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Med Prep > Surgery > Flashcards

Surgery Flashcards

1
Q

What is spontanenous bacterial peritonitis

A
  • ascitic fluid (from liver cirrhosis) infection
  • in the absence of intra-abdominal infection after surgery
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1
Q

Signs of peritonitis

A
  • rebound tenderness
  • rigid abdomen
  • guarding
  • fever
  • pain
  • nausea & vomiting
  • signs of sepsis
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2
Q

What are the signs of sepsis?

A
  • tachycardia
  • fever
  • hypotension
  • leukocytosis
  • form of organ failure e.g. oliguria or altered mental status
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3
Q

What is the SOFA score?

A

Used in Sepsis -> sequential organ failure assessment score

  • altered mental status -> CNS -> GCS score
  • coagulopathy -> DIC, petechiae, purpura
  • hypotension -> CV -> MAP
  • oliguria -> renal -> creatinine
  • jaundice -> liver -> bilirubin
  • respiratory distress -> respiration ratio

All scored 0-4
SOFA Score > 2 -> 10% risk of overall mortalitity

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4
Q

What is the qSOFA?

A

Considered positive if ≥ 2 of the following are present:

  • Altered mental status
  • Systolic blood pressure ≤ 100 mm Hg
  • Respiratory rate ≥ 22/min

Can predict poor outcomes; not recommended as a sole screening tool for sepsis

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5
Q

Which pediatric fractures areas are seen to require careful monitoring?

A
  • suprachondylar fracture of the humerus and fractures involving the epiphysis or growth plate with hyperextension of the elbow
  • dangerous due to close proximity to brachial artery and ulnar nerve
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6
Q

What are the 2 common forearm fractures in adults? Explain the site of injury.

A

Monteggia

  • impact on ulna
  • proximal third of ulnar diaphyseal injury
  • anterior dislocation of radial head

Galeazzi

  • impact on the radial bone
  • distal third of radius
  • radioulnar dislocation
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7
Q

Tx of monteggia and galeazzi fractures?

A

often requires open reduction
and internal fixation, whereas the dislocated one is typically handled with closed
reduction.

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8
Q

What is a Colles’ fracture?

A
  • common fracture due to a fall on outstretched hands (extended)
  • often in elderly with osteoporosis
  • distal radius fracture
  • radius is dorsally displaced on X ray -> dinner fork appearance
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9
Q

Colles fracture treatment?

A
  • Closed reduction and long arm cast
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10
Q

What is a smith fracture?

A
  • fall on outstretched arm with flexed wrist
  • possible neurovascular damage
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11
Q

What is carpal navicular fracture?

A

-scaphoid fracture -> emergency due to risk of avascular necrosis; especially proximal scaphoid

  • young adults fall on outstretched hands
  • present with wrist pain and tenderness over snuffbox
  • undisplaced show negative X ray
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12
Q

Treatment of carpal navicular (scaphoid) fracture?

A
  • non displaced -> thumb sica cast
  • Xray may be negative but just based on hx and PE
  • displaced and X ray positive -> ORIF
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13
Q

Where are metacarpal fracture commonly found?

A
  • 4th anf 5th metacarpal or both
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14
Q

Cause and treatment of metacarpal fractures?

A
  • closed fist injury e.g. wall punch -> present with a lot of swelling and tenderness
  • Tx depends on level of displacement, angulation and rotary malalignment
  • mild fracture -> closed reduction and ulna gutter splint
  • markedly displaced = K wire or plate fixation
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15
Q

Most common shoulder dislocation? How do they present?

A
  • anterior
  • shaking hand -> arm close to body with outwardly rotated
  • possible numbness over deltoid -> stretched of axillary nerve
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16
Q

When do posterior dislocation occur?

A
  • rapid uncoordinated muscle contractions e.g. seizure or electrical burn
  • arm kept close to body and internally rotated
  • X ray may easily miss it -> require axillary and scapular view
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17
Q

Common areas of fracture in clavilce?

A
  • middle and distal third (medial third is rare)
  • ALLMAN CLASSIFICATION
18
Q

Presentation of clavicle farcture?

A
  • general tenderness, swelling and reduced mobility
  • shoulder drooping (or shoulder dragging by upper limb)
  • skin tagging -> SCM pulling up medial fragment
  • shorten clavicle -> more adduction

*see AMBOSS picture

19
Q

Treatment of clavicle fracture?

A
  • most treated conservatively -> sling immobolisation 4-8 weeks
  • midshaft and medial fractures require surgery
20
Q

femoral neck fracture?

A
  • common in elderly
  • with osteoporosis
  • possible pathological fractures from metastases
  • 3 degrees
21
Q

Treatment femoral neck fractures?

A

Old -> total hip replacement or hip hemiarthroplasty

Young -> early ORIF within 6 hours

22
Q

When is surgery indicated in femoral neck fractures?

A
  • unstable fractures
  • fragment dislocation
23
Q

Open fracture of femur tx?

A

Irrigation and closure within 6 hours -> emergency case

24
Q

Pain on passive abduction on 30 degree flexed knee shows…

A

medial ligament injury

25
Q

Pain on passive adduction on 30 degree flexed knee shows…

A

lateral ligament injury

26
Q

What is a lachman test? What is the drawer test?

A

Used for ACL injury

  • knee flexed at 20 degrees held in one hand and pull tibia anterior to femur
  • no resistance or “endpoint” refers to ACL injury
  • drawer is when knee is 90 degree flexed
  • lower leg pulled anteriorly like pulling a drawer
27
Q

What are bisphosphonates are their function. Give examples.

A
  • induce osteoclast apoptosis -> reduce bone resorption
  • end in dronate e.g. alendronate
28
Q

Contraindications for Bisphosphonate

A

Renal impairment -> low creatinine clearance
Hypocalcemia
Hypersensitivity

29
Q

Indications for Bisphosphonates

A

Osteoporosis
Hypercalcemia
Tumor-induced osteolysis (e.g., metastasis to the bone)
Multiple myeloma
Paget’s disease of bone
Ostegenesis imperfecta

30
Q

What is a meniscus tear? Ex, CF?

A
  • Caused by an acute injury, most often due to axial loading and rotation with a fixed foot
  • knee pain worsens with weight bearing or physical activity
  • intermittent effusion
  • restricted knee extension
    A clicking sound and/or a popping and locking sensation may be present on movement
31
Q

What is the McMurray Test?

A

Test for Meniscus tear

  • have knee maximally flexed
  • extend knee passively and…
  • internally rotate for lateral tear
  • externally rotate for medial tear
  • presents with pain on palpation of joint space
  • Palpable or audible pop/click with maneuvers
32
Q

What is adhesive capsulitis?

A

aka frozen shoulder

global restriction in shoulder mobility, especially abduction and external rotation

systemic disease may be risk factors e.g. diabetes, scleroderma, thyroid disorder

33
Q

Tx of adhesive capsulitis

A
  • initially NSAIDs; oral steroids if NSAIDs not sufficient -> only work for up to 6 weeks
  • injecting steroids for severe kind
  • even worse -> nerve block (subscapular)
  • physiotherapy
34
Q

What is the salter harris classification?

A

Used for physeal or growth plate fractures

  • S → Separate → through the physis
  • A → Above → physis and metaphysis → MOST COMMON
  • L → beLow → physis and epiphysis
  • T → Through → metaphysis, physis and epiphysis
  • ER → ERaser → crush injury of physis → poor prognosis
35
Q

What is Paget’s Disease treatment?

A
  • basic analgesics
  • vit D and calcium supplement to prevent secondary hypoparathyroidism and hypocalcemia
  • zoledronic acid -> IV bisphosphonate
36
Q

Wha is Paget’s disease of the bone? CF?

A
  • weak woven bone formation from increased bone remodelling from increased osteoclast and osteoblast activity
  • unknown etiology

CF:
- bone pain
- pathological fracture
- enlarged skull -> increased hat size
- saber shins
- impaired hearing -> ankylosis of ossicles

37
Q

What is the Ottawa knee rules?

A

indication for X ray after knee injured

  • aged 55 years or over
  • tenderness at the head of the fibula
  • isolated tenderness of the patella
  • inability to flex knee to 90 degrees
  • inability to bear weight (defined as an
    inability to take four steps, ie. two steps on each leg, regardless of limping) immediately and at presentation
38
Q

What is a Thompson test?

A
  • used in Achilles tendon rupture
  • usually compression of the calf muscle, on affected side, leads to plantar reflex
  • absence of plantar reflex leads to positive Thompson test
39
Q

What position is the arm in during a anterior shoulder dislocation?

A
  • arm is abducted and externally rotated
40
Q

Most common areas involved in paget’s disease of the bone?

A
  • pelvis (most commonly)
  • femur
  • lumbar spine
  • skull
  • tibia
41
Q

Indications for urgent surgery?

A

1-Diffuse peritonitis(localized peritonitis is not always an indication)

2-Severe or increasing localized tenderness

3-Progressive abdominal distension

4-Tender mass with fever or hypotension (abscess)

5-Septicemia and abdominal findings

7-Bleeding and abdominal findings

8-Suspected bowel ischemia (acidosis,fever,tachycardia)

9-Massive bowel dilatation more than 12cm.

42
Q
A

Med Prep (7 decks)

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