Surgery Rotation 10 Flashcards
Side effect of succinylcholine
Hyperkalemia (arrhythmias)
Succ is a depolarizing agent; binds to ACh receptor triggering influx of Na+ and efflux of K+
Major side effect of Halothan
Liver failure - due to hepatotoxic intermediates
Now rarely used
Major side effect of Propofol
Severe hypotension due to arterial and venous dilation
What is feared complication of scaphoid fracture
Scaphoid fx = pain in anatomical snuffbox
Fear of osteonecrosis because this is where blood supply enters (radial artery)
signs of necrotizing surgical site infection
Dishwater drainage (purulent, cloud-gray discharge)
SubQ crepitus
Pain, edema, erythema
Systemic signs (fever, hypotension, tachycardia)
Parasthesia or anesthesia at edges of wound
Tx of necrotizing surgical site infection
Parenteral abx + surgical debridement
When are wound-vacs used
To accelerate healing process in healthy, granulating wounds
Not for infected or necrotic wounds
What is the next step in management after placement of central line?
CXR to see if catheter tip is in SVC
Management of patient who was successfully treated for acute pancreatitis due to gallstones?
Cholecystectomy to reduce risk of recurrent gallstone pancreatitis
What is pilonidal disease?
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
Tx of pilonidal disease?
Drainage of abscess and collected debris followed by excision of sinus tracts
What is hidradenitis suppurativa?
Follicular occlusion disease presenting with multiple, recurrent, painful nodules in axilla, inguinal folds, and perineal areas
Test used to determine diagnosis of peripheral artery disease
Ankle-brachial index
< 0.9 = abnormal
What is emphysematous cholecystitis
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
Diagnose and treat: pain at incision site, edema, induration with no drainage
Cellulitis
Tx with abx
Diagnose and treat: pain at incision site, induration with no drainage
Simple wound infection
Reopen wound and repack. No abx necessary
Diagnose and treat: pain at incision site, with salmon colored fluid from incision
Dehiscence
Surgical emergency! Go to OR, IV abx, primary closure of fascia
Describe stage 1 of pressure ulcer + tx
Skin intact but red. Blanches with pressure
Tx = basic, cream, decrease pressure
Stage 2 pressure ulcer + tx
Blister or break in dermis
Tx = basic, cream, decrease pressure
Stage 3 pressure ulcer + tx
SubQ destruction into muscle
Tx = surgery
Stage 4 pressure ulcer + tx
Involvement of joint or bone
Tx = surgery
Indications for surgery in spontaneous pneumothorax (e.g. emphysema rupture)
- Recurring spontaneous pneumo
- Bilateral
- Incomplete lung expansion
- Occupation that would be really bad if they pass out (e.g. pilot or scuba diver)
Surgical tx for pneumothorax
VATS = video-assisted thoracic surgery
or Pleurodesis = shove stuff in there to make pleura stick
Diagnose: small air-fluid level in lung
Abscess
Tx of lung abscess
Initially with abx - not drainage!
Indication for surgical drainage of lung abcscess
Abx fail, abscess > 6cm, or if empyema is present (collection of pus in a pre-existing abd cavity)
1st step of solitary lung nodule
Compare to previous x-ray
Tx of small benign solitary lung nodule
Close follow up
Don’t need to remove
4 main types of lung cancer
- Small cell
- Non-small cell
2a. Squamous cell
2b. Adenocarcinoma
2c. Large cell carcinoma
Most common type of lung cancer in non-smokers
Adenocarcinoma
Is adenocarcinoma peripheral or central?
Peripheral
Is squamous cell carcinoma peripheral or central
Central
Disease associated with squamous cell carcinoma of lung
Paraneoplastic
May produce PTH = hypercalcemia
What lung cancer is associated with Pancoast tumor
Small cell
Presentation of pancoast tumor
• 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
What cancer is associated with Lambert Eaton
Small cell carcinoma
Paraneoplastic syndromes associated with small cell carcinoma of lung
- ADH = SIADH
- ACTH = Cushing’s
- Antibodies against pre-synaptic Ca2+ channels = Lambert-Eaton
Is large cell lung carcinoma peripheral or central
Peripheral
Large cell has poor prognosis
Causes of ARDS
Gram neg sepsis, gastric aspiration, trauma, low perfusion, pancreatitis
How do you diagnose ARDS?
- Bilateral alveolar infiltrates on CXR
- PaO2/FiO2 ratio < 200 (=hypoxia)
- Rule out cardiac cause - PCWP < 18 (means pulmonary edema is non-cardio)
Treatment of ARDS
PEEP
What murmur is increased by valsalva?
Valsalva increases intrathoracic pressure, thus decreasing preload (opposite of inspiration)
Decreases the intensity of most murmurs EXCEPT increases intensity of hypertrophic cardiomyopathy
Holosystolic blowing murmur
Mitral regurg
Holosystolic murmur with late diastolic rumble in kids
VSD
Continuous machine like murmur
PDA
Wide fixed and split S2
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
Rumbling diastolic murmur with an opening snap
Mitral stenosis
Blowing diastolic murmur with widened pulse pressure
Aortic regurgitation
Tx of Zenker’s diverticulum
False diverticula in the esophagus (bad breath)
Tx = surgery
Tx of achalasia
Dysphagia to liquids and solids + bird beak barium swallow
Tx = CCB, nitrates
Tx of GERD
Behavioral modification, antacids, H2 blockers, PPIs
What are indications for surgery with GERD
Bleeding, stricture, Barrett’s, incompetent LES, max dose PPI with persistent sx
Tx of asymptomatic esophageal varices
DO NOT prophylactically band!
Give beta blockers
Only band symptomatic varices
Management of suspected esophageal cancer (e.g. progressive dysphagia with weight loss)
Barium swallow, then endoscopy with biopsy
