Pestanas- Trauma/Ortho, Gen Surg, Pre/Post Op Flashcards
(159 cards)
1
Q
Sedation type most common for anesthesia
A
rapid induction
2
Q
When must a fiberoptic bronchoscope be used for intubation?
A
subQ emphysema in neck
3
Q
Which head traumas must be operated on?
A
penetrating trauma
open/comminuted/depressed fractures
4
Q
Basilar skull fracture implications on treatment
A
must assess C spine with CT
avoid NT intubation
5
Q
When should hyperventilation be used In head trauma?
A
hyperventilate to PCO2 35 if pt shows herniation signs
6
Q
When is CT scan needed in neck trauma?
A
basilar skull fracture
neuro deficit
pain to local palpation over cspine
7
Q
Non vascular cause of central cord syndrome
A
forced hyperextension of neck
rear end collision
8
Q
How to prevent PNA in rib fracture
A
local nerve block/ epidural catheter
9
Q
PTX vs hemothorax PE findings
A
PTX- hyperresonant
Hemothorax- dullness to percussion
10
Q
Management hemothorax
A
chest tube, thoracostomy is ^^ blood recovery from wound
lung usually= source and usually self resolves = surgery usually not needed
11
Q
Sucking chest wound management
A
occlusive dressing (air out but not in)
12
Q
Flail chest:
assc injuries
A
multiple broken ribs
pulm contusion
+/- traumatic transection of aorta (check for this)
13
Q
Treatment of flail chest
A
bilateral chest tubes + fluid restriction/ diuretics
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)
15
Q
Myocardial contusion: dx
assc injury
A
EKG and troponins
assc with sternal fracture
16
Q
Traumatic diaphragm rupture: dx an tx
A
dx: Xray- bowel through LEFT side
tx: laparoscopy
17
Q
Traumatic rupture aorta:
mc location
dx
A
junction of arch/descending aorta
CT angio/spiral
18
Q
Traumatic rupture aorta:
mc injury mechanism
assc fractures
A
severe deceleration injury
first rib, scapula, sternum
19
Q
Suspect ____ as cause of sudden death in intubated chest trauma patient
A
air embolism
20
Q
Why is Trendelenburg necessary when placing central line?
A
to prevent air embolism
occurs when subclavian vein is opened to air
21
Q
Fat embolism:
clues
therapy
A
rash, low platelets, fever, respiratory distress, fractures
tx: respiratory support
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
23
Q
When does blunt abdominal trauma require surgical exploration?
A
peritoneal irritation +/- internal bleeding
24
Q
Sites for “hidden” bleeding leading to hemodynamic instability (3)
A
abdomen
thigh
pelvis
25
How to determine need for surgery in patient with signs of intra-abdominal bleeding
CT scan
| response to fluids
26
Best way to quickly dx intrabdominal bleeding in ED
FAST exam
27
MC source of signigicant intraabdominal bleeding
splenic lac
28
How to treat intraoperative coagulopathy
platelets, FFP x10 units each
| stop operation if hypothermic/ acidotic
29
Risks for post-op abdominal compartment syndrome
prolonged surgery
lots of fluids/blood given
closure with undue tension
30
Clue to abdominal compartment syndrome + tx
retention sutures cutting through the tissues, SAS
| open the abdomen
31
How to manage severely traumatized patient at risk for many complications
damage control lap
| clamp bleeders, clean up, get out, return later
32
Injuries that must be ruled out in pelvic trauma
rectum (proctoscopy)
bladder (retrograde cystogram)
vagina (pelvic exam)
urethra (retrograde urethrogram)
+ can leave pelvic hematoma alone if not expanding
33
Management of pelvic expanding hematoma
pelvic fixators --> to IR for bilateral internal iliac embolization
34
Fractures assc with urologic injuries
lower ribs --> kidneys
| pelvic --> urethra/bladder
35
Urethral injury:
clues
management
blood at meatus, scrotal hematoma, high prostate
DO NOT CATH, do retrograde urethrogram
36
Bladder injury:
extraperitoneal leaks
intraperitoneal leaks
management
extra: foley
intra: surgery --> suprapubic cystostomy
37
Traumatic kidney injury:
eval
assc sequelae
CT scan
AV fistula leading to CHF
renovascular HTN
38
Scrotal hematoma management
rule out testicular rupture with sonogram
39
Penile fracture: assc location
| management
corpora cavernosa
tunica albugenia
emergent surgery
40
Management of penetrating injury to extremity
not near vessel: clean wound, tetanus
near vessel, asx: Doppler/ angio
sx: surgery
41
Order of repair in extremity trauma that damages nerve/artery/bone
bone then artery then nerve; add px fasciotomy
42
Crush injury complications and management
^K, myoglobinemia/uria, renal failure, rhabdo, compartment syndrome
fluids. osmotic diuretic, alkalinize urine, fasciotomy
43
Management of chemical burns
irrigate, irrigate, irrigate.
do not alkalinize
44
Orthopedic injuries assc with electrocution
posterior shoulder
| crush vertebral fractures
45
Late complications of electrocution
cataracts
| demyelination syndromes
46
Inhalation burns:
| management
ABG
bronchoscophy
carboxyhemoglobin
47
Circumferential burn management
escharotomy at bedside
48
Child burn suspicious for abuse
both buttocks
49
Appropriate starting rate of fluids in burn patient
1k mL/hr lactated ringers if at least 20% BSA burnt
| 20 ml/kg/hr in baby
50
Standard topical treatment of in burns
silver sulfadiazine = mc
deep penetration= mafenide acetate
near eyes= triple antibiotics
51
Who is a candidate for early excision and grafting of burns
very limited burn less than 20% BSA
52
What bites are high risk for rabies and what should you do?
unprovoked dog bites or wild animals
| get Ig and vaccine
53
Rattlesnake bite management
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
54
Management of coral snake bites
red on yellow kills a fellow
| don't wait for signs or labs, just give antivenom state
55
Black widow bite signs + antidote
N/V muscle cramps
| IV calcium gluconate
56
Brown recluse bite management
necrotic center + halo of erythema
| give dapsone
57
human bites management
extensive irrigation + debridement + Augmentin
58
Developmental hip dysplasia:
| clue + dx method + tx
uneven gluteal folds (in addition to click)
| sonogram is diagnostic, don't order xray
59
Legg Calve Perthes disease
pathogenesis
dx
tx
avascular necrosis femoral head
xrays
casting and crutches
60
SCFE presentation
dx
dx
groin/knee pain
sole of foot on affected side towards other
cannot internally rotate hip
xray
surgical emergency
61
Osteomyelitis
dx
tx
MRI (not xray, takes weeks)
| antibiotics
62
Genu varum is normal until what age?
| Genu valgus is normal at what age?
varum 0-3
| valgus 4-8
63
Cause of genu varum persisting beyond age 3
medial proximal tibial growth plate disturbance
| surgery can be done
64
Oschood schlatter disease pathogenesis
osteochondrosis of tibial tubercle
65
Treatment of talipes equinovarus + what is this?
club foot
| serial plaster casts
66
Scoliosis: outcome of severe cases
decreased pulm function
67
How to manage supracondylar fracture of humerus in kids
can get casting and traction but monitor bc high risk of neurovascular damage/ compartment syndrome/ Volkmann contracture
68
How to handle growth plate fractures in kids
if displaced laterally and in one piece: closed reduction
if multiple pieces need ORIF
69
Osteosarcoma:
age
location
pattern
10-25
knee
sunburst
70
Ewing Sarcoma
age
location
pattern
5-15
diaphyses of long bones
onion skinning
71
Lesion type in breast vs prostate mets
breast: lytic
prostate: blastic
72
Multiple Myeloma treatment
chemo
73
Soft tissue sarcomas:
dx
treatment
MRI and incisional bx
| excision, rads, chemo
74
Fracture xrays needed
two views perpendicular, above and below joint
75
What should be imaged when feet are broken due to fall from height
lumbar spine
76
Posterior shoulder dislocation xrays
axillary or scapular views
77
Monteggia and Galeazzi fracture treatments
broken bone usually needs ORIF
| dislocated needs closed reduction
78
Treatment of scaphoid fracture
thumb spica cast
79
Appearance of leg in hip fracture
shortened and externally rotated
80
Important part of post op care in hip fractures
postop anticoagulation due to immobility
81
Treatment of ankle fracture
usually ORIF because displaced fragments
82
Pain under a cast:
| what to do?
REMOVE CAST AND EXAMINE LEG!!
83
How to posteriorly dislocate hip
head on car collision/ knees hit dashboard
84
Appearance of leg in posterior hip location + management
```
shortened and INTERNALLY rotated
emergency reduction (avoid avascular necrosis)
```
85
Treatment gas gangrene
IV Pencillin
debridement
hyperbaric oxygen
86
How to damage popliteal artery
posterior knee dislocation
87
Falls from height fracture ____
lumbar/thoracic spine
88
Facial fractures + closed head injuries should prompt
Cspine evaluation
89
Trigger finger explanation + therapy
unable to extend --> pop
| steroid injections
90
Mallet vs Jersey finger
Mallet- no extension
| Jersey- no flexion
91
Jersey and Mallet finger treatment
splinting
92
What to do with an amputated finger that is just chilling there on the ground
saline. over ice in sealed bag
93
Common location of disc herniation
L4-S1
94
Clinical test for lumbosacral disc herniation
dx
tx
straight leg test
MRI
spontaneous resolution/ nerve blocks/ surg
95
Cauda equina syndrome
| treatment
distended bladder, flaccid rectal sphincter, perineal saddle anesthesia
surgical emergency --> decompress
96
Best dx for bone mets
MRI
97
Diabetic ulcers, aterial insufficiency, venous stasis ulcers location
diabetic: heel/metatarsal head
arterial insufficiency: tip of toes
venous stasis: medial malleolus
98
Common sites of marjolin uclers
untreated burns/ chronic draining sinuses
99
Plantar fasciitis treatment
spontaneous resolution within 12-18 months but may remove the bone spur
100
Morton neuroma pain location
between 3rd-4th toes
| NSAIDs, no heels, can excise
101
Two treatments for gout flares and two for prevention
acute: indomethacin, colchicine
prevention: allopurinol, probenicid
102
What ejection fraction is a contraindication to surgery?
Under 35%
103
Single worst cardiac predictor of bad surgical outcome
JVD
104
How long after MI must pt wait until surgery?
After 6 months can start surgeries
105
What should occur before surgery for pulmonary clearance?
FEV1 --> blood gasses
Smoking cessation x 8 weeks
Pulm rehab
106
Definition of severe nutritional depletion
Loss of 20% body weight over a couple of months
Albumin under 3
Transferrin under 200
107
Metabolic condition that is an absolute contraindication to any surgical procedure
Diabetic coma/ DKA
108
How to manage pre-op clearance for severely malnutritioned patient
7-10 days nutritional support
109
Cause of fever within a half hour of surgery
Bacteremia
110
List causes of fever post op sequentially through time
Atelectasis --> PNA --> UTI --> DVT --> wound infection --> deep abscess
(Wind, water, walking, wound)
111
How soon after surgery might DVT occur? Wound infections?
DVT- 5 days
Wound infection (i.e. Cellulitis) 1 week
Abscess 2 weeks
112
Management of wound infection
Sonogram can distinguish cellulitis from abscess
So CT if suspect abscess.
PO abx for cellulitis
Perc drainage for abscess
113
When does post op MI usually occur
Days 2-3
114
Management of PE post op (and ever)
Spiral CT --> heparinize --> warfarin
115
Who should be anticoagulated post op as px?
Age greater than 40
Large bone fractures
Venous injury/catheter
Prolonged immobilization/hip stuff
116
Pt becomes difficult to bag or ventilate during surgery : what do you suspect?
TPTX --> needle through diaphragm or anterior chest
117
Disorientation following surgery: Ddx
Hypoxia (MC)
Delirium tremens
Na abnormality
Ammonium in varices pt
118
What puts patient at risk of ammonium intoxication
Portocaval shunt procedure for varices
119
When to cath pt post op
No urine x 6 hours
120
Zero vs low urinary output causes
Zero: mechanical
Low: renal failure
121
Radiologic appearance of paralytic ileus, ogilive syndrome, SBO
paralytic ileus: whole bowl distende
ogilive syndrome: distended colon
SBO: transition point seen
122
Paralytic ileus
Ogilive syndrome
SBO
management
Paralytic ileus- normal post op; just check K+
SBO: surg
Ogilive: colonoscopy --> rectal tube
123
How to identify colon of xray
huge outside boundaries of image
| edges of the colon has the small haustral markings
124
Management of evisceration
dress with warm saline
don't stick guts back in
emergency closure
125
Treatment of hypernatremia
half normal saline
126
Hyponatremia treatment
hypertonic saline (3 --> 5%); water deprivation
127
Cause of hypernatremia/ hypo
hyper- lost water/hypotonic fluids
| hypo- lost isotonic fluds/ water retention
128
Speed limit of IV K+
10 meQ/hr
129
Treatment for hyperkalemia
insulin + dextrose
NG suction
resins
IV calcium to stabilize myocardium
130
What can be administered to help kidney rid base in met alkalosis
KCl
131
What does duplex mean in ultrasound?
Doppler --> flow
sonogram --> image
both= duplex
132
The dysphagia in achalasia is worse for ____
liquids
133
What must precede endoscopy in dx of motility issues?
barium swallow
134
Emphysema in lower neck following procedure =
perforation of esophagus
135
Initial management of SBO
IVF
NPO
NG suction
Xrays
136
Typical WBC in appendicitis
10-15k
137
Clue to colon cancer on right vs left side
right- blood
| left- narrow caliber stool
138
When to operate in chrons
20 + years of disease
failure of medical therapy
TMC
139
WBC typical for TMC
above 50,000
140
Nonsurgical alternative to anal fissure treatment
CCB ointment
141
What should be ruled out in ischiorectal abscess
cancer
142
Fecal soiling and perineal discomfort + opening near anus -- treatment
fistulotomy
143
Anal cancer
5 week chemo rads protocol has 90% success
144
Common locations of GI bleed by age group
young- upper
| old- upper = lower
145
BRBPR first step in dx
pass NG tube to r/o rapid upper GI bleed
| nose to pylorus excluded, wil still need EGD
146
After excluding upper GI source of BRBPR -- next step
anoscopy to r/o hemorrhoids
either wait until bleeding stops --> colonoscopy
or do angiogram if bleeding is rapid/ excessive
147
Primary peritonitis culture clue
single organism
148
Acute diverticulitis treatment
NPO/IVF/abx
drain abscess if present
elective surgery after 2+ attacks
149
Sigmoid volvulus rads clue
RUQ air filled loop
| LLQ parrots beak
150
Treatment sigmoid volvulus
rectal tube like in ogilive
151
acute pain & GI bleed =
mesenteric ischemia
152
Hepatic adenoma management
CT scan --> resect
153
Treatment of amebic liver abscesses
metronidazole
154
Most common location of spine mets
vertebral pedicles
155
Thyroid lobectomy is required to diagnose what type of cancer?
follicular
156
What thyroid cancer can be treated with radioactive iodine?
follicular
157
Medullary cancer requirement
radical resection/ MEN workup
158
Cause of hypersecretion of insulin in the newborn
nesidioblastosis
| 95% need pancreatectomy
159
```
DM
anemia
glossitis
stomatitis
dermatitis
```
Glucagonoma
