EOR Topics to Review Flashcards
What is the MCC of an anal fistula?
Drainage of an anal/perianal abscess
Triad of chronic pancreatitis
- Abdominal pain (epigastric usually, radiates to the back)
- Diabetes mellitus (loss of endocrine pancreas function)
- Steatorrhea (loss of ability to process fats)
Findings on CT AP of chronic pancreatitis
Microcalcifications of the pancreas (can also show inflammation or fibrosis)
Chronic pancreatitis treatment
ERCP, pain control
Surgical options – pancreatic resection
Pancreatic malignancy imaging findings
Pancreatic duct stricture
Acute cholecystitis imaging findings
Pericholecystic fluid
Esophageal spasm presentation, diagnostics, and treatment
Presentation: dysphagia to solids and/or liquids WITHOUT WL (WL more c/w achalasia)
Diagnostics: initial upper endoscopy to r/o structural causes of dysphagia, then manometry – (+) for normal integrated relaxation pressure of the esophagogastric junction; barium swallow – (+) for premature contractions in barium swallow studies; barium esophagram (+) corkscrew esophagus
Treatment: FIRST LINE = CCBs (can try TCAs if sx are not controlled with a CCB)
Barium esophagram findings for achalasia versus esophageal spasm
Achalasia = bird beak appearance
Esophageal spasm = corkscrew
Tumor markers and their associations:
AFP
CA-125
CA19-9
CEA
AFP = HCC
CA-125 = ovarian cancer
CA 19-9 = pancreatic (primarily), also seen in CRC
CEA = CRC (primarily), but also thyroid, breast, gastric, and ovarian
Appropriate CRC screening modalities
Stool based tests:
- Annual gFOBT, FIT
- FIT-DNA every 1-3 years
Direct visualization tests:
- Colonoscopy q10 years
- CT colonography q5 years
- Flex sigmoidoscopy q5 years
- Flex sigmoidoscopy with FIT – flex done q 10 years and FIT done annually
For avg risk patients: start screening at age 45
For pts with a first degree fam member w history of CRC or advanced polyp: start w/ colonoscopy ate age 40 or 10 years prior to the age their relative was diagnosed
R sided vs L sided colon cancer stool appearance
L sided = hematochezia
R sided = melena (blood has farther to travel)
MC type of esophageal cancer
Adenocarcinoma (2/2 GERD or Barrett’s esophagus)
Anal fissure etiology
MC = prolonged straining
Atypical = IBD, TB, HIV, cancer, syphilis (consider if multiple fissures or fissure located in lateral anus)
When should you consider surgery for anal fissures?
If sx are refractory to first line tx OR persist for > 8 weeks
What is Courvoisier’s sign?
Painless jaundice + an enlarged, NT GB (a/w pancreatic carcinoma, will also see elevated CA 19-9)
Indications for laparoscopic appendectomy
Complicated appendicitis cases that do not respond to nonoperative mgmt
Non-operative mgmt of nonperforated appendicitis
IV abx, hospital observation (confirm resolution with repeat CT AP if sx are improving)
This approach is reserved for pts refusing surgery or who are not surgical candidates
Method of choice for appendectomy
Laparoscopic
Howship Romberg sign
Inner thigh pain with internal rotation of the hip
Indicates presence of an obturator hernia
What are indications for operative management of an SBO?
3-5 days of medical therapy with no improvement
Signs of peritonitis, shock, or perforation
Surgery = emergent laparotomy or laparoscopic adhesiolysis
Surgical indications for chronic pancreatitis
Severe pain that limits ADLs, persistent pain despite adequate analgesia and alcohol cessation
MCC of large versus small bowel obstruction
Large = malignancy
Small = postoperative
What is the role of vasopressin in treatment of diverticulosis?
Given if lower GI bleeding doesn’t self resolve
Transfusion indications in an upper GI bleed
RBCs if unstable and Hb < 9, stable and Hb < 7
Platelets if active bleed + plt count < 50 k
FFP if INR > 2
Difference between type 1 and type 2 hiatal hernias
Type 1 = sliding; GE junction and stomach slide into mediastinum – treated like GERD
Type 2 = rolling; fundus of stomach protrudes through the diaphragm with GE junction – treated with surgical repair (fundoplication)
5 W’s as causes of post op fever
Wind (atelectasis)
Water (UTI)
Wound (infection)
Walking (thrombophlebitis)
Wonder drugs/whopper
Femoral hernias are located _____ to the inguinal ligament, and inguinal hernias are located _____ to the inguinal ligament
Femoral = inferior
Inguinal = superior
Treatment of choice for IBD flares
Steroids (i.e. prednisone)
BMP findings for pyloric stenosis
Hypochloremic, hypokalemic metabolic alkalosis
Hypochloremic, alkalosis = excessive vomiting leads to to loss of HCl
Hypokalemic = volume down status leads to activation of RAAS, which causes increased aldosterone and decreased K+ reabsorption as a result
High fasting serum gastrin levels should make you think
Zollinger Ellison syndrome – multiple endocrine neoplasia tumors (a/w MEN1), specifically gastrinomas, whose G cells are not inhibited by secretin release
Gold standard test for diagnosing acute mesenteric ischemia
CTA (looking at flow and/or vasculature narrowing)
Initial and best test for diagnosing cholelithiasis
Transabdominal US (RUQ/gallbladder US)
Difference between incarcerated and strangulated hernia
Incarcerated = trapped, unable to be reduced
Strangulated = loss of blood supply, ischemic
MCC of hematochezia in patients < 50 and > 60 y/o?
< 50 = hemorrhoids (external)
> 60 = diverticulosis
What is Ogilivie syndrome?
Acute colonic pseudo-obstruction seen on CT, (+) colonic dilation without mechanical obstruction
RF: epidural administration, history of comorbid conditions, anticholinergics/antipsychotics/dopaminergic/opiates
H pylori triple and quadruple therapy
Triple = CAP (clarithromycin, amoxicillin, PPI)
Quad = Bowel Movements Toilet Paper (bismuth, metronidazole, tetracycline, PPI)
What is unique about CRC in Crohns compared to UC or other comorbid conditions?
CRC more likely in the ileum in Crohn’s, more common to be in the duodenum in other cases
Best initial test for hematemesis after hemodynamic stabilization?
EGD
T or F: Achalasia presents with dysphagia to both solids and liquids
True
T or F: Cholecystitis first line treatment is a lap chole
False – can be treated initially with IVF, abx, bowel rest and analgesics assuming no signs of complication (perforation, abscess, etc.) Definitive tx with lap chole in first 72 hours
MC type of gallstone in primary choledocholithiasis?
Pigmented d/t biliary stasis
Gold standard for diagnosing choledocholithiasis
ERCP
Intussusception presentation and treatment
Presentation: currant jelly stools, sausage shaped mass in RUQ that does NOT cross the midline, infant in distress, (+) target sign on US
Treatment: first step = reduction via hydrostatic or pneumatic pressure (pneumatic reduction aka different form of an enema), then can try surgical interventions if that is unsuccessful
Which type of polyp is most likely to become malignant?
Villous
THINK: Villous polyps are the biggest villains, most likely to become cancerous
What is used for primary prevention of esophageal variceal hemorrhage?
Propranolol (vasopressin, nitroglycerin, octreotide used for acute cases) b/c it decreases portal and collateral blood flow, reduces CO
Treatment for recurrent C diff infections unresponsive to vanco?
Fidaxomicin 200 mg Po q12h
Esophageal stricture big 5
Etiology: MC develops 2/2 chronic GERD
Presentation: progressive dysphagia with solids, odynophagia, chest pain, can see WL, atypical = chronic cough and asthma 2/2 aspiration
Diagnostics: initial = barium swallow – (+) luminal narrowing of esophagus; EGD = used to confirm diagnosis and exclude malignancy – (+) edema, basal cell hyperplasia and collagen deposition
Treatment: mechanical dilation and subsequent PPI administration
MC location of colonic ischemia
Splenic flexure and rectosigmoid junction (watershed area of the colon – decreased vascular supply, first area of ischemia if blood flow becomes compromised)
Colonic ischemia RF
Low output states: HF, diabetes, CVD, MI
Best methods of diagnosing H. pylori
If no active bleeding or recent PPI use: biopsy urease testing
If active bleeding or recent PPI use: urea breath test or stool antigen test
Clinical difference between R sided and L sided CRC?
R sided: tends to bleed, think IDA and melena
L sided: tends to obstruct, think pencil thin stools
Incisional hernia risk factors
Comorbidities:
- Connective tissue disorders
- Immunosuppression
- Advanced age
- Malnutrition
At what age do you start CRC screening in people who have a family history of FAP?
Age 10 w screening colonoscopy
Origin of internal versus external hemorrhoids
Internal = superior hemorrhoidal cushion
External = internal hemorrhoid plexus (arise from vasculature so they bleed more and are more painful)
Elevated 5-hydroxyindoleacetic acid levels in 24 hour urine indicate…
Carcinoid tumor (neuroendocrine presentation with vague abdominal pain, flushing, diarrhea, +/- respiratory symptoms)
diarrhea is due to serotonin breakdown (5-HIAA is a product of serotonin breakdown)
Cutoff/indication of AAA size for surgical repair
> 5.5 cm = indication for surgical repair via endovascular stent graft placement (also indicated if AAA is smaller but patient is symptomatic now)
Aortic dissection imaging of choice
HDS = CT angiogram (I.e. CT chest with contrast)
Hemodynamically unstable = rapid transport to OR with bedside TEE
6 P’s of acute arterial occlusion
Pain (extreme)
Pallor
Poikilothermia (cool to touch)
Paralysis (last to develop)
Pulselessness
Paresthesias
Which arteries are involved in pts with PAD and pain in the calf vs pain in the thigh/buttocks?
Calf = distal superficial femoral artery
Thigh/buttocks = aortoiliac disease (i.e. common iliac)
Venous versus arterial ulcer presentation
Venous = usually larger, more shallow, irregular borders, yellow exudate in wound bed w/ normal distal pulses (assuming no concurrent arterial insufficiency), less painful (described more as burning and aching versus overt pain), medial malleolus MC than lateral
Arterial = deep w/ a “punched out” appearance, extremely painful, MC found over lateral malleolus, irregular shape, diminished pulses, pallor, +/- gangrene, little to no drainage, no stasis dermatitis precedence
Best diagnostic tool for PAD?
ABI (< 0.9 = diagnostic, > 1.40 = non-compressible arteries)
Treatment of choice for moderate to immediately threatened limb ischemia
Revascularization
Signs of appendiceal perforation on CT AP
Free intraperitoneal gas – indication for immediate surgery assuming pt is agreeable and a suitable surgical candidate
MC post op complication of peptic ulcer surgery
WL 2/2 early satiety and decreased food intake
Gold standard for diagnostic eval of PUD?
Histologic tissue evaluation following endoscopy – allows tissue to be placed within a urea capsule to determine production of urease by H. pylori
Risk factors for development of post op N/V
- Female sex
- Increasing age
- General anesthesia, longer periods of anesthesia
- Non-smoker
- Prior episodes of post op N/V or N/V induced by chemo
- Opioid administration
MC electrolyte disturbance a/w respiratory alkalosis
Hypokalemia
Definitive treatment for pilonidal cyst
Surgical excision of all sinus tracts
What is the most important step in caring for a patient with a GI bleed?
Obtaining IV access
1st line medical therapy for PAD?
Antiplatelet therapy – aspirin, clopidogrel
Surgical methods of choice for carotid plaques that are vs. are not easily surgically accessible
Surgically accessible = carotid endarterectomy
Not easily surgically accessible = carotid stenting or angioplasty
Most common post op laparoscopic GI procedure acid base disturbance?
Metabolic alkalosis (volume contraction with intraperitoneal fluid loss and acid loss with post op NG decompression causes a hypokalemic, hypochloremic, metabolic alkalosis)
MC type of shock to develop postoperatively after laparoscopic procedures?
Hypovolemic shock (can either be hemorrhagic or nonhemorrhagic, which is due to fluid loss)
CRC risk factors
Familial history of CRC or hereditary cancer syndromes (Lynch, FAP, Peutz-Jaeger syndrome)
IBD
Diet high in refined sugar, red meat, salt cured and smoked foods
Alcohol use
Neuroendocrine tumors
Pheo treatment
FIRST: alpha blocker (phenoxybenzamine)
SECOND: beta blocker (propranolol) – avoid beta blocker first to limit any unopposed alpha adrenergic stimulation
THEN: adrenalectomy
All followed by long term monitoring with annual biochemical screening
MC area to see edema in nephrotic syndrome
Ambulatory = LE
Non-ambulatory = sacrum
Shapes of epidural versus subdural hematomas on CT
Epidural = lemon/lens/lenticular shaped
Subdural = crescent shaped
Subarachnoid = hyperdensities in ventricular spaces
What are indicators that gastric carcinoma is unresectable?
Vascular involvement of the aorta, hepatic or proximal splenic arteries
Distant metastases
MET guidelines for perioperative cardiac risk assessment
< 4 METs = poor (only able to do ADLs, write, can’t do strenuous physical activity)
4 - 7 METs = moderate (can climb steps or a hill, walk on flat ground at 3-4 mph, heavy work around the house such as scrubbing floors)
> 7 METs = good (can participate in strenuous physical activity such as swimming, football, skiing, etc.)
T or F: you can be on methadone and have surgery
True (same for other chronic narcotics)
Signs of perforated GB in cholecystitis?
Hypoactive BS, signs of toxicity (tachycardia, tachypnea, rebound tenderness)
MCC of hematochezia in patients > 60 y/o?
Diverticulosis
Acute arterial occlusion gold standard for diagnosis?
CTA with runoff
(Doppler US can be good at determining blood flow to an area, but it doesn’t help locate occlusion or determine vessel patency)
For children with a classic presentation of appendicitis, do you get imaging first or consult pediatric gen surg?
Consult peds gen surg b/c clinical presentations consistent with appendicitis is enough to start surgical process, don’t need unnecessary radiation exposure from CT
What is the best diagnostic tool to confirm the etiology of jaundice noticed on physical exam?
Fractionated bilirubin levels
Pre-op medications for pts undergoing carotid endarterectomy versus carotid stenting
Endarterectomy = baby aspirin prior to surgery and continue for at least 3 months after
Stenting = DAPT (clopidogrel + aspirin) prior to surgery due to increased risk of stroke
Are hot or cold nodules more concerning for thyroid malignancy on radioiodine uptake scans?
Cold – indicates need for FNA!
Best approach for any adrenal resections?
Open transabdominal – allows for greater visualization of surrounding structures and lymph nodes if resection may be necessary
Best imaging modality for assessing pulmonary preoperative risk factors?
CXR
Best test for detecting pheo in pts who are high versus low risk
High risk = plasma fractionated metanephrines
Low risk = 24 hour urine fractionated metanephrines and catecholamines
Most sensitive test for an SBO
CT AP with contrast
Hot vs. warm vs. cold thyroid nodules
Hot = increased iodine uptake compared to surrounding thyroid tissue (unlikely to be malignant)
Warm = same amount of iodine uptake compared to surrounding thyroid tissue (normal thyroid activity)
Cold = decreased uptake compared to surrounding thyroid tissue (more likely to be malignant)
MC type of thyroid cancer overall and MC type of thyroid cancer a/w MEN2
MC overall = papillary thyroid cancer
In MEN2 = medullary thyroid cancer
Is diastolic hypertension associated with hyper or hypothyroidism?
Hypothyroidism
Indications for thyroid radioscintigraphy
Subnormal TSH and abnormal thyroid nodule
***If TSH is grossly abnormal and nodule is suspicious for malignancy on physical exam, go straight to FNA
If a breast lesion is suspicious for malignancy, what is the best method for biopsy?
core needle biopsy
Imaging modalities for breast pain/disease based on age
Women under 30: unilateral breast US
Women aged 31-39: breast US + focused or bilateral mammogram
Women 40 and over: bilateral breast US + bilateral mammogram
MCC of metabolic acidosis in hospitalized patients?
Lactic acidosis (the L in MUDPILES)
When should patients on HD be dialyzed prior to any elective surgery?
One day before surgery
What is the usual timeline for the development of postoperative pneumonia?
Usually develops within 5 days postop
Initial anticoagulant of choice in HDS patients w/ or w/o malignancy and no other contraindications
SQ LMWH
(tPA if patient is hemodynamically unstable, and unfractionated heparin if pt has renal insufficiency)
What protein best assesses short term nutritional status?
Prealbumin (has a short half life – low levels indicate malnutrition)
3 sites of central line placement
Subclavian (preferred over IJ assuming no other CIs present) , IJ, and femoral (best site for an active code)
What medications are a/w decreased mortality in STEMI patients?
DAPT (aspirin and P2Y12 inhibitors such as ticagrelor) – these should be given prior to PCI if possible
Antidote for patients who are actively bleeding while on warfarin?
Vitamin K
Incentive spirometry is used as postop prophylaxis for what?
VTE, atelectasis, pneumonia
Most appropriate fluid for a preop patient who is NPO?
Lactated ringers
Typical go to treatment for basal cell carcinoma
Mohs surgery
Pruritus 2/2 opioids versus antibiotics
Opioids = pruritus with no observable rash
Antibiotics = pruritus with observable urticaria, +/- angioedema or anaphylaxis
Treatment for post operative drug eruption
Topical triamcinolone (topical corticosteroids) and hydroxyzine (oral antihistamines) 25 mg PO for symptom relief + d/c offending agents if applicable
IIH treatment of choice
Topiramate, acetazolamide for symptom control
Long term = WL, surgical options if refractory include ventriculoperitoneal or lumboperitoneal shunts, optic nerve fenestration
Causes of amauorosis fugax
Retinal vein occlusion
Retinal vasospasm
Papilledema
Ischemia – i.e. carotid artery stenosis (usually monocular)
Wernicke encephalopathy triad
AMS, ataxia, ophthalmoplegia
Hematuria w/ red cell casts on UA + hemoptysis should make you think…
Vasculitis or Goodpasture syndrome
Treatment of a TIA 2/2 carotid artery disease
Carotid endarterectomy (tPA contraindicated in TIA!)
Thoracentesis is used to obtain info for Light’s Criteria. If pleural fluid:serum protein ratio is </= 0.5, this is a ________ (transudative vs. exudative) process and if it is > 0.5 it is a ________ (transudative vs. exudative) process. Examples include ________
Transudative, exudative
Transudative = transient processes that cause changes in fluid accumulation levels (CHF is the MCC, cirrhosis, nephrotic syndrome) – usually clear/straw colored fluid
Exudative = oncotic pressure changes, often more acute than transudative (infections like PNA, malignancy, autoimmune causes, TB, PE, chylothorax)
Gold standard for determining whether or peripheral lung nodule is malignant versus infectious?
Open lung biopsy – done with video assisted thoracic surgery, allows for visual inspection and resection of lung mass and lymph nodes close to the pleural surface
other pros: quick recovery time, small incisions
Indications for transbronchial needle aspiration?
Sampling large, central lung lesions and obtaining samples from lymph nodes in the mediastinal and paratracheal areas
MCC of hypocalcemia
Hypoalbuminemia
What is the preferred form of vascular access in patients requiring long term HD?
UE AV fistula (in order of priority: UE > LE > upper chest > IVC)
DIC labs
TCP, decreased fibrinogen, increased fibrin degradation products (aka D dimer), increased INR, PT and PTT
Boundaries of Hesselbach’s triangle?
Rectus abdominis medially
Inferior epigastric vessels superolaterally
Inguinal ligament inferiorly
***this is where direct inguinal hernias often arise, do NOT go into the scrotum and do not travel with the spermatic cord contents
what volume of blood output indicates need for further exploration in the OR for a traumatic hemothorax?
Immediate output > 1500 cc’s
Presentation and treatment of cutaneous abscess?
Presentation: infection (MC staph aureus) of palmar and dorsal aspects of the hand – pain, swelling and tenderness over the web space w/adjacent fingers resting in the abducted position
Treatment: urgent open surgical drainage and debridement with volar and dorsal incisions w/ IV abx administered until wound closure, then PO abx
Treatment initiation for mild versus moderate Crohns
Mild: step up therapy is appropriate – glucocorticoids and eventual steroid taper following remission with f/u ileocolonoscopy q6-12 months OR 5-ASAs
Moderate to severe (aka extraintestinal manifestations, severe sx): top down approach – start with high potency biologic agents (i.e. inflixamab) in combination with azathioprine or mercaptopurine and remain on biologics indefinitely with mercaptopurine taper once remission is achieved
Chronic mesenteric ischemia presentation
- Long term abdominal pain that is worsened with meals (pain begins ~30 mins after eating, versus pain with PUD beginning ~2-5 hours after eating)
- N/V
- WL
- Abdominal bruit
Diagnostics: angiography = gold standard but diagnosis is usually clinical
Treatment: surgical revascularization = gold standard, percutaneous angioplasty = good alternative
Indications of strangulated versus incarcerated hernia
Strangulated = peritonitis sx (abdominal distention, rebound tenderness, guarding, rigidity, hypoactive BS) – development of these sx indicates peritonitis 2/2 ischemia
Incarcerated = overlying skin changes, non-reducible, painful, nausea
Posterior MI EKG findings
R waves and ST depression in V1-V6
Best NSAID to prevent GI toxicity when treating patients with PUD?
Celecoxib – selective COX2 inhibitor with decreased GI toxicity compared to other nonselective agents
What does serosanginuous fluid look like and what does it indicate?
Clear/straw colored – indicates body is healing well and recovering appropriately
Layers of adrenal gland and the hormones they secrete
Zona glomerulosa: aldosterone (Stress)
Zona fasciculata: cortisol (sugar)
Zona reticularis: androgens (sex)
Adrenal medulla: catecholamines
THINK: it just gets sweeter as you go deeper into the adrenal gland – stress, sugar, sex
Lactic acidosis in the postoperative setting indicates _____, which is consistent with Type A/B lactic acidosis
Hypoperfusion (2/2 sepsis, hypovolemia, cardiac failure or arrest), which is type A lactic acidosis (MC type)
UC colonoscopy versus abdominal radiograph findigns
Colonoscopy: diffuse ileal inflammation, affects superficial mucosa
Radiograph: mucosal thickening with thumbprinting 2/2 edema, +/- colonic dilation if severe dilation
What physical exam finding makes ileus more likely than SBO?
Mild, diffuse abdominal pain
(Both can have N/V, obstipation, abdominal distention)
Most appropriate therapy for a patient with distant metastatic thyroid cancer
External beam radiation therapy
(Primary tumor resection reserved for anaplastic tumors with localized disease, followed by adjuvant radiation and chemotherapy)
Thyroid cancer in patients with history of multinodular goiter should make you think of which type of thyroid cancer?
Anaplastic – distant metastasis often affects the lungs
Indications for carotid artery stenting over endarterectomy
- History of COPD
- Carotid lesion surgically inaccessible
- Prior ipsilateral carotid endarterectomy
- Other chronic cardiac or pulmonary diseases that increase the risk of anesthesia and/or surgery
Diagnostic study to CONFIRM miliary TB?
Acid fast smear and sputum culture
Which pre-op lab result indicates increases risk of wound complications after surgery?
A) Hb < 28
B) Albumin < 3.5
C) Glucose > 150
D) Totaly lymphocyte count > 3000
B – albumin < 3.5 indicates malnutrition, which means that impaired wound healing and increased wound infection risk is present. Address by preoperative protein supplementation
A – no evidence of anemia, and recent guidelines don’t show that anemia increases infection risk
C – look at A1c for increased risk versus one serum glucose value which isn’t as reliable
D – total lymphocytes < 1500 would be more concerning for malnutrition and poor wound healing
Fluid of choice in conjunction with blood transfusion?
Normal saline
***commonly given to post op patients because they are often alkalotic and hypokalemic d/t volume loss, want to avoid LRs or Plasma Lyte d/t their K+ concentration
Findings of hemorrhagic stroke on noncontrast CT
Focal hyperdensities within the brain parenchyma
Continuous peritoneal dialysis recommendations
- Monitor weight daily
- Avoid excessive water and phosphorus intake (accumulation in the setting of ESRD)
- Potassium intake < 1500 mg/day
Hypoglycemia treatment in the hospital
- If stable and has PO abilities – glucose tablets or sweetened juice
- If sedated or unable to protect airway – 25 g IV 50% dextrose
Preferred treatment for cecal volvulus
Ileocecotomy (w/ ileocolic anastomosis in patients who are not HDS)
Postoperative physical exam finding indicative for emergent fluid resuscitation?
Agitation – sign of hypovolemic shock (along with tachycardia, cool/clammy extremities, cyanosis, oliguria)
Decreased skin turgor, dry mucus membranes, increased cap refill indicate mild to moderate dehydration
Screening recommendations for women with a history of breast cancer who have undergone reconstructive surgery involving silicone implants
No need for mammograms if all breast tissue was removed – MRI for any implant related concerns can be obtained PRN
Next best step if nonsustained ventricular tachycardias are noted on EKG
Electrophysiologic study – identifies the mechanism of induction dysrhythmias
T or F: nectrotizing fasciitis progresses extremely rapidly and more commonly involves the UE
False – it does spread rapidly but is more common in the LE
Necrotizing fasciitis tx: surgical debridement, broad spectrum abx – vanc zosyn with blood cultures taken prior to initiation
Length of PPI treatment for gastric versus duodenal ulcers
Gastric: 8-12 weeks
Duodenal: 4-8 weeks
Risk factors for esophageal stricture development
- GERD
- Prior head or neck radiation
- Eosinophilic esophagitis
Burn classifications
Full thickness
- Affects entire epidermis and dermis, subcutaneous fat exposed
- +/- loss of sensation, only painful with DEEP palpation
Deep partial thickness
- Affects epidermis and parts of dermis
- Painful to touch ONLY (not air), blisters of varying colors that are easily unroofed with palpation
Superficial partial thickness
- Affects epidermis and parts of dermis
- Painful to touch AND air, weeping blisters that blanch when pressure is applied
Superficial
- Affects epidermis only
- Red, blanchable, very painful with and without applied pressure!
Varicose veins treatment if refractory to conservative therapy (i.e. compression)
Radiofrequency or laser ablation
What is a Spigelian hernia?
Defect in Spigelian aponeurosis (bordered by rectus abdominis medially and linea semilunaris laterally)
Best test for diagnosing Zenker’s?
Barium swallow with continuous fluoroscopy
Ulcers with calloused borders are consistent with…
Neuropathic ulcers (i.e. diabetic ulcers)
DVT prophylaxis for low versus high risk patients
Low = intermittent intra-operative and post0operative pneumatic compression devices
Moderate to high risk = SQ LMWH (or unfractionated heparin if renal disease, add warfarin to LMWH if they have active malignancy)
Thyroid nodule workup algorithm
1) Discovery of nodule on physical exam
2) Start with thyroid US and TSH level
3) If TSH subnormal, follow with a radionuclide thyroid scan
- if this reveals a functioning thyroid nodule – overt hyperthyroidism, initiate treatment
- if this reveals a nonfunctioning nodule – aspirate if it meets criteria or observe
4) FNA criteria: hypoechoic nodule with irregular margins microcalcifications and evidence of extathyroidal extension
Best method to achieve revascularization for acute arterial occlusion with moderately threatened limb ischemia
Open thrombectomy or embolectomy
Encapsulated organisms
THINK: SHNEKSS
Strep pneumo
H flu
Neisseria meningiditis
E coli
Klebsiella
Salmonella
Streptococcus group B
Which of the following can be used in patients with obesity to aid in WL by altering fat digestion due to pancreatic lipase inhibition?
A) Liraglutide
B) Lorcaserin
C) Orlistat
D) Phentermine-topiramate
C
A – GLP-1 that increases insulin secretion
B – activates serotonin 2C with functional selectivity, which reduces appetite
D – sympathomimetic amine aorectic drug that works in the hypothalamus to reduce appetite
Wernicke encephalopathy triad
Ataxia, confusion and nystagmus
Difference between presentation of inflammatory breast cancer versus Paget’s
Inflammatory: peau d’orange (nipple stippling and inversion) with lymph node involvement
Paget’s: eczematous rash overlying nipple
Post void residual > ____ mL indicates postoperative urinary retention
100
Sudden appearance of multiple SKs is a/w what malignancy?
HCC
T or F: Patients without a functional gut (i.e. s/p colectomy) should be started on TPN
True
Uncomplicated diverticulitis treatment
Acetaminophen and liquid diet, +/- PO abx (metronidazole and cipro)
