Surgery videos & books

2022-05-15 17:58:28 Open / Comment

2022-05-09 18:52:01 Postoperative wound infections usually occur between the fifth and eighth postoperative days. Evidence of a wound infection within the first 24 hours after surgery should alert the physician to the possibility of necrotizing fasciitis. Necrotizing fasciitis is a lifethreatening infection most commonly caused by clostridial myositis and hemolytic streptococcus. In addition to spiking temperature, the patient may be septic with tachycardia, leukocytosis, and hemodynamic instability. On examination of the wound, crepitus (gas in the soft tissue) and a dishwater-appearing effluent may be apparent. Early diagnosis by opening the wound and sending a Gram’s stain is critical. The Gram’s stain will reveal a mixed flora of gramnegative rods and gram-positive cocci. Although broad-spectrum antibiotics are indicated, definitive treatment requires emergent aggressive debridement of the affected tissues. Hyperbaric oxygen treatment has no role in the acute management of necrotizing fasciitis. Diabetic patients are especially prone to necrotizing fasciitis. Fournier’s gangrene is a type of necrotizing fasciitis that affects the groin and perineum. The mortality rate can be as high as 75%. Open / Comment

2022-05-08 18:51:55 55) A 64-year-old diabetic male undergoes a right hemicolectomy for an adenocarcinoma of the cecum. On the first postoperative night, he becomes tachycardic and is noted to have a temperature of 102.8°F. His surgical incision is tender with erythema and murky… Open / Comment

2022-05-08 18:50:26 55) A 64-year-old diabetic male undergoes a right hemicolectomy for an adenocarcinoma of the cecum. On the first postoperative night, he becomes tachycardic and is noted to have a temperature of 102.8°F. His surgical incision is tender with erythema and murky discharge. Which of the following is the most important intervention? Open / Comment

2022-05-02 13:56:01 Carcinoids are the most common neoplasm of the appendix and arise from Kulchitsky cells, a type of enterochromafin cell. Aside from the appendix, the next most frequent site of involvement is the small bowel followed by the rectum. Appendiceal and rectal carcinoids are almost never associated with carcinoid syndrome unless metastatic disease is present. Small bowel carcinoids are more commonly multifocal, metastatic, and associated with carcinoid syndrome. The majority of appendiceal carcinoids are located at the tip and the extent of surgical resection depends on the size and resulting malignant potential. Lesions less than 1 cm rarely metastasize and therefore require only simple appendectomy as in this question. Lesions greater than 2 cm require a right hemicolectomy due to the high potential for metastasis. Partial small bowel resection is indicated for a carcinoid of the small intestine. Partial cecectomy and total abdominal colectomy are not appropriate options. Open / Comment

2022-05-01 13:55:23 54) Following an uneventful appendectomy for acute appendicitis, the pathology report reveals the presence of a 1 cm carcinoid at the tip of the appendix. The patient has been otherwise asymptomatic. What is the most appropriate intervention? Open / Comment

2022-05-01 13:54:25 54) Following an uneventful appendectomy for acute appendicitis, the pathology report reveals the presence of a 1 cm carcinoid at the tip of the appendix. The patient has been otherwise asymptomatic. What is the most appropriate intervention? Open / Comment

2022-04-25 05:08:01 Hamman’s crunch” is precordial crackles heard on auscultation that correlate with heart sounds in the setting of mediastinal emphysema and is suggestive of esophageal perforation. When present along with subcutaneous emphysema of the chest and neck, pneumomediastinum from an esophageal perforation is the most likely diagnosis. The most common cause of esophageal perforation is iatrogenic, but it may be spontaneous (Boerhaave’s syndrome) or secondary to a malignancy or stricture. Diagnosis is often made after clinical suspicion by endoscopy or a swallow study with water-soluble contrast. If diagnosed early (within 24 hours), a primary repair is the first approach to treatment. Closure is dependent on the amount of infected or necrotic tissue, tension on the anastomosis, etiology of the perforation, and the ability to adequately drain the contaminated areas. Late perforations may be complicated in their management, requiring several procedures or diversion to provide for adequate healing. Open / Comment

2022-04-24 05:07:01 53) A 49-year-old male presents with crushing substernal pain and rules out for a myocardial infarction. He is noted to have subcutaneous emphysema of the chest and neck and precordial crackles that correlate to his heartbeat but not his respirations. Which… Open / Comment

2022-04-24 05:05:34 53) A 49-year-old male presents with crushing substernal pain and rules out for a myocardial infarction. He is noted to have subcutaneous emphysema of the chest and neck and precordial crackles that correlate to his heartbeat but not his respirations.
Which of the following is the most likely diagnosis? Open / Comment