Surgery Shelf Topics.docx

Surgery Shelf Topics

Biliary lectures were spot-on Appendicitis (worthwhile, I had a question on ischemia due to closed loop obstruction progression) Abnormal presentation in pregnancy If its atypical/abscess formation - surgery isnt emergent Breast topics (we didn't do a breast lecture, although I felt prepared from the Thursday breast lecture during clerkship) I had a roux-en-Y question-- I forget the specific context Bile-duct peritonitis question (Ducts of luschka wasn't specifically identified, but the objective was to know that the problem was caused by accessory ducts) Temporal cell arteritis and proper management (don't wait for biopsy results to give steroids) Tracheobronchial rupture ID (imaging with gastrografin versus barium) Endocrine surgery (thyroid and parathyroid and how to work up with imaging, ultrasound, FNA TSH, etc.) also, pheochromocytoma and what labs to get to assess (urine and serum normetanephrines and metanephrines) Carcinoid syndrome Common causes of GI bleeding (diverticulosis, AVM) Mesenteric ischemia Gallstone ileus Traumatic urethral injuries (do a retrograde urethrogram) Pre-op risk assessment (cardio: stress test, angiogram; Liver functioning: albumin, INR, Bilirubin, ascites, encephalopathy) Post-op causes of fever on days 0 (bacteremia from procedure), Day 1 (atelectasis), Day 3 pneumonia, UTI. Postop clostridium perfringens wound infection and postop abscess. Postop causes of hyponatremia--- I had 3 questions on that (SIADH versus renal etiology versus iatrogenic fluid admin-- they gave us the BMP, serum osmola, Urine lytes to compare urine and serum) Questions about management of pancreatic adenocarcinoma Causes of pneumobilia, know hemobilia (s/p liver GSW) Know first line imaging for common GI diseases - particularly urological Q’s - CT no contrast/US for stones, retrograde cystourethrogram, know first line test for pediatric uro diseases Pancreatic adenocarcinoma/cholangiocarcinoma → painless jaundice, Courseveir sign, etc Esophageal pathology (perforation, achalasia, CREST/scleroderma, GERD and management, boerhaave, mallory weiss) Ethics questions about telling a patient their diagnosis even though the family begs you not to tell them (ask the patient how much they want to know about their diagnosis is the best test answer) Ethics question about informed consent from an intellectually disabled patient How to manage a patient in PACU with PCO2 of 60, PO2 of 85, pH 7.24 (re-intubate and mechanically ventilate versus increase FiO2 versus spirometry) Know the uses of different types of breathing assistance - ventilator, peep, etc Most common cause of esophageal rupture (iatrogenic during a procedure) DIC, FFP, Cryoprecipitate, anticoagulants and their respective antidotes, (heparin and protamine sulfate) and when to give Blood donation adverse reactions (febrile hemolytic versus nonfebrile hemolytic versus TRALI. Most common cause of red blood cell reactions-- clerical error in typing/crossmatching

Trauma with tamponade versus tension pneumothorax (becks triad? Mediastinal shift? Lung sounds (dull, hyperresonant, normal) Air under diaphragm-- what to do? (straight to ex lap) Carpal tunnel and pre-op testing (EMG, nerve conduction studies, MRI of hands an wrists, arthroscopy of joints, or Xrays) Tests for ligament tears of knee Lung cancer surgical management Traumatic ruptured diaphragm (bowel sounds in chest) Ortho Femur fracture complications (fat embolism, hemorrhage into thigh compartment) Legg-calves perthes and slipped cap femoral epiphysis disease Osteoporosis as the answer as a cause of fracture (the question stem said patient was postmenopausal with anbormal DEXA scan---I forget the other possible answer choices) Melanoma, squamous and basal cell (covered pretty well by Dr. Salti) Marjolin ulcer question phrased as non-healing ulcer where a burn had once been-- how to manage: biopsy versus reassure versus oral 5-fluorouracil) Hidradenitis suppurativa (is this involving apocrine gland versus hair follicle? In the real world, the opinion is now being pushed toward follicle, but the old, established answer was the only one of the two as answer choices) Assessment of proper trauma fluid management (if low urine output, start with fluid bolus to assess if merely dehydration. Otherwise to urine output of 30-40 ml/h Pediatric surgical topics (esophageal atresia, imaging differences among duodenal atresia or annular pancreas vs. malrotation vs. intestinal atresia Different types of ulcers (venous stasis versus diabetic) Types of shock, although the question stem usually gives it away STEMI versus post motor vehicle versus SIRS-type presentation (cardiogenic, hypovolemic, septic) What to assess on a limb before amputation due to trauma or gangrene (blood flow analysis) Preop and postop medication mangement: know what to stop/continue, etc