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Surgery Clerkship > Pestana Surgery Review > Flashcards

Pestana Surgery Review Flashcards

1
Q

epidural hematoma (hemorrhage)

A

lucid interval
CT scan
emergency surgical decompression (craniotomy)

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2
Q

acute epidural hematoma

A

high speed automobile collision
CT scan
emergency craniotomy

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3
Q

chronic subdural hematoma

A

elderly becomes progressively senile over weeks
CT scan
craniotomy

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4
Q

base of skull fracture

A

raccoon eyes/clear fluid dripping from nose/clear fluid dripping from ear/ecchymosis behind the car

CT scan an cervical spine Xrays

Mx: neurosurgical consult and abx

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5
Q

High speed MVA with fixed dilated pupils, BP of 70/50 and HR of 130. What is the reason for low BP and high pulse rate?

A

NOT neurological injury b/c not enough room in the head for blood loss to cause shock.

Look for other significant blood loss outside or inside.

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6
Q

Hypovolemic shock

A

Management:

  • big bore IV needles
  • Foley catheter
  • IV antibiotics
  • ideally exploratory lap immediately then fluid and blood administration but give fluids if waiting for OR
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7
Q

pericardial tamponade management

A

Mx: no x-rays needed (clinical diagnosis!)

Do thoracotomy then exploratory lap (if trauma)

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8
Q

tension pneumothorax management

A

Mx: immediate big bore IV catheter placed into the right pleural space, followed by chest tube placement

Do NOT send to Xray right away

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9
Q

massive MI symptoms and management

A

Sx: cold, diaphoretic and low BP, irregular feeble pulse, distended neck and SOB

Mx: EKG, cardiac enzymes, cardiac care unit, possible thrombolytics, do NOT drown pt with fluids

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10
Q

vasomotor shock symptoms and management

A

Sx: low BP, high pulse, “warm and flushed” CVP low

Mx: vasoconstrictors, volume replacement can’t hurt

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11
Q

plain pneumothorax management

A

Mx: chest tube to underwater seal and suction (HIGH in pleural cavity)

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12
Q

hemothorax management

A

Mx: chest tube at BASE of pleural cavity

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13
Q

indications for a thoracotomy to ligate a vessel

A

initial blood retrieved from a hemothorax is >1500 cc or > 600 in the next 6 hours

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14
Q

25 y.o. man stabbed in R chest. Moderately SOB, stable VS. No breath sounds on the right. Resonant to percussion at apex on the R chest, dull at the base. CSR shows one single, large air-fluid level. What is the dx?

A

hemo-pneumothorax

Mx: chest tube, surgery only if bleeding a lot

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15
Q

“white-out” of lungs are x-ray

A

pulmonary contusion

sometimes doesn’t show up until 1-2 days after trauma

Mx: fluid restriction, diuretics, respiratory support (latter is key)

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16
Q

sternal fracture

A

increased risk for myocardial contusion and traumatic rupture of the aorta

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17
Q

symptoms of a diaphragmatic rupture

A
  • moderate respiratory distress
  • no breath sounds over the entire side (always on LEFT)
  • percussion unremarkable
  • CXR shows air fluid levels in the left chest
  • nasogastric tube curling up into the left chest

Mx: surgical repair

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18
Q

symptoms and management of rupture of the aorta

A

Sx: severe trauma (breaking bones that are hard to break like first rib, scapula, or sternum)

Dx by arteriorgram

Tx: emergent surgery

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19
Q

symptoms and management of traumatic rupture of the trachea or major bronchus

A
  • chest trauma
  • developing progressive subcutaneous emphysema all over upper chest and lower neck
  • CXR shows presence of air in the tissues

Mx: fiberoptic bronchoscopy to confirm dx and level of injury and to secure airway. Then surgery.

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20
Q

Management for penetrating wound to the abdomen PRIOR to surgery

A
  • indwelling bladder catheter
  • big bore IV needle
  • broad spectrum abx
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21
Q

where are the boundaries for an abdomen wound? A chest wound?

A
  • the belly begins at the nipple line
  • the chest does not end at the nipple line though

*belly and chest are separated by a dome so if a person has a wound 2 inches below the nipple need to work up for chest AND abd wounds

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22
Q

which solid organ gives the most clinically significant bleeding?

A

spleen

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23
Q

which solid organ is likely to bleed the most (but less likely to be clinically significant)?

A

liver

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24
Q

which immunizations are needed for an asplenic patient?

A
  • pneumovax
  • homophilus influenza B
  • meningococcus
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25
Q

MVA. Multiple upper and lower extremity injuries. BP is 75/55 and HR 110. PE shows tender abd with guarding and rebound in all quadrants.

What to do next?

A

exploratory lap

Of course, gives fluids too.

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26
Q

MVA + pelvic fracture + blood in the meatus

What to do next?

A

1st - retrograde urethrogram

b/c urethral injury would be compounded by insertion of a Foley catheter

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27
Q

MVA + pelvic fracture + blood in meatus + scrotal hematoma + “high riding prostate”

A

posterior urethral injury

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28
Q

What is the difference between a posterior urethral injury and an anterior urethral injury?

A

Anterior injury - repaired right away

Posterior injury - repair delayed 6 months

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29
Q

no blood at meatus + gross hematuria after insertion of Foley catheter + pelvic fracture from MVA

What to do next?

A

Likely a bladder injury

1st - retrograde cystogram

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30
Q

MVA + rib fractures and abdominal contusions + insertion of foley catheter shows gross hematuria + retrograde cystogram normal

What to do next?

A

Likely a kidney injury

1st - CT scan

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31
Q

Microscopic hematuria after a traumatic

A

not a big deal

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32
Q

microhematuria in kids

What to do next?

A

ALWAYS investigate

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33
Q

ruptured testicle diagnosis, symptoms, and and management

A

symptoms: scrotal hematoma d/t traumatic event
diagnosis: sonogram
management: if ruptured –> surgery. If intact –> symptomatic treatment

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34
Q

fracture of the penis management

A

emergent surgery

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35
Q

alkaline burn initial management

A

lots of water irrigation then rush to ER

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36
Q

electrical burn management

A

these burns are much deeper and bigger than appear

1st - extensive surgical debridement

2nd - think about myoglobinuria and renal failure –> give lots of IV fluids, diuretics (e.g. mannitol), and maybe alkalinize the urine

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37
Q

inhalation burn diagnosis and management

A

diagnosis: bronchoscopy
management: respiratory support

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38
Q

circumferential burn management

A

1st - compulsive monitoring of peripheral pulses and capillary filling

2nd - escharotomies at the bedside at the first sign of compromised circulation

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39
Q

third degree burn cream

A

silver sulphadiazine (silvadene)q

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40
Q

fluid resuscitation rate in adult

A

4 cc per kg of body weight per percentage of burn

  • try to give LR, and give half of calculated dose in the first 8 hours
  • give colloids on the 2nd day (not the first)
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41
Q

Monitoring for calculation of fluid resuscitation in a burn victim

A

CVP - keep below 15 to 20 mmHg

hourly urinary output - aim for 1 cc per kg body weight per hour

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42
Q

circumstances where additional fluid is needed (aiming for urinary output of 2 cc per kg per hour)

A
  • electrical burn

- patients who get an escharotomy

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43
Q

Patient is well resuscitated, had good hemodynamic parameters, but required a lot of fluid. On 3rd day he pees out a storm. What should you be concerned of?

A

Nothing. The fluid from the burn edema is coming back into the circulation. You should expect this.

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44
Q

Topical treatments for burns (most areas, where deep penetration needed, near eyes)

A

most areas - silvadene

where deep penetration is needed - sulphamyelon

around eyes - triple antibiotic ointment

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45
Q

When should rehabilitation for burn patients start?

A

day 1

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46
Q

For a very small and clearly third degree burn…

What to do next?

A

excise and graft on day 1

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47
Q

human bite management

A

surgical exploration and irrigation pronto

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48
Q

Farmer. Swedish ancestors. Raised waxy 1.2 cm skin mass on bridge of nose growing for past 3 years. No lymph nodes in next.

What is it?

How is it diagnosed?

Treatment?

A

What is it - basal cell carcinoma

How is it diagnosed? full thickness biopsy at the edge of the lesion (punch or knife)

Treatment: surgical excision with clear margins but conservative width

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49
Q

Farmer. Irish descent. Non-healing, indolent, punched out, clean looking 2 cm ulcer over the temple. Slow growing for past 3 years.

What is it?

How is it diagnosed?

Treatment?

A

What is it - basal cell carcinoma

How is it diagnosed? full thickness biopsy at the edge of the lesion (punch or knife)

Treatment: surgical excision with clear margins but conservative width

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50
Q

Blonde, blue eyed, 69 year old sailor with non-healing indolent 1.5 cm ulcer on lower lip. Slowly enlarging for past 8 months.

What is it?

How is it diagnosed?

Treatment?

A

What is it - squamous cell carcinoma

How is it diagnosed - biopsy

Treatment - excision (wider margins) or local radiation

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51
Q

Red head who loves to sun bake. Pigmented lesion that is asymmetrical, irregular borders, different colors, measuring 1.8 cms.

What is it?

How is it diagnosed?

Treatment?

A

What is it - likely melanoma

How is it diagnosed - full thickness biopsy at edge of lesion

Treatment - margin free excision if superficial (

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52
Q

What to be concerned about with deep melanoma…

A

metastasis to weird places:

  • left ventricle
  • duodenum
  • ischiorectal area
  • weird timing
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53
Q

18 year old with firm, rubbery mass in left breast that moves easily with palpation.

What is it?

How is the diagnosis made?

A

What is it - fibroadenoma

How is the diagnosis made - FNA and UA (mammogram not suitable for young breasts)

54
Q

Immigrant from Latin country. Large breast mass present for several years. Slow growing. Mass is firm, rubbery, completely movable. No palpable axillary nodes.

What is it?

How is the diagnosis made?

A

What is it - cystosarcoma phyllodes

How is the diagnosis made - tissue diagnosis. Margin free resection will follow.

55
Q

35 year old female with history of tender breasts with menstrual cycles. Now she has a lump that has not gone away for 6 weeks.

What is it?

Management?

A

What is it - fibrocystic disease

Management - aspiration of the cyst. If mass goes away after aspiration, then no more follow up. If fluid is bloody it will go to cytology. If mass does not go away or recurs after biopsy, then further testing needed.

56
Q

Bloody discharge for past several months. No palpable masses.

What is it?

Management?

A

What is it - intraductal papilloma

Management - mammogram and probably resection

57
Q

lactating mother with cracks in nipple, fluctuating red, hot, tender mass in the breast along with fever and leukocytosis.

What is it?

Management?

A

What is it - possibly an abscess

Management - incision and drainage

58
Q

Eczematous lesion in the areola, present for 3 months, not gone away with a variety of lotion and ointments.

What is it?

Management?

A

Likely cancer. A better answer is Paget’s disease of the breast (a cancer under the areola)

Management - core biopsy or incisional biopsy of the tissue underneath

59
Q

classic findings of cancer on a mammogram

A

irregular area of increased density with fine micro calcifications that were not found on prior imaging

60
Q

When should you do a lumpectomy vs. a modified radical mastectomy?

A

Lumpectomy - small tumor where most of breast can be spared

Modified radical mastectomy - larger tumors

61
Q

Adjuvant systemic therapy for breast cancer in women. Which ones get chemotherapy and which ones get hormonal therapy?

A

Chemotherapy - premenopausal women

Hormonal therapy (tamoxifen) - postmenopausal women

62
Q

If the numbers of TNM are not 1 for the tumor and zero for the nodes and met….

A

the tumor is bad news bears.

63
Q

Causes of amblyopia…

A
  1. child has a huge, pedunculate lipoma hanging from the right upper eyelid and obstructing vision on that eye
  2. child suspected of having strabismus

Management: surgically correction ASAP

64
Q

Causes of white pupil (leukocoria)

A

cataract or retinoblastoma (emergency!)

65
Q

“huge, shiny eyes in a baby”

A

congenital glaucoma –> if undiagnosed, blindness ensues

66
Q

Symptoms of acute angle glaucoma

A
  • severe frontal HA
  • starts after sitting in dark (e.g. watching a movie in the dark)
  • seeing halos
  • pupils mid-dilated and do not react to light
  • corneas are cloudy with greenish hue
  • eyes feel “hard as rock”
67
Q

Acute angle glaucoma management

A

Diomox, pilocarpine drops or mannitol

68
Q

symptoms and management of orbital cellulitis

A

Symptoms

  • swollen, red, tender eyelids of one eye
  • fever and leukocytosis

Management - immediate ophthalmologic consult. Do CT and then surgical drainage will follow

69
Q

Chemical burn of the eye

A

Copious water irrigation for 30 minutes BEFORE bringing person to ED

70
Q

symptoms and management of retinal detachment

A

Symptoms

  • seeing more than a dozen floaters
  • a “cloud” at the top of the visual field

Management - ophthalmologic emergency. Surgery is key.

71
Q

elderly pt suddenly loses sight from whole eye without any other neurological signs

what is it?

management?

A

what is it - embolic occlusion of the retinal artery

management - ophthalmologic emergency.

*have him breath into a paper bag en route and have someone press hard on eye and release repeatedly to try and make embolism move further down stream.

72
Q

Management of GERD…

In the clinic?

On exam questions?

A

in the clinic - symptomatic medication with no fancy work up

on exam questions - recommend endoscopy and biopsies to assess the extend of esophagitis and potential complications

73
Q

management of Barrett’s esophagus

A

surgery - probably a Nissen fundoplication

74
Q

progressive dysphasia over several months starting with solids and progressing to liquids. Likely diagnosis and management?

A

diagnosis - carcinoma of the esophagus

management - barium swallow first, then endoscopy and biopsies. CT scan next

75
Q

Women with difficulty swallowing for many years. Liquids more difficult to swallow than solids. Occasional regurgitation of large amounts of undigested food.

Diagnosis and management?

A

diagnosis - likely achalasia

management - manometry studies

76
Q

Person who drank heavily and vomits. Eventually vomits bright red blood.

Diagnosis and management?

A

diagnosis - Mallory Weiss tear

management - endoscopy. Bleeding usually self-limiting. Photocoagulation may be used if needed.

77
Q

Person who drank heavily and vomits. After violent episode of vomiting feels a severe, wrenching epigastric and low sternal pain. Develops fever and leukocytosis. Looks ill.

Diagnosis and management?

A

diagnosis - Boerhave’s syndrome

management - gastrographin swallow (for diagnosis) then emergent surgical repair

78
Q

Colicky abdominal pain and protracted vomiting for several days. Progressive abdominal distention, no BMs or passed gas for 5 days, high pitched loud bowel sounds that coincide with colicky pain. X-rays show distended loops of small bowel and air fluid levels. Hx of exploratory laparotomy for gunshot wound of abd.

What is it?

Management?

A

What is it - mechanical intestinal obstruction due to adhesions

Management - NG suction, IV fluids, careful obs

79
Q

Colicky abdominal pain and protracted vomiting for several days. Progressive abdominal distention, no BMs or passed gas for 5 days, high pitched loud bowel sounds that coincide with colicky pain. X-rays show distended loops of small bowel and air fluid levels. Hx of exploratory laparotomy for gunshot wound of abd.

DEVELOPED FEVER, LEUKOCYTOSIS, ABD TENDERNESS, AND REBOUND TENDERNESS after conservative treatment

What is it?

Management?

A

What is it - strangulation obstruction from compression of mesenteric blood supply

Management - emergency surgery

80
Q

Protracted diarrhea. Flushing of face. Expiratory wheezing. Prominent jugular venous pulse on neck.

What is it?

How to diagnose?

A

What is it - carcinoid syndrome

Diagnose - serum determinations of 5 - HT

81
Q

Differences between right and left sided colon cancer

A

Right side - 4+ occult blood in stool, anemia

Left side - blood coats outside of the stool, constipated, stools have become narrow caliber

82
Q

patient suffering from chronic ulcerative colitis. Now has severe abdominal pain, temperature of 104, leukocytosis, looks “toxic”

What is it?

Management?

A

What is it - toxic megacolon

Management - emergent surgery (always includes removing the rectum)

83
Q

Management of internal hemorrhoids with bright red blood in toilet paper after BM

A

cancer of the rectum has to be ruled out.

Correct answer - proctosigmoidoscopic exam

84
Q

Management of external hemorrhoids with anal itching and discomfort, very painful

A

cancer of the rectum has to be ruled out.

Correct answer - proctosigmoidoscopic exam

85
Q

Exquisite pain with defecation and blood streaks on the outside of stools. Refusing for anyone to “spread her cheeks”

What is it?

Management?

A

What is it - anal fissure

Management - still need to r/u cancer. Correct answer is examination under anesthesia.

After examination - surgical approach would be lateral internal sphincterotomy

86
Q

non-healing wounds around the anus should make you think of….

A

Crohn’s disease

Management: biopsies ot r/o cancer and diagnose Crohn’s

87
Q

Treatment for all abscesses

A

incision and drainage

88
Q

hx of perirectal abscess that was drained surgically. Cord-like tract palpated from opening towards the inside of the anal canal. Brownish purulent discharge expressed from tract.

What is it?

Management?

A

What is it - fistula in uno

Management - r/o cancer with proctosigmoidoscopy. 2nd is to do elective fistulotomy

89
Q

HIV + patient with fun gating mass growing out of anus

What is it?

How to diagnose?

Management?

A

What is it - squamous cell carcinoma of the anus

Diagnose - bx of fungating mass

Management - Nigro protocol of pre-operative chemo and radiation

90
Q

Patient with upper GI bleeding > 2 cc per minute.

Management?

A

emergency angiogram

91
Q

3 large bowel movements of dark red blood. Looks pale, diaphoretic, with BP 90/70 and HR of 110. NG tube shows clear, green fluid without blood.

What to do next?

A

He is bleeding from somewhere DISTAL to the ligament of Treitz.

92
Q

When is an angiography not the first choice of management for a GI bleed?

A

a slow bleed or bleeding that has stopped

93
Q

7 year old boy with large bloody bowel movement

What is it?

Diagnosis?

A

What is it - likely Meckel’s diverticulum

Diagnosis - radioactively labeled technetium scan (identifies gastric mucosa)

94
Q

Patient that has been in and out of septic shock. Had hemorrhagic pancreatitis with several percutaneous drainage procedures for abscesses. Starts to vomit bright red blood.

What is it?

Management?

A

What is it - stress ulcer

Management - angiographic embolization of left gastric artery. Should have been prevented with antacids.

Diagnosis - made by endoscopy

95
Q

Cirrhotic liver with ascites presents with generalized abdominal pain that started 12 hours ago. Mild fever and leukocytosis.

What is it?

How to diagnose?

Treatment?

A

What is it - peritonitis

How to diagnose - cultures of the ascitic fluid

Treatment - abx per cultures

96
Q

Pt with excruciating pain, very sharp time of onset, rigid abdomen, no bowel sounds, severe constant pain. Xray shows free air under the diaphragms.

What is it?

Management?

A

What is it - perforated viscus (perforated duodenal ulcer in most cases)

Management - emergency exploratory lap

97
Q

59 year old lady with hx of prior episodes of diverticulitis. Now having left lower quadrant pain, tenderness, and vague palpable mass. Has fever and leukocytosis.

What is it?

How to diagnose?

Treatment?

A

What is it - acute diverticulitis

Diagnosis - CT scan

Treatment - medical for acute attacks (abx and NPO) but elective sigmoid resection for recurrent disease. Emergency surgery may be needed if she gets worse.

98
Q

elderly man with severe abdominal distention, nausea, vomiting, and colicky pain. Hyperactive bowel sounds. X-rays show distended loops of small and large bowel and a very large gas shadow located in RUQ and tapers towards the left lower quadrant with the shape of a parrot’s beak.

What is it?

Management?

A

What is it - volvulus of the sigmoid

Management - proctosigmoidoscopy should relieve the obstruction. Rectal tube is another option.

Survey to prevent recurrence should be considered.

99
Q

elderly with a. fib who comes in with diffuse tenderness and mild rebound of the abdomen. X-rays show distended small bowel and colon.

What is it?

Management?

A

What is it - embolic occlusion of the mesenteric vessels

Management - not much can be done as bowel is usually dead

100
Q

total bilirubin of 6. Unconjugated, indirect bilirubin is 6 while direct, conjugated bilirubin is zero.

What is it?

What to do next?

A

What is it - hemolysis

What to do next - figure out what’s chewing up her red cells

101
Q

slightly elevated direct and indirect bilirubin, minimally elevated SGOT, super elevated alkaline phosphatase

What is it?

What to do next?

A

What is it - “generic” example of obstructive jaundice

What to do next - sonogram

102
Q

Most common cause of death in a patient with hemorrhagic pancreatitis?

A

pancreatic abscess

103
Q

Alcoholic with ill-defined upper abdominal discomfort and early satiety. Has a large epigastric mass that is deep within the abdomen and hard to define. He was discharged from the hospital 5 weeks ago after successful treatment of acute pancreatitis.

What is it?

Management?

A

What is it - pancreatic pseudocyst

Management - US but CT is best option. Needs to be drained by CT guidance.

104
Q

POD 1 fever

What is it?

Management?

A

What is it - atelectasis

Management - listen to the chest, CXR, encourage deep breathing and coughing.

105
Q

POD 3 fever

What is it?

Management?

A

What is it - UTI

Management - UA, urinary culture, antibiotics

106
Q

POD 7 fever with red, hot, tender wound

What is it?

Management?

A

What is it - wound infection

Management - open the wound, drain, and pack open

107
Q

2 weeks post-op with fever and leukocytosis with good healing wound that does not appear to be infected.

What is it?

Management?

A

What is it - deep abscess (commonly subphrenic and sub hepatic)

Management - CT to find abscess and guide percutaneous drainage

108
Q

Pink, clear salmon-colored fluid from incision around POD 5

What is it?

Management?

A

What is it - wound dehiscence

Management - keep patient in bed, tape belly together, and schedule surgery for re-closure of the wound if patient can take re-operate

109
Q

worrisome features of thyroid nodules

A
  • young
  • male
  • single nodule
  • history of radiation to neck
  • solid mass on US or cold nodule on scan
110
Q

What is the management for a patient with a “hot” adenoma who has lost weight despite a ravenous appetite, moist skin with a high pulse?

A

1st - confirm hyperthyroidism by measuring free T4

2nd - confirm source of the excessive hormone with radioactive iodine scan

3rd - do surgery after using a beta blocker

111
Q

Patient with virulent peptic ulcer disease. Eradicating H. Pylori fails to heal her ulcers. Several duodenal ulcers in first and second portions of duodenum. Watery diarrhea.

What is it?

What is the diagnosis?

A

What is it - gastronoma (Zollinger-Ellison)

Diagnosis
1st - measure serum gastrin

2nd - CT scans or MRI of pancreas to remove the tumor for surgery

112
Q

48 year old lady. Severe, migratory necrolytic dermatitis for several years that is unresponsive to any treatments. Thin, mild stomatitis, and mild diabetes mellitus.

What is it?

What is the diagnosis?

A

What is it - glucagonoma

Diagnosis - Determine glucagon levels. Eventual CT scan or MRI looking for the tumor then surgery.

113
Q

Management of hyperaldosteronism due to an adenoma?

A

Imaging studies then surgery

114
Q

Management of hyperaldosteronism due to hyperplasia?

A

Non-surgical. Treat with aldactone.

115
Q

Diagnosis of pheochromocytoma

A

1st - 24 hour urinary determination of metanephrine and VMA

2nd - CT scan of adrenal glands

3rd - surgery

116
Q

Young female with severe hypertension that doesn’t respond to normal anti-hypertensives. Has a faint bruit over her upper abdomen.

What is it?

Management?

A

What is it - renovascular hypertension due to fibromuscular dysplasia

Management - arteriogram then surgery (balloon dilatation)

117
Q

Two concerning conditions from infants who initially vomit green bile

A
  1. duodenal atresia

2. annular pancreas

118
Q

3 day old infant, feeding intolerance and bilious vomiting, X-rays show dilated loops of small bowel and “ground glass” appearance in lower abdomen. Mom has CF.

What is it?

Management?

A

What is it - meconium ileum

Management - gastrografin enema may be diagnostic and therapeutic

119
Q

8 week old baby with persistent, progressively increasing jaundice. Bilirubin is ⅔ conjugated, direct. US rules out extra hepatic masses, serology negative for hepatitis and sweat test normal.

What is it?

Management?

A

What is it - biliary atresia

Management - HIDA scan, percutaneous liver biopsy and exploratory laparotomy

120
Q

Management for intussusception

A

Barium enema - both diagnostic and therapeutic in most cases.

121
Q

supraclavicular node, non-tender, present for 3 months. 20 pound weight loss in past 2 months but otherwise asymptomatic.

What is it?

How do we diagnose?

A

What is it - malignant mets to a supraclavicular node from a primary tumor below the neck

How do we diagnose - look for the obvious primary tumors: lung, stomach, colon, pancreas, kidney then eventually biopsy the node

122
Q

Unilateral sensory hearing loss in adult. Did not engage in any activity that would subject patient to hearing loss on that side.

What is it?

How to diagnose?

A

What is it - acoustic nerve neuroma

How to diagnose - MRI

123
Q

Gradual, unilateral nerve paralysis suggests a neoplastic process.

What is it?

How to diagnose?

A

What is it - neoplastic process

How do diagnose - gadolinium enhanced MRI

124
Q

What is important to remember about parotid masses and diagnosis?

A

Parotid masses are NEVER BIOPSIED in the office or under local anesthesia.

Need referral to a head and neck surgeon for formal superficial parotidectomy.

125
Q

kid sitting up, leaning forward, drooling at the mouth, and looking very sick

what is it?

management?

A

what is it - acute epiglottis

management - diagnose with lateral X-rays of the neck and then off to OR for nasotracheal intubation

on the way start IV antibiotics for H. influenzae

126
Q

what are symptoms of a brain tumor?

A
  • neurological process that develop over a few months
  • increased intracranial pressure
  • morning headaches
  • sometimes N/V
127
Q

Ways to decrease intracranial pressure

A
  • mannitol
  • high dose steroids (decadron)
  • hyperventilation
128
Q

Febrile child with no history of trauma has persistent, severe localized pain in bone.

What is it?

Management?

A

What is it - acute hematogenous osteomyelitis

Management - do NOT fall for the X-ray choice (X-ray won’t show anything for 2 weeks…)

Choose “bone scan”

129
Q

Management of gas gangrene

A
  • IV penicillin
  • immediate surgical debridement of dead tissue
  • hyperbaric O2 treatment
130
Q

what is the treatment of an 86 year old man with asymptomatic prostate cancer?

A

Nothing!

Prostatic cancer is typically not treated after age 75 because they’ll die of something else first.

Surgery Clerkship (1 decks)

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