Surgery

Question 1

Keloid management

Answer 1

Intralesional steroids
Excision if that fails

Question 2

What to do about afib before emergency surgery?

Answer 2

If hds iv beta blocker or nondihydropyr ccb (eg dilt) for rate control to 100-110, want some tachy to meet metab demand

Then chadsvasc to guide postop ac

If hd unstable, cardiovert

Question 3

Rapid sequence intubation vs awake

Answer 3

Awake - pt independently maintains upper airway tone and spon ventilation while airway is visualized; do this if worry that intubation will fail and pt will become hypoxic, use ketamine

Rsi- pt anesthetized and paralyzed, eg with prop and rocuronium or succ

Question 4

Cricothyrotomy vs tracheostomy

Answer 4

Cric in emergency (faster,easier, lower hem risk) and can convert to trach later

Question 5

Free air under diaphragm on xr means

Answer 5

Gi Perf

Vs dilated loops of bowel, air fluid levels, no gas in rectum = obstruction)

Question 6

Timing of postop complications

Answer 6

Wind - atelectasis, pod1, then pna pod3
Water - uti, pod 3
Walking - thrombophlebitis, pod5
Wound - pod7

Question 7

Postop confusion, think…

Answer 7

Hypoxia first bc most deadly - ro with abg

Then sepsis, tme etc

Question 8

Congenital conditions requiring surgery, look for…

Answer 8

VACTERL
Vertebral (X-ray)
Anal (imperforation)
Cardiac (echo)
Tracheal (X-ray)
Esophageal
Renal (us)
Limb/Radial (X-ray)

Question 9

Hip dislocation vs fracture

Answer 9

Dislocation —> internally rotated leg, mva with knees hitting dashboard, surgical emergency

Fx—> ext rotation and shortening

Question 10

Subclavian steal

Answer 10

Arteriosclerotic plaque in aubclavian so when need extra blood to arm bc of exertion, dilate and vacuum forms so less blood to brain etc—> vision and balance sx

Tx is bypass

Question 11

Management of AAA

Answer 11

If sx, surgery
Diameter: 3-4.4 cm image annually
4.5-5.4 cm image every three mo
5.5 up or rapid expansion - surgery

One time screening us in all men 65-75yo who have ever smoked

Question 12

Leg claudication

Answer 12

If not interfering with life, quit smoking, take asa and pde3 inhib cilostazol, exercise

If pain is severe, get us (abi<0.9) and arteriogram to find stenosis, then can stent, bypass etc

Question 13

When to do preop cardiac stress testing?

Answer 13

Before cardiac procedure or if it would be indicated in absence of surgery

Question 14

Three meds you give unconscious undiff pt

Answer 14

Thiamine, naloxone, dextrose

Question 15

How to diagnose abdominal compartment syndrome

Answer 15

Measure intrabd pressure eg via foley

Tx surgical decompression

Question 16

Gallstone management

Answer 16

Asx - do nothing
Sx - elective chole
Atypical sx - try ursodeoxy and if it helps do chole
Sx without stones - cholecystokinin-stim cholescintigraphy and if low gb ef (fxal gb disorder), do chole

If us inconclusive, do hida
ERCP before chole if bad choledocho or acute cholangitis

Question 17

Test of choice for dx ptx in emergency

Answer 17

Ultrasound - lack of pleural sliding

Vs nonacute do upright cxr

Vs if think tension ptx, no imaging needed, just decompress

Question 18

Mallory Weiss tear tx

Answer 18

Ivf and ppi, then let heal on own
Actively bleeding or high risk to bleed, do endoscopic intervention

Question 19

Management of pneumomediastinum

Answer 19

Supportive, self resolves

Question 20

Dumping syndrome tx

Answer 20

High protein, low carb and small frequent meals