Surgery Rotation 3 Flashcards
Causes of air in the neck
Esophageal rupture
Tension pneumothorax
Tracheobronchial injury
Vitelline duct vs. urachus
Vitelline duct = connects the midgut to the yolk sac (persistance = Meckel’s_
Urachus = connection between bladder and belly button (remnant of allantois)
First step in management of patients with acute stroke
CT scan of the head without contrast to rule out hemorrhage
Clinical findings in lateral epicondylitis
Due to overuse of extensor muscles leading to non-inflammatory tendinosis at the common extensor origin on the lateral epicondyle
Presents with tenderness at the lateral epicondyle and reproduction on pain with resisted extension or passive flexion of the wrist
Most important intervention in COPD for prolonged survival
Long-term supplemental oxygen therapy
Treatment of acute disabling symptoms of Multiple sclerosis
Glucocorticoids - they hasten neurologic recovery
Uses of interferon alpha
Hep B and C, hairy cell leukemia, malignant melanoma, Kaposi sarcoma, Condyloma accuminata, RCC
Uses of interferon beta
Relapsing type multiple sclerosis
Uses of interferon gamma
Chronic granulomatous disease (CGD)
How do you differentiate between Serotonin syndrome and Neuroleptic malignant syndrome
SS = altered mental status, autonomic instability, and HYPERREFLEXIA and MYOCLONUS
NMS = altered mental status, autonomic instability, RIGIDITY and HYPOREFLEXIA
Recommended pneumococcus vaccines for adults
No vaccination for healthy individuals
Age 19-64
- PPSV23 (23-valent pneumococcial polysaccharide vaccine) alone
- Chronic hear, lung, or liver disease
- Diabetes, current smokers, alcoholics
- Sequential PCV13 (13-valent pneumococcal conjugate vaccine) + PPSV23
- For very high risk patients
- CSF leaks, cochiear implants
- Sickle cell disease, asplenia
- Immunocompromised (e.g. HIV, malignancy)
- Chronic idney disease
Age > 65
- Sequential PCV13 + PPSV23
- 1 dose of PCV13 followed by PPSV23 at a later time
Indications for Td vs. Tdap vaccination as an adult
All adults should recieve a one-time dose of Tdap in place of Td, followed by Td every 10 years thereafter
Tdap applies to patients who have not recieved Tdap as an adult or if the patient’s prior vaccine history is unknown
What is the cause and classical presentation of multiple myeloma
- Malignant proliferation of monoclonal plasma cell within the marrow
- Increased production of IgG and IgA (M spike on electrophoresis)
- Lytic bone lesions -
back pain (plasma cells activate osteoclasts) - Hypercalcemia
- Rouleaux formation of RBCs (increased serum protein leads to decreased charge between RBCs)
- Anemia (plasma cells packed in bone marrow inhibit production of other cells)
- Renal insufficiency (excessive antibodies plug up kidney)
What are maneuvers that can be used to identify an appendiceal abscess
Psoas sign
Obturator sign
Rovsing sign
Rectal tenderness
Peritoneal signs (rebound, guarding, rigidity) are more indicative of acute appendicitis/rupture
Definition of heat stroke
Core temp > 40 degrees and AMS
What arrythmia is this: chaotic and erratic baseline with no discrete P waves in between irregularly spaced QRS complexes
Atrial fibrillation
Treatment of A-fib in a patient with hemodynamic instability
Direct current cardioversion
Treatment of V-fib
Defibrillation
Differentiate between 1st, 2nd and 3rd degree heart block
1st = prolonged PR interval > 200 ms (time between atrial and ventricular depolarization)
2nd = progressive lengthening of PR until a beat is dropped or a beat dropping with no warning
3rd = atria and ventricles beat independently of each other
Management of hypersensitivity pneumonitis (Pigeon breeder’s lung)
Avoidance of antigen
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)
What is the treatment of choice in acute pulmonary edema caused by MI?
Loop diuretic (e.g. Furosemide)
Layers of the abd wall
Skin –> subcutaneous tissue –> fascia (Camper’s and Scarpa) –> external oblique m. –> internal oblique m. –> transversus abdominis m. –> transversalis fascia –> adipose tissue –> peritoneum
NAVeL
Femoral nerve, external iliac artery and vein, lymphatics
Contents of lateral, medial, and medial umbilical folds
Lateral = inferior epigastric vessels
Medial = obliterated umbilical artery
Median = obliterated urachus; para-umbilical veins
What is the midline line that connects the aponeurosis of the abdominal muscles
Linea alba
What is Hesselbach’s triangle
Inguinal triangle:
Medial = rectus sheath Lateral = inferior epigastric vessels Base = inguinal ligament
Insertion points of the inguinal ligament
Anterior superior iliac spine + inferomedial pubic tubercle
Inferior epigastric artery is a branch of what?
External ilia
Superior epigastric artery is a branch of what artery?
Internal thoracic, which is a branch of subclavian
Blood supply of anterior abd wall
Superior and inferior epigastric artery
Blood supply of lateral abd wall
Musculophrenic (branch of internal thoracic) + deep circumflex iliac (branch of external iliac) + subcostal (branches of thoracic aorta)
Branches of the celiac trunk
Splenic artery
Left gastric artery
Common hepatic artery (proper hepatic, R gastric, gastroduodenal)
Lobes of the liver
L and R
Anterior = quadrate
Posterior = caudate
What is the name of the triangle near the gallbladder
Calot’s triangle
Borders of Calot’s triangle
Medial = common hepatic duct
Inferior = cystic duct
Superior = cystic artery
What makes up the portal triad
Common bile duct
Portal vein
Hepatic artery proper
What hormones stimulate the pancreas
CCK from small intestine (pancreas and gallbladder)
Secretin from small intestine (stimulates pancreas to secreted HCO3-)
Causes of acute pancreatitis
• I GET SMASHED:
o Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypertriglyceridemia/Hypercalcemia, ERCP, Drugs (e.g. Sulfa, NRTIs, protease inhibitors)
Major drugs used for immunosuppression in transplant
Triple therapy: corticosteroids, azathioprine, cyclosporine/tacrolimus
MOA of azathioprine
Prodrug of 6-mercaptopurine (purine analog)
Inhibits lymphocyte proliferation by blocking nucleotide synthesis
MOA of cyclosporine/tacrolimus
Blocks T-cell activation by preventing IL-2 transcription
Most commonly used corticosteroid used for immunosuppression in transplant
Prednisone
MOA of Thymoglobulin
Polyclonal rabbit antibodies raised against human T-cells
Bind and deplete T cells
OKT3 is an anti-CD3 monoclonal antibody that depletes T-cells specifically
what is Unasyn?
Ampicillin + Sulbactam
