Surgery

Question 1

what amount of prednisone to cause adrenal insufficiency?

Answer 1

pred >20mg a day for 3 weeks

Question 2

Volkmann contracture

Answer 2

2/2 compartment syndrome

Question 3

How does hyperventilation lower ICP

Answer 3

causes cerebral vasoconstriction

Question 4

child with suspected diaphragmatic rupture on KUB, next step in mgmt?

Answer 4

CT

Question 5

Can you see a stress fx on plain film?

Answer 5

usually not, sometimes see periosteal reaction

Question 6

kid with GCS 15 s/p head trauma and LOC for 1 min, mgmt?

Answer 6

observe for 4-6 hours or do NCHCT

Question 7

sub Q emphysema, what kind of intubation

Answer 7

fiberoptic bronchoscope

Question 8

mgmt hemorrhagic shock in non urban setting

Answer 8

o Non urban setting: volume resuscitate first, then blood until urinary output is 0.5-2mL/kg/hr while not exceeding CVP of 15mmHg

Question 9

can hypovolemic shock happen from intracranial bleeding?

Answer 9

no, not enough space

Question 10

topical burn tx

Answer 10

silver sulfadiazine

Question 11

deep burn penetration

Answer 11

mafenide acetate

Question 12

tx burns near eyes

Answer 12

trile antibiotic ointment

Question 13

epinephrine dose for a bee sting

Answer 13

0.3-0.5mL 1:1000 IM

Question 14

tx black widow spider

Answer 14

Ca gluconate, muscle relaxants

Question 15

brown recluse spider bites tx

Answer 15

dapsone

Question 16

human bite mgmt

Answer 16

extensive irrigation and debridement in the OR

Question 17

penetrating wound to extremities with no vascular involvement, mgmt?

Answer 17

tetanus prophylaxis and cleaning of the wound

Question 18

what do you have to worry about in circumferential burns

Answer 18

blood supply!

Question 19

what burn victims are candidates for early excision and grafting

Answer 19

limited 3rd degree burns

Question 20

pt with severe chest pain, SOB and tachycardic: dx on POD 2 vs POD 7

Answer 20

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)

Question 21

DDx and tx for developmental dysplasia of the hip

Answer 21

Sonogram

Pavlik harness x 6 months

Question 22

dx osteo in a kid

Answer 22

MRI, tx abx (plain films take weeks to show)

Question 23

bowlegs are nml until when

Answer 23

age 3

Question 24

genu valgus nml when?

Answer 24

4-8 years old, no tx

Question 25

kid with hyperextension of elbow, or FOOSH | what injury at risk for? tx?

Answer 25

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

Question 26

tx fx of growth plate

Answer 26

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

Question 27

tx metacarpal neck fractures

Answer 27

closed reduction and ulnar gutter splint

Question 28

isolated collateral ligament injury tx

Answer 28

hinged cast

Question 29

point tenderness over tibia, x rays nml, dx?

Answer 29

stress fx | tx cast and repeat x rays in 2 weeks

Question 30

tx open fx

Answer 30

cleaning in OR and reduction within 6 hours

Question 31

tx gas gangrene

Answer 31

IV PCN, surgical debridement and hyperbaric O2

Question 32

patient who cannot extend finger unless they pull on it, wake up in middle of night with finger flexed dx, tx

Answer 32

dx: trigger finger ddx: no history of trauma tx: steroids, then surgery if fails

Question 33

tx de quervain tenosynovitis

Answer 33

splint, anti-inflammatories, steroid injection

Question 34

injury from thumb hyperextenion?

Answer 34

gamekeeper thumb, cast

Question 35

can't flex finger, dx

Answer 35

Jersey finger | splint

Question 36

can't extend finger, due to sports , dx, tx

Answer 36

dx: mallet finger tx: split commonly seen in volleyball

Question 37

finger amputation mgmt

Answer 37

clean finger wtih sterile saline, put on plastic bag on ice

Question 38

distended bladder, flaccid rectal sphincter, perineal saddle anesthesia dx, tx

Answer 38

cauda equina syndrome surgical emergency, needs immediate deompression

Question 39

what EF needed to have surgery?

Answer 39

>35%

Question 40

how soon have surgery s/p MI

Answer 40

best to wait 6 months

Question 41

how long stop smoking prior to surgery

Answer 41

8 weeks with resp rehab

Question 42

mgmt of deep thrombophlebitis

Answer 42

doppler studies of deep leg and pelvic veins. Anticoagulate with heparin

Question 43

FETID mneumonic prevention of wound closure

Answer 43

``` foreign body epithelialization tumor infection irradiated tissue IBD distal obstruction ```

Question 44

imaging for obstructive jaundice

Answer 44

RUQ US then ERCP

Question 45

what prolongs paralytic ileus

Answer 45

hypoK

Question 46

mgmt Ogilvie syndrome

Answer 46

KUB fluid and electrolyte correction IV neostigmine

Question 47

tx achalasia

Answer 47

balloon dilatation by endoscopy

Question 48

dx Carcinoid

Answer 48

24 hr urine 5-HIAA

Question 49

tx amebic liver abscess

Answer 49

Flagyl

Question 50

venu garum: when nml

Answer 50

until age 3 beyond 3 MC Blount dz, distrubance of medial proximal tibial growth plate--> surgery

Question 51

venu valgus: when normal?

Answer 51

between ages 4-8, no tx

Question 52

pt with GERD with severe dysplastic changes, what surgery? everyone else with GERD without these changes?

Answer 52

Resection Nissen fundoplication for everyone else

Question 53

Patient with AT III deficiency, what CAN'T you use to anti-coagulate them?

Answer 53

heparin

Question 54

urine output goal per hour burn victim?

Answer 54

1-2mL/kg/hr

Question 55

mgmt of electrical burn pt

Answer 55

48 hours on tele

Question 56

how manage airway of a patient with multiple facial fractures?

Answer 56

crichothyroidotomy

Question 57

retroperitoneal fluid found on abdominal CT in a patient who suffered blunt abdominal trauma?

Answer 57

duodenal rupture

Question 58

blood at urethral meatus, high riding prostate and scrotal hematoma: what injury? next best test?

Answer 58

consider pelvic fracture with urethral or bladder injury retrograde urethrogram (not a foley!) if nml retrograde cystogram to eval bladder

Question 59

how much fluid do you need to see on lateral decubitus film to do a thoracentesis?

Answer 59

>1cm