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surgery > Surgical next step > Flashcards

Surgical next step Flashcards

1
Q

dx esophageal cancer

A
  • endoscopy with biopsy
  • barium swallow/upper GI series
  • staging: CXR, CT chest/abd/pelvis, endoscopic US, - bronchoscopy
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2
Q

Tx esophageal cancer

A

surgery if early stage

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3
Q

dx upper GI bleed

A

EGD
NG lavage
angiography
- type and cross blood if needed

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4
Q

tx upper GI bleed

A
  • control bleeding (sclerotherapy or embolization)
  • resuscitation (NS/LR, pRBC)
  • correct any coagulopathies
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5
Q

dx lower GI bleed

A
  • colonoscopy
  • tagged RBC scan
  • angiography
  • Tc99m scintigraphy
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6
Q

dx SBO

A
  • KUB (stepladder pattern of dilated small bowel loops and air-fluid levels, absence of colon gas
  • CT abd/pelvis
  • labs: leukocytosis = strangulation
  • ABG: metabolic alkalosis due to vomiting
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7
Q

tx SBO

A

MEDICAL: NPO, NG tube decompression, pain mgmt
SURGICAL: ex lap to lysis adhesions, resect necrotic bowel, running the bowel for stricture, tumor, IBD, hernias

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8
Q

studies contraindicated in diverticulitis

A

colonoscopy and barium enema (risk of perforation)

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9
Q

dx diverticulosis

A

barium enema and/or colonoscopy

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10
Q

dx diverticulitis

A

CT is best

AXR (ileus, air-fluid levels, free air if perforated)

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11
Q

tx diverticulosis

A

fiber, stool softeners, resuscitation if massive bleeding

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12
Q

tx diverticulitis

A

IV fluids, bowel rest, antibiotics

  • if emergent, resection of bowel and colostomy
  • if elective, resection of bowel and primary anastomosis
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13
Q

dx colorectal cancer

A
  • fecal occult blood test/digital exam
  • sigmoidoscopy/colonoscopy (+/- biopsy)
  • barium enema
  • CT abd/chest/pelvis for staging
  • check for mets: LFT, CT, brain MRI
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14
Q

tx rectal lesions (colorectal cancer)

A

abdominoperineal resection

  • if near anal verge, remove rectum and anus and provide colostomy
  • otherwise primary anastomosis
  • adjuvant chemo (no rad)
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15
Q

tx colonic lesions (colorectal cancer)

A
  • resect lesion c 3-5 cm margins
  • resect lymphatic drainage and mesentery at origin of arterial supply
  • primary anastomosis of bowel
  • adjuvant chemo (no rad)
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16
Q

tx porcelain gallbladder

A

cholecystectomy and wedge resection of liver adjacent to GB (highly associated with malignancy)

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17
Q

tx acute cholangitis

A
  • antibiotics

- bile duct decompression via endoscopic sphincterotomy, percutaneous transhepatic drainage, or operative decompression

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18
Q

dx chronic pancreatitis

A

CT is best

  • KUB reveals calcifications
  • ERCP shows ductal dilation/strictures
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19
Q

tx hiatal hernias (both types)

A

1: antacids, small meals, head elevation
2: surgery (inc. risk of incarceration/strangulation)

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20
Q

tx acute arterial occlusion

A

immediate anticoagulation, surgical balloon catheter embolectomy, amputation

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21
Q

tx prostate cancer

A
  • radical prostatectomy (+ seminal vesicles)
  • radiation
  • androgen ablation (refractory or extraprostatic)
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22
Q

tx stage III lung cancer

A

chemo and rad, may be resected if down-staged

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23
Q

tx superior sulcus tumors (pancoast)

A

radiation over 6 weeks followed by resection of lung and chest wall

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24
Q

tx mesothelioma

A

unresponsive to therapy, most pts dead in 1 year

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25
Q

tx persistent pneumothorax

A

thoracoscopic excision of blebs and pleural abrasion (pleurodesis)

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26
Q

tx pharyngeal diverticulum

A

transection of cricopharyngeal muscle to relax esophageal entrance

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27
Q

tx achalasia

A

distal esophageal dilation

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28
Q

tx esophageal cancer

A

esophagectomy or palliation if severe

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29
Q

tx aortic dissection

A 
control HTN (beta-blockers, etc.)
surgery if asc. aorta
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30
Q

tx small, uncomplicated pneumothorax

A

observation if no other injuries or hemothorax

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31
Q

tx tamponade

A

drain then OR for pericardial window to see if source of bleeding

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32
Q

tx abdominal gunshot wound

A

mandatory ex lap

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33
Q

dx hypotension in fractured pelvis

A

pelvic angiogram (OK because angiography suite has resuscitation capability if pt is unstable)

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34
Q

tx increased intracranial pressure

A

elevate head, hyperventilation to PCO2 26 (if blown pupils), slow administration of mannitol
AVOID MEDS THAT DEPRESS CNS FUNCTION

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35
Q

tx base of skull fracture

A

expectant management, assess C-spine c CT

NO nasal ET intubation

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36
Q

tx epidural hematoma

A

emergency craniotomy

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37
Q

tx subdural hematoma

A
  • ICP monitoring and tx if acute

- surgical evacuation if chronic (in elderly)

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38
Q

dx spinal cord injury

A

MRI (CT if just for bone)

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39
Q

tx flail chest and pulmonary contusion

A

fluid restriction, diuretics
monitor blood bases for pulmonary dysfunction
posible chest tubes/respirator

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40
Q

tx myocardial contusions

A

tx possible arrhythmias

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41
Q

dx aortic rupture

A

CXR: widened mediastinum

CTA

42
Q

tx intraabdominal bleeding that responds to fluid resuscitation

A

surgery not required

43
Q

tx non-expanding pelvic hematoma

A

monitoring but rule out associated injuries (do rectal exam, urethrogram)

44
Q

tx penetrating urologic injuries

A

surgical exploration and repair

45
Q

tx blunt trauma to kidneys

A

CT scan, surgery not usually needed, monitor for renal HTN

46
Q

tx fracture of penis

A

emergency surgical repair to avoid impotence

47
Q

tx crushing injury to extremity

A

fluids!, osmotic diuretics, alkalinize urine (to minimize myoglobinemia-myoglobinuria-renal failure)

48
Q

tx inhalation injury

A

possible respiratory support/intubation

100% O2 if high carboxyhemoglobin

49
Q

tx high-voltage burns

A
  • debridement and possible amputation

- fluid, mannitol, alkalinize urine (same reason as crush injury)

50
Q

tx black widow bite

A

IV calcium gluconate (antidote)

muscle relaxants

51
Q

tx brown recluse

A

dapsone

maybe surgical excision/grafting

52
Q

tx human bites

A

irrigation/debridement in OR

53
Q

tx developmental dysplasia of hip

A

abduction splinting with Pavlik harness for 6 mo

NO X-RAYS (hip not calcified in newborn)

54
Q

dx and tx slipped capital femoral epiphysis

A

ortho emergency
dx with x-ray
surgical pinning of femoral head back in place

55
Q

dx septic hip

A

assertion of hip under general anesthesia

56
Q

dx and tx acute hematogenous osteomyelitis

A

MRI, abx

57
Q

tx Osgood-Schlatter

A

RICE

extension or cylinder cast for 4-6 weeks

58
Q

tx club foot

A

serial plaster casts starting in neonatal period
maybe Achilles tenotomy
surgery if no response

59
Q

tx fractures involving growth plate

A

ORIF

60
Q

tx multiple myeloma

A

chemo or thalidomide

61
Q

tx sarcoma

A

WLE, rad, chemo

62
Q

tx intertrochanteric fracture

A

ORIF

63
Q

tx open fracture

A

OR cleaning and closure within 6 hours

64
Q

imaging for knee injury

A

MRI

65
Q

tx tib/fib fractures

A

intramedullary nailing

66
Q

tx Achilles tendon rupture

A

casting heals in several months

surgery gives faster healing

67
Q

tx gas gangrene

A

IV pen
surgical debridement
hyperbaric O2

68
Q

tx lumbar disk herniation

A

3 weeks bed rest

nerve block

69
Q

tx cauda equina syndrome

A

immediate surgical decompression

70
Q

dx lumbar disk herniation

A

straight leg-raise test

MRI

71
Q

how to differentiate low urinary output in dehydrated pt vs. renal failure

A
  • renal failure will not respond to fluids c incr. urine output
  • urinary Na > 40 in renal failure
72
Q

tx Ogilvie syndrome

A

neostigmine

73
Q

tx GERD

A
  • laproscopic Nissen fundoplication

- surgery if refractory to meds, or complications (ulceration, stenosis)

74
Q

tx Mallory-Weiss tear

A

photocoagulation (laser)

75
Q

dx and tx Boerhaave syndrome

A

dx: contrast swallow
tx: emergency surgical repair

76
Q

steps for dx active red blood per rectum

A
  1. NG tube and aspiration (if blood = upper GI)
  2. colonoscopy not helpful (blood obscures field)
  3. exclude hemorrhoids
  4. angiogram
  5. tagged red-cell study
  6. technetium scan if in kids
77
Q

tx generalized acute abdomen

A

ex lap

78
Q

dx ureteral stones

A

CT

79
Q

tx diverticulitis

A

acute: NPO, IV, abx
chronic: surgery

80
Q

tx esophageal atresia

A
  • check for VACTERL
  • surgical repair
  • gastrostomy to protect lungs from reflux if surgery delayed
81
Q

tx imperforate anus

A

high rectal pouch: colostomy then repair

  • look for fistula
  • rule out VACTERL
82
Q

dx malrotation

A

contrast enema, upper GI study

83
Q

dx/tx meconium ileus

A

gastrografin enema (both diagnostic and therapeutic)

84
Q

tx biliary atresia

A

liver transplant

85
Q

dx/tx intussusception

A

barium or air enema (both diagnostic and therapeutic)

86
Q

tx Bell’s palsy

A

antivirals, steroids

87
Q

tx cavernous sinus thrombosis

A

IV axb, CT, drainage

88
Q

stroke prophylaxis

A

CEA, ASA

89
Q

dx and tx ischemic stroke

A

dx: CT to rule out hemorrhage/infarcts
tx: tPa quickly, rehab

90
Q

tx subarachnoid bleeding from aneurysm

A

surgical clipping or endovascular coiling

91
Q

dx brain tumor

A

MRI

92
Q

tx pituitary apoplexy

A

steroids

93
Q

tx testicular torsion

A

immediate surgery followed by orchiopexy

DON’T waste time with tests

94
Q

tx acute urinary retention

A

alpha-blockers

5-alpha-reductase inhibitors

95
Q

tx acute organ rejection

A

steroids

96
Q

tx wound dehiscence and evisceration

A

re-operation

- until then, cover area and mobilize

97
Q

tx hyperkalemia

A
  • hemodialysis
  • push K into cells: 50% dextrose and insulin
  • suck it out of GI: NGT, exchange resins
  • neutralize effects on cellular membrane: IV Ca
98
Q

tx amebic abscess of liver

A

metronidazole, seldom drainage

99
Q

tx asymptomatic gallstones

A

nothing

100
Q

tx pancreatic pseudocyst

A

drainage if > 6 cm (risk of rupture or bleed)

101
Q

dx rotator cuff tear

A

drop-arm test

102
Q

tx abscess from diverticulitis

A

if 3 cm drain with CT guidance

surgery (2 decks)

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