Surgery

Question 1

Indications for open thoracotomy in hemothorax?

Answer 1

Greater than 1500 cc of chest-tube output or continued bleeding that requires blood transfusion to maintain hemodynamic stability and chest-tube output greater than 250 cc per hour.

Question 2

Penetrating neck injury approximation

Answer 2

1. Above the angle of the mandible (zone III)
2. Between the angle of the mandible and the cricoid cartilage (zone II)
3. Below the cricoid cartilage (zone I)

Zone I and III: Endoscopy and angiography as surgical exploration of these zones surgically is challenging.

Zone II: managed with surgical exploration.

No-zone approach: based on patient stability and the presence of soft versus hard signs of injury regardless of the location. Soft signs for ex, CT angiography.

Question 3

Split-thickness skin graft

Answer 3

A thin layer of skin is removed from a donor site and transplanted to cover a wound or damaged area.
Include only part of the dermis.

Question 4

Free tissue transfer flap

Answer 4

Also called a free fla, is a microsurgical procedure where a section of tissue (including skin, muscle, fat, or bone) is completely detached from its original blood supply and transferred to another part of the body. The surgeon then reconnects the blood vessels using microsurgery to ensure the tissue survives in its new location.

Question 5

Laparoscopic sleeve gastrectomy is contraindicated in patients with?

Answer 5

GERD and Barret esophagus

Question 6

In necrotizing fascitis what is the most aproppiate step in establishing definitive diagnosis?

Answer 6

Open surgery, to establish the presence and extent of necroting fascitis.

Question 7

Middle mediastinum masses

Answer 7

Lymph nodes, pericardium, heart, great vessels, trachea, bronchi, esophagus.

Question 8

Dumping syndrome

Answer 8

It is a common complication post-gastrectomy.
GI symptoms (nausea, diarrhea, abdominal cramps) and vasomotor symptoms (palpitations, diaphoresis).
It results from the loss of pyloric sphincter function, causing rapid gastric emptying and fluid shifts to the small intestine, leading to hypotension and autonomic reflex stimulation.
DX clinical
TX: dietary modifications include small, frequent meals, avoiding simple sugars, increasing fiber and protein, and drinking fluids between meals.
Symptoms typically lessen over time, but refractory cases may require octreotide or reconstructive surgery.

Question 9

Leriche syndrome

Answer 9

Aortoiliac occlusion and includes: bilateral claudication in the hips, thighs, and glutes; absent or diminished femoral pulses; and erectile dysfunction.
Risk factors: age >50, hypertension, heavy smoking history.
Ankle-brachial index to evaluate peripheral artery disease.

Question 10

Blunt abdominal trauma necessitates immediate laparotomy for?

Answer 10

Patients displaying frank peritonitis, regardless of hemodynamic status.

Question 11

Tracheobronchial injury

Answer 11

Should be considered in trauma patients with extensive extrapulmonary air.
Classic findings are rapid, large air leak into the chest tube drainage system and persistent pneumothorax/pneumomediastinum despite tube thoracostomy.

Question 12

Shock in trauma patients

Answer 12

Hemorrhagic shock is the most common where large amounts of blood can be lost (or hidden) are “the floor” (external bleeding) “and 4 more”: chest, abdomen, pelvis/retroperitoneum, and thigh.

Question 13

Ankle brachial index

Answer 13

Systolic blood pressure in the lower extremity at the ankle/ systolic blood pressure in the arm at the level of the brachial artery.

A ratio less than 0.9= occlusive arterial vascular disease
between 0.9 and 1.3= normal arteries
>1.3= calcified vessels, the patient needs further evaluation for vascular disease.

Question 14

Most effective to reduce the risk of burn wound infections?

Answer 14

In patients with severe burn injuries, early excision of necrotic tissue and wound closure (eg, skin grafting) reduces the risk of burn wound infections.