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Surgery > Block 8- Appendix, Thyroid, Abdominal Trauma > Flashcards

Block 8- Appendix, Thyroid, Abdominal Trauma Flashcards

1
Q

Which of the ff. Is an indication for operative intervention in a patient with an isolated duodenal hematoma?

A

Contained retroperitoneal leak

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2
Q

The most appropriate treatment for a duodenal hematoma that occurs from blunt trauma is

A

Observation

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3
Q

Damage control surgery (DCS)

A

A. Limits enteric spillage by rapid repair of small bowel injuries with whipstitch, and complete transection with a GIA stapling device

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4
Q

A 23 year old man fell off his skateboard, reporting blunt injury to his upper abdomen. Abdominal CT and magnetic resonance cholangiopancreatography (MRCP) confirmed he suffered transection of the main pancreatic duct at the middle of the pancreatic body. Which of the ff. would be the most appropriate next step in management?

A

A. Distal pancreatectomy with splenic preservation

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5
Q

The most appropriate treatment of gunshot wound to hepatic flexure that cannot be repaired primarily is

A

Resection of the right colon with ileocolostomy

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6
Q

A 45-year-old male came in at the ER with multiple stab wounds on the upper quadrant of the abdomen, NGT was inserted draining to a bloody to coffee ground drain. The patient is GCS 15 with vital signs as follows: BP 90/60, CR: 120, T: 37, RR:18, O2 saturation: 98%. What is your next step?

A

A. Schedule for emergency exploratory laparotomy

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7
Q

While waiting for the RT-PCR result, the patient deteriorated and was intubated and brought to the OR. Upon opening, there are multiple stab injuries to the body of the stomach that are closely situated together. What is your operative procedure?

A

Segmental resection and anastomosis

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8
Q

In which portion of the duodenum is the ampulla of Vater located?

A

A. 2nd

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9
Q

A 56 year old male patient came in with blunt abdominal injury secondary to vehicular crash. Upon physical examination, there was a note of abdominal tenderness on all quadrants. The patient was scheduled for STAT laparotomy. Upon opening of the abdomen, 3 x 3 cm periduodenal hematoma was observed in the first portion of the duodenum. No other injuries were seen. What is your next step?

A

A. It should be explored to exclude underlying perforation

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10
Q

With the same case scenario as mentioned above, the patient came into the trauma room with a soft abdomen and stable vital signs. There was minimal tenderness and the right upper quadrant area upon deep palpation. No other injuries were noted. What is your next step?

A

A. Request for abdominal ct scan with iv contrast

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11
Q

Please refer to case #10. The CT scan showed periduodenal hematoma approximately 2.2 x 1.8 cm in size, no free peritoneal fluid scene and pneumoperitoneum. What is your next step

A

A. Insert the NGT and start parenteral nutrition

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12
Q

An 18-year-old male patient was involved in a mass vehicular crash. He came in GCS 7 and was intubated, with note of upper quadrant hematomas in his anterior abdomen. Vital signs were BP: 60 palpatory, CR: 140s, RR: 22, T: 36, O2 saturation: 88%. After resuscitation the vital signs were stabilized but erratic. The abdomen was distended with boardlike rigidity upon examination. What is your next step?

A

A. Schedule patient for laparotomy and resection with anastomosis of the involved bowel

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13
Q

All of the following are components of damage control surgery, except?

A

Start early feeding per orem

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14
Q

The patient was scheduled for a second look procedure after stabilization upon full kocherization of the duodenum, a note of leaking bile on the area was noted with an avulsed tissue of the second portion of the duodenum. The surgeon should explore the area and look for what structure?

A

A. Ampulla of Vater

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15
Q

After examination of the second portion of the duodenum no any other injuries were noted. A primary repair was done in a transverse manner but a mild narrowing in the lumen was observed due to tissue loss. What is your next procedure?

A

A. Do a pyloric exclusion

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16
Q

A 26-year-old female came in with multiple self inflicted stab wounds in her anterior abdomen. Omental evisceration was seen in the left paraumbilical area stab injury. The patient was scheduled for laparotomy. Omentectomy was done prior to opening of the abdomen. No other associated injuries were seen except for a hematoma in the jejunum. As a part of exploration, what portion of the small bowel should be examined?

A

The bowel should be examined from the ligament of Treitz to the ileocecal valve

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17
Q

A 28 year old male patient came in with a shotgun injury in his anterior abdomen by an unknown assailant. A huge abdominal defect was observed with small bowel evisceration. The patient was then scheduled for laparotomy. Almost all of the entire length of the small bowels were devitalized and was resected with a remaining bowel of approximately 80 cm of the jejunum from the ligament of treitz. What is the most common complication expected in this patient?

A

A. Short bowel syndrome

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18
Q

The pancreas receives its blood supply from what artery?

A

A. Celiac artery
B. Superior mesenteric artery

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19
Q

In damage control surgery involving the distal pancreas or tail of the pancreas in a multiply injured patient, what procedure should be done?

A

En bloc resection of the distal pancreas

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20
Q

Which of the ff. statements is correct?

A

A. The management of pancreatic trauma is determined by the presence or absence of the pancreatic duct injury

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21
Q

A 25 year old man presents ff. blunt trauma to the abdomen. FAST exam shows injury to the spleen. His HR is 110, RR is 25, and he is mildly anxious. What percentage of his blood volume do you estimate he has lost?

A

A. 15-30%

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22
Q

A 45 year old, otherwise healthy woman presents after a moving vehicle accident. She is hemodynamically stable and with only minimal tenderness in her right upper quadrant. A FAST exam is positive with fluid seen in the hepatorenal fossa and the pelvis. Which of the ff. is the next best step in her management?

A

A. CT scan

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23
Q

A stable patient with a Grade III splenic laceration has the ff. laboratory results 2 hours after admission: Hg/Hct 8.7/29 Pit 70,000 INR 1.3.

A

A. Transfuse PRBCs only

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24
Q

Quadrate lobe is located in what functional surgical segment of liver?

A

A. Medial inferior

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25
Q

In performing hepatic resection, a knowledge of the different lobes and segments of the liver is mandatory. The right and left lobes of the liver are separated by an imaginary plane (Cantlie line) that passes between the inferior vena cava (IVC) and which of the following?

A

Gallbladder

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26
Q

A 20-year-old man is brought to the emergency department with a gunshot wound to the abdomen. His blood pressure is 70 systolic and his heart rate is 140 beats per minute (bpm). He is taken directly to the operating room for an exploratory laparotomy. A large, actively bleeding liver laceration is found. A pringle maneuver is performed as part of the procedure to control his bleeding. The pringle maneuver compresses which structures?

A

Portal vein, hepatic artery, and CBD

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27
Q

The ff. statements concerning the liver are correct EXCEPT which?

A

A. It receives highly oxygenated blood from the portal vein

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28
Q

The management option for spleen injury on stable patients without associated multiple injuries.

A

Non-operative

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29
Q

The management option for spleen injury on hemodynamically unstable patient, multiple associated injuries, hilar injuries, completely shattered parenchyma.

A

Splenectomy

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30
Q

The management option for liver injury with shallow slowly oozing injuries.

A

A. Direct suture

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31
Q

The management option for liver injury with simple non-bleeding lacerations

A

A. Non-operative

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32
Q

The management option for liver injury on unstable patients who are coagulopathic, acidotic, and hypothermic.

A

A. Selective hepatic artery ligation

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33
Q

Liver complication that is caused by a vascular rupture into a bile duct; characterized by triad of RUQ pain, upper GI hemorrhage, jaundice?

A

A. Hemobilia

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34
Q

The management for the liver complication that is caused by a vascular rupture into a bile duct; characterized by triad of RUQ pain, upper GI hemorrhage, jaundice?

A

A. Angioembolization

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35
Q

What is the second most frequently injured organ in blunt abdominal trauma?

A

Spleen

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36
Q

rFocused assessment with sonography in trauma (FAST) examination is sensitive for detecting what volume of intraperitoneal fluid?

A

A. >250 сс

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37
Q

Indication for laparotomy in penetrating abdominal trauma

A

A. Hemodynamic instability
B. Obvious peritoneal signs
C. Herniated abdominal organs

38
Q

Kehr sign seen in blunt abdominal trauma is

A

A. Pain over left shoulder

39
Q

AAST grade imaging criteria for splenic organ injury with subscapular hematoma 10-50% surface area, intraparenchymal hematoma <5 cm, and parenchymal laceration 1-3 cm.

A

A. II

40
Q

AAST grade imaging criteria for splenic organ injury with subscapular hematoma >50% surface area, intraparenchymal hematoma <1 cm, and parenchymal laceration >3 cm.

A

A. III

41
Q

It is located between the ileum and the ascending colon

A

A. Cecum

42
Q

What is the blood supply in question 41?

A

A. Ileocolic artery of SMA

43
Q

It connects the descending colon to the rectum

A

A. Sigmoid colon

44
Q

It is located on the right side, extending from the cecum upward.

A

A. Ascending colon

45
Q

All of the ff. are blood supply of the rectum, EXCEPT?

A

Sigmoidal branches of IMA

46
Q

It is the most common cause of penetrating injury to the colon

A

Gunshot

47
Q

All of which are TRUE regarding colonic injuries EXCEPT:

A

For patients with penetrating abdominal wounds, A. extensive preoperative evaluation is necessary

48
Q

According to the American Association for the Surgery of Trauma Organ Injury Scales for Colon, Contusion hematoma without devascularization are classified as:

A

A. GRADE I COLON INJURY

49
Q

Full thickness, non destructive colon injury, AAST Grade 3-4. What is the management?

A

PRIMARY REPAIR

50
Q

What is the most common traumatic rectal injury?

A

A. Gunshot wound

51
Q

All are correct

A

A. Stable patients with blunt injury and selected patients with penetrating trauma should undergo CT scanning with contrast.
C. If an injury is identified, delayed operation is indicated.
D. For stable patients with a penetrating injury and blood present on digital rectal exam sigmoidoscopy is indicated

52
Q

According to American Association for Surgery of Trauma Organ Injury Scales for Rectum, extension into the perineum.

A

IV

53
Q

According to the American Association for the Surgery of Trauma Organ Injury Scales for Rectum, Laceration <50% of circumference is classified as

A

A. GRADE II RECTAL INJURY

54
Q

What should be the management for a Full-thickness Intraperitoneal Rectal Injury AAST Grades III-IV

A

A. Primary repair

55
Q

Which of the ff. is the management for Extraperitoneal rectal injuries?

A

A. Diversion
B. Debridement
C. Presacral drainage

56
Q

Which of the ff. are diagnostic procedures for traumatic rectal injuries?

A

A. X-ray pelvis and abdomen
B. Rigid proctosigmoidscope
C. Water soluble contrast study

57
Q

Most common congenital cervical anomalies along the migratory path of the thyroid

A

A. Thyroglossal duct cyst

58
Q

Treatment for Lingual Thyroid

A

A. Exogenous thyroid hormone

59
Q

Thyroglossal duct atrophies and may remain as fibrous bands which can be seen in 50% of individual

A

Pyramidal lobe

60
Q

Surgical indication as a treatment for Hyperthyroid

A

A. Have large goiters (>80 g) causing compressive symptoms

61
Q

Hyperthyroidism accompanied by fever, central nervous system agitation or depression, and cardiovascular and GI dysfunction, including hepatic failure precipitated by abrupt cessation of antithyroid medications

A

A. Thyroid storm

62
Q

Hypothyroid which is characterized by neurologic impairment and mental retardation

A

A. Cretinism

63
Q

Thyroiditis with severe neck pain, fever, and chills with commonly isolated bacteria is Streptococcus

A

A. Acute thyroiditis

64
Q

Clinical factor which support of thyroid malignancy

A

A. family hisory of thyroid cancer

65
Q

Physical examination findings suggestive of malignancy of the thyroid

A

A. Firm and hard nodule

66
Q

Indication of thyroid mass biopsy

A

suspected malignant thyroid nodule

67
Q

When should ultrasound guided FNAB be done for thyroid?

A

A. Multinodular goiter

68
Q

Among patients suspected to have thyroid cancer, what are the indications for pre-op evaluation of vocal cord function

A

A. Thyroid cancer with extrathyroidal extension

69
Q

Indication for completion thyroidectomy

A

A. Confirmed contralateral malignancy

70
Q

Who should be screened for thyroid cancer?

A

A. Family history of thyroid cancer

71
Q

Among patients who underwent FNAB, when is molecular testing warranted?

A

A. Indeterminate FNAB diagnosis

72
Q

Physical signs which shows pain in the right lower quadrant after release of gentle pressure on the left quadrant area?

A

A. Rovsing’s sign

73
Q

Is often the point of maximal tenderness in a patient with an anatomically normal appendix?

A

A. One-third of the distance between the ASIS and the umbilicus

74
Q

An imaging that suggests appendicitis which includes a diameter of greater than 6 mm, pain with compression, presence of an appendicolith, increased echogenicity of the fat, and periappendiceal fluid?

A

Abdominal Ultrasound

75
Q

It is routinely performed in children undergoing chemotherapy, compromised hosts with an unclear physical exam, patients with Crohn’s disease with a normal cecum, patients traveling to remote places with no urgent care and in patients undergoing cytoreductive operations for ovarian malignancies.

A

A. Incidental Appendectomy

76
Q

A term broadly describes a mucus-filled appendix that could be secondary to neoplastic or non neoplastic pathology

A

Appendiceal Mucocele

77
Q

Are considered the standard of care for patients with PMP syndrome from appendiceal primaries?

A

A. Cytoreductive Surgery and HIPEC

78
Q

Most common aerobic bacteria isolated in perforated appendicitis?

A

A. E. Coli

79
Q

An oblique incision at the right lower quadrant for appendectomy?

A

A. McBurney’s Incision

80
Q

What is the arterial blood supply of the appendix?

A

Ileocolic Artery

81
Q

In the event of the retraction of the appendiceal artery or unexpected bleeding, the right lower quadrant incision can be extended medially called?

A

A. Fowler’s Extension

82
Q

Walled-off right lower quadrant abscess of a perforate appendix called?

A

Phlegmon Formation

83
Q

Menstrual history with no fever or leukocytosis and mid menstrual cycle abdominal pain is called?

A

Mittel-schmerz

84
Q

Right lower quadrant pain with internal rotation of the hip?

A

A. Obturator Sign

85
Q

Right lower quadrant pain with internal rotation of the hip?

A

A. Obturator Sign

86
Q

Right lower quadrant pain with flexion of the hip?

A

A. Iliopsoas Sign

87
Q

Complicated appendicitis are treated with antibiotics for how many days?

A

A. 3-7 days

88
Q

CT Scan findings suggestive of appendicitis?

A

A. Enlarged lumen and double wall thickness greater than 6mm, periappendiceal fat stranding

89
Q

Recurrent right lower quadrant abdominal pain not associated with febrile illness with imaging findings suggestive of appendicolith or dilated appendix?

A

A. Chronic appendicitis

90
Q

An uncommon complication after surgery is the development of appendicitis in an incompletely excised appendix greater than 0.5cm in length?

A

A. Stump appendicitis

91
Q

Treatment of incompletely excised appendicitis?

A

A. Re-excision

92
Q

Carcinoid tumor of the appendix less than 1 cm is managed as?

A

A. Negative Margin Appendectomy

Surgery (9 decks)

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