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Surgery Clerkship > Dr. Pestana's Notes--Gen Surg > Flashcards

Dr. Pestana's Notes--Gen Surg Flashcards

1
Q

Best way to dx GERD

A

pH monitoring

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2
Q

Typical pt presenting w/ GERD

A

overweight, complains of burning retrosternal pain and “heartburn” brought about by bending over, wearing tight clothes or lying flat in bed at night; relieved by antacids or OTC H2 blockers

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3
Q

Dx peptic esophagitis and possible Barrett’s esophagus

A

endoscopy and bx

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4
Q

When is surgery indicated for GERD? (3)

A

(1) longstanding GERD that cannot be controlled by medical means, (2) developed ulcers/stenosis, or (3) dysplastic changes

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5
Q

Tx GERD [w/ dysplasia]

A

Nissen fundoplication [+ radiofrequency ablation]

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6
Q

Sxs motility problems in upper GI; Dx

A

crushing pain w/ swallowing in uncoordinated massive contraction and/or dysphasia; Manometry w/ barium swallow

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7
Q

Sxs achalasia

A

(MC in women) dysphagia, pt sits up to allow gravity to help, occasional regurgitation of undigested food

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8
Q

Dx achalasia. Tx

A

CXR or manometry shows megaesophagus; balloon dilation by endoscopy

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9
Q

Progressive sxs esophageal cancer

A

dysphagia starting w/ meat, then other solids, then liquids w/ significant weight loss

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10
Q

Esophageal cancers: (A) Squamous cell seen in ____ w/ hx of ______ (B) Adenocarcinoma seen in people w/ ______

A

[black] men; smoking and drinking; longstanding GERD

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11
Q

Dx esophageal cancers

A

barium swallow, then endoscopy + bx; CT to assess operability; most cases only get palliative care

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12
Q

Mallory-Weiss tear; Dx/Tx

A

occurs post prolonged, forceful vomiting, causing bright red blood to come up; endoscopy; photocoagulation

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13
Q

Progression of sxs in Boerhaave syndrome

A

post prolonged, forceful vomiting leading to esophageal perforation; sudden low sternal pain followed by fever, leukocytosis and “sick” pt

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14
Q

Dx Boerhaave syndrome; Tx

A

contrast swallow [Gastrorafin first, barium if negative]; surgery

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15
Q

MCC esophageal perforation; sxs

A

instrumental perforation of esophagus via endoscopy; emphysema in lower neck

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16
Q

Dx esophageal perforation; Tx

A

contrast studies; immediate surgery

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17
Q

Gastric adenocarcinoma is MC in ____ population. Sxs

A

elderly; wt loss, anorexia, vague epigastric pain, early satiety, sometimes hematemesis

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18
Q

Dx gastric adenocarcinoma; tx

A

endoscopy + bx, followed by CT to assess operability; sx

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19
Q

Gastric _____ presents similarly to gastric adenocarcinoma but is treated by chemotherapy/radiotherapy. Surgery only done if risk of _____.

A

lymphoma; perforation during therapy

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20
Q

A ______ can be reversed by eradication of H. pylori

A

MALTOMA [low-grade lymphomatoid transformation]

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21
Q

MCC mechanical intestinal obstruction

A

adhesions in pts w/ prior laparotomy

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22
Q

Sxs mechanical BOO

A

colicky abdominal pain, protracted vomiting, progressive abd distention [low obstruction], no flatus or BM; high-pitched bowel sounds

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23
Q

Dx mechanical BOO

A

Abd xray–distended loops of sm bowel w/ air-fluid levels

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24
Q

Tx mechanical BOO

A

(1) NPO, NG suction and IV fluids, hoping for spontaneous resolution (2) Surgery if unsuccessful after 24hrs

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25
Q

What sxs indicated BOO w/ strangulated bowel? Tx?

A

fever, leukocytosis, constant pain, signs of peritoneal irritation, ultimately full-blown peritonitis or sepsis; emergency sx required!!

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26
Q

Physical exam for mech intestinal obstruction caused by incarcerated hernia

A

irreducible hernia that used to be reducible; also fever, leukocytosis, and other sxs related to bowel strangulation

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27
Q

Tx incarcerated hernia

A

surgery: (A) strangulation, after proper rehydration (B) reducible hernia, electively

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28
Q

Cause of Carcinoid syndrome

A

small bowel carcinoid tumor w/ liver mets

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29
Q

Sxs carcinoid syndrome

A

diarrhea, flushing of face, wheezing, right-sided heart valvular damage (JVP)

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30
Q

Dx carcinoid syndrome

A

24hr urine 5HIAA (because only occurs sporadically and concentrations will only rise in the blood at those times, so must collect for 24hrs)

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31
Q

Sxs acute appendicitis; Tx

A

anorexia, periumbilical pain that becomes sharp, severe, constant and localized to RLQ; tenderness, guarding and rebound; low fever and leukocytosis (10-15,000) w/ neutrophilia and L-shift; Tx = sx

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32
Q

If unsure whether acute appendicitis, must do _____ to rule out other causes.

A

CT

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33
Q

Cancer of the _____ colon shows up w/ iron-deficiency anemia in the elderly. Stools 4+ for occult blood.

A

RIGHT

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34
Q

Dx colon cancer; Tx

A

colonoscopy/proctosigmoidoscopic exam + bx; surgery [R = right hemicolectomy, L = sx w/ preop chemoradiation for large tumors]

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35
Q

Caner of the ____ colon shows up w/ bloody bowel movements where blood coats the outside of the stool. May be constipation and stools may be “pencil-thin”

A

LEFT

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36
Q

Colonic polyps are premalignant. List risk of malignancy, starting w/ most likely (4)

A

(1) familial polyposis (Gardener)
(2) familial multiple inflammatory polyps
(3) villous adenoma
(4) adenomatous polyp

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37
Q

List the 4 colon polyps that are NOT premalignant.

A

juvenile, Peutz-Jeghers, isolated inflammatory, hyperplastic

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38
Q

IBD sxs. Which one [Crohn’s or UC] can be treated surgically?

A

severe diarrhea w/ blood and mucus; UC (except when Crohn’s causing bleeding/stricture/fistulization)

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39
Q

Why is surgical tx of UC avoided?

A

b/c gets rid of rectal mucosa, needing stoma or ileoanal anastomosis

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40
Q

When do you operate on UC? [usually avoided]

A

active dz >20yrs, severe nutritional depletion, mult hospitalizations, need for high-dose steroids/immunosuppressants, development toxic megacolon

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41
Q

MCC pseudomembranous enterocolitis caused by C. difficile

A

cephalosporins [also clindamycin]

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42
Q

Dx C. difficile; Tx

A

toxins in stool; abx discontinued, give metronidazole or vanco [DO NOT GIVE ANTIDIARRHEALS]

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43
Q

When do give emergency colectomy w/ C. difficile? What can you attempt to do before surgery?

A

when infection unresponsive to tx plus WBC >50,000 and serum lactate >5; fecal enema

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44
Q

Rule out anorectal cancer by doing a ______ exam

A

proctosigmoidoscopic

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45
Q

____ hemorrhoids bleed and can be treated w/ rubber band ligation; usually painless, but can become painfull and produce itching if _____

A

Internal; prolapsed

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46
Q

___ hemorrhoids hurt and can require surgery if conservative tx fails

A

external

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47
Q

Anal fissures usually happen to [this population]. Sxs

A

young women; extreme pain w/ defecation and blood streaks covering stools

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48
Q

MC location anal fissures; dx

A

posterior, in midline; physical exam, can be done under anesthesia (usually caused by tight sphincter)

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49
Q

MC Tx anal fissures

A

(1) diltiazem ointment 2% for 6wks have 80-90% success (2) botulinum toxin has 50% success. [Also….stool softeners, topical nitroglycerin, forceful dilation, lateral internal sphincterotomy]

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50
Q

Fissure, fistula or small anal ulceration that fails to heal and gets worse after surgical intervention is indicative of ______ because there is a lack of blood supply for healing

A

Crohn’s dz

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51
Q

What is contraindicated in Crohn’s dz of anus? How should fistulas be treated?

A

surgery; drained w/ setons + medical therapy + remicade

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52
Q

Sxs ischiorectal (perianal) abscess

A

febrile, perirectal pain that prohibits pt from sitting or having BMs, usually lateral to anus btwn rectum and ischial tuberosity

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53
Q

Tx ischiorectal abscess [if diabetic, must watch closely b/c necrotizing infection may occur!!]

A

incision and drainage (cancer must be ruled out)

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54
Q

______ can develop in pts who have ischiorectal abscess drained

A

Fistula-in-ano; epithelial migration from anal crypts and perineal skin form a permanent tract

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55
Q

Sxs Fistula-in-ano

A

soiling self and occasional perineal discomfort; PE shows opening lateral to anus w/ cordlike tract and discharge

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56
Q

Ddx Fistula-in-ano (what to rule out); Tx

A

necrotic and draining tumor; fistulotomy

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57
Q

Squamous cell carcinoma of anus most common in _____ population. Metastatic _____ nodes can be felt

A

HIV+ homosexuals w/ receptive sex; inguinal

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58
Q

Dx SqCC of anus; Tx

A

Bx; Nigro chemoradiation protocol (90% success) followed by surgery if residual tumor

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59
Q

MC location of GI bleeding (3/4 cases); 2nd MC location; 3rd

A

upper GI (nose to ligament of Treitz); colon/rectum; jejunum/ileum

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60
Q

Most colonic bleeding in elderly and MCCs are:

A

angiodysplasia, polyps, diverticulosis, cancer, hemorrhoids

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61
Q

When young person has GI bleed, most likely from ____; when older person gets bleed, most likely from _____

A

upper GI; either upper or lower [upper GI MC overall but age makes good candidate for lower GI bleeding]

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62
Q

Upper GI endoscopy is done when _______ or blood recovered by NG tube in pt w/ bleeding per rectum

A

vomiting blood

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63
Q

Melena always indicates _____ food. Must start workup with ____ GI endoscopy

A

digested; upper

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64
Q

Red blood per rectum occurs from _____ in the GI tract. Dx first includes

A

anywhere; NG tube and gastric content aspirate

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65
Q

In pt w/ blood per rectum, if NG tube plus gastric content aspirate has no blood with WHITE fluid, all but ___ of upper GI is excluded. ____ should follow for dx. If no blood and fluid is GREEN, ____ has been excluded.

A

duodenum; Upper endoscopy; entire upper GI

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66
Q

If upper GI excluded + red blood per rectum, ____ should be excluded first.

A

hemorrhoids (anoscopy; if bleeding, cannot do colonoscopy b/c can’t see field)

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67
Q

When upper GI AND hemorrhoids excluded + red blood per rectum, use estimated rate of bleeding to do dx testing: (A) if exceeds ____, then do angiogram (B) if less than ____, wait until bleeding stops and do colonoscopy (C) if in between, then do _____ study, which is slow

A

2mL/min (1 unit blood q 4 hrs); 0.5mL/min; tagged red-cell

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68
Q

If tagged red-cell study in pt w/ red blood per rectum shows puddling on R or L, could help guide surgeon to do ______ in the future. If no puddling, do ____ for dx of bleeding.

A

“blind” hemicolectomy; colonoscopy

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69
Q

Pts w/ recent hx blood per rectum who are not actively bleeding should have a ___ if young and ___ if old

A

upper GI endoscopy; upper and lower GI endoscopy

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70
Q

MCC blood per rectum in child; dx

A

Meckel’s diverticulum; technetium scan (look for ectopic gastric mucosa)

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71
Q

Massive upper GI bleed in stressed, multiple trauma or complicated postop pt probably from _____. ____ is confirmatory. Tx w/ _____ and _____

A

stress ulcers; Endoscopy; angiographic embolization maintaining gastric pH >4

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72
Q

Sxs acute abdomen caused by perforation; MCC

A

pt reluctant to move and protective of abd; peritoneal irritation (tenderness, muscle guarding, rebound, silent abd); peptic ulcer

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73
Q

Dx acute abdomen caused by perforation; tx

A

upright CXR shows free air under diaphragm; emergency sx

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74
Q

Sxs acute abdomen caused by obstruction of narrow duct (ureter, cystic, common)

A

sudden colicky pain w/ typical location; pt moving constantly

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75
Q

Sxs acute abdomen caused by inflammatory process; fever and leukocytosis, however, is NOT seen in ____

A

gradual onset (about 6-12hrs), starting constant and ill-defined and eventually localizes to area, then peritoneal irritation; pancreatitis

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76
Q

Severe abd pain and blood in gut lumen is indicative of ______

A

ischemic processes

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77
Q

______ should be suspected in child w/ nephrosis and ascites or adult w/ ascites w/ “mild” generalized acute abdomen +/- fever and leukocytosis

A

Primary peritonitis

78
Q

Dx primary peritonitis; tx

A

cultures of ascitic fluid will yield single organism; abx

79
Q

Tx generalized acute abdomen; if doesn’t look like peritonitis, how do you rule out (A) MI (B) lower lobe pneumonia (C) PE (D) pancreatitis (E) urinary stones

A

exploratory laparotomy; (A) troponin, EKG (B) CXR (C) immobilized pt hx (D) amylase, lipase (E) abd CT

80
Q

____ should be suspected in alcoholic w/ upper acute abdomen that occurs w/in a couple of hours w/ constant pain.

A

Acute pancreatitis

81
Q

Dx acute pancreatitis

A

serum (from 12-48hrs) or urinary (from 3-6th day) amylase or lipase; CT if not clear

82
Q

Tx acute pancreatitis

A

NPO, NG suction, IV fluids

83
Q

_____ is suspected w/ colicky flank pain radiating to inner thigh and scrotum/labia

A

ureteral stones [can also have urgency/frequency and microhematuria in UA]

84
Q

Dx ureteral stones

A

CT

85
Q

LLQ abdominal pain is most likely ____

A

acute diverticulitis [in women, remember to check ovaries/fallopian tubes]

86
Q

Sxs actue diverticulitis; Dx

A

fever, leukocytosis, peritoneal irritation in LLQ w/ occasional palpable mass; CT

87
Q

Tx acute diverticulitis

A

start w/ NPO, fluids, abx; if sxs don’t subside, need sx w/ possible percutaneous drainage if abscess is present [elective surgery in pt w/ 2 or more attacks]

88
Q

URQ pain in elderly w/ severe abdominal distention is indicative of _______

A

volvulus of sigmoid colon

89
Q

Dx volvulus of sigmoid colon

A

CXR shows air-fluid levels in small bowel w/ distended colon, huge air-filled loop in RUQ (“coffee-bean” sign)

90
Q

Tx volvulus of sigmoid colon

A

proctosigmoidoscopic exam (resolves acute prob), rectal tube left in; recurrent cases requires elective sigmoid resection

91
Q

_____ is seen in elderly, most often w/ development of acute abdomen following afib or recent MI. MCC is ____

A

mesenteric ischemia; clot in SMA

92
Q

If there is acute abd pain w/ GI bleeding, usually indicative of ____. Acidosis and sepsis have developed.

A

mesenteric ischemia (elderly)

93
Q

Early dx/tx mesenteric ischemia

A

arteriogram and embolectomy

94
Q

MC underlying causes of primary hepatoma (HCC)

A

cirrhosis, Hep B or Hep C

95
Q

Sxs HCC; Dx; Tx

A

vague RUQ discomfort w/ weight loss; AFP in serum, CT; resection if possible

96
Q

Mets of liver outnumbers primary cancer in US by ____. Found via ____ if F/U for being treated for primary tumor or because of rising ____ levels in those w/ colonic cancer.

A

20:1 ; CT; CEA

97
Q

If primary liver cancer is slow-growing, mets are confined to one lobe and _____ can be done; other tx can include _____

A

resection; radioablation

98
Q

Hepatic adenomas are a potential complication of _____. They are a problem because they can _______. CT is dx and sx required

A

birth control pills; rupture and bleed massively in abdomen

99
Q

____ is a complication of biliary tract dz, particularly acute ascending cholangitis

A

pyogenic liver abscess

100
Q

Sxs, Dx, Tx pyogenic liver abscess

A

fever, leukocytosis and tender liver; sonogram or CT; percutaneous drainage

101
Q

_____ of the liver favors med who have “Mexico connection”

A

Amebic abscess

102
Q

Tx of amebic abscess of liver

A

metronidazole, seldom requiring drainage [b/c ameba doesn’t grow in pus, it takes weeks for definitive serology diagnosis so empiric tx required]

103
Q

Sxs hemolytic jaundice. Workup should see what is chewing up RBCs

A

elevated UNCONJUGATED bilirubin only w/ no bile in urine

104
Q

Sxs hepatocellular jaundice; MCC

A

elevated unconjugated AND conjugated bilirubin w/ high transaminase levels and moderate elevation of ALP; hepatitis

105
Q

Sxs obstructive jaundice

A

elevated unconjugated AND conjugated bilirubin w/ moderately elevated transaminase levels and high ALP

106
Q

Dx obstructive jaundice includes ____, looking for dilation of biliary ducts. Stones in the _____ seldom seen; mostly seen in the _____.

A

sonogram; common duct; gallbladder

107
Q

Courvoisier-Terrier sign in malignant obstructive jaundice

A

large, thin-walled distended gallbladder on sonogram

108
Q

If gallstone suspected to be causing obstructive jaundice, must do ____ to confirm dx and then ____ to remove stone. _____ should follow

A

ERCP; sphincterotomy; cholecystectomy

109
Q

Describe the ERCP procedure

A

endoscope descends into duodenum, the ampulla is cannulated and xray dye injected; need sedation; can do sphincterotomies, retrieve stones, drain pus, deploy stents, bx tumors

110
Q

Describe MRCP procedure

A

noninvasive, fully-awake; need to be able to hold breath for 10 seconds; no further procedures can be done

111
Q

3 different cancers responsible for obstructive jaundice tumor

A

adenocarcinoma of head of pancreas, adenocarcinoma of ampulla of Vater, cholangiocarcinoma of common duct

112
Q

Dx cancers responsible for obstructive jaundice tumor; What if suspected (A) large pancreatic mass (B) ampullary mass (C) ductal neoplasm (D) tiny tumors in head of pancreas

A

CT, MRCP (smaller tumors visualized); (A) CT-guided percutaneous bx (B) endoscopy (C) ERCP and brushings (D) endoscopic US

113
Q

_____ cancers suspected w/ malignant obstructive jaundice plus anemia and positive blood in stool; dx

A

ampullary; endoscopy

114
Q

Procedure used to treat pancreatic cancer of head

A

Whipple procedure (pancreatoduodenectomy)

115
Q

Ampullary cancer and cancer of lower end of common bile duct has about ____ cure rate

A

40%

116
Q

_____ have the worst prognosis of ductal cancers; dx

A

cholangiocarcinomas arising w/in liver at bifurcation of hepatic ducts; MRCP

117
Q

Typical characteristics of pt w/ gallstones

A

Fat, forty, fertile, female; Mexican Americans and Native Americans

118
Q

Asxs gallstones are _____

A

left alone

119
Q

Biliary colic occurs when stone temporarily occludes _____. Sxs.

A

cystic duct; colicky RUQ pain radiating to shoulder/back, often triggered by fatty foods and N/V w/out signs peritoneal irritation or inflammation

120
Q

Tx biliary colic

A

anticholinergics

121
Q

Acute cholecystitis starts as ____ but stone remains in ____ duct until inflammatory process develops. Sxs

A

biliary colic; cystic; constant pain, modest fever and leukocytosis w/ peritoneal irritation in RUQ w/ mildly affected LFTs

122
Q

Sonogram in acute cholecystitis shows ____. Sometimes a ____ is used to show uptake in ducts

A

gallstones, thick-walled gallbladder and pericholecystic fluid; HIDA [radionucleotide scan]

123
Q

Tx Acute cholecystitis; MC population to NOT respond to initial medical tx, requiring emergency cholecystectomy

A

Start w/ NG suction, NPO, fluids and abx, then elective cholecystectomy if needed; men and diabetics

124
Q

Acute ascending cholangitis; sxs

A

stones reached common duct, producing partial obstruction and ascending infection; elderly pts w/ temp 104-105, chills, high WBC count (sepsis), sometimes hyperbilirubinemia, VERY HIGH ALP

125
Q

Tx Acute ascending cholangitis

A

IV abx and emergency decompression of common duct (ERCP or percutaneous transhepatic cholangiogram or surgery); eventual cholecystectomy to follow

126
Q

Sxs Biliary pancreatitis due to stone obstruction; Dx

A

transitory episode cholangitis w/ pancreatitis symptoms (elevated amylase/lipase); US

127
Q

Tx Biliary pancreatitis due to stone obstruction

A

NPO, NG suction, fluids usually leads to improvement w/ elective cholecystectomy to follow; if not, ERCP and sphincterotomy to dislodge stone

128
Q

Acute pancreatitis seen usually in ___ or ____

A

alcoholics, complication of gallstones

129
Q

Sxs acute edematous pancretitis; most telling diagnostic feature

A

tenderness and mild rebound in upper abdomen; high serum amylase or lipase (early on) or urinary amylase/lipase (after couple of days); elevated hematocrit

130
Q

Sxs acute hemorrhagic pancreatitis

A

starts like edematous but has LOWER hematocrit and the degree of amylase elevation doesn’t correlate w/ severity of dz

131
Q

What are the 3 factors in Ranson’s criteria of acute hemorrhagic pancreatitis? [seen at time of presentation]

A

(1) elevated WBC (2) elevated blood glucose (3) low serum calcium

132
Q

About a day post acute hemorrhagic pancreatitis, what do labs look like? Tx

A

Ht lower, serum calcium low despite calcium administration, BUN higher, metabolic acidosis and low arterial PO2; supportive therapy in ICU

133
Q

_____ are recommended to prevent/ameliorate development of multiple pancreatic abscesses (about ____ after onset of pancreatitis) and to drain them. IV ____ or ___ can also be used.

A

Daily CT scans; 10 days; imipenem; meropenem

134
Q

A ______ is done to tx necrotic pancreas when the dead tissue is well delineated, typically after ____ weeks. The procedure may be repeated until all dead matter cleared.

A

necrosectomy; four

135
Q

Pancreatic _____ can be a late sequela of acute pancreatitis or pancreatic trauma, usually developing about _____ after primary incident.

A

pseudocyst; 5 weeks

136
Q

Sxs Pancreatic pseudocyst

A

collection pancreatic juice outside ducts (lesser sac) and pressure causes early satiety, vague discomfort, deep palpable mass

137
Q

Dx Pancreatic pseudocyts

A

CT or US

138
Q

Tx of pancreatic pseudocyts (A) 6cm or smaller or those present less than 6 weeks (B) >6cm or cysts older than 6wks

A

(A) can be observed for spontaneous resolution (B) drainage (percutaneously, surgically into GI tract or endoscopically into stomach) b/c can rupture or bleed

139
Q

Chronic pancreatitis, usually in alcoholics, can cause pts to develop these 4 things

A

(1) calcified, burned-out pancreas (2) steatorrhea (3) diabetes (4) chronic epigastric pain

140
Q

Tx chronic-pancreatitis-caused (A) steatorrhea (B) diabetes (C) MRCP-indicated obstructions

A

(A) pancreatic enzymes (B) insulin (C) drainage pancreatic duct

141
Q

2 types of hernias that do not require elective surgery

A

(1) umbilical hernias in pts

142
Q

Hematogenous mets usually go to these 4 areas

A

liver, lung, brain and bone

143
Q

Epithelial tumors and adenocarcinomas spread ____ and ____. Breast spreads mostly to ____ and ____. Abdominal adenos spread to _____. Sarcomas spread only _____ to the ____ mostly.

A

hematogenously; lymphatically; brain; bone; liver; hematogenously; lungs

144
Q

Chemotherapeutic drugs causing following complications (A) myocardial damage (B) pulmonary fibrosis (C) hemorrhagic cystitis (D) neurotoxicity

A

(A) adriamycin (B) bleomycin (C) cyclophosphamide (D) platinum-based agents

145
Q

Fibroadenomas seen in ____ women. Sxs; Dx; Tx

A

young; firm, rubbery, painless mobile mass; FNA or US; removal is optional

146
Q

Cystosarcoma phyllodes seen in _____ women. Sxs; Dx; Tx

A

late 20yo; grow large and may distort breast, with most being benign and can be malignant sarcomas; core needle biopsy or incisional biopsy; must surgically remove

147
Q

Mammary dysplasia (fibrocystic dz or cystic mastitis) seen in ____ women and goes away w/ ____. Sxs

A

30 and 40yo; menopause; bilateral tenderness related to menstrual cycle w/ multiple lumps that come and go

148
Q

Dx mammary dysplasia

A

Aspiration done; if clear fluid and mass goes away, do nothing; if mass persists or recurs, formal bx required; if bloody fluid aspirated, sent to cytology

149
Q

_____ seen in 20 to 40yo women w/ bloody nipple discharge. Mammogram to look for other potential lesions (will not show this small lesion). Dx/Tx.

A

Intraductal papilloma; Galactogram; Sx resection

150
Q

Breast abscess only seen in _____ women. Tx

A

lactating; incision and drainage needed, also bx taken

151
Q

Suspicious indicators of breast cancer

A

ill-defined fixed mass, retraction of overlying skin, peau-d’orange, recent retraction of nipple, eczematoid lesions of areola, palpable axillary LNs

152
Q

Breast cancer during pregnancy diagnosed and treated same way except for NO ____ at any point in pregnancy and NO _____ during first trimester

A

radiotherapy/hormonal manipulations; chemotherapy

153
Q

(A) Tx of resectable small breast cancer lesions (B) Tx resectable large breast cancer lesions (C) if LN not palpable (D) if enlarged LNs

A

(A) lumpectomy or segmental resection followed by radiotherapy (B) total mastectomy (C) sentinel node dissection (D) axillary node dissection

154
Q

_____ is a type of infiltrating ductal carcinoma that has worse prognosis and need for neoadjuvant chemotherapy

A

inflammatory breast cancer

155
Q

_____ IDC has the highest incidence of bilaterality, but not enough to justify bilateral mastectomy. Name other 2 kinds of IDC

A

Lobular; medullary and mucinous

156
Q

DCIS cannot mets so NO ____ is needed; has a high incidence of recurrence if local resection, therefore usually ____ done. ____ is only done when confined to one quarter of breast.

A

axillary sampling; total mastectomy; lumpectomy + radiation

157
Q

Inoperability of breast cancer based on _____, not metastases

A

local extent

158
Q

In breast cancer patients, ____ should follow surgery in almost all cases, especially if ax LN (+). _____ is used if hormone receptor positive in premenopausal women and ____ is used in postmenopausal women.

A

hormone therapy; tamoxifen [SERM]; anastrozole [aromatase inhibitor]

159
Q

_____ pain in women who had breast cancer suggests metastasis. ____ are diagnostic. Brain mets tx.

A

headache or back (vertebral pedicles); MRI; radiated or resected

160
Q

Thyroid cancer can occur at any age and _____ affect thyroid function. Typically dx via _____, except for _____.

A

does not; FNA; follicular cancer

161
Q

Because thyroid cancer is ____-growing, surgical resection dictated by size of tumor and _____.

A

slow; presence of metastatic nodes

162
Q

Because it can use radioactive iodine, ____ cancer is usually treated w/ a total thyroidectomy in order to be able to identify future potential mets in a pt.

A

follicular thyroid

163
Q

______ is an aggressive thyroid cancer and requires radical surgery. Workup for _____ is also indicated due to potential MEN2 diagnosis.

A

Medullary cancer (C cells); pheochromocytoma

164
Q

_____ thyroid cancer seen mostly in elderly and incredibly aggressive; often only thing that can be done for pt is _____

A

Anaplastic; tracheostomy

165
Q

Hyperthyroidism mostly treated w/

A

radioactive iodine; also methimazole and PTU

166
Q

Sxs primary hyperPTH; 90% have single adenoma and ____ is curative

A

high serum calcium w/ low phosphorus and high PTH; parathyroidectomy (sestamibi scan can help localize adenoma)

167
Q

Sxs Cushings

A

overweight, buffalo hump, osteoporosis, diabetes, HTN, mental instability;

168
Q

Dx of Cushings includes overnight low-dose dexamethasone suppression test (positive if cortisol levels are ____), then high-dose suppression test–If no suppression then pt has ____; if suppressed, then probably ____. To confirm, do these diagnostic tests. Surgically remove adenoma.

A

the same; adrenal adenoma or paraneoplastic syndrome; pituitary microadenoma; MRI for pituitary, CT for adrenal

169
Q

For dx Cushings, the Mayo clinic uses 24hr urine for free cortisol levels: pts w/ adrenal adenomas have levels _____ times normal. They also measure _____ to differentiate which kind of adenoma is present.

A

3 to 4; corticotropin

170
Q

Dx Zollinger-Ellison; Tx

A

measure gastrin and do secretin test and locate w/ CT scan w/ contrast; surgically remove and omeprazole can help w/ mets

171
Q

_____ produces CNS symptoms and low blood sugar when pt fasting.

A

Insulinoma [DDx includes reactive hypoglycemia and self-administration of insulin]

172
Q

In insulinoma, both ____ and ____ are high in blood. Tx includes removal.

A

insulin, C-peptide [sulfonylureas to induce endogenous insulin secretion can mess up lab values]

173
Q

Nesidioblastosis; Tx

A

hypersecretion of insulin in newborn; 95% pancreatectomy

174
Q

_____ produces severe migratory necrolytic dermatitis resistant to all forms of therapy in pt w/ mild diabetes, anemia, glossitis, stomatitis.

A

Glucagonoma

175
Q

Dx glucagonoma; Tx

A

glucagon assay; CT to locate tumor + resection is curative (if mets and inoperable use stomatostatin or streptozocin)

176
Q

Primary hyperaldosteronism can be caused by ______ or ______. Key lab finding is _____ in hypertensive pt not on diuretics.

A

adenoma; hyperplasia; hypokalemia

177
Q

Lab findings of primary hyperaldosteronism; If pt responds to postural changes, indicative of _____. If pt doesn’t respond to postural changes, indicative of _____.

A

hypokalemia, high aldosterone concentration, low renin; hyperplasia; adenoma

178
Q

Tx Primary hyperaldosteronism

A

CT to localize and surgical removal of adrenal lesion

179
Q

_______ seen in thin, hyperactive women w/ attacks of ppunding headache, perspiration, palpitations and pallor.

A

Pheochromocytoma

180
Q

Dx workup pheochromocytoma. (Tumors usually large!)

A

24hr urinary VMA, metanephrines or free urinary catecholamines; follow w/ CT of adrenals or radionuclide studies (extra-adrenal)

181
Q

Tx pheochromocytomas

A

surgery w/ prep of alpha-blockers like phenoxybenzamine

182
Q

____ is usually in young pts w/ HTN in arms and normal pressure in LEs. Dx. Tx.

A

Coarctation of aorta; CXR shows scalloping of ribs and CT angio is diagnositc; surgery is corrective

183
Q

Renovascular HTN seen in (2 groups)

A

(1) young women w/ fibromuscular dysplasia (2) old men w/ arteriosclerotic occlusive dz

184
Q

Sxs renovascular HTN. Dx

A

resistant HTN w/ faint bruit over flank or upper abdomen; Duplex scanning of renal vessels, CT anio

185
Q

Tx renovascular HTN

A

In young women, balloon dilation and stenting; tx in old men controversial due to arteriosclerosis

186
Q

Define “-tomy”

A

to cut

187
Q

Define “-ectomy”

A

to take out/resect

188
Q

Define “-ostomy”. If only one organ. If two organs.

A

to make a mouth/opening; opening to outside; opening is between them = anastamosis

189
Q

Define “-plasty”

A

to change the shape of

190
Q

Define “-plexy”

A

to fix in place

191
Q

Define “-rrhaphy”

A

to saw together (ex. herniorrhaphy is historical way to fix hernia; ex. tarsorrhaphy is to saw eyelids together)

Surgery Clerkship (7 decks)

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