Surgery V Flashcards
What is the most common non-surgical cause of primary hypoparathyroidism?
Autoimmune
What is the most critical prognostic indicator for compartment syndrome?
Time to fasciotomy
What is the most essential part of management for an uncomplicated rib fracture (e.g. no hypotension, pneumothorax, etc.)?
Pain control
essential to maintain deep breathing and adequate cough, which helps prevent atelectasis and pneumonia
What is the most likely cause of superficial unilateral hip pain of the upper lateral thigh in a middle-aged adult?
Trochanteric bursitis
pain is exacerbated by external pressure (e.g. lying on hip when going to sleep) or with external rotation
What is the most likely diagnosis for a hard, immobile mass on the hard palate of a young individual?
Torus palatinus (benign bony growth)
can increase in size throughout life; no medical or surgical therapy is required unless the growth becomes sympatomatic
What is the most likely diagnosis given a patient with swollen, erythematous skin and the CT findings below?
Necrotizing fasciitis
What is the most sensitive finding indicative of blunt aortic trauma?
Mediastinal widening
common symptoms include anxiety, tachycardia, and hypertension; CXR may also show left-sided hemothorax
What is the most sensitive test for diagnosis of MCL tear?
MRI
generally reserved for patients being considered for surgical intervention
What is the next step for a ruptured ovarian cyst with hemoperitoneum in a hemodynamically unstable patient?
Exploratory laparotomy/laparoscopy
What is the next step for blunt abdominal trauma in a hemodynamically unstable patient with a positive FAST examination?
Exploratory laparotomy
if FAST reveals free intraperitoneal fluid, urgent laparotomy is indicated
What is the next step for blunt abdominal trauma in a hemodynamically unstable patient with an inconclusive FAST examination?
Diagnostic peritoneal lavage (DPL)
*DPL is only used for blunt, NOT penetrating abdominal trauma evaluation (penetrating trauma warrants immediate surgical laparotomy in this scenario)
What is the next step in management for a hemodynamically stable patient with penetrating abdominal trauma, rebound tenderness and guarding?
Exploratory laparotomy
rebound tenderness and guarding are signs of peritonitis, which is an indication for urgent exploratory laparotomy in patients with penetrating abdominal trauma; other indications are hemodynamic instability, evisceration, and blood from an NG tube or rectal exam
What is the next step in management for a hemodynamically unstable patient with penetrating trauma to the 6th intercostal space and an equivocal FAST exam?
Exploratory laparotomy
What is the next step in management for a patient with a gunshot wound in the right thigh? The right lower extremity is cool to the touch and distal pulses are feeble.
Urgent surgical exploration
signs of distal ischemia are a hard sign of vascular injury and warrant surgical exploration; other hard signs include pulsatile bleeding, an expanding hematoma, and/or the presence of a bruit/thrill over the injury
What is the next step in management for a patient with a perforated viscus?
Urgent exploratory laparotomy
What is the next step in management of a patient with diverticulitis complicated by an abscess < 3 cm?
IV antibiotics and observation
What is the next step in management of a patient with diverticulitis complicated by an abscess > 3 cm?
CT-guided percutaneous drainage
surgical drainage can be attempted if percutaneous drainage fails
What is the next step in management of a patient with migratory abdominal pain, McBurney point tenderness, nausea/vomiting, fever, and leukocytosis?
Laparoscopic appendectomy
acute appendicitis is a clinical diagnosis and imaging studies are NOT needed in patient’s with classic clinical/labratory features
What is the non-operative management for uncomplicated MCL tears?
analgesics and RICE (rest, ice, compression, elevation)
What is the preferred initial management for asymptomatic patients with a pancreatic pseudocyst?
Observation
What is the preferred initial management for symptomatic patients with a pancreatic pseudocyst (e.g. abdominal pain, vomiting)?
Endoscopic drainage
drainage is also warranted in patients with evidence of infection (e.g. fever, leukocytosis) and pseudoaneurysm; asymptomatic patients may be managed with NPO diet and expectant management
What is the preferred method for diagnosis of peripheral arterial disease in symptomatic patients?
Ankle-brachial index (ABI)
What is the preferred route of intubation in a cervical spine trauma patient without significant facial trauma?
Orotracheal intubation
also preferred in apneic/hyponeic patients, in which nasotracheal intubation is contraindicated
What is the procedure of choice to identify the site and attempt early therapeutic intervention for massive hemoptysis (> 600 mL/day)?
Bronchoscopy
initial management involves establishing an adequate patent airway, ventilation, and hemodynamic stability; patients who continue to bleed despite bronchoscopy and/or pulmonary artery embolization may need urgent surgical intervention
What is the recommended treatment for post-surgical DVT in a patient with ESRD?
Unfractionated heparin followed by warfarin (for at least 3 months)
stable patients can be initiated on anticoagulation as early as 48-72 hours after surgery; LMWH and factor Xa inhibitors are not recommended in ESRD because they are metabolized by the kidney
What is the recommended treatment for symptomatic meningioma (e.g. headache, seizure, weakness, etc.)?
Surgical resection
stereotactic radiosurgery (focused radiation) may be considered for partially resected or unresectable meningiomas; whole brain radiation is typically used for diffuse metastatic brain disease
What is the treatment for gallstone ileus?
surgical removal of stone and cholecystectomy
What is the treatment for peritonsillar abscess?
incision & drainage + antibiotics
What is the treatment for post-operative acute mediastinitis?
drainage, debridement, and antibiotics
symptoms include fever, chest pain, leukocytosis, and mediastinal widening on CXR
What is the treatment of choice for compartment syndrome?
Fasciotomy
What is the treatment of choice for sphincter of Oddi dysfunction?
Sphincterotomy
What is the treatment of choice for umbilical granuloma?
Silver nitrate
What is the underlying cause of hemorrhagic shock in a patient with decreased breath sounds, tracheal deviation, and dullness to percussion?
Hemothorax
each hemithorax is capable of holding up to 50% of circulating blood volume!
What is the underlying cause of hypocalcemia in a patient with hyperphosphatemia and normal renal function?
Hypoparathyroidism
What is used to assess for intraperitoneal hemorrhage in an alert, hemodynamically stable patient with blunt abdominal trauma?
Focused Assessment with Sonography for Trauma (FAST)
What is used to manage respiratory failure secondary to flail chest?
mechanical positive pressure ventilation (PPV)
improves oxygenation and causes the flail segment to move normally; can result in lung puncture with tension pneumothorax due to sharp rib segments
What knee injury presents acutely with “catching/locking” and reduced range of motion?
Meniscal tear
What life-threatening complication may occur due to contiguous spread of a retropharyngeal abscess?
Acute necrotizing mediastinitis
- penetrating trauma to posterior pharynx, causing retropharyngeal abscess formation
- drainage to superior mediastinum
- extension through alar fascia into the “danger space”, resulting in acute necrotizing mediastinitis
What major artery must be examined for injury following a clavicular fracture?
Subclavian artery
e.g. angiogram
What musculoskeletal pathology presents with subacute pain on abduction in patients who perform repetitive arm movement above shoulder height (e.g. painter)?
Rotator cuff tendinopathy
typically have normal ROM with positive impingement tests (e.g. Neers)
What nerve bundle must be examined for injury following a clavicular fracture?
Brachial plexus
e.g. motor function of hand/arm
What nerve is at risk for injury with supracondylar fracture of the humerus?
Median nerve
What nerve is at significant risk for injury during parotid gland dissection?
Facial nerve
What nerve is most commonly damaged by anterior shoulder dislocation?
Axillary nerve
What nerve is most commonly damaged by fracture of the medial epicondyle of the humerus?
Ulnar nerve
What nerve is most commonly damaged by humeral mid-shaft fractures?
Radial nerve
also may be injured with improperly fitted crutches
What nerve is most commonly damaged during an axillary lymphadenectomy?
Long thoracic nerve
also may be damaged by deep lacerations
