Surgery Rotation 13 Flashcards
What are the 4 combinations in which sodium can enter the body
Bound to neg charge = NaCl or NaHCO3
Or in exchange for another positive = H+ or K+
What are the ways we can convince the kidney to fix metabolic alkalosis
Provide KCl (5-10 mEq/hr)
This way the kidney will either exchange Na for K or absorb Na with Cl
So that the kidney will not exchange Na with H (don’t want to lose more acid) or absorb Na with HCO3 (don’t want to absorb more base)
What is Meniere disease
• Increased pressure and volume of endolymph • Features: o Recurrent vertigo o Ear fullness/pain o Unilateral sensorineural hearing loss o Tinnitus
Treatment of Prinzmetal / Vasospastic angina
- Calcium channel blocker (preventive)
- Sublingual nitroglycerin (abortive)
Tx of relapsing remitting MS
interferon-beta
Treatment of A-fib in a patient with hemodynamic instability
Direct current cardioversion
What is the cause of S3 heart sound
Rapid flow of blood from atria to ventricles
Caused by volume overload (e.g. CHF, mitral/tricuspid regurg)
What is the cause of S4 heart sound
Atrium contracting against a stiff ventricle (e.g. hypertrophic cardiomyopathy, aortic stenosis, LV hypertrophy)
Causes of acute pancreatitis
I GET SMASHED
Idiopathic. Gallstones. Ethanol. Trauma. Steroids. Mumps. Autoimmune. Scorpion sting. Hypertriglyceridemia/hyoercalcemia. ERCP. Drugs.
Components of MEN1
Parathyroid hyperplasia, pituitary adenoma, pancreatic tumor
Components of MEN2a
Parathyroid hyperplasia, medullary thyroid cancer, pheochromocytoma
Components of MEN2b
Pheochromocytoma, medullary thyroid cancer, Marfanoid/Mucosal neuromas
How do you diagnose a sarcoma
(painless enlarging mass)
Dx with biopsy (NOT FNA)
Tx of soft tissue sarcoma
Wide, local excision or amputation + radiotherapy
Where do sarcomas usually spread to first?
Lungs (hematogenously)
Tx of sarcoma met to lungs
Can do wedge resection if it is the only met and primary tumor is under control
Progression to liposarcoma
99% do NOT come from lipoma
Presentation and tx of thyroglossal duct cyst
Midline mass that moves when tongue moves
Remove surgically
Test to assess for reflux
Esophageal pH testing
Test to assess for achakasia
Mannometry
Test for a pt with clinically obvious chronic gerd
Endoscopy and biopsy to look at damage
Management of barrets esophagus
Nissen fundiplocation
Or intensive therapy of acid (eg PPI - omeprazole)
Testing prior to Nissen
Make sure Gerd is the cause. Mannometry to make sure esopageal contraction is good. Gastric emptying test to check pyloric sphincter. Barium swalllow to locate GE junction
Diagnose: liquids more difficult to swallow than solids
Achalasia
Vs. cancer where solids are harder
Gastroschisis - presentation, associated disorders, complications
Gastroschisis = viscera not covered by sac
Defect lateral to midline
Not usually associated with other disorders
May be atretic or necrotic requiring removal; short gut syndrome
Omphalocele - presentation, associated disorders
Covered by sac; midline
Associated with other disorders
Diagnose: 4 wk old infant with non-bileous vomiting and “olive” mass
Pyloric stenosis
Metabolic complications of pyloric stenosis
Hypochloremia; metabolic alkalosis
Tx of pyloric stenosis
Surgery = myotomy
Diagnose: 2 wk old infant with bileous vomiting. Pregnancy complicated by polyhydramnios
Intestinal atresia (narrowing or absence of portion of intestine) Duodenal atresia = double bubble on XR
Or annular pancreas
What disorder is associated with intestinal atresia
Down Syndrome
Diagnose: 1 wk old baby with bileous vomiting, draws up his legs, has abd distenstion
Malrotation and volvulus
Diagnose: 3 day old newborn that has not passed meconium
Meconium ileus (consider cystic fibrosis)
Hirschsprung disease (biopsy will show no ganglia)
Diagnose: 5 day old former 33 weeker develops bloody diarrhea
Necrotizing enterocolitis
Describe XR of necrotizing enterocolitis
Pneumocystis intestinalis (air in wall)
Tx of necrotizing enterocolitis
NPO, TPN (if nec), abx, resection of necrotic bowel
Diagnose: 2mo old baby has colicky abd pain and current jelly stool w/ sausage shaped mass in the RUQ
Intussusception
Barium enema is dx and tx
Medical tx of BPH
Tamsulosin (a1-antagonist which relaxes smooth muscle) or finasteride (5a-reductase inhibitor)
Surgical tx of BPH
TURP
Tx of prostate cancer
Surgery, radiation, leuprolide or flutamide
Best test to diagnose kidney stones
CT
Tx of kidney stones
If stone <5mm, hydrate and let it pass. If >5mm, do shock wave lithotripsy. Surgical removal if >2cm.
Diagnosis of testicular torsion
Do STAT doppler U/S -will show no flow (contrast w/ epididymitis)
Tx of testicular torsion
Can surgically salvage if <6hrs. Do orchiopexy to BOTH testes.
Location and presentation of osteosarcoma
Usually occurs in metaphysis – distal femur or proximal tibia (knee region)
Imaging reveals a mass with sunburst appearance and lifting of periosteum (Codman triangle)
-THINK: osteoSarComa (S = sunburst and C = Codman)
Location and presentation of Ewing Sarcoma
Arises in the diaphysis of long bones
Lytic bone lesions
X-ray reveals “onion-skin” appearance – tumor grows within medullary center of bone, pushing outwards and causing periosteum (outer layer) to lay down new layers of bone
- THINK: eWING = Chicken WINGS and onion rings
Why give epi with lidocaine
To prevent systemic absorption
Next step in management of pt with suspected esophageal cancer
Barium swallow BEFORE endoscopy and biopsy so you know obstruction and don’t rupture esophagus
Tx of Mallory Weiss tear
Endoscopy. Can maybe do photocoagulation
Differentiate Mallory Weiss vs boerhaave
B will have horrible pain and appear very sick
M is just vomiting blood
Management of suspected boerhaave
No endoscopy - can worsen tear
No barium - will spill out and worsen problem
Do gastrographing swallow first - water soluble and safer than barium. But gives poor quality pictures. May miss perforation
If gastrograph is negative then do barium to be sure
Tx of confirmed esophageal rupture
Surgery
