Surgery Flashcards
differential for anterior mediastinal mass
4 T’s 1. Thymoma (normal bHCG, AFP)
- Teratoma (elevated bHCG, AFP)
- Thyroid neoplasm
- Terrible Lymphoma (normal bHCG, AFP)
scrotal mass that increases in size with valsalva…what is it and what is tx
Varicocele “bag of worms” -presents with subfertility, testicular atrophy -us finding of retrograde venous flow -dilation of pampiniform venous plexus tx: gonadal vein ligation, scrotal support, NSAIDS
how to confirm presence of peripheral artery disease
Ankle-brachial index
<0.9 abnormal (diagnostic of occlusive PAD)
0.91-1.3 normal
>1.3 suggestive of calcified and uncompressible vessels
treatment of gallstones
- Gallstones without symptoms
- Gallstones with typical biliary colic sx
- Complicated gallstone dz
- gallstones w/o sx –> no tx necessary
- gallstones with typical biliary colic sx –> elective laparoscopic cholecystectomy
- complicated gallstone dz (acute cholecystitis, choledocolithiasis, gallstone pancreatitis) –> surgery within 72 hours
physical exam findings indicative of a urethral injury
blood at the meatus, high riding prostate
pubic ramus fx, return of frank blood on foley insertion without resistance and NO blood at meatus
EXTRAperitoneal bladder rupture (contusion or rupture of the neck, anterior wall, or anteriorlateral wall of bladder
intra vs extra peritoneal rupture of the bladder
intra –> rupture of the dome of the bladder resulting in intraperitoneal leakage and presents with signs of chemical peritonitis (guarding, diffuse abd tenderness)
extra –> localized pain in lower abd and pelvis, pelvic fracture almost ALWAYS seen, gross hematuria present
most critical prognostic indicator of compartment syndrome
time to fasciotomy (go to OR right away…NO time for eval or elevation or ice)
-in fact, the leg should be kept at the level of the torso, not higher or lower
retropharyngeal abscess
presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx. This infection can drain into the superior mediastinum. -If it extends through the alar fascia, it can enter the “danger fascia” and transmit infection into the POSTERIOR mediastinum and result in acute nectrotizing mediastinitis
ludwig angina
rapidly progressive bilateral cellulitis of the submandibular and sublingual spaces arising from an infected mandibular molar
succession splash over the epigastrum and a hx of acid ingestion several months ago in a suicide attempt
pyloric stricture = gastric outlet obstruction caused by mechanical obstruction leading to postprandial pain and vomiting and early satiety
-can be caused by gastric malignancy, crohns, PUD, ingestion of caustic agents
timeline of post-op fever
0-2 hours: prior trauma/infection, blood products, malignant hyperthermia
24hrs-1 week: nosocomial infection, noninfective (MI, DVT, PE), Group A strep, Clostridium perfringes
1 week-1 month: other bacteria not above, catheter infection, drug fever, dvt, pe
>1 month: viral infections, SSI (indolent organisms)
post-op fever defined as what temp
>100.4 = 38
tx of anal fissures
- topical anesthetics and nifedipine
- sitz bath
- high fiber diet and adequate fluid intake
- stool softeners
paradoxical chest wall movement
seen in flail chest with multiple rib fractures. Chest expands when inhales and retracts when exhale
colonic thickening and fat stranding, think what
ischemic colitis
persisting pneumo despite bilateral chest tube placement
think of tracheobronchial rupture secondary to blunt thoracic trauma. The right main bronchus is most commonly injured in these patients
-also may see pneumomediastinum or subq air
whistling noise post rhinoplasty, suggests what?
(think Me Myself and Irene)
septal perforation likely resulting from a septal hematoma
treatment of pancreatic pseudocyst that is symptomatic
endoscopic drainage (these psuedocysts can release amylase into circulation) -if the patient is asymptomatic, no treatment is needed
heparin to use in end stage kidney disease pts
use: unfractionated heparin
do NOT use: LMWH (enoxaparin) and rivaroxaban
complicated diverticulitis treatment
(you saw this)
CT guided percutaneous drainage of abscess
acute mesenteric ischemia presentation
sudden onset severe, poorly localized mid-abdominal pain accompanied by nausea and vomiting
acalculus cholycystitis occurs in what type of pts?
occurs in critically ill hospitalized patients. Pts have jaundice in addition to pain/mass in URQ
retroperitoneal hematoma dx, presentation, tx
non-con abd pelvis CT
presents: as sudden hemodynamic instability and ipsilateral back pain
tx: supportive
dx of suspected urethral injury
retrograde urethrogram (x-ray of lower GI tract with injection of radiopaque contrast in the urethra)
acute bacterial parotidis
usually occurs in dehydrated post-op patients with crappy oral hygiene
ALT >150 in regards to pancreas
95% PPV for gallstone pancreatitis
tx of spontaneous pneumo in your tall athletic kiddo with no trauma
- If small (<2cm), give O2 and supportive
- If large, do small needle decompression
torus palantinus
benign, hard immobile mass on the roof of the mouth
- the thin epithelium tends to ulcerate and takes a long time to heal given poor vascular supply
- surgery only indicated if symptomatic
anterior cord syndrome is seen with what procedure and presents how?
seen in thoracic aortic aneurysm repair
The anterior spinal artery provides blood to the anterior 2/3 of the spinal cord including motor tracks and sensory tracks (spinothalamic)
- The dorsal column is SPARED (vibration and proprioception)
- Presents with bilateral flaccid paralysis with UMN signs
**ALSO seen in whiplash injuries in old people
the two lobes of the parotid gland are separated by what?
the FACIAL nerve
chronically wounded, burned, scarred skin predispose to what?
Squamous cell carcinoma
-If arise within a burn called a majorlin ulcer
what pH is sodium bicarb indicated?
<7.2
hypocalcemia pt presentation
initially nonspecific symptoms such as fatigue anxiety, depression
- Involuntary contractions involving the lips, face, and extremities are seen when more severe
- prolonged QT
*surgically this is common in post-thyroidectomy pts
ejection fraction in hypovolemic shock
INCREASED
The left ventricle is decreased due to decreased filling volume tries to compensate by increasing ejection fraction
- also see an increase in sympathetic nervous system resulting in an increase in total peripheral resistance and HR
- presents with, hypotension, tachycardia, cold extremities, and evidence of poor organ perfusion (somnolence, unresponsiveness) and physical exam findings of hypovolemia (flat neck veins)
nasopharyngeal carcinoma is associated with reactivation of what?
EBV
- It is especially endemic in China
- often presents with nasal congesion and epistaxis, HA, CN palsy (facial numbness) and/or serious otitis media
Aflatoxin B1
mycotoxin that contaminates agricultural products and is associated with an increased risk of Hepatocellular Carcinoma
Broken penis, what do ya do?
- First, this is rupture of the corpus cavernosum due to traumatic tear in tunica albuginea
- MUST do retrograde urethrogram and then take pt to OR for surgery
acute adrenal insufficiency (adrenal crisis)
- seen in acute adrenal hemorrhage or infarction or stressors such as surgery
- presents as hypotension/shock, n/v, abd pain, weakness, fever
occurs in patients with primary adrenal insufficiency (addisons) or suppression of HPA axis due to chronic glucocorticoid use
tx: hydrocortisone or dexamethasone
supracondylar fx of the humerus in a child has what common complication
entrapment of median nerve or brachial artery
acalculus cholycystitis
most often seen in severely ill pts in the ICU with multisystem organ failure, severe truama, sepsis…
- likely due to cholestasis or gallbladder ischemia leading to secondary infection by enteric organisms
- raise suspicion with gallbladder wall thickening and presence of pericholystic fluid
tx: abx and cholycystectomy
tx meningioma
(think HA clinic pt)
surgical resection (dx is confirmed intraoperatively)
stasis dermatitis
result of lower extremity venous valvular incompetence resulting in pooling of blood and increased pressures in the postcapillary venules
leriche syndrome
aortoiliac occlusion
Triad:
- bilateral hip, thigh, gluteal claudication
- impotence
- symmetric atrophy of lower extremities due to chronic ischmeia
