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Step 3 > Surgery > Flashcards

Surgery Flashcards

1
Q

What is the treatment for acute Diverticulitis with localized peritoneal signs and abscess seen on imaging?

A

NPO
IV Fluids
IV Ab’s
Percutaneous Drainage

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2
Q

What is the treatment for acute Diverticulitis with generalized peritoneal signs and/or perforation on imaging?

A

Emergency Surgery

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3
Q

What is the treatment for acute Diverticulitis with NO peritoneal signs?

A

Ab’s on outpt basis

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4
Q

What is the treatment for recurrent episodes of acute diverticulitis?

A

Elective Surgery

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5
Q

What test is absolutely contraindicated in pt presenting with possible acute diverticulitis?

A

Colonoscopy (risk of perforation)

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6
Q

What are 3 complications of acute pancreatitis?

A

Abscess formation
Pseudocyst formation
Chronic pancretitis

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7
Q

In a pt with acute pancreatitis found to have low hct, low calcium, high glc, high BUN, and WBC>18000, what should also be suspected?

A

Hemorrhagic Pancreatitis

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8
Q

What is the indication for CT in the work-up of acute pancreatitis?

A

Unclear dx after serum amylase/lipase done

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9
Q

What is the treatment for acute pancreatitis?

A

NPO
NG tube suction (decompression)
IV Fluids

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10
Q

When is surgery indicated to treat pancreatic pseudocyst?

A

Pain + >6cm + present>6wks

Can also do endoscopic drainage

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11
Q

What is the most likely diagnosis for a pt presenting ~5 wks after acute pancreatitis episode, now with anorexia, pain, and palpable abdominal mass?

A

Pseudocyst

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12
Q

What is the treatment for an infected pancreatic pseudocyst?

A

Percutaneous external drainage

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13
Q

What is the treatment of chronic damage secondary to recurrent acute pancreatitis?

A

Insulin

Pancreatic Enzyme replacement

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14
Q

What does Rovsing’s Sign demonstrate?

A

need answer

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15
Q

Waht study is preferred if presentation of suspected Appendicitis is unclear?

A

CT Abdomen

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16
Q

If appendicitis also has perforation, what should change in management?

A

Continue IV antibiotics until fever and WBC are normal

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17
Q

Which Antibiotics are used in the treatment of acute appendicitis?

A

Metronidazole and Cipro
Ampicillin/Sulbactam
Clindamycin and Levofloxacin
Cefoxitin or Cefotetan

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18
Q

What are the indications for elective surgery for Chronic Ulcerative Cholitis?

A

Pt had disease >20yrs
Multiple hospitalizations
Pt. needs chronic high-dose steroids/immunosuppressants
Toxic megacolon

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19
Q

What are the three major arterial vessels that supply the gut?

A

Celiac Trunk
Superior Mesenteric Artery
Inferioir Mesenteris Artery

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20
Q

What is the next best step in management for an elderly pt presenting with severe abdominal pain and a benign exam?

A

Surgery or CT angiography

Draw labs for ABG, CBC w/ diff, Chemistries (but do not wait for results)

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21
Q

Which artery is most commonly involved in mesenteric ischemia?

A

Superior Mesenteric Artery

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22
Q

What tests are used to dx intra-abdominal abscess?

A

CBC w/diff

CT Ab/pelvis w/ contrast

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23
Q

What is the treatment for intra-abdominal abscess?

A 
Drain (surgically or percutaneously) to treat abscess
IV Ab (start before surgery) to prevent spread
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24
Q

What is the next step in working up a pt who is female, fat, fertile, and in her 40’s with recurrent abdominal pain esp after eating a fatty meal?

A

1) Phys Exam: Murphy’s Sign
2) Sonogram-RUQ esp
3) Labs:

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25
Q

What is the treatment for Obstructive Jaundice secondary to gallstones?

A

ERCP with sphincerotomy

Cholecystectomy within 2 wks (elective)

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26
Q

What are the features of Reynold’s Pentad for acute ascending cholangitis?

A 
Jaundice
Fever
Abdominal Pain
Hypotension/Shock
Altered Mental Status
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27
Q

In a pt with cirrhosis for whom surgery is being considered, what risk factors would be a contraindication to surgery?

A

Hepatic Risk Factors (multiple):
Bilirubin >2
Prothrombin Time >16
Albumin

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28
Q

What lab value indicates an increased risk of postoperative pneumonia in a pt with COPD?

A

FEV1

29
Q

What cardiac risk factor would prohibit non-cardiac surgery?

A

EF

30
Q

For a pt scheduled to have an elective procedure but had a recent MI, what should be done regarding his operation?

A

Delay surgery for at least 6 mos post MI

31
Q

In a smoker, what test should be done prior to surgery?

A

PFT (FEV1) –> if FEV1 abnormal—> ABG

Smoking Cessation for at least 8WKS BEFORE surgery

32
Q

What should be done for a pt scheduled for surgery who is found to have lost >20% body weight in a few months and serum albumin is

A

5-10 days of nutritional supplements (enteral) BEFORE surgery

33
Q

What metabolic parameter is an absolute contraindication to surgery?

A

Transferrin

34
Q

What should be done for a pt recently in Diabetic coma who is scheduled for surgery?

A

Stabilize blood sugars
Rehydrate
Normaliza acidosis ALL BEFORE surgery

35
Q

What is the next best step in a pt who becomes disoriented a few hours following an uncomplicated but lengthy surgery?

A

ABG (to assess for hypoxia)

36
Q

What is the next step in management for a pt who is 9 days post sigmoid resection now having feculent drainage from wound drain, afebrile, stable vitals, and no complaints?

A

Observation and correct any metabolic/volume derangements
(GI fluid leakage draining to outside postoperatively is NOT indication for emergency surgery. It should resolve spontaneously)

Note, only need intervention if fecal material is accumulating within the body. This would result in systemic signs.)

37
Q

When an infant presents with congenital anomoly, what is the most important thing to do prior to surgery?

A

Check for additional abnormalities according to:VACTERL

Vertebral(XRAY)
Anus (imperforation)
Cardiac (Echo)
Tracheal (CXR)
Esophageal (fistulas/blind pouch)
Renal/Radial (sonogram/xray)
Limb
38
Q

What pediatric conditions are typically associated with “Double Bubble” sign on XRAY?

A

Intestinal Atresias
Annular Pancreas
Intestinal Malrotation

39
Q

When Fracture is suspected, what choice of Xrays are needed?

A

2 XRAYS, 90 degrees to each other and MUST include at least Joint Above and Joint Below

(consider all possible areas of injury along the line of force)

40
Q

What is the treatment for clavicular fracture?

A

Figure-8 sling for appx. 6 wks (adults, children don’t really need this)

41
Q

What is the typical presentation for an upper extremity Anterior Dislocation?

A

Adducted arm with forearm EXTERNALLY rotated.

42
Q

What is the typical presentation for an upper extremity Posterior dislocation?

A

Adducted arm with forearm INTERNALLY rotated.

43
Q

What is the management for a pt with intrertrochanteric fracture?

A

Open reduction and pinning

Anticoagulation post op (bc high tendency for thrombosis)

44
Q

What is the management for a pt with a displaced femoral neck fracture?

A

Prosthetic replacement of femoral head.

d/t high risk of avascular necrosis

45
Q

What is the presentation for Colles’ fracture?

A

Fall on OUTSTRETCHED Hand.

46
Q

What is the management for femoral shaft fracture?

A

Intramedullary Rod Fixation

high risk of fat emboli

47
Q

What is a major complication of comminuted bilateral femoral shaft fractures?

A

Blood sequestration –> severe hypovolemia

48
Q

What is the management for a pt with severe comminuted femoral shaft fractures who is hypotesnsive with severe head and thoracic injuries?

A

External Fixation (pin above and below fractured area)
Large bore IV
Type/screen
Fluids/blood
Address other life threatening issues first

49
Q

What is the most likely diagnosis in a pt presenting with knee trauma, pain on palpation, swelling, passive ab/adduction elicits pain, joint has increased mobility when passively ab/adducted c.w. contralateral knee.

A

Collateral ligament Injury

50
Q

What is the management for a pt with collateral ligament injuries?

A

Single Ligament: Casting

Multi-ligament: Surgery

51
Q

What is the management for a pt with a Cruciate ligament injury?

A

Young/Athletes: Arthroscopy

Older: Immobilization and Rehab

52
Q

What tests should be done in a pt suspected of a cruciate ligament injury presenting with knee trauma resulting in pain and swelling?

A

Anterior/Posterior drawer tests

53
Q

What is the most likely diagnosis in a pt who presents with persistent pain/swelling of the knee dispite conservative management with sensation of “catching” or “locking” of the knee while is in motion?

A

Meniscal Tear

54
Q

What is the management for meniscal tear?

A

Arthroscopic repair

55
Q

What is the best diagnostic test for any ligament tear in knee?

A

MRI

56
Q

What is the next step in management for a pt presenting with pain/tenderness to palpation over specific area of the lower leg in a pt who carries our repetitive motion activities (those who march)?

A

Xray (may be negaitive initially in stress fractures)
Cast
No weight bearing (order crutches)
Repeat XRAY in 2 wks

57
Q

What is the management for a pedestrian hit by car with closed leg fracture(s)?

A 
Vitals
Exam
XRAY
Assess for volume status (if normal):
Casting 
   (those that can be properly aligned)
 Open Reduction (those that are more severe)
58
Q

What is the next step in management on a pt with a h/o fracture with casr repair who has persistent pain, especially with passive extension of leg

A

Immediate cast removal and fasciotomy

59
Q

What hisotry findings are typically associated with Achilles Tendon rupture?

A

Out of shape person overdoing it
Fluoroquinolone use
Sudden popping sound while playing sport (basketball/tennis)

60
Q

What is the management for pt. with Achilles Tendon Rupture?

A

Surgical repair
or
Casting in Equinus position

61
Q

What is a key finding on exam suggestive of hip fracture?

A

Leg that is shortened and externally rotated.

62
Q

Within how much time must an open fracture be cleaned?

A

6hrs

63
Q

What is the most likely diagnosis associated with a shortened INTERNALLY rotated leg?

A

Posterior dislocation of hip

Immediate surgery to prevent avascular necrosis of femoral head

64
Q

What is a common complication of oblique/distal humerus fractures?

A

Radial Nerve entrapment

65
Q

What is a dangerous complication of a posterior knee dislocation?

A

Popliteal Artery occlusion

66
Q

What is the next step in management for a pt diagnosed with posterior knee dislocation?

A

Check distal pulses (use doppler or Arteriorgram)

Immediate reduction
or
Prophylactic Fasciotomy (if cannot reduce immediately)

67
Q

What should be ordered for a pt in an MVA with multiple head injuries to assess extenet of damage?

A

CT Head and Neck

68
Q

What is the next step in management for a patient suspected of having radial nerve entrapment?

A

Assess for dorsifelxion (extension) of the wrist. (if unable, immediate reduction)

69
Q

What is the next step in management for a pt with radial nerve entrapment with persistent paralysis after reduction of fracture?

A

Surgery

Step 3 (12 decks)

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