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
1
Q
Signs of peritonitis
A
- rebound tenderness
- rigid abdomen
- guarding
- fever
- pain
- nausea & vomiting
- signs of sepsis
2
Q
What are the signs of sepsis?
A
- tachycardia
- fever
- hypotension
- leukocytosis
- form of organ failure e.g. oliguria or altered mental status
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
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
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
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
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.
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
9
Q
Colles fracture treatment?
A
- Closed reduction and long arm cast
10
Q
What is a smith fracture?
A
- fall on outstretched arm with flexed wrist
- possible neurovascular damage
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
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
13
Q
Where are metacarpal fracture commonly found?
A
- 4th anf 5th metacarpal or both
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
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
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
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
Pain on passive abduction on 30 degree flexed knee shows...
medial ligament injury
25
Pain on passive adduction on 30 degree flexed knee shows...
lateral ligament injury
26
What is a lachman test? What is the drawer test?
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
What are bisphosphonates are their function. Give examples.
- induce osteoclast apoptosis -> reduce bone resorption
- end in dronate e.g. alendronate
28
Contraindications for Bisphosphonate
Renal impairment -> low creatinine clearance
Hypocalcemia
Hypersensitivity
29
Indications for Bisphosphonates
Osteoporosis
Hypercalcemia
Tumor-induced osteolysis (e.g., metastasis to the bone)
Multiple myeloma
Paget's disease of bone
Ostegenesis imperfecta
30
What is a meniscus tear? Ex, CF?
- 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
What is the McMurray Test?
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
What is adhesive capsulitis?
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
Tx of adhesive capsulitis
- 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
What is the salter harris classification?
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
What is Paget's Disease treatment?
- basic analgesics
- vit D and calcium supplement to prevent secondary hypoparathyroidism and hypocalcemia
- zoledronic acid -> IV bisphosphonate
36
Wha is Paget's disease of the bone? CF?
- 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
What is the Ottawa knee rules?
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
What is a Thompson test?
- 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
What position is the arm in during a anterior shoulder dislocation?
- arm is abducted and externally rotated
40
Most common areas involved in paget's disease of the bone?
- pelvis (most commonly)
- femur
- lumbar spine
- skull
- tibia
41
Indications for urgent surgery?
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
