Surgery

Question 1

An amputated digit should be brought to hospital how?

Answer 1

Wrapped in saline moisturized gauze placed in sealed sterile bag and the bag placed in chilled container with ice mixed in saline/sterile water.

Question 2

High suspicion for scaphoid fx should get what imgs?

Answer 2

xray, if neg get mri since it can up to two wks to show up

If xray neg need mri before u cast them bc casting nonfracture can impede function

Question 3

Risk of intreated scaphoid fracture

Answer 3

Nonunion and AVN

Question 4

Calcification of right hypochondrium on xray should be confirmed with what? What does it mean and what should u do?

Answer 4

Ct of the abd

Porcelain gallbladder. Even if asymp need to do elective cholecystectomy

Question 5

Unilateral testicular pain with normal cremaster reflex and +prehn sign (relief with elevation) is? What are next tests to do?

Answer 5

Epididymitis- ua, urethral swab

Question 6

Kid who had appendectomy now presented 2-3 wks after with r shoulder pain, f, cough, high wbc due to

Answer 6

Subphrenic abscess

Get abd u/s to diagnose

Question 7

Pt with multiple fx experiences sob, ams, petechiae rash. What is it and how to prevent it from occurring?

Answer 7

Fat embolization

Petechiae due to occlusion of dermal capillaries leading toe extravasation if erythrocytes

No evidence that heparin reduces risk

Question 8

How soon should u dc raloxiFENE before surgery?

Answer 8

1 month bc incr risk of dvt

Raloxifene is a Selective estrogen modulator for preventing OP and br ca chemoprevention

Question 9

Osteonecrosis of femur- what is best test to diagnose?

Answer 9

Mri!! Xray may miss it

Stage 4 osteonecrosis should get total hip replacement

Question 10

Should u get anymore preop workup for pt getting ortho procedure who has slowly worsening sob but still can climb flight of stairs? (4 mets)

Answer 10

Nope. Dont even need cardiopulm or pft workup.

Question 11

What is most common complication from anal abscess? Skin inf/fistula/fecal impaction?

Answer 11

Fistula in 50%!!

Question 12

Baby w cleft lip- how did they inherit and when to fix?

Answer 12

Many modes of inheritance- ar, ad, x linked

Tx in 10 WEEKS at 10 lbs

Question 13

Arterial thrombus followed by thrombectomy. Man gets excruciating pain after and tingling/ant crawling sensation/burning has…

Answer 13

Compartment syn!!

Phantom pain only refers to amputated legs

Question 14

How much vit d does a roux en y gastric bypass pt need daily??

Answer 14

2-3000 iu/day

Question 15

Horizontal laceration to upper eyelid and see orbital fat means what kind of injury?

Answer 15

Levator muscle

Question 16

What is side effect of compartment syndrome?
Renal failure
Pe

Answer 16

Renal failure from rhabdo and muscle necrosis

Question 17

Athlete training for marathon now w pain in lower leg and tibial tenderness has what? What would u see in xray?

Answer 17

Stress fx. See nothing in first month!!!

Once it shows something u find bonescletosis, cortical thicekning, fracture, periosteal elevation

Question 18

Displaced fracture of clavicle management?

Answer 18

Orif!!! Bc displaced and have shortening

Vs nondisplaced can manage conservatively w ice, figure 8, mobility as tol, sling

Question 19

Pt w PAD in legs- ie claudication. Tx?

Answer 19

Asa or plavix, control bp and dm2, give statin

Dont give pentoxifylline which is second line and not always effective

Next try supervised exercise program!! If that fails then surgery- per or surgical revas

Question 20

Head or neck cancer in pt should be treated w

Answer 20

combined CRT!!!! Superior to either alone

Question 21

Elderly w hip fx should get surgery within how long? Even if dmx htn 160/68

Answer 21

2 days decr mortality

Question 22

2 yo aa baby w genu varum (10 deg) should have fu how?

Answer 22

No tx

Unless >15 deg

Question 23

Which opioid best for elderly lady w hip f

Answer 23

Hydrocodone!!!!!!

Not even fentanyl