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Surgical Clerkship > Pestana's Surgical Notes > Flashcards

Pestana's Surgical Notes Flashcards

1
Q

Airway with subcutaneous emphysema in neck

A

Fiberoptic bronchoscope

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2
Q

Clinical signs of shock

A

Low BP
Fast feeble pulse
Low UOP (<0.5mL/kg/h)
Pale, cold, shivering, sweating, thirsty

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3
Q

Shock in trauma setting

A

Bleeding, pericardial tamponade, tension PTX

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4
Q

CVP is ____ in pericardial tamponade/tension PTX

A

High

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5
Q

Clinical signs of tension PTX

A

Resp distress, no breath sounds + hyperresonance, displacement of trachea

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6
Q

Volume replacement for hypovol shock

A

2L LR (w/o sugar), pRBCs until UOP 0.5-2mL/kg/h with CVP<15

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7
Q

Preferred route of fluid resus

A

2 PIVs, 16g

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8
Q

Alternative routes of fluid resus

A

1) Percut fem vein catheter
2) Saphenous vein
3) Intraosseus cannulation of prox tibia

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9
Q

Management of pericardial tamponade

A

Pericardiocentesis, pericardial window, tube, or open thoracotomy

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10
Q

Management of tension PTX

A

Big needle or big IV catheter into affected pleural space + CT connected to underwater seal

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11
Q

Hypovol shock causes

A

Burns, peritonitis, bleeding, pancreatitis, diarrhea

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12
Q

Cardiogenic shock causes

A

MI, myocarditis (look for high CVP)

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13
Q

Vasomotor shock causes

A

Anaphylaxis, high spinal cord transection or anesthetic

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14
Q

Head trauma w/ LOC requires ___

A

CT scan (for intracranial hemorrhage), observation for 24hr

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15
Q

Signs of basilar skull fracture

A

Raccoon eyes, rhinorrhea, otorrhea/ecchymosis behind ear

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16
Q

Basilar skull fracture requires ___

A

CT scan (for cervical fractures)

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17
Q

Avoid ___ in basilar skull fracture pts

A

Nasal endotracheal intubation

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18
Q

Neurologic damage from trauma (3)

A
  1. Initial blow
  2. Subsequent hematoma
  3. Later increased ICP
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19
Q

Signs of acute epidural hematoma

A

Moderate side head trauma –> LOC –> lucid interval –> coma again // fixed dilated pupil on side of hematoma // CL hemiparesis with decerebrate posture

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20
Q

CT scan of acute epidural hematoma

A

Biconvex lens

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21
Q

Tx for acute epidural hematoma

A

Emergency craniotomy

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22
Q

Signs of acute subdural hematoma

A

Bigger trauma –> no LOC –> sicker patient

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23
Q

CT scan of acute subdural hematoma

A

Semiular crescent-shaped hematoma

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24
Q

Rx for acute subdural hematoma

A 
Craniotomy for midline deviation
ICP monitoring
Head elevation
Hyperventilation 
Avoid fluid overload
Give mannitol, furosemide 
Hypothermia
Sedation
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25
Q

Goal for PCO2 in subdural pts

A

PCO2 = 35

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26
Q

CT scan on DAI

A

Diffuse blurring of gray/white matter, multiple punctate hemorrhages

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27
Q

Rx for DAI

A

Prevent increased ICP

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28
Q

Rx for chronic subdural hematoma

A

Surgical evacuation –> dramatic cure

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29
Q

Can hypovolemic shock happen from head trauma?

A

NO

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30
Q

When to explore exploratory neck trauma?

A
  1. Expanding hematoma
  2. VS deteriorating
  3. Spitting up blood
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31
Q

Mgmt for gunshot wounds in upper zone of neck

A

Arteriographic diagnosis preferred

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32
Q

Mgmt for gunshot wounds in lower zone of neck

A

Arteriography, esophagogram, esophagoscopy, bronchoscopy –> surgery

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33
Q

Severe blunt neck trauma necessitates ___

A

CT scan for C spine injury

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34
Q

Anterior cord syndrome

A

Loss of motor & P/T sensation

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35
Q

Central cord syndrome

A

Paralysis and burning in UE, preservation of LE

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36
Q

Cause of central cord syndrome

A

Elderly in rear-end collision (forced hyperextension)

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37
Q

Precise diagnosis of cord injury made by ___

A

MRI

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38
Q

Rib fracture in elderly leads to ___

A

Hypoventilation 2/2 pain –> atelectasis –> PNA

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39
Q

Treat rib fracture with __

A

Local nerve block and epidural catheter

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40
Q

Plain PNX signs

A

Moderate SOB; one side no BS, hyperresonant to percussion

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41
Q

Chest tube placed ___

A

Upper, anterior part of chest

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42
Q

Hemothorax signs

A

Moderate SOB; no BS, dull to percussion

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43
Q

Diagnose hemothorax/PNX

A

CXR

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44
Q

Rx for hemothorax

A

CT placed low for evacuation; bleeding stops by itself 2/2 low pressure system of lung

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45
Q

Bleeding intercostal a. requires ___

A

Surgery (thoractotomy)

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46
Q

Indications for surg in hemothorax

A

1500mL or more of blood w/ CT on insertion, collecting over 600mL of blood over 6hr

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47
Q

Monitoring in severe chest trauma

A

Blood gases, CXR, cardiac enzymes, EKG

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48
Q

Signs of sucking chest wound

A

Flap that sucks in with inspiration, closes during expiration

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49
Q

Rx for sucking chest wound

A

Occlusive dressing (3 sides taped, air only goes out)

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50
Q

Problems with flail chest

A

Underlying pulm contusion

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51
Q

Problem with pulm contusion?

A

Very sensitive to fluid res, MUST restrict and diurese

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52
Q

Management of flail chest

A

BL CT for respirator (prevents tension pneumothorax), blood gases, LOOK FOR TRAUMATIC TRANSECTION OF AORTA!!

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53
Q

What does pulm contusion look like on CXR?

A

“White out” with deteriorating blood gases

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54
Q

How long does pulm contusion take?

A

Immediate to 48hrs (must monitor!)

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55
Q

Suspect ___ in sternal fractures

A

Myocardial contusion

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56
Q

Tests for myocardial contusion

A

EKG, Order troponins!

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57
Q

CXR of diaphragmatic rupture

A

Bowel on L chest

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58
Q

Evaluation of diaphragmatic rupture

A

Surgery

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59
Q

Traumatic rupture of the aorta happens at ___

A

Junction of arch & descending aorta

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60
Q

Injury for ruptured aorta

A

Big deceleration injury

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61
Q

Symptoms of ruptured aorta

A

ASYMPTOMATIC until hematoma in adventitia breaks!

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62
Q

Signs of ruptured aorta

A

Injury type; presence of “hard-to-break” fractures like first rib, sternum, scapula; wide mediastinum

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63
Q

Diagnostic tests for ruptured aorta

A

Transesophageal echocardiography, spiral CT (“CT angio”), MRI angiography

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64
Q

DDx subcutaneous emphysema

A

Trachea, large bronchus, esophagus, tension ptx

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65
Q

Signs of fat embolism

A

Multiple trauma, SOB, petechiae on chest/axilla, fever/tachy/low plt count, BL patchy infiltrates on CXR

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66
Q

Gunshot wound to abdomen –> ___

A

Ex lap

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67
Q

Stab wounds that penetrate –> __

A

Ex lap

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68
Q

Blunt trauma to abdomen w/ signs of peritoneal irritation –> ___

A

Ex lap

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69
Q

Signs of blood loss occur when ___ of blood lost

A

25-30% (1500mL)

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70
Q

Where can blood hide?

A

Pelvis, femur, abdomen

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71
Q

Acute ID of internal bleeding hemodynamically stable

A

CT scan

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72
Q

Acute ID of internal bleeds hemodynamically unstable

A

DPL/sonography –> ex lap

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73
Q

Intra-op dev of coagulopathy treated with ___

A

FFP and platelet packs (10 each)

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74
Q

Must stop surgery with coagulopathy if ___

A

Hypothermia & acidosis occur

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75
Q

Signs of abdominal compartment syndrome

A

2 days after procedure – distension, hypoxia 2/2 inability to breathe, renal failure from pressure on vena cava

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76
Q

Rx for abdominal compartment syndrome

A

MUST open and give temporary cover

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77
Q

Rx for pelvic hematomas

A

LEFT ALONE if not expanding

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78
Q

Must-dos for pelvic hematomas (3)

A

Rectal exam, pelvic exam, retrograde urethrogram

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79
Q

Rx for expanding pelvic hematomas

A

External fixators + IR for angiography embolization of both internal iliacs

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80
Q

Penetrating urologic injury —> ____

A

Exploration by retrograde urethrogram

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81
Q

Urethral injury can present with ____

A

blood at the meatus or scrotal hematoma, inability to pass Foley

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82
Q

Posterior urethral injury may also have ___

A

Sensation of wanting to void, high-riding prostrate on DRE

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83
Q

Dx of bladder injuries

A

Retrograde cystogram (include post-void)

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84
Q

Rx for intraperitoneal leaking bladder

A

Surgical repair, protection by suprapubic cystostomy

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85
Q

Rx for extraperitoneal leaking bladder

A

Foley

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86
Q

Renal injuries associated with ___ fracture

A

Lower rib

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87
Q

Assessment of renal injury

A

CT scan

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88
Q

Renal injury may lead to development of ____

A

AV fistula leading to CHF or renovascular HTN 2/2 renal artery stenosis

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89
Q

Rx for scrotal hematoma

A

None needed

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90
Q

Penile fracture –> ____

A

Emergency surgical repair, or face impotence from AV shunts

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91
Q

Penetrating extremity injuries —> ____

A

CT angio/Doppler, may need exploration/repair

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92
Q

Combined injury of bone/arteries/nerves —> ____

A

(1) Stabilize bone
(2) Delicate vascular repair
(3) Nerve repair
(4) Fasciotomy

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93
Q

High-velocity gunshot wounds –> ___

A

Extensive debridement, possible amputation

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94
Q

Crushing injuries may lead to ___

A

Myoglobinuria, myoglobinemia, hyperkalemia, renal failure, compartment syndrome

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95
Q

Rx crush injuries

A

IVF, osmotic diuretics, alkalinization of urine, fasciotomy

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96
Q

Chemical burns –> ___

A

Massive irrigation

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97
Q

What’s worse: alkaline or acid burns?

A

Alkaline (Drano)

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98
Q

High-voltage electrical burns —> ___

A

Massive debridement (ALWAYS worse than they appear)

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99
Q

Consequences of electrical burns

A

Ortho: posterior shoulder dislocation, compression fractures of vertebral bodies
Ophtho: cataracts
Neuro: demyelinization
Renal: myoglobinuria/failure

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100
Q

Dx respiratory burns

A

Fiberoptic bronchoscopy, blood gases, monitor carboxyhemoglobin

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101
Q

Circumferential burns –> __

A

Escharotomies provide immediate relief

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102
Q

Scalding burns in peds —> __

A

Check for child abuse

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103
Q

“Rule of Nines” in burns (adult)

A

9%: head
2x9%: UE
4x9%: trunk
4x9%: LE

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104
Q

Desired UOP in burn patients

A

1-2mL/kg/hr

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105
Q

IVF for burn patients (>20%)

A

1000mL/h LR (w/o sugar to avoid osmotic diuresis) –> adjust as needed

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106
Q

“Rule of Nines” in burned babies

A

2x9% = head
3x9% = LE
otherwise same

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107
Q

3rd degree burns: adult v. peds

A

Grey, leathery vs. deep bright red

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108
Q

IVF for burned babies

A

20mL/kg/hr, tuned to UOP

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109
Q

Topical agents for burns

A

(1) Silver sulfadiazine
(2) Mafenide acetate for deep penetration
(3) Triple antibiotic (near eyes)

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110
Q

Nutritional mgmt for burns

A

NGT suction –> intensive nutritional support via gut (high calorie/high nitrogen) for 2-3 weeks

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111
Q

Early excision and grafting is done for___

A

Limited 3rd degree burn (<20%)

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112
Q

All bites require ___

A

Tetanus prophylaxis and wound care

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113
Q

Provoked dog bites –> ___

A

Observation of dog

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114
Q

Unprovoked dog or wild animal bites —> ___

A

Rabies prophylaxis mandatory (IG + vaccine)

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115
Q

Signs of snakebite envenomation

A

Swelling, severe local pain, discoloration in <30min

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116
Q

Testing for snakebites

A

Typing and crossmatch for blood, coagulation, liver/renal function

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117
Q

Antivenin dosage varies with ___

A

Size of bite, not patient

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118
Q

Epinephrine dose for anaphylaxis

A

0.3-0.5mL of 1:1000 solution

119
Q

Black widow spider bite

A

N&V, severe generalized muscle cramps

120
Q

Rx for black widow bite

A

Calcium gluconate IV, muscle relaxants

121
Q

Brown recluse spider bites

A

Ulcer with necrotic center and surrounding erythematous halo

122
Q

Rx brown recluse bites

A

Dapsone, surgical excision + grafting

123
Q

Rx human bites

A

Extensive irrigation and debridement

124
Q

Rx developmental hip dysplasia

A

Abduction splinting with Pavlik harness, 6wk

125
Q

Hip pathology may have ___ or ___ pain

A

Hip, knee

126
Q

Legg-Calve-Perthes disease is also known as __

A

Avascular necrosis of capital femoral epiphysis

127
Q

Sx for LCP disease

A

Age , limping, decreased hip motion, antalgic gait

128
Q

Dx for LCP disease

A

AP and lateral hip XR

129
Q

Rx for LCP disease

A

Contain femoral head within acetabulum by casting, crutches

130
Q

SCFE

A

Slipped capital femoral epiphysis

131
Q

People who get SCFE

A

Chubby or lanky boys, age 13

132
Q

Sx of SCFE

A

Groin/knee pain, limping, sole of affected foot points to other side on dangling, inability to internally rotate hip

133
Q

Sx septic hip

A

Febrile illness, hold leg with hip flexed (abducted, external rotation), high ESR

134
Q

Dx septic hip

A

Aspiration of hip under general anesthesia –> continue to open drainage

135
Q

Sx acute hematogenous osteomyelitis

A

Small children with febrile illness, severe localized pain in bone w/ no hx of trauma

136
Q

Dx acute hematogenous osteomyelitis

A

MRI

137
Q

Genu varum is normal up ‘til age __

A

3

138
Q

Genu valgus is normal in ages ___

A

4-8

139
Q

Osgood-Schlatter disease is also known as

A

Osteochondrosis of tibial tubercle

140
Q

Sx of Osgood-Schlatter dz

A

Teenagers, persistent tibial pain, aggravated by hip flexion

141
Q

Rx Osgood-Schlatter dz

A

RICE —> extension/cylinder cast for 4-6wk

142
Q

Club foot is also known as

A

Talipes equinovarus

143
Q

Club foot sx

A 
Feet turned inward
Plantar flexion of ankle
Inversion of foot
Adduction of forefoot
Internal rotation of tibia
144
Q

Rx club foot

A

Serial plaster casts in neonatal period, Achilles tenotomy, long-term braces, surgery between 9-12mo

145
Q

Sx of scoliosis

A

Hump over R thorax

146
Q

Supracondylar humeral fractures occur when. . .

A

Hyperextended elbow, FOOSH

147
Q

Complications of supracondylar fractues

A

Vascular/nerve injuries, Volkmann contracture

148
Q

Rx supracondylar fractures

A

Open reduction and internal fixation

149
Q

Clavicle fractures usually at

A

Junction of middle/distal thirds

150
Q

Rx clavicle frax

A

Arm in sling

151
Q

Sx of anterior dislocation of shoulder

A

Arm held close to body, rotated outwards; numbness over deltoid

152
Q

Posterior shoulder dislocations occur with ___

A

Seizure or electrical burns

153
Q

Sx of posterior shoulder dislocation

A

Arm held close to body, internally rotated; may be missed by XR

154
Q

Colles fractures

A

FOOSH in elderly women, dinner fork wrist (distal radius)

155
Q

Rx Colles fractures

A

Close reduction and long arm cast

156
Q

Monteggia fracture

A

Blow to ulna –> diaphyseal fracture of prox ulna with anterior dislocation of radial head

157
Q

Galeazzi fracture

A

Distal third of radius direct blow –> fracture of radius + dorsal dislocation of distal radioulnar joint (mirror of Monteggia)

158
Q

Rx for Monteggia, Galeazzi fractues

A

1) Open reduction and internal fixation of broken bone

2) Closed reduction of dislocation

159
Q

Scaphoid fracture

A

FOOSH, localized tenderness over anatomic snuff box

160
Q

Rx scaphoid frax

A

Thumb spica cast –> open reduction and internal fixation if displaced/angulated frax

161
Q

Boxer’s fracture

A

Metacarpals of 4th/5th

162
Q

Rx Boxer’s fracture

A

Closed reduction and ulnar gutter splint if mild

Kirschner wire or plate fixation if bad

163
Q

Sx of hip fractures

A

Shortened leg, external rotation

164
Q

Femoral shaft fractures —> ___

A

Intramedullary rod fixation

165
Q

Consequences of femoral shaft injury

A

Fat emboli, hypovolemic shock

166
Q

Dx MCL injury

A

Pain on abduction (valgus stress test)

167
Q

Dx LCL injury

A

Pain on adduction (varus stress test)

168
Q

Dx ACL

A

Anterior drawer, Lachman

169
Q

Dx meniscal tears

A

MRI (hard to diagnose by XR, PE)

170
Q

Unhappy triad

A

Medial meniscus, MCL, ACL

171
Q

Tibial stress frax occur with ___

A

Forced marches

172
Q

Dx of tibial stress frax

A

Tenderness to palpation over bone, XR initially nl

173
Q

Dx of tibia/fibula frax

A

Angulation, XR diagnostic

174
Q

Rx tibia/fibula

A

Casting or intramedullary nailing

175
Q

Sx of Achilles rupture

A

Loud popping noise, fall clutching ankle – limited plantarflexion, gap on palpation of tendon

176
Q

Ankle frax

A

Both malleoli break, AP/lateral/mortise XR diagnostic –> fix with open reduction/internal fixation

177
Q

Causes: compartment syndrome

A

Prolonged ischemia followed by reperfusion
Crush injury
Fracture with closed reduction

178
Q

Sx: compartment syndrome

A

Pain (esp. with extension), paresthesias, pulseless, pallor, poikilothermia, paralysis

179
Q

Rx: compartment syndrome

A

Emergency fasciotomy

180
Q

Pain under a cast –> ___

A

Remove cast and examine

181
Q

Open fractures –> ___

A

Cleaning in OR and suitable reduction WITHIN 6 HOURS

182
Q

Posterior dislocation of hip occurs with __

A

Head-on car collision

183
Q

Sx of posterior hip dislocation

A

Leg shortened, adducted, internally rotated (vs. broken hip, external rotation)

184
Q

Rx posterior hip dislocation

A

Emergency reduction

185
Q

Rx gas gangrene

A

Copious IV penicillin, extensive emergency surgical debridement, hyperbaric O2

186
Q

Radial n injury in ___ frax

A

Mid-humerus

187
Q

Popliteal a. injury in ___ dislocation

A

Posterior knee

188
Q

Fall from height –> what is injured?

A

Leg/hip but also lumbar/thoracic spine

189
Q

Head-on automobile collisions –> what is injured?

A

Head/face/torso but also femoral dislocations

190
Q

Facial fractures –> what is injured?

A

Look at C spine

191
Q

Average adult needs ___ kcal/kg/day

A

25-30

192
Q

___ % of calories should be from fat

A

20-25

193
Q

Average traumatized adult needs ____ g/kg/day of protein

A

1-1.5

194
Q

Head trauma requires decreased energy needs – t or f?

A

F – INCREASED

195
Q

Harris Benedict equation for men

A

BMR = 66.5 + (13.75 x weight in kg) + (5.003 x height in cm) - (6.775 x age in yrs)

196
Q

Harris Benedict equation for women

A

BMR = 655.1 + (9.563 x weight in kg) + (1.850 x height in cm) - (4.676 x age in years)

197
Q

Multiply BMR by what to estimate daily calorie requirements?

A

Activity and disease factors

198
Q

___ is the best way to assess a patient’s daily caloric needs

A

Indirect calorimetry

199
Q

Nitrogen balance equation

A

NB = (protein in g / 6.25) - (24hr BUN + 4)

200
Q

What markers to assess patient’s nutritional status?

A

Prealbumin (carries thyroxine, vit A), CRP, transferrin, albumin (if chronic)

201
Q

Refeeding syndrome markers

A

K, phosphate, magnesium

202
Q

Causes of post-op fever

A 
POD1: atelectasis
POD3: PNA, UTI
POD5: DVT
POD7: wound infection 
POD10-15: deep abscesses
203
Q

PE usually happens at POD _

A

7

204
Q

Post-op MI usually happens at POD __

A

2-3

205
Q

PE signs

A

Distended neck veins, tachy, diaphoretic, hypoxemia, hypocapnia

206
Q

Prevention of aspiration

A

NPO and antacids before induction

207
Q

Intraoperative tension PTX

A

Happens when put on resp support, BP down/CVP up as they try to bag

208
Q

How to rx intraoperative tension PTX

A

Decompress through diaphragm or anterior chest wall in pleural space

209
Q

1st thing to suspect when post-op pt gets confused/disoriented?

A

Hypoxia (may be 2/2 sepsis)

210
Q

ARDS criteria

A

“CXR” – CWP <200

211
Q

Rx ARDS

A

PEEP and low ventilatory volumes (avoids barotrauma)

212
Q

DTs occur at POD __

A

2-3

213
Q

Rx for hyponatremia with fluid resus

A

Add sodium (100mL of 5%, 500mL of 3%) + osmotic diuretics

214
Q

Chart for hyponatremia

A

Large fluid intake, weight gain, rapid lowering sodium

215
Q

Chart for hypernatremia

A

Large/unreplaced UOP, rapid weight loss, and rapidly rising sodium concentration

216
Q

Rx for hypernatremia

A

Use D5-1/2 or D5-1/3 NS

217
Q

Coma in a cirrhotic pt with bleeding esophageal varices with portocaval shunt

A

Ammonium intoxication

218
Q

0 UOP usually caused by __

A

Plugged/kinked catheter

219
Q

Low UOP w/ normal perfusion pressure

A

Fluid deficit or ARF

220
Q

Dx cause of low UOP (3 ways)

A 
1) Give fluid bolus (500mL IVF over 10-20min)
OR
2) urinary sodium 40 in renal failure
OR
3) FENa > 1
221
Q

Paralytic ileus should resolve after __ days

A

3

222
Q

Mechanical bowel obstruction should be suspected after POD __

A

5

223
Q

Ogilvie syndrome

A

“Paralytic colon”

224
Q

Who gets Ogilvie syndrome?

A

Elderly sedentary patients who become more immobilized

225
Q

What does Ogilvie syndrome look like?

A

Large abdominal distension (tense, not tender) and XR shows massively dilated colon

226
Q

Give IV ___ to restore colonic motility

A

Neostigmine

227
Q

Wound dehiscence is typically seen POD __ after open lap

A

5

228
Q

What does dehiscence look like?

A

Pink, salmon colored fluid (peritoneal) comes out of dressing

229
Q

Evisceration

A

Happens when pt coughs, strains, or gets out of bed –> must schedule surgery ASAP!!

230
Q

GI tract fistulas cause problems by. . .

A

1) Sepsis
2) Fluid/electrolyte loss
3) Nutritional deprivation
4) Erosion of bowel wall

231
Q

Fistulas are more problematic at the __ of the GI tract

A

Beginning

232
Q

FETID mnemonic for prevention of fistula healing

A

Foreign body, epithelization, tumor, infection, irradiated tissue, IBD, or distal obstruction

233
Q

Every __ mEq/L of serum sodium above 140 = 1 L water lost

A

3

234
Q

Rx hyponatremia from ADH excess

A

Water restriction

235
Q

Rx hyponatremia from hypovolemic/dehydrated pt retaining water

A

Volume restoration with NS or LR (isotonic)

236
Q

Hypokalemia (slow) causes

A

Diarrhea, loops, aldosterone

237
Q

Hypokalemia (fast) causes

A

Correction of DKA (K+ moves into cells)

238
Q

Safe speed limit for IV K+ administration

A

10mEq/h

239
Q

Hyperkalemia

A

Renal failure, aldo antagonists, crush injury, dead tissue, acidosis

240
Q

Rx hyperkalemia (4 methods)

A

Hemodialysis
OR
Push 50% dextrose and insulin (K+ goes into cells)
OR
NG suction, exchange resins
OR
IV calcium (neutralizes effect on cell membrane)

241
Q

Sx of acute appy

A

Anorexia, vague periumbilical pain –> sharp, severe RLQ pain with tenderness, guarding, and rebound

242
Q

R colon cancer

A

Anemia (hypochromic, iron deficiency), 4+ occult blood

243
Q

L colon cancer

A

Bloody bowel movements

244
Q

Malignant polyps

A

FAP > familial multiple inflammatory polyps > villous adenoma > adenomatous polyp

245
Q

Nonmalignant polyps

A

juvenille, Peutz-Jeghers, isolated inflammatory, hyperplastic

246
Q

Toxic megacolon

A

Abd pain, fever, leukocytosis, epigastric tenderness, massively distended transverse colon on XR with gas in colon wall

247
Q

MCC of C. diff

A

Clindamycin, cephalosporins

248
Q

Sx of C diff

A

Crampy pain, leukocytosis, watery diarrhea

249
Q

Rx anal fissures

A

Topical nitroglycerin, local botulinum, forceful dilatation, lateral internal sphincterotomy, CCBs (dilt 2% TID for 6wk)

250
Q

Ischiorectal abscess

A

Febrile, exquisite pain –| sitting, BM, abscess lateral to anus

251
Q

Fistula-in-ano

A

Epithelial migration from anal crypts and perineal skin –> permanent tract

252
Q

Rx. SCC of anus

A

Nigro chemoradiation (and rarely surg)

253
Q

Upper GI tract

A

Tip of nose to ligament of Treitz

254
Q

MCC of bleeding in GI tract?

A

Upper GI (3/4 cases)

255
Q

Causes of colonic bleeding

A

Angiodysplasia, polyps, diverticulosis, cancer, hemorrhoids

256
Q

Vomiting blood means the GI injury can’t go further than ___

A

Ligament of Treitzz

257
Q

Melena is a sign of ___

A

Upper GI bleeding

258
Q

Causes of bright red blood per rectum

A

Anywhere in GI tract (think Meckel’s in kids!)

259
Q

Workup for BRB PR to R/O upper GI

A

NG suction –> upper GI endoscopy

260
Q

Acute abdomen may be caused (generally) by. . .

A

Perforation, obstruction, inflammatory, ischemia

261
Q

Perforated acute abdomen (signs/sx)

A

1) Sudden onset; constant, generalized; severe
2) + tenderness, guarding, rebound, no BS
3) Free air under diaphragm

262
Q

Obstructed acute abdomen (signs/sx)

A

1) Sudden onset; colicky, localized, radiation

2) Few physical findings

263
Q

Inflammatory acute abdomen (signs/sx)

A

1) Gradual onset – at least 6-10hr; constant, ill-defined –> localizing, radiation
2) Peritoneal irritation localized
3) Fever, leukocytosis

264
Q

Ischemic acute abdomen

A

Severe abd pain + blood in lumen of gut

265
Q

Suspect primary peritonitis if. . .

A

1) Peds: nephrosis, ascites

2) Adults: mild generalized acute abdomen, fever, leuks

266
Q

Rx primary peritonitis

A

Abx

267
Q

Rx generalized acute abdomen

A

Ex lap

268
Q

What looks like acute abdomen?

A

Pancreatitis (amylase), urinary stones (CT scan)

PE (immobilized pt), lower lobe PNA (CXR), MI (EKG)

269
Q

Alcoholic with sudden upper acute abdmen

A

Acute pancreatitis (couple hrs)

270
Q

Sx of acute pancreatitis

A

Fast, constant, epigastric, radiating to back, N&V, retching

271
Q

Dx acute pancreatitis

A

Serum amylase or lipase (serum 12-48hr, urine 3rd-6th day)

CT

272
Q

Rx acute pancreatitis

A

NPO, NG suction, IV fluids

273
Q

Signs/sx urethral stones

A

Colicky flank pain radiating to inner thigh and scrotum/labia

274
Q

Middle-aged pt, fever/leukocytosis/peritoneal irritation in LLQ

A

Diverticulitis

275
Q

Rx. diverticulitis

A

NPO, IVF, abx

276
Q

Acute abdomen in someone with a-fib or recent MI

A

Mesenteric ischemia

277
Q

Volvulus of sigmoid colon

A

Air-fluid levels in SB, distended colon, huge air-filled loops in RUQ taping down to LLQ

278
Q

Hemolytic jaundice tends to have relatively ___ bilirubin

A

Lowish (3-4), all indirect

279
Q

Hepatocellular jaundice

A

Elevations of both bili fractions
High transaminases
Modest elevation of Alk phos

280
Q

Obstructive jaundice

A

Elevations of both bili fractions
Modest elevation of transaminases
Sky-high AlkPhos

281
Q

Tumors that may cause obstructive jaundice

A

Adenocarcinoma at head of pancreas, adenocarcinoma of ampulla of Vater, cholangiocarcinoma of common duct

282
Q

Biliary colic

A

RUQ colicky pain radiating to R shoulder and back, triggered by fatty food, accompanied by N&V but no signs of peritoneal irritation

283
Q

Acute cholecystitis

A

Fever, leukocytosis, constant pain, findings of peritoneal irritation

284
Q

Rx acute chole

A

NG suction, NPO, IV fluids, abx

285
Q

Acute ascending cholangitis

A

High febers, chills, high WBC, hyperbilirubinemia, high AlkPhos

286
Q

Rx. acute ascending cholangitis

A

IV abx and emergency decompression by ERCP –> lap chole

287
Q

Pancreatic rest

A

NPO, NG suction, IVF

288
Q

Course of hemorrhagic pancreatitis

A

Look for lower crit/Ca, elevated WBC/glucose

Progresses to: high BUN, met acidosis, low arterial PO2

289
Q

Abx for hemorrhagic pancreatitis

A

IV imipenem or meropenem

290
Q

Pancreatic cysts most likely to rupture?

A

Bigger (>6cm) and older (>6wk)

291
Q

Sx of chronic pancreatitis

A

Calcified pancreas, steatorrhea, diabetes, constant epigastric pain

292
Q

Mammography should be started at age __

A

40

293
Q

Fibroadenomas

A

Young women, firm/rubbery mass, mobile

Surgical Clerkship (1 decks)

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