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Surgery > Pestanas- Trauma/Ortho, Gen Surg, Pre/Post Op > Flashcards

Pestanas- Trauma/Ortho, Gen Surg, Pre/Post Op Flashcards

1
Q

Sedation type most common for anesthesia

A

rapid induction

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2
Q

When must a fiberoptic bronchoscope be used for intubation?

A

subQ emphysema in neck

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3
Q

Which head traumas must be operated on?

A

penetrating trauma

open/comminuted/depressed fractures

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4
Q

Basilar skull fracture implications on treatment

A

must assess C spine with CT

avoid NT intubation

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5
Q

When should hyperventilation be used In head trauma?

A

hyperventilate to PCO2 35 if pt shows herniation signs

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6
Q

When is CT scan needed in neck trauma?

A

basilar skull fracture
neuro deficit
pain to local palpation over cspine

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7
Q

Non vascular cause of central cord syndrome

A

forced hyperextension of neck

rear end collision

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8
Q

How to prevent PNA in rib fracture

A

local nerve block/ epidural catheter

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9
Q

PTX vs hemothorax PE findings

A

PTX- hyperresonant

Hemothorax- dullness to percussion

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10
Q

Management hemothorax

A

chest tube, thoracostomy is ^^ blood recovery from wound

lung usually= source and usually self resolves = surgery usually not needed

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11
Q

Sucking chest wound management

A

occlusive dressing (air out but not in)

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12
Q

Flail chest:

assc injuries

A

multiple broken ribs
pulm contusion
+/- traumatic transection of aorta (check for this)

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13
Q

Treatment of flail chest

A

bilateral chest tubes + fluid restriction/ diuretics

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14
Q

Pulm contusion dx/tx

A

dx: white out on CXR up to 48 hours post trauma
tx: same as flail chest (chest tubes, diuretics)

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15
Q

Myocardial contusion: dx

assc injury

A

EKG and troponins

assc with sternal fracture

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16
Q

Traumatic diaphragm rupture: dx an tx

A

dx: Xray- bowel through LEFT side
tx: laparoscopy

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17
Q

Traumatic rupture aorta:
mc location
dx

A

junction of arch/descending aorta

CT angio/spiral

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18
Q

Traumatic rupture aorta:
mc injury mechanism
assc fractures

A

severe deceleration injury

first rib, scapula, sternum

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19
Q

Suspect ____ as cause of sudden death in intubated chest trauma patient

A

air embolism

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20
Q

Why is Trendelenburg necessary when placing central line?

A

to prevent air embolism

occurs when subclavian vein is opened to air

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21
Q

Fat embolism:
clues
therapy

A

rash, low platelets, fever, respiratory distress, fractures

tx: respiratory support

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22
Q

Management of gunshot vs stab wounds to abdomen

A

gunshot: always ex lap

knife wound: ex lap if protruding viscera/ hemodynamically unstable, otherwise can do digital exploration around knife

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23
Q

When does blunt abdominal trauma require surgical exploration?

A

peritoneal irritation +/- internal bleeding

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24
Q

Sites for “hidden” bleeding leading to hemodynamic instability (3)

A

abdomen
thigh
pelvis

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25
Q

How to determine need for surgery in patient with signs of intra-abdominal bleeding

A

CT scan

response to fluids

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26
Q

Best way to quickly dx intrabdominal bleeding in ED

A

FAST exam

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27
Q

MC source of signigicant intraabdominal bleeding

A

splenic lac

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28
Q

How to treat intraoperative coagulopathy

A

platelets, FFP x10 units each

stop operation if hypothermic/ acidotic

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29
Q

Risks for post-op abdominal compartment syndrome

A

prolonged surgery
lots of fluids/blood given
closure with undue tension

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30
Q

Clue to abdominal compartment syndrome + tx

A

retention sutures cutting through the tissues, SAS

open the abdomen

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31
Q

How to manage severely traumatized patient at risk for many complications

A

damage control lap

clamp bleeders, clean up, get out, return later

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32
Q

Injuries that must be ruled out in pelvic trauma

A

rectum (proctoscopy)
bladder (retrograde cystogram)
vagina (pelvic exam)
urethra (retrograde urethrogram)

+ can leave pelvic hematoma alone if not expanding

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33
Q

Management of pelvic expanding hematoma

A

pelvic fixators –> to IR for bilateral internal iliac embolization

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34
Q

Fractures assc with urologic injuries

A

lower ribs –> kidneys

pelvic –> urethra/bladder

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35
Q

Urethral injury:
clues
management

A

blood at meatus, scrotal hematoma, high prostate

DO NOT CATH, do retrograde urethrogram

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36
Q

Bladder injury:
extraperitoneal leaks
intraperitoneal leaks
management

A

extra: foley
intra: surgery –> suprapubic cystostomy

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37
Q

Traumatic kidney injury:
eval
assc sequelae

A

CT scan
AV fistula leading to CHF
renovascular HTN

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38
Q

Scrotal hematoma management

A

rule out testicular rupture with sonogram

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39
Q

Penile fracture: assc location

management

A

corpora cavernosa
tunica albugenia

emergent surgery

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40
Q

Management of penetrating injury to extremity

A

not near vessel: clean wound, tetanus
near vessel, asx: Doppler/ angio
sx: surgery

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41
Q

Order of repair in extremity trauma that damages nerve/artery/bone

A

bone then artery then nerve; add px fasciotomy

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42
Q

Crush injury complications and management

A

^K, myoglobinemia/uria, renal failure, rhabdo, compartment syndrome

fluids. osmotic diuretic, alkalinize urine, fasciotomy

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43
Q

Management of chemical burns

A

irrigate, irrigate, irrigate.

do not alkalinize

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44
Q

Orthopedic injuries assc with electrocution

A

posterior shoulder

crush vertebral fractures

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45
Q

Late complications of electrocution

A

cataracts

demyelination syndromes

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46
Q

Inhalation burns:

management

A

ABG
bronchoscophy
carboxyhemoglobin

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47
Q

Circumferential burn management

A

escharotomy at bedside

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48
Q

Child burn suspicious for abuse

A

both buttocks

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49
Q

Appropriate starting rate of fluids in burn patient

A

1k mL/hr lactated ringers if at least 20% BSA burnt

20 ml/kg/hr in baby

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50
Q

Standard topical treatment of in burns

A

silver sulfadiazine = mc
deep penetration= mafenide acetate
near eyes= triple antibiotics

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51
Q

Who is a candidate for early excision and grafting of burns

A

very limited burn less than 20% BSA

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52
Q

What bites are high risk for rabies and what should you do?

A

unprovoked dog bites or wild animals

get Ig and vaccine

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53
Q

Rattlesnake bite management

A

wait for signs of evenomation (severe pain, swelling, discoloration in first 30 minutes)

then: T&C, coag studies, liver/ renal function…give CROFAB based on evenomation dose

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54
Q

Management of coral snake bites

A

red on yellow kills a fellow

don’t wait for signs or labs, just give antivenom state

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55
Q

Black widow bite signs + antidote

A

N/V muscle cramps

IV calcium gluconate

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56
Q

Brown recluse bite management

A

necrotic center + halo of erythema

give dapsone

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57
Q

human bites management

A

extensive irrigation + debridement + Augmentin

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58
Q

Developmental hip dysplasia:

clue + dx method + tx

A

uneven gluteal folds (in addition to click)

sonogram is diagnostic, don’t order xray

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59
Q

Legg Calve Perthes disease
pathogenesis
dx
tx

A

avascular necrosis femoral head
xrays
casting and crutches

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60
Q

SCFE presentation
dx
dx

A

groin/knee pain
sole of foot on affected side towards other
cannot internally rotate hip

xray
surgical emergency

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61
Q

Osteomyelitis
dx
tx

A

MRI (not xray, takes weeks)

antibiotics

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62
Q

Genu varum is normal until what age?

Genu valgus is normal at what age?

A

varum 0-3

valgus 4-8

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63
Q

Cause of genu varum persisting beyond age 3

A

medial proximal tibial growth plate disturbance

surgery can be done

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64
Q

Oschood schlatter disease pathogenesis

A

osteochondrosis of tibial tubercle

65
Q

Treatment of talipes equinovarus + what is this?

A

club foot

serial plaster casts

66
Q

Scoliosis: outcome of severe cases

A

decreased pulm function

67
Q

How to manage supracondylar fracture of humerus in kids

A

can get casting and traction but monitor bc high risk of neurovascular damage/ compartment syndrome/ Volkmann contracture

68
Q

How to handle growth plate fractures in kids

A

if displaced laterally and in one piece: closed reduction

if multiple pieces need ORIF

69
Q

Osteosarcoma:
age
location
pattern

A

10-25
knee
sunburst

70
Q

Ewing Sarcoma
age
location
pattern

A

5-15
diaphyses of long bones
onion skinning

71
Q

Lesion type in breast vs prostate mets

A

breast: lytic
prostate: blastic

72
Q

Multiple Myeloma treatment

A

chemo

73
Q

Soft tissue sarcomas:
dx
treatment

A

MRI and incisional bx

excision, rads, chemo

74
Q

Fracture xrays needed

A

two views perpendicular, above and below joint

75
Q

What should be imaged when feet are broken due to fall from height

A

lumbar spine

76
Q

Posterior shoulder dislocation xrays

A

axillary or scapular views

77
Q

Monteggia and Galeazzi fracture treatments

A

broken bone usually needs ORIF

dislocated needs closed reduction

78
Q

Treatment of scaphoid fracture

A

thumb spica cast

79
Q

Appearance of leg in hip fracture

A

shortened and externally rotated

80
Q

Important part of post op care in hip fractures

A

postop anticoagulation due to immobility

81
Q

Treatment of ankle fracture

A

usually ORIF because displaced fragments

82
Q

Pain under a cast:

what to do?

A

REMOVE CAST AND EXAMINE LEG!!

83
Q

How to posteriorly dislocate hip

A

head on car collision/ knees hit dashboard

84
Q

Appearance of leg in posterior hip location + management

A 
shortened and INTERNALLY rotated 
emergency reduction (avoid avascular necrosis)
85
Q

Treatment gas gangrene

A

IV Pencillin
debridement
hyperbaric oxygen

86
Q

How to damage popliteal artery

A

posterior knee dislocation

87
Q

Falls from height fracture ____

A

lumbar/thoracic spine

88
Q

Facial fractures + closed head injuries should prompt

A

Cspine evaluation

89
Q

Trigger finger explanation + therapy

A

unable to extend –> pop

steroid injections

90
Q

Mallet vs Jersey finger

A

Mallet- no extension

Jersey- no flexion

91
Q

Jersey and Mallet finger treatment

A

splinting

92
Q

What to do with an amputated finger that is just chilling there on the ground

A

saline. over ice in sealed bag

93
Q

Common location of disc herniation

A

L4-S1

94
Q

Clinical test for lumbosacral disc herniation
dx
tx

A

straight leg test
MRI
spontaneous resolution/ nerve blocks/ surg

95
Q

Cauda equina syndrome

treatment

A

distended bladder, flaccid rectal sphincter, perineal saddle anesthesia

surgical emergency –> decompress

96
Q

Best dx for bone mets

A

MRI

97
Q

Diabetic ulcers, aterial insufficiency, venous stasis ulcers location

A

diabetic: heel/metatarsal head
arterial insufficiency: tip of toes
venous stasis: medial malleolus

98
Q

Common sites of marjolin uclers

A

untreated burns/ chronic draining sinuses

99
Q

Plantar fasciitis treatment

A

spontaneous resolution within 12-18 months but may remove the bone spur

100
Q

Morton neuroma pain location

A

between 3rd-4th toes

NSAIDs, no heels, can excise

101
Q

Two treatments for gout flares and two for prevention

A

acute: indomethacin, colchicine
prevention: allopurinol, probenicid

102
Q

What ejection fraction is a contraindication to surgery?

A

Under 35%

103
Q

Single worst cardiac predictor of bad surgical outcome

A

JVD

104
Q

How long after MI must pt wait until surgery?

A

After 6 months can start surgeries

105
Q

What should occur before surgery for pulmonary clearance?

A

FEV1 –> blood gasses
Smoking cessation x 8 weeks
Pulm rehab

106
Q

Definition of severe nutritional depletion

A

Loss of 20% body weight over a couple of months
Albumin under 3
Transferrin under 200

107
Q

Metabolic condition that is an absolute contraindication to any surgical procedure

A

Diabetic coma/ DKA

108
Q

How to manage pre-op clearance for severely malnutritioned patient

A

7-10 days nutritional support

109
Q

Cause of fever within a half hour of surgery

A

Bacteremia

110
Q

List causes of fever post op sequentially through time

A

Atelectasis –> PNA –> UTI –> DVT –> wound infection –> deep abscess

(Wind, water, walking, wound)

111
Q

How soon after surgery might DVT occur? Wound infections?

A

DVT- 5 days
Wound infection (i.e. Cellulitis) 1 week
Abscess 2 weeks

112
Q

Management of wound infection

A

Sonogram can distinguish cellulitis from abscess
So CT if suspect abscess.

PO abx for cellulitis
Perc drainage for abscess

113
Q

When does post op MI usually occur

A

Days 2-3

114
Q

Management of PE post op (and ever)

A

Spiral CT –> heparinize –> warfarin

115
Q

Who should be anticoagulated post op as px?

A

Age greater than 40
Large bone fractures
Venous injury/catheter
Prolonged immobilization/hip stuff

116
Q

Pt becomes difficult to bag or ventilate during surgery : what do you suspect?

A

TPTX –> needle through diaphragm or anterior chest

117
Q

Disorientation following surgery: Ddx

A

Hypoxia (MC)
Delirium tremens
Na abnormality
Ammonium in varices pt

118
Q

What puts patient at risk of ammonium intoxication

A

Portocaval shunt procedure for varices

119
Q

When to cath pt post op

A

No urine x 6 hours

120
Q

Zero vs low urinary output causes

A

Zero: mechanical
Low: renal failure

121
Q

Radiologic appearance of paralytic ileus, ogilive syndrome, SBO

A

paralytic ileus: whole bowl distende
ogilive syndrome: distended colon
SBO: transition point seen

122
Q

Paralytic ileus
Ogilive syndrome
SBO
management

A

Paralytic ileus- normal post op; just check K+
SBO: surg
Ogilive: colonoscopy –> rectal tube

123
Q

How to identify colon of xray

A

huge outside boundaries of image

edges of the colon has the small haustral markings

124
Q

Management of evisceration

A

dress with warm saline
don’t stick guts back in
emergency closure

125
Q

Treatment of hypernatremia

A

half normal saline

126
Q

Hyponatremia treatment

A

hypertonic saline (3 –> 5%); water deprivation

127
Q

Cause of hypernatremia/ hypo

A

hyper- lost water/hypotonic fluids

hypo- lost isotonic fluds/ water retention

128
Q

Speed limit of IV K+

A

10 meQ/hr

129
Q

Treatment for hyperkalemia

A

insulin + dextrose
NG suction
resins
IV calcium to stabilize myocardium

130
Q

What can be administered to help kidney rid base in met alkalosis

A

KCl

131
Q

What does duplex mean in ultrasound?

A

Doppler –> flow
sonogram –> image

both= duplex

132
Q

The dysphagia in achalasia is worse for ____

A

liquids

133
Q

What must precede endoscopy in dx of motility issues?

A

barium swallow

134
Q

Emphysema in lower neck following procedure =

A

perforation of esophagus

135
Q

Initial management of SBO

A

IVF
NPO
NG suction

Xrays

136
Q

Typical WBC in appendicitis

A

10-15k

137
Q

Clue to colon cancer on right vs left side

A

right- blood

left- narrow caliber stool

138
Q

When to operate in chrons

A

20 + years of disease
failure of medical therapy
TMC

139
Q

WBC typical for TMC

A

above 50,000

140
Q

Nonsurgical alternative to anal fissure treatment

A

CCB ointment

141
Q

What should be ruled out in ischiorectal abscess

A

cancer

142
Q

Fecal soiling and perineal discomfort + opening near anus – treatment

A

fistulotomy

143
Q

Anal cancer

A

5 week chemo rads protocol has 90% success

144
Q

Common locations of GI bleed by age group

A

young- upper

old- upper = lower

145
Q

BRBPR first step in dx

A

pass NG tube to r/o rapid upper GI bleed

nose to pylorus excluded, wil still need EGD

146
Q

After excluding upper GI source of BRBPR – next step

A

anoscopy to r/o hemorrhoids
either wait until bleeding stops –> colonoscopy
or do angiogram if bleeding is rapid/ excessive

147
Q

Primary peritonitis culture clue

A

single organism

148
Q

Acute diverticulitis treatment

A

NPO/IVF/abx
drain abscess if present
elective surgery after 2+ attacks

149
Q

Sigmoid volvulus rads clue

A

RUQ air filled loop

LLQ parrots beak

150
Q

Treatment sigmoid volvulus

A

rectal tube like in ogilive

151
Q

acute pain & GI bleed =

A

mesenteric ischemia

152
Q

Hepatic adenoma management

A

CT scan –> resect

153
Q

Treatment of amebic liver abscesses

A

metronidazole

154
Q

Most common location of spine mets

A

vertebral pedicles

155
Q

Thyroid lobectomy is required to diagnose what type of cancer?

A

follicular

156
Q

What thyroid cancer can be treated with radioactive iodine?

A

follicular

157
Q

Medullary cancer requirement

A

radical resection/ MEN workup

158
Q

Cause of hypersecretion of insulin in the newborn

A

nesidioblastosis

95% need pancreatectomy

159
Q 
DM 
anemia 
glossitis 
stomatitis 
dermatitis
A

Glucagonoma

Surgery (4 decks)

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