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Surgery 1 > S1 > Flashcards

S1 Flashcards

1
Q

Respiratory distress following central venous removal?

A

Venous air embolism

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2
Q

etiology for air embolism?

A

Trauma,surgery(e.g nurosurgery)
Central venous catheter manipulation
Barotrauma(posetive pressure ventilation)

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3
Q

CM?

A

Sudden RD
Obstructive shock
Cardiac arrest
Hypoxia

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4
Q

management?

A

left lateral decubitus position/LL with tredebelerge (Reduce RVO by making embolus to attach RV lateral wall)
High flow/Hyperbaric o2–Help N2 absorption to tissue

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5
Q

pathophysiology?

A

B/c of CVP is low–susceptible for air embolus–travel to RV–RVO/PE–V/Q mismatch(hypoxia)/OS

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6
Q

prone position?

A

reduce atelectasis in case of ARDS/Persistent hypoxemia despite MV

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7
Q

semi-recumbent position?

A

help for reduction of AP in MV patients

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8
Q

Ottawa ankle rules?

A

X-ray indication for Foot/Ankle in time of Pain at the foot or ankle to differentiate # from an ankle sprain

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9
Q

x-ray of ankle required?

A

Pain at malleolar zone + Tenderness at posterior margin /TIP of M/L malleolus or unable to bear weight and to do 4 steeps(2 each)

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10
Q

X-ray of foot required?

A

midfoot zone pain + one of the Foll
1-Tenderness at navicular
2-Tenderness at base of 5 th digit
3-Unable to bear weight and Unable to do 4 steeps

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11
Q

bariatric surgery indication?

A

BMI >40
BMI > 35 with serious comorbidity(T2DM,HTN and OSA)
BMI > 30 with Tx resistant T2DM or metabolic syndrome

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12
Q

medical therapy indication?

A

BMI > 30

BMI–25-29 with wight related complication

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13
Q

drugs used?

A

orlistat
lorcaserine
Naltroxone/pupropion
Liraglutide

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14
Q

initial assessment?

A

review px attempt at weight loss/diet and Ex.habit
review psychiatric hx, coping skill and readiness to change
Review hx of cardiac pul dis

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15
Q

caloric restriction for weight loss?

A

1500-2000
if aggressive (800-1500)
< 800 nit recommended b/c of high failure risk

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16
Q

Faucher, does that suggest malignancy in peritoneal fluid analysis?

A

Persistent(repeated aspiration to r/o traumatic) hemorrhagic fluid

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17
Q

what to do if hemorrhagic?

A

Abdominal imaging
AFP
Cytologic analysis

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18
Q

MCC from malignancy?

A

Hepatocelular carcinoma

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19
Q

what bout TB?

A

Mainly straw color

Rarely bloody but will have abdominal pain and Symptom complex

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20
Q

giant cell tumor cxs?

A 
Benign
Locally destructive
MC at epiphysis of long bone
Can be associated with Paget disease
V-Ray(soap bubble with eccentric lesion)
Giant cells on biopsy
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21
Q

complication?

A

pulmonary metastasis

malignant transformation

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22
Q

management?

A

surgery

Denosumab for tumour shrinkage

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23
Q

ganglion cyst cxs?

A

mobile and non-tender
MC at the wrist but occur in UE and LE
Mucinous fluid-filled with connection with joint(transilluminate)
Common inpatient with joint disease/joint trauma

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24
Q

Management?

A

Mostly resolve by itself

Surgery/aspiration in persistent symptom or pain

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25
Q

dermoid cyst?

A

MC at the plantar surface of the digit
Central punctum
< 1 cm

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26
Q

what about the rheumatoid nodule?

A

not Transilluminate

Common at pressure area(like olcranon)

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27
Q

hypocalcemia feature?

A 
perioral paraesthesia
tetany
muscle spasm
QT prolongation
seizure
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28
Q

normal serum phosphorus?

A

2.8-4.5

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29
Q

how to relate with Phyopoparatyroidism from other causes?

A

In hyperparathyroidism, there will be hyperphosphatemia/normal

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30
Q

Peyronie disease CM?

A

Pain during erection
The difficulty of normal penile curvature during erection
Nodule/plaque at dorsal penile surface

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31
Q

pathophysiology?

A

Repetitive injury(AT S>I)–wound healing by fibrosis–Fibrosis at tunica albuginia

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32
Q

management?

A

Mostly resolve with 1-2 week
active or progressive–NSAID,pentoxifylline/intralesional Collagenase injection
Surgery in refractory cases

33
Q

CM of psoas abscess?

A

abdominal/flank pain radiate to the groin
anorexia and weight loss
subacute fever
Abdominal pain with hip extension(psoas sighn)

34
Q

Diagnosis?

A

Abdominopelvic CT
High WBC and inflammatory marker
Blood and abscess culture

35
Q

Management?

A

Drainage

broad-spectrum AB

36
Q

Cause?

A

From distant infection

or from intrabdominal infection

37
Q

risk factor?

A

DM
HIV
IV drug use
Crohn’s disease

38
Q

Diferencial diagnosis?

A 
Rectocecal appendix(may have + psoas sighn)
BUT RA--Pain on rectal examination
39
Q

CM of testicular Ca?

A

Painless unilateral scrotal mass

may have lower abdomen drawing pain

40
Q

diagnosis?

A

Firm/hard ovoid mass in tunica albuginia

41
Q

Diagnosis?

A

B-HCG,LDH, and AFP may be elevated in NSGCT
Ultrasound
Confirm by doing inguinal orchidectomy (biopsy)

42
Q

U/S feature?

A

Solid hypoechic lesion(seminoma)

Cystic area and calcification in NSGCT

43
Q

Clinical menifestation of cholagiocarcinoma?

A 
Abdominal pain
Jaundice
Hyperbilirubinemia(CB) sx
Cholestatic liver enzyme elevation(High AP,Nor./Mi.EL TA)
Right UQ mass/hepatomegaly
44
Q

lab?

A

Elevated CEA and CA 19-9 with normal AFP

45
Q

MC risk factor?

A

PBC which is common in ulcerative colitis

46
Q

Testicular neoplasm clasification?

A 
Germ cell(95%)
Stromal (5%)
47
Q

Stromal cell tumor?

A

Leyding
Sertoli
Granulosal
Not produce Tumor marker Like HCG,AFP or

48
Q

Leydig cell tumor pathigenesis?

A

Produce Testosterone primarily or Estrogen

As a result, FHS and LH suppressed

49
Q

CM?

A

Hyper E.–Gynacomastia, Dec. Libido, and erectile D

Hyper T–Acne.Hirsutism

50
Q

CM of UC?

A

Abdominal Pain
Diharoa may be bloody
Rectosigmoid Ulcer

51
Q

Mild UC defn?

A

<4/day diarrhea
Hematocasia is rare/intermitent
Normal inflammation marker

52
Q

Management?

A

5-ASA medication(mesalamine. sulfasalazine, balsalazide)
Localized to rectosigmoid(suppository or enema form)
Sever(Oral)

53
Q

Moderate/severe?

A

> 6 stool per day
A rise in inflammatory marker
Frequent heamatocasia
Anemia

54
Q

Management?

A

TNF alpha In.(Infliximab,Adalimumab,golimumab)

55
Q

refractory case?

A

Protocolectomy with ilioanal anastmosis

56
Q

corticostoroid consideration?

A

Chronic severe disease

Acute flare

57
Q

de Quervain tendinopathy?

A

Tendinopathy of A.P longes and E.P. previs at the extensor retinaculum
Repetitive use is a risk(abd, And extension)
Common in women in 30-50 in 4-6 week postpartum

58
Q

CM?

A 
Tenderness at the radial side of the wrist at the base of the hand
Finkelstein Test(extension on hand fist produce pain)
59
Q

Management?

A

NSAID

SPLINT(thumb spica)

60
Q

A complication of CO2 peritoneal inflation?

A

Peritoneal stretching–VN activation—Bradychardiaa.Heart block and asystole
Co2 systemic absorption–peripheral vasodilation–Reflex tachycardia and hypotension
CO2 embolization–Obstructive shock
Vena Cava obstruction–Hypotension

61
Q

first thing to do in diabetic foot ulcer?

A

X-ray to assess osteomyelitis

62
Q

Indication?

A 
Deep
>=2 CM size
>7-14 days stay
Elevated ESR/CRP
Adjacent soft-tissue infection
63
Q

VHL disease?

A

Heamangioblastoma of retina and cerebellum
Pheochromocytoma
Bilateral RCC(preceded by multiple cystic lesion in kidney)

64
Q

Colonic ischemia?

A

Hypotension in atherosclerosis patients/–watershed area ischemia(splenic flexure and rectosigmoid junction)

65
Q

CM?

A

Moderate Abd,Pain /tenderness
Hematocasia and diarrhea
Leukocytosis and lactic acidosis

66
Q

DXS?

A

CT: colonic wall thickening and Fat stranding

End.:Edematous friable mucosa

67
Q

management?

A

Bowel rest
IV Ab with enteric coverage
Colonic resection if necrosis develop

68
Q

Pregnancy and Iodine scan?

A

C/I in px because of high risk for congenital hypothyroidism, Intel, Disability, and malignancy in the fetus.

69
Q

The optimal time for thyroidectomy?

A

Best at postpartum but it is emergency 2nd TM is best

70
Q

what type of nutrition is recommended in critically ill patients?

A

early (<=48 hr) enteral feeding initiation
reduce infection risk and mortality
maintain gut integrity

71
Q

what to do?

A

Naso or orogastric tube advance to passing pylorus if the risk of aspiration is high
evidence of normal bowel functioning not required

72
Q

indication for anticoagulation in atrial flutter?

A

the same as fibrillation

73
Q

BZD withdrawal symptoms?

A

same as Alcohol withdrawal symptom

74
Q

what sign indicates Strangulation in SBO?

A

Peritonitis sign
Shock
Sepsis sign

75
Q

MCC of SBO?

A

Adhesion

76
Q

Focal nodular hyperplasia of the liver?

A 
incidental finding
Not require Tx
Contraceptive is no risk
A hyperdense lesion with arterial contrast with central scar
Due to vascular malformatiopn
77
Q

treatment?

A

rarely require

78
Q

sign of anastomotic leak?

A 
the first week after the operation
abdominal pain
fever
tachypnea
tachycardia
79
Q

what is the CM of epidural hematoma after Spinal anesthesia or LP?

A

Cauda eqina syndrome

Surgery 1 (11 decks)

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