surgery Flashcards
signs to progress to ex lap from conservative measures in SBO
fever, hemodynamic instability, luekocytosis, metabolic acidosis
“pain out of proportion to exam findings”
acute mesenteric ischemia
peritonsalar abcess sx
fever, pharyngeal pain, earache
saliva pooling, deviated uvula,
tertiary hyperparathyroid
renal transplant
femoral nerve
innervates muscles of anterior thigh –> flexion of hip and extension of knee
sensation to medial thigh/medial leg via saphenous
tibial nerve
posterior compartment of thigh/leg
flexion at knee, digits and foot
scaphoid fracture
FOOSH
pain over snuff box
avascular necrosis –> radial artery goes distal pole to proximal pole
does not show up on xray immediately –> thumb spica splint, relook in 2 weeks
clinical triad of fat embolism syndrome
petechiae
neurologic dysfunction
respiratory distress
patchy alveolar infiltrates not restricted by anatomic borders after trauam
pulmonary contusion
leriche syndrome
arterial occlusion at bifurcation of common iliac
–>chronic glute, thigh, hip pain and impotence
ways to decrease ICP
hyperventilation –> Co2 removal leads to vasoconstriction
- elevate head of bed –> venous outflow
- sedatoin –> dec metabolic demand
- mannitol
atelectasis is most common _____ post op
day 2-3
bloody/ painful diarrhea after AAA repair
ischemic bowel due to loss of IMA after graft placement
retrograde urethrogram
used in suspected urethral injury
- penile fracture
- urinary retention
- blood at meatus
- dysuria, hematuria
presentations of pancreatic cancer (besides weight loss/fatigue)
- migratory thrombophlebitis (trouseau’s sign)
- painless jaundice –> panc head, jaundice may come later if at tail
- gnawing epigastric pain that is worse at night
4T’s of mediastinal mass
thymoma
teratoma
thyroid neoplasm
terrible lymphoma
hypocalcemia, hyperphosphatemia, normal renal fx
hypoparathyroid
- post surgical
- autoimmune
- digeorge
- non autoimmune
reversal of warfarin for emergency ex lap vs non emergent
FFP, vit k
FFP will instantly normalize PT time with vit k dependent clotting factors
obstructive sx 24-36 hours after blunt abdominal trauma
duodenal hematoma
req NGT decompression, parenteral nutrition until resolve
flail chest
> 3 contiguos ribs in >2 locations
causes paradoxical movement of chest on inpiration
diagnostic characteristics of meningiomas
extra axial, dural based, partially classified
pathologic nipple discharge
unilateral, spontaneous, single duct
persistent pneumo despite chest tube with addition of pneumomediastinum
tracheobronchial rupture (after blunt chest trauma) most common in R bronchus
risk factors for post op PNA
age >50 thoraco/ abdominal surgery surgery >3hrs preexisting lung dz poor health
IS!!!
Scurvy
cutaneous manifestations ( petechiae, coild hairs, follicular hyperkeratosis
- bleeding gingiva
- impaired wound healing
- arthralgias, malaise
alcoholics!!!
complicated diverticulosis + management
assoc with abcess, perf, fistula
<3= abx
>3= percutaneous drainage
persist for 5 days –> lap drainage/debridement
wound infections in burn patients (>20%)
- first 5 days= gram +
- > 5 days= gram - (PSA), fungi (candida)
- CHANGE IN APPEARANCE (partial thickness to full thickness)
- unexplained hyperglycemia
- oliguria
evaluation of posterior urethral injury
retrograde urethrogram
QT prolongation after thyroidectomy?
hypocalcemia
patient on longterm GC therapy with cushingoid feature at high risk for……. with surgery
acute adrenal crisis
hypotn, n/v, hyponatremia, hypoglycemia
how do you prevent acute adrenal crisis
stress dose
anyone on >20mg pred for 3 weeks
which side of the diaphragm is “weaker”? What is it prone to in BAT
L
detachment
hiatal hernia!!!
head injury, loc, lucid interval
EPIdural hematoma
does not cross suture lines
which side is varicocele more common?
L
“nutcracker effect” (l spermatic –> l renal passes under SMA)
what pH is indication for bicarb in severe acidosis
<7.2
marjolin ulcer
SCC arising in burn wound
PPV in tension pneumo?
BAD, increases insult of one wayvalve of air out of lung into pleural thatcannot escape
nerve injured in anterior shoulder dislocation
axillary, weakend deltoid abduction
spinal cord injury during repair of TAA
anterior cord syndrome (radicular arteries supply anterior spinal artery,artery of Adamkeweitz)
loss of movement, pain, temp (spinothalamic)
maintain position/vib
loss of ventricular preload after PPV?
hypovolemia –> dec CVP –> PPV –> dec venous return –> collapse capacitance
CI to LMWH after surg provoked Dvt?
ESRD
use unfractionated and bridge to warf for 3months
post op bacterial parotitis
who: dehydrated, elderly post, post op
prevention: hydration/oral hygeine
what: staph a
compensatyory mechanisms of hypovolemic shock
inc SVR, HR, EF
extraperitoneal bladder injury vs intra
EPBI- pelvic fracture
IPBI- rupture of dome –> intraper leakage –> chemical peritonitis
lab measurement assoc with gallstone panc?
ALT>150
common EARLY sx of compartment syndrome?
pain with passive motion, parasthesas
uncommon= pallor and lossofpulses
common path after distal gastrostomy (hypotn n/v aftereating)
dumping syndrome–>no pyloric regulation
