Surgery Shelf

Front 1

What is Flail Chest?

Back 1

A flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks under extreme stress and becomes detached from the rest of the chest wall. Typically caused by 3 or more adjacent rib fractures that break in two places and create an unstable chest wall segment that moves in a paradoxical motion with respirations.

Flail chest is invariably accompanied by pulmonary contusion, a bruise of the lung tissue that can interfere with blood oxygenation.[4] Often, it is the contusion, not the flail segment, that is the main cause of respiratory failure in patients with both injuries

Flail chest should be suspected in patients with blunt thoracic trauma who remain tachypneic and hypotensive despite aggressive fluid resuscitation. Classic x-ray findings reveal multiple rib fractures over lying a lung contusion.

Front 2

Intermittent bloody discharge from 1 nipple

Back 2

= classic presentation for Intraductal Papilloma
(benign, no masses usually present)

Front 3

Hamman sign--what is it and what causes it?

Back 3

=Crunching sound on auscultation of the heart due to mediastinal emphysema (because the heart beating against air-filled tissues)

Caused by pneumomediastinum or pneumopericardium

Front 4

Positive Arm drop test indicates

Back 4

rotator cuff tear

Front 5

In differentiating etiologies of hypoxemia, a Low-normal PCWP (< 18 mm Hg) indicates ____________, and a High PCWP indicates ___________.

Back 5

Low-normal PCWP (<18) supports leaky capillaries (ARDS) as the etiology;

High PWCP suggests a Hydrostatic mechanism, such as Cardiogenic Pulmonary Edema

Front 6

Mgmt for suspected cancer of the esophagus

Back 6

1- Barium Swallow 1st!
2- Endoscopy and Biopsy
3-CT

Front 7

Mgmt for Boerhavve syndrome/Esophageal Perforations

Back 7

1st-GASTROGRAFIN SWALLOW STUDY to confirm the dx
2nd-Tx with EMERGENCY SURGICAL REPAIR

Prognosis depends on time elapsed between perforation and treatment.

Front 8

How do you diagnose Carcinoid syndrome?

Back 8

24-hour urinary concentration of 5-hydroxy-IndoleAcetic acid

Front 9

Acute abdomen plus perforated viscus equals

Back 9

Perforated Duodenal ulcer (in most cases)

Front 10

Mgmt for Volvulus

Back 10

Proctosigmoidoscopy should relieve the obstruction. Leaving in a rectal tube is another option.

Front 11

Coincidence of malignant obstructive jaundice and anemia/blood in stools

Back 11

Ampullary cancer
(ampullary cancer can bleed into the lumen like any other mucosal malignancy, at the same time that it can obstruct biliary flow by virtue of its location

Front 12

Migratory necrolytic dermatitis--which is resistant to all forms of treatment, in a pt with mild diabetes, a touch of anemia, glossitis, & stomatitis

Back 12

Glucagonoma

Front 13

When would you do a Retrograde cystogram?

Back 13

You'd do a RETROGRADE CYSTOGRAM WI/POSTVOID FILS when you suspect a BLADDER INJURY
(ie after major trauma, esp w/ pelvic fracture)

Front 14

Mgmt for Anterior and Posterior Urethral Injury

Back 14

Anterior UI: immediate surgical reapir

Posterior UI: Retrograde urethrogram (and then suprapubic cath which repair delayed 6 months)

Front 15

Findings in pericardial tamponade:

Back 15

Blunt chest trauma, distended neck veins, and tachycardia & hypotension despite fluid resuscitation, with NORMAL CHEST X-RAY without tension pneumo

(b/c only takes 100-200 mL of blood to cause a sudden rise in intrapericardial pressure that compresses the cardiac chambers and compromises venous return)

Front 16

1st step in evaluating a pt w/ suspected Peripheral Artery disease:

Back 16

ABI (Ankle-Brachial index) using Doppler--to confirm the diagnosis;

this can then be followed by other tests once it is confirmed by ABI, to more accurately identify the culprit vessel(s) before pursuing treatment (arterial duplex sonography or more invasive--arteriorgram)

Front 17

Old person--> MVA--> now weakness of upper extremities, but ok in lower extremities

Back 17

Central Cord syndrome

(results from hyperextension injuries in old people, esp with degenerative cervical spine changes like cervical spondylosis)

Front 18

Compartment pressures > ___ mm HG indicate the presence of Compartment syndrome and the need for __________________(tx). The most reliable indicators of early compartment syndrome include : (2 things)

Back 18

> 30 mm Hg, Fasciotomy;
severe pain in the affected extremity that is ot of proportion to PE findings, and pain that is exacerbated by passive stretch of the muscles in the affected compartment

Front 19

Colicky or paroxysmal abdominal pain with episodic hyperactive bowel sounds attibutable to peristaltic rushes, abdominal dissension, and diffuse abdominal tenderness are signs and symptoms of:

Back 19

MECHANICAL BOWEL OBSTRUCTION

--w/ failure to pass flatus or stool, this indicates COMPLETE bowel obstructino and necessitates surgery!
--(if only partial obstruction, can manage conservatively wth NG tube decompression and observation.

Front 20

_________________ should be expected in any elderly patient who dev's acute abdominal pain followed by rectal bleeding, and the most common setting for this is:

Back 20

ISCHEMIC COLITIS,
and the most common setting for this is the early post-op period after ABDOMINAL AORTIC ANEURYSM REPAIRwhen impaired blood flow thru the inferior mesenteric artery may put the colon at risk!!!

Front 21

Anterior shoulder dislocation may cause injury to the _______ or ___________.

Back 21

Axillary nerve or artery.

Front 22

Most common cause of lower GI bleeding in an elderly patient

Back 22

Diverticulosis

Front 23

Mgmt of Pulmonary Contusion

Back 23

Fluid restriction, diuretics, respiratory support

Front 24

Mgmt of penetrating wound to the abdomen

Back 24

Penetrating wound to the abdomen gets EXPLORATORY LAPAROTOMY EVERY TIME!!!

Before surgery, you wanna get indwelling bladder catheter, a big more venous line for fluid admin, and a dose of broad spectrum abc.

Front 25

Primary vs Secondary Peritonitis: definition and management

Back 25

Primary Peritonitis most often spontaneous bacterial peritonitis (SBP) seen in cirrhotics with ascites, or in children with nephrotic syndrome and asicites.

PRIMARY--MANAGE BY CULTURING ASCITIC FLUID AND TREATING WITH ABX.
SECONDARY--REQUIRES EMERGENT SURGERY!

Secondary peritonitis is by far the most common form of peritonitis encountered in clinical practice--it is due to another condition, most commonly the spread of an infection from the digestive tract.
Secondary peritonitis has several major causes. Bacteria may enter the peritoneum through a hole (perforation) in the gastrointestinal tract. Such a hole may be caused by a ruptured appendix, stomach ulcer, perforated colon, or injury, such as a gunshot or knife wound.
Secondary peritonitis can also occur when bile or chemicals released by the pancreas (pancreatic enzymes) leak into the lining of the abdominal cavity.
Foreign contaminants can also cause secondary peritonitis if they get into the peritoneal cavity. This can occur during use of peritoneal dialysis catheters or feeding tubes.
Inflammation of the peritoneal cavity caused by bacteria can result in infection of the bloodstream (sepsis) and severe illness.
Secondary peritonitis can also affect premature babies who have necrotizing enterocolitis.

Tertiary peritonitis often develops in the absence of the original visceral organ pathology. Tertiary peritonitis has been conceptualized as a later stage in the disease, when clinical peritonitis and systemic signs of sepsis persist after treatment for secondary peritonitis and either no organisms or low-virulence pathogens, such as enterococci and fungi, are isolated from the peritoneal exudate