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General Surgery > Exam Pearls > Flashcards

Exam Pearls Flashcards

1
Q

Most common swallowed object?

A

coins

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2
Q

Most common aspirated object?

A

peanuts

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3
Q

Most common patient population to swallow foreign bodies?

A

Kids (80%)

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4
Q

Two common sites of esophageal obstruction?

A 
Cricopharyngeus muscle (right chest)
GE junction (left chest)
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5
Q

Most common cause of Boerhaave’s syndrome?

A

Retching from EtOH

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6
Q

Cap Medusa, dilated veins

A

Mallory Weiss tear

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7
Q

Most common cause of alkali esophageal injuries?

A

Bleach

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8
Q

Most common in Asia, Africa, and Iran?

A

Esophageal cancer

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9
Q

Makes up 60% of esophageal cancer in the US?

A

Adenocarcinoma

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10
Q

Most common hiatal hernia?

A

Sliding Type 1 (85%)

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11
Q

Very very bad halitosis or regurgitation of undigested food?

A

Zenker’s Diverticulum

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12
Q

Pathogen that causes gastric ulcers?

A

H. pylori

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13
Q

Hypersecretion of gastric acid tumor?

A

Zollinger- Ellison Syndrome

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14
Q

Fasting pain in the epigastric region, better with food and antacids

A

Duodenal ulcer

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15
Q

Young infant, with hollow pit in stomach and projectile vomiting?

A

Hypertrophic pyloric stenosis

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16
Q

Olive pit in epigastrium

A

Pyloric stenosis

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17
Q

What are the Rule of 2s?

A

2% of the population
2 tissue types (gastric or pancreatic)
2 feet from the ileocecal valve

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18
Q

What does the Rule of 2’s apply to?

A

Meckels Diverticulum

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19
Q

If a person has “unusual dietary habits” they mostly can get ?

A

Bezoar

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20
Q

What the 3 types of bariatric surgeries?

A

Gastric banding
Sleeve gastrectomy
Roux-en-Y

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21
Q

What is the most common type of gastric bypass?

A

sleeve gastrectomy

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22
Q

Most common cause of small bowel obstruction from prior surgery?

A

adhesions

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23
Q

Most common cause of small bowel obstruction world wide?

A

incarcerated hernia

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24
Q

Uncommon source of obstruction in SB?

A

Small bowel cancer

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25
Q

Mouth to anus, Cobblestone, skip lesions, transmural

A

Crohn’s disease

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26
Q

Positive Psoas sign?

A

appendicitis

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27
Q

What scoring is used for appendicitis?

A

Alvarado’s score

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28
Q

What does MANTRELS stand for?

A 
Migration to R iliac fossa
Anorexia
Nausea/Vomiting
Tenderness in R illac fossa
Rebound pain
Elevated temp (fever)
Leukocytosis
Shift of leukocytes to left
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29
Q

McBurney incision?

A

appendicitis (open)

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30
Q

What is the most common risk associated with appendicitis?

A

Carcinoid

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31
Q

What 3 rare pathologies are associated with appendicitis?

A

Carcinoid
Lymphoma
Adenocarcinoma

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32
Q

Cholecystitis?

A

inflammation of the gall bladder

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33
Q

Cholecystectomy?

A

gall bladder removal

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34
Q

Cholelithiasis?

A

stone in the gall bladder

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35
Q

Choledocho?

A

bile duct

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36
Q

Choledochoilithiasis?

A

stones in the bile duct

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37
Q

Fat, Fair, Forty, Female?

A

Cholelithiasis

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38
Q

Most gallstones are made of?

A

cholesterol

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39
Q

Imaging of choice for gallstones?

A

ultrasound

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40
Q

A fracture through C2?

A

Hangman

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41
Q

Necrosis around the umbilical cord?

A

Cullens

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42
Q

A good prognosis factor in acute pancreatitis?

A

Creatinine

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43
Q

What vaccine should be given after a splenectomy?

A

Pnemovax

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44
Q

When should OPSI vaccine be given in a elective splenectomy?

A

2 wks prior to surgery

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45
Q

Diagnostic and therapeutic for choledocholithaisis?

A

ERCP

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46
Q

Most common cause of acute pancreatitis?

A

gallstone

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47
Q

Persistent hypoglycemia and elevated insulin level?

A

Insulinoma

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48
Q

What occurence is expected after a splenectomy?

A

Thrombocytosis

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49
Q

A 4ym, admitted for grade 2 spleen injury remains HDS with benign exam overnight, what is preffered txt?

A

non-operative

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50
Q

Pouch which involves all layers of the bowel wall

A

Diverticulum

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51
Q

Pouch which only involves the outer layer?

A

Pseudodiverticulum

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52
Q

Diverticula present

A

Diverticulosis

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53
Q

Inflammation of diverticula

A

Diverticulitis

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54
Q

What is a common complication of diverticulosis not found in acute diverticulitis?

A

diverticular bleeding

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55
Q

What is the most common cause of colonic hemorrhage?

A

Diverticulosis

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56
Q

Benign abdomen (asymptomatic) w/ massive bleeding?

A

Diverticulosis

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57
Q

How does the bleeding stop in diverticulosis?

A

stops spontaneously (90%)

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58
Q

What is the treatment for diverticulosis?

A

admit, resuscitate, NPO

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59
Q

What 3 things allows for a benign course of diverticulosis?

A

High fiber diet
Exercise
Statin use

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60
Q

What causes the bleeding in diverticulosis?

A

vessels that perforate the bowel wall, intracolonic pressure pushes the mucosa out through where the vessels emerge

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61
Q

Patient presents with LLQ pain and tenderness, mass or phlegmon?

A

Diverticulitis

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62
Q

What imaging is done for diverticulitis?

A

KUB, CT with rectal and oral contrast

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63
Q

Which imaging should be AVOID! in diverticulitis?

A

COLONOSCOPY or FLEXIBLE SIGMIDOSCOPY!!!

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64
Q

What is the txt for diverticulitis?

A

admin, resuscitation, broad spectrum IV abx

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65
Q

What is the txt for outpatient diverticulitis

A

metronidazole + fluoroquinolone for 10-14 days

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66
Q

When can a colonoscopy be safely performed in diverticulitis?

A

6-8 weeks later for cancer screening

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67
Q

What are 2 complications of diverticulitis?

A

Diverticular abscess, colo-vesicle fistula

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68
Q

A patient with diverticulitis, now has fever, chills, sweats, and sepsis?

A

Diverticular abscess

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69
Q

What is the txt for diverticular abscess?

A

percutaneous drainage

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70
Q

A pt with diverticulitis, now has pneumouria, and recurrent UTI?

A

Colo-vesicle fistula

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71
Q

What is the txt for colo-vesicle fistula?

A

segmental colectomy and bladder repair

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72
Q

What is the 2 surgical txt for diverticulitis?

A

Segmental resection w/ anastomosis OR

Segmental colectomy with diversion (colostomy)

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73
Q

Where does lower GI bleeds start?

A

below Ligament of Treitz

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74
Q

T/F Lower GI bleeds are painful?

A

FALSE

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75
Q

What diagnostic test are used for LGI bleeds?

A

Fecal Occult Blood (FOBT)
NGT suction/ EGD
Colonoscopy

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76
Q

What is the txt for Lower GI bleed?

A

admin, resuscitation

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77
Q

What are 3 surgical considerations for LGI bleed?

A

Patient deteriorates
Persistent bleeding (>3 U PRBC)
Recurrent bleeding

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78
Q

How can you determine where a LGI bleed is coming from prior to surgery?

A

Mesenteric angiogram

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79
Q

Most common colorectal cancer?

A

adenocarcinoma

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80
Q

What are Risk factors for colorectal cancer?

A 
Adenomatous polyp
Villous polyp
UC and Crohn's
Hereditary non-polyposis
Familial Adenomatous Polyposis
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81
Q

When does colorectal cancer screening start?

A

at 40 (50) or 10 years prior to dx in a first degree relative

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82
Q

Autosomal dominant, almost 100% risk of colorectal cancer lesions at 40yr

A

Familial Adenomatous Polyposis

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83
Q

Most common cause of colon obstruction?

A

colorectal cancer

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84
Q

Most common side of colon cancer?

A

left

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85
Q

Pt has tenesmus the need to have a bm but can’t evacuate?

A

rectal cancer

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86
Q

Where does colon cancer commonly mets?

A

liver

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87
Q

Iron deficiency anemia in patients is what until proven otherwise?

A

colon cancer

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88
Q

What is curative resection?

A

removes all tumor and nodes prior to mets

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89
Q

What is palliative resection?

A

remove tumor burden to avoid obstruction and bleeding

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90
Q

What prophylactic can be done in pts w/ familial polyposis?

A

a colectomy

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91
Q

What are the stages of colon cancer?

A

Stage 0- Stage IV

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92
Q

What is the most common cause of colon obstruction?

A

colon cancer

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93
Q

T/F a pt w/ a colon obstruction CAN’T pass stool but may pass flatus initially?

A

True

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94
Q

Can be both diagnostic and therapeutic for a colon obstruction?

A

Barium enema

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95
Q

Apple core lesion is highly suggestive for?

A

colon cancer

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96
Q

Twisting of cecal or sigmoid colon?

A

volvulus

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97
Q

Presents in children, with massive amounts of stool in dilated colon?

A

Hirschprung’s

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98
Q

Arthritis, iritis, erythema nodosum, liver dysfunction is associated with?

A

Ulcerative colitis

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99
Q

Limited to colon (cecum to rectum) and contiguous, with bloody diarrhea

A

Ulcerative colitis

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100
Q

Where are internal hemorrhoids located?

A

above dentate line are NOT innervated by sensory nerves (painless)

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101
Q

Where are external hemorrhoids located?

A

below dentate line and ARE innervated by sensory nerves (painful)

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102
Q

What can be used to identify internal hemorrhoids?

A

anoscope

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103
Q

Txt for hemorrhoids?

A

stool softener (colace, metamuicil)
sitz bath
Topical anesthetic-lidocaine jelly 2%
wipes

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104
Q

What surgical procedure is contraindicated for external hemorrhoids?

A

rubber band ligation

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105
Q

What surgical txt can be used for thrombosed hemorrhoids?

A

incise and drain

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106
Q

Sentinel tag, painful ulcer or slit-like opening on anus?

A

anal fissure

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107
Q

Txt for anal fissure?

A

stool softener, sitz baths, topical anesthetics, surgery

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108
Q

Very sick pt, pelvic/posterior heaviness, and septic shock?

A

PeriRECTAL (ischio-rectal) abscess

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109
Q

Txt for perirectal abscess?

A

SURGERY!!!

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110
Q

“Never let the sun go down on a ???

A

periRECTAL abscess

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111
Q

Tender, fluctuant mass on the anal verge?

A

perianal abscess

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112
Q

Txt for perianal abscess?

A

I&D

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113
Q

Truck driver, a pilot presents with a raised pit in the gluteal cleft that has tracts of hair?

A

pilonidal disease

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114
Q

Txt for pilonidal disease?

A

bascom cleft lift

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115
Q

Txt for rectal foreign body?

A

peri-anal block anesthesia

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116
Q

RLQ, Periumbilical pain, n/v?

A

Appendictitis

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117
Q

pain may slightly improve, but it will not completely resolve and will soon become consistent with perionitis?

A

perforation of appendix

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118
Q

Imaging used for appendicitis?

A

CT
MRI (children)
US (preggo)

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119
Q

What IV abx are used to treat appendicitis?

A

2nd or 3rd gen cephalosporin w/ Metronidazole

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120
Q

If a pregnant woman has appendicitis is a appendectomy still needed?

A

Yes

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121
Q

What are the 2 types of perforations?

A

Generalized peritonitis

Localized abscess

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122
Q

What is the treatment for a generalized perforated appendix?

A

Operate ASAP!!

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123
Q

What is the treatment for a localized perforated appendix?

A

abx and percutaneous drainage then appendectomy (after 6 wks)

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124
Q

What is the overall goal of treating appendicitis early?

A

prevent septic shock and perforation

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125
Q

Whom has a higher rate of appendix perforation due to a delay in diagnosis?

A

children, developmentally delayed and elderly

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126
Q

Inguinal hernia originates where?

A

above the inguinal ligament

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127
Q

Femoral hernia originates where?

A

below the inguinal ligament

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128
Q

Incarcerated hernia are?

A

non-reducible

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129
Q

Strangulated hernia’s are?

A

incarcerated and ischemic

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130
Q

Where are indirect inguinal hernia’s located?

A

internal inguinal ring and are lateral to the inferior epigastric artery

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131
Q

Where are direct inguinal hernia’s located?

A

through Hesselbach’s triangle

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132
Q

What makes up Hesselbach’s triangle?

A

inguinal ligament inferiorly, inferior epigastric vessel lateral and rectus muscle medially

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133
Q

Where is the femoral hernia located?

A

empty space at the medial aspect of femoral canal, inferior to inguinal ligament

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134
Q

What causes a congenital hernia?

A

patent processus vaginalis

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135
Q

Most common hernia in both sexes?

A

indirect inguinal (congental) hernia

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136
Q

What imaging confirms a hernia?

A

CT

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137
Q

What is the first imaging done for a hernia?

A

US

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138
Q

What surgical repair i done for a bilateral hernia?

A

Laparoscopic

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139
Q

What surgical repair is doen for a unilateral hernia?

A

Open

then Laparoscopic if failed

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140
Q

What causes a direct inguinal hernia?

A

Acquired weakened floor of inguinal canal

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141
Q

What is placed over the inguinal canal to reinforce the floor?

A

mesh

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142
Q

Hernia more common in women?

A

femoral hernia

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143
Q

What makes up the femoral triangle?

A

Inguinal ligament
Sartorius
Adductor longus

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144
Q

What symptom is seen in a femoral hernia as opposed to the others?

A

constipation

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145
Q

Not a true hernia?

A

Sports hernia and Diastasis recti

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146
Q

What are 3 indications for sport’s hernia?

A

lifestyle limiting pain
failure of conservative tx > 8wks
Exclusion of other dx

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147
Q

Fluid filled sac next to testis, and it transilluminates?

A

Hydrocele

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148
Q

Acute onset testicular pain, associated w/ prostatitis or vasectomy?

A

Epididymitis

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149
Q

Txt for epididymitis in young men?

A

scrotal support and abx for STI

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150
Q

TX for epididymitis in older men?

A

scrotal support, abx for gm neg rods

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151
Q

Fluid fill mass attached to epididymis, non tender?

A

Spermatocele

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152
Q

Imaging and txt for a spermatocele?

A

US and surgery

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153
Q

“Bag of worms”?

A

Variocele

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154
Q

Txt for varicocele?

A

surgery for infertility

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155
Q

solid painless firm non-tender mass on testicle?

A

Testicular cancer

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156
Q

Imaging for testicular cancer?

A

US

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157
Q

Extreme testicular pain, n/v, sweating after strenous activity?

A

testicular torsion

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158
Q

Imaging for testicular torsion?

A

Urgent US w/ Doppler

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159
Q

Txt for testicular torsion?

A

orchiopexy if viable

Orchiectomy if not

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160
Q

Protrusion through the linea alba above the umbilicus?

A

Epigastric hernia

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161
Q

Nontender mass, normally easily reducible, no ileus or obstruction?

A

Epigastric hernia

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162
Q

Txt for epigastric hernia?

A

routine surgery or abdominal corset

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163
Q

When does a umbilical hernia close in a newborn/child?

A

prior to school age

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164
Q

When is a umbilical hernia needed for surgery in a child?

A

at age 5 if it persists

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165
Q

T/F Children umbilical hernia are rare to incarcerate?

A

True

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166
Q

T/F Adults umbilical hernia may incarcerate?

A

True

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167
Q

Herniation through previous operative site?

A

incisional hernia

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168
Q

Dehiscence through the facial closure w/ intact skin?

A

incisional hernia

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169
Q

Yellow-pink (salmon) colored fluid indicates?

A

Wound dehiscence (peritoneal fluid)

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170
Q

Txt for a wound dehiscence?

A

Surgery ASAP for fascial closure

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171
Q

Txt for acute fascial dehiscence?

A

Urgent surgical evaluation

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172
Q

Txt for delayed fascial dehiscence?

A

routine surgery

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173
Q

Widening of the linea alba?

A

Diastasis recti

174
Q

What can cause diastasis recti?

A

pregnancy
obesity
increased intra-abdominal pressure

175
Q

Prominent midline bulge when pt raises head?

A

Diastasis recti

176
Q

When does epithelialization start?

A

within one day

177
Q

A full thickness burn has no?

A

epithelialization or hair follicles

178
Q

Rule of 9’s?

A

calculating Burn Surface Area

179
Q

Commonly referred to as first degree burn?

A

superifical burns

180
Q

Injury limited to the dermis

A

superifical burns

181
Q

Txt for superifical burns?

A

Acetaminophen/ NSAIDS

Hydrating lotions- avoid alcohol based

182
Q

Commonly referred to as second degree burn?

A

Partial thickness

183
Q

Injury extends into dermis?

A

partial thickness

184
Q

Txt for partial thickness burn?

A

initially- cover and protect
Tetanus
Narcotics

185
Q

What topical abx is used for parital thickness burn?

A

silvadine cream

silver wraps

186
Q

Less expense cream for burns?

A

bacitracin

187
Q

Pt should protect the skin from trauma and sunlight for ??

A

1 year

188
Q

Injury extends to SQ fat, muscle, tendon, bone

A

Full thickness

189
Q

Commonly referred to as 3 and 4 degree burn?

A

full thickness

190
Q

Txt for full thickness burn?

A

IV abx

agressive fluid intake

191
Q

What is the formula for burn fluid resuscitation?

A

2-4ml x TBSA x Weight (kg)

192
Q

How much fluid is given in the first 8 hrs?

A

1/2

and the remaining over 16 hrs

193
Q

Txt for pain out of proportion to exam in circumferential burns?

A

escharotomy

194
Q

How often should dressing on full thickness burns be changed?

A

24-48 hrs

195
Q

How should extremities be splinted?

A

in position of function (NOT COMFORT)

196
Q

A wound contraction in the direction of comfort can be treated with?

A

Z-plasty

197
Q

Autograft?
Allograft?
Xenograft?

A

self
same species
another species

198
Q

Sheet graft?

A 
only skin (no fenestration)
covers smaller area
reserved for bone, tendon, vessels
199
Q

Split thickness skin graft

A

Covers other surfaces
healthy skin grafted from donor
meshed

200
Q

Electrical burns over >1000v is seen in?

A

industrial/ lightning

201
Q

Cardiac monitoring in a electrical burn is due to ?

A

cellular damage and leaking K+ (peak T waves)

202
Q

Txt for cord biting?

A

no immediate surgery/debridement

reconstruction of mouth after healing

203
Q

Chemical burn that can cause coagulation necrosis?

A

acids

204
Q

chemical burn that can cause liquefaction necrosis?

A

alkaline

205
Q

What burns go to the burn center?

A

> 20% TBSA
exposed tendon, bone
face, genitalia, hands, feet, mouth
inhalation injury

206
Q

What should UOP be maintained at for burns?

A

> 0.5 ml/kg/hr

207
Q

What swallowed objects must be removed?

A

batteries, multiple magnets and sharp objects

208
Q

Where is Boerhaave’s syndrome mostly located?

A

left posterior esophagus

209
Q

Presents with mediastinal crunch of Hamman, chest/back pain, and presents in neck

A

Boerhaave’s syndrome

210
Q

Partial erosion of the esophageal mucosa?

A

Mallory Weiss tear

211
Q

Txt for UGI bleed due to Mallory Weiss tear?

A

resolves spontenously

212
Q

Txt for Mallory Weiss tear?

A

EGD

213
Q

Battery acid, toliet bowl cleaner?

A

acids

214
Q

drain cleaners, oven cleaners, and concentrated detergents?

A

alkali

215
Q

Cause coagulation necrosis injuries?

A

acids

216
Q

Causes liquefaction necrosis injuries?

A

alkali

217
Q

Injure stomach > esophagus?

A

acids

218
Q

Injure esophagus > stomach?

A

alkali

219
Q

What txt should NOT be preformed in esophageal injuries?

A

induce emesis, blindly neutralize chemical or insert a NG tube

220
Q

Associated with EtOh, tobacco, nitrosiamines, hot drinks?

A

Squamous cell carcinoma of the esophagus

221
Q

Associated with Barretts, GERD, obesity and tobacco?

A

Adenocarcinoma of the esophagus

222
Q

Normal txt for esophageal cancer?

A

palliative care- chemo, rads, stent to allow swallowing

223
Q

Curative txt for esophageal cancer?

A

esophagoectomy

224
Q

Txt for refractory GERD?

A

surgery

225
Q

Up to 80% associated with pts with symptomatic GERD?

A

Sliding Type I

226
Q

Much less common hiatal hernia?

A

para-esophageal hiatal hernia (Type II-IV)

227
Q

Dx and Txt for hiatal hernia?

A

UGI

Linx device or Nissen Fundoplication

228
Q

Txt for Zenker’s diverticulum?

A

Cricopharyngeal myotomy

229
Q

Often aggravated by meals?

A

gastric ulcers

230
Q

Txt for gastric cancer?

A

isolated- endoscopic mucosal resection (EMR)

transmural- gastric resection w/ regional lymph nodes

231
Q

Ulcer is refractory to PPI tx although pt is compliant?

A

ZES

232
Q

85% sensitive for ZES?

A

Somatostatin receptor scintigraphy

233
Q

What is the TOC for ZES?

A

Surgical resection

234
Q

Associated with hyperacidity, not with cancer?

A

Duodenal ulcers

235
Q

gnawing epigastric pain, worse w/ fasting, relieved with anti-acids and foods?

A

Duodenal ulcer

236
Q

Txt and Dx for a duodenal ulcer?

A

EGD

UGI if unsuccessful

237
Q

Projectile vomiting of non-bilious emesis?

A

pyloric stenosis

238
Q

Txt for pyloric stenosis?

A

pylormyotomy

239
Q

When can feedings be resumed after a pylormyotomy?

A

24 hrs

240
Q

Txt for Bezoar?

A

Endoscopy

surgery if fail

241
Q

Early satiety, n/v, undigested material?

A

Bezoar

242
Q

Air fluid levels on upright abdominal xray (KUB) suggests?

A

Small bowel obstruction

243
Q

Prior intra-abdominal surgery can cause?

A

adhesions

244
Q

Txt for adhesions?

A

most resolve spontaneously or surgery

245
Q

Txt for incarcerated hernia?

A

SURGERY ASAP!

246
Q

No air fluid levels, acute onset colicky pain, abdominal distention, n/v?

A

Volvulus

247
Q

Telescoping of the small bowel into the colon at the ileocecal junction?

A

Intussusception

248
Q

Dx of choice for intussusception?

A

Barium enema

249
Q

Bucket handle tear?

A

internal hernia

250
Q

What can cause a internal hernia?

A

high speed MVC

251
Q

Truly an obstruction?

A

gallstone ileus

252
Q

What are the -/+ of a capsular endoscopy?

A 
no anesthesia needed
camera can obstruct
expensive
not readily available
only diagnostic
253
Q

Crohn’s txt?

A

5-ASA drugs, Steroids, Abx

Surgery is palliative

254
Q

Isolated colon/rectum, bloody diarrhea?

A

ulcerative colitis

255
Q

UC txt?

A

non-op, surgery (colectomy)

256
Q

What is used to look for a pneumoperitoneum?

A

3 way abdomen- flat/ upright, cxr

257
Q

A CT slices what 3 views?

A

axial, sagittal, coronal

258
Q

Where does most of the air in the GI tract come from?

A

swallowed air

259
Q

If no air is seen in the small intestine what must be r/o?

A

ileus or obstruction

260
Q

Altered motility of GI tract, normally after surgery?

A

Ileus

261
Q

Medical txt for Ileus?

A

Alvimopan (pro-motility drug)

262
Q

Txt for obstruction?

A

ng tube decompression, fluids, surgery

263
Q

N/v, abdominal discomfort, absent bowel sounds?

A

Ileus

264
Q

fever, peritoneal signs, shock, present high-pitched bowel sounds?

A

obstruction

265
Q

What should be checked prior to giving contrast agents?

A

BUN/CREATININE

266
Q

What contrast is more water soluble and is used for suspected perforations?

A

Gastrografin

267
Q

For lower GI, what contrast study is both therapeutic and dx?

A

Barium enema

268
Q

Good for fluid filled and semi-solid structures. Good to detect free air/fluid

A

US

269
Q

Non-ionizing rad, used for seeing soft tissues?

A

MRI

270
Q

Free air sounds?

A

hypertympanic

271
Q

Pain out of proportion in older CAD pt suggest?

A

bowel ischemia and suspect mesenteric ischemia

272
Q

Acronym for admission?

A

ADC-VAN-DISMEL

273
Q

Emergent surgery “Done now or they will die”?

A

blunt trauma
penetrating trauma
ruptured aneurysm
aortic transection

274
Q

Urgent surgery <24hrs?

A

Appendicitis
Ectopic pregnancy
Incarcerated hernia

275
Q

Acute pancreatitis is usually?

A

mild, self limiting (90%)

276
Q

What is the most common cause of acute pancreatitis?

A

gallstones

277
Q

Mid-epigastric boring pain, radiating to the back, w/ tachy?

A

acute pancreatitis

278
Q

Amylase rises within?

A

6-12 hr and lasts <48h

279
Q

Lipase rises within?

A

4-8hr and lasts 1-2 weeks

280
Q

What marker is more sensitive for EtOH induced pancreatitis?

A

Lipase

281
Q

What imaging is used for acute pancreatitis?

A

CT with contrast

282
Q

Diagnostic criteria for acute pancreatitis?

A

2/3:
acute, persistent sever epigastric pain
high serum amylase or lipase
findings on US, CT or MRI

283
Q

What two things shows a good prognosis in acute pancreatitis?

A

normal HCT and Creatinine

284
Q

Ranson Criteria?

A

prognostic for acute pancreatitis

285
Q

Txt for acute pancreatitis?

A

ERCP

286
Q

Most common cause of EtOH abuse?

A

Chronic pancreatitis

287
Q

Clinical tetrad for chronic pancreatitis?

A

Abdominal pain
Weight loss
Diabetes
Steatorrhea

288
Q

Occurs 4 weeks after infection or trauma?

A

pancreatic pseduocyst

289
Q

Persistent elevation of amylase and early satiety?

A

pseudocyst

290
Q

a acute pseudocyst resolves in?

A

4-6 weeks

291
Q

a chronic pseudocyst persists pass?

A

> 6 weeks

292
Q

Txt for pseudocyst?

A

Percutaneous

Internal-cyst-gastrostomy

293
Q

Txt for pancreas trauma?

A

mild- no surgery and self limited

severe- surgery

294
Q

Painless jaundice, weight loss, new onset DM?

A

Pancreatic cancer

295
Q

Risk factor for pancreatic cancer?

A

smoking, DM, high fat/low fiber diet

296
Q

5 year survival rate for pancreatic cancer?

A

<10%

297
Q

Treatment for pancreatic cancer?

A

Whipple Procedure for head adenocarcinoma (pancreaticoduodenectomy)

298
Q

Most common pancreatic endocrine tumor?

A

insulinoma

299
Q

Whipple’s triad?

A

symptomatic, fasting hypoglycemia
Serum glucose <50mg/dl
Relief of symptoms after glucose

300
Q

Most insulinoma’s are?

A

90% benign and solitary

301
Q

Txt for insulinoma?

A

surgery (excellent long term prognosis)

302
Q

What causes a insulinoma?

A

beta cells produce too much insulin

303
Q

Most common gastrinoma malignancy?

A

PNET in MEN-1

304
Q

Persisten PUD refractory to aggressive PPI therapy?

A

gastrinoma

305
Q

What is Passaro’s triangle seen in?

A

gastrinoma

306
Q

Where are gastrinoma typically located?

A

Passaro’s triangle

307
Q

What makes up Passaro’s triangle?

A

junction of cystic and CBD
junction of 2-3rd portions of duodenum
Neck of pancreas

308
Q

What dx is used to detect a gastrinoma?

A

Somatostatin receptor scintigraphy

309
Q

Txt for gastrinoma?

A

surigical resection

310
Q

What are the 3 functions of spleen?

A

filtration of blood
host immune defense
storage of blood and lymphocytes

311
Q

What is the difference between hypersplenism and splenomegally?

A

Hypersplenism- overactive function by spleen

Splenomegally- spleen enlargement

312
Q

Second most common site of aneurysm?

A

splenic artery aneurysm

313
Q

Txt for spleen trauma?

A

NON-operatively if pt remains HDS

314
Q

What does OPSI stand for?

A

Overwhelming Post Splenectomy infection

315
Q

What is the OPSI for a splenectomy?

A

2 weeks prior to elective surgery
2 weeks after em surgery
3 moths after chemo/rad

316
Q

What organisms are vaccines targeted for in OPSI?

A

Strep pneumoniae, H. flu, Meningococcus

317
Q

When are prophylaxis abx given pre-op?

A

within 1 hr of surgery

< 24 hrs after

318
Q

ASA Categories?

A

Class 1- healthy pt NO systemic disorder

Class II- mild to mod disorder that need NOT to be associated w/ surgical problem

Class III- severe systemic disease that limits activity but is NOT incapacitating

Class IV- incapacitating, life-threatening systemic disease

Class V- moribund pt, NOT expected to SURVIVE 24hrs without operation

319
Q

How long should surgery be postponed after a MI?

A

> 6 mo

320
Q

What criteria is used to determine liver dysfunction?

A

Child’s score

321
Q

T/F elevated creatinine is correlated w/ increased mortality in surgery pts?

A

True

322
Q

What is optimum gluocose pre-op?

A

80-110mg/dl

323
Q

Addisonian crisis/

A

Hypotension, Hyponatremia, hyperkalemia

324
Q

Albumin <3g/dl suggests?

A

chronic malnutrition

325
Q

Prealbumin < 16 mg/dL suggests?

A

acute malnutrition

326
Q

What is the goal of electrolyte repletion

A

Mg- 2 mEq/L
PO4- 3 mg/dl
K- 4 mEq/L

327
Q

Where is the box located in sterile?

A

between xyphoid and waist

328
Q

When can Avagard be used?

A

lieu of full surgical scrub if:

  • Full scrub was done for first case
  • Haven’t left the OR
  • Not gone to latrine, eaten or smoked
329
Q

One of the most common complications of general anesthesia?

A

atelectasis

330
Q

Due to CHF, volume overload, and Diuretics makes it better?

A

Pulmonary edema

331
Q

Non-cardiogenic pulmonary edema, DOES NOT get better with diuretics?

A

Acute Respiratory Distress Syndrome (ARDS)

332
Q

Txt for ARDS?

A

Mechanical ventilation and PEEP

333
Q

What are the settings for mechanical ventilatoin for ARDS?

A

Moderate PEEP- 10-15cm
Lower tidal vlm 5-7ml/kg
Maintain FiO2 < 60% to avoid O2 toxicity
Increase expiration time (inspirational hold) –> more alveoli open

334
Q

Associated w/ long bone/pelvic fx?

A

fat embolus

335
Q

Presents 6-24 hrs after injury, respiratory insufficiency, neuro changes, petechiae?

A

fat embolus

336
Q

txt for fat embolus?

A

supportive care

337
Q

Screening criteria for PE?

A

Wells score

PERC

338
Q

What is seen on EKG for PE?

A

new onset a fib or RBBB

339
Q

What is Virchow’s Triad associated with?

A

Deep Vein Thrombosis (DVT)

340
Q

Virchow’s Triad?

A

Venous stasis
Endothelial injury
Hypercoagulability

341
Q

Prolonged immobility on air, bus, long car ride are at risk for what?

A

Deep Vein thrombosis (DVT)

342
Q

Pain out of proportion/ loss of function, distal pluses, long bone fracture?

A

Compartment syndrome

343
Q

Txt for compartment syndrome?

A

Fasciotomy

344
Q

What two drugs can cause ototoxicity?

A

aminoglycosides, vancomycin

345
Q

What is the most common cause of antibiotic associated diarrhea?

A

Pseudomembranous colitis

346
Q

What bacteria causes Pseudomembranous colitis?

A

Clostridium difficle

347
Q

What abx cause C. dif?

A

Clindamycin, cephalosporins, floroquinolones

348
Q

> 3 loose stools in 24hrs might have?

A

C. dif

349
Q

Txt for Pseudomembranous colitis?

A

oral vanc or metronidazole

fecal transplant, subtotal colectomy

350
Q

Consider first in post operative patient?

A

Pre-renal - dehydration/ hypovolemia

351
Q

Consider in pts who received IV contrast, abx and diuretics

A

Intra-renal

352
Q

Consider in pts who have Prostate hypertrophy, obstructed bladder catheter, urethral injury, neurogenic bladder

A

Post-renal

353
Q

Most common complication- UTI?

A

Bladder catheterization

354
Q

What nerve injury can happen during a hernia repair?

A

ilio-inguinal nerve- skin numbness

355
Q

What nerve injury can happen during a mastectomy?

A

long thoracic nerve- winged scapula

356
Q

What nerve injury can happen during a carotid endaretectomy?

A

hypoglossal nerve- deviated tongue

357
Q

What must be considered first in mental status changes?

A

hypoxia/ hypovolemia

358
Q

Lethal Triad of Hypothermia?

A

Metabolic acidosis
Coagulopathy
Hypothermia

359
Q

What should be considered after a long abdominal case with manipulation or trauma which required massive fluids?

A

Abdominal compartment syndrome

360
Q

What is most common nosocomial infection?

A

surgical site infection (36%)

361
Q

SIRS?

A

Temp (101.5F)
Tachycardia
Tachypnea
Leukocytosis

362
Q

Crampy RUQ pain, correlated with meals, n/v anorexia?

A

Cholelithiasis

363
Q

Transient colicky, post prandial RUQ pain, normal labs, WITHOUT thickened gallbladder wall?

A

Biliary colic

364
Q

Inflammation of gallbladder due to infection, thickened gallbladder wall >4mm

A

Cholecystitis

365
Q

Txt for cholecystitis?

A

IV abx and surgery (24-48hr)

366
Q

What is Murphy’s sign seen in?

A

Acute cholecystitis

367
Q

Gallbladder infection not caused by stones?

A

Acalculous cholecystitis

368
Q

Diagnostic imaging of choice for cholecystitis?

A

Ultrasound

369
Q

Mickey Mouse sign?

A

Portal vein (Head), CBD and hepatic artery (ears)

370
Q

Pt appears jaundiced and has acholic “clay colored stools”

A

Common bile duct obstruction

371
Q

Most serious complication of cholelithiasis?

A

Cholangitis

372
Q

Lethal if not treated ASAP?

A

Cholangitis

373
Q

Charcot’s Triad?

A

Fever, Jaundice, RUQ pain

374
Q

Reynolds Pentad?

A

Fever, Jaundice, RUQ pain, confusion, shock

375
Q

What does ERCP stand for?

A

Endoscopic Retrograde Cholangio-Pancreatogram

376
Q

What does MRCP stand for and used for?

A

Magnetic Resonance Cholangoi-Pancreatogram
dx only
good test for CBD obstruction

377
Q

What surgery can be used for a frail old lady who can’t have ERCP/IOC?

A

Percutaneous gall bladder drainage

378
Q

Common in all ages, with smooth walled, well circumscribed?

A

Congenital liver cysts

379
Q

When multiple cyst invade and replace normal hepatocytes?

A

Polycystic liver disease

autosomal dominant

380
Q

Most common solid hepatic tumor?

A

Hepatic hemangioma

381
Q

“Cold” nodule, associated w/ estrogen therapy?

A

Hepatic adenoma

382
Q

“hot” nodule, most asymptomatic?

A

Focal nodular hyperplasia

383
Q

Most common cuase of new liver dysfunction in the US?

A

Non-Alcoholic SteatoHepatitis (NASH)

384
Q

Primary cancer of the liver rare in western society but common ww?

A

Hepatocellular carcinoma

385
Q

Most come malignant liver tumor in the US

A

Metastatic liver tumor

386
Q

What may prevent first bleed in chronic liver disease?

A

beta blockers

387
Q

Thrombosis of hepatic veins near IVC , mostly in women in hypercoagulable state?

A

Budd-Chiari syndrome

388
Q

Most common type of breast cancer?

A

infilitrating Ductal carcinoma

389
Q

Most rare type of breast cancer?

A

lobular carcinoma

390
Q

Most common organism of acute mastitis?

A

staph aureus or Strep

391
Q

Txt for acute mastitis?

A

abx, continue to drain

392
Q

40-60yr woman, with thick, green black sticky discharge from nipple

A

Breast abscess

393
Q

txt for breast abscess?

A

stop nursing, IV abx, I& D in OR

394
Q

Bra straps digging in shoulder, no longer find fitting clothing, upper back pain

A

Macromastia

395
Q

Txt for Macromastia?

A

reduction mammoplasty

396
Q

extra nipple

A

supernumerary nipple

397
Q

T/F 80% of breast masses are benign?

A

True

398
Q

Most common benign breast lesion?

A

Fibroadenoma

399
Q

Woman approaching menopause with a smooth lobulated mass?

A

Fibroadenoma

400
Q

Bilateral breast pain, nipple discharge and pain correlates with menses

A

Fibrocystic changes

401
Q

Txt for fibrocystic breast?

A

caffeine free
support bras
NSAIDS
Vitamin E/ Primrose oil

402
Q

Bilateral milky discharge in non-lactating women?

A

Galactorrhea

403
Q

Young male, with one big boob

A

Unilateral gynecomastia

404
Q

Txt for unilateral gynecomastia?

A

regress with time, but can do a subcutaneous mastectomy

405
Q

Man that has decreased androgen production and decreased testosterone and also is on meds?

A

Bilateral gynecomastia

406
Q

Txt for bilateral gynecomastia?

A

reassurance and consult to surgery

407
Q

What is BI-RADS used for?

A

Breast imaging-reporting and data system

408
Q

BI- RADS

A

0- additional imaging needed
1- Negative/Normal
2- Benign Findings (stable lesions)
3- Probably benign (repeat in 6 mo or bx)
4- Suspicious (consider bx)
5- Highly suggestive of malignancy (definitely bx)
6- Biopsy proven malignant

409
Q

Those with dense breast can use what imaging?

A

breast MRI

410
Q

Usually painless, unilateral w/o nipple discharge, hard mass w/ irregular margins?

A

Breast cancer

411
Q

Spring loaded needle biopsy?

A

core bx

412
Q

Used for a non-palpable mass seen on MMG/US?

A

Needle localized Bx (has the wire)

413
Q

Incisional bx

A

piece of mass taken for bx

414
Q

What are the benefits of a incision bx?

A

a excision or mastectomy can be performed in OR

415
Q

Excisional bx?

A

Entire mass removed and suture placed

416
Q

What are the benefits of a incision bx?

A

can remove in situ in one surgery

417
Q

Breast cancer that’s only treated with chemotherapy?

A

Triple negative

418
Q

“Fried egg appearance”?

A

Paget’s disease

419
Q

Nipple itching/burning/ eczematoid/crusted lesion on nipple

A

Paget’s disease

420
Q

Erythema and edema of breast tissue usually without palpable mass. Doesn’t respond to abx, especially in non-lactating women

A

Inflammatory breast cancer

421
Q

Highly malignant breast cancer, with a rapid onset!

A

Inflammatory breast cancer

422
Q

Breast cancer associated with male breast cancer

A

BRCA 2

423
Q

Modified Radical Mastectomy (MRM)

A

remove all breast tissue, nipple, axillary nodes

424
Q

Radical Mastectomy

A

removes all of the breast, overlying skin, pectoralis muscles and lymph nodes

425
Q

What is the most prognostic variable in breast cancer?

A

whether the tumor has metastasized to axillary lymph nodes

426
Q

Injury to long thoracic nerve

A

winged scapula

427
Q

Injury to thoracodorsal nerve

A

latissimus dorsi

428
Q

Cosmetic surgery done for breast cancer surgery?

A

TRAM (Transverse Rectus Abdominus Muscle)

429
Q

1:1:1

A

PRBC: FFP: PLT

430
Q

Formula for CPP?

A

CPP= MAP-ICP

431
Q

ICP needs to be?

A

20mmHg

General Surgery (1 decks)

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