UW - Surgery Flashcards
What is acute mediastinitis and how do patients usually present? what is the proper treatment?
-Complication of cardiac surgery from wound complication
-Fever, tachycardic, chest pain, leukocytosis, sternal wound drainage/purulent discharge
Tx: surgical debridement and antibiotics
What is the treatment for a patient presenting with scaphoid fracture (radiolucent line across bone on xray)? when would this treatment change?
Wrist immobilizaiton for 6-10 weeks
Open Red and IF if initial xray shows >2mm fracture displacement
What are common causes of gastric outlet obstruction and how can you ascertain this?
- Malignancy, PUD, crohn’s, strictures (w/ pyloric stenosis) 2/2 ingestion of acid or other caustic agents, gastric bezoars
- May hear abdominal succussion splash
- confirm with endoscopy
How long can hemiarthroplasty for femoral neck fractures be delayed, and what me a reason for doing this?
Delay up to 72 hours, if other medical comorbidities (e.g. MI) need to be investigated
What is the cause of atelectasis post-op?
Pain and changes in lung compliance may cause impaired cough and shallow breathing –> limited recruitment of alveoli at lung bases
how can you distinguish tension pneumothorax vs. diaphragmatic hernia from blunt abdominal injury?
TPX - pt would be hypotensive, pulmonary vasculature less prominent on CXR
Hernia - usually left side, resp distress or delayed n/v, NGT in pulmonary cavity on CXR
What is the cause of volkmann’s contracture?
compartment syndrome, leading to ischemia and infarction
What are the most common complications of supracondylar fractures of the humerus?
entrapment/injury to brachial artery or median nerve
less likely: cubitus varus deformity and volkmann contracture
When should sodium bicarbonate be used for treating acidosis?
Severe cases, where pH is
What are the two most common causes of syringomyelia?
-Arnold chiari malformation and previous spinal cord injury
What are worrisome signs of ruputured AAA?
acute onset severe back pain, syncope, hypotension,
-possible formation of aortocaval fistula with IVC leading to venous congestion in retroperitoneal structures (e.g. bladder, causing gross hematuria)
What are signs of a retroperitoneal abscess?
Fever, chills, and deep abdominal pain
What is sphincter of Oddi dysfunction and how do you treat?
Elevated sphincter pressure causing post -cholecystectomy pain
Treat with ERCP and sphincterotomy
How can you differentiate the bacteria involved for prosthetic joint infection? What is the management of each?
Early onset infection - 3 months; Coag - staph, propionibacterium, enterococci; remove/replace implant
What abdominal injury/disease can cause referred pain to the shoulder and why?
Peritonitis (as from leaked gastric, bowel, or bladder contents) which will irritate the hemidiaphragm whose phrenic nerve branches refer pain to shoulder
Who are prone to form duodenal hematomas and where do these occur? How do you treat?
- Blunt abdominal trauma to peds
- forms from blood collecting between submucosal and muscular layers of duodenum causing obstruction
- NGT and TPN, will resolve in 1-2 weeks
What is included in the Ddx of anterior mediastinal mass?
The 4 T’s : Thymoma, teratoma, thyroid neoplasm, and terrible lymphoma
What is a respiratory quotient and what does this number tell you?
Steady-state ratio of CO2 produced to O2 consumed per unit time
Makes assesments on metabolism in the body, close to 1 = mostly carb diet, 0.8 = mostly proteins, 0.7 = mostly fatty acids
What do patients with medial meniscus tears usually complain of?
Popping sound followed by severe pain at time of injury
What test can confirm medial collateral ligament injury?
valgus stress test
What is an absolute contraindication to surgery?
DKA - sky high glucose
What are major contraindications to surgery?
DKA, poor nutrition (albumin 20% weight loss, transferrin
What is the most optimal way to provide patients with nutrition preop?
enteral feeding
Where should O2 be kept for patients with COPD or smokers getting surgery/coming out of anesthesia?
Keep relatively low, because these patients are chronic CO2 retainers and you don’t want to suppress respiratory drive
What are the most important risk factors in the Goldman’s Index?
- CHF (biggest predictor of preop mortality) - get EF
- Recent MI (w/in 6 mo) - get EKG, stress test, CABG
- Arrhythmia
- Age (>70)
- Emergent operation
- Aortic stenosis - LISTEN FOR MURMUR
What is Leriche syndrome?
Chronic ischemia of both LEs causing bilateral claudication of hip thigh and buttocks, impotence and muscle atrophy
What conditions will cause paralytic ileus?
Exaggerated intestinal rxn after abdominal Surgery, retro peritoneal hemorrhage after vertebral fractures,
What are the main priorities in managing patients with rib fractures?
Pain management and respiratory support, to prevent hypo ventilation which would lead to atelectasis and PNA
What should be the next step once perforated peptic ulcer is discovered?
Immediate surgical intervention
What is early dumping syndrome?
Occurs in patients who are post gastrectomy, involves rapid emptying of hypertonic fluid from stomach into duodenum causing fluid shifts from intravascular space, release of intestinal vasoactive polypeptides, and stimulation of autonomic reflexes
What is a likely cause of isolated symptomatic hypokalemia?
Autoimmune primary hypoparathyroidism
What are signs of alveolar hypoventilation postop?
- Elevated pCO2 (50-80mmHg)
- Respiratory Acidosis
- Normal A-a gradient
What is the most likely cause of persistent PTX and SubQ emphysema following blunt abdominal trauma?
Tracheobronchial perforation (esoph rare, because elastic)
How long does it take for S/S of fat embolism to set in following long bone fracture, or other major bone trauma?
12-72 hours
What is the compensatory response to atelectasis post op, and what can result from this?
Hyperventilation –> Respiratory Alkalosis
How can diagnosis of a retroperitoneal hematoma from femoral cath site be confirmed?
Non-Con CT
What is the proper management of acute cholecystitis?
Cholecystectomy within 72 hrs
What meds need to be stopped preop?
Aspirin (7-10 days), Warfarin (INR
How can ventilator settings be adjusted if PaCO2 is too low or too high?
Change Rate or Tidal Volume (but TV is preferred because increasing rate has no effect on non-ventilating alveoli in lungs)
How long does it take for S/S of fat embolism to set in following long bone fracture, or other major bone trauma?
12-72 hours
What can’t be given to patients with ATIII deficiency?
Heparing, wont work
What blood lab abnormalties are seen with von willebrand deficiency?
Normal platelets, but increased bleeding time and PTT
How do you differentiate which antibiotic to use for burn patients (describe downside of each)?
- Silver Sulfadiazine - doesn’t penetrate eschar and may cause leukopenia
- Methanide - Penetrates eschar but hurts a lot
- Silver Nitrate - Doesn’t penetrate eschar, causes HypoK and HypoNa
What is the first step to do following electrical burn?
Do EKG, if abnormal 48 hrs of tele
What is the main worrisome side effect of myoglobinuria?
High K+
What physical exam findings may be seen with fat embolism?
Petechial rash in chest axilla and neck, with confusion
What may be the cause of retroperitoneal fluid + blunt abdominal trauma?
Duodenal rupture
What is Colle’s fracture?
Old lady falls on outstretched hand, distal radius displaced, make cause “dinner fork” deformity
What could be a cause of very high fever and ill appearing patient on POD 1?
Major atelectasis, or Nec Fasc along SubQ (Scarpa’s fascia)
What is the first treatment modality for an abscess w/in the lung cavity?
Antibiotics first
Surgery if Abx fail or if there is an empyema
What is a characteristic effusion in lung adenocarcinoma?
Exudative with high hyaluronidase
What are the main peripherally located lesions?
Adenocarcinoma and large cell carcinoma
What criteria diagnose ARDS?
- PaO2/FiO2
What are the symptoms associated with insulinoma?
Sweat, tremors, hunger, seizures
What could be a cause of very high fever and ill appearing patient on POD 1?
Major atelectasis, or Nec Fasc along SubQ (Scarpa’s fascia)
What is the first treatment modality for an abscess w/in the lung cavity?
Antibiotics first
Surgery if Abx fail or if there is an empyema
What is a characteristic effusion in lung adenocarcinoma?
Exudative with high hyaluronidase
What are the main peripherally located lesions?
Adenocarcinoma and large cell carcinoma
What criteria diagnose ARDS?
- PaO2/FiO2
What are the symptoms associated with insulinoma?
Sweat, tremors, hunger, seizures
What are the most common causes of hepatic bacterial abscess?
E Coli, bacteriodes, enterococcus
