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Surgery 1 > S5 > Flashcards

S5 Flashcards

1
Q

Is mention treatment other than Ab in septic arthritis?

A

easily accessible joint–Serial Needle aspiration(may need daily)
A deep joint like HIP—arthroscopic irrigation/open surgical drainage.
A splint may be used but not cast to relieve pain

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2
Q

ACR sign in Liver transplant?

A

Fever, fatigue, and elevated LE
MC in first 3 months of LT
The definitive diagnosis is Biopsy

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3
Q

Biopsy feature?

A

Mixed inflammatory cell infiltration(L,E, N) of portal tracts
Interlobular BD destruction
Endothelitis(Inflammation with Lymph.Subendothelial invasion of Portal and hepatic vein

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4
Q

Management hemorrhoid?

A

High dose corticosteroid(Usualy reverse) if resist Immunosupresant(Tymoglobulin,sirolimus…)
Repeat transplant if all medical management fails

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5
Q

Dietary Management hemorrhoid?

A

Inc Water intake
Low-fat diet
Increase fiber diet
Moderation of alcohol intake

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6
Q

behavioral?

A

Limite sitting time in the toilet
Reduce frequency of defecation to 1
Avoid straining during defication

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7
Q

Topical agent?

A

Analgesic (e.g benzocain)
Phlebotonic agent(calcium debisulate)
Astrizget (e.g which hezel)
Hydrocortison

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8
Q

Rubber band ligation and surgical repair indication?

A

Refractory case

Non-reducible hemorrhoid

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9
Q

Post oprative manuber help reducing post oprative pnumonia?

A 
Incentive spirometry(most effective)
Deep breathing exercise
Continuous PPV
Intermittent PPV
Pain control in subcostal surgery in age <50
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10
Q

Sign of Perforation in bowel obstruction?

A

Air under the diaphragm on upright/left decubitus position
Peritonitis
CT: Fluid/Air on CT(if X-ray does not see the air and strong clinical suspicion there)

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11
Q

Zincker psudodiverticulum diagnosis?

A

Barium swallow

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12
Q

CM?

A 
Age>60
progressive dysphagia
Undigested food regurgitation
Halithosis
Recurrent aspiration pneumonia
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13
Q

Pathophysiology?

A

Motor dysfunction–Increase pressure in pharynx–mucosa and submucosa protrusion through inferior pharyngeal constrictor and cricopharyngeus muscle

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14
Q

Management

A

Diverticulotomy

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15
Q

CM of osteosclerosis?

A

Progressive CHL
Paradoxical improvement of hearing in a noisy environment unlike SNHL
Redish hu behind hue membrane(excessive bone resorption–B/V become visible)
AD penetrance

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16
Q

Dumping syndrome CM?

A

15-30 min after meal
Abd pain, diarrhea, and nausea
Hypotension and tachycardia
dizziness/fatigue, confusion and diaphoresis

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17
Q

Pathogenesis?

A

%0% post gasterectomy–injury to pylorus–Rapid emptying of hypertonic gastric content–Interstitial fluid loss.AN activation and VIP release

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18
Q

management?

A

Small frequent meals
replace simple sugar with complex carbohydrate
Incorporate high fiber food and protein-rich food

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19
Q

when to suspect gastrinoma?

A

multiple gastric/duodenal ulcer with prominent gastric fold

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20
Q

test first to do?

A

Serum gastrin level off from PPI fro 1 week

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21
Q

Next step?

A

<110 pg.dl–no gastrinoma
110-1000–do secretion stimulation test–If + diagnose /if -no gastrinoma
>1000—Do gastric PH if <4 gastrinoma if >4 no gastrinoma(it may be achloridia)

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22
Q

If gastrinoma is diagnosed what to do?

A

Localize the tumor

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23
Q

management?

A

High dose PPI

Surgery for localized one

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24
Q

open globe injury RF?

A 
Blunt trauma(rapture)
Penetrating trauma(laceration)
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25
Q

CM?

A

Extrusion of vitreous humor (gush of fluid)
Eccentric or teardrop pupil(due to irris dilatation by laceration or IOFB)
Decrease visual acuity
Relative afferent papillary defect
Decrease intra ocular pressure

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26
Q

management?

A 
Emergency ophthalmology referral
Eye shield
CT scan of the eye
IV Ab
Tetanus prophylaxis
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27
Q

complication?

A

Endopthalmitis
Cataract
decrease vision

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28
Q

Hypopyon?

A

Layering of inflammatory cell in anterior chamber in below(like pus)

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29
Q

Pancreatic Ca manifestation?

A

Constant and progressive epigastric pain
Radiate to back
worsen bay eating and lying back and relive by recumbent position
Wt loss,Jaundice and wight loss may be present

30
Q

Diagnosis?

A

CT scan

31
Q

Common bacteria for osteomylitis after puncture wound?

A

S. Aures

Pseudomonas (Warm and hot area like foot)

32
Q

X-ray feature seen in osteomylitis?

A

> 2 week

33
Q

patella dislocation pathophysiology?

A

quick lateral movt with flexed knee–Quadriceps contraction—lateral displacement of patella–tear of medial pattelofemoral ligament

34
Q

CM?

A

Feeling knee give away,sever pain and pooping
Decrease knee extension
Lateral dislocation of patella(iregular mass lateral to femoral throcanter)
Heamartrosis and tenderness at medial knee–Due to tear of MCL
empityness at patela area
flexed and decrease knee range of motion(unlike knee ligament and meniscial injury)

35
Q

diagnosis?

A

Clinical

X-ray require for assesment of further injury after reduction

36
Q

Management?

A

Usually resolve spontaneously
Closed reduction if resist
Splinting and rehabilitation

37
Q

Popilital(becker cyst) ethiology?

A

Extrusion of fluid from joint space to SM and GS bursa

38
Q

RF?

A 
Trauma(e.gmenisci tear)
Joint disease (OA ,RA.....)
39
Q

CM?

A

Asymptomatic swelling in posterior knee that reduce with flexion
Pain,Swelling and stiffens in posterior knee that may extend below

40
Q

complication?

A

Venous compresion(Leg and knee swelling)
Di section to calf(Edema,Erythema and positive homman sign)
Cyst rapture(acute calf pain,warmth,echemosis and erythema)
Medial malolus mass and cresentic echemosis

41
Q

Investigation?

A

U/S r/o DVT and confirms PC

42
Q

Porclain gall bladder?

A

Accumulation of Ca in gall bladder wall—due to chronic infn or stone irritation

43
Q

Diagnosis?

A

X-ray may show calcification but CT confirm diagnosis

44
Q

Managment?

A

Cholecystectomy specialty symptomatic(pain and mass) and incomplete mural calcification

45
Q

Ankle sprain management?

A

Compression bandage/brace
Ice pack
Crunch

46
Q

commonly injured in sprain?

A 
Anterior thalofibular(MC)
Calcanofibular in sever injury
47
Q

post cardiac surgery DRESSLER syndrome?

A

present after several weak
may have plural effusion
echo–Pericardial effusion

48
Q

managment?

A

Mild:NSAID and Cholchicine
Sever:Steroid

49
Q

complication?

A

mainly resolve but can cause recurrent pericarditis and lead to constrictive pericarditis

50
Q

heamaturia pattern in relatin with site of lesion?

A

Be for urine–Urethra
throughout urination–Any wear from kidney to bladder
Terminal–Bladder trigon,Neck,Prostate and Posterior urethra

51
Q

What to do in terminal heamaturia?

A

Cystoscopy

52
Q

indication to cystoscopy?

A

Gross hematuria w/o evidence of GD or infection
Microscopic hematuria w/o evidence of GD or infection but risk of ca
Recurrent UTI
Obstructive Sx with suspect ion of stricture or stone
Abnormal imaging or urine cytology

53
Q

Illius cause?

A

Surgery with bowel manipulation(pathological if >3-5 day post op)
Hypokalemia
Opiates

54
Q

CM?

A

nausea,Vomiting
Diffuse abdominal pain with minimal tenderness
Distended bowel without AFL in x-ray
Decrease bowel activity

55
Q

Common shoulder dislocation?

A

Anterior(sholder injury while in abducted and ER location)

56
Q

Complication?

A

Axillary nerve injury(Innervate tares minor and deltoid)–Inability to abduct shoulder and loss of sensation in lateral shoulder

57
Q

Blunt aoric injury cause?

A

Fall from >3 m

58
Q

CM?

A

Sever chest pain
Hypo-tension
Hypertension(SN activation)/Nonsensitive in incomplete rapture
Widened media-sternum(>8 CM in supine and >6 CM in erect X-ray)
Left side Plural effusion

59
Q

Diagnosis?

A

Trans esophagial echo for HU patient

CT angiography in HS patient

60
Q

Cardiac contusion diagnosis?

A

EKG(arrhythmia or new BBB)

ECHO(wall motion abnormality)

61
Q

Future in PFT in MV patient with pnumothorax?

A

Increase peak pressure(due to MV) and peak airway pressure

62
Q

spontaneous pneumothorax management?

A

<2 CM and HS–Observation and supplementary O2(Regardless of O2 saturation B/C it helps in resorption)
>2 CM and HS–Needle tracheotomy (at 2nd and 3rd ICS at MCL and 5th ICS at Anterior and Mid axillary line)
>2 CM and HU–Emergency CT placement
recurent or failure of lung expansion >90 % after CT–Plurodenesis or laparoscopic tracheotomy in suscpection of continuous leak

63
Q

Central venous catheter insertion?

A

IJV (U/S guided)

SCV (By anatomy)

64
Q

what to do after insertion?

A

X-ray to asses misplacement (the tip should be located in lower SVC,at angle of trachea and right main bronchus)

65
Q

improper insertion/tip placment complications

A

Right atrium–Arrhythmia
Tip in small vessel(SC,AZ…)–Venous rapture
Lung–Pulmonary contusion–Pneumothorax
Cardiac–Perforation–Cardiac Temponade

66
Q

X-ray feature of HIP osteoarthritis?

A

Subaccitabular sclerosis
Joint narrowing
Periarticular osteophytes

67
Q

uretric/renal Stone managment in absence of urosepsis,ARF or complete obstruction?

A

<5 mm –Outpatient(>2-2.5/l water,analgesics Strain urine)
5-10–Add alpha blocker
>10 consider lithotripsy

68
Q

Angle-closure glaucoma management?

A 
Topical
Timolol--Reduce AH production
Apraclonidine--Reduce AH production and increase the flow
Pilocarpine--Increase flow
systemic
Acetazolamide--reduce AH production
Irridectomy
69
Q

Imaging indication in cervical spine injury suspects?

A 
Neurologic deficit
Spinal tenderness
AMS
Intoxication
Distracting injury
70
Q

Best imaging?

A

Spinal CT without contrast(X-Ray have low sensitivity 55% unlike CT 95%)

Surgery 1 (11 decks)

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