Surgery Casebook / Pestana Flashcards Iv

Front 1

alcoholic with sever epigastric px and calcifications in retropt? tx?

Back 1

chronic pcitis
tx = stop alcohol, replace pancr enzymes
further invest with ERCP for possiblel surgery

Front 2

1 day post surgical fever due to? tx?

Back 2

atelectasis
tx = try to cough, breath deep, monitor with ausc, xray

Front 3

3rd day post - surg fever? tx?

Back 3

uti, to urinalysis, u culture,
tx with ab's

Front 4

any thyroid mass, tx?

Back 4

probably benign if soft, but do FNA

Front 5

young, male, single nodule, history of radiation to the neck, solid mass on sonogram and cold nodule on scan.

Back 5

prob thyroid cxr...still do FNA...will need surg

Front 6

tx for hot nodule?

Back 6

surgery (or radioablation before?)

Front 7

tx for lateral appearing l/n containing "normal thyroid tissue" on pathology?

Back 7

=metastatic follic thyroid carc. tx = radio scan to define it, then, surg

Front 8

persistent hypercalcemia in asx pt? tx?

Back 8

think hyperPTH due to PTH adenoma

tx: PTH determination and sistimibi scan to localize the adenoma. Surgery will follow.

Front 9

CUSHING'S mngment?

Back 9

r/o csteroid therapy;
do am / pm cortisol levels as well as dexamethasone supression test. if +, remove microadenoma from pit via trans nasal, transsphenoidal route surgery

Front 10

tx for inoperable glucagonoma?

Back 10

if can't do surgery, give
somatostatin to help symptomatically and streptozocin is the indicated chemotherapeutic agent.

Front 11

diff in tx b/w hyperaldosteronism causing HTN that fluctuates with lying down, standing, vs doesnt fluctuate?

Back 11

fluctuating = adrenal hyperplasia
non = adrenal adenoma - needs surgery

Front 12

tx for cong diaph hernia in newby?

Back 12

. It is better to wait 36 to 48 hours to do surgery to allow transition from fetal circulation to newborn circulation. Meanwhile the trick is to keep the kid alive with endotracheal intubation, hyperventilation (careful not to blow up the other lung), sedation and NG suction.

Front 13

OTHER condition presenting exactly same as duod atresia?

Back 13

annular pancreas
and midgut volvulus (but onset anytime, not nec immediately after birth)

Front 14

newby with green vomit plus double bubble plus air distal to the duodenum?tx?

Back 14

MALROTATION!!
Do a contrast enema, and if not diagnostic order a water-soluble 9gastrographin) upper GI study.

Front 15

tx for NEC?

Back 15

Stop all feedings, broad spectrum antibiotics, IV fluids/nutrition. Surgical intervention if they develop abdominal wall erythema, air in the biliary tree or pneumoperitoneum.

Front 16

management for meconium ileus?

Back 16

Gastrografin enema may be both diagnostic and therapeutic, so it is the obvious first choice. If unsuccessful, surgery may be needed.

Front 17

tx for pyl stenosis?

Back 17

Ramsted Pyloromyotomy.

Front 18

management for biliary atresia?

Back 18

HIDA scan, percutaneous liver biopsy and exploratory laparotomy

Front 19

tx for intussusception?

Back 19

Barium enema is both diagnostic and therapeutic in most cases. It should be your first choice. If reduction is not achieved radiologically, exploratory laparotomy and manual reduction will be needed.

Front 20

meckel's vs gastrinoma test?

Back 20

meckels = technetium scan
gastrinoma = octreotide scan

Front 21

tx for enlarged l/n in alcoholic smoker 70y/o

Back 21

Don’t biopsy the node! FNA is OK, but the best answer is to do a triple endoscopy (examination under anesthesia of the mouth, pharynx, larynx, esophagus and tracheobronchial tree).

Front 22

tx for any suspected sq cell carc of head and neck?

Back 22

triple endoscopy to find and biopsy the primary tumor and to look for synchronous second primaries.

Front 23

suspected parotid gland tumor...dx?

Back 23

parotid glands are never biopsied in the office or under local anesthesia. ...referral to a head and neck surgeon for formal superficial parotidectomy.

Front 24

dbl vision in pt with recurrent sinusitis?

Back 24

URGENT! orbital cellulitis or cavernous sinus thrombosis
tx = hosp, high dose IV AB's, drainage, and CT for guidance

Front 25

epistaxis in 18 y/o with no hx of nose-picking?

Back 25

Either septal perforation from cocaine abuse, or posterior juvenile nasopharyngeal angiofibroma.

Front 26

when is surgery indicated for aortic stenosis?

Back 26

gradient >50mmHg OR angina, syncope, CHF sx

Front 27

tx for acute aortic insuff due to acute endocarditis ie in drug user?

Back 27

Emergency valve replacement, and antibiotics for a long time.

Front 28

tx for elderly man with lung cancer and FEV1 of 1100? of 2000?

Back 28

since surg pneumonectomy will take out a large portion of the lung, consider FEV to be halved after surgery (unless % of FEV for that lung is given). at least 800 FEV is required for survival after surg; thus for FEV1 of 1100, only 550 will remain = don't do surgery - do chemo/rad therapy. for FEV2000, go ahead with surgery

Front 29

explorative tests before pneumonectomy?

Back 29

CT scan and mediastinoscopy

Front 30

tx for small cell carcinoma of lung?

Back 30

chemotherapy and rad...NOT surgery

Front 31

neurologic sx in pt with arm px upon exertion? dx? tx?

Back 31

subclav steal syndrome
dx = angiography showing retrograde vertebral art flow and/or subclav narrowing
tx = vasc surgery

Front 32

how to do aortogram for ao dissection?

Back 32

the forces that dissected the vessel plus the force of the dye injection could further shear the aorta, thus study is done with beta blockers or IV nitrates to lower blood pressure.

Front 33

sub arach hemorrhage tx?

Back 33

surgery to clip the bleeding aneurysm

Front 34

Measures to decrease intracraneal pressure while awaiting surgery for brain tumor?

Back 34

include mannitol, hyperventilation, and high dose steroids (decadron).

Front 35

6y/o with headaches and ataxia, for months?

Back 35

cerebellar tumor

Front 36

Signs and symptoms suggestive of brain tumor that develop in a couple of weeks with fever and an obvious source on infection ...? tx?

Back 36

brain abscess!!
do CT
tx = neurosurgery / resection

Front 37

acute management of ANY spinal injury?

Back 37

high dose corticosteroids to minimize the permanent damage

Front 38

m/c lumbar disc compressions? tx?

Back 38

L4-L5 or L5-S1
MRI
bed rest
surg only if does not resolve, or sphincter dysfunction

Front 39

leg pain on exercise with straight back, not on exercise with hunched ie cycling?

Back 39

neurogenic claudication...tx = surg decompression of cauda equina

Front 40

tx of Tic doloreaux (trigeminal neuralgia)

Back 40

anti cholinergics

Front 41

management of scoliosis in kid?

Back 41

Baseline X-Rays are needed to monitor progression. (At the onset of menses skeletal maturity is about 80%

Front 42

WORKUP for pathological, acute bone snap/fracture in elderly?

Back 42

TUMOR! X-Rays to diagnose this particular broken bone, whole body bone scans to identify other mets, and start looking for the primary. In women, breast. In men, prostate. In heavy smokers, lung…and so on

Front 43

tx for posterior knee dislocation?

Back 43

MUST check popliteal: pulses, arteriogram, and prompt reduction of knee

...actually this is tx for post and anterior dislocation, as both tend to affect popliteal

Front 44

tx for tenderneess of tibia after long hike/march with normal xray?

Back 44

= stress fracture; won't show up on xray until 2 weeks later.
need to cast leg and repeat xray in 2 wks

Front 45

tx for gas gangrene after rusty nail trauma to foot?

Back 45

Tons of IV penicillin and immediate surgical debridement of dead tissue, followed by a trip to the nearest hyperbaric chamber for hyperbaric O2 treatment.

Front 46

mngment for venous stasis ulcer?

Back 46

unna boot, support stalking, and/or varicose vein surgery

Front 47

how to diff b/w test torsion and epididymitis?

Back 47

Use US

Front 48

tx of ureteral obstruction AND infection?

Back 48

in septic pt: dont do stone extraction surg which may be hazardous; do decompression by ureteral stent or percutaneous nephrostomy

Front 49

included test for any pyelonephritis?

Back 49

US to r/o obstruction too

Front 50

tx for priaprism?

Back 50

IMMEDIATE inj of alpha agonist (phenylephrine, epinephrine or terbutaline) into the corpora

Front 51

tx of hematuria in kid after minor trauma ie on playground injury?

Back 51

Hematuria from the trivial trauma in kids means congenital anomaly of some sort.
Management: start with sonogram. IVP may be needed later

Front 52

pyelonephritis sx in young boy?

Back 52

this means congenital anomaly of some sort, since boys rarely get pyelonephritis or even uti's
Management: start with sonogram. IVP may be needed later

Front 53

colicky flank px in young boy who drank a lot? NSIM?

Back 53

ureretopelvic jxn obstruction
do US and/or IVP or retrograde cysturethrogram
then surgical repair

Front 54

gross hematuria in elderly pt w/o renal failure?

Back 54

think CXR!!!
do US or IVP first, then cystoscopy

Front 55

NSIM for flank mass in elderly with abnormal lft's, epo, etc?

Back 55

suspect cxr; do CT or ivp FIRST

Front 56

NSIM for bladder cxr suspected due to bleeding?

Back 56

IVP first, then cystoscopy

Front 57

NSIM for rock hard mass in prostate?

Back 57

needle bx, then surg resection if cxr

Front 58

palliation in post cxr/-prostatectomy pt with now widespread bone px with bone mets? how long will it last?

Back 58

palliation via bilat orchiectomy, but his will only last 2-3 yrs.
also may give LHRH agonist or antiandrogens ie flutamide

Front 59

when is ASX prostate cxr treated

Back 59

never after age 75 b/c most men at this age get it, but die of something else

Front 60

post surgical day 2, pt with problem with incontinence? tx?

Back 60

acute overflow incont...
give bladder catheter

Front 61

best option for tx of 8 mm ureteral stone?

Back 61

shock-wave-lithrotripsy

Front 62

A 33 year old man has urgency, frequency, and burning pain with urination. The urine is cloudy and malodorous. He has mild fever.

Back 62

think prostatitis over UTi b/c uti's not so common in this age men. if prostate is normal on exam, then think uti but need to check via IVP or US for other causative etiology ie obstruction, etc.

Front 63

elderly man with pneumaturia, what test immediately?

Back 63

CT to check for colon/sigmoid cancer causing fistula

eventually, surgery