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Surgery Clerkship > Pestana > Flashcards

Pestana Flashcards

1
Q

What is tx for linear skull fracture?

A

if closed –> leave alone
if open (overlying wound) –> close wound
if comminuted or depressed –> OR

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2
Q

What is tx for rib fracture?

A

local nerve block and epidural catheter to prevent hypoventilation –> atelectasis

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3
Q

What is presentation of pulmonary contusion?

A

right away up to 48 hrs after chest trauma, high A-a gradient, hypoxemia, hypercapnea

have deteriorating blood gas and white out of lungs on CXR

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4
Q

What is the difference in how you manage gunshot vs knife wound to abdomen?

A

gunshot = always go straight for ex-lap, if RUQ only can do conservative w/ serial ab CT

stab = if clear penetration or peritoneal or instability do ex lap, otherwise can do digital exploration, if equivocal do CT

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5
Q

What do you do if intra-op develop coagulopathy?

A

empriric platelets and FFP

if also have hypotehrmia and acidosis –> terminate lap and pack

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6
Q

What do you need to do if patient w/ penetrating injury to extremities?

A

if no major vessels in vicinity –> do tetanus ppx and clean wound

if near major vessels and asymptomatic –> doppler or CTA

if obvious vascular injury –> surgical exploration

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7
Q

What are indications for topical agent for burn?

A

standard = silver sulfadiazine
if thick cartilage, eschar = mafenide acetate
if near eye = triple abx

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8
Q

When do you do early excision and grafting in burn?

A

burns

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9
Q

When can you expect that high degree of angulation will remodel in kid vs not remodel?

A

remodel everywhere except if in growth plate or supracondylar fracture of humerus

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10
Q

What is tx for clavicular fracture?

A

sling

only need open reduction and internal fixation if want for cosmetic reasons

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11
Q

What is tx for intertrochanteric fracture?

A

open reduction and internal fixation w/ post op anticoagulation b/c high risk DVT/PE

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12
Q

What is tx for femoral neck fracture?

A

replace femoral head w/ prosthesis for earlier mobilization

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13
Q

What is tx for compartment syndrome?

A

emergency fasciotomy

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14
Q

What is presentation of comparetment syndrome?

A

mcc in lower leg = 2/2 fracture w/ closed reduction

pt: pain and limited use of extremity, compartment feels tight and tender to palpation, excruciating pain w/ passive extension, pulses may be normal

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15
Q

What is mallet finger?

A

extended finger forcefully flxed in volleyball

- tip of finger repains flexed when hand extended

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16
Q

What is jersey finger?

A

injury to flexor tendor

when making fist, distal phalanx does not flex

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17
Q

What should you do before surgery if pt w/ severe nutritional depletion (loss 20% body wt, albumin

A

4-5 days of preop nutritional support preferably via gut

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18
Q

When are you likely to see peri-op MI?

A

during operation triggered by hypotension

or post-op in first 2-3 days

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19
Q

What is tx for MI in periop?

A

emergency angioplasty or coronary stent

do not use clot busters

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20
Q

What is typical presentation of post op PE?

A

POD7

pleuritc CP and SOB

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21
Q

What is tx for would dehiscence?

A

tape securely, bind abdomen, arrange for re-op

if peritoneal signs = evisceration and need emergency ab closure

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22
Q

What is tx for GI fistula (draining bowel contents from wound or drain site)?

A

fluid and electrolyte replacement, nutritional support, compulsive protection of ab wall (suction tubes, ostomy) to let nature heal fistula

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23
Q

What are some things that prevent healing in GI fistula?

A

FETID

  • foreign body
  • epithelialization
  • tumor
  • infection
  • irradiated tissue
  • IBD
  • distal obstruction
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24
Q

What is the difference in presentation between external and internal hemorrhoids?

A

internal bleed –> tx rubber band ligation, only pain/itching if prolapse
external hurt –> tx surgery if conservative tx fails

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25
Q

What does NGT tell you about source of GI bleed?

A

if blood = upper source
if no blood and fluid is white = excludes above pylorus, may still want to do upper GI endoscopy
if no blood and fluid is green (bile) = above ligament of treitz excluded

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26
Q

What should you think if pt w/ LLQ pain, feer, leukocytosis, palpable tender mass? enxt step?

A

acute diverticulitis
next: do CT, start NPO, IVF, abx

most cool down w/ medical tx

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27
Q

What is tx for breast cancer in pregnancy?

A

do surgery but:

  • no radiotherapy at any time in pregnany
  • no chemo during first trimester
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28
Q

What happens to aldosterone when upright vs lying down in adrenal hyperplasia vs adenoma?

A

hyperplasia: more aldosterone when upright
adenoma: lack or response or lower when upright

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29
Q

What should you think if baby w/ excess salivation and NGT coils in upper chest?

A

if normal gas patern on XR –> blind pounch upper esophagus and fistula between lower esophagus and tracheobronchial tree

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30
Q

What should you suspect if baby with XR showing multiple dilated loops of small bowel and ground glass appearance in lower abdomen in setting of feeding intolerance and bilious vomiting? next step?

A

meconium ileus

next step = gastrografin enema to dx (microcolon and inspissated pellets of meconium in terminal ileum) and therapeutic

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31
Q

What is likely dx if baby w/ stridor, resp distress w/ crowing respiration during which hyperextends and some difficulty swallowing? What dx tests? tx?

A
  • need to r/o tracheomalacia for resp sx w/ bronchoscopy

do barium swallow –> shows extrinsic compression = vascular ring

tx: surgery divides smaller of two aortic rach

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32
Q

How do you determine operability of lung cancer?

A

minimum FEV1 of 800 is needed

determine FEV1 determine fraction from each lung by VQ scan, if less than 800 would be lest do not do pneumonectomy

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33
Q

What is tx for aterial embolization to extremity from AFib clot?

A

urgent eval w/in 6 hrs
- do doppler
- early incomplete occlusion –> clot buster
complete –> embolectomy w/ fogarty catheter
if severe hrs have passed, do fasciotomy

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34
Q

What is presentation of basal cell? what loctations?

A

waxy raised lesion

prefers upper face, slow growing

35
Q

What should you think if smoker w/ rotten teeth prsents w/ painless ulcer in floor of mouth and persistent U/L headache?

A

think squamous cell carcinoma of mucosae

dx: do triple endoscopy and bx

36
Q

What is etiology / tx if pt w/ trauma has normal facial nerve function at time of asmission and later develops paralysis?

A

2/2 swelling/edema

will resolve spontaneously

37
Q

what is likely dx/tx for pt w/ hx rheumatic fever and progressive DOE, orthopnea, PND, cough, hemoptysis, Afib?

A

likely mitral stenosis causing atrial enlargement and back up pulm edema into lungs

dx: echo
tx: repair w/ surgical commissurotomy or balloon valvuloplasty

38
Q

What type of mets will be curable w/ pneumonectomy? which will not?

A

curable = hilar mets

nodal mets at carina or mediastinum do not allow curative resection

39
Q

What is next step if suspect aortic dissection?

A

CTA/spiral CT = best test

also could do MRA or TEE

40
Q

What is dx step if suspect nonhealing ulcer is skin cancer?

A

full thickness bx at edge of lesion

41
Q

What is presentation of branchial cleft cyst?

A

anterior edge of sternomastoid muscle

can have little opening/dimple and blind tract in skin

42
Q

What is presentation of cystic hygroma?

A

at base of neck, large mushy ill-defined mass
occupies entire supraclavicular area
seems to extend deeper into chest
must do CT

43
Q

What is presentation of acute epidydimitis? next step?

A

testicle and cord are swollen and painful (vs torsion no pain in cord)
fever, pyruia
tx: abx and do US to r/o torsion

44
Q

What should you think if pt w/ normal urine output but drinks for first time and colicky flank pain?

A

ureteropelvic junction obstruction = gets obstructed w/ large volume diuresis

45
Q

What is main tx for seminoma?

A
  • surgical excision

+ platinum based chemo for mets

46
Q

What is next step for penetrating trauma to upper zone, middle zone, and base of neck?

A

upper: ateriogram
middle: surgical exploration if sx of hematoma, worsening tials, coughing or spitting blood
base of neck: arteriography, esophagogram, esophagoscopy, bronchoscopy before surgery

47
Q

What is next step if pt w/ blunt trauma to abdomen and sx of peritoneal irritation?

A

exploratory laparotomy

48
Q

What is next step for penetrating ab injury causing hematuria?

A

exploratory lap and repair

49
Q

What should you think if baby w ab mass that moves up and down with respiration?

A

malignant liver tumor –> hepatoblastoma or HCC
check AFP

tx: resect

50
Q

What should you think if baby w/ deep ab mass that is nonmobile? next?

A

wilms from kidney or neuroblastoma in adrenal
dx: CT or MRI

tx: surgical resction

51
Q

What is next step for 55 yo woman w/ palpable breast mass?

A

mammo or US guided core bx

52
Q

When is genu varum (bow) and genu valgus (knock-knee) normal?

A

genu varum = normal to 3, after = blount dz

genu valgus = normal 4-8yo

53
Q

What should you suspect if pt had knees hit dashboard in car collision now w/ hip pain, leg sohortened, adducted, internally rotated?

A

posterior dislocation of hip

need to do emergent reduction to avoid avascular necrosis

54
Q

What is de quervain tenosynovitis?

A

young mother, forced wrist flexion and thumb extension

complain of pain radial wrist, reproduce by holding thumb in closed fist and deviating wrist to ulnar

tx: steroidd injection

55
Q

What is dupuytren contracture?

A

contract palm of hand, palmar fascial nodules

56
Q

What is usual presentation of UTI post-op?

A

POD3

57
Q

What is usual presentation of wound infection post op?

A

POD 7, erythema, warmth, tenderness

58
Q

What is presentation of L colon vs L colon?

A

R colon = anemia, occult blood

L colon = bloody bowel movement, narrow stool caliber, blood coats outside of stool

59
Q

What is tx for pyogenic liver abscess 2/2 ascending cholangitis?

A

percutanoues drainage

60
Q

When do you do lumpectomy vs mastectomy for breast cancer?

A

lumpectomy: if small, far from nipple
mastectmoy: large tumor under nipple and areola, if occupies most ofsmall breast

61
Q

What is next step if pt w/ hx of breat cancer and persistent back pain?

A

do MRI and resect or radiate

62
Q

What should you think if baby w/ green vomiting and multiple air fluid levels in abdomen?

A

intestinal atresia 2/2 vascular accident

63
Q

What should you think if baby w/ green vomiting and double bubble?

A

malrotation: normal gas beyond, do contrast enema or upper GI study
duodenal atresia: double bubble only
annular pancreas: double bubble only

64
Q

What is presentation of chronic constrictive pericarditis? findings on cardiac cath?

A

DOE, hepatomegaly, ascites

square root sign and equalization of pressures on cath

65
Q

What is presentation of retinal detachment? tx?

A

flashes aof light and floaters
no pain
tx: emergency laser spot welding

66
Q

At what point do you allow stones to pass vs use shock wave lithotripsy?

A

allow to pass =

67
Q

What should you do next if cant insert IV in adult but need to give IVF? what about kid

A

adult = percutaneous femoral vein cath or saphenous cut down

kid

68
Q

How do you dx bladder injury in ab trauma?

A

retrograde cystogram including postvoid films to see etraperitoneal leaks at base of bladder

69
Q

What is a complication of b/l comminuted femoral shaft fractures?

A

may produce enough internal blood loss to lead to shock –> should place in external fixation while patient is stabilized

70
Q

What is tx when break both malleoli?

A

open reduction and internal fixation

71
Q

What is surgical tx for longstanding GERD?

A

nissen fundoplication

plus give radiofreq ablation if severe dysplastic changes

72
Q

What should you think if young woman w/ pain w/ defection and blood streaks covering stool w/ fear of pain so avoid BMs? tx?

A

anal fissure

do exam under anesthesia and topical CCB (diltiazem)

73
Q

What should you think if pt presents with jaundice and US w/ large thing walled distended gallbladder? next step?

A

= courvoisier-terrier sign = sign of malignancy (pancreatic, ampulla of vater adenoCA, or cholangiocarcinoma)
next step = do CT

74
Q

What should you do if pt w/ jaundice and courvoisier sign on US w/ negative CT?

A

do mrcp to show smaller tumors

75
Q

What should you think if pt w/ fever and leukocytosis 10 days after onset of pancreatitis? dx? tx?

A

pancreatic abscess

  • do CT
  • tx: percutaneous radiological drainage
76
Q

What is tx for congenital diaphragmatic hernia?

A
  • delay repair 3-4 days to allow lung maturation

- in meant time do ET intubation, low pressure ventialation, may require ECMO

77
Q

What is likely dx if premature infant w/ feeding intolerance, ab distension and rapid dropping platelet count? tx?

A

necrotizing enterocolitis
tx: stop ffeds, abx, IVF, IV nutrition
immediate surgical intervention if ab wall erythema, air in portal vein,, intestinal pneumatosis, or pneumoperitoneum

78
Q

What is likely etiology if pt w/ sudden onset acute generalized pain?

A

perforation

79
Q

What is next step if pt w/ kidney transplant and signs of acute rejection?

A

steroid bolus = first line

if unsuccesssful give antithymocyte serum

80
Q

What is work up for hematuria?

A
  • first CT for cancer

- if negative and high suspicion do cystoscopy

81
Q

What is next step if pt w/ kidney stone now w/ fever and flank pain?

A

urgen nephrostomy tube or stent placement + IV abx = combo of obstruction and infection

82
Q

What is likely dx if older pt s/p surgery presents w/ ab distension and massively dilated colon? tx?

A

ogilvie syndrome

tx: colonoscopy, suck air out, place long rectal tube

83
Q

What kind of brain pathology presents w/ kids who do knee-chest position?

A

ependymoma = to open flow of CSF and relieve HA

Surgery Clerkship (5 decks)

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