Surgery shelf Flashcards
Diaphoretic, pale, cold, shivering, anxious BP<90, PR: 120
Hypovolemic shock
Causes of shock in trauma setting
- Bleeding
- Pericardial Tamponade
- Tension Pneumothorax
Cardinal sign for pericardial tamponade or tension pneumothorax
Big distended veins in the neck ( elevated JVD/CVP)
Trauma patient with BP 60/40, PR: 150, Absent breath sounds on one side, hyperresonant to percussion, elevated JVD/CVP, tracheal deviation
Tension Pneumothorax
How to fluid resucitate
2 big 16 gauge catheters in both arms or puncture at the femoral vein. 1 or 2L of ringers lactate
Whats the access point for a child who you cant get peripheral IV access on
intraosseus cannulation of the proximal tibia
Trauma patient with high CVP, normal breathing, BP<80/50, PR: 150, no tracheal deviation, sweating, diaphoretic, shivering, cold and pale
Pericardial Tamponade
Management of Pericardial Tamponade
Pericardiocentensis, pericardial window, pericardial tube, mediasternotomy (decompress pericardial sac). In the meantime of placing these things give patient fluid
Management for Tension Pneumothorax
Big bore needle in the pleural space to be followed by chest tube.
Types of shock in the non trauma setting
- Bleeding
- Cardiogenic shock
- Vasomotor shock
Patient with severe chest pain, cold, diaphoretic, BP 8-/65, PR:130, Neck veins are distended, shortness of breath
Cardiogenic shock from massive MI
Patient with BP 75/20, PR:150, warm and flushed, CVP is low
Vasomotor shock (sudden loss of peripheral vascular tone)
Management of linear skull fracture
No therapy for the linear skull fracture but clean and close the scalp laceration
Management for Trauma Patient with head trauma who has loss consciousness
CT scan of head
Racoon eyes, rhinnorhea, clear fluid leaking from the ear, ecchymosis behind the ear
Base of the skull fracture
Trauma patient, Lucid interval, fixed dilated pupil, contralateral hemiparesis
Acute epidural hematoma
How do you treat ICP
Elevate head, Hyperventilation, osmotic diuresis, mannitol
Indications for surgery in neck injuries
- Rapid deteriorting patient
- Gun shot wounds to the middle neck
- Penetrating injuries to important veesel (expanding hematoma, spitting up blood)
Patient stabbed in the back, paralysis and loss of proprioception on ipsilateral below legion and loss of pain and temperture contralateral below lesion
Brown Sequard syndrome (hemisection)
Patient sustains burst fracture of vetebral bodies, loss of motor function, loss of pain and temperature bilaterally. Vibratory sense remains normal
Anterior Cord syndrome
Patient hyperextends their neck, develops burning and paralysis bilaterally on both upper extremities. Motor function of legs are normal
Central Cord syndrome
Management of rib fracture in old patient
local Nerve block
Management of pnuemothorax
Chest x-ray then chest tube. (2nd intercostal space in front of chest)
Explain management of hemothorax
- Use chest tube if there is a small amount of fluid (<600)
2. Use thoractomy if there is a large amount of fluid retained from chest tube (1000cc)
Severe deceleration injury, chest trauma, BP 80/40, PR: 150, widened mediatstinum
Aortic dissection
Paradoxically breathing is a sign of
Flial chest
Managment for pulmonary contusion
Fluid restriction, diuretics, monitor ABG
Reasons for air and emphysema in the chest and lower neck
- Tension pneumothorax
- Tracheal bronchial injury
- Endoscopy–> esophageal rupture
sudden death in a trauma patient
Air embolism
Patient with multiple long bone fractures, Petechial rashes, fever, tachycardia, hypoxemia, bilateral patchy infiltrate, low platelets
Fat embolism
Management for gun shot wound to the abdomen
Exploratory laparotomy
Management for acute abdomen
Exploratory laparotomy
Signs of acute abdomen
Abdominal pain, rebound tenderness, guarding in all quadrants
Trauma patient in shock, CVP is low and no evidence of bleeding anywhere but the abdomen. WHats the managment
Direct peritoneal lavage or sonogram in the ER
Trauma patient that is hemodynamically stable, no evidence of bleeding anywhere but the abdomen. What is the managment
CT scan of abdomen
Most common site of compartment syndrome
Forearm and lower leg
What are the concerns in a crushing injury
Myoglobinemia/myoglobinuria and hemoglobinemia/hemoglobinuria. Also monitor levels of serum potassium. Renal failure. Compartment syndrome
What do you monitor in a patient with respiratory burn
Monitor ABG and Carboxyhemoglobin
Whats the formula for fluid rescucitation for burns on day 1
wgt in kg x % of burn x 4
How do you adjust fluids on the second day of a burn
half of the fluids from day 1
Whats the rate to start at in a burn patient for fluid resuscitation
1000cc/hr
What should be a normal hourly urinary output
1cc/kg/hr….so anywhere from half your body weight to 2 times your body weight
Managment from bite of black widow spider
IV calcium gluconate
Symptom of bite from black widow spider
Sever muscle contractions
Patient with nausea and vomiting, early satiety, abdominal distention, hyperresonant bowel sounds, tympany to percussion
Small bowel obstruction
New born child with uneven gluteal folds, hip can be displaced posteriorly with a snap. Runs in the family
Developmental dysplasia of the hip
Diagnostic test and management for developmental dysplasia
Sonogram and abduction splinting or have patient wear double diapers for about six months
6 year old patient, guarding with passive motion of the leg, knee pain, limping, less time on the affected leg
Avascular necrosis of the capital femoral epiphysis
13 yr old patient obese patient, pain in groin, limping, sole of foot pointing towards other foot, limited hip motion, when hip flexed leg goes into external rotation
slipped capital femoral epiphysis
Toddler with febrile illness a few days before problem started in the hip. Elevated sedimentation rate
Septic hip
Tenderness right over the tibial tubercle. No swelling in the knee
Osteochondrosis of the tibial tubercle
Baby born with both feet turned inward. Plantar flexion of the ankle
Club foot
Child falls with an extended arm and has a supracondylar frature of the humerus. What is the managment
Monitor the vascular supply
16 yr old patient low grade but constant pain in the distal femur for several months. X-ray shows a sunburst pattern,
osteogenic sarcoma
10 yr old consistent pain deep in the middle of thigh with periosteal skinning
ewing sarcoma
60 yr old patient with fatigue and pain in specific places on several bones. found to be anemic. multiple punched out lesions on x-ray
Multiple myleoma
Managment for fracture of clavicle
Figure of 8 device for 4-6 wks
Patient falls on an outstretched hand. Pain at the anatomical snuff box and wrist pain
Fracture of the scaphoid bone
Managment for scaphoid fracture
Thumb spica cast and x-ray 2 weeks later
If x rays show displacement of the scaphoid bone what is the management
Open reduction and external fixation
Management for femoral neck fracture of the hip
Prosthesis of femoral head
Management for intertrochanteric fracture of the hip
open reduction and pinning and post op anticoagulation
Management for femoral shaft fracture
intermedullary rod fixation
Management for gas gangrene
Penicillin and surgical debridement and hyperbaric oxygen treatment
Which nerve travels in the groove of the radius and causes an inability to dorsiflex the wrist
Radial nerve
Managment for carpel tunnel syndrome
Splint and NSAIDS
Managment for trigger finger
steroids
Predictors of operative risk
MI within 6 months Emergency operation age PVC and A.Fib Congestive heart failure (increase JVD
What causes malignant hyperthermia
Enzyme missing where succinylcholine couldnt be broken down
What drugs can lead to malignant hyperthemia
Halothane and succinylcholine
Management of malignant hyperthermia
IV Dantrolene
First postop day with fever of 102. Most common cause
atelectasis
3rd post op day with fever. Most common cause
UTI
5th post op day fever. Most common cause
DVT
7th post op day fever. Most common cause
Wound infection
10th post op day fever. Most common cause
Subphrenic abscess
Severe chest pain in a post op patient. Most common cause
MI or PE
What kind of testicular masses transilluminate with light and what is the management
hydrocele. reassurance and observation
Diagnostic test of choice for splenic injury
abdominal CT with contrast
Whats the risk factor for nasopharyngeal carcinoma and what race of people is this usual seen in
EBV virus and asians
Patient in a high speed accident with decreased breath sounds on the right, normal breath sounds on the left and hypotension. Chest tube placed. Multiple bruises over the chest wall and subcutaneous emphysema and pneumomediastinum
Trachealbronchial rupture
Patient has a history of crohns disease and comes in with an episode of left flank pain, hematuria and vomiting. Pain is relevied with analgesics. Whats the cause of the symptoms
Increased absorption of oxalate
What is the cause of intraluminal contents coming from the abdomen. Patient is afebrile and no signs of acute abdomen
GI tract fistula
What things prevent a fistula from healing
Foreign body Epithelization Tumor Infectious/irridiated tissue/inflammatory bowel disease Distal obstruction
Patient went out drinking one night and started vomiting repeatedly. First bile is coming up and then bright red blood is seen. What is the diagnosis
mallory weiss syndrome
Patient drinking heavily and drunk and starts vomiting repeatedly. A violent episode of vomiting sets in. Severe epigastric and substernal chest pain, diaphoretic, fever, leukocytosis is also seen. Whats the diagnosis
Esophageal perforation
Patient has an upper endoscopy for gastric cancer and is sent home. When the patient gets home he starts to feel ill. Fever, leukocytosis and sweating ensues. There is retrosternal chest pain. Subcutaneous emphysema is seen in the neck. What is the diagnosis
Esophageal perforation due to an instrument
Whats the diagnostic order of tests for esophageal perforation
Gastrographing swallow–>barium swallow–>surgery
Whats the diagnostic test if your thinking its a stomach cancer
endoscopy and biopsy and then CT scan
Management of small bowel obstruction
NPO nasogastric suction and IV fluids. If the bowel doesnt clear then go to surgery
Patient comes in with colicky abdominal pain, abdominal distention, protracted vomiting, x-ray showing loops of bowel and air fluid levels, hasnt had a bowel movement or passed any gas, tampany to percussion. Patient is then put on NPO and has nasogastric suction. Patient then develops fever, leukocytosis, abdominal tenderness and guarding. What the diagnosis
Strangulation of the small bowel
Protracted diarrhea, episodes of flushing of face, expiratory wheezing, prominent jugular venous pulse recognized on her neck. What is the diagnosis
Carcinoid syndrome
Patient comes in with anorexia, vague periumbilical pain for a few hours that becomes sharp severe constant in the right lower quadrant. Leukocytosis, fever, guarding, rebound abdominal tenderness. What is the diagnosis
Acute appendicitis
If your thinking appendicitis what diagnostic test would you order
Either sonogram or CT scan
What is the classical presentation of a cancer of the colon on the right side
Anemia
Name polyps an order of premalignant to benign
Familial polyposis, villious adenomas, adenmatous polyp, juevnile polyps (benign)
Patient with Chronic ulcerative colitis, weighs 90lbs, over 40 hospital visits, severe abdominal pain, fever, leukocytosis, tender abdomen with muscle guarding and rebounding, distended transverse colon and gas in the bowel. Whats the next best step
Surgery. Colon resection
Female patient comes in with sever pain with defecation, blood streak stools, avoids defecating from pain, patient wouldnt let doctor exam them
Anal fistula
How does a anal fistula occur?
A tight sphincter is present which creates small tears in the anal mucosa then the blood supply gets cut off and the tears dont heal causing pain and bleeding
Chronic perianal fistula which was operated on and then things keep getting worse with multiple unhealing ulcers and purulent discharge. Whats the diagnosis
Crohns disease
Characteristics of sqamous cell carcinoma of the anus
mass protruding out of anus. associated with viral infection (HIV). metastsis to lymph nodes in abdomen and groin nodes
33 yr old Patient with 3 large bowel movement made up of dark red blood, sweating, pale, BP 90/70 PR 110. Patient just had a bloody bowel movement 20 min ago. What is the Next step in management?
Nasogastric tube aspiration looking for blood
7 yr old boy passes a large bloody bowel movement. What is the diagnosis and management
Meckels diverticulum. Technitium 99 scan is diagnostic
What 3 general groups of conditions cause abdominal pain or acute abdomen
- Perforation(sudden onset, constant pain, severe, generalized, guarding rebound tenderness, absent bowel sounds)
- Obstruction( sudden onset, colicky pain, localized)
- Inflammatory( gradual onset, constant pain, localized, guarding and rebound tenderness that localized, fever, leukocytosis)
Patient with cirrhoisis and ascites presents with generalized abdominal pain that started 12hrs ago. Moderate tenderness in all quadrants with some guarding and rebound tenderness with mild fever and leukocytosis. What is the diagnosis?
Primary bacterial peritonitis
Excruciating sudden onset of pain, rigid abdomen and lies motionless with absent bowel sounds. Free air under the diaphagram. What is the diagnosis
Perforation
alcoholic man presents with severe epigastric pain after alcohol intake, pain is constant and radiates to the back. Vomiting is present. What is the diagnosis
Acute pancreatitis
A 40 yr old obese mother of 6 children has severe right upper quadrant pain colicky in nature that radiated to the left shoulder and around the back. Has tenderness to deep palpation and rebound tenderness in the right upper quadrant. Nausea and vomiting is present. Constant pain. Fever and leukocytosis. Similar episodes with ingestion of fatty foods. What is the diagnosis
Acute cholecystitis
50 yr old man with right flank pain that radiates to the groin and has microscopic hematuria. What is the diagnosis
ureteral stone
What is the diagnostic test for diverticulitis
CT scan
82 yr old patient with colicky abdominal pain, severe abdominal distention, no gas, no stools, distended loops of small and large bowel, large air shadow (parots beak), nausea, vomiting, hyperactive bowel sounds, tympanic to percussion. What is the diagnosis
sigmoid volvulus
79 yr old man with A. Fib develops an acute abdomen. Develops acidosis and look sick. Silent abdomen with diffuse tenderness, trace of blood in stool, distension in small bowel up to the transverse colon. What is the diagnosis?
Mesenteric ischemia
Whats the blood marker for hepatocellular carcinoma
Alpha feto protein
Patient develops vague right upper quadrant discomfort, palpable liver with nodularity, CEA within normal limits after cholecystectomy. Now the CEA is 2 times above upper limits. What is the diagnosis
Metastatic cance of liver
Diagnostic test for liver cancer
CT scan
What are the two kinds of liver abscess?
- Pyogenic liver abscess (due to biliary traact disease)
2. Amebic abscess of liver ( due to infection from mexico)
Whats the treatment for an amebic abcess of the liver?
metronidazole
