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Surgery > Pestanas- Specialties > Flashcards

Pestanas- Specialties Flashcards

1
Q

Excessive salivation shortly after birth + choking with feeds=

A

esophageal atresia

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2
Q

Most common type esophageal atresia

A

upper atresia

lower fistula

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3
Q

With esophageal atresia must r/o:

A 
VACTER
vertebral
anal
cardiac
trachea
esophageal
renal/radial
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4
Q

Management of imperforate anus

A

fistula nearby –> delay surgery but before toileting
high rectal pouch –> colostomy
low rectal pouch –> primary repair

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5
Q

How to locate rectal pouch in IA

A

upside down xray

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6
Q

CDH management

A

delay repair x 3-4 days

may need ET tube, ECMO, sedation

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7
Q

Treatment of gastroschisis/omphalocele

A

small –> primary closure
large –> silo

*gastroschisis will need parenteral feeds x 1 month

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8
Q

Bladder exstrophy must be repaired by ___

A

days 1-2 of life

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9
Q

3 causes of green vomit + double bubble and how to dx

A

duodenal atresia
annular pancreas
malrotation

contrast enema/ upper GI

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10
Q

green vomiting + multiple air fluid levels in baby=

A

intestinal atresia (vascular accident en utero)

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11
Q

Hint to NEC

A

rapidly dropping platelet count

**will need abx and surgery if intestinal pneumatosis present

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12
Q

Meconium ileus - what is dx and tx

A

gastrograffin enema

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13
Q

Hypertrophic pyloric stenosis – typical age

A

3 weeks

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14
Q

Jaundice at 6-8 weeks.. suspect? next step?

A

biliary atresia

do HIDA 1 week s/p phenobarb –> if no improvement do surgical exploration

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15
Q

How to dx hirschsprungs

A

xrays (distended proximally)

full thickness bx rectum

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16
Q

What may be mistaken for undescended testicle?

A

overactive cremasteric muscle –> can be PULLED DOWN (benign)

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17
Q

Management undescended testicle

A

age 1 orchipexy

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18
Q

Baby with abdominal mass- ddx?

A

liver: moves with respiration

otherwise- wilms vs neuroblastoma

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19
Q

Age vs prognosis with neuroblastoma

A

younger better

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20
Q

Newborn with stridor, difficulty swallowing, hyperextended position = what?

Next step in management?

A

vascular rings compressing both trachea & esophagus… –> confirm with barium/bronch then do surgery

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21
Q

Key difference in presentation between vascular rings and tracheomalacia

A

tracheomalacia= just stridor, no difficulty with esophagus

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22
Q

Which kiddo heart defect is assc with frequent colds?

A

ASD

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23
Q

Two types of VSDs and their management

A

small, muscular –> will self resolve in most cases by age 3

large, membranous –> will likely need surgical closure due to FTT

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24
Q

Which type of shunt has decreased vascular markings?

A

R –> L

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25
Q

How does truncus arteriosus kill?

A

overloading pulmonary circulation

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26
Q

Most common cyanotic anomaly in kids?

A

Tetralogy

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27
Q

Location of tet murmur

A

left 3rd intercostal space

systolic ejection murmur

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28
Q

Dx/ tx tet

A

echo, EKG (RVH) –> surgical repair

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29
Q

Transposition requires _____

A

some sort of defect

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30
Q

Location of AR/AS murmur

A

right 2nd ICS/ LSB

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31
Q

When to replace valve in AR/AS

A

AS- symptoms or more than 50 mmHg gradient

AR- LVD

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32
Q

When to replace valve in endocarditis

A

florid CHF

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33
Q

Valve disease that leads to hemoptysis

A

MS

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34
Q

MR/MS risk

A

afib –> clots

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35
Q

Vessel commonly used for grafts in CABG

A

internal mammary

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36
Q

Cardiac disease assc with square root sign

A

constrictive pericarditis

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37
Q

Progression in lung cancer dx

A

CXR –> CT and sputum sample –> bx (bronch, perc, VATS) –> tx

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38
Q

Which lung cancer cannot be treated surgically?

A

small cell

mets except hilar

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39
Q

Requirement for lung cancer resection

A

residual FEV1 must be 800 mL

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40
Q

Claudication of arm, vision changes, altered equilibrium –> pathogenesis and management

A

plaque at origin of subclavian (subclavian steal syndrome)

duplex scanning –> bypass surgery

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41
Q

AAA when to observe and when to cute

A

4 cm or smaller observe

5-6 cm or growing more than 1 cm/ year –> surgery

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42
Q

Tender AAA - rupture is pending within ____ amount of time? Back pain- rupture is pending within ____?

A

Tender AAA- days
Back pain- minute to hours until rupture (this is retroperitoneal hematoma)

in both cases need immediate repair

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43
Q

Drug that provides symptom relief in PVD

A

cilostazol

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44
Q

Management of PVD

A

ABI –> if less than 1 cont to CT angio and plan revascularization

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45
Q

Appearance of PVD legs

A

hairless
shining
atrophic skin
lacking peripheral pulses

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46
Q

Cause of sudden cold/painful extremity

A

afib or postMI mural thrombus throwing clots

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47
Q

Incomplete/complete PV embolus management:

A

early incomplete- clot busters
complete- embolectomy w/ fogarty catheter

*consider fasciotomy if will take hours

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48
Q

Best option for AD dx

A

CT angio/ spiral CT

though MRI/TEE do happen

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49
Q

Management of ascending vs descending AD

A

ascending- surgery

descending- medical (risk loss of blood supply to spinal cord)

50
Q

Two contraindications to FNA

A

testicular mass

hemangioma

51
Q

Incisional vs excisional bx on skin

A

incisional is for larger masses when you cannot just cut the whole damn thing out

excisional is for masses that are small enough to just remove

52
Q

Margins needed for BCC, SCC, and melanoma

A

BCC 1mm
SCC 0.5-2 cm
melanoma 2cm

53
Q

Contrast BCC and SCC locations

A

BCC above lip SCC below

54
Q

Management of melanoma based on size

A

1-4 mm depth most benefit from aggressive therapy

beyond 4 mm–> no hope

55
Q

Chemotherapy for systemic melanoma mets

A

interferon

56
Q

Management of strabismus

A

from birth –> surgery

later –> may just need glasses

57
Q

Acute angle glaucoma presentation

A

eyes dilated and nonreactive
seeing halos
eye is hard and painful

58
Q

Drug therapy for acute angle glaucoma

A

a agonist
BBer
+/- Diamox

59
Q

Orbital cellulitis management

A

emergent CT scan and drainage

60
Q

RD presentation

A

flashes and floaters/ veil over visual field

needs retina surgeon for spot welding

61
Q

First aid for CRAO

A

breathe into paper bag; have someone press hard on the eye and release while in transit to ED

62
Q

How long from dx of DM1 until retinal damage

A

20 years

63
Q

Location of thyroglossal vs branchial cleft cysts vs cystic hygroma

A

thyroglossal- midline; moves with swallowing
brachial cleft- lateral; along SCM muscle
cystic hygroma- base of neck/ supraclavicular area

64
Q

Lymphoma- presentation/dx/tx

A

young person with multiple nodes
must remove node and bx
chemo is tx

65
Q

Where does met to supraclavicular nodes come from?

A

below clavicles –> not head and neck

66
Q

SCC of neck dx

A

often just a node
must use triple endoscopy to find primary source
bx primary source (do not open bx node in neck, ruins surgical planning)

67
Q

SCC of neck tx

A

resection, radical neck dissection, rads, plat based chemo

68
Q

Acoustic neuroma:

presentation and dx

A

unilateral sensorineural hearing loss

MRI

69
Q

Facial nerve tumor presentation vs Bells Palsy

A

it is gradual. (sudden in bells)

also note: will be upper and lower face

70
Q

Most common parotid mass

A

pleomorphic adenoma

71
Q

Signs that parotid mass is malignant (not pleomorphic adenoma)

A

hard, painful, producing paralysis

72
Q

Management of parotid mass

A

no open biopsy

excise whole gland

73
Q

Cause of unilateral ENT problem in toddlers

A

foreign body

will need endoscopy under anesthesia

74
Q

Abscess on floor of mouth is caused ______ and poses risk of ______.

A

Ludwigs angina

airway compromise

75
Q

Management of Bells Palsy

A

antiviral

steroids

76
Q

Diplopia in sinusitis patient suggests…

A

Cavernous sinus thrombosis

77
Q

Management of epistaxis in kids + location of bleeding

A

anterior septum

phenylephrine + pressure

78
Q

Management of epistaxis in teen + location of bleeding

A

cocaine; septal perforation –> posterior packing

angiofibroma –> resection

79
Q

Management of epistaxis in elderly or hypertensive pts

A

posterior packing +/- surgical ligation

80
Q

Constrast presentation of inner ear dizziness; dizziness of neuro origin; Menieres

A

inner ear- room spins
brain- room stable
Menieres- vertigo, tinnitus, hearing loss

81
Q

Management of menieres disease

A

diuretics

82
Q

Management of vertigo 2/2 inner ear pathology

A

meclizine; promethazine; diazepam

83
Q

Contrast presentation of ischemic vs hemorrhagic stroke patients

A

ischemic- painless

hemorrhagic- painful

84
Q

Characteristics of brain tumor pain

A

constant

85
Q

Window for tPA in stroke

A

within 3 hours of symptoms

86
Q

Cause of hemorrhagic stroke

A

uncontrolled HTN

87
Q

How does surgical team manage SAH? radio?

A

surg- clips

rads- coiling

88
Q

Most common sources of brain mets

A

lung breast melanoma

89
Q

How is increased ICP 2/2 brain tumor managed while awaiting surgery?

A

decadron

90
Q

Vital signs- clues to ^^^ICP

A

bradycardia

hypertension

91
Q

Eye changes in frontal lobe tumors

A

ipsi side- CN2 atrophy

contra side- papilledema

92
Q

Workup for prolactinoma

A

TSH, pregnancy test, PRL –> MRI if ++

93
Q

When to resect prolactinoma

A

pts who wish to get pregnant

failed bromocriptine

94
Q

Acromegaly management

A

somatomedin C levels –> MRI –> surgical removal

95
Q

Bleeding into a pituitary tumor is termed ____.

What must be done urgently?

A

pituitary apoplexy

give steroids

96
Q

Tumor that produces loss of upper gaze?

A

pineal gland

97
Q

Which tumor causes children to prefer knee- chest position?

A

ependymoma in ventricle IV

98
Q

Contrast brain abscess and brain tumor symptoms

A

abscess has more rapid onset

99
Q

Crushing injury –> later cold and cyanotic extremity:

cause? management?

A

causalgia –> successful sympathetic block is curative

treat with sympathectomy

100
Q

Treatment of trigeminal neuralgia

A

carbamazepine –> radioablation –> separate nerve and vessel

101
Q

Contrast testicular torsion and acute epididymitis

A

torsion: high riding testis w/ horizontal lie– worse with elevation of scrotum
epididymitis: vertical lie– relieved by elevation of scrotum

102
Q

Management of testicular torsion vs epididymitis

A

torsion- surgery + orchipexy

epididymitis- abx

103
Q

When are stones a urologic emergency

A

anytime both obstruction ++ infection are present, must be treated emergently

104
Q

Tx of stone + infection

A

stent or nephrostomy ++ abx …cannot leave stone

105
Q

When should IVP be avoided

A

Cr above 2

106
Q

Dx of prostatitis

A

exquisitely tender prostate on DRE ONLY ONCE

repeat DREs can lead to sepsis

107
Q

Newborn boy cannot urinate at birth. Cause = _____

A

posterior urethral valves

108
Q

The two –spadias: contast.

What should be avoided?

A 
hypo= under= ventral 
epi= top= dorsal

never circumcise

109
Q

Little boy with repeat UTIs: dx

A

Vesicoureteral reflux

110
Q

Little girl constantly dripping urine: cause and management

A

low implantation of ureter
vaginoscopy
corrective surgery

111
Q

Three labs elevated in RCC

A

RBC
Ca
LFTs

112
Q

management of bladder cx

A

CT –> cysto

surgery and intravesicular BCG

113
Q

Prostate cx:

presentation & management

A

rock hard nodule on DRE
transrectal needle bx
surgery or radiation

114
Q

Chemo type in testicular cancer

A

platinum based

115
Q

Common cause of acute urinary retention

A

BPH patient gets cold and uses antihistamines + nasal drops –> will need bladder cath x3 days

116
Q

BPG management

A

start with ablocker (tamsulosin) –> finasteride for 40+g glands –> TURP is final option (rare)

117
Q

Most common type of incontinence seen in post-op patients

A

overflow incontinence from retention

118
Q

At what size is a stone too large to pass spontaneously

A

7mm

119
Q

Cause of pneumaturia

A

Fistula between bladder and GI tract

120
Q

Only absolute contraindication to organ donation

A

HIV

121
Q

Three types of transplant rejections

A

Hyperacute (minutes)
Acute (w/in 3 months)
Chronic (years)

122
Q

Management of acute rejection (3 months)

A

Biopsy to confirm

Can use tacrolimus/mycophenolate +/- prednisone

Surgery (4 decks)

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