Surgery Specialty Flashcards
Adult with conjunctivitis
Pink eye
In adult usually viral (adenovirus)
Random cancer mets everywhere and can’t find the origin
Invasive melanoma can metastasize to anywhere
Only cancer that does that. It does not respond to chemo or radiation. It can be locally resected. It relapses and remits. It grows and shrinks
Treatment for BPH
Alpha-blockers to open the urethra and 5-alpha-reductase inhibitors to shrink the prostate.
Therapy begins with the alpha-blockers (Tamsulosin) and can escalate to combination therapy with Tamsulosin and Finasteride.
Presentation of coarctation of the aorta in child
A 1-year-old child who refuses to walk. He/she has claudication of his/her calves but is not able to communicate that pain in any other way other than crying.
Presentation of coarctation of the aorta in an adult
An adult (teenager to elderly) who has hypertension in the upper extremities and hypotension in the lower extremities. The older the person gets, the more difficult this is to separate from peripheral vascular disease, so the vignette will likely give you someone a little younger without atherosclerotic risk factors.
Work-up for coarctation of the aorta
Chest X-ray looking for rib notching
Diagnosis is then confirmed with some form of angiography of the aorta—CT scan chest with IV contrast, MRA, or regular angiogram.
Tx: Surgery w/ graft or anastomosis placed
Child with cyanotic heart
A child with cyanotic congenital heart disease not diagnosed at birth should prompt thorough evaluation for Tetralogy of Fallot.
Management of brain bleed
In any brain bleed, reverse anticoagulation (FFP) as the first step unless there are already signs of herniation (then choose craniotomy).
Scaphoid fracture management
Tenderness of the anatomic snuff box is pathognomonic for Scaphoid fracture, even if the x-rays are initially negative.
Tx with thumb cast and repeat xray in 3 weeks
Management of Abdominal Aortic Aneurysms
Surgery for AAA >5.5 cm
Surgery for AAA growing >0.5 cm/year, or those that are tender.
All others can be followed with serial Ultrasounds
Subarachnoid hemorrhage Diagnosis
Start with CT scan without contrast if (+) great
if Negative but high suspicion for SA hem then do LP and look for blood (xanthochromia)
The next step, after defining there is a subarachnoid hemorrhage is
An angiogram of the cerebral vessels
Either with direct catheterization (cerebral angiogram) or with a CT scan of the head with IV Contrast (CT Angiogram)
PAD Surgical treatment
Stenting is performed for femoral lesions less than 3 cm, all other lesions must be bypassed surgically.
Pituitary Apoplexy Management
The adenoma outgrew its vascular supply and died.
When you lose the pituitary all at once, you get a pan-hypopituitarism of sudden onset.
IV dexamethasone for the corticosteroid effect to regain blood pressure.
Femoral head fracture management
femoral head fracture require open reduction and internal fixation with replacement of the femoral head given its tenuous vascular supply
Hypertension and hypokalemia in a patient
Hypertension and hypokalemia speaks towards primary hyperaldosteronism (Conn’s syndrome)
Management of patient post subarachnoid hemorrhage
After the acute period where surgical management of the aneurysm has been performed (Coil, clip) seizure prophylaxis and vasospasm prophylaxis (CCBs) are indicated.
Femoral shaft fracture treatment
fracture involved the femoral shaft, you can use a rod, open reduction and internal fixation with rods.
femoral Intertrochanteric fracture treatment
Intertrochanteric fracture, you can use a plate, open reduction and internal fixation with plates.
Zollinger-Ellison (gastrinoma) diagnosis
1) high gastrin levels
2) Administer secretin and gastrin will go up
3) Somatostatin scintigraphy will tell you where the cancer is
Treatment for squamous cell carcinoma in situ of the skin?
Imiquimod- immune response modulator
Acute limb ischemia management
Threatened limbs are salvageable - they have Dopplerable pulses, partial sensation, and weakness.
Irreversible limbs are amputated - they have no pulses, no motion, and no sensation.
Swollen, hot, and erythematous eye lid with systemic signs of infection
Orbital cellulitis presents with paralysis of extraocular movement.
CT scan or MRI is done to assess extent and location of an abscess
Acute angle glaucoma
Characterized by severe unilateral eye pain, decreased visual acuity, and an unreactive pupil
start B-blocker drops, carbonic anhydrase inhibitors, and pilocarpine to try to constrict the pupil down
Optho will drill hole to release pressure
Diagnosis of dissecting aneurysm
CT angiogram is the best test for dissecting aneurysm.
Surgery for ascending
medical therapy for descending
Mitral stenosis
low, rumbling, diastolic murmur with an opening snap
Tx: Commissurotomy, or balloon dilation
Gonococcal conjunctivitis treatment
Treat with ceftriaxone IM/IV. Topical therapies are for prophylaxis only.
Meconium ileus treatment
Gastrografin enema is used to both diagnose and treat meconium ileus (which is common in CF)
Acute epididymitis in Men under the age of 35
Neisseria gonorrhoeae and Chlamydia trachomatis
Tx: Ceftriaxone (250 mg, IM single dose) plus doxycycline (100 mg orally, twice daily for 10 days)
Acute epididymitis in Men over the age of 35
Escherichia coli, other coliforms, and Pseudomonas species
Tx: Levofloxacin (500 mg orally, once daily for 10 days) OR ofloxacin (300 mg orally, twice daily for 10 days)
Infection of the epididymis
Unilateral and associated with urethritis
Doppler ultrasound of the scrotum typically shows increased blood flow to the affected side (i.e., hyperemia)
Epispadias
Urethral meatus is found on the dorsal (top) surface of the penis
Hypospadias
Urethral meatus is found on the ventral (bottom) surface of the penis
Associated with chordee, cryptorchidism, and inguinal hernias.
