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SURGERY > PESTANA3 et al > Flashcards

PESTANA3 et al Flashcards

1
Q

How do you treat a rectal CA less than 5 cm from the anal verge?

A

Abdominoperineal Resection with end colostomy

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1
Q

What can be given preoperatively to a pt with hemophilia A?

A

DDAVP (increases vWF which increases the likelihood of binding factor VIII which is deficient- i.e. makes the most out of what you have)

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2
Q

What is the typical progression of sx of a brain tumor

A

Starts out with months (usually) of headache often worse in morning assoc with nausea or projectile vomiting that may eventually develop focal neurologic deficits

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2
Q

How would you tx a pt s/p CABG with fever, tachy, leukocytosis, and purulent drainage in JP’s?

A

Surgical debridment of mediastinum with immediate closure and prolonged abx; Acute mediastinitis

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2
Q

What is the most important aspect of managing fat embolus syndrome? How can you technically confirm the dx?

A

Respiratory support; Fat globules in urine (come on)

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3
Q

What is the cause of elevated PT in pancreatic cancer? What mood abnormality can pancreatic CA cause directly?

A

Malabsorption of vitamin K due to blockage of the CBD; depression

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4
Q

Name 2 adjuvant therapies for metastatic melanoma

A

Interferon, Vemurafenib

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4
Q

What problem in the post-op period can masquerade as urinary incontinence?

A

Urinary retention with overflow incontinence; you should palpate the bladder (bladder scan)

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4
Q

What must be done for a pt with ckd on dialysis preoperatively?

A

Dialyze 24 hours pre-op

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5
Q

What is the Parkland formula for adults? Kids?

A

Kg x %BSA x 3-4; Kg x % BSA x 2-3; Give half over the first 8 hours and the rest over the next 16

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5
Q

What is the most likely cause of death in a massive hemoptysis?

A

i.e. > 600 ml; asphyxiation > exsanguination

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6
Q

What is the deal with perforated diverticulitis mgmt?

A

If < 3 cm abscess can manage with IV abx and observation; if > 3 cm then CT-guided drainage by IR

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7
Q

What is done if those who wish to become pregnant with h/o prolactinoma fail bromocriptine therapy?

A

Transnasal transphenoidal surical removal of the prolactinoma

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8
Q

What is the most important diagnostic test in chest trauma after the ABC’s are done?

A

CXR!

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8
Q

CXR with NGT in pulmonary cavity following trauma

A

Traumatic rupture of the diaphgragm

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9
Q

What is the treatment for chronic rejection?

A

There is none it is irreversible (although I’d imagine there is some form of symptomatic mgmt, i.e. inotropes for the heart etc)

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9
Q

What medications must be stopped prior to surgery?

A

Aspirin, NSAIDs, clopidogrel, vitamin E (2 weeks before surgery); Warfarin 5 days before get INR below 1.5

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9
Q

Colonoscopy shows cyanotic mucosa with sharp transition points?

A

Ischemic colitis

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9
Q

What is the mgmt of duodenal hematomas?

A

If obstructing - TPN and NGT until resolve; if do not resolve surgical removal may be needed

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10
Q

What is the timing of fluids that should be given to a burn pt after calculating how much they need via the Parkland formula?

A

Half over the first 8 hours and the second half over the next 16 (cut the rate of the first half in half)

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12
Q

Where is the AS murmur best heard

A

Harsh midsystolic in R second IC space

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12
Q

What should you do when there is a large stone (i.e. 7mm or more at the UPJ )?

A

Extra-Corporeal Shockwave Lithotripsy (ESWL) – if not then basket extraction, laser, sonic probe, or even open surgery

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13
Q

What is the minimum FEV1 needed in order for a non-small cell CA to be operated on with pneumonectomy?

A

800 ml (that is if there is less than 800 predicted after surgery they are not a surgical candidate and need chemoradiation instead)

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14
Q

What is the appropriate way to excise a parotid tumor

A

Never open biopsy always do either a superficial parotidectomy if superficial to facial nerve or deep parotidectomy if deep to it

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14
Q

What is the classic presentation of ureteropelvic junction obstruction?

A

Colicky pain after a large diuresis (i.e. maybe someone with ICP needs mannitol or a kid who binge drinks for the first time) since the jxn can handle the usual volume but when a large volume is encountered it is an issue

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14
Q

How should you give antibiotics to burn pts?

A

Topically (silver sulfadiazine, mafenide acetate, triple abx cream)

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15
Q

When is surgery indicated in aortic insufficiency

A

At the first echocardiographic indication of LV dilatation

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16
Q

What abx penetrates the burn eschar but hurts like hell?

A

Mafenide acetate

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17
Q

What causes hyperacute rejection?

A

Preformed antibodies

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18
Q

What is the best initial mgmt of early dumping syndrome?

A

Dietary modification as it often resolves, if not octreotide can be added; ultimately conversion to roux en Y may be needed

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18
Q

What EKG findings may be seen in a pt s/p thyroidectomy?

A

QTc prolongation due to hypocalcemia from iatrogenic hypoparathyroidism

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19
Q

What is the number 1 cause of death in burn victims in the setting of adequate volume resuscitation?

A

Bacterial infxn

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19
Q

How do you manage post-pericardiotomy syndrome?

A

NSAIDs and steroids with pericardiocentisis if tamponade physiology develops

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20
Q

How does elevation of head of bed decrease ICP? How does sedation?

A

Increases venous outflow; decreases metabolic demand of the brain

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21
Q

Care must be taken to avoid too much of what dietary component in a ventilated pt?

A

Carbs; it can increase the respiratory quotient and give them a respiratory acidosis secondary to hypercarbia that will make weaning more difficult

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23
Q

What test is diagnostic for atrial septal defect? What is the mgmt?

A

echo; surgical closure or catheterization

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24
Q

What is the first line therapy for acute organ rejection?

A

steroid boluses

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25
Q

When can anticoagulation safely be restarted post-op?

A

In 48-72 hours if pt is hemodynamically stable

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26
Q

What drug is indicated in asymptomatic bradycardia?

A

none; but if symptomatic, then atropine would be first line

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27
Q

After doing a DRE and finding a tender prostate c/w acute bacterial prostatitis how often should you do serial DRE’s?

A

Try not to do them as palpation of the infected prostate can cause sepsis

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28
Q

What are the 2 indications for surgery in aortic stenosis

A

When there are indications of CHF (syncope, angina, or dyspnea); or when the valvular gradient is greater than 50 mmHg

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29
Q

How do you diagnose a cancer of the lung if sputum cytology is equivocal?

A

Percutaneous bx for peripheral lesions or bronchoscopy (EBUS) for internal lesions; if those are unsuccessful then VATS with wedge resection

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30
Q

What abx does not penetrate the burn eschar and can cause hyponatremia and hypokalemia

A

Silver nitrate

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31
Q

Which IBD more classically has rectal bleeding

A

UC

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32
Q

What is excruciating back pain in a normotensive pt with known AAA

A

It is already leaking into the retroperitoneum and blowout into the peritoneal cavity is minutes to hours away

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34
Q

How do you avoid a workup for lung CA when you find a “coin lesion” on CXR?

A

Check to see if there is an old film in which the lesion was present and verify that it is unchanged since

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35
Q

How would you work up galactorrhea and amenorrhea in a young woman?

A

rule out pregnancy, rule out hypothryoidism, determine prolactin levels and if high do MRI of brain

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37
Q

How do you manage a tender AAA?

A

It will probably rupture within the next day or 2 so immediate repair is indicated

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37
Q

How do you manage a kid who cant pee after being born?

A

Insert foley catheter to decompress bladder; A voiding cysteourethrogram should then be done (you are looking for posterior urethral valves) these can then be fulgurated or resected

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37
Q

What is a fleshy immobile mass on the hard palate most likely to be? What is the tx?

A

Torus palatinus (exostosis of midline suture); if ulcerates or symptomatic, surgery can fix

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38
Q

Shock in a post-surgical pt is presumed to be from what until proven otherwise?

A

Hemorrhage!

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39
Q

Which cyanotic heart lesion kills more like a noncyanotic heart lesion?

A

Truncus arteriosus because it overloads the pulmonary circ

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40
Q

What is urine dripping out of the vagina of a small girl suggestive of? What test can be ordered?

A

Low implantation of the ureter; intravenous pyelogram will show it

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40
Q

If an elderly person with comorbidities fractures their hip when should they go to OR?

A

The rule is ASAP, BUT, surgery can be delayed 48-72 hours in order to optimize their health

40
Q

Nasal whistling after rhinoplasty is most likely due to?

A

Septal perforation

41
Q

How is the presentation of a brain abscess different from a brain tumor?

A

Much shorter timetable and often a fever and a clear source such as otitis media or mastoiditis

42
Q

What is the most important prognostic factor in a developing comparment syndrome?

A

Time to fasciotomy

42
Q

Why should you bolus a pt with IVF prior to putting them on a ventilator?

A

In a pt with low CVP, positive pressure ventilation will increase the intrathoracic pressure and lower CVP even more

44
Q

For which lung cancers must you assess operability?

A

Non-small cells only

44
Q

What should be added to pre-op orders in a pt who is on warfarin and needs and ex lap

A

FFP

46
Q

What nodal mets are ok in lung CA surgically and which preclude a curative resection?

A

Hilar mets are ok but carinal and mediastinal mets preclude curative resection

47
Q

What are 2 absolute contraindications to surgery?

A

Diabetic coma (nonketotic hyperosmolar coma) and DKA

48
Q

Why is there decreased capillary refill in trauma?

A

There is peripheral vasoconstriction

49
Q

What abx does not penetrate a burn eschar and can cause leukopenia?

A

Silver sulfadiazine

51
Q

What condition must be ruled out when acute epididymitis is suspected?

A

Testicular torsion; so still perform a US doppler but in torsion the cord is not tender and it is in epididymitis; epididymitis is treated with antibiotics

52
Q

If you are to confirm a diagnosis of pericardial tamponade, in trauma, how would you do it?

A

FAST; a CXR would not show an enlarged cardiac silohuette since it is acute and the pericardium has not had time to expand

53
Q

What is the best treatment of a massive hemoptysis (i.e. > 600 ml)

A

Bronchoscopy

54
Q

Which congenital defect often has a history of frequent colds?

A

atrial septal defect

55
Q

What should you think if a person has facial nerve paralysis after trauma? What if they were normal at first but develop it later?

A

There is true trauma to the facial nerve; there is swelling that is affecting it but it will go away with time

57
Q

How is a brain tumor most likely to present in a child?

A

With cerebellar symptoms like stumbling or ataxia

58
Q

What is the clicking sensation of a Morton neuroma called?

A

Mulder sign

60
Q

How do tumors of the pineal gland present?

A

Parinaud syndrome (loss of upper gaze)

61
Q

What margins are needed for basal cell CA?

A

1 mm negative margins

63
Q

What is the surgical mgmt of mitral stenosis? What is the surgical mgmt of mitral regurg?

A

Commissurotomy or balloon valvuloplasty; Annuloplasty (preferred over replacement)

64
Q

What is the number 1 cause of a central line infxn?

A

S. epidermidis (CoNS)

66
Q

What occurs when there is bleeding into the pituitary?

A

Pituitary apoplexy - look for clues or a hx of pituitary tumor with an acute event i.e. headache, visual changes, and signs of pituitary destruction like stupor and hypotension

66
Q

How do you establish an airway in a pt with poor pulse ox and serious maxillofacial trauma?

A

Crictothryotomy

68
Q

How is tic dolouroux managed?

A

Often successfully with anticonvulsants (carbamazepine (Tegretol)); if not radiofrequency ablation

70
Q

What should you think when a baby has respiratory distress with a “crowing respiration” i.e. hyperextends the neck?

A

Vascular rings or laryngomalacia; if difficulty swallowing is also present it is most likely a vascular ring if only the resp sx are present then probs laryngomalacia

71
Q

What mode on the ventilator setting is important for weaning a pt?

A

Pressure support (i.e. a pt controls the rate but gets a boost of pressure)

72
Q

What is the best initial step in mgmt of an electrical burn?

A

EKG; if abnml admit to telemetry floor 48 hours

73
Q

What is the treatment of a contrast enhancing cyst on CT of kidneys?

A

Surgical excision by nephrectomy or nephron-sparing nephrectomy; This is a Bosniak III-IV lesion

74
Q

What is the most likely cause of immediate post-op fever in a pt who was tranfused?

A

Febrile nonhemolytic transfusion rxn (fever and chills occur since leukocytes in the stored blood still release cytokines)

75
Q

What is the only absolute contraindication to organ donation?

A

Positive HIV status

75
Q

What is technically the most accurate test for detecting DAI?

A

MRI; though classically, minute punctate hemorrhages the grey white jxn are picked up on CT of head in trauma

77
Q

What is the safe INR preoperatively?

A

1.5

77
Q

Moh’s microsurgery is standard of care for what?

A

Squamous cell carcinoma of the skin

78
Q

What can present in a similar manner to a ruptured AAA but occurs within 12 hours of angiogram?

A

Retroperitoneal hematoma from groin access site; i.e. the ateriotomy site will seem normal because the hematoma is spreading retrograde (Dx = non con CT)

80
Q

How do you diagnose and treat reflex sympathetic dystrophy?

A

A sympathetic block is diagnostic and sympathectomy is curative

81
Q

What if you have ureteral colic type symptoms and a distended abdomen?

A

Probably a ureteral stone with a vagus rxn causing paralytic ileus

83
Q

What if you need to anticoagulate someone with antithrombin III deficiency?

A

Cant give heparin!!!

84
Q

What is the operative mgmt of a kid with a vascular ring?

A

i.e. a double aortic arch; surgically divide the smaller of the arches

85
Q

Why must you be careful giving too much supplemental O2 to a COPD pt in the post-op period?

A

Too much O2 can suppress the respiratory drive

87
Q

What is the most likely cause of signs of deteriorating liver function in the first few days after a liver transplant?

A

Technical difficulities from the surgery not acute rejection; the first step is to get a US for CBD obstruction and doppler for vascular thrombosis

89
Q

What do you do in a pt with penetrating abdominal trauma who is stable? Unstable? What do you do in a pt with blunt abdominal trauma who is stable? Unstable?

A

FAST or DPL; Ex lap w/ tetanus ppx; CT; Ex lap w/ tetanus ppx

91
Q

If a urine dipstick is positive for blood but negative for RBC’s, what electrolyte may also be elevated?

A

K; since myoglobinuria is assoc. with cellular damage and leakage of K (hyperkalemia)

92
Q

How do you workup a painless testicular mass?

A

Radical orchiectomy via inguinal route with pre-op tumor markers B-hCG and AFP; most testicular tumors are very radiosensitive and chemosensitive

93
Q

What is the indication for high dose steroids in burn victims?

A

There is none, since burn victims are already hyperglycemic and immunosuppressed! Steroids would worsen both of these

95
Q

What would the arm symptoms minus the neurologic symptoms of subclavian steal be?

A

Thoracic outlet obstruction

96
Q

What is the mgmt of non-small cell central lung lesion? Peripheral?

A

Pneumonectomy; Lobectomy

97
Q

What is the best initial treatment if you suspect smoke inhalation? What is the best test?

A

100% O2 via non-rebreather mask with low threshold for intubation; Carboxyhemoglobin levels as pulse ox is useless

98
Q

How do you manage a UTI in children?

A

Should always have a “urologic workup” just like in men since it is a complicated UTI so a voiding cystorurethrogram or US

99
Q

How do you treat incomplete arterial occlusions vs. complete arterial occlusions?

A

Incomplete can be txd with thrombolytics; complete can be treated with Fogarty catheter embolectomy and often times a fasciotomy; done within 6 hours

100
Q

In what category is stress incontinence commonly seen?

A

Middle aged women who have had lots of kids who leak urine when laughing, sneezing, etc.

101
Q

What should you start considering when there is fracture of the first or second rib?

A

Possible underlying aortic or carotid injury (CXR and carotid US)

102
Q

What determines whether a superficial or deep parotidectomy is done?

A

The location of the tumor with respect to the facial nerve

103
Q

What is the next best step after intubating a pt?

A

Check for breath sounds bilaterally; if only one one side prob intubated a main bronchus so pull back on the tube

104
Q

What is the usual mechanism by which a person acquires a psoas abscess?

A

Hematogenous spread

105
Q

What is the most common cause for a newborn boy to not urinate after being born?

A

Posterior urethral valves (keyhole deformity); also look for meatal stenosis

106
Q

Can a person with hepatitis be an organ donor?

A

yes but only if the recipient also has the same hepatitis

106
Q

What is a major difference in the clinical presentation of a occlusive cause of stroke (thrombotic or embolic) vs a hemorrhagic cause?

A

Occlusive causes often have no headache while hemorrhagic causes often have a headache

107
Q

What is the treatment for small cell CA?

A

Chemoradiation

109
Q

What if a coin lesion is found on CXR and there is no old film to compare it to?

A

Check sputum cytology and get CT of chest and upper abdomen (i.e. to evaluate the liver for mets)

111
Q

What should you think if there are nosebleeds in an 18 year old

A

Suspect cocaine or juvenile angiofibroma (requires surgery but is benign)

112
Q

What surgery should not be done on a kid with hypospadias?

A

Circumcision as you need the excess skin for the reconstruction

113
Q

A person was transfused with blood 4 hours ago and is developing respiratory distress with a normal PCWP?

A

TRALI

115
Q

What is the cause of bloody bowel movements IMMEDIATELY after AAA repair?

A

Ischemic colitis from compromising the IMA; if months or years after it could be a Aortoenteric fistula but these are rare and it would probably more likely be a diverticular bleed

117
Q

While waiting for surgery of a brain tumor, how is ICP treated?

A

Dexamethasone (Decadron)

119
Q

What surgery can be done for hormonal control in prostatic CA?

A

Orchiectomy

120
Q

What will a CT of pancreatitis show?

A

Maybe nothing but can show enlarged pancreas with stranding of adjacent fat planes

121
Q

What are the best tests for painless jaundice?

A

Helical CT scan or endoscopic US

122
Q

When do you start screening colonoscopies in pts with FMHx of FAP?

A

10 years old

123
Q

How do you treat Ludwig angina?

A

I/D and possibly need to intubate

124
Q

Fever, white count, and elevated LFT’s in a hospitalized pt in the absence of hypotension

A

Acalculous cholecystitis; if hypotensive could be shock liver

125
Q

Emphysematous cholecystitis is often seen in pts with what other condition?

A

Type II DM

126
Q

What is the concern if there is a high BUN (>100) prior to surgery?

A

Bleeding secondary to qualitative platelet dysfunction (normal platelets, increased bleeding time)

127
Q

How does the workup of pneumaturia start?

A

CT scan since it is probably diverticulitis or crohns

128
Q

What can an organ donor with metastatic cancer donate?

A

Cornea

129
Q

What is Foster-Kennedy syndrome?

A

A tumor at the base of the frontal lobe that produces inappropriate behavior, optic nerve atrophy on the side of the tumor, papilledema and anosmia

130
Q

What chronic issue may occur secondary to compartment syndrome?

A

Volkmann’s Ischemic Contracture - a deformed extremity as a result of dead muscle being replaced by fibrous tissue

131
Q

How is hyperacute rejection prevented?

A

ABO matching and lymphocytic crossmatching

132
Q

What anesthetic drug can precipitate adrenal crisis in pts with known HPA supression?

A

Etomidate, avoid in anyone on chronic steroid use (> 20 mg per d for 3 weeks)

133
Q

How do you manage a pt who has been trying to spontaneously pass a ureteral stone that suddenly becomes febrile, and has chills?

A

IV abx, and immediate decompression of the urinary tract with either a percutaneous nephrostomy or a ureteral stent

134
Q

When is surgery indicated in patent ductus arteriosus?

A

Those who fail indomethacin, already in CHF, or a full term baby

SURGERY (4 decks)

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