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Surgery > Pestana > Flashcards

Pestana Flashcards

0
Q

If trying to secure an airway in the setting of cervical spine injury, appropriate management is

A

Cervical immobilization and Oropharyngeal airway or Oropharyngeal airway with flexible bronchoscope or nasotracheal airway.

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1
Q

If a patient with a compromised airway has subcutaneous emphysema in an emergency room setting, appropriate management is

A

Orotracheal intubation with FIBEROPTIC BRONCHOSCOPY

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2
Q

In the setting of extensive facial injuries, a _______

A

Cricothyroidotomy should be performed.

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3
Q

A patient bleeding into airway and throat, appropriate airway management is

A

Cricothyroidotomy

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4
Q

A patient who comes in with shock (esp hypovolemic shock secondary to bleeding) should be managed as follows:

A

2 large bore IVs, Foley cathether, IV antibiotics in preparation for exploratory laparotomy to control bleeding. THEN fluids and blood products as necessary.

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5
Q

If pericardial tamponade is due to a sternal wound with knife injury, then the appropriate next step is

A

Median sternotomy in OR.

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6
Q

Do not be tempted in a head injury setting to pick some kind of intracranial injury as source of shock symptoms. You cannot lose enough blood in the brain to cause shock.

A

Repeat.

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7
Q

72 year old man with no trauma lives alone is found to be diaphoretic, pale, cold. BP of 80/65. HR of 130. Neck and forehead veins distended.

A

Cardiogenic shock.

Management: confirm elevated CVP. EKG, cardiac enzymes, CCU. Do NOT drown this pt with fluids. Use thrombolytics if offered.

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8
Q

In anaphylactic shock, pts are warm and flush, CVP is low.

A

Repeat

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9
Q

If someone has a fracture concerning for base of skull injury or is in a coma, then…

A

All patients in coma should get CT scan. If they have a base of the skull fracture, they should be considered for cervical spine injury.

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10
Q

In the setting of diffuse atonal injury, management is focused on:

A

Lowering ICP. Surgery cannot help much.

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11
Q

Penetrating wounds anywhere in the neck that are associated with hemodynamic instability need

A

Immediate surgical exploration.

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12
Q

Any penetrating wound in the middle of the neck (“around the thyroid cartilage”) even if the patient is stable, should be…

A

Immediately explored surgically.

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13
Q

Stable wounds at the base of the neck can be explored with imaging first.

A

Repeat

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14
Q

Completely Asymptomatic patients with Stab wounds in the upper and middle zones of the neck can be

A

Observed for 12 hours without expensive surgical exploration or work-up.

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15
Q

Tenderness to palpation over the midline of the back of the neck should make me suspicious of cervical spine injury. If neurological exam is normal, x-rays (AP and lateral cervical and odontoid views) should be performed to rule out injury. If these are clear and there is still high suspicion, CT scan is warranted.

A

Repeat.

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16
Q

Chest tube management:

A

100ml/hr or more in 6 hours

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17
Q

A patient with flail chest injury is also at risk for what 2 types of injury that must be ruled out?

A

Aortic rupture, Abdominal trauma

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18
Q

One big air fluid level in the chest in setting of trauma and signs of hemothorax

A

Hemopneumothorax

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19
Q

What are the 3 injuries that can lead to subcutaneous emphysema?

How do the manage the trachea/bronchial rupture method of injury?

A

Esophageal rupture, trachea/bronchial rupture, tension pneumothorax.

Diagnosis: CXR would confirm air in tissues.
Management: Intubate and identify injury level with FIBEROPTIC bronchoscopy. Then, surgery.

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20
Q

A patient who has received a chest tube for traumatic pneumothorax who is putting out a lot of air from the tube and his/her lung is not expanding is concerning for…

A

Major Bronchial injury

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21
Q

A patient who is intubated and on a respirator and had a chest tube placed in appropriate pleural cavity has a sudden cardiac arrest after being Hemodynamically stable.

A

Diagnosis: air embolism from injured bronchus to injured pulmonary vein that transfers air to left ventricle.

Management: cardiac massage, trendelenburg and then, thoracotomy.

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22
Q

What is the mainstay management of fat embolism?

A

Respiratory support

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23
Q

A patient receives a penetrating gunshot wound to the abdomen and is Hemodynamically stable.

A

Appropriate management: definitively - exploratory laparotomy. Preparation for surgery include large bore venous Catheter for fluids, a Foley catheter and broad-spectrum antibiotics.

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24
Q

Where does the belly begin anatomically that is important to bear in mind in trauma?

A

The belly begins at the nipple line so an individual with an injury two inches below the nipple in the anterior chest needs not just chest trauma work-mip (CXR and/y. or chest tube) but if it is a penetrating abdominal injury like a gunshot, he/she needs an exploratory laparotomy.

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25
Q

If a penetrating abdominal injury shows signs of peritoneal penetration, then an exploratory laparotomy is warranted.

A

Repeat.

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26
Q

You can safely observe splenic injury with _______ in a Hemodynamically stable patient.

A

Serial CT scans.

Also, if an ex lap had been indicated, all efforts are made to repair the spleen rather than remove it especially in kids.

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27
Q

A patient with HYPOTHERMIA + COAGULOPATHY (bleeding from all surfaces) + ACIDOSIS who is undergoing exploratory laparotomy. Next step: _____

A

Immediate closure and no further operation. Not even formal abdominal closure.

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28
Q

A trauma patient is post-op day 1 and develops a tense, distended abdomen and hypoxia, renal failure. Management:

A

This patient has probably developed abdominal compartment syndrome following surgery. Appropriate management is decompressing the abdomen by releasing the sutures and using an absorbable mesh.

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29
Q

In a Hemodynamically stable patient with concern for pelvic injury. Appropriate diagnostic work-up is:

If the work-up shows a pelvic hematoma and the patient is stable, appropriate next step is:

A

CT scan.

Appropriate next step: rule out injury to the rectum, vagina and bladder. Rule out injury to the rectum and vagina with physical exam. Rule out injury to the bladder with Foley cathether.

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30
Q

What is the definitive treatment for a penetrating urologic injury where blood is in the urine?

A

Surgical repair is the definitive treatment.

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31
Q

If blood is found at the meatus in a male pelvic injury, it is most likely a ________ urethral injury.

A

Posterior. It is worked up with a retrograde urethrogram. Repair is delayed.

32
Q

If blood is found at the meatus of a male pelvic injury and you are told it is the rarer, anterior urethral injury. Note that the surgical repair of anterior urethral injuries takes place right away.

A

Repeat.

33
Q

If a male pelvic injury occurs and there is no blood at the meatus and a Foley catheter is inserted and gross hematuria is visualized, the diagnosis is:
Work-up:

A

Bladder injury. The fact that the Foley was inserted without resistance or blood visualized suggests that the urethra is not injured. That only leaves the bladder.
Work-up: retrograde cystogram – if positive, extravasation intraperitoneally will be noted. If negative, obtain a film with the bladder empty to visualize potential retroperitoneal trigone injury.

34
Q

Traumatic hematuria from the kidneys does not require surgical intervention unless the pt is Hemodynamically unstable or the kidney pedicle is avulsed. An injury concerning for a kidney injury would be NO PELVIC FRACTURE, Gross hematuria visualized on inserting the Foley cathether. Appropriate imaging for the kidneys in this setting is a CT scan.

A

Repeat.

35
Q

A patient with renal injuries that do not require surgery is sent home and 6 weeks later develops acute shortness of breath and flank bruit. Diagnosis:

A

Heart failure in the setting of traumatic arteriovenous fistula of the renal pedicle.

36
Q

Traumatic micro hematuria in the adult — no need to investigate

Traumatic micro-hematuria in a child – always investigate – suggests congenital anomaly especially if the trauma does not warrant the injury. Appropriate work-up is sonogram or intravenous pyelography with sonogram preferred.

A

Repeat

37
Q

In a child with a scrotal hematoma, appropriate management is:

A

Sonogram to determine testicular rupture. If testicle is ruptured, surgery. If intact, symptomatic management.

38
Q

A hematoma of the penile shaft with a normal appearing glans is concerning for:

A

Penile fracture, urgent surgical repair. In the fracture, the tunica albuginea is affected.

39
Q

In an upper thigh penetrating injury where there is no anatomical concern for the femoral artery, management is:

If an anatomical concern of injury to the femoral artery is present, management:

If a hematoma indicative of potential femoral artery injury is presen, management is:

A

Clean the wound, tetanus prophylaxis. The bullet can be left where it is.

If the femoral artery could be involved, in the absence of clinical signs, an arteriogram should be ordered.

If there is obvious femoral artery injury, surgical intervention is warranted.

40
Q

In the setting of an injury in the upper extremity to bone, artery and nerve. The appropriate order of surgical repair is:

A

Bone first, then artery/vein, then nerve last. Because of the delayed vascular repair, a Fasciotomy is usually necessary.

41
Q

In crushing injuries, the concern is for myoglobinemia and delayed swelling leading to compartment syndrome.

Management of myoglobinemia

A

Myoglobinemia management - want to avoid acute renal failure: fluids, osmotic diuretics (mannitol), alkalinize the urine

42
Q

A patient has an electrical burn in this thigh with the entrance would in the upper outer thigh and the exit burn lower on the same side. management:

A

Management is EXTENSIVE surgical debridement for ELECTRICAL burns. Also, there is a concern for myoglobinemia so IV fluids, mannitol, alkalinize urine to address myoglobinemia.

Other associate injuries are posterior dislocation of the shoulder, vertebral compression fractures from muscle spasms, later development of cataracts or demyelination syndromes.

43
Q

A patient who has been in a fire and may have inhaled smoke. Management:

A

Concerns are carbon monoxide poisoning, chemical injury from smoke inhalation.
Carbon monoxide poisoning - carboxyhemoglobin levels, 100% oxygen
Respiratory burns - bronchoscopy, ABGs

44
Q

Burns - moist, blisters suggest second degree burns. In kids, third degree burns are deep bright red whereas in adults, third degree burns are leathery.

A

To manage a second degree burn use, silver sulfadiazine.

45
Q

An adult with burns on over 20% of his/her body should have ringer’s lactate started at 1000ml/hr. Use the burn formula to calculate the total amount needed for The day.

A

Repeat.

46
Q

Parkland Burn Formula

A

Weight (kg) x burned body surface area (%) x 4. The first half is given over the first __ hours (8 hours) and the rest over the next ___ hours (16 hours).

47
Q

A baby with a bunt needs more fluid so 4-6ml/kg/%

A

Repeat.

48
Q

What are burned near the eyes covered with? How is burn pain managed?

A

Triple antibiotic ointment. All pain meds are given IV in a burn. Rehab starts day one. NG suction should take place and by first or second day after this enteral high calorie/high protein diet should begin.

49
Q

If a patient has a very small well defined third degree burn, management is:

A

EARLY excision and grafting.

50
Q

If someone is bitten by a potentially rabid animal, treatment is:

A

Rabies immunoglobulin AND vaccine

51
Q

If a patient is bitten by a poisonous snake, 30% of the time, he/she is not envenomated. The best hint of whether anti-venom is needed is if local pain, swelling or discoloration takes place in the first ____ mins. If so, then given anti-venom. Otherwise, observe for 12 hours and provide tetanus prophylaxis and wound care.

A

30 mins.

52
Q

In a concerning snake bite (I.e. Pain, swelling, discoloration), what studies are appropriate to order:

A

Draw blood – type and cross match
Anticoagulation studies
Liver function, renal function

53
Q

Anti-venin dose is independent of pt size

A

Repeat.

54
Q

What is the antidote to a black widow spider bite? (Black with red hourglass on belly)

A

IV calcium gluconate

Expected symptoms of bite: nausea, vomiting, generalized muscle aches

55
Q

In the setting of a brown recluse spider bite, treat with dapsone. Do not excise skin of necrotic region until full extent (occurs about 1 wk after bite).

A

Repeat

56
Q

Human bites should be managed with:

A

Surgical exploration by orthopedic surgeon.

57
Q

If a young boy has a painless or painful limp and guards passive motion of his hip, rule our:

A

Legg-Calve-Perthes (avascular necrosis of the femoral head). Management: x-rays.

58
Q

SCFE is an orthopedic emergency

A

Repeat.

59
Q

A child with a febrile illness starts to complain of localized bone pain a that is severe. Diagnosis:
Management:

A

Diagnosis: Acute hematogenous osteomyelitis. Bone scan first.

Management: antibiotics

60
Q

A neonate with club feet (talipes equinovarus). Management:

A

Serial casts. Treatment MUST occur before the age of 1-2yrs. If no response by 8 months of age, surgery is warranted.

61
Q

A fracture in the humerus of a child with the exception of special types of fractures, will respond to virtually any form of immobilization. Even if angulation is visualized after immobilization, if it is NOT in a critical spot of the humerus. No further action is necessary.

A

Repeat.

62
Q

Supracondylar fracture of humerus. Management:

A

If there is no severe angulation or displacement. CLOSED reduction and a cast. Concerns of the fracture are non-union, injury to brachial artery or ulnar nerve or Volkmann contracture (ischemic contracture), compartment syndrome.

63
Q

A tumor concerning for a soft tissue sarcoma should be managed how?

A

MRI

64
Q

For the less common posterior shoulder dislocation,you need an axillary or scapular view x-ray to visualize it.

A

Repeat.

65
Q

No matter what, treat a colles fracture with:

A

Closed reduction and long arm cast.

66
Q

An elderly patient who hurts his hip and there is concern for femoral head blood supply is a candidate for metal hip prosthesis.

A

Repeat.

67
Q

What is standard of care for a femur fracture?

A

INTRAMEDULLARY ROD fixation

68
Q

Femur fracture in the setting of hypovolemic shock is managed with:

A

Fixation of the femur, IV fluids, blood products.

69
Q

For ACL injury what is the appropriate management for a sedentary patient? Athlete?

A

Sendentary patient - immobilization. Atheletes - arthroscopic ACL repair.

70
Q

Meniscal tears are managed with arthroscopic surgery.

A

Repeat.

71
Q

Normal pulses DO not rule out compartment syndrome.

A

Repeat.

72
Q

Patient complaining of pain from a recently placed cast, needs the cast removed.

A

Repeat.

73
Q

If patient comes in with a radial nerve injury following humeral fracture, NO NEED FOR SURGICAL exploration. Just use cast. However, if your closed reduction is what induces radial nerve injury, need open reduction..

A

Repeat.

74
Q

Plantar fasciitis is foot pain that is worse in the morning and hurts every time someone’s foot strikes the ground. Evolves in 12-18 months. Symptomatic treatment only.

A

Repeat

75
Q

A patient with signs of heart failure with preserved ejection fraction alone has to be optimized using medical therapy: CCBs, beta-blockers, digitalis, diuretics prior to surgery.

A

Repeat.

76
Q

Anyone with symptoms of severe progressive angina should undergo coronary revascularization before surgery.

A

Repeat.

77
Q

A patient with high operative risk as a result of nutritional issues should be optimized with nutrition via the gut for 4-5 days or ideally 7-10 days. Nutritional compromise is indicated by transferrin levels below 200 or albumin below 3.

A

Repeat.

Surgery (2 decks)

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