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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
CM?
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
26
management?
``` Emergency ophthalmology referral Eye shield CT scan of the eye IV Ab Tetanus prophylaxis ```
27
complication?
Endopthalmitis Cataract decrease vision
28
Hypopyon?
Layering of inflammatory cell in anterior chamber in below(like pus)
29
Pancreatic Ca manifestation?
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
Diagnosis?
CT scan
31
Common bacteria for osteomylitis after puncture wound?
S. Aures | Pseudomonas (Warm and hot area like foot)
32
X-ray feature seen in osteomylitis?
> 2 week
33
patella dislocation pathophysiology?
quick lateral movt with flexed knee--Quadriceps contraction---lateral displacement of patella--tear of medial pattelofemoral ligament
34
CM?
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
diagnosis?
Clinical | X-ray require for assesment of further injury after reduction
36
Management?
Usually resolve spontaneously Closed reduction if resist Splinting and rehabilitation
37
Popilital(becker cyst) ethiology?
Extrusion of fluid from joint space to SM and GS bursa
38
RF?
``` Trauma(e.gmenisci tear) Joint disease (OA ,RA.....) ```
39
CM?
Asymptomatic swelling in posterior knee that reduce with flexion Pain,Swelling and stiffens in posterior knee that may extend below
40
complication?
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
Investigation?
U/S r/o DVT and confirms PC
42
Porclain gall bladder?
Accumulation of Ca in gall bladder wall---due to chronic infn or stone irritation
43
Diagnosis?
X-ray may show calcification but CT confirm diagnosis
44
Managment?
Cholecystectomy specialty symptomatic(pain and mass) and incomplete mural calcification
45
Ankle sprain management?
Compression bandage/brace Ice pack Crunch
46
commonly injured in sprain?
``` Anterior thalofibular(MC) Calcanofibular in sever injury ```
47
post cardiac surgery DRESSLER syndrome?
present after several weak may have plural effusion echo--Pericardial effusion
48
managment?
Mild:NSAID and Cholchicine Sever:Steroid
49
complication?
mainly resolve but can cause recurrent pericarditis and lead to constrictive pericarditis
50
heamaturia pattern in relatin with site of lesion?
Be for urine--Urethra throughout urination--Any wear from kidney to bladder Terminal--Bladder trigon,Neck,Prostate and Posterior urethra
51
What to do in terminal heamaturia?
Cystoscopy
52
indication to cystoscopy?
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
Illius cause?
Surgery with bowel manipulation(pathological if >3-5 day post op) Hypokalemia Opiates
54
CM?
nausea,Vomiting Diffuse abdominal pain with minimal tenderness Distended bowel without AFL in x-ray Decrease bowel activity
55
Common shoulder dislocation?
Anterior(sholder injury while in abducted and ER location)
56
Complication?
Axillary nerve injury(Innervate tares minor and deltoid)--Inability to abduct shoulder and loss of sensation in lateral shoulder
57
Blunt aoric injury cause?
Fall from >3 m
58
CM?
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
Diagnosis?
Trans esophagial echo for HU patient | CT angiography in HS patient
60
Cardiac contusion diagnosis?
EKG(arrhythmia or new BBB) | ECHO(wall motion abnormality)
61
Future in PFT in MV patient with pnumothorax?
Increase peak pressure(due to MV) and peak airway pressure
62
spontaneous pneumothorax management?
<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
Central venous catheter insertion?
IJV (U/S guided) | SCV (By anatomy)
64
what to do after insertion?
X-ray to asses misplacement (the tip should be located in lower SVC,at angle of trachea and right main bronchus)
65
improper insertion/tip placment complications
Right atrium--Arrhythmia Tip in small vessel(SC,AZ...)--Venous rapture Lung--Pulmonary contusion--Pneumothorax Cardiac--Perforation--Cardiac Temponade
66
X-ray feature of HIP osteoarthritis?
Subaccitabular sclerosis Joint narrowing Periarticular osteophytes
67
uretric/renal Stone managment in absence of urosepsis,ARF or complete obstruction?
<5 mm --Outpatient(>2-2.5/l water,analgesics Strain urine) 5-10--Add alpha blocker >10 consider lithotripsy
68
Angle-closure glaucoma management?
``` Topical Timolol--Reduce AH production Apraclonidine--Reduce AH production and increase the flow Pilocarpine--Increase flow systemic Acetazolamide--reduce AH production Irridectomy ```
69
Imaging indication in cervical spine injury suspects?
``` Neurologic deficit Spinal tenderness AMS Intoxication Distracting injury ```
70
Best imaging?
Spinal CT without contrast(X-Ray have low sensitivity 55% unlike CT 95%)

Surgery 1 (11 decks)

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