Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Didactics > Flashcards

Didactics Flashcards

1
Q

Steps in treatment for bleeding after pelvic fracture

A

Start w/ binder around pelvis to reduce pelvic volume

If no improvement, angiography to embolize artery that is bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Current indications for laparoscopic hernia repairs

A

For uncomplicated unilateral hernia repair, open is preferred 2/2 lower recurrence rate

2 indications for lap hernia repair = bilateral and recurrent hernias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Differentiate the two types of ileostomy

A

End ileostomy = opening in the end of colon to the outside

Loop ileostomy = opening connects back to more colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe abdominal Xray findings of an SBO

A

Small bowel obstruction:

  • distended loops (considered distended for small bowel if over 3cm diameter)
  • presence of air fluid levels, sometimes referred to as ‘step ladder’ pattern of differing fluid levels
  • possibly string of beads/pearl sign in abdomen representing gas bubbles trapped in a fluid-filled lumen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

3 steps to take when pt is hypercalcemia

A

Hypercalcemia tx

  1. fluids (tons of fluid!!!)
  2. saline
  3. alendronate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe dumping syndrome

A

In gastric bypass pts: feeling of diaphoresis, tachycardia, vasovagal symptoms, faint/nausea/diarrhea after large food intake

2/2 hypovolemia (fluid rushes into intestines after hyperosmolar food load dumped in too quickly) and hypoglycemia (huge insulin secretion 2/2 carbo-load)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

E-FAST vs. FAST

A

FAST = focused assessment w/ sonography in trauma: assess pericardial, pleural, and peritoneal cavities for fluid/air

E-fast is the extended version in which you also look for hemothroax and pneumothroax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most dangerous complication of gastric bypass surgery

(a) Tx

A

Leak at the anastomotic site- seen in about 1% of pt

(a) Tx = immediate re-op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Differentiate congenital vs. acquired hernias

A

Congenital hernias are 2/2 failure of the processus vaginals to close, while acquired hernias are due to gradual weakining fo the abdominal wall tissue over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most common etiology of SBO

A

Post-op

-prior abdominal surgery!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which nerve runs through the internal ring?

A

Genital branch of the genitofemoral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Key step before giving meds to delirious trauma pt

(a) What meds could you give?

A

Need to rule out hypoxia before giving meds to calm down a delirious pt

(a) If QTc is normal- can give Haldol, otherwise can consider Ativan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How long does it take a colonic polyp to develop into cancer?

A

7 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why does someone w/ a fever require increased maintenance fluids?

A

Bulk of maintenance fluids is used in metabolism, so pts w/ increased metabolic demand (ex: fever/inflammatory state, hyperthyroid) require more fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

At what GCS do you intubate?

A

Intubate for GCS under 9, so 8 or below = intubate

“GCS 8, intubate”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Rank from most to least invasive: gastric bypass, lap band, sleeve gastrectomy

Compare/contrast benefits

A

Most invasive = Gastric bypass

  • about 70% excess body wt lost
  • Risks: leak in 1%, stricture in 5%, internal hernia, severe dumping syndrome

Middle = Sleeve

  • increasing in popularity, cut the stomach but no anastamosis, huge decrease in grehlin (b/c no fundus)
  • average 60% EWL

Least invasive = Lap band- foreign object w/ strict f/u for monthly adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is RSI? Give overview of procedure

A 
RSI = rapid sequence intubation, used when intubating/putting under anesthesia who hasn't had time to be NP (ex: trauma pt) and therefore is at high risk of aspiration 
RSI = pharmacologically induced sedation and nueormuscular paralysis prior to tracheal intubation

2 steps to RSI

  1. Induction agents for prompt unconsciousness
    - ketamine, propofol
  2. Neuromuscular blockers for paralysis
    - sux (succinylcholine)
    - roc (rocuronium)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe why appendiceal pain starts generalized then migrates to RLQ

A

At first inflammation in the area causes referred generalized pain to the umbilicus via the T8-T10 dermatome

Then as the appendix becomes inflammed enoughed to hit the peritoneum, there is somatic pain localizable to the RLQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List the order in which certain features get blocked in an incarcerated hernia

A

Incarcerated hernias: first lymphatics are blocked, then venous return is blocked, then arterial blood flow is obstructed

Loss of lymphatics –> venous –> arterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Key clinical features of intermittent claudication

A
  • present on exertion, relieved by rest

- reproducible (same activity level can reproduce same pain, cant just walk it off…)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Most common hernia in

(a) M
(b) F

A

Most common in both is indirect inguinal

But…overall femoral are more common in F than M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Benefit of using mesh in hernia repair

(a) What is the alternative to using mesh

A

Benefit of using mesh = reduced recurrence rates 2/2 tension-free

(a) Alternative is Shouldice repair = 4 layer repair in which you directly sew tissue together
- higher recurrence rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Best lab value to acutely determine tissue perfusion when pt is losing blood

A

Not reliable to use Hb/hct- can be diluted/concentrated or lag behind

-use lactate as a marker of tissue perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Buzzword pencil thin stools

A

Buzzword for colorectal polyps or cancer, specifically ‘apple core’ lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Distinguish displaced vs nondisplaced fractures

A

Displaced = no continuity btwn two bone fragments

Nondisplaced = hairline fracture, bones remain continuous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Once you get in laparoscopically, what visual cues could tell you you’re confusing appendicitis for Crohn’s disease

A

Get in and don’t see inflammed appendix, but see fat wrapping around bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

POD0 gastric bypass pt w/ tachycardia

A

Anastamotic leak until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Differentiate incidence vs. prevalence of a disease

A

Incidence is the number of cases per unit of time (incidence: x annual cases)

Prevalence = number of cases at any one time (very prevalent at this time…)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Differentiate treatment of rectal vs. colon cancer

A

Colon cancer: tx is always surgery, no adjuvant chemo or radiation

Rcctal cancer: neoadjuvant local radiation and chemo for stage 3/4 disease
-stage 1/2 = resection, but stage 3/4 benefit from neoadjuvant systemic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Is LR or NS used to flush line after blood transfusion?

A

Can’t use LR b/c the citrate in the transfused blood can precipitate w/ the Ca2+ in LR
-while NS is safe b/c it has no calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

2 most common etiologies of pseudomyxoma peritonei

A
  1. appendiceal cystadenoma
  2. ovarian carcinoma

Pseudomyxoma peritonei = intraperitoneal mucinous spread (mucus throughout the peritoneum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Mgmt of appendiceal mucocele

A

Appendiceal mucocele tx = surgical removal 2/2 risk of malignancy (underlying cystadenocarcinoma possible) and rupture
-rupture could lead to pseudomyxoma peritonei (mucus throughout the peritoneum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Name the 3 views in FAST

A

FAST = focused assessment w/ sonography in trauma

P’s: look for free fluid (blood…) or air

  1. pericardial
  2. pleural
  3. peritoneal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Define shock

A

Shock = dysfunctional cellular metabolism 2/2 tissue underperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Explain how a bariatric surgery pt could have an SBO w/ zero output from NG tube

A

Risk of gastric bypass = internal hernia, causing SBO

-no NG tube output b/c it is the blind loop (the remnant) that is obstructed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Hepatocystic triangle: define borders

A
  • cystic duct laterally
  • common bile duct medially
  • inferior edge of the liver is the superior border
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Lab values differentiating choledocolithiasis and gallstone pancreatitis

A

Both can have elevated alk phos, but pancreatitis will also have elevated amylase/lipase
-amylase/lipase may be super super high, then precipitously drop if the stone passes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Parameters for a successful bariatrics surgery

A

Cut at least 30% of excess weight or achieve BMI under or at 35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Malrotation appearance on Xray

A

Upper GI series: see bowel concentrated on the right (2/2 narrow mesenteric base)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Post-op consideration for pt after hepatic resection

A

Add phosphorus to fluids b/c phosphorus needed for liver regeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

PTH’s effect on

(a) phosphate
(b) magnesium

A

(b) Hypomagnesemia stimulates PTH secretion
- PTH enhances Mg resorption by kidneys

(a) PTH decreases renal phosphate reabsorption => high PTH would cause decrease in phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When do inguinal hernias get repaired?

(a) When do femoral hernias get repaired?

A

Repair inguinal hernias when they’re symptomatic

(a) ALWAYS repair femoral hernias b/c of the 30% complication risk (strangulation) even if asymptomatic
- higher baseline risk => repair

43
Q

If you can’t intubate- give options and how to chose which

A

If endotracheal intubation can’t be done: options are cric vs. trach

Cric is more superficial and faster
Trach is more permanent

44
Q

Give some etiologies of brisk upper GI bleed

A

Brisk upper GI bleed

  • esophageal varices
  • Mallory-Weiss or Boerrhave’s
  • Aortoenteric vistulas = communication btwn aorta and GI tract
  • Peptic ulcer disease
45
Q

Differentiate

(a) cholelithiasis
(b) biliary colic
(c) acute cholecystitis

A

(a) Cholelithiasis simply is the presence of gallstones
(b/c) Difference is the chronicity of the pain. Biliary colic is intermittent RUQ pain after fatty meal than does not persist 2/2 stone lodging and dislodging out of duct.

While acute cholecystitis is persistent RUQ pain b/c stone is stuck in duct (not lodging in and out)

46
Q

How many units of the following would you’d give to replace 1L of lost blood

(a) packed RBCs
(b) whole blood

A

(a) One unit of packed cells is 250 cc => give 4U of packed cells to compensate for 1L blood loss
(b) One unit of whole blood is 500cc

47
Q

Cutoff measurement for thickened gall bladder wall

A

Gall bladder wall considered thickened if over 3 cm thick

48
Q

2 steps for repairing malrotation in 1 mo. old who presents w/ sudden onset bilious emesis

A

Malrotation repair

  1. Take down/divide Ladd’s bands
  2. Widen mesenteric base
49
Q

Recommendation for pregnancy and bariatric surgery

A

Recommended for female pts to wait about 2 years after wt loss surgery for wt loss to plateau b/c pregnancy during rapid wt loss can be dangeorus for the developing fetus

50
Q

Why is surgery indicated in even a well controlled UC pt after 25+ yrs of disease

A

After 25 yrs UC pts have such a high colon cancer risk that colostomy is suggested even if the pt is controlled on biologic agents

51
Q

Which two views are taken on mammorgaphy?

A
  1. Medio-lateral
  2. Cranio-caudal

-looking for symmetry and abnormalities

52
Q

Differentiate where Mallory-Weiss tear vs. Boerrhaves occurs

A

Boerrhaves = full perforation, occurs about 5cm proximal to the GE jxn

Mallory-Weiss happens at the lesser curvature of the stomach

53
Q

Using the 4:2:1 rule, calculate the amount of daily maintenance fluids for a 80 kg pt

A

Per hour: 40cc (4 x first 10kg) + 20 cc (2 x next 10kg) + 60 cc/hr (for total weight -20kg) = 120 cc/hr

120cc/hr x 24 hrs = 2600 cc

54
Q

Name 6 surgically correctable causes of hypertension (this is hard…)

A
  1. Renal artery stenosis
  2. Pheochromocytoma
  3. Hyperthyroidism
  4. Coarctation of the aorta
  5. Cushing’s syndrome
  6. Conn’s syndrome = adrenal adenoma
55
Q

To what degree do the following increase risk of breast cancer

(a) ADH
(b) LCIS

A

(a) ADH = atypical ductal hyperplasia- increases by 3-5x

(b) LCIS increases risk by 7-11x

56
Q

Differentiate the effect of adult vs. kid falling on sprained ankle

A

Ligamentous attachments are stronger than the growth plate
In kids- you’d get a break at the physis (growth plate)
While in adults you’d get a sprain of the ligament

57
Q

Which has a better prognosis: Wilms tumor or neurobloastoma

A

Nephroblastoma (Wilms) has better prognosis than neuroblastoma

58
Q

Explain why a newborn w/ a diaphragmatic hernia may require ECHMO?

A

Diaphragmatic hernia allows passage of bowel contents into the thorax => compression of the lungs and pulmonary hypoplasia
-pulmonary HTN 2/2 hypertrophy of the pulmonary arteries, pulm HTN may become severe enough to require vents/echmo

59
Q

In the vogelgram: name late vs. early mutations seen in CRC

A

Colorectal cancer:
first is APC inactivation (hence why Lynch syndrome is such a shitshow)
-after APC inactivation is K-ras activation

Late is p53 inactivation

60
Q

In the US why do we remove appendix surgically?

A

B/c 25% risk of recurrence if managed medically!

-we know this b/c abx is the standard of care used in Europe

61
Q

Where is the large majority of maintenance fluids used?

A

Water used in metabolism

62
Q

Best imaging study if suspecting

(a) cholecystitis
(b) choledocolithialsis

A

(a) Abdominal ultrasound for cholecystitis

(b) MRCP if suspecting choledocholithiasis

63
Q

What percent of pts w/ gallstones are symptomatic?

A

Only 20% of pts w/ gallstones will have symptoms

-so 80% are symptomatic

64
Q

Give 4 indications for CABG procedure

A
  1. Severe tripple vessel CAD
  2. Symptomatic angina despite maximum medical therapy
  3. Severe (over 50%) left main coronary artery stenosis
  4. Multivessel disease w/ decreased EF
65
Q

Carcinoma vs. sarcoma

A

Carcinoma = neoplasm from epithelial tissue

Sarcoma = neoplasm from mesenchymeal tissue

66
Q

Which abdominal wall defect may require ‘paint and wait’

A

Paint and wait technique sometimes used in omphalocele (covered by sac) b/c defects tend to be much larger and may even include the liver

67
Q

Explain the purpose of D5 solution

A

NOT for calories! 2L of D5 will only give you 400 calories…

-used for safety: prevent lysis by having a benign solute present

68
Q

Why would EMS use NS instead of LR in an emergency situation?

A

B/c LR has very low K+, so may replete someone’s calcium, avoid LR until you know someone’s K+ level

While NS has high K+ and would even help replenish K+

69
Q

Give example of meds used in RSI in burn victim

A

Rapid sequence intubation in burn victim

  1. Induction w/ fentanyl, propofol
  2. Neuromuscular blockade w/ rocoronium
    - don’t give succinylcholine 2/2 risk of hyperkalemia
70
Q

UC vs. Crohn’s

(a) Gross pathology inside the colon
(b) Gross pathology outside the colon

A

UC: surgically curative
-in the colon see psuedopolyps

Crohn’s- avoid surgery as long as possible

(a) Inside colon: non-caseating granulomas, transmural, cobblestoning
(b) Outside colon: fat-wrapping (‘creeping fat’), transmural

71
Q

Most common etiology of large bowel obstruction

A

Carcinoma! (colon cancer) 60%

  • 20% diverticulitis
  • 10% volvulus
72
Q

Most common location for extra-adrenal pheo

A

Paraganglioma (extra-adrenal pheo) most commonly found at the bifurcation of the aorta

73
Q

Why are change in bowel habits seen w/ left vs. right sided colonic lesions

A

B/c stool is more liquid in the right colon (so more easily passes regardless) and the right colon has a larger diameter

74
Q

Define dislocation, differentiate from displaced

A

Dislocation can only happen at a joint

-fracture in the middle

75
Q

Most common location for diverticulitis

A

Sigmoid colon

76
Q

Define carcinoma in situ

A

Carcinoma in situ means the full thickness of the epithelium is involved, but the basement membrane has not been invaded

77
Q

Management of asymptomatic gallstones

A

Surgery NOT indicated, only requires surgery if symptomatic

-80% of pts w/ gallstones are in fact asymptomatic

78
Q

Calot’s triangle

A

Calot’s triangle = 3 C’s- anatomic structures important in view during lap choley

  • cystic duct laterally
  • cystic artery superiorly
  • common bile duct medially
79
Q

Use of oncotyping in breast cancer

A

Do oncotype in breast cancer pts to stratify risk of recurrence, which in term determines indication for chemotherapy

Oncotyping stratifies into low, int, high risk of recurrence, deterine if adjuvant chemo would be indicated

80
Q

Name 3 medications that are relevant when taking a history from someone w/ blood in stool

A

Iron- can turn stool black

ASA/NSAIDs- can cause gastric irritation/PUD

81
Q

Steps to consider pre-op for removal of pheo

A

Need alpha blockade

-also need to give TONS of fluids b/c w/o the pheo the pt will vasodilate peripherally

82
Q

Charcot’s triad

A

Charcot’s triad of symptoms of acute cholangitis (bile duct inflammation)

  1. RUQ
  2. fever
  3. jaundice
83
Q

Classic clinical presentation of UC

A

Bloody, mucosy diarrhea

84
Q

How many grams of dextrose are in 1L of D5?

A

D5 means there is 5g of dextrose per 100cc of fluid => 50g of dextrose in 1L

85
Q

Differentiate management of trauma to r. vs. left renal vein

A

Injury to left vein- just tie it off, b/c there are collaterals on the left

Injury to the right vein requires nephrectomy b/c it lacks collaterals

86
Q

Why do we not just use water for maintenance fluids?

A

B/c water is hypotonic to our cells => would hemolyze us!!!

87
Q

Name 3 extra-colonic features of UC

A
  1. pyoderma gangrenosum
  2. PSC
  3. Anterior uveitis
88
Q

Explain the 4:2:1 rule for maintenance fluids

A
  • 4 cc/hr for the first 10kg
  • 2cc/hr for the next 10kg
  • 1cc/hr for the rest of the kg
89
Q

Which 2 groups of women w/ breast cancer get axillary LN dissection

A

Only indications for LN dissection

  1. Positive LN found before surgery
  2. +LN found on mastectomy
90
Q

Which part of the GCS is the best predictor of outcome in a head injury pt

A

EVM (eyes, verbal, motor)

Motor is the best predictor of outcome, especially in head injury

91
Q

Most common cause of lower GI bleed

A
  1. Angiodysplasia

2. Diverticulosis

92
Q

Who gets adjuvant chemo in CRC?

A

A single positive node w/ CRC indicates adjuvant chemo

93
Q

Genetics vs. genomics

A

Genetics = inherited DNA

Genomics = the entire genetic code, including mRNA and proteins made

94
Q

How to diagnose diverticulitis

A

CT is diagnostic

-WBC, LLQ pain, palpable mass are supportive- but CT is diagnostic

95
Q

Composition of gall stones

A

80% of gall stones are cholesterol stones

20% are pigment stones

96
Q

Ideal urine output for

(a) normal adult
(b) normal child
(c) Adult w/ burns

A

Urine output goals

(a) Normal adult: .5 cc/kg/hr
(b) Kids and burn victims: 1 cc/kg/hr

97
Q

How would a pt present if their lap band was eroding

A

Erosion of the port site! manifests as port site infection

98
Q

Rule for upper limit of normal diameter of bowel on abdominal Xray

A 
3-6-9 Rule
ULN diameter:
-3 cm for small bowel
-6 cm for colon
-9 cm for cecum
99
Q

Which stones would we attempt to medically break up?

A

Kidney stones, NOT gall stones

  • if you break up a kidney stone you’re just putting pieces into the bladder/urine (no biggie)
  • but if you were to break up gallstones you’d just shoot tiny pieces out into more tiny ducts
100
Q

Define ascending cholangitis

A

Ascending cholangitis = infection of the bile duct 2/2 ascending infection from small intestines (usually from duodenum)
-increased risk of bile duct is already partially obstructed by presence of gallstones

101
Q

Define aneurysm

A

Focal arterial dilation of at least 50% above expected

ex: upper limit of normal diameter for abdominal aorta in adult male is 2cm => above 3cm is considered an aneurysm

102
Q

5 P’s of compartment syndrome

A

5 P’s of compartment syndrome

  • pain w/ passive stretch
  • pallor
  • poikilothermia (warmth)
  • pulselessness
  • paresthesia
103
Q

2 ddx for rapidly growing neck mass

A

Anaplastic thyroid carcinoma vs. lymphoma

Surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions