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Step 3 > Surgery > Flashcards

Surgery Flashcards

1
Q

For patients with an obstruction caused by volvulus what procedural management is indicated? What if recurrent episodes?

A

Rigid proctosigmoidoscopy

Recurrent: consider sigmoid resection

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2
Q

For abdominanl hernias in patients

A

Elective

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3
Q

What is the most accurate diagnostic test for diverticulitis?

A

CT abdomen with contrast to look for fat stranding, abscess, or free air

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4
Q

What is appropriate treatment in the following cases of diverticulitis?

No peritoneal signs
Abscess
Perforation
Recurrent diverticulitis

A

No peritoneal signs: OP with antibiotics
Abscess: NPO IVF, antibiotics, CT-guided aspiration
Perforation: emergent surgery
Recurrent: elective surgery

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5
Q

What are lab value warning signs of hemorrhagic pancreatitis?

A

Lower Hct which continues to fall
WBC > 18000
Hypocalcemia

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6
Q

How are pseudocysts managed in pancreatitis? Hint, it depends on pain.

A

Painless: do not drain
Painful: If > 6cm and lasting > 6weeks then drainage. If infected though do a MIS drainage (i.e. percutaneous)

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7
Q

What lap value has the highest specificity for pancreatitis? Highest sensitivity?

A

Specific: Lipase (SPIN)
Sensitive: Amylase (SNOUT)

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8
Q

What should be done before appendectomy in acute appendicitis?

A

Administer antibiotics

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9
Q

Is chronic ulcerative coliltis managed surgically?

A

Generally no, medical management.

Only surgical if severe and refractory cases with complications

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10
Q

You suspect acute mesenteric ischemia in a patient and you emergently take them to the operating room. You confirm the dx. What do you do in the OR?

A

Embolectomy and revascularization with potential resection

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11
Q

You suspect acute mesenteric ischemia and take a patient to angio right away. You confirm the dx in the angio suite. What do you do next?

A

Give vasodilators and thrombolysis

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12
Q

What is the first step in the diagnosis of obstructive jaundice caused by gallstones? What can be used to confirm the dx?

A

Sonogram (ultrasound)

Can confirm with endoscopic ultrasound or MRCP

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13
Q

What is treatment of obstructive jaundice due to gallstones?

A

ERCP and/or cholecystectomy

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14
Q

How is biliary colic due to gallstone obstruction of cystic duct managed?

A

Elective cholecystectomy

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15
Q

How is acute cholecystitis managed?

A

NPO, IVF, NG suction, antibiotics

Elective cholecystectomy 6-12 weeks later

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16
Q

When is an emergent cholecystectomy done for acute cholecystitis?

A

When peritoneal signs or due to generalized peritonitis or emphysematous cholecystitis (i.e. d/t perforation or gangrene)

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17
Q

What causes acute ascending cholangitis? How is it managed?

A

Gallstone obstructing common bile duct leads to ascending infection

NPO, IVF, NG suction, antibiotics
Emergent decompression via ERCP or percutaneous transhepatic cholangiogram (PTC)

Cholecystectomy should follow down the line

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18
Q

What is the best initial test for fecal incontinence? What is the most accurate test?

A

Initial: Anoscopy
Accurate: Anorectal manometry

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19
Q

How is fecal incontinence managed?

A

Combine bulking agents (e.g. fiber) with biofeedback techniques. If doesn’t work can consider endoscopic injections of dextranomer/hyaluronic acid as a pseudo-sphincter

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20
Q

How long after an MI should you defer surgery?

A

6 months

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21
Q

How long before surgery should smoking be stopped? What FEV1 threshold is a marker of higher surgical risk?

A

Stop smoking 8 weeks prior

FEV1

22
Q

Describe the “4 W’s” mneomic for post-op fevers

A

Wind: POD1, atelectasis (CXR)
Water: POD3, UTI (UA)
Walking: POD5, DVT (US)
Wound: POD7, wound infection (PE, CT r/o deep infection)

23
Q

Your patient is 16hrs post-op and becomes very disoriented. What should you acquire right away and why?

A

ABG because if patient hypoxic that is one of the lethal causes in the early post-op period

24
Q

How is a fecal fistula generally managed?

A

Observation, as long as draining on outside. If draining on inside then it’ll probably cause infection and fever

25
Q

How can you confirm esophageal atresia?

A

Place NG tube and see it get coiled up on CXR

26
Q

How long after birth is congenital diaphragmatic hernia repaired?

A

3-4 days, usually after hypoplastic lung has had time to mature (you intubate the patients and keep on low-pressure ventilation prior to repair; also NG suction)

27
Q

Distinguish gastroschisis from omphalocele

A

Gastroschisis does not have a covering

Omphalocele has a covering

28
Q

What trisomies are associated with gastroschisis and omphalocele?

A 
Trisomy 18 (Edward's)
Trsiomy 13 (Patau's)
29
Q

How does the size of the defect affect the operative plan for gastroschisis and omphalocele?

A

Small defects can be closed primarily

Large defects require a silo to be placed over with a small portion being replaced intra-abdominally each day

30
Q

What presents with double-bubble sign?

A

Duodenal atresia, BUT ALSO annular pancreas and malrotation

31
Q

When should exstrophy of the bladder be repaired?

A

First 1-2 days of life. Patient needs to be transferred to a facility which does these

32
Q

What is generally the cause of intestinal atresia?

A

Vascular accident in utero

33
Q

What is treatment of gas gangrene?

A

Large doses of IV penicillin and hyperbaric oxygen

34
Q

You suspect a fracture but the original X-ray does not show one. What is your next image of choice?

A

Repeat X-ray of the joint at 90 degrees to the original

35
Q

A patient presents with facial bruising and injuries after a fight where he was tossed around. What additional imaging do you want to obtain?

A

Cervical spine radiographs

36
Q

Figure-eight sling is the best choice in the management of which fracture?

A

Clavicular fractures

37
Q

How should a Colles’ fracture be managed?

A

Closed reduction and casting

38
Q

Diaphyseal fracture of the ulna requires what kind of mgmt?

A

Open surgical reduction and fixation

39
Q

When a patient presents with pain in the “anatomic snuffbox” what fracture is this indicative of? What should be done for immediate mgmt?

A

Scaphoid fracture

Place in thumb spica cast to prevent nonunion bc these fractures often don’t appear on X-rays right away (may take 3 weeks or more)

40
Q

Femoral neck fractures in the elderly are treated with …

A

Femoral head replacement (d/t tenuous blood supply)

41
Q

Intertrochanteric fractures are treated with …

A

Open reduction and pinning

42
Q

How are femoral shaft fractures treated?

A

Intramedullary rod fixation

43
Q

What is the best initial therapy in patients with either trigger finger or DeQuervain tenosynovitis?

A

Steroid injections

44
Q

What is Dupuytren contracture and how is it managed?

A

Palm contracture with palmar fascia nodules

Collagenase or surgery

45
Q

A shortened and internally rotated leg may be due to what injury?

A

Posterior hip dislocation (commonly from a MVC with knees hitting dashboard)

*Emergency reduction is needed to avoid avascular necrosis

46
Q

If only a single ligament is involved then how is an MCL or LCL injury managed? What if multiple are injured?

A

Single: Casting
Multiple: Surgical

47
Q

How are ACL or PCL injuries managed? How does it differ by age?

A

Young athletes often need arthroscopic repair

Elderly may be immobilized and require rehab

48
Q

How are meniscal injuries managed?

A

Arthroscopic repair

49
Q

How are tibial stress injuries managed?

A

Cast
Don’t bear weight
Repeat films in 2 weeks

50
Q

How are achilles tendon ruptures managed?

A

Casting in the equine position or surgical repair

Step 3 (19 decks)

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