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Surgery 1 > SB9 > Flashcards

SB9 Flashcards

1
Q

Confirmatory diagnosis for esophageal tear?

A

Water-soluble contrast

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2
Q

middle mediasternal mass diferencial?

A 
Bronchogenic cyst
Tracheal tumor
Pericardial cyst
Lymphoma
LN enlargement
Aortic aneurysm of the aortic arch
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3
Q

risk factor for bladder ca?

A 
Smoking
Work(Painter and metalworker)
Chronic cystitis
An iatrogenic drug-like CPD
Pelvic radiation exposure
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4
Q

epidemiology of malignant hyperthermia?

A

Gen.Mutation alters control of intracellular Ca
Volatile anesthetics
Succinylcoline
Exessive heat

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5
Q

CM?

A 
can occur during induction/maintenance or soon after cessation of GA
Masseter muscle/generalized rigidity
Sinus tachycardia
Hypercapnia resistant to MV
Rhabdomyolysis
Hyperkalemia
Hyperthermia(Late manifestation)
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6
Q

treatment?

A

Respiratory/ventilator suport
Immediate cessation of the causative agent
Dantrolene

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7
Q

Comma diagnosis finding?

A

Impaired brainstem activity
Motor dysfunction(decorticate/decerebrate rigidity)
LOC

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8
Q

Lymphangitis epidemiology?

A

Cutaneous injury–pathogen invasion of lymphatics in the deep dermis
S.Pyogenes and MSSA

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9
Q

CM?

A

Tender erythematous streak proximal to wound
Regional tender LDP
Systemic Sx(fever, tachycardia)

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10
Q

TX?

A

Cephalexin

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11
Q

what about sporotricosis?

A

Nodular(not streak) and develop within weeks(unlike days in lymphangitis)

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12
Q

Greater trochanteric pain syndrome(trochanteric bursitis)?

A

Age >=50
Wommen > Men
Obesity
Low bac & LE symptom

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13
Q

CM?

A

Chronic lateral hip pain
Pain on hip flexion and lying on the affected side
Normal range of motion(ABD may agravate pain)

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14
Q

diagnosis?

A

Focal tenderness on G.Trochanter are
X-Ray to r/o other joint disorder
U/S-Degeneration of tendon or tendinosis

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15
Q

tx?

A

Exercise, Physical therapy, activity modification
NSAID
Corticosteroid injuction

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16
Q

Pathophysiology?

A

Repetitive use of Gluteus medius and minimus

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17
Q

what about meralgia paresthetica (LFCN injury)?

A

Variable area MID lateral thigh pain

No trochanteric tenderness

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18
Q

Sternal dehiscence?

A

Separation of the approximated sternum in cardiac surgery.
COPD and Other factor affect wound healing are risks
Internal thoracic artery harvesting can cause sternal ischemia and it is a risk

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19
Q

CM?

A

pain or chest instability during chest movement
Palpable rocking or clicking on the sternum
can occur w/o superficial tissue infection/mediastinitis

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20
Q

Management?

A

Emergency(wire and bone fragment can damage cardia tissue)

Emergency wound exploration wound debridement, and sternal fixation

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21
Q

Compressive sternal dressing and negative pressure wound therapy?

A

Used in sternal wound failure to protect wound speed healing

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22
Q

Vertebral osteomyelitis RF?

A

Injection drug user(S.A MCC)
SCD
IC
Recent distant infection

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23
Q

CM?

A 
Chronic(> 6 weeks), Insidious back pain unrelieved by rest
Fever <50%
Tenderness at spinal percussion
Normal or elevated WBC
Elevated ESR and Thrombocytosis
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24
Q

Diagnosis?

A

MRI

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25
Q

Management?

A

IV ab

May/may not need surgery

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26
Q

what about vertebral compression fracture?

A

Have the same Sx but VCF occur in an old patient with risk of osteoporosis

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27
Q

Medullary thyroid ca?

A 
Tumors arise from thyroid parafollicular cells
Calcitonin secreting(calcitonin measurement used for metastasis risk assessment recurrence)
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28
Q

Associated genetic abnormality?

A

RET proto-oncogene(MEN2 )
A–paratyroid and pheochoromocytoma
B–Pheochromocytoma and marfanoid habitus

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29
Q

CM?

A

Asymptomatic thyroid mass
Flushing and diarrhea(rarely)
Serum Ca usually normal due to downregulation of Calcitonin receptor

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30
Q

Diagnosis?

A

FNAC

31
Q

Management?

A

Thyroidectomy
Serial calcitonin measurement post-surgery
Levothyroxine replacement

32
Q

Diagnosis of acute mesenteric ischemia?

A

CT angiography

Need immediate operation

33
Q

Managment?

A

embolectomy with endovascular bypass
Broad-spectrum AB
Anticoagulation in absence of bleeding

34
Q

Hemobilia?

A

Bleeding to biliary tract

35
Q

Risk?

A 
Hepatobiliary procedure(like liver biopsy, cholecystectomy and ECPG)
Biliary tract tumour 
Blunt abdominal trauma
36
Q

CM?

A 
UGI bleeding (melena and hematochezia)
RUQ pain
Jaundice (inc DB)
Hemorrhagic shock/Anemia
Leukocytosis
37
Q

Management?

A

Usually, management is conservative(resuscitation)–IV fluid and transfusion
Angiography with embolization or surgery

38
Q

Leriche syndrome?

A

Aortic occlusion at iliac artery branching

39
Q

CM?

A

Bilateral Hip, Buttock, and thigh claudication
Absent/Diminished LE pulse
LE atrophy
Impotence(always present)

40
Q

syringomyelia pathogenesis?

A

meningitis/trauma/inflammatory disorder and tumour–affected cerebrospinal flow—months/years after developing a cystic cavity in the central channel–surrounding structure damage

41
Q

Diagnosis and management?

A

MRI

Shunt placement

42
Q

Indication for aortic valve replacement?

A

Sever AS + One of the following
1–the onset of symptom
2-LVEF<50 %
3–Undergoing other cardiac surgery(like CABAG)

43
Q

Sever AS criterion?

A

Aortic jut velocity >4m/sec
MTVPG >40 mmHg
Valve area < 1 cm 2

44
Q

Acute graft versus host disease pathogenesis?

A

Donor T cells affect host

Occurs in the first 100 days

45
Q

CM?

A

Maculopapular rash
Acute profuse watery diarrhea
Hepatobiliary inflammation

46
Q

Diagnosis?

A

Colonoscopy then biopsy after ruling out CD and CMV

47
Q

Management?

A

Graft removal

Corticosteroid

48
Q

Poterior hip dislocation?

A

Hip placed on adducted Internally rotated, and flexed position
Sciatic nerve injury b/c near to it
Leg shortening

49
Q

Indication for just clinical observation in pleural effusion develops after cardiothoracic surgery?

A

should fulfill all below three criterion
1-Mild to moderate size and not enlarging
2-Develop starting from 1-2 days after surgery
3-No respiratory symptom

50
Q

what to do in Acute decompensation in the cirrhotic patient?

A

Do abdominal U/S(to r/o HCC and PV thrombosis)

Normally cirrhosis patient needs U/C screening for HCC every 6 month

51
Q

Diagnosis of hydatid cyst of the liver(E.G)?

A

Large smooth hydatid cyst with septation(dauter septation)

Ig E Ab in serum

52
Q

Management?

A

Albendazole
Percutanious intervantion if > 5 CM
Surgery if rapture(signs are fever and eosinophilia)

53
Q

CM of plantar faciatis?

A

Pain in first steep of walking

Localized tenderness with dorsiflexion of the toe(Unlike Achilles tendinopathy which is worsened by ankle flexion)

54
Q

Raptured plantar fascia CM?

A

Sudden onset palmar pain
Loss of the height of the palmar arch
Visible ecchymosis or swelling

55
Q

Tarsal tunnel syndrome CM?

A

Pain, paraesthesia, and numbness at the sole foot

Pain elicited by taping posterior tibial nerve

56
Q

A complication of primary sclerosing colangitis?

A

Biliary stricture
Cholangitis and cholilitiasis
Cholangiocarcinoma, Colon cancer and biliary cancer
Cholestasis

57
Q

Diagnosis?

A

MRCP( Intra and extrahepatic biliary duct stricture with intermittent dilation)

58
Q

What to do inpatient with the first diagnosis of PSC?

A

Colonoscopy to r/o IBD(UC>CD)

59
Q

Torus palanitus?

A

A benign boney growth located at the midline of hard palate
SIze < 2 CM ,It may enlarge over time
Usually asymptomatic
The underlying skin may ulcerate and affect healing
Surgery may consider if asymptomatic
May affect eating, speech, and dental implantation in later life–may consider surgery

60
Q

MC opportunistic infection after organ transplantation?

A

CMV(reactivation)

61
Q

CM?

A

Nausea, Abd.Pain and bloody diarrhea(colitis)
Viremia
BM suppression (Pancytopenia)

62
Q

Investigation?

A

Atypical lymphocyte in blood
End organ biopsy at the affected site
Colonoscopy(multiple large,ahallow,erosion or ulcer)

63
Q

What to do in a patient with a positive fecal occult blood test?

A

Colonoscopy
Upper GI endoscopy(If have IDA, UGIB Sx and if colonoscopy fails to show any lesion)
Video capsule endoscopy if bot fails to show a lesion

64
Q

Trousseau syndrome?

A

Mucin secreting tumor–platelet-rich microthrombi–Superficial venous thrombosis at unusual sites

65
Q

Risk?

A 
Pancreatic Ca(MC)
Prostate
Stomach 
Colon
Acute leukemia
66
Q

Thyroglobulin?

A

Precursor for T3 and T4

Used for asses recurrence in case of Troid ca

67
Q

How to do the level?

A

First, withdraw the supplemental levothyroxine(T4)–this allows to increase TSH–Stimulate remaining Thyroid cells —Detect/Rising TG level

68
Q

Why Levothyroxine has been given after Thyroidectomy for thyroid ca?

A

Treat deficiency

it inhibits TSH production–Reduce thyroid gland stimulation

69
Q

A complication of using radioactive Iodine radiation after thyroidectomy for ca?

A

Sialadenitis
Pulmonary fibrosis
Dry mouth

70
Q

Acute diverticulitis CM?

A 
Occur inpatient with diverticulosis
MC involve sigmoid
LLQ pain and tenderness (<20)
Mild fever
Change bowel habit(constipation or diarrhea)
Nausea and vomiting
Bladder irritation sx(U,F..)
Sterile pyuria(+LE/WBC but no bacteria/-nitrate)
71
Q

Management?

A

Broad-spectrum AB

Surgery if complication

72
Q

Diagnosis?

A

Imaging (CT scan)

73
Q

Risk for diverticulosis?

A

Old age
Obesity
Diet poor in fiber and high meat
Smoking

Surgery 1 (11 decks)

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