Sugery Halo-halo 3

Question 1

Martality associated with SIRS

Answer 1

2 - 5%
3 - 10%
4 - 15-20%

Question 2

Classification of NSTI

Answer 2

NECROTIZING SOFT TISSUE INFECTION

TYPE 1

• most common
• polymicrobial source

TYPE 2

• monomicrobial source of B-hemolytic streptococcus or staphylococcus
• history of trauma
• assoc’d with toxic shock syndrome

TYPE 3

• V vulnificus
• traumatized skin exposed to a body of salt-water

Question 3

Hard signs of penetrating neck injury

Answer 3

Massive hemoptysis

Rapidly growing hematoma

Question 4

Zones of the neck

Answer 4

ZONE I

• level of the clavicular heads
• inferior to the clavicle
• aka thoracic outlet

ZONE II
-bet clavicles and angle of the mandible

ZONE III
-above the angle of the mandible

• dati, zone I and II are separated by CRICOID
• injuries to zone I and III obstruct the airway and have the greatest risk for morbidity and mortality (old, not sure today)
• injury to zone II are most common, but with lower morbidity and mortality because maccontrol with direct pressure and easily visualized

Question 5

Luminal diameters of esophageal narrowings

Answer 5

Cricopharyngeus
1.5 cm

Crossing of the left main stem bronchus and aortic arch
1.6 cm

Hiatus of the diaphragm
1.6-1.9cm

Question 6

Narrowest part of airway

Answer 6

Pediatric:
Cricoid ring (subglottic)

Adult:
Vocal cords
Glottis (2.5 cm, Snell)
“Rima glottidis”
Bounded in front by vocal cords
And behind by the medial surface of the arytenoid cartilages (Snell)
~laryngeal prominence?

Question 7

Tension pneumothorax and hyperbaric

Answer 7

“Tension pneumothorax is an absolute contraindication to hyperbaric oxygenation (HBO) (Statpearls)

Question 8

BIrads

Answer 8

0: Incomplete
1: negative
-normal finding
-routine screening recommended
2: benign finding
-roiutine screening recommended
3: probably benign finding
<2% risk of malignancy
-short interval follow-up (6 months) to establish stability
-then every 6-13 months for 1-2 years

4A: low suspicion (3-10%)
4B: intermediate risk (11-50%)
4C: Moderate risk (51-94%)
-perform CORE NEEDLE BIOPSY ⭐️

5: Highly suggestive of malignancy (>95%)
- appropriate actions should be taken
6: biopsy proven malignancy
- assure that treatment is completed

Question 9

Highest mortality in burns

Answer 9

“Flame burns are the most common cause for hospital admission of burns, and have the HIGHEST MORTALITY. This is primarily related to their association with structural fires and the accompanying INHALATION INJURY and/or CO POISONING ⭐️” (Schwartz)

Question 10

Nutcracker esophagus

Answer 10

“Supersqueezer esophagus”
-most common of the primary esophageal motility disorders

Mean peristaltic amplitute (10 wet swallows) in distal esophagus >= 180 mmHg

Increased mean duration of contractions (>7.0 secs)

Normal peristaltic sequence

Question 11

Achalasia

Answer 11

Incomplete LES relaxation (<75% relaxation)
Aperistalsis in the esophageal body
Elevated LES pressure <= 26mmHg
Increased intraesophageal baseline pressures relative to gastric baseline

Question 12

Hypertensive lower esophageal sphincter

Answer 12

Eleveated LES pressure >= 26 mmHg
Normal LES relaxation
Normal peristalsis in the esophageal body

Question 13

Ineffective esophageal motility disorders

Answer 13

Decreased or absent ammplitude of esophageal peristalsis (<30 mmHg)
Increased number of nontransmitted contractions

Question 14

Barium esophagogram: corkscrew deformity

Answer 14

Diffuse esophageal spasm (DES)
Simultatneous (nonperistaltic contractions) (>20% of wet swallows)
Repetitive and multipeaked contractions
Spontatneous contractions
Intermittent normal peristalsis
Contractions may be of increased amplituted and duration

Question 15

Nutcracker fractures

Answer 15

Cuboid fractures, and may indicate a Lisfranc injury

Question 16

Other name for SMA syndrome

Answer 16

Wilkie’s syndrome
Cast syndrome
Mesenteric root syndrome

Acute angulation of the SMA causes compression of the 3rd part of duodenum

Question 17

Nutcracker “syndrome”

Answer 17

Vascular disorder resulting from the comrpession of the left renal vein betweein SMA and aorta