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MS3 > Surgery Rotation 6 > Flashcards

Surgery Rotation 6 Flashcards

1
Q

Damage and presentation of anterior shoulder dislocation

A

Axillary nerve damage - sensation to lateral shoulder and deltoid (shoulder abduction) weakness

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2
Q

Damage and presentation of humeral mid-shaft fracture

A

Damage to radial nerve - sensation to posterior arm, forearm, and dorsolateral hand; extensor muscles

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3
Q

Presentation of uncal herniation

A

Ipsilateral hemiparesis and CN III (oculomotor) palsy

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4
Q

Presentation of pulmonary contusion

A

Presents <24 hours after blunt thoracic trauma

Tachypnea, tachycardia, hypoxia

CT scan or CXR with patchy, alveolar infilatrate

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5
Q

Positive Neer’s impingement test indicates what?

A

Rotator cuff impingement or tendinopathy

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6
Q

What is wound dehiscence

A

Opening of wound

Salmon colored fluid coming from closed wound, indicating that peritoneal fluid is leaking out - aka deeper layers are not healed yet

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7
Q

Treatment of wound dehiscence

A

Protection of wound, minimal activity, give it time to heal without increased abd pressure

At a convenient time, repair wound

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8
Q

Management of abd fistula

A
  • fluid replacement
  • electrolyte replacement
  • elemental nutrient replacement (something that won’t stir up enzymes)
  • protection of abd wall from bowel contents (suction device)
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9
Q

Things that prevent a fistula from healing

A

FETID

  • Foreign body
  • Epithelialization (epithelium from skin and from bowel can grow towards each other to line the lumen)
  • Tumor
  • Infection, irradiated tissue, IBD
  • Distal obstruction
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10
Q

Studies to evaluate blunt GU trauma

A

Clinical signs of renal trauma (e.g. CVA tenderness) = contrast CT

Clinical signs of urethral injury (e.g. gross hematuria) = gross hematuria

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11
Q

CAUSECause of hypoxia in flail chest

A

Pain causes patients to take shallow breaths

Rib fracture may cause lung contusion/hemothorax

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12
Q

Management of flail chest

A

Pain control, supplemental O2

Positive pressure ventilation (+/-) chest tube if respiratory failure

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13
Q

Presentation of esophageal rupture

A

subcutaneous crepitus in chest and pneumomediastinum

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14
Q

Will you have increased or decreased bowel sounds in small bowel obstruction and in ileus

A 
SBO = increased bowel sounds
Ileus = decreased/absent bowel sounds
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15
Q

Muscles of rotator cuff

A

SItS:

  • Supraspinatus (initial abduction of arm, before deltoid)
  • Infraspinatus (lateral rotation)
  • Teres minor (lateral rotation and adduction)
  • Subscapularis (medial rotation and adduction)
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16
Q

Test used to assess damage to supraspinatus

A

Drop arm test = patient’s arm is abducted above the head and patient is asked to lower arm slowly - in a tear, the arm will drop rapidly around mid-adduciton

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17
Q

What structures are at risk for damage in a supracondylar fracture of the humerus (right above the elbow)

A

Entrapment of brachial artery (which branches into radial and ulnar artery) or median nerve

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18
Q

Steps to find the source of blood per rectum

A

Could be from upper or lower GI:

1) NG tube to aspirate gastric contents to check for blood - if no blood, then you can exclude tip of nose to pylorus
2) Upper GI endoscopy to exclude duodenum - want to see green fluid (bile tinged)
3) Anoscopy to exclude hemorrhoids (cannot do colonoscopy during active bleeding b/c blood obscures the field)
4a) 1/2 options - angiogram for more severe bleeds
4b) 2/2 options - if less blood, wait until bleeding stops and do a colonoscopy

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19
Q

Most common cause of perforated abd

A

Perforated peptic ulcer

20
Q

Presentation of glucagonoma

A

Necrolytic dermatitis, diabetes (hyperglycemia), DVT, weight loss, depression

21
Q

Difference in gallbladder in obstruction caused by stones vs. malignancy

A

Stones = dilated ducts with nondilated gallbladder full of stones

Malignancy = large, thin-walled distended gallbladde

22
Q

Describe the percentage of body surface area when dealing with burns in adults

A

Rule of 9s:

Head = one 9
Each upper extr = one 9
Trunk = four 9s; two in front and two in back
Each lower extr = two 9s; one in front and one in back

23
Q

Describe the percentage of body surface area when dealing with burns in kids

A

Rule of 9s:

Head = two 9s
Each upper extr = one 9
Trunk = four 9s; two in front and two in back
Both lower extr = total of three 9s; 1.5 each

24
Q

Definition of “-pexy”

A

To hold in place

25
Q

Definition of “-rrhaphy”

A

To saw together

26
Q

Components of Whipple procedure

A
  • Cholecystectomy
  • Truncal vagotomy
  • Antrectomy
  • Pancreaticoduodenectomy—removal of head of pancreas and duodenum
  • Choledochojejunostomy—anastomosis of common bile duct to jejunum
  • Pancreaticojejunostomy—anastomosis of distal pancreas remnant to jejunum
  • Gastrojejunostomy—anastomosis of stomach to jejunum
27
Q

Definition of “-tomy”

A

To cut

28
Q

Definition of “-ectomy”

A

To take out or resect

29
Q

Definition of “-ostomy”

A

To make a mouth/opening

Could be from a single organ to the outside (colostomy) or could be an anastomoses between two organs (gastrojejunostomy)

30
Q

Definition of “-plasty”

A

To change the shape of something

31
Q

Fluid given for hypovolemic hypernatrermia (both symptomatic and asymptomatic)•

A

Non-symptomatic
o 5% dextrose
Symptomatic
o 0.9% saline (isotonic solution) until Euvolemic, then 5% dextrose (hypotonic solution)

32
Q

What causes metabolic alkalosis

A 
♣	Causes:
•	Losing H+  excessive vomiting, diuretics, hyperaldosteronism 
♣	Differential of metabolic alkalofis (pH > 7.45; HCO3- > 24)
•	Low urine chloride
♣	Will respond to saline
o	Vomiting/nasogastric aspiration
o	Prior diuretic use
•	High urine chloride
o	Hypovolemia/euvolemia
♣	Current diuretic use
•	Will responds to saline
♣	Bartter &amp; Gitelman syndrome
•	Saline unresponsive
o	Hypervolemia
♣	Excessive mineralocorticoid activity
o	Saline unresponsive
•	Primary hyperaldosteronism
•	Cushing disease
•	Ectopic ACTH production
33
Q

Differential dx of acute abd

A

Perforation
Obstruction
Inflammatory process
Ischemic process

34
Q

Cause and presentation of thrombotic thrombocytopenic purpura (TTP)

A

o Platelets used up in pathologic formation of microthrombi in small vessels
o Due to decreased ADAMTS13, enzyme that normally cleaves vWF for degradation
♣ No vWF degradation = abnormal platelet adhesion = microthrombi
o Findings (Pentad):
♣ Thrombocytopenia = platelets being used up
♣ Microangiopathic hemolytic anemia = RBCs sheared by microthrombi
♣ Renal insufficiency (thrombi involve vessels of the kidney)
♣ Neurological symptoms (confusion, HA, seizures, coma) – thrombi involve vessels of CNS
♣ Fever

35
Q

Will Na+ and K+ be high or low in DKA?

A

♣ Sodium levels will be low
• Hyponatremia due to sodium loss via diuresis (osmotic diuresis due to increased glucose)
♣ High serum potassium but low total body potassium
• Cells will exchange H+ for K+ causing high potassium
• Potassium in the blood will be excreted cause low total body potassium

36
Q

What causes metabolic acidosis

A 
•	Anion gap  Adding acid to the blood
o	MUDPILES:
♣	M – Methanol
♣	U – Uremia (renal failure) 
♣	D – Diabetic ketoacidosis
♣	P –  Propylene glycol/Paraldehyde
♣	I – Isoniazid/Iron
♣	L – Lactic acidosis
♣	E – Ethylene glycol (antifreeze)
♣	S – Salicylates (aspirin)
•	Non-anion gap  Losing excessive HCO3-
o	Diarrhea, Renal tubular acidosis, Spironolactone, Acetazolamide
37
Q

IV fluids given to treat DKA

A

♣ 0.9% normal saline initially

♣ Add dextrose 5% when serum glucose <200 mg/dL

38
Q

What is the difference between an epidural and subdural hematoma (on XR and clinically)

A

Epidural = lens shaped; can occur from less serious trauma; longer lucid interval

Subdural = crescent shaped; can be acute with severe trauma, or chronic

39
Q

What type of brain bleed can easily occur the elderly and alcoholics and why

A

Subdural

Their brains have shrunk but cranial cavity is the same size so it is easy for the brain to be “rattled” and to tear bridging veins

40
Q

How do you manage head trauma in a patient with no bleed

A

Prepare for edema

Mannitol, furosimide, hyperventilation

41
Q

Describe Cushing reaction (Triad of hypertension, bradycardia, and respiratory depression in response to increased intracranial pressure)

A

Increased ICP = pressure constricts arterioles in brain = cerebral ischemia = sympathetic response increases peripheral vasoconstriction, thus increasing BP = aortic baroreceptors sense increased BP = respond with reflex bradycardia and respiratory depression

42
Q

How does hyperventilation help with cerebral edema

A

A drop in PaCO2 due to hyperventilation causes vasoconstriction = decreased cerebral blood flow = decreased ICP

43
Q

Where is the damage in:

  1. initial hematuria (blood only at beginning of voiding)
  2. terminal hematuria (blood at end of voiding)
  3. total hematuria (blood throughout entire voiding)
A
  1. Urethral damage
  2. Bladder, prostate, or posterior urethra
  3. Kidney or ureters
44
Q

Potential complication of thoracic aortic aneurysm surgery that causes bilateral flaccid paralysis and loss of pain/temp in lower extremities

A

Spinal cord infarction (due to aortic cross-clamping) leading to anterior spinal cord syndrome

45
Q

What do hyperactive bowel sounds suggest?

A

Diarrhea, malabsorption (e.g. Celiac or lactose intolerance), incomplete mechanical bowel obstruction

MS3 (88 decks)

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