EOR exam questions (Kaplan notes + others) Flashcards
What electrolyte must you check preoperatively if a patient is on hemodyalsis?
K+
What 2 lab test must all childbearing women have prior to surgery
Preganancy test and CBC
If the patient is taking insulin should they take it on the day of surgery?
No, only half of daily dose and start on D5NS
Charcot’s triad
Fever
Jaundice
RUQ abdominal pain
seen in cholangitis
Where is turner’s sign seen?
On the side
Where is Virchow’s node? Which cancer?
metastatic tumor to the left supraclavicular node
seen in gastric cancer
What is Boerhavve’s syndrome?
esophageal perforation
What is Budd-Chiari syndrome?
Thrombosis of the hepatic vein
What is cushing’s syndrome
Excessive cortisol production
What is Mirizzi’s syndrome
Extrinsic obstruction of the common hepatic duct from a gallstone in the gallbladder or cystic duct
What is RED reaction syndrome
Rapid vancomycin infusion resulting in skin erythema
What is refeedng syndrome and what do electrolytes look like?
HypoK, HypoMg, HypoPhos
all 3 down
For non-cardiac pt for surgery the ejection fraction must be
> 35%
Which metabolic risk is an absolute CI for surg?
Diabetic coma
MI patients should not have surgery for how long after MI?
6 months
MCC of fever 1-3 days post up is
PNA (wind)
order a CXR
Incentive spirometry prevents what
Atelectasis
NOT PNA
What do you order for CAUTI
1 = remove foley
then UA and culture
How do you treat CAUTI?
Cipro
think cyprus
MCC of fever on day five
DVT
Which score do you use for DVT
Wells score
When do you order an US for DVT?
Wells score of 3 or more
high risk
MCC of day 7 fever
wound infection
Post-op day 10 fever
deep wound infection/abscess
What should you order post op fever day 10 and treatment
CT abd/pelvis with abd surgery
I&D followed by IV Cipro + Metro
Malignant hyperthermia is
seen after 30-45 min of an anesthetic with temp over 104
MCC of post-op fever day 1
Atelectasis
1-3 days is PNA, so think of atelectasis progressing to PNA
All patients with dyspepsia should be tested for
H pylori
MCC of non-GI n/v
otitis media
What lvl of bilirubin will cause jaundice
> 3
bil is a 3 letter word
MCC of recurrent jaundice
Gilbert syndrome
Poor gil gets so many episodes of jaundice
Gilbert syndrome deals with which bilirubin
Unconjugated bilirubin
Painless jaundice with weight loss is likely
Pancreatic CA
get a CT of abd
MCC of upper GI bleed
PUD
Hx of cirrhosis and portal HTN
Esophageal varices
MCC of PUD
H Pylori
SE of pepto-bismol
Dark colored tongue and stools
Norovirus is MCC of what?
Gastroenteritis
MCC of diarrhea in children
Rotavirus
vaccinate
Which bug can cause diarrhea after fried rice
B cerus
MCC of traveler’s diarrhea
E coli
s/s of e coli
watery diarrhea, cramps, vomiting
Med that is the MCC of C dif
Clinda
Campylobacter enteritis is contracted from what?
Poultry (turkey)
at the camp they eat a lot of turkey
Ecchymosis of the inguinal ligament
Fox sign
seen in pancreatitis
What extraintestinal manifestation is seen more commonly in Crohn’s disease then UC?
Erythema nodosum
Multiple polyps, sebaceous cysts, benign soft tissue tumors, desmoid tumors
Gardner syndrome
RF for hepatic adenoma
Woman
Anabolic steroids
OCPs
RF for sigmoid volvulus
elderly
instituionalized
chronic constipation w/ laxative use
Is smoking protective for UC or crohn’s?
UC
Arthritis of the 2nd and 3rd MCPs, hips, and knees.
Hemochromatosis
joint pain of the fingers is a red flag for this disease!
Describe specifically the pain associated with diverticulitis
refered pain?
characteristic of pain?
Steady ache in the LLQ with referal to the back
What does a porcelain gallbladder increase your risk of?
gallbladder cancer
MCC of bacterial diarrhea in the US
campylobacter
According to Kaplan
remember, associated with poultry (turkey)
on thanksgiving?
Common cause of painless colonic bleeding in the elderly
Arteriovenous malformation (AV malformation)
communication between an arteriole and venule in the cecum, resulting in a bleed
Palpable Blumer shelf, left supraclavicular node, and periumbilical mass are associated with _____.
Gastric cancer
MC type of kidney vs gallbladder stone
kidney = calcium oxalate
gallbladder = cholestrol
*
t/f biliary colic is RUQ pain that comes and goes
FALSE
constant NOT intermittent (according to Kaplan, but Idk if this is true)
Your patient has pruritis, fatigue, and hypothyroidism. What serum lab value will likely be elevated and why?
also has enlarged liver and xanthomas and high cholestrol
antimitochondrial antibodies
associated with primary biliary cirrhosis and hashimoto thyroiditis
Your patient has peritonitis and is on CAPD, what is the first-line management of this
Rocephin + Vanc
wanna cover for Staph and Epidermidis
Your patient has s/s of biliary colic and US shows no stones. HIDA and IV cholecysokinin don’t show contractability of the gallbladder. What is the likely diagnosis?
Biliary dyskinesia
decreased ejection fraction with cholecystokinin challenge
What test for H pylori is useful for showing exposure but NOT as a test for cure to demonstrate eradication of the organism?
Serology testing
What SINGLE antibiotic regimen can be used for acute diverticulitis?
Augmentin
What happens to PT time with long standing cirrhosis?
Prolongs
Chronic alcoholic with dementia, paralysis of lateral gaze, and difficulty walking is likely to have deficiency in what?
Thiamine
B1
remember, 1 brain
Which ulcer type is more commonly associated with malginancy - duodenal or gastric?
Gastric
less common luckily
If you are exposed to some1 with Hep A, what should be done?
Get Hep A IG w/in 2 weeks of exposure
MC early sign of colorectal cancer
chang in bowel habits
carcinoid syndrome is associated with what neurotransmitter?
serotonin
What can be used to prevent travelers diarrhea? Treat it?
Pepto to prevent
Cipro to treat
You have a child with bloody diarrhea and greenish NG aspiration. Workup for anal pathology is unremarkable. What is the next step in management and why?
Radioactively labeled technetium scan, as this is a likley cause of bleed in this patient pop.
What often precipitates hepatic encephalopathy in the setting of liver failure?
GI bleeding
First manifestation of Hep A
Shedding of fecal HAV
even b4 development of IgM anti-HAV
fecal-oral, remember?
What is a worrying complication of Acute Pancreatitis d/t circulating phospholipase?
ARDS
because phospholipase can attack aveoli
adult respiratory distress syndrome
Treatment of Wilson disease
D-penicillamine
What is the pattern of crohn’s disease?
Cobblestone, transmural
t/f diuretics can be used to prevent hepatic encephalopathy
false
What marker is positive in the setting of UC
P-ANCA
Patient with down syndrome, bilious vomitting, and gas-filled stomach with abscence of gas in distal bowel likely has
Duodenal atresia
this is the double bouble sign
Where is the pyloris?
helpful for knowing the pahotphys of pyloric stenosis
the lower part of the stomach that connects to the small intestine
this is why there is projectile vomitting - it can get to the stomach
MC benign lesion of the breast in young women
fibroadenoma
are fibroadenomas tender?
No
First line management of acute lmb ischemia
revascularization
1.
Gold standard to determine if a peripheral lung lesion is malginant or infectious
Open lung biopsy
First line medication for disease flares of crohn’s disease
prednisone
What are the BP findings of type A vs B acute aortic dissections
Type A = hypotension
Type B = hypertension
Initial management of Type B acute aortic dissection
BB
what lab value is elevated with carcinoid tumors?
5-hydroxyindoleacetic acid?
First-line treatment of perianal abscess
I&D
Apart from MONA, what is given prior to percutatenous coronary intervention?
Ticagrelor
Best way to establish dx of Zenker’s
Barium swallow
MC benign cause of large bowel obstruction
volvulus
CRC is MCC overall, but is not benign
Treatment of AAA that is > 5.5 cm
endovascular stent-graft placement
you see an ulcer near the medial malleuolus - what should you think?
venous ulcer
treatment = compression therapy
first line treatment of PAD?
statin therapy
cilostazol (increases walking distance)
anti-coag treatment of DVT if there is active malignancy
Monotherapy with LMWH
What is ogilvie syndrome
Radiographic evidence and signs of LBO with no sign of mechanical obsctruction
Indications for dialysis
AEIOU
acidosis
elocrolytes: hyperK
ingestions
overload (volume)
uremia
what compartment pressure requires emergent fasciotomy?
30+
normal = 0-4
concerning = 15-20
hourly monitoring = 20-30
What meds are given for a pheo?
Alpha blockades
CCB
phenoxybenzamine = alpha blocker
when should you get a toe brachial index?
ABI > 1.4
indicates noncompressible arteries d/t vascular calcification
What is boerhaave syndrome?
Sponatenous perforation of the esophagus after increased intraesophageal pressure with negative intrathoracic pressure
most commonly effects the left posterolateral aspect of the distal intrathoracic esophagus
what is a HIDA scan aka?
Cholescintigraphy
Gs for acute cholecystitis
parkland formula for fluid correction
4 x bw in kg x % BSA = total mL given
1/2 given in first 8 hours
1/2 given in the last 16 hours
MC clinical presentation of primary hyperPTH
asymptomatic hyperCa caught on routine screening
T/f metformin can be taken the day of surgery
FALSE
stop a day b4 and mng with insulin as needed
T/f thyroid meds can be taken the day of surgery
True
T/f cardio meds can be taken the day of surgery
true
classic triad of renal cell carcinoma
flank pain
palpable abd mass
hematuria
first line management of post-op inability to void
in-and-out cath
first-line management of drug induced exanthem
topical triamcinolone and hydroxyzine
prednisone only if severe
MCC of hematochezia in an infant and other symmptoms of this
Intussception (ballooning)
crying and drawing up legs to the abd
treatment of intussception
pneumatic dilation
What is a RF of SCC that are not RF of adeno of esophagus?
Eth
What is a RF of adeno that are not RF of SCC of esophagus?
GERD
What arrises from the superior hemorrhoidal cushion?
Internal hemorrhoids
when is total parental nutrition indicated
If the gut is not functional
Use mouth in all patients if you can!
definitive treatment of chronic pancreatitis
Address underlying cause is the only treatment
a plt count < ____ is an indication for plt transfusion if undergoing surgery
50k
a plt count < ____ is an indication for plt transfusion if there is CNS or ocular bleeding
100k
a plt count < ____ is an indication for plt transfusion in NON-bleeding patients
10k
MC urologic CA
bladder CA
what specifically is seen on CT non-contrast for SHD
concave, cresent-shape hypodensity
when do you use autolytic vs sharp debridement for pressure ulcers?
Autolytic = stage 1-2
Debridement = 3 (with necrosis)+
MC stone of primary choledocholithiasis
brown/pigmented
Imaging of choice for hernia
CT w/ IV + oral contrast
When do you feel pain with duodenal ulcers?
2-5 hours after eating a meal
Biggest complication of ERCP
acute pancreatitis
where do you feel pain with hemolytic anemia?
back
what abx can lead to flares of G6PD?
Bactrim
Sulfonamides
what gene is affected with sickle cell anemia? Alpha or beta globulin?
Beta globulin
what breast disease goes away after menopause?
fibroadenomas
what breast disease is associated with nipple discharge prior to menstruation?
fibrocystic disease
seen prior to menopause
what is paget’s disease aka
infiltrating ductal carcinoma
not to be confused with infiltrating intraductal or infiltrating lobular
Over this age, a colonoscopy screening is a grade C (instead of A)
75+
What are the two types of 2nd degree burn?
Superfiscial partial
Deep partial
What differs a deep partial from a superfiscial partial burn?
Deep partial = only pain with pressure, blisters are easily unroofed and are wet/waxy
deep punch out appearance is seen in
arterial ulcers of PAD
Thiamine deficiency in a chronic alcoholic can lead to
Wernicke syndrome
1st line and 2nd line option for stopping esophageal variceal heomrrhage
1st line = band ligation
2nd line = balloon tamponade (as long as within 24 hours)
t/f mucous is found in the stool for UC
true
outpatient management of diverticulitis
Tylenol and a liquid diet
What is Barrett esophagus at the cellular level?
columnar metaplasia of the squamous epithelium
What is propofol?
A sedative-hypnotic for sedation and anesthesia
MCC of bloody discharge from the nipple
Intraductal papilloma
Muscular hypertrophy leading to pain/swelling to the UE, and cyanosis of the fingers
UE DVT
indications for US/ Mammogram for breast pain
20-50
Women under 30 years of age should have an ultrasound of the breast completed. Women between the ages of 30 and 39 years old should have an ultrasound and a focused or bilateral mammogram. Women over 40 years of age should have both a bilateral mammogram and an ultrasound.
Pyloric stenosis US classic finding buzzword
Target sign of the RUQ
```
~~~
basal cell hyperplasia + increased type III collagen + dysphagia
esophageal stricture
MC type of thyroid cancer and RF
Papillary
head/neck radiation exposure
What is medullary thyroid CA associated with?
MEN2
BUZZ WORDS
pheochromocytoma + hyperPARAthyroid
best location for a vena cava filter for DVT
At the inflow of the renal veins
Orchiopexy procedure
surgical procedure that moves an undescended testicle into the scrotum. It’s also sometimes used to treat testicular torsion.
which side of the colon is more likely to dvlp cancer?
left
t/f change of bowel habits is the MC finding of right-sided CRC
FALSE
melena is
MCC of childhood malginancy of the abd
Wilm’s tumor
abd pain + palpable mass to the right of hte abd
Hamman sign
mediastinal crunching sound that correlates with diastole of the heart, indicating esophageal perforation.
most appropriate IV fluid for a preop patient who is NPO
LR
treatment of sigmoid volvulus
sigmoidoscopy for detorsion
where do you do Moh’s surgery for BCC?
what size if not in this area?
H zone
also if > 2 cm
areas around the eyes, lateral cheeks, ears, nose, and mouth
surgeries with high cardiac risk
open chole
open ventral hernia repair
whipple procedure
McGinn-White sign
S1Q3T3 pattern on ECG associated with pulmonary embolism.
t/f umbilical hernias are MC in females
true
preferred initial intervention of SBO
NG decompression
then adhesion removal
What does hypothyroidism do to BP?
Diastolic HTN
when might you use TPA for a PE
if hemodynamically unstable
MCC of painless urinary bleed?
Bladder cancer
biggest RF for bladder CA
smoking
triad of mesenteric ischemia
abdominal pain, fever, and heme-positive stool. T
ypically, patients will have forceful evacuation of bloody stool.
RF of mesenteric ischemia
fluid resuscitation, thrombolytic therapy, fibrinolytic intervention, or surgical resection of necrotic bowel.
Common RF of anal fistulas
Crohn’s disease
Color of hematochezia other than bright red
maroon
Go to imaging for aortic dissection stable
CTA
MRA
Go to imaging for aortic dissection unstable
TEE (preferred)
TTE
MCC of hematochezia in pt > 60
diverticulosis
what specific US is first line for cholylithiasis
transabdominal US
triad of cardiac tamponade is known as
Beck triad
Beck triad
hypotension
JVD
Muffled heart sounds
pericardiocentesis!!!
when is a biopsy urease test not the test of choice for PUD?
If the patient has active bleeding or recent PPI or antibiotic use, then the most appropriate study would be a stool antigen test or breath urease test.
Biopsy urease testing during endoscopy will yield falsely negative results when there is bleeding.
age of colonic volvulus
younger patients
what thyroid condition can find-needle aspiration NOT dx
Follicular CA
when do you do a FNA vs Radinucleotide thryoid scan after a 2 cm thyroid mass?
TSH normal or elevated = fine needle
TSH subnormal = Radinucleotide thryoid scan
shave biopsy of BCC
multifocal nests of basophilic staining cells with peripheral palisading nuclei
treatment of low vs high risk patient for acute cholangitis
low = MR
high = pip/taz
INITIAL intervention of cholystitis
IV fluids
TOC of aneurysmal SAH
Nimodipine
what condition is known for gastrinomas?
ZES
get a fasting gastin test!
Chagas disease often leads to this GI condition
achlasia
Treatment of necrotic arerial ulcer 2ndary to PAD
surgical debridement
Between this range, an US should be completed every 6 months for AAA
5-5.4 cm
how often should a 4.0 to 4.9 centimeter AAA be evaluated?
12 months
how often should a 3 to 3.9 centimeter AAA be evaluated?
3 years
what cancer is crohn’s associated with?
adenocarcinoma
leading to SBO
what echo is first line for new murmur
transTHORACIC echo
NOT
transESOPHAGEAL echo
Transesophageal echocardiogram is recommended if transthoracic echocardiogram is insufficient. While its diagnostic accuracy is higher compared with transthoracic echocardiography, it requires sedation.
treatment for complicated diverticulitis with pericolonic abscess
in addition to bowel rest and IV antibiotics
percutaneous drainage
Type of surgery rec for appendicitis
laproscopic
What plexus are external hemmorids associated with
internal hemorrhoidal plexus
If you wanna get a CTA instead of a colonscopy, how often do you need to get it done for screening?
every 5 years
If you wanna get a Fecal immunochemical test and DNA methylation instead of a colonscopy, how often do you need to get it done for screening?
every 10 years
first thing to give to correct hyperK
Calcium gluconate or chloride to maintain the cardiac membrane
presentation of hepatic enchpalopathy
confusion
scleral icterus
bloody nose
liver tox
treatment of hepatic encephalopathy
lactulose + rifaximin
what cancer is Epstein-Barr virus associated with?
CML
Increased fibrin degradation products + schistocytes and decreased Plts
with AMS and bleeding
DIC
1st line prophylaxis of esophageal varices
BBs
Posterior cerebral artery infarct symptoms
homonymous hemianopia
memory deficits
Preservations
Visual defects
treatment of idiopathic intracranial HTN without HA
Acetazolamide
treatment of idiopathic intracranial HTN with HA
topiramate
does a cold nodule uptake iodine?
No
Preop plan to lower risk of complications of an ET tube in a pt with asthma
Administering an inhaled rapid-acting beta-agonist before surgery
Prevention of cholithiasis in patients with rapid weight loss
Ursodeoxycholic acid is a bile salt that is used to prevent gallstone formation in patients with rapid weight los
Presentation of chronic mesenteric ischemia
postprandial pain
fear of eating
weight loss
get a CTA and can do surgery or angioplasty
what location is pilondidal disease?
Pilonidal disease is a chronic glandular inflammation due to blocked hair follicles that occurs along the superior and inferior gluteal cleft
what thickness of margins are concerning for gastric CA
thickened
what are crypt abscesses seen in?
UC
best way to dx strangulated groin hernia
clinically
protein measurement that best assesses short-term nutritional status
prealbumin
preferred method of breast biopsy
core-needle biopsy
first line treatment of esophageal spasm
start with CCB alone
when do you do a carotid endarterectomy
70-99% stenosis and symptomatic
Treatment of symptomatic carotid artery disease < 50% stenosis
ASA and clopidogrel
DAPT
what surgery do you use to remove an adrenocortical carcinoma?
complete surgical resection
worry of surgical correction of anal fissure
irreversible fecal incontinence
t/f the wound of a stage 1 ulcer extends into the skin
FALSE
it would be stage 2 then
