Surgery Flashcards
what’s the most common fracture of the wrist
scaphoid
risk in scaphoid fracture
avascular necrosis
work for scaphoid fracture
plain xrays
particularity of plain xrays in scsphoid fracture(2)
can be normal
needs 10 days to show abnormalities
negative xray in susoect scaphoide fracture next step?(2)
thumb spica
xray in 10 days
clue for scaphoid scaphoid fracture
pain in anatomic snuffbox
cause of dermatitis in lower legs
venous stasis
venous hypertension
physio patho of venous satsis
vein insufficiency
minor traumatic brain injury next step
glasgow 15
discharge
management of mild TBI
glasgow 13-15 and vomiting’
discharge and sent home under surveillance
if normal ct
Management of moderate TBI
glasgow 9-12
sednt home under surveillance if normal CT
management of severe TBI
glasgow
cause of hematochezia(5)
diverticulosis angiodysplasia ischemia infectious neoplasm
first thing to di if you suspect lower GI bleeding
nasogastric tube
you suspect lower GI bleeding nasogastric tube has no blood next step
colonoscopy
in case of diverticulosis if colonoscopy is negative in a setting of hematochezia next step(2)
erythrocye scyntigraphy
or
angiography
technique to perfrom scintigraphy
technetium 99 labeled erytrocyte scynctigraphy
quid of lower GI bleeding
bhelow treitz ligament
patient with AFIB with abdominal pain and heme positive stools
bowel infarction
most common cause of acute mesenteric ischemia
embolus from the heart
quid of trendelenburg sign
drooping of controlateral pelvis occuring when the patient is standing
cause of trendelenburg sign(2)
gluteus medius muscle weakness
gluteus minus muscle
in case of gluteus medius mx weakness where is located the pain
in the knee
abdominal pain and bloody diarrhea following abdominal aortic aneurism repair
bowel ischemia
what to do to prevent bowel ischemia during aortic aneurism rapair surgery
check sigmoid perfusion following the placement of aortic graft
quid lugwig angina
cellulitis of submandibular and sublingual spaces
clinical clue for lugwig angina(3)
dysphagia
drooling
crepitus of submandibular area
most common cause of death in ludwig angina
asphyxia
what cause ludwig angina
infection in 2 et 3 e mandibular molar
rx of ludwig angina(2)
remove the infected teeth
antibiotics
led edema worst when the leg is dependent and improves with leg elevation
venous valve incompetence
could varice be unilateral
yes can be unilateral
pulastile mass in the groin
femoral artery aneurism
the most common peripheral aneurism
popliteal aneurism
what to do in front of peripheral aneurism
check abdominal aneurism
RLQ pain plus positive psoas sign
psoas abcess
scaphoid fracture management
plain xray
plain xray in scaphoid fracture
radioluscent line across the wrist
management of scaphoid fracture
wrist immobilization for 6-10 weeks
what to do if you suspect scaphoid fracture with negative Xray(2)
immobilize wrist
repeat xray in 7-10 jours
why immobilization in suspect scaphoid fracture
because of the risk of non union
management of spinal cord injury(4)
stabilize cervical spine
stabilize airway
hemodynamic stabilization
urine catheter in place
mechanism of spinal cord injury in traumatic patient
compression
contusion
shear injury
spinal cord edema leadig to hemorragic central necrosis
important step in teh management of spinal cord injury
bladder catherization
patient presenting whistling noise after rhinoplasty
nasal septal perforation
cause of septal of nasal septal perforation(6)
self inflicted trauma during picking nose syphilis TB intranasal cocaine use sarcoidosis wegener(granulomatosis with polyangitis)
what cause the perforation in the case of rhinoplasty
septal hematoma
pale and cold arm after closed reduction of humerus fracture what complication you can have in the future
volkman contracture
rx of compartment syndrome
immediate fasciotomy
widened mediatinum in patient taking KCL pills
perforation esophagienne compliquee de mediastinitis
quid of hamman sign
crunching sound in the haert due to emphysema in esophageal perforation
confirmatory test in esophageal perforation
esophagography with water soluble contrast
cause of esophageal perforation(6)
trauma pills esophagitis Barret caustic substance ingestion infection a candida Boherhave syndrome
clue for esophageal perforation
emphysema
patient presents with free peritoneal fluid the most likely finding during laparotomy
splenic laceration
traumatic injuric most common cause of intraabdominal hemorrage(3)
1-spleen 60%
kidney
liver
patient with dyspnea petechiae after tibial fracture dx
fat embolism
confirmatory DX of fat embolism(2)
fat droplets in urine
presence of intra arterial fat globule on fondoscopy
rx of fat embolism
respiratory support
after trauma patient present with only upper extremities weakness
central cord syndrome
mechanism trauma causing central cord syndrome(2)
hyperextension injury
degenerative cervical changes in spine
what position of spine is reached in central cord syndrome
central position of anterior spinal cord
clue for central cord syndrome
weakness more prononced in upper extremities than in lower extremities
why pain and temperature problem in central cord syndrome
damage of spino thalamic tract
what to do if you suspect cervical spinal cord injury
orotracheal intubation
when to suspect cervical spine
any patient with trauma with maxillofacial and neck edema
patient with unRX appendicitis develops ten days later tender boggy fluctuant mass in rectal examination DX (2)
perforated appendix with fluid in rectovesical pouch
it’s a pelvic abscess formation
complication of ruptured appencitis
pelvic abcess
patietn develops pain and paresthesis below right elbow after full thickness burn Dx
compartment syndrome
rx for compartemnt syndrome induced by burne
escharotomy to relieve constriction
dx of compartment syndrome
doppler ultrasonography
what pressure during Dopler should mandate escharotomy
25-40 mm de Hg
if escharotomy fails next step in Rx compartment syndrome induced by burn
fasciotomy
child 5-7 ans with hip pain xray shows flatenned ofr fragmented left femoral head dx?
idiopathic avascular necrosis
or Legg calve perthes diseae
classic presentation of slipped femoral capital epiphysis
obese children with complaint of pain hip
clue for slipped femoral capital epiphysis
capital femoral epiphysis remains intact within the acetabulum
risk in patient with pelvic frasture
posterior uretral injury
clue post uretral injury(5)
blood at urertral meatus high riding prostate scrotal hematoma inability to void palpable distended bladder
cause of anterior uretral injury(3)
perineal tenderness
or perineal hematoma
no inability to void
why patient with post uretral injury can develop sepsis
because of risk of extravasation of urine in the scrotum peritonerum and abdominal wall
quid of anterior uretra
uretra distal to urogenital diaphragm
quid of post uretra
prostatic and membranous uretra
patient with eschar on the chest , consequence of that
respiratory failure
patient with hip pain and elevated ALP
paget
complication of Paget
hearing loss
athlete or military recruit with foot pain
stress fracture
rx of stress fracture
rest and pain control
the most common metatara involved in stress fracture
the second
management of 2e 3e 4e metatarsal fracture (2)
conservatively
or hard soled shoe
patients present with epigastric pain and vomiting after trauma
duodenal hematoma
why the duodenal hematoma is formed
collection of blood between submucosal and muscular layer
mamagement of duodenal hematoma(2)
nasogastric tube
and parenteral nutrition
after an accident patient developsn decreased breath sounds after chest tube placement patient stilll has air in pleural space and pneumodiastinum Dx
bronchial rupture
dx of bronchial rupture
ct of the chest
after an accident patient develops subcutaneos emphysema and pneumomediastinum
tracheobronchial rupture
after catherisation patient develops bacvk pain and hypotension dx
retroperitoneal hematoma
dx of retroperitoneral pain
ct scan of abdomen
major complication of heart catheterization(3)
MI
stroke
death
minor complication of cardiac catheterization(7)
hemostasis at access site hematoma formation AV fistula pseudo aneurism arterial thrombosis perforation contrast allergy
the most common cause of death in brain injury
diffuse axonal injury
ct scan of diffuse axonal injury
numerous punctuate hemorrage at gray white matter junction with blurring of gray white interface
hydrocele in newborn infant(2)
reassurance
observation
time limit for hydrocele to resove in children
12 months
why hydrocele should be remove if persistance after 12 months
because of risk of inguinal hernia
why the left Diapphragm is more susceptilble of trauma than the right
protective reffect of the liver
best test to Dx ruptured diaphragm
CT of chest and abdomen
cause of diaphragm rupture
vehicle accident
xray in diaphragm rupture(2)
shifting of mediastinum to the right
left lower lung opacity with obscure left hemidiaphragm
first step after central line placement
portable chest xray
why portable chest xray after central line placement
to rule out complications
complications of central line placement(6)
arterial puncture pneumothorax hemothorax thrombosis air embolism sepsis vascular perforation MI leading to tamponade
before you administer drugs in central line placement next step
chest xray
clue for fat necrosis of breast
breast mass with biopsy revealing foamy macrophages with fat globules
cause of fat necrosis of breast(2)
breast trauma
surgery
characteristics of breast calcification in breast cancer
microcalcification
characteristics of breast calcification in fat breast necrosis
coarse calcifivcation
rx of fat breast necrosis
no rx
patient with marked limitation of extension of the wrist following a midshaft humerus fracture
radial nerve injury
patient with lupus develops hypotension hyponatremia
adrenal crisis
why lupus is important in this vignette
association entre lupus and prednisone intake
condition predisposing fro adrenal crisis
prednisosne >/ a 20 mg par jour pendant 3 semaines
clue for cushing features(4)
buffalo hump
central obesity
moon facies
weight gain
what happens to patient taking prednisone
risk for hypothalamic pituitary adrenal axis suppression(HPA)
if you suspect HPA suppresion during surgery what to give in term of medication
ETOMIDATE
patient with LLQ pain older with prior dx of diverticulitis develops perisigmoid fluid collection dx?
perisigmoid abcess
rx of perisigmoid abcess
percutaneous drainage
complication of diverticulitis(4)
abcess
perforation
0bstruction
fistula formation
first step in front of clavicular fracture(2)
angiogram
neurovascular exam
why in front of clavicular fracture angiogram and neurovascular exam are mandatory
because of proximity of subclavian artery and plexus brachial
patient with clavicle fracture presents loud bruit during auscultation beneath the clavicle
rapidly ask angiogram
clue for anterior cruciate ligament tear ACL(3)
popping sensation
followed by rapid hemarthrosis
instability in bearing weight on the affected side
dx of ACL tear
MRI
physical exam finding in ACL tear
laxity of anterior motion of tibia relative to femur
knee pain with valgus stress test positive
medial collateral ligament tear(MCL)
the most common ligament involved in knee trauma
MCL
best dx test for ligament tear of knee
MRI of knee joint
rx of MCL tear(2)
bracing
early ambulation
origin of torus mandibularis/palatinus
congenital
hard palate mass with bony hard consistence
torus mandibularis or palatinus
when to operate torus
when the mass interferes with eating or speaking
patient presenting with with crepitus in suprasternal notchafter effort of vomiting
esophagus perforation Known as boherhave syndrome
condition to have boherhave syndrome
when the patient is resisting the urge to vomit
complication of Boherhave
pneumomediastinum
meniscal injury
Knee pain
popping sensation under the examination fingers
work up of meniscal injury
MRI
rx of meniscal injury
surgery
worsening substernal chest pain and mild shortness of breath after endoscipy
esophageal rupture
next step if you suspect esophageal rupture
esophagoghraphy with water soluble contrast substance
common chest xray finding in in esophageal rupture(3)
left pleural effusion
pneumomediastinum
pneumothorax
test of choice to Dx esophageal rupture
esophagoghraphy with water soluble contrast substance
after surgery patient develops fever cloudy grey discharge and dusky friable subcutaneous tissue
decreased sensation on the edges of the woung dx?
necrotizing surgical infection
rx of necrotizing surgical infection
urgent surgical exploration
risk factor for necrotizing surgical infection
diabetics
cause of medial meniscus injury
twisting of the knee with fixed foot
clue for meniscal injury(2)
popping sensation
no effusion following the injury
why no effusion in meniscal tear
meniscus are not perfused
quid of murray sign
audible snap during slowly extending the leg at the knee from full extension while simultaneously applying tibial torsion
why the knee is locked at terminal extension in Murray sign
bucket handle tear
patient presenting one arm weakness after clonic tonic seizures
posterior shoulder dislocation
clue for posterior shoulder dislocation(2)
inability to externally rotate the right arm
or
arm is adducted and internally rotate
what cause the dislocation of shoulder during seizure
violent muscle contraction during tonic clonic seizure
popping sensation at the knee and knee swelling occuring 12-24 h later
meniscal tear
clue for ligamentous tear(2)
after the trauma immediate effusion
popping sensation
indicator in glasgow(3)
eye opening
speech
motor response
motor response
0bey =6 localizes pain=5 withdrawal=4 decortication=3 decerebration=2 no mvt =1
which is worst decortication or decerebration
decerebration
decerebration(3)
extension
3 E
you got 3 in glasgow
back pain plus hypotension plus syncope
ruptured AAA
physiopatho of hematuria in AAA rupture
blood in retroperitoneum creates aorto caval fistula leading to venous congestion in tretroperitoneal structure (bladder)
fragile the bladder can dbe distended and rupture
one YO patient comes with lesion of epidermolysis first thing to do
admit the patient and do a skeletal suvey
3 steps to tkae if you suspect child abuse(4)
physical examination
skeletal survey
report to care to child protective services
admit the patient
patient with brain trauma simple measur eto decrease high ICP(4)
head elevation
or sedation
or IV mannitol
hyperventilation
eye mvt in glasgow(4)
open spontanously=4
open a la demande=3
open with pain stimulation=2
closed eyes =1
speech in glasgow(5)
oriente=5 confuse=4 inapropppriate words=3 whisper incomprehensive words=2 say nothing=1
how elevation helps in decreasing high ICP
by decreasing venous flow from the head
how sedation helps in decreasing high ICP
by decreasing the metabolic demand
control of the hypertension
how iv mannitol helps in decreasing high ICP
extraction of free water out the brain tissue causing osmotic diuresis
how hyperventilation helps in decreasing high ICP
allowing co2 wash out leading to cerebral vasoconstriction
appropriate next step in penile fracture(2)
retrograd uretrogram
plus
surgical exploration
risk factor for penile fracture
woman on top of the man during sexual intercourse
pain of Mac Burney(1)
RLQ pain
rovsing sign
palpation of LLQ causes pain in RLQ
Dx of appendicitis(3)
it’s clinic
if all the symptoms are present no image needed
surgery tet dwat
when asking sono or CT for appendicitis
whrn the typical features are absent
physiopatho of ombilical pain in appendicitis
it’s visceral pain
physiopatho of RLQ pain in appendicitis(2)
it’s somatic
irritation locale of parietal peritoneum
dx differentiel of appendicitis(3)
diverticulitis
ileitis
IBD
subluxation of radial head in kid cause(2)
risky behavior
lifting the child with with child’s forearm
management of subluxation of radial head in kid
gentle passive elbow flexion and forearm supination
maneuver to reduce radial head subluxation(3)
extend the elbow and distract it
supinate the forearm
hyperflex the elbow with your thumb over the radial head in order to feel the reduction
patient with head trauma lost consciousness and has lucid interval followed by progressive deteriorationof consciousness DX?
epidural hematoma
dilated pupil in epidural hematoma why?
oculomotor compression in the side of the lesion
ct of epidural hematoma
biconvex hematoma
rx of epidural hematoma
emergent craniotomy
burn injury becoming chronically drained and painfull
SCC
condition favorising SCC(3)
skin over chronic osteomyelitis
radiotherapy scars
venous ulcers
all chronic wound with failure to heal next step?
biopsy
SCC from burn woung
marjolin ulcer
cause of paralytic ileus(3)
abdominal surgery
retroperitoneal hemorrage associated with vertebral fractures
radio of ileus paralytic(2)
air fluid levels
distended fas filled loops
history clinical of retroperitoneal hemorrage(2)
history of falling back
vertebral fracture
first thing to do if you suspect post yretral injury
retrograde uretrogram
what to not to if uretral injury is suspected
foley catheterization
why to not use foley catheterization if uretral injury is suspected
risk of abcess formation
worsen of uretral damage
why can you have atelectasia and pneumonia in rib fracture
hypoventilation
goal in rib fracture
ensure appropriate analgesia
patient hemodynamically unstable with sharp penetrating abdominal trauma and gunshot wound next step
exploratory laparotomy
why you should act emergently on unstable blunt abdominal trauma(2)
to prevent sepsis
to repair bleeding organ
patient begins to develop shortness of breath after placement of central venous catheter in the right subclavian vein dx
tension pneumothorax
rx of tension pneumothorax induced by placement of central venous catheter
needle thoracostomy
unstable patient after blunt ntrauma abdomen what to do
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