Surgery COMAT questions
What is the size guideline for treatment of a spontaneous pneumothorax?
• CORRECT ANSWER- Spontaneous pneumothorax:
<2 cm observe
2 cm large and stable = needle aspiration or chest tube
5 W's of Post-op surgery?
• CORRECT ANSWER- 5 W's
• Wind
○ Pneumonia, PE, Aspiration
• Wound
○ Surgical site infections
• Water
○ Urinary tract infections
§ Increased risk due to indwelling catheters
§ Associated with enteric organisms ie. E. coli, Klebsiella, Proteus mirabillis
• Walk
○ Deep vein thrombosis
• Wonder Drugs
○ Drug fever, blood products, IV lines
○ Drug fever: diagnosis of exclusion
§ Usually associated with anticonvulsants, antibiotics (beta-lactams, sulfonamides)
and allopurinol
§ Occurs within 1-2 weeks of drug initiation
Modified Radial Mastectomy vs. Simple mastectomy?
, • CORRECT ANSWER- MRM includes:
• Includes axillary dissection
• Level I and Level II axillary dissection being the standard procedure
Alternate name for hidradenitis suppurative?
• CORRECT ANSWER- acnes inversa
What is hidradenitis suppurativa?
• CORRECT ANSWER- Chronic skin inflammatory condition that is associated with:
• Induration
• Abscess
• Sinus tracts
It is similar in character and location as many other conditions but can be
differentiated by careful history and identifying presence of hyperkeratosis
induced follicular occlusion (family history and reccurrence)
What is Paraphimosis?
• CORRECT ANSWER- Paraphimosis is considered a urological emergency and
occurs when the retracted foreskin develops a fixed constriction proximal to the
glans
Treatment of paraphimosis?
• CORRECT ANSWER- The glans is first compressed for several minutes to
decrease edema
Followed by application of ice and attempting to push the prepuce distally while
the glans is pushed proximally
Balanoposthitis
• CORRECT ANSWER- is an inflammation secondary to an infection of the glans
penis and the surrounding foreskin
, The majority of cases are due to poor hygiene or external irritation with
subsequent colonization by a fungus
Treatment of Balanoposthitis?
• CORRECT ANSWER- Cleaning the region with soap and water, adequate
hygiene, avoiding moist environment and application of antifungal creams such
as nystatin or clotrimazole
Peyronie's disease
• CORRECT ANSWER- Peyronie's disease is a rare condition also known as chronic
inflammation of the tunica albuginea
Associated with abnormal growth of the fibrous plaques and scar formation in
the sheath of tissue surrounding the corpora cavernosa (tunica albuginea) of the
penis
Phimosis
• CORRECT ANSWER- Phimosis is the inability to retract the foreskin proximally to
the glans penis
• Can be a result of normal development or may be due to infection or poor
hygiene
Priapism?
• CORRECT ANSWER- Priapism is another urological emergency but is not
involved with foreskin constriction or retraction difficulties
• Priapism is a urological emergency and is defined as painful, involuntary and
persistent erection in which both corpora cavernosa are engorged with stagnant
blood
• Impotence can result with sustained erection, thus urgent action is imperative
when faced with this condition
, Treatment of priapism?
• CORRECT ANSWER- adequate analgesia, hydration, stopping the offending
agent, administration of terbutaline (beta2-mimetic), application of ice packs and
corporal aspiration of blood
A-fib complication and acute abdomen?
• CORRECT ANSWER- The patient in the vignette has A-fib as seen in the exhibit
and is reportedly non-compliant with medical therapy predisposing him to atrial
clot formation which can subsequently embolize and cause ischemic colitis. These
patients present with:
• Acute abdominal pain
• Bloody diarrhea
• Vomiting
• Abdominal tenderness
Other causes of ischemic colitis
• CORRECT ANSWER- • Embolus
• Hypoperfusion from any cause
• Bowel obstruction
Clinical findings of ischemic colitis?
• CORRECT ANSWER- • Labs show characteristically elevated WBC count and
elevated lactic acid level because of ischemia
• Imaging techniques:
○ CT scan can show bowel wall thickening
○ Barium enema may show a "thumb printing"
○ Sigmoidoscopy can reveal bloody and edematous tissue
Treatment of ischemic colitis?
What is the size guideline for treatment of a spontaneous pneumothorax?
• CORRECT ANSWER- Spontaneous pneumothorax:
<2 cm observe
2 cm large and stable = needle aspiration or chest tube
5 W's of Post-op surgery?
• CORRECT ANSWER- 5 W's
• Wind
○ Pneumonia, PE, Aspiration
• Wound
○ Surgical site infections
• Water
○ Urinary tract infections
§ Increased risk due to indwelling catheters
§ Associated with enteric organisms ie. E. coli, Klebsiella, Proteus mirabillis
• Walk
○ Deep vein thrombosis
• Wonder Drugs
○ Drug fever, blood products, IV lines
○ Drug fever: diagnosis of exclusion
§ Usually associated with anticonvulsants, antibiotics (beta-lactams, sulfonamides)
and allopurinol
§ Occurs within 1-2 weeks of drug initiation
Modified Radial Mastectomy vs. Simple mastectomy?
, • CORRECT ANSWER- MRM includes:
• Includes axillary dissection
• Level I and Level II axillary dissection being the standard procedure
Alternate name for hidradenitis suppurative?
• CORRECT ANSWER- acnes inversa
What is hidradenitis suppurativa?
• CORRECT ANSWER- Chronic skin inflammatory condition that is associated with:
• Induration
• Abscess
• Sinus tracts
It is similar in character and location as many other conditions but can be
differentiated by careful history and identifying presence of hyperkeratosis
induced follicular occlusion (family history and reccurrence)
What is Paraphimosis?
• CORRECT ANSWER- Paraphimosis is considered a urological emergency and
occurs when the retracted foreskin develops a fixed constriction proximal to the
glans
Treatment of paraphimosis?
• CORRECT ANSWER- The glans is first compressed for several minutes to
decrease edema
Followed by application of ice and attempting to push the prepuce distally while
the glans is pushed proximally
Balanoposthitis
• CORRECT ANSWER- is an inflammation secondary to an infection of the glans
penis and the surrounding foreskin
, The majority of cases are due to poor hygiene or external irritation with
subsequent colonization by a fungus
Treatment of Balanoposthitis?
• CORRECT ANSWER- Cleaning the region with soap and water, adequate
hygiene, avoiding moist environment and application of antifungal creams such
as nystatin or clotrimazole
Peyronie's disease
• CORRECT ANSWER- Peyronie's disease is a rare condition also known as chronic
inflammation of the tunica albuginea
Associated with abnormal growth of the fibrous plaques and scar formation in
the sheath of tissue surrounding the corpora cavernosa (tunica albuginea) of the
penis
Phimosis
• CORRECT ANSWER- Phimosis is the inability to retract the foreskin proximally to
the glans penis
• Can be a result of normal development or may be due to infection or poor
hygiene
Priapism?
• CORRECT ANSWER- Priapism is another urological emergency but is not
involved with foreskin constriction or retraction difficulties
• Priapism is a urological emergency and is defined as painful, involuntary and
persistent erection in which both corpora cavernosa are engorged with stagnant
blood
• Impotence can result with sustained erection, thus urgent action is imperative
when faced with this condition
, Treatment of priapism?
• CORRECT ANSWER- adequate analgesia, hydration, stopping the offending
agent, administration of terbutaline (beta2-mimetic), application of ice packs and
corporal aspiration of blood
A-fib complication and acute abdomen?
• CORRECT ANSWER- The patient in the vignette has A-fib as seen in the exhibit
and is reportedly non-compliant with medical therapy predisposing him to atrial
clot formation which can subsequently embolize and cause ischemic colitis. These
patients present with:
• Acute abdominal pain
• Bloody diarrhea
• Vomiting
• Abdominal tenderness
Other causes of ischemic colitis
• CORRECT ANSWER- • Embolus
• Hypoperfusion from any cause
• Bowel obstruction
Clinical findings of ischemic colitis?
• CORRECT ANSWER- • Labs show characteristically elevated WBC count and
elevated lactic acid level because of ischemia
• Imaging techniques:
○ CT scan can show bowel wall thickening
○ Barium enema may show a "thumb printing"
○ Sigmoidoscopy can reveal bloody and edematous tissue
Treatment of ischemic colitis?
