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Surgery 1 > S4 > Flashcards

S4 Flashcards

1
Q

Management cerebellar hemorrhage?

A

Reverse anticoagulation
Manage HTN
ICP management
Surgical evacuation

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2
Q

Surgical evacuation?

A

Hemorrhage > 3 CM
Neurologic deterioration
Brainstem Compression
Obstructive hydrocephalus

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3
Q

AAA CM?

A

Upper: Abd/flank/Back pain
Lower: Lower Abd/Groin pain
Calcification X-ray

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4
Q

Management?

A

Hemodynamically stable:CT

Hemodynamically Unstable: Bedside U/S and immediate surgery

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5
Q

MRI indication in back pain?

A

Acute + red flag sign

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6
Q

GB CM?

A

ICP sign and Sx
Personality change
Frontal lobe serpiginous mass

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7
Q

Acute mediastinitis Tx?

A

Wound debridement
Antibiotic Management
10-50% mortality
Complicate 5% of open cardiac surgery

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8
Q

AF after CABG?

A

<24 hr–Beta blocker/amidadrone

last > 24 hr after CABG–Anticoagulation and or Cardioversion

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9
Q

Can SAH patients have FEVER?

A

Yes?But usually low grade

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10
Q

Acute pancreatitis diagnosis algorithm?

A 
>=2 from 3 criteria
1)Abd.Pain that radiates to back
2)Rise in serum amylase/lipase >3
3)Cx imaging finding in CT/MRI or U/S
CT finding may delay 48 hr but amylase and lipase rise within hours(as a result more used)
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11
Q

ERCP complication?

A

Perforation(BW,BD,PD)
Pancreatitis
Ascending cholangitis

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12
Q

Bladder rupture after BAPT CXS?

A

The dome is usually Affected
Intraperitonial fluid/urine
Peritonitis does not develop acutely due to urine is sterilized

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13
Q

CM of bladder rapture?

A

Hematuria (90 %)
Suprapubic tenderness
Difficulty of voiding
Associated with pelvic #

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14
Q

Diagnosis?

A

Retrograde Cystography(water-soluble contrast inflated using catheter then do CT)

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15
Q

Management?

A

Surgical repair if intraperitonial

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16
Q

When considering DPL?

A

Hemodynamically unstable –No time for CT

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17
Q

cause of femoral nerve injury?

A

Hip dislocation
Pelvic #
Illiacus heamatoma
Iatrogenic

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18
Q

Iatrogenic cause of FNI?

A

Prolonged dorsal lithotomy position(Childbirth, pelvic surgery)
Femoral artery/vein procedure

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19
Q

CM?

A

The inability of hip flexion
Knee extension
Loss of sensation in the anterior and medial thigh

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20
Q

Effect of Intubation on Hypovolumic shock patien?

A

HS patients have low CVP–Increase intrathoracic Pressure by positive ventilation—compress veins like IVC—Cardiac arrest/Respiratory failure due to decreased cardiac preload

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21
Q

The only Major modifiable RF associated with Chron’s disease progression and severity?

A

Smoking
Increase hospitalization
Increase need for surgery
Failure of medical treatment

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22
Q

Another risk for severe disease?

A 
Start at a young age<30
High anatomic area involvement
Stricture formation
Fistula
Deep ulceration
Prior need surgery
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23
Q

AAA rapture suspect approach?

A

HS: CT
HU: FAST if have no hx but immediate surgery if already px diagnosis of AA.

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24
Q

Acute Bacterial prostatitis CM?

A 
AUR
Fever
Dysuria
Leukocytosis
Tender Prostate
25
Q

pathogenesis?

A

Urine reflex–enter to prostate
Common etiology are urinary tract pathogen
Protus, E.Coli…

26
Q

Management?

A

6 weeks (TM–CTM and Levofloxacline)
Prostate Ab acumulation
Urine culture for etiology

27
Q

Chronic bacterial prostatitis epidemiology?

A

MC in young and middle-aged men

DM, Smoking, and urinary procedure increase the risk

28
Q

Clinical presentation?

A

Recurrent UTI/Sx of UTI with the same organism
Pain during ejaculation
Hx of antibiotic use–transient improvement
Prostatic swelling and tenderness are usually absent

29
Q

diagnosis?

A

pyuria/bacteriuria in urinalysis

30
Q

TM?

A

antibiotic for 6 week

31
Q

what about chronic epididymitis?

A

N.gonoriha and chlamydia are common etiology
tenderness at the upper border of tests
may have pain during ejaculation and LUT sx

32
Q

How is muscle exercise is useful in osteoarthritis?

A

Non-use due to pain mainly at old age—Exacerbate articular degeneration. Exercise prevents this.

33
Q

Blunt orbital trauma pathophysiology?

A

BOT–Increase IO pressure–# of medial and inferior well–Muscle entrapment–Difficulty/diplopia) in seeing to upward and latteraly.

34
Q

What is CVP indicate?

A

RAP(2-6 mm Hg)

35
Q

what it helps in identifying the type of shock/

A

Low CVP–Distributive/hypovolumic

High CVP—Obstructive/cardiogenic

36
Q

cause of cardiac-related shock?

A

RV injury–Further rise in CVP after fluid
LV injury–Refractory shock
Cardiac Tamponade—Beck triad

37
Q

extraperitoneal bladder injury CM?

A

MC associated with pelvic #
Like IP heamaturia,AUR and Suprapubic ditension/tenderness
More localized symptom
Negative FAST/No late peritonitis or ascites

38
Q

Diagnosis and management?

A

RCU

39
Q

What about ureter injury?

A

MC associated with penetrating AT/surgery
Haematuria
Flank/Lower Abd pain depending on location

40
Q

Post BA trauma pan.psudocyst CM?

A

Occur after weeks
epigastric pain/tenderness
Bilious vomiting
Good differential for duodenal hematoma(DH develop 24-48 hr after trauma)

41
Q

papillary thyroid ca managment?

A

Surgery
The extent of surgery depends on the stage
Radioiodine replacement after surgery for patients with a high risk of recurrence
Adequate Thyroid supplementation to suppress TSH(TSH increase tumor cell growth)

42
Q

Partial thyroidectomy indication?

A

Size <1-2 CM

Not involve LN, adjacent tissue, another thyroid lobe(in this case and large do total thyroidectomy)

43
Q

high risk of recurrence?

A

large size
Extratyroid tissue involvement
LDN
Incomplete resection

44
Q

Post-surgery refractory shock cause in a patient with chronic glucocorticoid usage?

A

Low HPA–Secondary AI

45
Q

Eye chemical injury CM?

A 
Eye pain
Blepharospasm
Gritty sensation in the eye
Eye erythema
Severe--ischemia--white conjunctiva
46
Q

Path?

A

Acid: Coagulative Nec.-no further injury
Base: Liquifactive Nec–further damage(more severe)

47
Q

Management?

A

Irrigate with saline until neutral PH(asses using TBT)

we may use Topical Ab

48
Q

etiology for fat embolism syndrome?

A

of marrow containing bone
Orthopedic surgery
Pancrititis

49
Q

CM?

A 
24-72 Hr after the event
Triads
1-RD(mainly due to ARDS)
2-Neurologic dysfunction(e.g AMS)
3-Petichial rash(<50 %)
Thrombocytopenia (PLT attach to fat globule)
50
Q

Diagnosis?

A

Clinical
CT may miss b/c of the small size of FAT globule
manage by supportive therapy and imobilization

51
Q

How to d/t from aspiration pneumonia with ARDS?

A

Will have a fever and leukocytosis unkike FES

52
Q

what about DRESS-related ARDS?

A

Eosinophilia
Macular rash
Mainly related to CPZ and LMT

53
Q

Paraesophagial hernia pathophysiology?

A

Diaphragmatic membrane defect–Esophagial fundus herniation/intraabdominal organ herniation–If an advanced respiratory compromise

54
Q

CM?

A 
Nausea and vomiting
early satiety
Epigastric discomfort
Dysphagia
chest pain
55
Q

diagnosis and Management?

A

Air fluid level cavity on chest(may also be seen in HH)

Mainly need surgical repair, unlike HH which is managed by GERD sx Tx.

56
Q

What about HH?

A

Mainly asymptomatic
May have GERD symptom
Cardia will herniate
Due to diaphragm mam laxity

57
Q

Catheter-associated UTI inpatient in need of prolonged cath. can be prevented by?

A

Intermittent catheterization(removal, clean, and reinsert every 4-6 hr)–by a caregiver

58
Q

If unable to do IC?

A 
Indwelling catheterization(keep fo month and change)--High risk of CAUTI
Suprapubic catheterization
59
Q

Hypoxia management in epiglotitis?

A

1st–Bag-valve-Mask with 100 % ) O2–if archive saturation
2nd-Video-assisted intubation–If fails do not repeat unless Video-assisted did in the previous one
If intubation fails–cricothyroidotomy

Surgery 1 (11 decks)

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