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MS3 > Surgery Rotation 12 > Flashcards

Surgery Rotation 12 Flashcards

1
Q

What is the tx for immune thrombocytopenia

A

Splenectomy

Spleen is what is producing the antibodies and also what is consuming the antibody-bound platelets

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2
Q

What are the two important medications to give to a post-op splenectomy

A

Aspirin - can have post-op thrombocytosis

Prophylactic penicillin

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3
Q

What is Kehr sign

A

L shoulder pain to due irritation of the diaphragm

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4
Q

When do you go to surgery in a pt with appendicitis

A

Always if we think they have appendicitis

Do not need imaging if there is a good clinical picture

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5
Q

How does management of appendicitis change if there is perforation or abscess

A

Drain abscess and give abx first, then appendectomy once stabilized

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6
Q

1 site for carcinoid tumor

A

appendix

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7
Q

Sx of carcinoid symdrome

A

BFDR

Bronchospasm
Flushing
Diarrhea
R-heart lesions

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8
Q

What else should you look for in a pt with carcinoid syndrome

A

Niacin (B3) deficiency

Because serotonin and niacin are both made from tryptophan; so if all tryptophan is being used for 5HT, none is used for Niacin

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9
Q

Presentation of Niacin deficiency

A

Pellagra = diarrhea, dermatitis, dementia

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10
Q

Tx of carcinoid tumor of appendix if >2cm, at base of appendix, or with + nodes

A

Hemicolectomy

Otherwise appendectomy is good enough

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11
Q

1st step in management of possible SBO

A

Upright CXR to look for free air

CT can show point of obstruction

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12
Q

Tx of SBO

A

IVF, NG tube

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13
Q

When do you do surgery for SBO

A

If peritoneal signs, increased WBC, or no improvements within 48 hr

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14
Q

Diagnose: dilation of both small and large bowel on XR

A

Post-op ileus

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15
Q

Most common location of Crohn’s

A

Terminal ileum

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16
Q

Tx of diverticulitis

A

NPO, NG suction, IVF, broad spectrum abx

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17
Q

When is surgery indicated for diverticulitis

A

Multiple episodes, age < 50

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18
Q

Sx of R-sided vs L-sided colon cancer

A

R-sided = bleeding

L-sided = obstruction

19
Q

When is surgery indicated in AAA

A

> 5 cm

20
Q

1 cause of death post-op AAA

A

MI

21
Q

Post-op diarrhea after AAA repair

A

Ischemic colitis

22
Q

Post-op weakness and decreased pain/sensation after AAA repair

A

ASA syndrome

23
Q

Post-op AAA repair 1-2 yrs later if have brisk GI bleeding

A

Aortoenteric fistula

24
Q

Diagnose: severe mid-epigastric pain after eating, food fear, weight loss
Pain out of proportion to exam

A

Mesenteric ischemia

25
Q

Work up of suspected acute mesenteric ischemia

A

Angiography (aorta and SMA/IMA)

26
Q

Tx of acute mesenteric ischemia

A

Surgical emergency!

Embolectomy

27
Q

Cause of chronic mesenteric ischemia

A

Slow progressing stenosis

28
Q

Tx of chronic mesenteric ischemia

A

Aortomesenteric bypass or transaortic mesenteric endarterectomy

29
Q

Best test for peripheral artery claudication

A

Ankle-brachial index

Normal >1

30
Q

Tx of acute arterial occlusion

A

Immediate heparin + prepare for surgery

31
Q

When would you use thrombolytics in acute arterial occlusion

A

No surg in <2 weeks

Hemorrhagic stroke

32
Q

Common complication of tx of acute arterial occlusion

A

Compartment syndrome during reperfusion period

Do fasciotomy + watch for myoglobinuria

33
Q

Tx of DVT

A

Heparin bridge to Warfarin, continue Warfarin 3-6 months

34
Q

Work-up of suspected PE

A

Give Heparin 1st! Then work up with V/Q scan, then spiral CT

Pulmonary agiography is gold standard

35
Q

Tx of PE

A

Heparin Warfarin overlap

Use thrombolytics if severe but NOT if s/p surgery or hemorrhagic stroke

Surgical thrombectomy if life threatening

36
Q

1st step in assessing thyroid nodule

A

Check TSH

37
Q

Next step in thyroid nodule if TSH is low

A

Do RAIU to find the “hot nodule”

Excise or radioactive iodine

38
Q

Next step in thyroid nodule if TSH is normal

A

FNA

39
Q

Next step in thyroid nodule if normal TSH and benign FNA

A

Leave it alone

40
Q

Next step in thyroid nodule if normal TSH and malignant FNA

A

Excise and check pathology

41
Q

Next step in thyroid nodule if normal TSH and malignant FNA with indeterminate pathology

A

Re-biopsy or check RAIU

42
Q

Next step of cold thyroid nodule

A

Surgically excise and check pathology

43
Q

How do you differentiate amide anesthetics from ester anesthetics

A

Amides have an “I” other than the I in “caine”

E.g. Lidocaine, Bupivacaine, Prilocaine
Vs. Procaine, Chlorprocaine, Tetracaine

44
Q

Are amide or ester anesthetics longer acting

A

Most amides are intermediate to long acting

Esters are short acting except for tetracaine

MS3 (88 decks)

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