Surgery Flashcards
Prostatic Valve Dysfunction Diagnosis
Echo
Adolescent boy
Proximal Femur pain worse at night, relieved with NSAIDs, unrelated to activity
Small, round lucency (Xray)
Osteoid Osteoma
Breast pain
Cyclic, bilateral diffuse
mass
Next Step
Imaging
Breast pain
cyclic, bilateral, diffuse
No mass
observe
Breast pain
noncyclic, unilateral focal
no mass
Abnormal imaging
biopsy
Breast pain
noncyclic, unilateral focal
no mass
normal imaging
Observe
Breast pain
noncyclic, unilateral focal
mass
biopsy, referral to breast surgeon
Prior esophageal/gastric resection or reconstruction, Nissen fundoplication
Abdominal pain, diarrhea, nausea, hypotension, tachy, dizziness, AMS
15-30 minutes after meals
Dumping syndrome
Dumping Syndrome management
clinical diagnosis
small, frequent meals, replace simple sugars with complex carbs, high fiber and protein rick foods
Manage ureteral stone <10mm
Hydration
pain control
alpha blockers
strain urine
Diagnosis of postop urinary retention
Portable bladder ultrasound
Thunderclap headache, visual field defects, ophthalmoplegia
pituitary apoplexy
Within minutes to 24 hours of transfusion
fever, chills, hypotension, hemoglobinura, flank pain
Acute hemolytic transfusion Reaction
Lab findings of Acute hemolytic transfusion reaction
postive Coombs test
Hemolysis
Complications of Acute hemolytic transfusion reaction
acute renal failure
DIC
Diagnosis of open angle glaucoma
Tonometry
Diagnosis of Zenker’s Diverticulum
contrast esophagography
Hypotension, shock
nausea, vomiting, ab pain, fever, general weakness
Adrenal crisis
Treatment of adrenal crisis
hydrocortisone
Dexamethasone
Prolonged clamping of infrarenal aorta and iliac arteries complications
Metabolic acidosis via lactic acidosis
Increased bicarbonate reabsorption and increased H+ excretion, increased urinary Cl- excretion, increased excretion of ammonium
Trauma in one eye, then blurry vision in opposite eye. Path…
Sympathetic ophthalmia
T cell sensitization of self antigens
Brown Recluse Spider
eschar/ necrosis
clean wound and apply ice, supportive management
acute pericarditis ECG findings and diagnosis
diffuse ST segment elevations and PR segment depression
D(x): echo
Abrupt onset dyspnea, low grade fever, diffuse crackles/wheezes, infiltrate in dependent portion of lung
Chemical pneumonitis (from gastric acid) supportive care
Young patient with one sided headaches
Nausea and vomiting
Ruptured arteriovenous malformation
Anesthesia, succinylcholine or excessive heat
Rigidity
tachy
Hypercarbia resistant to increased minute ventilation
Rhabdo
Hyperkalemia
Hyperthermia
Malignant Hyperthermia
Treatment for perforated bowel
Surgical exploration
Medial knee pain and focal tenderness
pes anserinus syndrome
Manage with quadricep strengthening exercise
Hemodynamically stable patient with free fluid on FAST..next?
CT ab and pelvis
Hemodynamically unstable with free fluid on FAST
Laparotomy
Where is pelvic blood loss hidden?
retroperitoneum
Postop weakened dorsiflexion and diminished pinpoint sensation of big toe
common fibular N injury
Reassurance and physical therapy
High protein Ascites
CHF, constrictive pericarditis, peritoneal carcinomatosis, TB, Budd Chiari, fungal
Low Protein Ascited
Cirrhosis, nephrotic syndrome
Treatment for radiculopathy
NSAIDs and avoidance of provocative maneuvers
Infections in solid organ transplants
Nosocomial infections
CMV, PCP, Aspergillus
Local anesthetic complication
perioral numbness, metallic taste, tinnitus –> generalized tonic clonic seizures.
LUQ pain, left pleuritic chest pain and left pleural effusion
Splenic abscess ( via infective endocarditis- staph, strep, salmonella)
Unilateral frontal, parietal or temporal lobe lesion
NO PUPILARY INVOLVEMENT
Subfalcine herniation
elderly FOOSH
Colles Fracture
First step of management is closed reduction of fracture
head trauma or acceleration/deceleration
GCS <8, impaired more than imaging MRI finidings
Diffuse Axonal Injury
Punctate hemorrhages in white matter, blurring of gray-white matter junction
Slipped capital femoral epiphysis X ray findings
posteriorly displaced femoral head
Fever, focal/severe back pain, neuro findings
Spinal epidural abscess
Diagnosis with MRI of spine with contrast
Treatment for spinal epidural abscess
antibiotics (vanco + ceftriaxone)
urgent aspiration/ surgical decompression
Bowel problem that is associated with erythema nodosum
Inflammatory bowel disease
Crohns > UC
lytic lesion at epiphysis of distal femur
Soap bubble appearance on X ray
Giant cell tumor
Night driving difficulty and halos around bright lights
no pain
cataracts
Spinal abscess diagnosis
MRI with contrast
jaw pain and swelling exacerbated by eating
recurrent sialadenitis via sialolithiasis
ab pain and tenderness, hematochezia, diarrhea, lactic acidosis
colonic ischemia
Diagnosis of colonic ischemia
CT: colonic wall thickening fat stranding
Endoscopy: edematous and friable mucosa
Colonic Ischemia treatment
IVF and bowel rest
Abx with enteric coverage
colonic resection if necrosed
Patient >40
painless hematuria, hydronephrosis and voiding symptoms
bladder cancer
Do cystoscopy
Profuse watery diarrhea, liver inflammation and maculopapular rash after hematopoietic stem cell transplant
Acute graft vs host disease
D(x) with biopsy
snake bite treatment
limb immobilization and wound management
coag studies
antivenom
observe 12-24 hr
Most common pulmonary postop complication
Atelectasis (impaired cough and shallow breathing)
Diagnose Pulmonary embolism
CTA
ab/flank pain that radiates to groin or hip, ab pain with hip extension
Psoas abscess
Diagnose psoas abscess
CT scan of abdomen and pelvis
back pain, cachexia, high alkaline phosphatase and multiple osteoblastic/osteolytic vertebral lesion,
High AFP
hepatocellular carcinoma or testicular cancer
Treat priapism
aspirate blood fro the corpora cavernosa
Causes of priapism
cocaine, alcohol, testosterone, sickle cell disease, trazadone
blood products given in hemorrhagic shock
4 units FFP and 4 units platelets
Pleural effusions that can be managed with observation
small-moderate and not enlarging
early onset (1-2 days)
not associated with respiratory symptoms
Management of tender, purple bulge below the dentate line
external hemorrhoid
excision
Chronic back pain, intermittent bilateral heel pain, impaired spinal mobility and limited chest wall expansion
Ankylosing spondylitis
Heart complication of ankylosing spondylitis
chronic aortic regurgitation
Nausea vomiting
No flatus
Abdominal distension
Decreased or absent bowel sounds
Ileus
Management of ileus
antiemetics, bowel rest, serial examinations
What decreases risk of infection in burn patients
Early wound excision and grafting
chest/back pain or epigastric pain, crepitus, Hamman sign, pleural effusion
widened mediastinum on CT
Esophageal perforation
D(x): Esophagography with water soluble contrast
Treatment for UC
5-ASA agents (mesalamine, sulfasalazine)
How to prevent perioperative complications in patient with obstructive hypertrophic cardiomyopathy
ensure adequate IV hydration
Acute Infective Endocarditis Preload Afterload Contractile function EF Forward stroke volume
Mitral regurgitation Preload: HIGH Afterload: low Contractile function: no change EF: HIGH Forward stroke volume: low
Management of sigmoid volvulus
Endoscopic detorsion (flex sig) and elective colectomy
Young male with weak/spraying stream, incomplete emptying
Urethral stricture
Dx postvoid residual
Manage: dilation/ urethroplasty
flexed hip, adducted, internal rotation
posterior hip dislocation
Treat hip dislocation
reduction within 6 hours of injury
if no fracture: closed reduction
if fracture: open reduction
if limp ischemia: CTA
Reason for transfusion reaction within an hour
ABO compatibility
Abx for osteomyelitis in sickle cell patients
clindamycine and ceftriaxone
Abx for osteomyelitis in healthy children
clindamycin/vancomycin
Diagnostic test to identify cause of priapism in patient with hepatosplenomegaly
CBC
Male breast mass management
Mammography
Hemorrhagic shock- continuing normal saline fluid can cause what complication
Increased risk for coagulopathy
Boys insidious hip pain, limp, restricted hip abduction, internal rotation, positive trendelenburg
Normal X ray
legg Calve Perthes
Avascular necrosis of femur
complications of nearsightedness
retinal detachment and macular degeneration
widened mediastinum prior falling from height
thoracic aortic injury
What type of hernia is more likely to be incarcerated
femoral hernia
History of alcohol and recent pancreatitis. Now progressive ab distension, nausea and vomiting.
CT round, well circumscribed, encapsulated fluid collection
Pancreatic pseudocyst
T(x): endoscopic drainage procedure
Exudative effusion
pleural/serum protein >.5
Pleural/serum LDH > .6
Pleaural LDH > 2/3 upper limit of normal for serum LDH
postop unilateral back pain, nausea and vomiting
hydronephrosis
unilateral floaters and progressive vision loss.
candida endophthalmitis
new onset hypoxia by pulse ox due to anesthetic use
acquired methmoglobinemia
headache, nausea, vomiting, ipsilateral ataxia, dysarthria, vertigo, nystagmus
cerebellar hemorrhage
Manage: surgical decompression
management of hidradenitis suppurativa
prolonged antibiotic
contraindication in cardioembolic stroke
thombolytics
diagnosis of meniscal tear
MRI
next step in management of infected foot ulcer
osteomyelitis (bone biopsy)
X ray: disruption of cortical contour, external rotation of distal fragment, shortening of neck, lucency or hazy sclerosis at fracture plane
femoral neck fracture
progressive sensorineural hearing loss, episodic vertigo with nystagmus due to changes in pressure in the inner ear (Valsalva)
Perilymphatic fistulas
Liver mass in women on long term OC, possible hemorrhage or malignant transformation
Hepatic adenoma
Liver mass with acute or chronic liver injury
Regenerative nodules
Most common place for colonic ischemia
splenic flexure
Complication of rhinoplasty
whistling noise
nasal septal perforation
Hematuria, flack/abdominal pain, elevated LDH/AKI
Enlarging kidney on imaging
Renal Vein thrombosis
Differentiate between level 1 axillary LN and Level 2
Pectoralis minor
Thyroid storm SVR Cardiac output: venous-o2 content pulm capillary wedge pressure
SVR: low
Cardiac output: high
venous O2 content: high
Pulm capillary wedge pressure: high
young patients with no tobacco exposure and multiple sexual partners.
enlarged firm neck mass and ulcerated tonsillar lesion
head and neck squamous cell carcinoma via HPV
First line treatment for high risk basal cell carcinoma
Mohs micrographic surgery
recurrent epistaxis and nasal crusting
CPAP usage
Brittle hair, skin depigmentation, neuro dysfunction, anemia, osteoporosis
What is deficient?
Copper deficiency
Risk factors of Euthyroid sick syndrome
severe acute illness
ICU admission
High dose glucorticoid therapy
Euthyroid thyroid labs
Low T3, normal TSH and T4
Aortic dissection patient
Initial study of choice in hemodynamically stable patients with no evidence of renal dysfunction
CT angio
0-6 hours post op fever reasons
tissue trauma
blood products
malignant hyperthermia
T(x) symptomatic
Frostbite management
- rapid rewarming
- Analgesia and wound care
- Angiography/ technetium 99m scan
- thrombolysis in severe cases
ear pain with normal ear exam
poor dentition
Referred otalgia via muscosal head and neck squamous cell carcinoma
Secretory diarrhea, bloating, abdominal cramps, umremarkable serum & stool studies
bile acid diarrhea
Treatment for bile acid diarrhea
choestyramine or colestipol
Unilateral, pruritic breast rash with breast erythema and edema, axillary LAD
Inflammatory breast cancer
Inflammatory breast cancer diagnosis
breast biopsy (core needle)
Management of venous air embolism
Left lateral decubitus positioning
High flow/hyperbaric O2
Throbbing headache and nausea
Unilateral pronator drift
CT: calcifies extra axial mass
MRI: Homogenous, dural based
meningioma
Management of symptomatic meningioma
complete resection
post gastric surgery, bloating, flatulence, chronic water diarrhea, low B12 high folate
SIBO
Management for small bowel obstruction
nasogastric tube insertion and emergency laparotomy
dorsal penile plaque and pain/ curvature with erection
Peyronie disease
Weakness in upper and lower extremities, atrophy in hands with hyperreflexia in legs, electric shock pain with neck flexion
cervical spinal cord compression
First line therapy for burn wound infection
Meropenem and vanco
velcro inspiratory crackles
CT: lower lobe subpleural honeycombing and reticular markings greatest and periphery
idiopathic pulmonary fibrosis
Management: antifibrotic therapy (pirfenidone, nintedanib)
Management of HIT
stop heparin and start direct thrombin inhibitor (argatroban) or fondaparinux
First line therapy for IBD induced toxic megacolon
IV corticosteroids
fall with object in mouth, gradual onset hemiplegia, aphasia, neck pain and thunderclap headache
Carotid artery dissection
Management of acute limb ischemia
anticoagulation (heparin)
Thrombolysis/surgery
Within first 3 months of transplant. Fever, malaise, LFT elevations
Histo: inflammatory infiltration
Acute cellular rejection
Management of acute cellular rejection
high dose corticosteroids
sudden onset severe unilateral ab pain right after strenuous activity
US: pelvic free fluid
ruptured ovarian cyst
Recommendation for medically stable patients who recover fro acute pancreatitis
Cholecystectomy
fracture of >3 adjacent ribs in >2 locations
isolated chest wall segment that moves paradoxically
flail chest
High alk phos and bilirubin
multifocal strictures of intrahepatic and extrahepatic bile ducts
PSC
CKD patient with femoral neck fracture what lab do you order?
parathyroid hormone level
small puncture wound appears minor initially
septic arthritis
Clenched fist bite injury
Management of clenched fist bite injury
urgent surgical irrigation and debridement
amp/sul or amp/clav
Complications of varicocele
infertility and testicular atrophy
Diagnosis of acute diverticulitis
CT abdomen
risk factors of avascular necrosis
femoral head fracture glucocorticoids excessive alcohol use sickle cell SLE
shortened internally rotated leg, hip flexed and adducted, knee flexed
unable to dorsiflex or straighten leg
posterior hip dislocation
liver abscess management
percutaneous aspiration
HIGH fever, tachy, hypertension, CHF, arrhythmia, agitation, delirium, goiter
postop
thyroid storm
Management of thyroid storm
B blockers
PTU
glucocorticoids
surgical indication in infective endocarditis
acute heart failure
extension of infection
difficult to eradicate organisms
persistent bacteremia on abx, large vagetation/ persistent septic emboli
shortened external rotation
femoral neck fracture
Pain out of proportion to injury, pain incrases on passive stretch, rapidly increasing and tense swelling, paresthesia
compartment syndrome
abx for acute bacterial prostatitis
Levofloxacin
complication of prolactinoma
bone loss
PAD diagnostic management
ABI
High pressure injection injury management
fasciotomy and debridement in the operating room
electrical injury complications
rhabdomyolysis
hard mass in the olecranon
tophaceous gout
indications for CT scan in orbital trauma
severe eye pain evidence of fracture painful extraocular movements decreased visual acuity suspected intraocular foreign body inadequate examination
Diagnostic imaging of appendicitis
CT abdomen
Treatment of spiral fracture of toddler
immobilization and pain control
adolescent
proximal airway obstruction
recurrent pneumonia
hemptysis
bronchial carcinoid tumor
Path of flail chest
impaired generation of negative inspiratory pressure
imaging for intraabdominal organ injury
CT scan
abdominal distention, failure to pass flatus, absent bowel sounds.
X ray dilated gas filled loops with no transition point
paralytic ileus
unilateral, painless testicular mass
dull ache in lower abdomen
High AFP, BhCG, LDH
testicular cancer
Diagnose testicular cancer
scrotal US
labs
Radical inguinal orchiectomy
Colles Fracture Nerve compression
Median N
Salter III Fracture complication
limb length discrepancy
Parasite that causes SBO
ascaris lumbricoides
jaundice, pruritis, acholic stools, dark urine, weight loss, RUQ pain
high direct bilirubin ALP and GGT
CEA, CA19 and AFP
cholangiocarcinoma
Candida infection is lost likely from what?
Central venous catheters
contact lens abrasion management
topical antibiotic
gold standard for sphincter of oddi dysfunction
Sphincter of oddi manometry
Treatment for Zenkers
cricopharyngeal myotomy
post burn injury
hyperglycemia, increased body temp, increased muscle wasting
tachy and HTN
Hypermetabolic response to burn injury
Treatment of Hypermetabolic response in burn injury
early burn exciion and grafting
B blocker
Insulin
Nutrition and steroid
rapid progressive cellulitis of the submandibular and sublinguial spaces
Ludwig angina
Indications of worse prognosis in acute pancreatitis
elevated BUN
SIRS criteria
third spacing of fluid
Predictors of postop outcomes following lung resection
Preop FEV1 and DLCO
post gastric bypass, fever, ab pain, tachy and tachypnea
anastomotic leak
D(x) oral contrast enhanced CT
stabbed in chest, respiratory distress, unilateral absent breath sounds, hypotension and distended neck veins
tension pneumothorax
TBI, episodic HTN, tachy, diaphoresis
paroxysmal sympathetic hyperactivity
most common opportunistic infection after renal transplant
CMV
Actively bleeding + DVT management
inferior vena cava filter
Right sided varicocele management
US abdominal
causes of sialadenosis
chronic alcohol use, bulimia, malnutrition
Type of dressing for venous stasis ulcers developed to cellulitis
wet to dry dressing
Cervical spine imaging necessary if
neuro deficit, spinal tenderness
AMS
intoxication
distracting injury
pain with ejaculation, many UTI
chronic bacterial prostatitis
valve issue that is most common cause of pregnancy related complications
mitral stenosis
Rectal prolapse with debilitating symptoms management
surgery
tumor that causes nasal congestion with epistaxis, headache, cranial nerve palsy, serous otitis media
nasopharyngeal carcinoma via EBV
treatment of plantar fasciitis
activity modification
stretching exercises
heel pads/ orthotics
blood thinner, acute ab pain, abdominal mass and anemia
rectus sheath hematoma
management of initial bloody output >1500mL via chest tube
emergent thoracotomy
Arterial embolism vs. arterial thrombosis
Arterial embolism= pain, pallor, paresthesia, pulseless, paralysis
arterial thrombosis= claudication
Most concerning of parotid malignancy
presence of facial droop
pelvic fracture + unstable patient
first step in management
pelvic binder
local complication of cardiac catheterization
AV fistula (continuous bruit with palpable thrill)
Organisms that cause deep infections following puncture wounds
staph aureus
pseudomonas
<24 hours after blunt thoracic trauma
tachypnea, tachy, hypoxia
CT: patchy, alveolar infiltrate not restricted by anatomic borders
pulmonary contusion
persistent hoarseness and fungating laryngeal mass
smoker
laryngeal SCC
complication of succinylcholine
cardiac arrhythmia due to electrolyte derangement
progressive hearing loss, paradoxical improvement in noisy environments
reddish hue behind TM
otosclerosis
Treatment for c. diff
fidaxomicin or vanco
complication of C. diff
toxic megacolon
arm in extension and pronated
no swelling, deformity or focal tenderness
Nursemaid elbow
treat via hyperpronation or supination of forearm and flexion of elbow
post surgery, traumatic injury
Abdominal distension, pain, obstipation, vomiting
Xray: colonic dilation, normal haustra, nondilated small bowel
Oglivie syndrome
unilateral bloody nipple discharge with no breast mass or LAD
intraductal papilloma
treatment of small pneumothorax
supplemental oxygen
abdominal pain, RUQ mass, jaundice
cystic dilation
biliary cyst
treat with ERCP
posterior knee an calf pain with tenderness and swelling of the calf resembing DVT
arc of ecchymosis distal to medial malleolus
ruptured popliteal cyst
management of suppurative parotitis
US/CT
hydration and oral hygiene
abx
massage
bilateral hip, thigh, and buttock claudication
absent/ diminished femoral pulses, impotence
leriche syndrome
post op fever, leukocytosis, high LFTs and RUQ pain
acalculous cholecystitis
nonhealing ulcer at the site of chronic burn scar
squamous cell carcinoma
CT well defined cyst with eggshell calcification
dogs at home
hyadatid cyst
alopecia, pustular skin rash, hypogonadism, impaired wound healing, impaired taste, immune dysfunction
zinc deficiency
most common empyema organisms
strep pneumo, staph aureus
diagnostic of laryngomalacia
laryngoscopy
malignant pericardial effusion management
TTE
weeks to months after amputation
focal tenderness, altered local sensation
decreased pain with anesthetic injection
post traumatic neuroma
complication of cardiac surgery. mild chest pain or sensation of chest wall instability and clicking
sternal dehiscence
T(x) surgical emergency sternal fixation
irregular exophytic growths in clusters on vocal cords
laryngeal papillomas
sudden sharp pain while pivoting ankle.
Cannot move foot when calf is squeezed, cannot walk of tippy toes
Achilles tendon rupture
neuroendocrine malignancy from parafollicular cells
medullary thyroid cancer
check calcitonin
bilateral renal infarcts and several abdominal arteries with microaneurysms and distal abrupt cutoffs
polyarteritis nodosa
Management of pheochromocytoma preop
alpha blockage prior to beta blockade
thyroid tumor marker
thyroglobulin
abdominal pain or nausea post cholecystectomy
dilated common bile duct
postcholecystectomy syndrome
ERCP
staging evaluation for rectal adenocarcinoma
CEA, CT scan, colonoscopy
Thyroid nodule evaluation
- TSH and thyroid US
2. radioactive scintigraphy
posterior displacement of distal humerus
nerve and artery damage
median nerve
brachial artery
artery injured in knee dislocation
popliteal artery
anterior mediastinal mass high AFP and B hCG
mixed germ cell tumor
liver mass with arterial flow and central scarring
focal nodular hyperplasia
RUQ pain, jaundice, anemia and hyperbilirubinemia after liver biopsy, upper GI bleed
hemobilia
quick twisting motion around flexed knee, severe pain, popping noise
patellar dislocation
indurated, erythematous mass near anal orifice associated with severe constant anal pain and low grade fever
perianal abscess
occlusion of an anal crypt gland
blunt abdominal trauma with billous emesis, gastric dilation and scant distal gas
duodenal hematoma
reduce intracranial pressure
hypertonic saline
post splenectomy abx if fever
amoxicillin- clav
