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Surgery 1 > S8 > Flashcards

S8 Flashcards

1
Q

What to do immediately after acute limb ischemia is diagnosed?

A

Stars immediately heparin

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2
Q

psudomonas arginosa folliculitis CM?

A

most cases develop within the hour to days
after swimming in inadequately chlorinated water
generally tender papule,pustule or nodule
treat with fluoroquinolone

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3
Q

what about S.Aureius?

A

MCC of folliculitis
A purulent lesion with surrounding erythema and induration
Respond to cotrimoxazole

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4
Q

Ogilvie syndrome?

A

Acute colonic pseudo-obstruction

Manifest as paralytic ilius

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5
Q

Etiology?

A

Major surgery, traumatic injury, and severe infection
Electrolyte derangement(low K,Ca and Mg)
Medication(Opiates and anticolinegics)
Neurogenic disorder(Parkinson and strock)

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6
Q

imaging?

A

x-ray–Colonic dilation with normal haustra and normal SB

CT scan: Colonic dilation with normal anatomy(haustral non dilated segment)

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7
Q

management?

A

NPO.NG tube decompression

Neostigmine if no improvement within 48 hr/local diameter > 12 CM or perforation sighn

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8
Q

Does a common tumour metastasize to the spine?

A

Breast
Prostate
Lung
Multiple myeloma

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9
Q

SX progression?

A

back pain 1-2 month–motor symptom–bowel/bladder dysfunction

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10
Q

Glucocrticoid benifit?

A

Reduce vasogenic edema caused by vessel obstruction by tumor

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11
Q

phantom limb sx?

A

Neuropathic pain(shooting and burning)
On absent limb site
The pain increased by unrelated activity like defecation
Prior major NV injury and post-op pain in.risk

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12
Q

Management?

A

Multimodal
1-pharmacotherapy: Antidepressant, antiepileptic, NMDA receptor antagonist, and analgesics
2–adjuvant–CBT, Biofeedback and minor therapy

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13
Q

managment of diverticulitis?

A

depend on whether uncomplicated or not(abscess, perforation, obstruction, and fistula_?

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14
Q

Uncomplicated ?

A

Bowel rest, Oral Ab and observation

Hospitalization and IV Ab if IC, Elderly, Very high fever, and significant leukocytosis

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15
Q

Abscess management?

A

<3-4 CM–Iv Ab but if sx persist surgery

>3-4 CM–CT guided SC drainage but if sx persist surgery

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16
Q

Surgical drainage indication?

A

Perforation with peritonitis
Obstruction
Fistula
Recurrent attack

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17
Q

Complication of pancriatic psudosist?

A

duodenal/biliary obstruction
psudoanurythm
pancreatic ascites
pleural effusion

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18
Q

management?

A

No Sx/Compl–Sx tx and NPO

Sx/complication –drainage

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19
Q

CM?

A

Nausea and Vomiting
Abd pain
Elevated amylase
Abdominal distension

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20
Q

Alpha 2 antagonist in urethral stone?

A

Dilate the spasmodic contraction of urethral smooth muscle—Facilitate passage

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21
Q

A cause for hemorrhagic shock in patients with trauma and normal chest, Negative fast and normal pericardium?

A

Pelvic fracture(pelvic X-ray routine, bleed may accumulate in retroperitoneum)
Neurologic shock due to spinal injury–But will have bradycardia and motor Sx
Adrenal injury–But occur in a patient with adrenal insufficiency

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22
Q

When a patient with a superior sulcus tumor will have pulmonary Sx?

A

When tumor advances

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23
Q

Diagnosis approach to SCC suspicion?

A

Biopsy involving deep dermis

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24
Q

Risk factor for UE DVT?

A

CV catheter
Repetitive arm movt(pinching)–Vien damage
Malignancy
Wight lifting—Scalen and SClavius muscle Htr–Vien obstruction
Thoracic outlet obstruction—Vien obstruction

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25
Q

CM?

A

Acute right arm edema, heaviness, pain, and erythema.
Dilated SC collateral vein in upper chest and UE
PE

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26
Q

Tx?

A

3-month anticoagulation

Thrombolysis(if Non-CIV related)

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27
Q

Hepatic adenoma immaging?

A

Well demarcated hyperechoic lesion with peripheral enhancement

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28
Q

Typical patient?

A

Women with long term OCP usage
anabolic androgen
pregnancy

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29
Q

Complication?

A

Groweth
Rapture
malignant transformation

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30
Q

Management?

A

Surgical removal

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31
Q

Prosthetic joint infection classification?

A

early onset
delayed onset
late-onset

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32
Q

early onset?

A

,3 month
acute pain wound infection or breakdown, and fever
S.A, G -Ve rods, and anaerobes are common etiology

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33
Q

delayed onset?

A

3-12 month
Chronic joint pain, Implant loosening, and sinus tract formation
Coag -Ve staph,Enterococci and propiniobacterium species

34
Q

Late-onset?

A

> 12 month
Acute symptom in previously asymptomatic joint
Recent infection at a distant site
S.A.G-Ve rods and BHS

35
Q

MCC for acute back pain and tenderness w/o neurologic deficit?

A

Vertebral compression fracture(usually will not have neurologic deficit)

36
Q

What about Disk herniation?

A

Unlike VCF pain is relieved by rest (VCF exacerbated on lying back)
DH—Neurologic deficite

37
Q

Negative pressure pulmonary edema?

A

Upper airway obstruction–exhalation against closed glotis—High negative pulmonary pressure–Noncardiogenic pulmonary edema
Can occur after extubation due to laryngeal spasm especially in head and neck surgery.

38
Q

What to do inpatient with secondary polycythemia with no sign and sx chronic hypoxia?

A

Abdominal CT(to r/o liver and renal malignancy)

39
Q

How to d/t from rotator cuff tendinopathy/impingement from tear?

A

T/I–pain on shoulder abduction and ER w/o weakness
tear—they will have a weakness
Diagnose with MRI

40
Q

Clavicular fracture managment?

A

if the hard sign of vascular injury—Open reduction(I,AP,B/T and EH)
If the soft sign of VI(CT angiography)
If simple middle 13 fracture–Closed reduction with 8 bandage
Distal 1/3 may need

41
Q

renal abscess CM?

A 
Previous Hx of 1-2 moth prior UTI
Insidious onset
Right flank pain
Localized tenderness or mass
Fatigue, Weight loss, fever, and diaphoresis
UTI sx usually absent
Urinalysis may suggest UTI if abscess contact with collecting tubule
Elevated ESR and CRP may be present
Leukocytosis and AKI sign may be present
42
Q

Diagnosis?

A

CT

Ultrasound

43
Q

Management?

A

Ab

Percutaneous drainage

44
Q

risk factor?

A

Anatomic abnormality(VUR/NB)
Uncontrolled DM
Nephrolithiasis
Tobacco usage

45
Q

Indication for thoracotomy in hemothorax?

A

If initial drains >1500ml with chest tube
Continuous drainage >200ml/hr for more than 2 hours
Continuous need of transfusion to maintain hemodynamics

46
Q

Pyogenic liver absces CM?

A

RUQ apin
Fever
Lukocytosis
Elevated Liver enzyme

47
Q

Imaging?

A

round hypoatinuated lesion

48
Q

Cause?

A

Penetrating trauma
Adjacent tissue infection(AC)
Distant infection(IE)
Through portal vein–Any GI infection

49
Q

management?

A 
Percutaneous aspiration(diagnostic and management)
Ab
Place drainage tube
Surgery if PC drainage is not effective
Blood culture
50
Q

what about a Hyaditid cyst?

A

Asymptomatic unless enlarged and rapture

septated cystic lesion with may have calcification

51
Q

what about amebic liver abscess?

A

suspect if no have a risk for PLA
Live in an endemic area
Diagnose using serology and stool ova

52
Q

auscultatory finding in pulmonary contusion?

A

localized
Rales
Decrease breath sound

53
Q

treatment?

A

Pain control
Pulmonary hygiene(incentive respiration & PT)
O2 supplementation

54
Q

diagnosis?

A

ground-glass opacity on Chest CT

55
Q

treatment of varicocele?

A

Yonge children and adolescent–gonadal vein ligation to prevent infertility
Testicular support and NSAID for older who don’t want fertility

56
Q

referred otalgia causes?

A

TMJ disease
Dental disease
Nasopharyngeal SCC

57
Q

Diaphragmatic injury diagnosis modality?

A

CT

58
Q

cause of immidiate post oprative period?

A 
within hour
1--prior infection or trauma
2-Inflammation due to surgery
3-Malignant hyperthermia
4-Anesthetic medication
5--Blood product
59
Q

Drug-related fever in the postoperative period?

A

MC in B-lactam
Present after one week
Will have a rash and peripheral eosinophilia

60
Q

Sphincter of Oddi dysfunction cause?

A

Functional or stenosis
Inflammatory dysfunction
Opioids–precipitate it

61
Q

CM?

A

RUQ pain
Jaundice
Elevated ALT/ALP
Dilated CBD in absence of stone

62
Q

Diagnosis and management?

A

Sphincter Oddi manometry

Spnicterectomy for management

63
Q

In low suspicion to abdominal injury?

A

Serial PE and HCT and F-UP?

64
Q

Common site of cervical facet dislocation?

A

C5/6–CN6 inj—defect in wrist extension and numbness on forearm and thumb
C6/7–CN 7–defect in elbow extension, wrist flection, and numbness on index and middle finger.

65
Q

Central cervical cord syndrome CM?

A

early–Bilateral UE sensory sx–Due to AC lesion

Late(expanding)—Motor weakness in early UE Then LE.because UE motor neuron found medially.

66
Q

Angiosarcoma CM?

A

ecchymotic/purpuric mass on the area of lymphedema/localized radiation.
metastasize through B/V early
The second one has a poor prognosis

67
Q

Management?

A

Surgery

68
Q

rectus abdomens hematoma risk factor?

A 
forceful coughing
abdominal trauma
anticoagulation
old age
female sex
69
Q

CM?

A 
Acute onset abdominal pain
palpable abdominal mass
Blood loss anemia
Leukocytosis
-/+ nausea, vomiting, and fever
70
Q

Management?

A

HS:reverse anticoagulation,follow with CBC,transfuse if anemic.
HU: Angiography with surgical embolization and surgery

71
Q

Diagnosis?

A

CT

72
Q

Stress fracture CM?

A

Insidious onset of localized pain
Point tenderness at the fracture site
Possible negative x-ray in first 6 week
The anterior tibia and 2nd metatarsal are commonly affected

73
Q

Management?

A

Reduce weight bearing 4-6 week
In middle 2nd/3rd/4th not need splint just analgesic(PCM, NSAID not recommended)–nearby tarsal act as a splint–Do splint if pain persists.
1st and 5th metatarsal splint with hard shoe

74
Q

Is prophylactic dose heparin is preventive for PE in high-risk patients?

A

No

75
Q

What is the preferred drug for PE in cancer patients?

A

Therapeutic dose low molecular heparin (dalteparin and enoxaparine)
Oral anticoagulant, not preferred due to high risk of bleeding

76
Q

why the SCC of the head and neck will have otalgia?

A

Ix–Inervate base of tognque
X–inervate larynex,hypopharnex
and both nerves innervate external auditory meatus

77
Q

what to do inpatient with haematuria w/o clear reason and age >40?

A

Cystoscopy

CT urography to visualize kidney to help see kidney and staging if B Ca.

78
Q

cause of hypercalcemia in cancer?

A 
Metastasis(whole body scan)
PHrP secretion(serum level)
79
Q

Lung SCC CM?

A

Central mass(usually hilar area)
Hypercalcemia
Hypercalcemia symptom
Smoking is a single MC risk factor

80
Q

Epidermal inclusion cyst CM?

A

MC at face, neck, scalp, and trunk
Cystic mass
May have central punctum
May have cheasy discharge

81
Q

Epidermal inclusion cyst CM?

A

MC at face, neck, scalp, and trunk
Cystic mass
May have a central punctum
May have cheesy discharge

82
Q

Tracheobronchial injury sign?

A

may have persistent pneumothorax and pneumomediastinum despite chest tube placement
bronchoscopy is diagnostic
surgical repair is diagnostic
the more proximal the lesion the more leak

Surgery 1 (11 decks)

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