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58 Cards in this Set
- Front
- Back
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Why use clips (staples) to close a thyroidectomy?
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-neck is fairly vascular region, therefore you just need something to hold the skin together for a few days while the skin heals
-sutures take up to 7-10 days to disappear, and will leave a mark -vs clips: no mark |
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Why need to suture peritoneal area?
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-fairly avascular region, therefore need sutures
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After a appendictectomy, how fast does the pain disappear?
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-very soon after (parietal/visceral) pain goes away quickly
-left with wound pain afterwards |
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Why need to use a local anaesthetic before wounds are sutured in surgery even though patient is already under a general anesthetic?
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-local (bupivacaine or Marcain), lasts 3-4 hours postop, decreases need for pain relief postop
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Why do you need a port for someone with bowel Ca?
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-need to give chemotherapy through a port
(port - is like a Central venous cathetar, but there is a different opening) |
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If bleeding is not found on upper GI endoscopy, or colonoscopy, and Hb is rapidly dropping, what other investigation is there?
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-capsule endoscopy or angiography
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Requirements for capsule endoscopy or angiography for suspected upper GI bleed?
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-capsule: patient must be stable (b/c it takes time)
-angiography: need to have ACTIVE bleeding (tf ask pt if they are still bleeding) |
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After an operation how long does it take for the small bowel to recover? Large bowel?
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Small bowel -> recovers immediately (inaffected by anesthesia)
large bowel & stomach -> take more time (tf when listening to abdomen -> you are listening for stomach and large bowel sounds postop) |
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After abdo surgery with colostomy, what is important to note?
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Is colostomy bag working? (is there output?, does the patient feel bubbles/gas coming out of the bag?
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After a hernia repair, what 2 meds should the pt be discharged on?
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lactulose
pain meds |
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For cholecystectomy, what meds to give?
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2nd generation cephalo (given at Mt Gambier), to cover for E. coil (MC organism), but 3rd generation is better
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Pt had a CT, dilated bile ducts, no stone in the CBD. What is your DDx?
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-tumour -> not always picked up by CT
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After surgery, how long does it take for a postop infection to surface?
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4-5 days (NOT immediately postop)
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Patient w/ appendectomy 7 days ago. Has felt fine until yesterday, had (38 C) fever, abdo pain on LIF region. DDx?
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Hx: Diarrhea? (inflmmation close to rectum causes this)
PR exam: hot, tender mass displacing rectum backwards -classic in post appendectomy -peritonitis -intra-abdo abscess DO CT to look for abscess collection -if patient is female, can drain it through (vaginal??) check this |
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Fav surg board question: you have done laparotomy for sigmoid colectomy. Pt is 30 yr female. Do you remove the appendix while you are there?
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-controversial
-if pt is young, and still in age where she could get appendictis, then you could make argument to remove it -sigmoid colectomy is a 'contaminated' surgery anyway -may spare the patient an episode of appendicitis and need for removal of appendix later on in life -if old lady, then keep it in |
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In which patients do you insert a drain?
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Depends on
-surgeon -type of surgery -if you dissect through lymph node, then drain would be good way to get rid of excess lymph fluid w/o it collecting inside and necessitating another surgery |
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When can you remove the drain?
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-depends on the operation
-thyroidectomy -> insert drain, just in case there is hematoma, can remove in 1-2 days if no drainage (CHECK) -if colectomy -> must leave drain in for at least a few days, can remove once it stops draining (Dr. E removed drain at 30ml) |
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Pt with laparomtomy, wound dehisence (due to increased pressure from bladder). No wound taking long time to heal. Why?
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-infection
-even though wound itself not erythematous, the fact that it is taking long time to heal is indication |
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Child comes in with one-sided lymphadenopathy. Initial workup?
Likely cause? |
-exam: is there other lymph nodes elevated (if so, think of lymphoma)
-bloods -CXR -> r/o TB (TB can cause lymphadeonpathy) -U/S -> determine if it's a lymph node, etc -Dr. B: DO it for females to rule out pelvic pathology only! (eg ovarian torsion), so don't need U/S in boys Likely: benign -after infection, lymph nodes become elevated and may take a long time to subside in children. Not a worry. |
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Child with anal pruritis. Treatment?
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-TELL parents to stop cleaning anus so thoroughly (v hard to do, explain that the region is naturally 'dirty')
-anus has thin skin, so if it's vigorously cleaned, it may break down ->gets irritated -> parents try to clean it more -> vicious cycle |
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Pt with BCC asked what will happen if you do nothing to treat it?
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-BCC will just keep increasing in size, until it looks like a 'wound', when it gets that big, it's harder to remove
-explain that it's not dangerous, can't kill you, BCC does not travel through blood like colon cancer |
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Pt with suspected skin lesions. 2 options?
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-removal
-punch biopsy -> send for histopath, then remove according to results |
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Evidence for doing an intra-operative cholangiogram for cholecystectomy?
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-no evidence for it
BUT all the major teaching hospitals will teach their trainees to do this, but when you ask what will you do if you see a stone in the CBD, you don't get a good answer |
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What are the arguements against doing an intraoperative cholangiogram for cholecystectomy?
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-do cholecystectomy, then do cholangiogram
-if cholangiogram shows stone in CBD, what do you do about it? -Should you try to remove stone? What if you cause further morbidity to patient by doing so? Also, patient may very well just pass the stone anyway. -also: it's time consuming to do intraoperative cholangiogram |
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Why were there so many CBD injuries when laparoscopic cholecystectomy first began?
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-because you pull up on gallbladder and cause traction, also pulling up the CBD
-so when dissecting out gallbladder, it was unrecognized that CBD may also be in the region as well -problem is well known now, so area around neck of gallbladder is carefully dissected out first |
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Complications of cholecystectomy?
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-bleeding, infection
-CBD injury -stones from gallbladder, if small enough, can enter CBD, chance of being trapped |
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PR exam. Ask patient to bear down and perineal area bulges out towards you. Why?
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-perineal mm lax -> common in females, less common in males
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Patient has mucous in stool. Potential worry?
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Colon Ca. Needs colonoscopy.
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PR. Ask patient to squeeze. What are you testing?
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-puborectalis (sling)
-EXTERNAL anal spinchter |
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Which mm cut in sphincterotomy?
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-internal anal spincter
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Patient presents with constipation. Hx of sexual abuse. What can you do?
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-patient has opposite response when told to relax mm as if going to toilet (they tense up muscles instead)
Rx: physio-type training -note: this is unrecognized or ignored by most GPs |
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Parents worried about child's bowel movements. One option if problem is legit and severe enough to warrant treatment?
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-try regular laxatives to encourage normal pattern
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Treatment of bowel obstruction?
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-not necessarily for surgical intervention
-fluids and NG to decompress stomach is important |
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Rx for anal fissure?
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Ix: rigid sigmoidoscopy
Rx: -anal dilatation and fissurotomy (not standard practice in UK though) |
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FU for lap chole?
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-gallbladder sent for histo (risk of Ca is rare)
-FU 7-10 days to remove clips/sutures |
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Pain under a wound made during surgery?
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-possibly hematoma under wound (eg lap chole)
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Rx for diarrhea?
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coke (real coke not diet)
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Pt's drain is draining increasing fluid after bowel surgery. Concerns?
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-transected ureter (tf test for urea)
-transected a lymph node (don't care about this) |
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Q; why insert drain after surgery?
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-prevent buildup of lymph fluid (check this)
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Define indurated? Fluctuant?
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eg perineal abcsess
indurated -> skin is thickened fluctuant -> can feel the transmission of fluid if press on the lesion (if you put 2 fingers apart) -means its either fluid(eg abscess) or cyst |
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What can you give for IBS?
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colefac
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Rx of adhesions?
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1/3 same, 1/3 better, 1/3 worse
-can dev after surgery -may not be evident until bowel gets caught (may not happen for years) then suddenly pt is symptomatic -dilemma re: whether to treat these patients or not |
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Pt w/ pneumaturia, but gone now. Should you intervne?
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-no, tell pt to come back when it recurts
-colovesical fistula has high change of reoccuring |
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Pt w/ inguinal hernia. What question are NB?
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-bowels ok? (constipation can contribute to straining)
-urination ok? (straning can contribute to mm waekness) Exam: check prostate (urinary retention) |
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Pt w/ bilat inguinal hernia. One complication of surgery?
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-after surgery, mm in region of ooperation can spasm and can cause urinary retention
-if unilat hernia repair can go home but bilat need to stay until you know they don't have retention -another complication: pins & needles (b/c of swelling) there is decreased space which irriates nerves |
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Pt w/ large lump on back of neck. Can get behind it. DDx?
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-lipoma
Exam; can you get behind it (attached to underlying structures, eg thyroid?) -roll skin over (see if it's attached to skin) |
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Generic name for tegretol?
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carbamazepine (stabilizes nerve as in neuralgia)
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Placebo effect and surgery, or medicine and determination of if pt gets better?
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-important to 'sell the operation' to the patient to ge the maximum placebo effect
-also important in medicine too -must convince patient that they will get better |
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Inserting a urinary catheter and you see blood. What do you do?
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-if see blood, STOP! Probably tore the urethra. If you keep advancing catheter then you may go through tear and make it worse. Stop and call a more senior person. They will either try threading another cateher or use cystoscopy to thread catheter OR insert a suprapubic catheter.
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Pulling out a suprapubic catheter and it's stuck. What do you do?
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-apply constant pulling pressure. (not back and forth motion)
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Female with chronic constipation. One DDx?
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-Hx sexual abuse
-need biofeedback -contact colorectal surgeon and ask if they have facilities to do so. -need constant training -takes long time for this to resolve -should not be relying on "picoprep" and others to move bowels because they don't work after a few years |
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Patient with painful varicose veins. Varicose vein surgery 10 yrs ago. Dx?
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-no more deep saphenous vein, so not varicose veins
-probably incompetence of deep perforating veins Rx: Compression stockings -if doesn't work, need to come back for Duplex US |
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What is the one complication of cholecystectomy you are worried about?
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-wound infection
-subphrenic abscess |
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Just finished colonoscopy. Afterwards, patient with severe dyspnoea. Palpation of region lateral to substernal notch reveals 'crunching' to palpation. Dx?
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subcut emphysema from perforated esophagus
CXR -mediastinal air WHy? air crosses tissue planes so get crunching |
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Man with fractured tibula after a fall. Mx?
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ORIF
-fix plate with screws to tibular -apply cotton, then plaster, then different material over top), -apply plaster all the way to just under groin -immobilize in plaster for 6 weeks -remove plate & screws in 9-12 mos |
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Young man, 26, with fratured 2nd Metacarpal after punching someone. Mx?
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-if no rotation of bone -> conservative Mx
-if there is rotation-> need ORIF -ORIF: plate and screws -cotton, then plaster, leave 1st MCP open, just immobilize the wrist in extension -sutures out in 7-10 days -will be able to weightbear in 3wks time (makes no diffence) -remove plate and screws in 6 mos |
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What is the MC reason for atelectasis?
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Pain, tf important to manage this.
Why pain? b/c pple DN breathe deeply |
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Why do pple complain of itching w/ varicose veins?
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-swelling of legs -> pigment goes out into tissues (?lipofuscin) -> causes itching
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