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MS3 > Surgery Rotation 10 > Flashcards

Surgery Rotation 10 Flashcards

1
Q

Side effect of succinylcholine

A

Hyperkalemia (arrhythmias)

Succ is a depolarizing agent; binds to ACh receptor triggering influx of Na+ and efflux of K+

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2
Q

Major side effect of Halothan

A

Liver failure - due to hepatotoxic intermediates

Now rarely used

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3
Q

Major side effect of Propofol

A

Severe hypotension due to arterial and venous dilation

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4
Q

What is feared complication of scaphoid fracture

A

Scaphoid fx = pain in anatomical snuffbox

Fear of osteonecrosis because this is where blood supply enters (radial artery)

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5
Q

signs of necrotizing surgical site infection

A

Dishwater drainage (purulent, cloud-gray discharge)
SubQ crepitus
Pain, edema, erythema
Systemic signs (fever, hypotension, tachycardia)
Parasthesia or anesthesia at edges of wound

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6
Q

Tx of necrotizing surgical site infection

A

Parenteral abx + surgical debridement

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7
Q

When are wound-vacs used

A

To accelerate healing process in healthy, granulating wounds

Not for infected or necrotic wounds

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8
Q

What is the next step in management after placement of central line?

A

CXR to see if catheter tip is in SVC

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9
Q

Management of patient who was successfully treated for acute pancreatitis due to gallstones?

A

Cholecystectomy to reduce risk of recurrent gallstone pancreatitis

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10
Q

What is pilonidal disease?

A

Edematous, infected hair follicle in the intergluteal region becomes occluded

Abscess forms which can rupture and create a pilonidal sinus tract

Presents with fluctuant mass cephalad to anus with mucoid, purulent, or bloody drainage

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11
Q

Tx of pilonidal disease?

A

Drainage of abscess and collected debris followed by excision of sinus tracts

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12
Q

What is hidradenitis suppurativa?

A

Follicular occlusion disease presenting with multiple, recurrent, painful nodules in axilla, inguinal folds, and perineal areas

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13
Q

Test used to determine diagnosis of peripheral artery disease

A

Ankle-brachial index

< 0.9 = abnormal

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14
Q

What is emphysematous cholecystitis

A

Life-threatening form of acute cholecystitis due to infection with gas-forming bacteria (e.g. Clostridium)

Imaging shows air-fluid levels in gallbladder, gas in gallbladder wall, occasional pneumobilia

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15
Q

Diagnose and treat: pain at incision site, edema, induration with no drainage

A

Cellulitis

Tx with abx

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16
Q

Diagnose and treat: pain at incision site, induration with no drainage

A

Simple wound infection

Reopen wound and repack. No abx necessary

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17
Q

Diagnose and treat: pain at incision site, with salmon colored fluid from incision

A

Dehiscence

Surgical emergency! Go to OR, IV abx, primary closure of fascia

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18
Q

Describe stage 1 of pressure ulcer + tx

A

Skin intact but red. Blanches with pressure

Tx = basic, cream, decrease pressure

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19
Q

Stage 2 pressure ulcer + tx

A

Blister or break in dermis

Tx = basic, cream, decrease pressure

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20
Q

Stage 3 pressure ulcer + tx

A

SubQ destruction into muscle

Tx = surgery

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21
Q

Stage 4 pressure ulcer + tx

A

Involvement of joint or bone

Tx = surgery

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22
Q

Indications for surgery in spontaneous pneumothorax (e.g. emphysema rupture)

A
  • Recurring spontaneous pneumo
  • Bilateral
  • Incomplete lung expansion
  • Occupation that would be really bad if they pass out (e.g. pilot or scuba diver)
23
Q

Surgical tx for pneumothorax

A

VATS = video-assisted thoracic surgery

or Pleurodesis = shove stuff in there to make pleura stick

24
Q

Diagnose: small air-fluid level in lung

A

Abscess

25
Q

Tx of lung abscess

A

Initially with abx - not drainage!

26
Q

Indication for surgical drainage of lung abcscess

A

Abx fail, abscess > 6cm, or if empyema is present (collection of pus in a pre-existing abd cavity)

27
Q

1st step of solitary lung nodule

A

Compare to previous x-ray

28
Q

Tx of small benign solitary lung nodule

A

Close follow up

Don’t need to remove

29
Q

4 main types of lung cancer

A
  1. Small cell
  2. Non-small cell
    2a. Squamous cell
    2b. Adenocarcinoma
    2c. Large cell carcinoma
30
Q

Most common type of lung cancer in non-smokers

A

Adenocarcinoma

31
Q

Is adenocarcinoma peripheral or central?

A

Peripheral

32
Q

Is squamous cell carcinoma peripheral or central

A

Central

33
Q

Disease associated with squamous cell carcinoma of lung

A

Paraneoplastic

May produce PTH = hypercalcemia

34
Q

What lung cancer is associated with Pancoast tumor

A

Small cell

35
Q

Presentation of pancoast tumor

A

• Hoarseness recurrent laryngeal nerve
• Horner syndrome (ptosis, miosis, anhydrosis) superior cervical ganglion
• SVC syndrome superior vena cava
o Facial plethora
o Jugular venous distension
o Edema and blue discoloration of arms and face
• Sensorimotor deficit

36
Q

What cancer is associated with Lambert Eaton

A

Small cell carcinoma

37
Q

Paraneoplastic syndromes associated with small cell carcinoma of lung

A
  • ADH = SIADH
  • ACTH = Cushing’s
  • Antibodies against pre-synaptic Ca2+ channels = Lambert-Eaton
38
Q

Is large cell lung carcinoma peripheral or central

A

Peripheral

Large cell has poor prognosis

39
Q

Causes of ARDS

A

Gram neg sepsis, gastric aspiration, trauma, low perfusion, pancreatitis

40
Q

How do you diagnose ARDS?

A
  1. Bilateral alveolar infiltrates on CXR
  2. PaO2/FiO2 ratio < 200 (=hypoxia)
  3. Rule out cardiac cause - PCWP < 18 (means pulmonary edema is non-cardio)
41
Q

Treatment of ARDS

A

PEEP

42
Q

What murmur is increased by valsalva?

A

Valsalva increases intrathoracic pressure, thus decreasing preload (opposite of inspiration)

Decreases the intensity of most murmurs EXCEPT increases intensity of hypertrophic cardiomyopathy

43
Q

Holosystolic blowing murmur

A

Mitral regurg

44
Q

Holosystolic murmur with late diastolic rumble in kids

A

VSD

45
Q

Continuous machine like murmur

A

PDA

46
Q

Wide fixed and split S2

A

ASD

  • Occurs during right heart overload (e.g. atrial septal defect)
  • ASD = L-to-R shunt = increased RA and RV volumes = increased flow through pulmonic valve such that, regardless of breath, pulmonic closure is delayed
47
Q

Rumbling diastolic murmur with an opening snap

A

Mitral stenosis

48
Q

Blowing diastolic murmur with widened pulse pressure

A

Aortic regurgitation

49
Q

Tx of Zenker’s diverticulum

A

False diverticula in the esophagus (bad breath)

Tx = surgery

50
Q

Tx of achalasia

A

Dysphagia to liquids and solids + bird beak barium swallow

Tx = CCB, nitrates

51
Q

Tx of GERD

A

Behavioral modification, antacids, H2 blockers, PPIs

52
Q

What are indications for surgery with GERD

A

Bleeding, stricture, Barrett’s, incompetent LES, max dose PPI with persistent sx

53
Q

Tx of asymptomatic esophageal varices

A

DO NOT prophylactically band!

Give beta blockers

Only band symptomatic varices

54
Q

Management of suspected esophageal cancer (e.g. progressive dysphagia with weight loss)

A

Barium swallow, then endoscopy with biopsy

MS3 (88 decks)

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