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18
Q

How to determine if a lung cancer is operable

A

-small cell lung cancers get chemo and radiation, so workup for surgical candidacy only applies to non-small cell:
operability is dependent on residual function after resection, need at least 800 ml of FEV1 after resection

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19
Q

Next steps after diagnosing pelvic fracture

A

Look for (and rule out) injury to the rectum, bladder, vagina/urethra

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20
Q

Serum marker for cancer seen in ppl w/ HepB/C

A

Hep B/C => cirrhosis => HCC (hepatocellular carcinoma)

Serum marker = alpha-fetoprotein (AFP)

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21
Q

Tx for brain abscess

A

Surgical resection, not just I and D

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22
Q

At what ABI should further steps be taken to plan revascularization?

A

ABI of 0.8 or less, do CT angio or MRI angio to assess anatomy and plan revascularization

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23
Q

First steps to evaluate smoker for pre-op pulmonary clearance

A
  1. FEV1
    - b/c want to assess for ventilation (high pCO2), not oxygenation
  2. if FEV1 is abnormal, f/u w/ bood gasses
    - cessation of smoking for 8 weeks and intensive respiratory therapy should preceded surgery
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24
Q

Crohn’s vs. ulcerative colitis

(a) Which has transmural involvement?
(b) Which is surgically curative?

A

(a) Transmural involvement = Crohn’s

(b) UC can be cured w/ surgery

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25
Q

Step taken to prevent air embolism when placing a central venous line

A

When entering the great veins, use Trendelenberg (tip back head of the bed) for air embolism ppx

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26
Q

Tx for anal squamous cell carcinoma

A

As per Nigro protocol: chemoradiation, not resection

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27
Q

Differentiate etiology of ulcers on toe vs. heel of foot

A

Ulcers:

On toe: from arterial insufficiency (toe is the farthest away from the heart)

On heel of foot: from pressure (think 2/2 diabetic neuropathy)

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28
Q

Describe the anterior drawer test

A

With knee flexed 90 degrees, leg can be pulled anteriorly (like a drawer opening)

= anterior cruciate ligament (ACL) injury

Anterior more common than posterior

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29
Q

PUD resistant to H. pylori eradication

A

R/o Zollinger-Ellison (gastrinoma)

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30
Q

Workup for UTI in a child

A

UTI in a child always requires further workup- do voiding cystourethrogram to look for reflux (vesicoureteral reflux)

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31
Q

Presentation of subclavian steel syndrome

A

Subclavian steel syndrome = atheriosclerotic stenotic plaque at origin of subclavian before the takeoff of the vertebral: enough blood to the arm for normal activity but not during exercise
=> arm sucks blood away from brain by reverse flow

When arm is exercised pt presents w/ arm claudication and posterior neurologic signs (visual symptoms, equilibrium problems)

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32
Q

Most reliable physical exam finding for compartment syndrome

A

Excruciating pain w/ passive extension

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33
Q

What is Volkmann’s contracture?

A

Permanent claw-like deformity 2/2 undiagnosed compartment syndrome due to brachial artery obstruction

-fracture of elbow/upper arm (classically supracondylar fracture of the humerus) causing brachial artery obstruction => ischemia

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34
Q

Esophageal cancer- two most common types and RF

A

Esophageal cancer:

Squamous cell in men w/ h/o smoking and EtOH

Adenocarcinoma in ppl w/ long-standing GERD (Barret’s esophagus)

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35
Q

4 steps to initial treatment of a burn

A
  1. IV fluids
  2. tetanus prophylaxis
  3. debridement/cleaning of wound
  4. topical agent: usually silver sulfadiazine
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36
Q

Mechanism of 2 drugs for BPH

A

BPH (benign prostatic hypertrophy)

1st line: Tamsulosin = selective alpha-blocker
2nd line: Finesteride = 5alpha reductase inhibitor (for very large glands, above 40g)

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37
Q

Tetanus ppx after unprovoked dog bite

A

IVIG + tetanus vaccine

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38
Q

Ideal tx for pelvic fracture

A

Pelvic fixation and IR embolization of both internal iliac arteries
-but not available in all settings

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39
Q

Most common source of significant intraabdominal bleeding in blunt abdominal trauma

A

Splenic rupture

-most common source of general intraabdominal bleeding (both sig and insignificant) = hepatic rupture

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40
Q

Most common cause of malignant hyperthermia

A

Succinylcholine = neuromuscular blockade agent

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41
Q

Glasgow score that indicates intubation

A

Glasgow coma score of 8 or below indicates lack of consciousness => intubate

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42
Q

How to cure subclavian steel syndrome

A

Subclavian steel (atherosclerotic plaque at subclavian before the vertebral branches off) treated w/ bypass surgery

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43
Q

26 yo F w/ firm, rubbery, mobile breast mass

(a) Dx
(b) Mgmt

A

(a) Fibroadenoma
(b) FNA or sonogram
- removal optional (up to pt but not medically necessary)

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44
Q

How long after MI do you wait for surgery?

A

If you can hold off, want to defer surgery to 6+ mo post MI 2/2 risk of cardiac complications

-operative mortality w/in 3 mo of infarct is 40%, while it drops to 6% after 6 mo

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45
Q

Malignant bone tumor: lytic lesion vs. blastic lesion- most likely primary?

A

Metastatic bone tumors in adults

  • lytic lesions = from breast (in F)
  • blastic lesions = from prostate (in M)
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46
Q

Vasomotor shock- what is it? Etiology?

A

Vasomotor shock- pink and warm shock- shock from producing vasodilation w/o fluid loss
-ex: anaphylaxis 2/2 bee sting

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47
Q

How long after an MI do you want to wait to do an elective surgery?

A

At least 6 mo s/p MI

-operative mortality w/in 3 mo of infarct is 40%

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48
Q

Define the type of operation

'tomy'
'ectomy' 
'ostomy'
'plasty'
'pexy'
A

Type of operation

  • tomy = cut
  • ectomy = remove
  • ostomy = make an opening (to the outside or anastamosing to something else)
  • plasty = change in shape
  • pexy = to fix in place
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49
Q

Branchial cleft cyst

(a) Etiology
(b) Location

A

Branchial cleft cyst = from failure of obliteration of the 2nd branchial cleft

(b) Location = anterior edge of the SCM (lateral neck)

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50
Q

Differentiate presentation of testicular torsion and acute epididymitis

A

Testicular torsion- sudden onset severe testicular pain, cord not tender, testes tender and high riding

Acute epididymitis- fever and pyuria, testes swollen and tender but in normal position

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51
Q

Initial tx for SBO

A

NPO (bowel rest), NG suction (bowel decompression), and IV fluids

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52
Q

Common complications of acute pancreatitis

A

Pancreatic pseudocyst and chronic pancreatitis

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53
Q

Best test for intra-abdominal bleed in HDS vs HDUS pt

A

HDS pt- CT scan

HDUS- FAST ultrasound = focused abdominal for trauma- basically look for blood in the peritoneal cavity

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54
Q

Contraindication to organ donation

A

The only absolute contraindication to organ donation is +HIV

-even hepatitis isn’t absolute (you can give organs to someone already w/ hepatitis)

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55
Q

When is surgery indicated in necrotizing enterocolitis

A

If infant develops

  • abdominal wall erythema
  • air in the portal vein
  • intestinal pneumatosis (presence of gas in bowel wall)
  • pneumoperitoneum (signs of intestinal necrosis and perforation)
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56
Q

Ideal candidate for early excision and grafting after a burn

A

Limited burn (less than 20% of body surface area) w/ third degree burn

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57
Q

Tx for hyperkalemia

A
  1. IV calcium to stabilize myometrial membrane
  2. D50 and insulin to push K+ into cells
    - albuterol
  3. Kaexalate (poop it out)
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58
Q

Green vomiting in newborn w/ multiple air-fluid levels on abdominal CT

(a) Dx
(b) Etiology

A

(a) Intestinal atresia = malformation of some part of the intestines where it narrows or even is a blind opening
(b) Vascular accident in utero

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59
Q

Next step after clinically recognizing a skull fracture

A

Expectant management, no real thing for the skull- but key is to assess the integrity of the cervical spine

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60
Q

Alzheimer’s pt POD4 from hip surgery c/o constipation and abdominal distention

A

Ogilvie syndrome- paralytic colonic ileus

-thought to be from unopposed sympathetic innervation to bowel (lack of parasympathetic innervation0

61
Q

Carcinoid syndrome- what is it?

(a) Presenting symptoms
(b) Diagnosis

A

Carcinoid syndrome = paraneoplastic syndrome 2/2 serotonin-secreting tumor

(a) Diarrhea, flushing, wheezing (2/2 bronchoconstriction), 50% right heart valve damage
(b) Dx w/ 24 hr urine 5-HIAA
- not serum b/c serum only high if during one of the episodes/attacks

62
Q

Differentiate presentation of plantar fasciitis and motor neuroma

A

Plantar fasciitis = overweight pt w/ sharp heel pain when foot strikes the ground
-TTP and visual bone spur on Cray

Motor neuroma = inflammation of common digitall ve at the 3rd interspace btwn 3rd and 4th toes
-TTP btwn 3rd and 4th toes

63
Q

Most durable option to treat peripheral arterial occlusion

A

Saphenous vein graft: most durable option, but there is angioplasty and stents

64
Q

Abdominal mass in child that moves up and down w/ respiartion

A

Think malignant liver tumor: hepatoblastoma or hepatocellular carcinoma

65
Q

60 yo M who complains of muscle pain and tingling of arm and dizziness during exercise

A

Arm claudication + posterior neurologic signs when exercise the arm- think subclavian steal syndrome (stenotic plaque at subclavian before vertebral artery branches off)

66
Q

When to do total mastectomy for DCIS

A

Only if there are multicentric lesions (a bunch of lesions where you’d be doing a bunch of lumpectomies anyway)
-otherwise DCIS technically cannot metastasize => no axillary sampling needed

67
Q

After head trauma who gets a CT scan?

A

Anyone w/ head trauma + LOC gets head CT to r/o intracranial hematoma

68
Q

Basal cell vs. squamous cell carcinoma

(a) location
(b) invasive vs. metastatic potential
(c) Margins

A

Basal cell (50%) skin cancers vs. squamous (25%)

(a) Basal cell above the mouth vs. squamous more likely lips and below
(b) Basal very locally invasive, while squamous can metastatsize
(c) Basal cell: remove w/ .1mm margins
Squamous cell: remove w/ .5 to 2cm margins (need wider margins 2/2 metastatic potential)

69
Q

Acute epidural vs. subdural hematoma

(a) Shape of hematoma on imaging
(b) Tx

A

Acute epidural hematoma

(a) lens-shaped hematoma b/c confined by sutures
(b) Emergent craniotomy can be curative

Acute subdural hematoma

(a) Crescent shaped hematoma b/c blurs past suture lines
(b) Much more severe, hyperthermia or hyperventilate to reduce O2 demand
- craniotomy not curative here

70
Q

Best indicator of wether or not a ureteral stone will pass

A

Size!
3mm or under- 70% will pass spontaneously
7mm or over- only 5% will pass spontaneously

71
Q

Differentiate hyperacute, acute, and chronic transplant rejection

A

3 mechanisms by which transplanted organ can be rejected

1st = hyperacute w/in minutes (happens as soon as blood supply to organ is reestablished) caused by vascular thrombosis by preformed antibodies
-prevent by ABO matching and lymphocytotoxic crossmatch (so not seen)

2nd = acute rejection from 5 days to 3 mo
-can occur despite appropriate maintenance immunosuppression

3rd = chronic rejection
-gradual, insidious loss of organ fxn

72
Q

Ischemic stroke vs. TIA

A

Both are 2/2 occlusion/ischemia, difference is the permanent consequence (whereas ischemic stroke has permanent damage and TIA does not)

73
Q

How to correlate serum sodium w/ amount of water lost

A

Every 3 mEq/L in serum Na over 140 represents about 1L of water loss

ex: Serum Na of 146 = about 2L of water loss

74
Q

Following trauma: resistance felt while attempting to pass foley catheter in a male + scrotal hematoma

(a) Dx
(b) Next step

A

Urethral injury- next step r/o pelvic fracture

75
Q

Presenting feature of achalasia

A

Achalasia = incomplete LES relaxation/increased LES tone

Presenting feature = dysphagia worse w/ liquids than solids

76
Q

What is Ludwig’s angina?

(a) Complication
(b) Tx

A

Ludwig’s angina = abscess on the floor of the mouth, often from a bad tooth infection

(a) Complication = threat to airway
(b) Tx = I and D immediately, also make sure to secure airway (even if intubation/tracheostomy needed)

77
Q

Thyroglossal duct cyst

(a) Etiology
(b) Presentation
(c) Tx

A

Thyroglossal duct cyst = leftover thyroid tissue from embryologic development

(b) Presents w/ irregular central mass at the level of the hyoid bone
(c) Tx = surgical removal

78
Q

Young female w/ blood in the abdomen w/o trauma and liver mass on CT

A

Hepatic adenoma = complication of OCPs

-tendency to rupture => bleed into abdomen

79
Q

Hypovolemic vs. cardiogenic shock

(a) CVP
(b) use of IVF in treatment

A

Hypovolemic shock

(a) Low CVP
(b) IV fluids is necessary in tx

Cardiogenic shock

(b) High CVP- see big distended neck veins
(b) IV fluids can be lethal! avoid fluids

80
Q

Treatment for Legg-Calve-Perthes disease

A

Tx for avascular necrosis of the capital femoral epiphysis (ischemia of the femoral head which leads to necrosis and bone loss => hip instability)
-need to take pressure off the joint => casting and crutches

81
Q

What is a duplex?

A

Ultrasound + doppler

ex: When assessing for DVT

82
Q

Next step after a respiratory burn

A

Respiratory burn = inhalation injury

Next step: blood gases to assess for need for respirator

83
Q

Treatment/management of malignant hyperthermia

A

IV Dantrolene

84
Q

What is malignant hyperthermia?

A

Temp of or above 104F shortly after onset of anesthetic (halthane or succinylcholine)

-also get metabolic acidosis and hypercalcemia

Proposed mechanism:

85
Q

Clinical signs of skull fracture

A

Racoon eyes, rhinorrhea, otorrhea, eccymosis behind the ear

86
Q

Most common location for scoliosis

A

Scoliosis- most common in adolescent girls in the thoracic spine, most commonly curved to the right

87
Q

What is strabismus?

(a) Why must it be corrected?

A

Strabismus = when eyes don’t share a common fixation point (cross eyed), when reflection of light comes from a different area of the cornea in each eye

(a) Must correct stabismus to prevent amblyopia (brain and eye not working well together to process images)

88
Q

First thought for post-op pt who develops fever on

(a) POD1
(b) POD3
(c) POD5
(d) POD7
(e) POD10-15

A

Post-op fever

(a) POD1 = atelectasis
(b) POD3 = pneumonia 2/2 undiagnosed atelectasis
(c) POD5 = deep thrombophlebitis
(d) POD7 = wound infection
(e) POD10-15 = deep abscess

89
Q

Imaging finding of chronic pancreatitis

A

Calcifications of the pancreas

90
Q

First step when someone gets chemicals in the eyes

A

Flush w/ water…immedately

-literally flush w/ water for 30 minutes, then go to the ED

91
Q

Tenderness to palpation over the anatomic snuffbox

A

Fracture of the scaphoid (small wrist bone)

  • ex: adult falls on outstretched hand => wrist pain
  • fracture doesn’t show on Xrays until 3 weeks later
92
Q

Acute abdomen in pt w/ AFib

A

Mesenteric ischemia

93
Q

10 yo w/ onion skinning bone lesion on Xray in femur

A

Ewing sarcoma = second most common primary malignant bone tumor
-younger children (5-15) in diaphysis of long bones

94
Q

First line tx for acute organ rejection s/p transplant

A

Steroid bolus

95
Q

Describe the cause of air fluid levels in the bowel

A

Normal peristaltic churning motion makes foam out of the air and fluid normally in the GI tract

When obstructed, normal movement isn’t functioning so fluid goes to bottom and air stays on top

96
Q

Factors used to predict operative mortality in pts w/ liver disease

A

2 clinical findings and 3 lab values

Clinically: encephalopathy, ascites
Lab values: serum albumin, prothrombin time (INR), bilirubin

97
Q

What malignant tumros come from the three layers of the embryo?

A
  1. Ectoderm => epithelial tumors = carcinoma
  2. Mesoderm => sarcomas
  3. Endoderm => adenocarcinoma
98
Q

Sudden complete loss of vision in one eye in pt w/ atherosclerotic disease

A

Think embolic occlusion of the retinal artery

99
Q

USe of IV pyelogram vs. cystoscopy

A

IV pyelogram to look at the renal parenchyma, ureters, and bladder

Cystoscopy gives much better look at the bladder (IV pyelogram would miss bladder carcinoma): gives detail of the bladder mucosa

100
Q

What is a pancreatic pseudocyst?

(a) Tx

A

Collection of pancreatic juice outside the pancreatic ducts
-complication of acute pancreatitis

(a) Tx = drainage of the cyst if big (over 6 cm b/c of rupture/bleed risk)
- not surgical rmeoval!

101
Q

How to decide volume of fluids to give a burn victim

A

There are a bunch of intense long algorithms, but instead what is actually used:

Start w/ arbitrary amount (usually about 1,000 ml/hr) then adjust to urinary output of 1-2 ml/kg/hr

102
Q

Fear of first feed in premature infant

A

Nec = necrotizing enterocolitis (bowel necrosis)

-2nd most common cause of morbidity in premature infants

103
Q

Current classification system to assess for hepatic risk during pre-op workup

A

Child class: takes into account encephalopathy, ascites, serum albumin, INR, and bilirubin

104
Q

Medication helpful to tx claudication

A

Cilostazol = quinolone derivative (why Gma Evelyn drinks tonic water which has quinolones), PDE3 inhibitor that works as selective vasoconstrictor

105
Q

Surgical vs. radiological tx for intracranial aneurysm

A

Intracranial aneurysm (dangerous b/c can cause subarachnoid bleeding)

Surgical tx = clipping
Radiologically = endovascular coiling

106
Q

Mgmt when suspect wound dehiscence

A

Surgical emergency 2/2 risk of evisceration (abdominal contents fall out): go back to OR, debride the wound and close again w/ new margins

107
Q

3 ways to differentiate small bowel vs. colon on CT

A
  1. Location: small bowel centrally, colon laterally
  2. Size: colon is larger
  3. Fine details: haustral markings (small indentations that don’t go all the way across) on colon, vs. small lines that go all the way across in small bowel
108
Q

Choice of fluid for resuscitation in hyponatremic pt

A

Use NS only if there is alkalsosi

-LR for acidotic pts and those w/ normal pH

109
Q

3 markers to assess nutritional status of high risk patient

A
  1. albumin: normal of 4
    - half life like 20 days
  2. pre-albumin: normal over 16
    - half life 2-3 days
  3. transferrin: normal over 200
110
Q

Benefits of core biopsy over FNA

A

FNA only gives cells (cytology), doesn’t give architecture (histology) so much less sensitive

111
Q

What is wound dehiscence?

A

When the abdominal wall tension (intraabdominal pressure) overcomes the strength of the closure (sutures/staples)

  • can be partial or complete, both are surgical emergencies
  • dangerous when pt coughs/strains/gets out of bed (basically when they increase intraabdominal pressure)
112
Q

Symptoms of vascular rings

A

Symptoms of pressure of the tracheobronchial tress (stridor and respiratory distress) and pressure on the esophagus (dysphagia)

113
Q

What is pseudomembranous enterocolitis?

(a) Most common etiology

A

Pseudomembranous enterocolitis = C. diff overgrowth

(a) Most commonly by cephalosporins

114
Q

Define severe nutritional depletion

A

Loss of 20% of body weight over a couple months, serum albumin below 3, transferrin under 200 mg/dl
-huge increase in operative risk => if possible, defer surgery for at least 4-5 days

115
Q

30 yo w/ tibia fracture, ORIF and casting, develops increasing pain in leg

A

Immediately remove cast to assess for compartment syndrome

116
Q

Clinical finding of wound dehiscence

A

Abundant pink (‘salmon colored’) fluid soaking thru the dressing = serosanguinous peritoneal fluid

117
Q

5 P’s of compartment syndrome

A

Compartment syndrome

  1. pallor
  2. poikilothermia (warmth)
  3. pulseness
  4. pain
  5. parasthesia/paralysis
118
Q

Most common presentation of testicular cancer

A

Painless testicular mass in a young male

-biopsy always done b/c benign testicular tumors are virtually nonexistant

119
Q

Why it is so important to appropriately diagnose testicular torsion vs. acute epididymitis

A

Testicular torsion needs emergency surgery, while acute epidiymitis is tx w/ abx
-so key not to miss testicular torsion that even if you’re sure it’s acute epididymitis (fever, pyuria), do US to r/o torsion (doppler flow), then start the abx

120
Q

Presentation of esophageal cancer

A

Esophageal cancer classically presents w/ dysphagia of solids progressing to liquids

121
Q

When is surgery indicated for coronary stenotic disease?

A

Stenosis of 70-99%

122
Q

Pneumothorax vs. hemothroax

(a) Percussion
(b) Placement of chest tube

A

Pneumothorax

(a) Hyperresonant to percussion- b/c just dead air space
(b) Place chest tube superiorly and anteriorly- air rises

Hemothorax: drain to prevent empyema

(a) Dull to percussion
(b) Place chest tube inferiorly- b/c duh gravity

123
Q

Current system used to classify operative mortality in pts w/ liver disease

A

Child class

  • class A: 10% mortality, class B 30%, class C 80%
  • considers: encephalopathy, ascites, INR, serum albumin, bilirubin
124
Q

Most feared fungal infection seen in soft tissue infections

(a) Tx

A

Mucormycosis

(a) IV amphotericin

125
Q

Tx of intestinal atresia of the newborn

A

Tx of intestinal atresia = laparotomy (open abdominal surgery) to remove damaged part of intestines and anastamose normal parts back

126
Q

How to treat strabismus in child

A

Want to suppress the dominant eye (eye patch, atropine drops) to force the brain to function w/ the weaker eye

-don’t want strabismus to let brain suppress image from the weaker eye, which can eventually lead to unilateral blindness

127
Q

White pupil in a baby

A

Absence of red reflex- need to r/o retinoblastoma (opthalmologic emergency)
-may be congenital cataracts, but still needs to be tx

128
Q

Most common skin cancers

A

Basal cell carcinoma 50%
squamous cell carcinoma 25%
melanoma 15%

129
Q

Describe a closed reduction

A

Bones that are not badly displaced or angulated: align by external manipulation, then immobilize in case

130
Q

Most common cause of pneumaturia

A

Pneumaturia (air in the urine) most commonly 2/2 vesicoureteral fistula from diverticulitis

131
Q

Tx of gout

(a) acute
(b) chronic

A

Tx of gout

(a) Acutely: indomethacin (NSAID) for the pain + colchicine
(b) Chronically: give allopurinol = xanthine oxidase inhibitor to reduce uric acid formation

132
Q

Dx: trauma pt w/ hypovolemic shock of unknown etiology w/ normal CXR and no evidence of pelvic or femur fracture

A

Intraabdominal bleed until proven otherwise

Only 3 places in the body (abdomen, thighs, pelvis) that can hide enough blood to cause hypovolemic shock

133
Q

First line tx for Ogilvie’s

A

Colonoscopy to suck out the air

  • neostigmine (acetylcholinesterase inhibitor) to stimulate colonic motility
  • -works b/c immobility is 2/2 unopposed sympathetic activity, also explains why epidurals sometimes work here
134
Q

Bone tumors in children: sunburst vs. onion skinning

A

Sunburst appearance on Xray = osteogenic sarcoma (most common primary malignant bone tumor)

Onion skinning on Xray = Ewing sarcoma (second most common primary malignant bone tumor)

135
Q

First step to work up melena

A

Melena = black, tarry stool = digested blood

First step = upper GI endoscopy

136
Q

Mechanism by which smoking increases pulmonary operative risk

A

Smoking increases pulmonary risk by compromising ventilation (high pCO2), not by poor oxygenation (not by low pO2)

137
Q

Preferred adjuvant systemic therapy for metastatic melanoma

A

Interferon

138
Q

Pulmonary coin-shaped lesion found on CXR

Workup

A

First- find old Xray to compare it to
-new found coin lesion on CXR has 80% chance of being malignant if pt over 50

First: compare to old CXR (if available), then get CT (better picture) and sputum cytology

If cytology is not diagnostic- do bronc and biopsy for central lesion, or percutaneous biopsy for peripheral lesion

139
Q

POD3 pt develops hallucinations, confusion, and becomes very aggressive

(a) Dx
(b) Tx

A

Is this dude an alcoholic?

(a) Thinking delirium tremens which develops around the 3rd day of withdrawal

(b) IV benzos
- also sometimes give IV alcohol to tx the withdrawal

140
Q

Complication of wound dehiscence

(a) Short term
(b) Long term

A

Wound dehiscence is a surgical emergency b/c

(a) Short term- worried about evisceration: abdominal organs just falling out!!
(b) Long term worried about ventral hernia

141
Q

Finding of hypokalemia in a hypertensive F

A

First- is she on diuretics?

If not, suspect primary hyperaldosteronism

142
Q

What is a cystic hygroma?

(a) How to plan for surgical removal

A

Cystic hygroma = irregular development/formation of the lymphatic system => large, mushy, ill-defined mass in the supraclavicular area

(a) Often extends into the mediastinum so need to do CT scan before surgical removal is attempted

143
Q

20 yo w/ sunburst pattern lesion on Xray in the upper tibia

A

Osteogenic sarcoma: ages 10-25 around the knee (lower femur or upper tibia)

144
Q

Final complication of strabismus (adult vs. child)

A

Strabismus (cross eyed) will cause double vision in adults, but due to neuroplasticity of the child- child’s brain will adapt and suppress image from one eye => can have permanent cortical blindness of the completely normal eye due to suppression

145
Q

What lung cancers get surgery vs. chemoradiation?

A

Small cell lung caners get chemotherapy and radiation

Operability only applies to non-small cell cancer

146
Q

Pt seeing flashes of light and floaters in the eye

A

Retinal detachment = emergency

147
Q

Hypospadias- what is it?

(a) Tx?

A

Hypospadias = urethral opening present on the ventral side of the penis

(a) Don’t circumcise, then use foreskin for plastic reconstruction

148
Q

Name the 3 places in the body that can hide enough bleeding to cause hypovolemic shock

A

Need to lose 25-30% of blood volume (about 1,500 ml in average sized person) to go into hypovolemic shock => most spaces (ex: head, lungs, heart, neck) can’t accumulate that much blood w/o being overtly obvious

When have hemorrhage w/o obvious cause:

  1. abdomen
  2. thighs
  3. pelvis

Surgery (10 decks)

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