Surgery Step 2 12-16-2015 breast, head, burns, bites

ruhland1's version from 2015-12-16 14:14

Section 1

Question Answer
18 F, firm rubbery movesfibroadenoma
fibroadenomaget Tissue dx FNA>Core BX
18F mammogramuseless
very young breastonly SONOGRAMS are useful
lg mass, slow grow 7 years, firm, rubbery, moveable1st core/incisional bx, must r/o malignant sarcoma
35 F, BIL tender, related to menstrual cycle, firm round 2 cm mass for 6 wkfibrocystic dz
fibrocystic dz mxCyst aspiration, Bx impractical (if bloody->cytology, does not go away->bx
34 F unil bloody disch, on and off several mo, NO palp masses intraductal papilloma
detect breast cx that is not palpget mammogram,
Intraductal papilloma mxget mammo b/c non palp, if (-) still may resect guided by galactogram
26 F lactating, cracks in nip, flux red hot tender mass F and up WBCabscess
only _____ ___ are entitled to abscesseslactating breasts
breast abscesscx until r/o, I and D with bx
49 Y firm 2 cm massmust get bx to r/o cx, (core bx OK) only excisional bx to r/o cx)
69 F 4 cm hard mass, ill defined borders, "orange peel", nip retractCx, Core BX= OK but need Exicisional Bx to r/o cx
72 F red swollen breast. orange breast, get bx (punch bx is sufficient)
62 F + eczematoid lz areola for 3 mopaget (get bx)
42 F trx to breast + lump 3cm + superficial ecchycx until proven otherwise, trx often brings new attn to area
58 F mass R axilla, discreet hard movable 2 cm, (-) breast examneed mammogram (no palpable breast) and bx node
60 F mammo (up density + up calcificationsuspect cx therefore .: get tissue bx (stereotactic radio guided core bx) if (-) get localized excison bx
44 F 2 cm palp mass in UO quad, bx=infiltrating ductal cxdo lumpec + rads + axilla node disect
lumpectomyonly if <4cm if >4cm get mod radical mastect and axilary LN dissec even if no palp in axilla
44 F bleeding breast, fungating mass, firmly attached to chest wallcommon= neglect and denial dx= advanced cx mx= core bx tx= pallitatio (use chemo to shrink tmx and remove it)
37 F has lumpec + ax dissec for 3 cm infil ductal cx, + meta in 4 LNodespremenopausal get CHEMO postmenop get HORMONAL
66 F post med radical mastect for infil ductal cx, 4 cm + LN meta + estro and progest recep +Tamoxifen (hormonal therapy)
44 F severe HA several wk, 2 yr post op for bad tumorbrain mets (get CT brain)
TNMif not 1 for tmx and 0 for nodes then it bad
39 F post chemo for breast cx 6 mo ago, constant back pain last 3 wk, palp on thor/lumbar spinebone mets, get a bone scan, if postitive get x-rays to r/o positive findings if possible

Section 2

Question Answer
14 Y hit side of head baseball. unconscious few min recovers, 1 hour later loses cuncscious again, R pupil fixed/dilR epid hematoma
dx epid hematomaCT wo contrast
epid hema txemergent decompression (craniotomy)
epid hematomathink trx to middle meningeal artery/foramen spinosum
32 YO accident, black out regains then coma, fixed dil R pupilthink acute subdural b/c no hx of trx side of head
subdural hema dxCT+ cervical spine davis series (in flexion/ext/normal)
subdural hema txemerg craniotomy, poor prog
77 M "senile" over 4 weeks, fell from horse 1 wk before sx onsetChronic subdural hematoma (get CT)
subdural hemalz of bridging veins
trx, coma, racoon eyes, ecchy behind earbasilar skull frx, need CT and davis series
Basilar skull frx Txneurosurg consult + ABX`
any intra-cranial bleedneed emergent decomp (crainotomy)
any traumaneed X-ray of cervical spine
alkalosis (draino) burnscopious immediate profuse irrigation for atleast 30 min before going to ER
electrical burndeep destruction, surgical debride, worry about myoglobinemia, with causes myogolobin uria and renal failure
electric burn txIVF, mannitol diuretic, alkalinization of urine
respiratory burnmost pt will not have face burn, dx with bronchoscopy, immediate intub
circumfrential burnsup massive emdema/compartment syndrome, 1st sign of comprimised get escharotomy
kid vs adult 3rd degree burnkid= deep bright red, adult= white leathery
kid burnthink child abuse, get silvadene, may report to CPS
2nd degree burnmoist, blister, painful
burn %9% head/arm, 18 for leg, 36 for whole trunk
burn fluid mx4cc * kg * %burned, L. Ringers 1/2 during first 8 hours, 1/2 for next 16
kid burnhead is 18% each leg is 14%
colloidsonly use for burn mx in 2nd day
burn CVP and hourly urine outputCVP= keep below 20, Urine Output 1cc/perKg/perHr. do 2CC if electric burn or need to get escharotomy
3rd day post burn and IV fluids pees alotnormal, fluid is returning from burn edema
burn txcleansing, silvadene, sulphamyelon if deep, abx ointment near eyes(avoid silvadene), rehab starts day 1
42 to white dry leathery, anesthetic upper thighget excised and grafted because not crazy bad.
1 cm sharp cut over knucklehuman bite, no rabies shot, surgical exploration by ortho made be required.
fair skin, hard raised waxy mass on nose for 3 yrbasalcell cx
upper lip and abovethink basal cell cx
fair skin, ulcer lower lip 8 mo, pipe smokersq cell cx (resect with 1 cm margins + local rads
fair skin, shoulder, pigemented lz abnormal ABCDEmelanoma or dysplastic nevus
melanoma Clark lvl 1 or 2 or <.75 mmmargin free excision
melanoma Clark > lvl 2 and > .75mmwide local incision with 2/3 cm margin
melanomameta to LN liver lung brain bone, but can go anywhere