ABSITE TrueLearn
Aortic Injury
- MC Location in Blunt Trauma
- MC Location in Penetrating Trauma
- Which is worse? - ANS- MC Location in Blunt Trauma = Isthmus
- MC Location in Penetrating Trauma = Infra-renal aorta (+IVC)
- Which is worse?: suprarenal injuries, so normally blunt
MCCOD in Blunt Trauma - ANSBrain Injury
EGD Findings a/w growth ulcer re-bleeding (3) - ANS1. Active Bleeding / Oozing
2. Visible Vessel
3. Adherent Clot
DDx Inguinal Ulcer/Lesion (three) - ANS1. Hidratenitis: impacts apocrine (axilla/inguinal)
glands, represents persistent contamination of gland
2. Granuloma Inguinale: handiest inguinal, think 3rd international
3. Lymphogranulosum Venerum: inguinal, suppose STI
Glomus Tumor
- Define
- Presentation Triad
- Two Key Signs
- Treatment - ANS- Define: sub-ungal AV fistula
- Presentation Triad: ache, bloodless insensitivity, tenderness on palpation
- Two Key Signs
1. Love's = factor tenderness
2. Hildreth's = alleviation with insufflation
- Treatment: surgical treatment
Inguinal Hernia
- Recurrence with/with out mesh
- Risk of incarceration every year - ANS- Recurrence with/with out mesh = five vs. 20%
- Risk of incarceration each 12 months = 0.18%/year
Procidentia
- Etiology (2)
- Recognizing full vs. Mucosal prolapse
,- Definitive Test
- three Treatments + Description - ANS- Etiology (2)
1. Pudendal nerve harm
2. Laxity of anal sphincter
- Recognizing complete vs. Mucosal prolapse
1. Full = circular folds
2. Mucosal = linear folds
- Definitive Test = defecating proctogram
- 3 Treatments + Description
1. Transanal Excision = Altemier (incision 2cm above dentate line to open peritoneum, then
tack peritoneum at degree to puborectalis)
2. Delorme (perfect of older patients): Mucosal excision + muscular plication
three. LAR with Sigmoid Pexy
Biliary Dyskinesia
- When to suspect?
- Describe technique
- Treatment - ANS- When to suspect?
Signs/signs and symptoms of biliary colic with poor USG, CT, ERCP
- Describe approach
Gallbladder gets packed with Tc99, infuse CCK. If EF <35% at 20min = diagnosis
- Treatment = lap chole
Injecting dye before WLE cancer/breast:
- When to inject?
- Where to inject (layer of skin)?
- Why now not inject after WLE? - ANS- When to inject? Hours earlier than procedure
- Where to inject (layer of pores and skin)? Dermis, wherein lymphatics are
- Why not inject after WLE? B/c WLE disrupts the lymphatic pathways
Post-Hemorrhoidectomy Bleeding Etiologies/Mgmt
- Early (<24hrs)
- Late (>POD5) - ANS- Early (<24hrs): likely to be surgical error, needs evaluation
- Late (>POD5): probable to be eschar from surgery falling off, no intervention
Esophageal CA Review
- Why so malignant (aka how do they spread?)
- Test to Diagnose?
- Test to decide resection?
- CI to Resection (3)
,- SCC vs. Adeno: occurrence, etiology, region/mets
- Tx
1. Chemo/XRT Options (2)
2. Surgeries (4) all of which require _____
3. Endoscopic Option for ____
four. Complications (2) + Treatment - ANS- Why so malignant (aka how do they unfold?)
Through submucosal lymphatic channels
- Test to Diagnose? Esophagram
- Test to decide resection? CT Chest/Abd
- CI to Resection (3)
1. Invasion of nerves (hoarse RLN, Horners Brachial Plexus, or Phrenic Nerve)
2. Visceral Invasion (airway, vertebra, malignant effusion)
three. +Nodal Base (broadly mets)
- SCC vs. Adeno: occurrence, etiology, area/mets
1. Adeno: MCC, lower esophagus associated with GERD/Achalasia, mets to liver
2. SCC: lightly divided, a/w smoking, ETOH, mets to lung
- Tx
1. Chemo/XRT Options (2): 5FU + Cisplatin
2. Surgeries (4) all of which require pyloromyotomy
- Transhiatal: cervical anastamosis, gastric headaches
- Ivor Lewis: thoraco anastomosis, thoracic complications
- three Hole: 3 incisions neck, thorax, abdomen
- Colonic interposition: 3 anastamosis
3. Endoscopic Option for mucosal sickness <2cm
4. Complications (2) + Treatment
- Stricture = dilation
- Fistula to airway = aspiration, palliatve stent
What hormone is NOT released during stress? - ANSTSH
Pros/Cons of Burn Care
1. Silvadene
2. Silver Nitrate
3. Sulfamylon - ANS1. Silvadene: good for cartilagenous areas (face/ears), causes
leukopenia
2. Silver Nitrate: good for large burns, but very concentrated and quenches cells leading to
hypoNa and hypoCl; also can cause methemoglobinemia
3. Sulfamylon: good for penetrating wounds, but painful and CA inhibitor so causes
metabolic acidosis
, Lumbar Hernia
- Boundaries
- Primary vs. Secondary
- Causes
- When to repair? - ANS- Boundaries: 12th rib, EOM, iliac crest
- Primary vs. Secondary
1. Primary: true hernia
2. Secondary: denervation injury
- Causes: surgical trauma (kidney operations)
- When to repair?: repair PRIMARY if large and symptomatic
Esophageal Leiomyoma
- MC ____ of the esophagus
- Location within esophageal wall (review layers)
- Location along esophagus
- Dx (2)
- Biopsy?
- When/how to treat? - ANS- MC benign tumor of the esophagus
- Location within esophageal wall (review layers)
Occurs in muscularis b/c this is MESECNHYMAL tumor (mucosa --> submucosa -->
muscular propria...NO SEROSA)
- Location alongside esophagus: lower 2/three in which the SMOOTH MUSCLES are
- Dx (2): Esophagram --> CT to r/o CA
- Biopsy? NEVER; reasons fibrotic tissue that makes remedy very tough
- When/a way to deal with? Excision (ENUCLEATION) with proper thoracotomy (if high
higher/mid esophagus) or left thoracotomy (if low esophagus or GEJ) for those which might
be SYMPTOMATIC or >5cm
Pancreatic Divisum
- Gold trendy diagnosis
- First line remedy
- If first line fails... - ANS- Gold widespread diagnosis: ERCP
- First line remedy: minor papillotomy with duct stenting
- If first line fails...Surgery with minor papilla sphincteroplasty and longitudinal duodenotomy
Liver Anatomy
- Right and left liver divided by way of _____
Aortic Injury
- MC Location in Blunt Trauma
- MC Location in Penetrating Trauma
- Which is worse? - ANS- MC Location in Blunt Trauma = Isthmus
- MC Location in Penetrating Trauma = Infra-renal aorta (+IVC)
- Which is worse?: suprarenal injuries, so normally blunt
MCCOD in Blunt Trauma - ANSBrain Injury
EGD Findings a/w growth ulcer re-bleeding (3) - ANS1. Active Bleeding / Oozing
2. Visible Vessel
3. Adherent Clot
DDx Inguinal Ulcer/Lesion (three) - ANS1. Hidratenitis: impacts apocrine (axilla/inguinal)
glands, represents persistent contamination of gland
2. Granuloma Inguinale: handiest inguinal, think 3rd international
3. Lymphogranulosum Venerum: inguinal, suppose STI
Glomus Tumor
- Define
- Presentation Triad
- Two Key Signs
- Treatment - ANS- Define: sub-ungal AV fistula
- Presentation Triad: ache, bloodless insensitivity, tenderness on palpation
- Two Key Signs
1. Love's = factor tenderness
2. Hildreth's = alleviation with insufflation
- Treatment: surgical treatment
Inguinal Hernia
- Recurrence with/with out mesh
- Risk of incarceration every year - ANS- Recurrence with/with out mesh = five vs. 20%
- Risk of incarceration each 12 months = 0.18%/year
Procidentia
- Etiology (2)
- Recognizing full vs. Mucosal prolapse
,- Definitive Test
- three Treatments + Description - ANS- Etiology (2)
1. Pudendal nerve harm
2. Laxity of anal sphincter
- Recognizing complete vs. Mucosal prolapse
1. Full = circular folds
2. Mucosal = linear folds
- Definitive Test = defecating proctogram
- 3 Treatments + Description
1. Transanal Excision = Altemier (incision 2cm above dentate line to open peritoneum, then
tack peritoneum at degree to puborectalis)
2. Delorme (perfect of older patients): Mucosal excision + muscular plication
three. LAR with Sigmoid Pexy
Biliary Dyskinesia
- When to suspect?
- Describe technique
- Treatment - ANS- When to suspect?
Signs/signs and symptoms of biliary colic with poor USG, CT, ERCP
- Describe approach
Gallbladder gets packed with Tc99, infuse CCK. If EF <35% at 20min = diagnosis
- Treatment = lap chole
Injecting dye before WLE cancer/breast:
- When to inject?
- Where to inject (layer of skin)?
- Why now not inject after WLE? - ANS- When to inject? Hours earlier than procedure
- Where to inject (layer of pores and skin)? Dermis, wherein lymphatics are
- Why not inject after WLE? B/c WLE disrupts the lymphatic pathways
Post-Hemorrhoidectomy Bleeding Etiologies/Mgmt
- Early (<24hrs)
- Late (>POD5) - ANS- Early (<24hrs): likely to be surgical error, needs evaluation
- Late (>POD5): probable to be eschar from surgery falling off, no intervention
Esophageal CA Review
- Why so malignant (aka how do they spread?)
- Test to Diagnose?
- Test to decide resection?
- CI to Resection (3)
,- SCC vs. Adeno: occurrence, etiology, region/mets
- Tx
1. Chemo/XRT Options (2)
2. Surgeries (4) all of which require _____
3. Endoscopic Option for ____
four. Complications (2) + Treatment - ANS- Why so malignant (aka how do they unfold?)
Through submucosal lymphatic channels
- Test to Diagnose? Esophagram
- Test to decide resection? CT Chest/Abd
- CI to Resection (3)
1. Invasion of nerves (hoarse RLN, Horners Brachial Plexus, or Phrenic Nerve)
2. Visceral Invasion (airway, vertebra, malignant effusion)
three. +Nodal Base (broadly mets)
- SCC vs. Adeno: occurrence, etiology, area/mets
1. Adeno: MCC, lower esophagus associated with GERD/Achalasia, mets to liver
2. SCC: lightly divided, a/w smoking, ETOH, mets to lung
- Tx
1. Chemo/XRT Options (2): 5FU + Cisplatin
2. Surgeries (4) all of which require pyloromyotomy
- Transhiatal: cervical anastamosis, gastric headaches
- Ivor Lewis: thoraco anastomosis, thoracic complications
- three Hole: 3 incisions neck, thorax, abdomen
- Colonic interposition: 3 anastamosis
3. Endoscopic Option for mucosal sickness <2cm
4. Complications (2) + Treatment
- Stricture = dilation
- Fistula to airway = aspiration, palliatve stent
What hormone is NOT released during stress? - ANSTSH
Pros/Cons of Burn Care
1. Silvadene
2. Silver Nitrate
3. Sulfamylon - ANS1. Silvadene: good for cartilagenous areas (face/ears), causes
leukopenia
2. Silver Nitrate: good for large burns, but very concentrated and quenches cells leading to
hypoNa and hypoCl; also can cause methemoglobinemia
3. Sulfamylon: good for penetrating wounds, but painful and CA inhibitor so causes
metabolic acidosis
, Lumbar Hernia
- Boundaries
- Primary vs. Secondary
- Causes
- When to repair? - ANS- Boundaries: 12th rib, EOM, iliac crest
- Primary vs. Secondary
1. Primary: true hernia
2. Secondary: denervation injury
- Causes: surgical trauma (kidney operations)
- When to repair?: repair PRIMARY if large and symptomatic
Esophageal Leiomyoma
- MC ____ of the esophagus
- Location within esophageal wall (review layers)
- Location along esophagus
- Dx (2)
- Biopsy?
- When/how to treat? - ANS- MC benign tumor of the esophagus
- Location within esophageal wall (review layers)
Occurs in muscularis b/c this is MESECNHYMAL tumor (mucosa --> submucosa -->
muscular propria...NO SEROSA)
- Location alongside esophagus: lower 2/three in which the SMOOTH MUSCLES are
- Dx (2): Esophagram --> CT to r/o CA
- Biopsy? NEVER; reasons fibrotic tissue that makes remedy very tough
- When/a way to deal with? Excision (ENUCLEATION) with proper thoracotomy (if high
higher/mid esophagus) or left thoracotomy (if low esophagus or GEJ) for those which might
be SYMPTOMATIC or >5cm
Pancreatic Divisum
- Gold trendy diagnosis
- First line remedy
- If first line fails... - ANS- Gold widespread diagnosis: ERCP
- First line remedy: minor papillotomy with duct stenting
- If first line fails...Surgery with minor papilla sphincteroplasty and longitudinal duodenotomy
Liver Anatomy
- Right and left liver divided by way of _____
