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Surgery 1 > S2 > Flashcards

S2 Flashcards

1
Q

Test to do the first inpatient with symptom suggestive of pancreatic Ca?

A

CT scan:Weight loss, Constant A.P,

Abdominal U/S if only have painless jaundice.wight loss and anorexia

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2
Q

Pancreatic Ca risk?

A

smoking

Chronic pancreatitis

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3
Q

DM and Pan.Ca?

A

In Pan .Ca patient 25 % will have T2DM diagnosis in the previous 2 years before Ca was diagnosed
Maybe a risk or paraneoplastic syndrome (adrenomedullin cause insulin resistance)

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4
Q

Anterior cruciate ligament injury sign?

A

Sudden pain
Pooping sound at the time of injury
Joint effusion/heamartrosis
Anterior drawing of Tibia/Lechman test-90 % sensitive

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5
Q

Mechanism of injury?

A

Sudden decrease speed
Sudden change in direction
Trauma to knee
Pivoting on stood leg

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6
Q

DIAGNOSIS?

A

MRI

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7
Q

Management?

A

RICE(Rest,Ice,compression and elevation)

+/- surgery

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8
Q

Gastric Ca CM?

A

Epigastric pain
Nausea/Vomiting
Wight loss due to early satiety
Iron deficiency nemia

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9
Q

Diagnosis?

A

Esophagogastroduodenoscopy (To see lesion and take biopsy)

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10
Q

why common in east Europe/Asia and South America?

A

Diet rich in salt and nitrous food

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11
Q

what sign indicates metastasize to the liver?

A

Elevated AST/ALT and low albumin

Hepatomegaly

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12
Q

Differential?

A

HOOK worm(A.pain.Nausea/Vomiing and IDA)
But no hepatomegaly or elevated TA/AP
There will be peripheral eosinophilia

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13
Q

Free air in retroperitoneum after blunt abdominal trauma?

A

Duodenal, ascending or descending colon injury

Duodenum is more susceptible due to the presence of attached many ligaments and proximity to vertebra

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14
Q

Other manifestation?

A

Symptom delay
Peritonitis
Flank pain

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15
Q

MC cause for peritonitis with FAST positive after blunt abdominal trauma?

A

Pancreatic laceration

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16
Q

Blunt abdominal trauma approach?

A

1) Heamodynamicaly unstable

2) Hemodynamically stable

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17
Q

1)Heamodynamicaly unstable?

A

1–peritonitis–laparotomy
2–No peritonitis and FAST positive–Laparotomy
3–No peritonitis and FAST Negative–DL/CT of A & P

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18
Q

2)Hemodynamically stable?

A

1-Peritonitis–Laparotomy (CTAP on way to OR)
2-No peritonitis but positive FAST–CTAP
3–No peritonitis but Negative FAST–CTAP/serial monitoring

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19
Q

VIT K stored for?

A

30 day in normal liver patient

7-10 days with a patient with an underlying disease

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20
Q

In which type of patient, it will occur?

A

Malabsorption (Bowel, Prolonged NPO, and broad-spectrum antibiotics)

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21
Q

What to do inpatient with hemoptysis?

A

Imaging(C-XR)–TB sugestive–Respiratory isolation
massive>600ml/day—Bronchoscopy after ABC
Hemodynamically unstable/RD/Poor Gas exchange/Massive hemoptysis–Intubation

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22
Q

other things to do?

A

Put the patient on left lateral position

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23
Q

bronchoscopy benefits?

A

aspirate blood
visualization
For procedures like ballon and cautery

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24
Q

What to do next After gastric Adenocarcinoma is diagnosed?

A

CT of A & P to determine the stage

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25
Q

Limited stage?

A

Radical resection

Eradication therapy for H.Pylori

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26
Q

Advanced stage?

A

Chemotherapy

Palliative surgery

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27
Q

acalculous cholecystitis CM?

A 
RUQ pain and tendernes/mass
Fever
Leukocytosis
Jaundice
\+/- abnormal LFT
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28
Q

risk factor?

A

Severe trauma
Recent surgery
Server illness
TPN?Prolonged fasting

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29
Q

Diagnosis?

A

Abdominal U/S(Cholic.sighn w/o gall stone)
If nonconclusive
CT/HIDA scan(more sensetive)

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30
Q

Management?

A

Enteric coverage Ab
Cholycystostomy–Initial drainage
Cholecystectomy–After the patient stable

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31
Q

HIDA scan?

A

During the procedure, a technician injects a tiny amount of a radioactive compound into your bloodstream. As it travels through your liver, gallbladder, and small intestine, a camera tracks its movement and takes pictures of those organs. A HIDA scan shows how well your gallbladder is working

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32
Q

Complicated parapneumonic sign?

A 
PH<7.2
WBC>50,000
Glucose<60
Pus in aspirate
Common in immunocompromised
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33
Q

management?

A

2-4 week AB

Chest tube

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34
Q

what to do if we found a thyroid nodule?

A

Asses for malignancy feature and Regional LDP

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35
Q

If have NO feature?

A

Thyroid U/S and TSH

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36
Q

What If U/S shows FNA is indicated?

A

> 1 CM with Mal,F(Microcalcification. irregular border and internal vascularity
All >2 cm non-cystic mass

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37
Q

If Have no above Indication?

A 
Do TSH(If low RI scan(if cold nodule do FNAC and if HOT work for thyrotoxicosis)
If normal or HIgh/Normal do FNAC based on above
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38
Q

normal TSH?

A

0.5-5

39
Q

Cause of ischemic hepatitis(Shock Liver)?

A

Cardiac(MI,VTAC,CS)
hypovolumic/Septic shock
Respiratory failure

40
Q

CM?

A 
TA>1000 shortly after insult
Bilirubin rise latter
Zone 3 will be more affected
Hepatocyte ischemic injury
Recover in 7 days except in MOF patients(poor prognosis)
41
Q

Non-tender, Nonflactuanat bilateral Parotid enlargement with no associated pain with eating?

A

Sialadenosis

42
Q

Pathophysiology?

A

Chronic alcohol/bulimia/Malnutrition–Excessive secretary granule accumulation may be due to AD
DM/LIVER disease–Fatty accumulation

43
Q

management?

A

treat underlying cause may reduce but does not completely resolve

44
Q

Acute mesenteric ischemia sign?

A

Porley localied Abd.Pain
Pain out of proporsion of PF
Hematocaia(late complication)

45
Q

Risk F?

A

Embolic source
DIC
Atherosclerosis

46
Q

lab?

A

Leukocytosis
Elevated amylase and lipase
Elevated lactate

47
Q

what indicate infarction?

A

Localized peritonitis
Sepsis
Rectal bleeding

48
Q

Otosclerosis?

A

Middle ear(stapes) damage
AD
Advanced in pregnancy
cause CHL

49
Q

Subphrenic abscess manifestation?

A 
RUQ pain
Leukocytosis
Fever
SOB, Hiccup, and pleural effusion
MC after appendectomy
Diagnose by CT
50
Q

immediate things to do in Tension Pneumothorax?

A

Needle thoracostomy

51
Q

risk for emphysematous cholecystitis?

A

DM
Vascular compromise
Imunosupresion

52
Q

CM?

A

All cholecystitis sign
Elevated UB and Mild E TA
Crepitasion in the abdominal wall around gall blader

53
Q

diagnosis?

A 
Air fluid level in gall bladder
Gas in gall blader wall
Culture of gas-forming Clostridium or E,Coli
Elevated UB and Mild E TA
CT is more diagnostic
54
Q

management?

A

Broad-spectrum AB

Immediate cholecystectomy

55
Q

Complication?

A

C.P toxin–Hemolysis.Tissue necrosis and Septic shock
Gangrenous GB
GB perforation

56
Q

Intracapsular femoral #?

A

Head and neck #

High risk of avascular necrosis

57
Q

Extracapsular femoral #?

A

intrathrocantric/subtrochantric

58
Q

How long we can delay surgical intervention for #?

A

72 hr

to stabilize patient

59
Q

Cervical spondylosis and near collusion?

A

Neck hyperextension in narrow Cervical Chanel–spinal cord injury–Upper extremity sign/spare LE b/c fibers found medially

60
Q

Cause of postamputation pain?

A

4

61
Q

1) Acute stump pain?

A

Tissue and nerve injury

Sever pain last 1-3 week

62
Q

2)Ischemic pain?

A

Swelling, Skin discoloration
Wound breakdown
Dec.transcutaneous 02 tension

63
Q

3)post traumatic nuroma?

A

Weeks to a month after amputation
Focal tenderness
Altered local sensation
Dec. pain with anesthetic

64
Q

4)phantom limb pain?

A

Onset usually within 1 week
An increase in patients with severe acute pain
Intermittent cramping, Burning felt in distal limb

65
Q

post-traumatic neuroma path and management?

A

inflammation–form mass in unmyelinated fiber
make prosthetic device usage difficulty
surgery is the definitive management
TCA and antiepileptic until surgery

66
Q

pancriatic ingury(ductal inv.) after BT CM?

A 
Delayed presentation
persistent abdominal pain/tenderness
Persistent nausea/emesis
Increase amylase over serial measurement
Pancreatic fluid collection in upper abdomen
67
Q

management?

A

small–conservative

large–repair

68
Q

open cardiac surgery complication?

A

Temponad

evidenced by equalization of diastolic RAP,RVP, and PWP

69
Q

what to do inpatient with warfarin to do surgery?

A

Stop warfarin immediately
If INR>2 PCC(if no available FFP)
IV Vit K

70
Q

what about hemophilia patients?

A

Desmopressin

71
Q

Nasopharyngeal Ca risk?

A

Endemic to Asia
Linked to EBV reactivation
smoking, salt fish diet, and genetics

72
Q

CM?

A

Obs–Nasal congestion, epistaxis, and headache
Mass effect–CN palsy and OM
Spread–Neak mass, cervical LDP

73
Q

Diagnosis?

A

Endoscopy guided biopsy

74
Q

Management?

A

Radiotherapy

Chemotherapy

75
Q

Ameobil liver abscess dxs?

A

serology

can affect lung

76
Q

Flail chest?

A

> =3 rib in >=2 space #
Difficulty information of negative pressure–RD
V/Q mismatch at an area–Hypoxia
Decrease air entry at site of flial chest

77
Q

When we suspect thoracoabdominal injury?

A

Injury below 4th rib

All chest and abdomen should be investigated

78
Q

Immediate indication for laparotomy in penetrating abd trauma?

A

Peritonitis
Bowel inviseration
Hemodynamic instability

79
Q

Rare VHD manifestation i.e other than H/P/RCC?

A

Pancriatic nuroendocrine tumor

Endolymphatic duct tumor

80
Q

Scaphoid # sign?

A

Pain at the radial wrist at the base of tumb
Tenderness at anatomic snuff box
Risk of osteonecrosis

81
Q

anatomic snuffbox?

A

Extensor pol.Long–medially

Extensor Pol.Previs and Abd. Pol.Lomg–Laterally

82
Q

Bacterial etiology for osteomyelitis in diabetic foot ulcer?

A

Contagious spread

Polymicrobial(G+,G- and anaerobes)

83
Q

etiology of urethral stricture?

A

Trauma including Catheterization
Radiotherapy
Urethritis

84
Q

Symptoms?

A

Weak/spraying symptom
Incomplete voiding’Irritative Sx(urgency,freq..)
Incomplete emptying

85
Q

complication?

A

AUR
Recurrent UTI
Bladder stone

86
Q

Diagnosis?

A

Postvoid residual
Urethrography
Cystourethroscopy

87
Q

Management?

A

Dilation

Urethroplasty

88
Q

Common CM of compartment syndrome?

A

Pain out proportion to the injury
Pain inc. on passive stretch & not respond to narcotics
Rapidly increasing and tense swelling
Paraesthesia(burning or prickling sensation)–early finding)

89
Q

Cause?

A

Direct trauma
Prolonged extremity compression
Revascularisation of ischemic limb

90
Q

Uncommon CM?

A

Dec, sensation
Motor weakness(hrs)
Paralysis(late)
Dec.Distal pulse

91
Q

Diagnosis and Tx?

A 
Measure compartment P
Fasciotomy immediately (Delay Time determine prognosis)
92
Q

Indication for hypertonic saline usage?

A

In acute Hyponatrmimia(<48 Hr): Serum Na< 130 with any sign of ICP
In chronic Hyponatrimia(>48 hr):;Serum Na<120,Sever sx(Seizure) or concomitant ICSOL

93
Q

Why was 48 hr used?

A

If >48 brains will adapt to new osmolarity and risk of ODS will be high

Surgery 1 (11 decks)

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