BTK-AccessSurgery

@accesssurgery, @gmdoherty, @pubmeg, and @behindtheknife bring you #absitequestionoftheweek every Wednesday, with answers revealed every Sunday.

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While you wait for more questions from @gmdoherty and @AccessSurgery, why not grab a copy of @BehindTheKnife’s ABSITE Podcast Companion? Out now on Amazon! Paperbacks coming soon...https://t.co/zXfZI9ryrC

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Local anesthetics work by binding of the cationic form of the molecule to transmembrane sodium receptors in the inactivated-closed state. More importantly, remember max dosing is 4-4.5 mg/kg lidocaine and 2-2.5 mg/kg bupivacaine without epi. #absitequestionoftheweek

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#absitequestionoftheweek The mechanism of action of local anesthetics is best described as (answer choice is in this format - Binding of ______ form of local anesthetic to ______ receptors):

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#absitequestionoftheweek The mechanism of action of local anesthetics is best described as (answer choice is in this format - Binding of ______ form of local anesthetic to ______ receptors):

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Something to study, but not super high yield for ABSITE: This is most likely a reactive lymph node. Branchial cleft cysts are usually described along the SCM and wax/wane in size with drainage. #absitequestionoftheweek

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#absitequestionoftheweek A 10-year-old girl presents with a solitary left-sided submandibular neck mass that has been present for a month. It is nontender and initially grew over the course of 2-3 days and then has not grown further. The most likely etiology of this mass is:

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#absitequestionoftheweek A 10-year-old girl presents with a solitary left-sided submandibular neck mass that has been present for a month. It is nontender and initially grew over the course of 2-3 days and then has not grown further. The most likely etiology of this mass is:

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#absitequestionoftheweek Correct! Lefort II does not include the mandible. Check their vision, CNs, and airway. Management = internal fixation.
(📸: @UWRadiology)
Tune in Wednesday afternoons for a new question each week!

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#absitequestionoftheweek Le Fort II fracture entails injuries to all of the following EXCEPT

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#absitequestionoftheweek Le Fort II fracture entails injuries to all of the following EXCEPT

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#absitequestionoftheweek In the first 24 hours, plasmatic imbibition keeps skin grafts alive. This process, which traces its origins from plant biology, is when normal skin surrounding the graft transfers nutrients via plasma which forms a layer between the two.

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#absitequestionoftheweek How does a skin graft survive within the first 24 hours?

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#absitequestionoftheweek How does a skin graft survive within the first 24 hours?

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This seems to be the toughest question so far... the correct answer is CT scan of the head! Based on his symptoms, localization of the disease does not require CT head. #absitequestionoftheweek

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#absitequestionoftheweek A 60-year-old man has had recurrent episodes of amaurosis fugax and hemiparesis for the last year. Which of the following measures would be LEAST helpful in the workup of this man’s disorder?

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#absitequestionoftheweek A 60-year-old man has had recurrent episodes of amaurosis fugax and hemiparesis for the last year. Which of the following measures would be LEAST helpful in the workup of this man’s disorder?

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#absitequestionoftheweek Excellent job! Carotid endarterectomy has no benefit if the carotid is completely occluded as collaterals have already developed. Below image is courtesy of @gmdoherty showing the steps of a CEA. @AccessSurgery @MHMedical

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#absitequestionoftheweek Carotid endarterectomy:

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#absitequestionoftheweek Carotid endarterectomy:

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Great job! In this stable patient with RICA dissection after blunt injury, completing the workup of associated injuries and medical management of the dissection are more appropriate than proceeding to the operating room for neck exploration and repair. #absitequestionoftheweek

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#absitequestionoftheweek A 22yoM presents to ED after being struck in the neck with a baseball bat. Initial VS: GCS 15, P 96 bpm, R 16, and SBP 125. Arteriogram is performed and reveals a right internal carotid artery dissection.

Initial mgmt includes all the following except:

[BTK-AccessSurgery @ABSITEQofWeek]

#absitequestionoftheweek A 22yoM presents to ED after being struck in the neck with a baseball bat. Initial VS: GCS 15, P 96 bpm, R 16, and SBP 125. Arteriogram is performed and reveals a right internal carotid artery dissection.

Initial mgmt includes all the following except:

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#absitequestionoftheweek Of the following, the groin hernia that is most likely to incarcerate and strangulate is a:

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Way to go! Laparoscopic surgery generally has higher intraoperative costs. However, it is key to note that due to shorter hospital LOS and other factors, laparoscopy is sometimes less expensive overall than open. #absitequestionoftheweek @gmdoherty @AccessSurgery @MHMedical

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#absitequestionoftheweek Factors associated with a laparoscopic inguinal hernia repair compared to an open repair include all of the following except:

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#absitequestionoftheweek Factors associated with a laparoscopic inguinal hernia repair compared to an open repair include all of the following except:

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Great job! A defect in collagen synthesis is not as likely to cause recurrence of inguinal hernias after repair when compared to overlooking an indirect sac, tension on the fascial repair, a missed femoral hernia, or failure to close the fascial defect adequately.

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#absitequestionoftheweek The least common reason for recurrence of a groin hernia within the first year after repair is

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#absitequestionoftheweek The least common reason for recurrence of a groin hernia within the first year after repair is

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#absitequestionoftheweek Shouldice repair = 4-layer suture. Absolute contraindication to lap hernia repair is intolerance of general anesthesia. The one most got incorrect - MRI is more sensitive than CT scan. See the attached photos of a fluid collection not detected on CT.

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#absitequestionoftheweek A four-layer, suture repair of an inguinal hernia is a