Surgical Disorders Quick Review


Brain Disorders
traumatic head injury, conscious in ER followed by unconsciousnessEpidural hematoma (“lucid interval”)
“Worst headache of my life”Subarachnoid hemorrhage
Pituitary tumor, pancreatic tumor, and parathyroid tumorMEN- I
rapid correction of hyponatremiaCentral pontine myelinosis
Altered Mental Status
Confusion, ataxia, and ophthalmoplegiaWernicke’s encephalopathy
Hearing loss, tinnitus, and vertigoMénière’s disease
Eye Disorders
traumatic blinding in one eye followed by blindness
in the contralateral eye 2 weeks later
Sympathetic ophthalmia
Mitotic pupil, ptosis, and anhydrosisHorner’s syndrome
Ear Disorders
Otorrhea (clear) and Battle’s signBasilar skull fracture
Nose Disorders
Adolescent boy with nasal obstruction and recurrent epistaxisJuvenile nasopharyngeal angiofibroma
Mouth Disorders
Buccal mucosa with pigmentationPeutz-Jeghers syndrome
Marfanoid body habitus and mucosal neuromasMEN II-b
Necrotizing migratory erythemaGlucagonoma
Bleeding gums and wound dehiscenceVitamin C deficiency

Neck Disorders

Child with MIDLINE neck massThyroglossal duct cyst
Child with LAtERAL neck massBranchial cleft cyst
Epiglottis Disorders
Child <5 years of age sitting upright and drooling, with “hot-potato”
Thyroid Disorders
Psammoma bodiesPapillary thyroid cancer
Thyroid tumor with AMYLOID tissueThyroid medullary cancer
Medullary thyroid cancer, pheochromocytoma, and hyperparathyroidismMEN-IIa
Parathyroid Disorders
PALPABLE neck tumor and hypercalcemiaParathyroid cancer

Upper Extremity Disorders

Arm pain and syncope with arm movementSubclavian steal syndrome
Supracondylar fracture and contracture of forearm flexorsVolkmann’s contracture

Chest Disorders

EsophagusEmesis, chest pain radiating to back, and mediastinal airBoerhaave’s
Vomiting, retching, and epigastric painMallory-Weiss tear
Newborn with inability to “pass an NG “Esophageal atresia
AortaChest pain radiating to back and described as a “tearing” painAortic dissection
Hypertension, diaphoresis (episodic), and palpitationsPheochromocytoma
Cardiac Disorders
Angina, syncope, and CHFAortic stenosis
Hypotension, decreased, heart sounds, and JVDPericardial tamponade
Four ribs broken in two places and pulmonary contusionFlail chest
Shortness of Breath
Femur fracture, respiratory failure, petechiae, and mental status changesFat embolism
tracheal deviation, decreased breath sounds, and hyperresonanceTension pneumothorax
Pleuritic Chest Pain
tobacco use, asbestos exposure, and pleuritic chest painMesothelioma
Fever, central line, and HYPERglycemiaCentral line infection
18-year-old woman with bloody nipple dischargeDuctal papilloma

Abdominal Disorders

LiverRUQ pain, travel, and exposure to sheepHydatid cyst
Liver abscess with “anchovy paste”Amebic abscess
Female taking birth control pills with liver massHepatic adenoma
Liver tumor with “central scar”Focal nodular hyperplasia
RUQ bruit and CHF in young adultLiver hemangioma
A 25-year-old man with liver mass with fibrous septae and NO history of cirrhosis or hepatitisFibrolamellar hepatocellular carcinoma
GallBladderA 45-year-old woman with RUQ pain or 12 hours, fever, and leukocytosisAcute cholecystitis
RUQ pain, jaundice, and feverCholangitis
PylorusInfant with projectile
Pyloric stenosis
DuodenalUlcer and decreased pain with foodDuodenal ulcer
Misc.Upper GI bleed, jaundice, and RUQ painHemobilia
PancreasEpigastric pain radiating to back, with nausea and vomitingPancreatitis
Epigastric pain radiating to back and any ecchymosisHemorrhagic pancreatitis
Gallstones, epigastric pain radiating to back, and nauseaGallstone pancreatitis
Pancreatitis and palpable epigastric massPancreatic pseudocyst
Elderly man with large non-tender palpable gallbladderPancreatic cancer (Courvoisier’s sign)
Pancreatic mass, gallstones, diabetes, and diarrheaSomatostatinoma
Irritability, diaphoresis, weakness, tremulousness, and palpitationsInsulinoma
“Currant jelly” stools and abdominal colicIntussusception
Appendectomy followed by ever and abdominal pain on postoperative day #7Peritoneal abscess
LLQ pain, ever, and change in bowel habitsDiverticulitis
Institutionalized, abdominal pain, vomiting, and distention, with proximal colonic dilationSigmoid volvulus
Pneumaturia and LLQ painColovesicular fistula
Newborn with failure to pass meconium in first 24 hoursHirschsprung’s
Lower Abdominal Disorders
Jejunal ulcersZollinger-Ellison syndrome
Abdominal pain, fever, hypotension, HYPERkalemia, and HYPOnatremiaAdrenal insufficiency (Addisonian crisis)
Newborn with pneumatosisNecrotizing enterocolitis (NEC)
Child with abdominal mass that crosses midlineNeuroblastoma
Child <4 years of age with abdominal tumor
that does NOt cross midline
Wilms’ tumor
Elderly woman, SBO, and air in biliary tractGallstone ileus
Lower GI bleed, technetium pertechnetate scanMeckel’s diverticulum
Flushing, diarrhea, and right-sided heart failureCarcinoid
Elevated urine 5-HIAACarcinoid
Desmoid tumor, oste oma, and colon cancerGardner’s syndrome
Abdominal pain, hypotension, and abdominal pulsatile massRuptured abdominal aortic aneurysm (AAA)
Abdominal pain “out of proportion” to abdominal examMesenteric ischemia
Caput medusaPortal hypertension
Increasing creatinine on ACE inhibitorRenal artery stenosis
Abdominal pain, diarrhea, and anal fistulaeCrohn’s disease
Increased peak airway pressure, low urine output, and urinary bladder 25 mmHgAbdominal compartment syndrome
Infant with bilious vomitingMalrotation
Newborn with an abdominal defect and umbilical cord on sacOmphalocele
IV antibiotics, fever, diarrheaClostridium difficile pseudomembranous colitis
Anal Disorders
Excruciating pain with bowel movementAnal fissure
Hematochezia and tenesmusRectal cancer

Pelvic Disorders

PelvisElderly woman with pain down inner aspect of thighObturator hernia (Howship-Romberg sign)
Crush injury and dark urineMyoglobinuria
BladderA 60-year-old white man with painless hematuriaBladder cancer

Back Disorders

Flank Pain
Hematuria, flank pain, and abdominal mass (palpable)Renal cell carcinoma

Urinary Disorders

Massive urine output and HYPERnatremiaDiabetes insipidus
Increased urine osmolality, HYPOnatremia, and low serum osmolalitySIADH

Lower Extremity Disorders

Advancing crepitus, fever, and blood blistersNecrotizing fasciitis
Thigh Disorders
tibia fracture, “pain out of proportion,” pain on
passive foot movement, and palpable pulses
Compartment syndrome

Infectious Disorders

Fever on postoperative day #1, with “bronze” weeping, tender woundClostridial wound infection

Metabolic Disorders

EKG with “peaked” wavesHyperkalemia
EKG with flattening of T waves and U wavesHypokalemia
Polydipsia, polyuria, and constipationHypercalcemia
Hypokalemia refractory to IV potassium supplementationHypomagnesemia

Bleeding Disorders

Factor VIII deficiencyHemophilia A

Substance Abuse

A 40-year-old man with tachycardia/hypertension
and cofusion on postoperative day #2
Alcohol withdrawal

Operative Disorders

High INtRAoperative feverMalignant hyperthermia

Post-Op Disorders

Day 1atelectasis
Day 2pneumonai
Day 3UTI
Day 5DVT
Day 7wound infection
Day 10deep abscess (CT scan)