Surgery Flashcards
what amount of prednisone to cause adrenal insufficiency?
pred >20mg a day for 3 weeks
Volkmann contracture
2/2 compartment syndrome
How does hyperventilation lower ICP
causes cerebral vasoconstriction
child with suspected diaphragmatic rupture on KUB, next step in mgmt?
CT
Can you see a stress fx on plain film?
usually not, sometimes see periosteal reaction
kid with GCS 15 s/p head trauma and LOC for 1 min, mgmt?
observe for 4-6 hours or do NCHCT
sub Q emphysema, what kind of intubation
fiberoptic bronchoscope
mgmt hemorrhagic shock in non urban setting
o Non urban setting: volume resuscitate first, then blood until urinary output is 0.5-2mL/kg/hr while not exceeding CVP of 15mmHg
can hypovolemic shock happen from intracranial bleeding?
no, not enough space
topical burn tx
silver sulfadiazine
deep burn penetration
mafenide acetate
tx burns near eyes
trile antibiotic ointment
epinephrine dose for a bee sting
0.3-0.5mL 1:1000 IM
tx black widow spider
Ca gluconate, muscle relaxants
brown recluse spider bites tx
dapsone
human bite mgmt
extensive irrigation and debridement in the OR
penetrating wound to extremities with no vascular involvement, mgmt?
tetanus prophylaxis and cleaning of the wound
what do you have to worry about in circumferential burns
blood supply!
what burn victims are candidates for early excision and grafting
limited 3rd degree burns
pt with severe chest pain, SOB and tachycardic: dx on POD 2 vs POD 7
POD 2: hypotension, see ST depression and T wave flattening with EKG and troponins
POD 7 : PE (usually don’t get in first few days post op)
DDx and tx for developmental dysplasia of the hip
Sonogram
Pavlik harness x 6 months
dx osteo in a kid
MRI, tx abx (plain films take weeks to show)
bowlegs are nml until when
age 3
genu valgus nml when?
4-8 years old, no tx
kid with hyperextension of elbow, or FOOSH
what injury at risk for? tx?
supracondylar fracture of the humerus
vascular / nerve injury can cause a Volkmann’s contracture
need casting, montior vascular and nerve intregrity, watch out for compartment syndrome
tx fx of growth plate
closed reduction if epiphyses and growth place are displaced laterally but in 1 piece
if growth plate is in 2 pieces, need precise alignment: ORIF
tx metacarpal neck fractures
closed reduction and ulnar gutter splint
isolated collateral ligament injury tx
hinged cast
point tenderness over tibia, x rays nml, dx?
stress fx
tx cast and repeat x rays in 2 weeks
tx open fx
cleaning in OR and reduction within 6 hours
tx gas gangrene
IV PCN, surgical debridement and hyperbaric O2
patient who cannot extend finger unless they pull on it, wake up in middle of night with finger flexed
dx, tx
dx: trigger finger
ddx: no history of trauma
tx: steroids, then surgery if fails
tx de quervain tenosynovitis
splint, anti-inflammatories, steroid injection
injury from thumb hyperextenion?
gamekeeper thumb, cast
can’t flex finger, dx
Jersey finger
splint
can’t extend finger, due to sports , dx, tx
dx: mallet finger
tx: split
commonly seen in volleyball
finger amputation mgmt
clean finger wtih sterile saline, put on plastic bag on ice
distended bladder, flaccid rectal sphincter, perineal saddle anesthesia
dx, tx
cauda equina syndrome
surgical emergency, needs immediate deompression
what EF needed to have surgery?
> 35%
how soon have surgery s/p MI
best to wait 6 months
how long stop smoking prior to surgery
8 weeks with resp rehab
mgmt of deep thrombophlebitis
doppler studies of deep leg and pelvic veins. Anticoagulate with heparin
FETID mneumonic prevention of wound closure
foreign body epithelialization tumor infection irradiated tissue IBD distal obstruction
imaging for obstructive jaundice
RUQ US then ERCP
what prolongs paralytic ileus
hypoK
mgmt Ogilvie syndrome
KUB
fluid and electrolyte correction
IV neostigmine
tx achalasia
balloon dilatation by endoscopy
dx Carcinoid
24 hr urine 5-HIAA
tx amebic liver abscess
Flagyl
venu garum: when nml
until age 3
beyond 3 MC Blount dz, distrubance of medial proximal tibial growth plate–> surgery
venu valgus: when normal?
between ages 4-8, no tx
pt with GERD with severe dysplastic changes, what surgery? everyone else with GERD without these changes?
Resection
Nissen fundoplication for everyone else
Patient with AT III deficiency, what CAN’T you use to anti-coagulate them?
heparin
urine output goal per hour burn victim?
1-2mL/kg/hr
mgmt of electrical burn pt
48 hours on tele
how manage airway of a patient with multiple facial fractures?
crichothyroidotomy
retroperitoneal fluid found on abdominal CT in a patient who suffered blunt abdominal trauma?
duodenal rupture
blood at urethral meatus, high riding prostate and scrotal hematoma: what injury?
next best test?
consider pelvic fracture with urethral or bladder injury
retrograde urethrogram (not a foley!)
if nml
retrograde cystogram to eval bladder
how much fluid do you need to see on lateral decubitus film to do a thoracentesis?
> 1cm
