Surgery Rotation 4 Flashcards
Treatment of hypernatremia
D5 1/2 NS - for slow development
D5 1/3 NS - for rapid development
Treatment of hyponatremia
Water restriction - for slow developing
NS or Ringers lactate - for rapid developing
Treatment for hypo and hyperkalemia
Hypo - IV potassium
Hyper - hemodialysis, insulin
What is in cryoprecipitate
Used in coagulopathies
Fibrinogen, factor 8 and 13, fibronectin, VWF
What does pronator drift test for
o Test:
♣ Patient outstretches the arms with palms up and eyes closed so that only proprioception is used to maintain arm position
♣ UMN lesions cause more weakness in supinator muscles compared to pronator muscles of the upper limb – so affected arm drifts downward and the palm turns (pronates) toward the floor
o Positive in UMN or Pyramidal/Corticospinal tract disease
♣ E.g. Multiple Sclerosis
Initial management of patient with unprovoked first seizure
CT without contrast to rule out acute neuro problems (e.g. intracranial or subarachnoid bleed)
MRI is better than CT to identify structural causes of epilepsy in non-emergent situations
Treatment of gas gangrene
Penicillin
Debridement
Hyperbaric chamber
Review bone breaks and associated nerve/artery damage
Do it!!
Artery damaged in posterior dislocation of knee
Popliteal artery
Important because there is very little collateral arteries back there
Must check if there is good blood supply to lower leg
Management of carpal tunnel syndrome
Wrist xray
Splint and anti-inflammatories
If it needs surgery - precede by electromyography
Management of trigger finger
Steroid injections
Management of uncomplicated SBO
Bowen rest, NG tube suction, fluids
Signs of complicated SBO
Changes in pain, fever, hemodynamic instability (tachycardia, hypotension), guarding, leukocytosis, metabolic acidosis
Increased risk of ischemia, strangulation, and necrosis
Management of complicated SBO
Emergency exploratory laparotomy
Management of acute mesenteric ischemia
Angiography of mesenteric vessels
Ddx for anterior mediastinal mass
4 Ts
Thymoma, teratoma (and other germ cell tumors), thyroid neoplasm, terrible lymphoma
Management of small and uncomplicated pneumothorax
Observation and O2
Treatment of large but stable pneumothorax
Needle aspiration or chest tube
Management of unstable pneumothorax
Chest tube or urgent needle decompression
Management of uncomplicated diverticulitis
Bowel rest, oral abx, observation
What is complicated diverticulitis
Diverticulitis associated with Abscess, perforation, obstruction, fistula
Management of complicated diverticulitis with abscess
Percutaneous drainage guided by CT for fluid > 3
Surgical drainage if percutaneous drainage fails
Most common organ injuries in blunt abd trauma
Hepatic and splenic laceration
Major risk factor for pancreatic cancer
Smoking
Presentation of pancreatic cancer
Systemic sx (weight loss), abd/back pain, jaundice, migratory thrombophlebitis, recent onset DM
Test for MCL injury
Valgus stress test - one hand on medial leg and one on lateral thigh. Push lateral thigh inwards. Laxity indicates MCL injury
Test for meniscal tear
McMurray test - passive knee flexion and extension while holding the knee in internal or external rotation. Pain, clicking, or catching indicates meniscal tear
Causes of pre-renal AKI
- Decreased renal perfusion:
- true volume depletion
- decreased EABV (e.g. HF, cirrhosis)
- displacement of IV fluid (e.g. sepsis, pancreatitis)
- renal artery stenosis
- afferent arteriole vasoconstriction (e.g. NSAID)
How do you treat pre-renal AKI
Restoration of renal perfusion
Management for fx of metatarsal
Middle metatarsals (2, 3, 4) - can usually heal with rest and analgesics
5th metatarsal has increased risk for nonunion - managed with casting or internal fixation
Management of peritonsillar abscess
Needle aspiration or incision and drainage + abx
Causes of post-op fever
Malignant hyperthermia (immediate) Bacteremia Atelectasis Pneumonia UTI (3 days later) DVT (5 days later) Wound infection
Remember: 4 Ws for timing Wind - atelectasis Water - UTI Walking - DVT Wound - infection Wonder where - abscess
What is dumping syndrome
Result of rapid emptying of food into the small bowel
Hyperosmolality of food causes rapid fl ruin shifts from plasma into bowel, resulting in hypotension and sympathetic nervous system response
Presentation = colicky abd pain, diarrhea, nausea, tachycardia
Causes of severe post-op chest pain
MI or PE
How soon after surgery will post-op MI occur
1-3 days
How soon after surgery will post op PE occur
5-7 days
In PE will you see hyper/hypxemia and hyper/hypocapnea
Hypoxia and hypocapnea
Vs. respiratory failure which has hypercapnea because pt cannot blow off CO2
What is the name of internal hernia after Roux-en-Y with small bowel herniating through mesenteric defect?
Petersen’s hernia
Contents of inguinal canal
Spermatic cord or round ligament
Blood vessels
Lymphatic vessels
Ilioinguinal nerve
Contents of the spermatic cord
Ductus deferens Testicular artery Pampiniform plexus Genital branch of genitofemoral nerve Cremasteric muscle
What is Cooper’s ligament?
Aka pectineal ligament
Extension of the lacunar ligament that runs on the pectineal line of the pubic bone
Boundaries of the femoral canal
- Cooper’s ligament posteriorly
- Inguinal ligament anteriorly
- Femoral vein laterally
- Lacunar ligament medially
What does TURP stand for?
Transurethral resection of the prostate
What is the referred subscapular pain from gallstones called?
Boas sign
What is Charcot’s triad
For cholangitis
Jaundice, fever, RUQ pain
What is the pentad of sx associated with cholangitis
Reynold’s pentad
jaundice, fever, RUQ pain, hypotension, AMS
