Surgery

Question 1

Young IVDA with CHF Sx =

Answer 1

Acute Ao regurg 2/t endocarditis.

Question 2

LMWH all DVT pts except… (3)

Answer 2

CRF (UFH)
Bleed risk- need to “turn off” quick (UFH)
Hx HIT (Argatroban)

Question 3

20-40yoM heavy smoker with rest pain in LE

Answer 3

Thromboangitis Obliterans aka Buerger’s Disease (vasculitis caused by smoking without real tx)

Question 4

First line for intermittent claudication?

Answer 4

Modify risk factors/inc exercise

THEN cilostazol/pentoxyfilline/ASA.

Question 5

Murmur of acute AR 2/t endocarditis?

Answer 5

Loud diastolic murmur in Ao region

Question 6

How do you tx acute AR 2/t endocarditis?

Answer 6

Emergent valve replacement + long-term abx

Question 7

What is affected in Reynaud’s?

Answer 7

Arteries (exaggerated response)

Question 8

Claudication + erectile dysfxn + dec fem pulses =

Answer 8

Leriche’s (bilat aortoiliac PAD)

Question 9

Imaging for severe extremity wound in a diabetic?

Answer 9

MRI (XR only shows late-stage osteomyelitis)

Question 10

ABI cutoffs?

Answer 10

<0.9 = to vasc specialist
<0.8 = to surg

Question 11

Three special tests in diabetic PVD exam?

Answer 11

Trendelenburg test
ABI
Doppler the pulses

Question 12

Bypass grafting for aortoiliac disease? (4)

Answer 12

Ao-fem if bilat (preferred)
Ao-iliac or iliofem if unilat
Fem-fem if bad anesthesia candidate
Axillopop as a last ditch effort

Question 13

Bypass grafting for infrainguinal disease?

Indications? (3)

Answer 13

Fempop or saphenous if it’s past popliteal a

If ulcers, ABI<0.8, or persistent infection

Question 14

Indications for carotid endardectomy? (2)

Answer 14

Sx + >50% occlusion

ASx + > 70% occlusion

Question 15

C/C is painless problems with night driving and fine print. What are three possible fundoscopic findings most likely to fit this dx?

Answer 15

Nuclear opacification (= myopia)
Posterior subcapsular haze (= blinding glare when in bright light)
Cortical spoking

{cataracts}

Question 16

Triad for ruptured AAA? What are two additional inspection findings?

Answer 16

Pulsatile mass + hypotension + lower abd or back pain

Cullen sign: periumbilical ecchymosis
Grey-Turner sign: flank ecchymosis

Question 17

Pre-op, what are the two big concerns with an AAA?
Peri-op? (1)
Post-op? (5)

Answer 17

Pre-op: rupture or embolus causing acute limb ischemia

Peri-op: injuring lumbar aa = spinal cord paralysis

Post-op: MI, CVA, embolus to fem & below, ARF, and ischemic sigmoid

Question 18

Surgical indication and options for AAA?

Answer 18

Rupture, obviously, or AAA >5cm

EVAR or open

Question 19

Initial Dx for AAA?

Answer 19

U/S

Might have gotten CT already if you thought it was diverticulitis

Question 20

Main cause of AAA? Of pseudoaneurysm?

Answer 20

AAA - atherosclerosis risk factors

Pseudo - injury

Question 21

Proximal Ao dissection might have two specific Sx:

Answer 21

AR

Pericardial tamponade

Question 22

If you happen to get CXR before CTA in suspected Ao dissection, what might you see?

Answer 22

Wide mediastinum (>8cm supine or >6cm upright)

Question 23

Classifications and brief overview of Ao dissections?

Answer 23

Type A Stanford = Ascending Ao; more common and more fatal (emerg)
Type B Stanford = Descending Ao; try medical tx before surg tx since it’s a risky fix
Debakey Type I = both those.

Question 24

Medical intervention for Ao dissection?

Answer 24

IV esmolol + IV nicardipine or nitropress to BP 100/60