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Surgery 1 > SB10 > Flashcards

SB10 Flashcards

1
Q

Courvoisier sign?

A

Painless jaundice and non-tender distended gallbladder

CM of pancreatic head tumor

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2
Q

pancreatic tumour location and CM?

A

Head–courvoiser sign

Bodie and tail–Abdominal pain

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3
Q

Sign of IBD?

A

Abdominal pain
Chronic diarrhea
IDA
Elevated C reactive P and ESR

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4
Q

What to do?

A

Colonoscopy

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5
Q

What complication occurs if gallstone obstructs ampulla of vater?

A

Obstructive jaundice
Cholangitis
Pancreatitis

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6
Q

How to manage?

A

ERCP

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7
Q

why CT is not good?

A

Many gallstones are radiolucent –It may miss them

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8
Q

Pnumoperitomium plus acute Abd, Pain?

A

Perforated PUD

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9
Q

What to do immediately after any type of knee dislocation?

A

Immediate reduction

Assess vascular injury

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10
Q

How to assess vascular injury?

A

Palpation of popilital and distal pulse
Ankle-brachial index
Dopler if available

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11
Q

peritonsillar abscess management?

A

Drainage of abscess

Antibiotic covering GAS and oral anaerobe

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12
Q

Indicators for an upper airway burn injury?

A 
Burn of the face
singeing of the eyebrow
Oropharyngeal inflammation
Blistering or carbon deposit
Carbonaceous sputum
Stridor
Carboxyhemoglobin >10 %
Hx of confinement in a burning building
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13
Q

If we found >=1 above sign?

A

early intubation is indicated

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14
Q

Indication for parathyroidectomy in primary hyperparathyroidism?

A

Age < 50
Symptomatic hypercalcemia
Complication(Renal stone,nephrosclerosis,CKD and osteoporesis)
Elevated risk of complication(Serum Ca >1mg/dl over the normal value and renal exresion >400mg/day

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15
Q

what to do?

A

CT

then refer to surgery

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16
Q

cause?

A

PTH adenoma(MC)
PTH hyperplasia
Parathyroid ca

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17
Q

Sternal wound soft tissue dehiscence w/o sternal dehiscence management?

A

CT to evaluate mediastinitis sign
emergency surgical debridement
tissue culture
Immediate IV antibiotic

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18
Q

Renal vein thrombosis management?

A

If have AKI–emergency clot removal

If no AKI—anticoagulation

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19
Q

Green discharge in chest tube after a thoracic injury?

A

esophageal perforation

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20
Q

MAC lymphadenitis CM?

A

Necrotic LN
Violaceous discoloration of the skin
Frequent fistula formation

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21
Q

Brachial cleft cyst location?

A

anterior to SCM muscle, B/N ICA, and ECA, Below mandible
remnant of 2nd Bracial cleft
Clinically detected when superinfected like in case of URTI

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22
Q

laryngiocele?

A 
Is outpoching of larengial mucosa
Acquired(in glassblowers and trumpet players) or congenital
Located in a lateral neck mass
Increase with Valsalva
Protrude through the thyrohyoid membrane
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23
Q

mainstay of larengial papilomatosis?

A

Surgical debridement

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24
Q

Management of NPH?

A

High volume lumbar puncture with placing VP/VC shunt

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25
Q

diagnosis for epiglotitis?

A

Direct visualization

Lateral neck X-Ray

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26
Q

Laryngiothracheal(anterior neck tenderness) may be a sign of?

A

Epiglottitis

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27
Q

Evaluation and management of pharyngitis?

A 
Based on this 4 criterion
1-Fever by Hx
2-Tender ACLDP
3-Tonsilar exudate
4-Absence of cough
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28
Q

then?

A

0-1–no investigation/tx
2-3–Rapid Strep Ag test
4–emperic penicilin/Rapid Streep ag test

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29
Q

What to do patient with BAT and mesenteric hematoma/contusion?

A

Follow inpatient b/c they are a risk for delay perforation due to progression to full-thickness injury and perforation–which warrant immediate laparotomy

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30
Q

Etiology of a meniscal tear?

A

Young: Rotation on a planted foot

Old–Degeneration of meniscal cartilage

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31
Q

CM?

A

Acute pooping sensation
Catching/locking and Reduced ROM
Slow onset joint effusion

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32
Q

examination?

A

Joint line tenderness

Pain/Caching in provocative tests

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33
Q

diagnosis?

A

MRI(Do if pt young, mechanical limitation or recurrent effusion)
Arthroscopy

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34
Q

Management?

A

Mild sx, older patient–rest and activity modification

Persistent Sx,impaired activity–Surgery

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35
Q

Management after perforated PUD diagnosed?

A 
IV PPI
Broad spectrum Ab
IV Resusitation
NG tube resection
Immidiate Laparatomy/laparascopy
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36
Q

Which area injury make us should suspect liver trauma?

A

 Lower right rib(8th and 9) fracture

 Flank heamatoma

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37
Q

Relation of Serum Ca level and rabdomylolysis?

A

 During the acute phase Hypocalcaemia and Hypophosphatemia

 During recovery/diuretic therapy—Hypercalcemia/hyperphosphatemia

38
Q

Best management of BCC in cosmetically sensitive area like face?

A

 Mohs electrosurgical surgery(Layer by layer incision by seeing tumour margin on microscope)

39
Q

Cause of hypercalcemia with low PTH after ruling out of PTHrP and Vit D toxicity

A 
	Granulomatous lesion
	Drug toxicity like thiazide
	Milk Alkali syndrome
	Thyrotoxicosis
	Vit A toxicity
	Immobilization
40
Q

Immobilization induced Hypercalcemia

A

 Develop after 4 week of immobilization (3 day in patient with CKD)
 It is due to increase osteolytic bone destruction
 Patient with underlining Inc. Bone destruction(young, Paget disease) are at risk
 Bisphosphonate are effective treatment

41
Q

Corrected calcium level

A

 Corrected calcium =Measured calcium + 0.8 *(4-albumin)
 Low albumin will cause low Ca level and vise versa
 Since albumin not affect free serum Ca level—Not cause Sx

42
Q

Nasal septum haematoma CM

A

 Nasal obstruction
 Fluctuant mass in nasal septum
 Blood accumulate b/n perichondrium and septal cartilage

43
Q

Management?

A

 Incision and drainage
 NSAID
 Nasal Pack
 Antibiotics

44
Q

Complication?

A

 Perforation
 External nasal deformity (Saddle nose)
 Can be infected after 3-5 day and may cause abscess

45
Q

Superficial wound dhescience?

A

skine and SC tissue damage
Intact fascia
Abnormal SC fluid(Seroma Accumulate)–Serosangious fluid leakage

46
Q

Management?

A

Regular dresing change

47
Q

Massive PE CM?

A 
Hypotension
RSHF(raised JVP, Hypotension)
RBBB on ECG--DUe to RH strain
Bradycardia
Syncope is MC Sx(unlike dyspnea and pleuritic chest pain observed in other PE)
48
Q

Diagnosis?

A

It time permits(Do chest angiography)

IF not try to see by Echo in bedside(poor sensitivity)

49
Q

Management?

A

Fibrinolysis if surgery is not in previous 10 day

50
Q

Medial collateral ligament injury sign?

A

Blow to latteral knee/twisting injury
Knee pain
Local Swelling,Joint line tenderness and echemosis
Acute joint effusion is uncommen

51
Q

managment?

A

Uncomplicated—RICE(rest,Ice,compression and elevaion),antipain and return to activity when tolerated
MRI for patients considerd for surgery

52
Q

Agitation,Tachycardia and lower abdominal/suprapubictenderness in early post op days?

A

Acute urinary retension

53
Q

RIsk factor?

A

Male sex
Advanced age
History of BPH
Hx of nurologic disorder
Surgery(Abd,Pelvic and joint arthroplasty)
Drug like Ansthetics,opoids and AntiCH pricipitate it

54
Q

DIagnosis?

A

Bladder U/S(Accumulation of >300 ml urine is indicative)

55
Q

Managment?

A

Catheterization

56
Q

Hemorrhagic stroke in young patients with recurrent localized headache history?

A

AVM–ICH

57
Q

what about ICH in olds?

A 
Amyloid angiopathy (Dementia patient)
Hypertensive vasculopathy (In chronic HTN patients)
58
Q

Breast cyst managment algorothm?

A

Complex cyst—Core needle biopsy

SImple Cyst–Asymptomatic(observe) but if Tenderness present FNAC

59
Q

What to do after FNAC?

A

If bloody aspirate—Biopsy,Aditional immaging
Non bloody aspirate–If cyst resolve after aspiration(Reapet u/s after 4-6 week) but if persist or recurent—Biopsy and aditional immaging

60
Q

Conclusion?

A

Asy and simple–Observation
Symp and simple –FNAC
Do core needle biopsy–For complex cyst and Heamoragic or persistent/recurrent Sx simple cyst

61
Q

Fibrotic stricture in Chrons D CM?

A

Partial/complete bowel obstraction
Young age onset and smoking is arisk(inc inflamation and disease progresion)
Usualy cause mechanical SBO
Surgical resection based on location and severity
Suspect Ca induced SBO if significant wight loss there

62
Q

RCC RF?

A

Age >50

Risk increase with smoking

63
Q

CM?

A 
Heamaturia,microscopic/gross--clot
Abd/Flank mass/pain
Left side non reducible varicocele
PNS(EPO,PTHrP)
Intermitent feverj
64
Q

DXs?

A

CT

partial/complete nephrectomy

65
Q

What about hydronephrosis?

A

flank mass,wt loss and systemic Sx is absent

66
Q

What immaging survay to do after ABC in high energy mechanism injury?

A

CXR
Pelvic X-Ray
FAST
Cervical immaging(CT)

67
Q

Indication for cervical immaging?

A 
High energy injury
Nurologic deficiete
Spinal tenderness
AMS
Intoxication
Distracting injury
68
Q

Indicaation to do thoracolumbar spine x-ray?

A 
CT show cervical spine injury
Focal pain, tenderness, bump up
Focal neurologic deficit
AMS
Distracting injury
High energy mechanism(Car collision and Fall from >3 M hight)
69
Q

Breast cyst managment algorothm?

A

Complex cyst—Core needle biopsy

SImple Cyst–Asymptomatic(observe) but if Tenderness present FNAC

70
Q

What to do after FNAC?

A

If bloody aspirate—Biopsy,Aditional immaging
Non bloody aspirate–If cyst resolve after aspiration(Reapet u/s after 4-6 week) but if persist or recurent—Biopsy and aditional immaging

71
Q

Conclusion?

A

Asy and simple–Observation
Symp and simple –FNAC
Do core needle biopsy–For complex cyst and Heamoragic or persistent/recurrent Sx simple cyst

72
Q

Fibrotic stricture in Chrons D CM?

A

Partial/complete bowel obstraction
Young age onset and smoking is arisk(inc inflamation and disease progresion)
Usualy cause mechanical SBO
Surgical resection based on location and severity
Suspect Ca induced SBO if significant wight loss there

73
Q

RCC RF?

A

Age >50

Risk increase with smoking

74
Q

CM?

A 
Heamaturia,microscopic/gross--clot
Abd/Flank mass/pain
Left side non reducible varicocele
PNS(EPO,PTHrP)
Intermitent feverj
75
Q

DXs?

A

CT

partial/complete nephrectomy

76
Q

What about hydronephrosis?

A

flank mass,wt loss and systemic Sx is absent

77
Q

What immaging survay to do after ABC in high energy mechanism injury?

A

CXR
Pelvic X-Ray
FAST
Cervical immaging(CT)

78
Q

Indication for cervical immaging?

A 
High energy injury
Nurologic deficiete
Spinal tenderness
AMS
Intoxication
Distracting injury
79
Q

Indicaation to do thoracolumbar spine x-ray?

A 
CT show cervical spine injury
Focal pain, tenderness, bump up
Focal neurologic deficit
AMS
Distracting injury
High energy mechanism(Car collision and Fall from >3 M hight)
80
Q

Breast cyst managment algorothm?

A

Complex cyst—Core needle biopsy

SImple Cyst–Asymptomatic(observe) but if Tenderness present FNAC

81
Q

What to do after FNAC?

A

If bloody aspirate—Biopsy,Aditional immaging
Non bloody aspirate–If cyst resolve after aspiration(Reapet u/s after 4-6 week) but if persist or recurent—Biopsy and aditional immaging

82
Q

Conclusion?

A

Asy and simple–Observation
Symp and simple –FNAC
Do core needle biopsy–For complex cyst and Heamoragic or persistent/recurrent Sx simple cyst

83
Q

Fibrotic stricture in Chrons D CM?

A

Partial/complete bowel obstraction
Young age onset and smoking is arisk(inc inflamation and disease progresion)
Usualy cause mechanical SBO
Surgical resection based on location and severity
Suspect Ca induced SBO if significant wight loss there

84
Q

RCC RF?

A

Age >50

Risk increase with smoking

85
Q

CM?

A 
Heamaturia,microscopic/gross--clot
Abd/Flank mass/pain
Left side non reducible varicocele
PNS(EPO,PTHrP)
Intermitent feverj
86
Q

DXs?

A

CT

partial/complete nephrectomy

87
Q

What about hydronephrosis?

A

flank mass,wt loss and systemic Sx is absent

88
Q

What immaging survay to do after ABC in high energy mechanism injury?

A

CXR
Pelvic X-Ray
FAST
Cervical immaging(CT)

89
Q

Indication for cervical immaging?

A 
High energy injury
Nurologic deficiete
Spinal tenderness
AMS
Intoxication
Distracting injury
90
Q

Indicaation to do thoracolumbar spine x-ray?

A 
CT show cervical spine injury
Focal pain, tenderness, bump up
Focal neurologic deficit
AMS
Distracting injury
High energy mechanism(Car collision and Fall from >3 M hight)

Surgery 1 (11 decks)

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