pestena

Question 1

Linear skull fractures rx

Answer 1

•Left alone if they are closed (no overlying
wound)
•Open fractures require wound closure.
• If comminuted or depressed–> operating room (OR).

Question 2

When is surgery used in subdurals?

Answer 2

If midline structures are deviated, craniotomy will help, but prognosis is bad.

Question 3

Subdural with no deviation rx

Answer 3

If there is no deviation, therapy is centered on preventing further damage from ↑ ICP

Question 4

up to 48 hours after chest trauma
deteriorating blood gases
“white out” lungs on chest x-ray

Answer 4

Pulm Contusion

Question 5

Flail chest/ pulm contusion rx

Answer 5

• sensitive to fluid overload–> fluid restriction and diuretics
• blood gases have to be monitored
• may need respirator (chest tubes might help here)

also ps: To get a flail chest big trauma is required, thus traumatic transection of the aorta must be actively
sought.

Question 6

Myocardial contusion

Answer 6

suspected in sternal fractures.
EKG monitoring will detect it.
Troponins are quite specific and should be ordered

rx focused on the complications (arrhythmias)

Question 7

If i coagulopathy, hypothermia, and acidosis during an operation, what do you do?

Answer 7

laparotomy promptly terminated, with packing of bleeding surfaces and temporary closure

Question 8

second postoperative day
develops distention, retention sutures cutting through the tissues, hypoxia secondary to inability to breathe, and renal failure

Answer 8

abdominal compartment syndrome

long surgery–> abdominal swelling

may even show up at closing time

Question 9

pericardial effusion specific ekg findings

Answer 9

electrical alternans

Question 10

skin infection from pseudomonas

hemmoragic pustule

Answer 10

ecthyma gangrenosum

usually with profound neutropenia

looks like rotten burnt chick

Question 11

usually from drugs, infection, or autoimmune

multiple tender red plaques- usually legs

Answer 11

erythema nodosum

light red spotches on legs

Question 12

rapidly progressive ulcer

purlurent base, purple border

usually with systemic disease

Answer 12

pyoderma gangrenosum

yellow icky ulcer with dead surrounding

Question 13

what does every stable GSW need

Answer 13

tetanus prophylaxis

Question 14

Burn urine output goal for reassuring good fluid volume

Answer 14

UA of 1 or 2 mL/kg/h

Question 15

the candidate for early excision and grafting after burn will have?

Answer 15

very limited burn

removal in the OR (on day one) of the burned areas, with immediate skin grafting. 
limited burns (under 20%) that are 3rd degree

Question 16

The standard topical agent for burns is

Answer 16

silver sulfadiazine.

Question 17

Burns near the eyes are covered with?

Answer 17

triple antibiotic ointment

Question 18

developmental dysplasia of hip rx

Answer 18

abduction splinting with Pavlik harness for about 6 months

Question 19

Legg-Calvé-Perthes disease is?

Answer 19

avascular necrosis of the capital femoral epiphysis

occurs ~ 6 yo

insidious development of limping, decreased hip motion, and hip/knee pain

Question 20

Slipped capital femoral epiphysis is an emergency, rx is?

Answer 20

surgical treatment pins the femoral head back in place.

Question 21

Femoral neck fractures rx

Answer 21

Faster healing and earlier mobilization can be achieved by replacing the femoral head with a prosthesis.

Question 22

Intertrochanteric fractures

Answer 22

less likely –> avascular necrosis

reated with open reduction and internal fixation.

↑ risk of DVT/PE, thus post-op anticoagulation is
recommended

Question 23

describe catching and locking that limit knee

motion, and a “click” when the knee is forcefully extended

Answer 23

Meniscal tears

rx: open repair

Question 24

Open fractures require cleaning in the OR and suitable reduction within __________ from the time of the injury.

Answer 24

6 hours

Question 25

Prinzmetal angina rx

Answer 25

ca- channel blocker

diltiazem: dilates coronary well, ↓ dilation of peripheral arteries

Question 26

injury of the ulnar collateral ligament sustained
by forced hyperextension of the thumb

collateral laxity at the thumb-metacarpophalangeal joint

Answer 26

gamekeeper thumb

rx: casting

Question 27

tip of the affected finger remains flexed when the hand is

extended

Answer 27

Mallet finger

splinting is usually
the first line of treatment.

Question 28

a squamous cell carcinoma of the skin developing in a

chronic leg ulcer.

Answer 28

Marjolin ulcer

A dirty-looking, deeper ulcer develops at the site, with heaped up tissue growth
around the edges. Biopsy is diagnostic. Wide local excision and skin grafting
are done.

Question 29

afebrile stable pt with fistula draining out of wound closure, rx?

Answer 29

Fluid/ electrolyte replacement
nutritional support (preferably elemental diets
delivered beyond the fistula)
compulsive protection of the abdominal wall

let nature heal itself

Question 30

3 of 4 cases of upper GI bleed are where? (anatomy)

Answer 30

from the tip of the nose to the ligament of Treitz (holds up duodenum)

1 in 4 from colon/rectum

few arise from the jejunum/ ileum

Question 31

________ pancreatitis occurs in the alcoholic or the patient with gallstones

Answer 31

Acute edematous pancreatitis

Question 32

____________ pancreatitis is a much more deadly disease (vs edema).

Answer 32

Acute hemorrhagic pancreatitis

starts as the edematous form, early laboratory clue is dropping hematocrit

needs icu care

daily CT scans are recommended to look for abscess

Question 33

Necrosectomy

Answer 33

debriding the dead pancreatic tissue

Patients do far better by waiting at least 4 weeks
before debriding

Question 34

late sequela of acute pancreatitis or of

pancreatic (upper abdominal) trauma

Answer 34

Pancreatic pseudocyst -collection of pancreatic juice outside the pancreatic ducts (most commonly in the lesser sac)

Bigger (>6 cm) or older cysts (>6 wk) are more likely to rupture or bleed, and they need to be treated. Treatment involves drainage of the cyst.

Question 35

Acute hemorrhagic pancreatitis

Answer 35

starts as the edematous form, early laboratory clue is dropping hematocrit

needs icu care

daily CT scans are recommended to look for abscess

Question 36

Pancreatic pseudocyst, when to drain

Answer 36

Bigger (>6 cm) or older cysts (>6 wk) are more likely to rupture or bleed, and they need to be treated. Treatment involves drainage of the cyst.

Question 37

steatorrhea, diabetes, and constant epigastric pain

Answer 37

Chronic pancreatitis

lots of episodes of pancreatitis (usually alcoholic) eventually develop calcified burned out pancreas,

Question 38

bloody nipple discharge

Answer 38

Intraductal papilloma

Mammogram is needed to identify other potential
lesions, but it will not show the papilloma (they are tiny).

Galactogram may be diagnostic and guides surgical resection.

Question 39

Treatment of resectable breast cancer

Answer 39

lumpectomy + axillary sampling + post-op radiation
(small tumor, far from nipple)

or

modified radical mastectomy + axillary sampling.

*Adjuvant systemic therapy should follow surgery in virtually all patients- Chemotherapy is used in most
cases

Question 40

Axillary sampling in breast ca is done by identification and removal of ____________-

Answer 40

sentinel nodes.

Question 41

A total thyroidectomy should be performed in__________, so that if needed, radioactive iodine can be used in the future to treat blood borne metastasis

Answer 41

follicular cancers

Question 42

hot adenomas

Answer 42

Thyroid nodules in hyperthyroid patients are almost never cancer, but they may be the source of the hyperfunction (“hot adenomas”).