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Surgery 1 Flashcards

1
Q

65-year-old woman undergoes an elective colectomy for colon cancer.
Which of the following wound classes best describes this procedure?

A

Class 2

Note**
For ABx:
Class one» no abx is given

Class 2and 3» prophylactic abx except in low risk pt

Class 4» therapeutic abx

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2
Q

Class 2 surgical wound, u will give abx or not?? If yes how?

A

Yes!

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3
Q

When to call the surgery wound infection is from surgery or not? (Time period?))

A

If 30 days post Op then it’s infection from surgery

Or

Surgery with implants (foreign body) and infection was post op by 90 days

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4
Q

Post cholecystectomy, MC organism infection??

Post appendectomy, mc organism?

A

E. Coli
( think of gram +ve and gram -ve if Upper GI surgery )

Bacteroids fragilis ( if lower GI surgery think of gram -ve and anarbos)
Note**
E coli is second most common organism after appendectomy

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5
Q

What are the wounds phases + which one is the weakest??

A
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6
Q

What are the types of wound healing????

A
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7
Q

Child injured his hand with a piece of glass, 2 days later, swelling and RED STREAKS TWARED axilla , mc organism ? Ttt?

A

Strep pyogen( group a)

Cephalosporins

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8
Q

Pt came to ER after 8 hrs from getting injured with a nail, now swelling, redness and pain, he can’t remember when it’s the last time he got vaccinated for tetanus, ur management??

A

This is a tetanus prone wound, (wound is > than 6 hours old)

Management: Local wound care, iv metronidazole or penicillin, tetanus toxoid , tetanus IG !

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9
Q

When to say wound is tetanus prone???

A
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10
Q

Post op fever , ddx? (Hint :5 W s)

A
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11
Q

+ what is the cause of high blood glucose level in this case???

A

Next step is : remove central line, send tip for lab and do blood culture then give antibiotics

Cause of high blood sugar is:
It’s a late sign of sepsis!! ( unexplained high glucose levels in blood)

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12
Q

Surgical pt, new DVT, what to choose?

A

Note,
Never ever choose warfarin alone! Need time to work+ need other anticoagulants with it as a bridging + cause thrombosis if used alone initially!

Iv Filter: used if DVT is developed right away after surgery ( in recovery room)

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13
Q

What are the pre operative methods for warfarin reversal?????

A

Note*

When he says in Q ( procedure is planning for next day..) then this mean semi urgent ‼️

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14
Q

Nutritional tubes approach?

A
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15
Q

Re feeding syndrome?

A

Hypo k
Hypo po4
Hypo mg

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16
Q
A

After 4-6 weeks

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17
Q
A

Stop gas inflation right away!

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18
Q
A
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19
Q

Transfusion related reaction ??

A
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20
Q

Appendicitis signs ???

A
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21
Q

Next step in appendicitis scenarios !!! Golden slide✨

A
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22
Q

How to deal with appendicitis mass if u find it pre operative and how to deal if u find it intra op?

A
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23
Q

Abscess in appendicitis approach ??

A
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24
Q

Pt with appendicitis signs and s, open surgery was done and appendix was normal, next step?

A
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25
Q

Pt with appendicitis signs and s, open surgery was done and appendix was normal, u found crohns dis signs, next step?

A
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26
Q

Few days post appendectomy, fecal material from the wound , next step??

A
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27
Q

Appendicular carcinoma management??

A

Oncological resection = rt hemicoloctomy

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28
Q

Golden slide for acute bowel ischemia ✨ ( not that important:) )

A
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29
Q

When managing a tracheal injury in a 30 year old female who sustained a blunt injury to her neck, which method would you use for intubation?

A

1st is !!!!

Fiberoptic intubation ( مثل الكاميرا تدخل اول شي وتشوف الطريق)

Surgical airway is the last thing u think about ! especially the pt is not unstable!

30
Q

Patient came to hospital by ambulance after an RTA. Patient GCS is 7 and BP is 86 / 48. There is a suspicion for cervical injury and your colleague is performing in-line stabilization. You decided to intubate the patient. What would help you in intubating this patient?

A

الفكرة اني مقدر احرك البيشنت ،
So,
1st thing to do is: Bougie

If didn’t work go for surgical airway

31
Q

Patient came to hospital by ambulance after an snowmobile accident.
In the resuscitation area, patient oxygen saturation dropped. There is an open wound in the anterior neck. What is the next step ?
A. Oxygen mask
B. Mechanical ventilation
C. Cricothyrotomy
D. Nasogastric

A

Don’t be tricked!
Answer is A , why?? NEXT STEP!

Always and always no matter what is in the scenario, start with Endotracheal tube! 2 trials! , don’t be tricked by (tracheal injury) , and before endotracheal tube always start with oxygen mask to make O2 sat 100%

Last step is surgical

32
Q

After an RTA, 24 year old female was found to have extensive mandibular and facial fracture. Her GCS started to drop significantly.
You decided to secure her airway. What is the best method ?
What is the next method?

A

Best is cricothyrotomy ( because of mandibular and facial fracture!)

Next is : endotracheal tube trial

33
Q

Patient came by ambulance from a burning building. Patient conscious level started to change, and GCS score went from 15 to 11. there is a voice changed and there is singed nasal vibrissae. Patient vital signs are stable. What is the most appropriate step?

A

Elective intubation

34
Q

Which of the following indicates compensated shock?
A) Anuria
B) Confusion
C) Hypotension
D) cold and pale peripheries

A

Answer is D

Anuria is End organ damage while oligourea indicates compensated shock

35
Q

22-year-old female victim of MVA presented 1 h after the accident. She was febrile and conscious asking for some water then she lost consciousness. Her Bp 90/60 and HR 139
What type of hemorrhagic shock?

A

Stage 4

36
Q

What are the 3 Indications for intubation in Neck Injury????

A

Expanding Hematoma
Stridor
Respiratory Distress

37
Q

60 year old male stabbed in anterolateral side of his neck. He is being transferred to your facility via Stars (Helicopter ). The Paramedic told you that the patient is stable and the wound is between the cricoid and the angle of mandible. Which zone the paramedic is talking about?

A

Zone 2

Note*
Zone 1» great arteries /vessels of superior mediastinal

38
Q

When dealing with neck trauma, hard signs are important in clinical decision. Which of the following is considered NOT hard sign?

A. Expanding Hematoma
B. Stroke
C. Subcutaneous emphysema
D. Active bleeding

A

C!
Subcutaneous is not a hard sign , only massive, if he said emphysema reaches his face this consider massive as well

39
Q

17 year old male stabbed in his neck just below the left angle of mandible with a pen knife. He is hemodynamically stable. No aerodigestive symptoms. On exam there is hematoma at wound site with no active bleeding. What is the next step in management?

A

CT neck scan

(Pt is stable, no hard sign)

40
Q

You admitted the patient for observation and went to see the radiologist to review the scan. There is an injury suspicion to the aerodigestive track. The patient is hemodynamically stable and does not have any hard signs. What is the best management ?
A. Observation
B. Take the patient to the OR for exploration
C. Endoscopy and bronchoscope
D. Repeat scan in 24h

A

Answer is C
Pt already admitted for observation, CT is already done, and raided sus of aerodiagistive trach injury so c is right

41
Q

Flial chest (pradoxical chest movement) what is the initial step management??
(No signs of respiratory distress + pt is stable&raquo_space; answer is not ABC ;)

A

Pain control and chest physiotherapy to prevent atelectasis and chest infection

42
Q

Pneumothorax, u placed chest tube, pt still desat and not improving , what is ur next step??

A
  • second chest tube!!

If ask about definitive management&raquo_space; thoracotomy

43
Q

What are the indications of thoracotomy ?? What is the initial and best management of hemothorax (bleeding more than 200 ml per hour/in 4 hours ???

A

Initial is clamping the chest tube

Best is to call surgeon for thoracotomy

44
Q

•41-year-old male stabbed in his left chest medial to left nipple. He is hemodynamically unstable. On examination, muffled heart sound and distended JVP. What is the best management:
A. Chest tube insertion
B. Pericardiocentesis
C. Sternotomy
D. ED Thoracotomy

A

Answer is C , why? Pt unstable , so,

Blunt injury, if u suspect cardiac tamponade»stable or not?? If stable do FAST , if +ve&raquo_space; surgery (sternotomy or pericardiocentesis ) if negative, look for another cause (obstruction, neurological, etc)

But if penetrating,&raquo_space; stable or not? Stable > fast , which is rare and mostly in the end they need surgery,
not stable> surgery which is sternotomy only! U can’t do pericardiocentesis !

Most of the time, if the case in medical, the answer will be pericardiocentesis ( like if pt have cancer)

If surgical > surgery

45
Q

What are the findings of aortic injury??

A
46
Q

What are the indications for immediate laparotomy?

A
47
Q

Young guy is stabbed in anterior abdomen in a fight after a football match. He presented to emergency with a 1 cm laceration that is 3 cm above umbilical. He has no pain and vitally stable. What is the best management?
A. DPL
B. Wound exploration
C. Laparotomy
D. CT scan

Q 2: what are the CI of your answer???

A

Answer: B

48
Q

47 year old female victim of domestic violence. Diagnosed with grade
3 splenic injury that was associated with blush on CT. No other injuries.
She is hemodynamically stable. She was admitted for observation.
What is the next step in her management?

A

Angiogram ad embolization

Grade 2 and less» observe if stable , not stable> surgery

Grade 3 and more» stable or not?

Stable : Angiogram ad embolization

Not stable: responsive > embolisation > if not available or not improving or not responding&raquo_space; OR -ectomy

49
Q

Penetrating truama to abdomen, packing is done, after 5 hours in ICU , pt is desat and O2 decreasing and never going up, decrease UOP as well , what u will think of?

A

Abdominal compartment syndrome

50
Q

Disc herniation Q: which disc prolapse is affected if pt complain of radiating pain to:

Big toe?
Little toe ?
Medial leg?
Knee?
Thigh?
Inguinal area?

A

Big toe? L5
Little toe and lateral side of leg and planter?S1
Medial leg?L4
Knee?L3
Thigh?L2
Inguinal area?L1

51
Q

What is the most likely pathology + best imaging modality for the following findings????

A
52
Q

The most common cause of congenital hydrocephalus is:

A

Aqueductal stenosis.

53
Q

The most common craniosynostosis is:

A

Sagittal.

54
Q

Mc vessel injury in the 4 types if hemorrghic stroke??

A
55
Q

Worst headache of my life, vessel injury other than circle of welles+ how to dx?

A

Subarachnoid hemo

Anterior communicating artery aneurysm

Dx by:

• CT brain&raquo_space; CT Angio&raquo_space; Cerebral Angiogram (DSA).

If all negative and still high suspicion&raquo_space; LP

56
Q

60 years old female Diabetic, old myocardial ischemia presented with left facial assymetry with weak arm. What best describes her condition?
A. Middle cerebral artery stroke.
B. Posterior cerebral artery stroke.
C. Anterior cerebral artery stroke.
D. Basilar artery thrombosis.

A

A

If 2 ( e.g. arm and visual ) this is called watershed area, which is the mc to happen

57
Q

Mcc of brain metastatic ca in male??

Mcc of malignant tumor in pediatric?

A

Lunggggg cancerrrrr
Note*
In female > breast

Medulloblastoma

58
Q

• 22 years old female university student, who was complaining of acute worsening vision and 3 months amenorrhea. What would you suspect?

Best immediate management???

A

Pituitary apoplexy ( bleeding inside the adenoma )
It’s not adenoma because it’s acute worsening, adenoma is chronic,

Pituitary apoplexy needs emergency surgery! (Definitive)

Best immediate management is steroid

59
Q

Role of steroid in NEURO SURGERY ! Golden slide

A
60
Q

Old female with AAA suspicion, she is having abd pain with heart rate more than 120, what is the best diagnostic modality, and what is the most important risk factor for rupture?

Q 2
When to do surgery for such pt?

Q3
Most important lab test to do to rule out other ddx?

A

CTA( pt is symptomatic, going for surgery, having shock) , HTN

Note*
If pt have no symptoms, or coming for screening( due to e.g. fam hx) do US!

Risk factor for developing the AAA is&raquo_space;smocking

Q2 answer:
If pt symptomatic, shock or size more than 5.5» CTA Followed by surgery
If less than 5.5 or incidental finding» follow up by US

Q3
Lipase to rule out pancreatitis

61
Q

When to say : class B dissection?

And what is ur management?

A

Distal to subclavian artery

Approach of dissection is always medical( conservative ) even if acute, unless if it’s class A or ruptured , start with labetalol ( BB first to prevent reflex tachycardia, then vasodilation to decrease BP -<120/80 - , if pt is refractory to medication or need high BP such in pt with stroke, then surgery most be considered so we can lower BP )

62
Q

Acute embolic limb , what is the arrangement of events ?

What is the initial and best investigation for chronic limb ischemia? And what is the gold stander? what are the signs of critical limb ischemia?

A

Pulselessness> pain> pallor> paresthesia> paralysis

Note*
Drop foot consider very late sign

Initial for chronic limb ischemia is duplex US, best is CT A
Goldstander >conventional radiology

63
Q

53 year old male diabetic on insulin. He was diagnosed with chronic limb ischemia after he presented with claudication. He presented to you today complaining of buttocks claudication. On examination his femoral pulses are weak. What is the best management?
A. Hybrid procedure
B. Femoro-femoral bypass
C. Aorto-bi-femoral bypass
D. Endarterectomy

A

C because there is buttocks pain, so bilateral iliac most likely stenosed

64
Q

Elderly male with ABI < 0.6. Able to walk 400 m only. He is a smoker and drink glass of wine every night. His diabetes is controlled. What would increase his walking capacity
A. Revascularization
B. Smoking cessation
C. Walking exercise
D. Aspirin

A

C , the q is ( What would increase his walking capacity? ) which is C

If q was ( what would stop progression of the dis?) smocking would be right!

65
Q

55 year old male diagnosed with acute lower limb ischemia. I.V heparin andl.V fluid fluid started. What is the most appropriate next step in this patient management ?
A. CT-A
B. DSA
C. US-Duplex
D. Immediate embolectomy

Q2 , what is the Gold standard in acute emboli?

A

C (next step not best step)

Q2
CT A is the best and gold

Not like gold in chronic ( conventional angiography!)

66
Q

Approach in limb ischemia management:

Best management in the following:

More than 6 hours of symptom start:

Early presentation (normal sensation):

Late presentation:

Next step in all previous???

A

Best management in the following:

More than 6 hours of symptom start:
Amputation

Early presentation (normal sensation):
Catheter thromblysis

Late presentation: (less than 6 hours)
Embolectomy

Next step in all previous???
Heparin

67
Q

Leg ulcer, next step?

A

ABI

68
Q

Elderly gentleman with DM and HT. Came back to your office with unhealed ulcer that started 2 months back at his left first toe. Biopsy shows’
“ pseudoepithelial hyperplasia “. What is the best next step?
A. Repeat biopsy
B. Amputation
C. Debridement
D. Observation

A

Answer is A حفظ

We r worried that this pt might have squamous cell carcinoma

69
Q

40-year-old female underwent surgical management for her varicose vein. The operation went uneventful. On day 3 post-op she started to complain of numbness in her inner thigh. Examination shows loss of light touch and temperature, but power is intact. Which nerve injury cause this complication?
A. Sciatic
B. Femoral-
C. Peroneal
D. Saphenous

A

D

70
Q

Varicose vein, no skin changes, what investigation u order before ttt? Most appropriate!!!!!

Q 2
Varicose hx, now , Cord like pain and swelling , dx and most appropriate management?

A

Duplex ( give full information + less invasive ) never ever doppler US ! Because it’s only voice :)

Q2
Thrombophlebitis&raquo_space; give NSAID !

71
Q

Ttt of varicose vein ?

A

Sclerotherapy is cosmetic and asymptomatic pt only

Vein stripping is the last step and if complications developed! Such as ulcer..etc

Thermal ablation is the most appropriate management and first line in ttt!

Compression stocks in the next step :)

72
Q

pleasant 37 ear old female presented with clinical suspicion for lymphedema. What you should include in your history taking ?
A. Family History
B. Smoking
C. Trauma
D. Medication

A

A !!!! مهم حفظظظظ

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