Exam Pearls Flashcards
1
Q
Most common swallowed object?
A
coins
2
Q
Most common aspirated object?
A
peanuts
3
Q
Most common patient population to swallow foreign bodies?
A
Kids (80%)
4
Q
Two common sites of esophageal obstruction?
A
Cricopharyngeus muscle (right chest) GE junction (left chest)
5
Q
Most common cause of Boerhaave’s syndrome?
A
Retching from EtOH
6
Q
Cap Medusa, dilated veins
A
Mallory Weiss tear
7
Q
Most common cause of alkali esophageal injuries?
A
Bleach
8
Q
Most common in Asia, Africa, and Iran?
A
Esophageal cancer
9
Q
Makes up 60% of esophageal cancer in the US?
A
Adenocarcinoma
10
Q
Most common hiatal hernia?
A
Sliding Type 1 (85%)
11
Q
Very very bad halitosis or regurgitation of undigested food?
A
Zenker’s Diverticulum
12
Q
Pathogen that causes gastric ulcers?
A
H. pylori
13
Q
Hypersecretion of gastric acid tumor?
A
Zollinger- Ellison Syndrome
14
Q
Fasting pain in the epigastric region, better with food and antacids
A
Duodenal ulcer
15
Q
Young infant, with hollow pit in stomach and projectile vomiting?
A
Hypertrophic pyloric stenosis
16
Q
Olive pit in epigastrium
A
Pyloric stenosis
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
18
Q
What does the Rule of 2’s apply to?
A
Meckels Diverticulum
19
Q
If a person has “unusual dietary habits” they mostly can get ?
A
Bezoar
20
Q
What the 3 types of bariatric surgeries?
A
Gastric banding
Sleeve gastrectomy
Roux-en-Y
21
Q
What is the most common type of gastric bypass?
A
sleeve gastrectomy
22
Q
Most common cause of small bowel obstruction from prior surgery?
A
adhesions
23
Q
Most common cause of small bowel obstruction world wide?
A
incarcerated hernia
24
Q
Uncommon source of obstruction in SB?
A
Small bowel cancer
25
Mouth to anus, Cobblestone, skip lesions, transmural
Crohn's disease
26
Positive Psoas sign?
appendicitis
27
What scoring is used for appendicitis?
Alvarado's score
28
What does MANTRELS stand for?
```
Migration to R iliac fossa
Anorexia
Nausea/Vomiting
Tenderness in R illac fossa
Rebound pain
Elevated temp (fever)
Leukocytosis
Shift of leukocytes to left
```
29
McBurney incision?
appendicitis (open)
30
What is the most common risk associated with appendicitis?
Carcinoid
31
What 3 rare pathologies are associated with appendicitis?
Carcinoid
Lymphoma
Adenocarcinoma
32
Cholecystitis?
inflammation of the gall bladder
33
Cholecystectomy?
gall bladder removal
34
Cholelithiasis?
stone in the gall bladder
35
Choledocho?
bile duct
36
Choledochoilithiasis?
stones in the bile duct
37
Fat, Fair, Forty, Female?
Cholelithiasis
38
Most gallstones are made of?
cholesterol
39
Imaging of choice for gallstones?
ultrasound
40
A fracture through C2?
Hangman
41
Necrosis around the umbilical cord?
Cullens
42
A good prognosis factor in acute pancreatitis?
Creatinine
43
What vaccine should be given after a splenectomy?
Pnemovax
44
When should OPSI vaccine be given in a elective splenectomy?
2 wks prior to surgery
45
Diagnostic and therapeutic for choledocholithaisis?
ERCP
46
Most common cause of acute pancreatitis?
gallstone
47
Persistent hypoglycemia and elevated insulin level?
Insulinoma
48
What occurence is expected after a splenectomy?
Thrombocytosis
49
A 4ym, admitted for grade 2 spleen injury remains HDS with benign exam overnight, what is preffered txt?
non-operative
50
Pouch which involves all layers of the bowel wall
Diverticulum
51
Pouch which only involves the outer layer?
Pseudodiverticulum
52
Diverticula present
Diverticulosis
53
Inflammation of diverticula
Diverticulitis
54
What is a common complication of diverticulosis not found in acute diverticulitis?
diverticular bleeding
55
What is the most common cause of colonic hemorrhage?
Diverticulosis
56
Benign abdomen (asymptomatic) w/ massive bleeding?
Diverticulosis
57
How does the bleeding stop in diverticulosis?
stops spontaneously (90%)
58
What is the treatment for diverticulosis?
admit, resuscitate, NPO
59
What 3 things allows for a benign course of diverticulosis?
High fiber diet
Exercise
Statin use
60
What causes the bleeding in diverticulosis?
vessels that perforate the bowel wall, intracolonic pressure pushes the mucosa out through where the vessels emerge
61
Patient presents with LLQ pain and tenderness, mass or phlegmon?
Diverticulitis
62
What imaging is done for diverticulitis?
KUB, CT with rectal and oral contrast
63
Which imaging should be AVOID! in diverticulitis?
COLONOSCOPY or FLEXIBLE SIGMIDOSCOPY!!!
64
What is the txt for diverticulitis?
admin, resuscitation, broad spectrum IV abx
65
What is the txt for outpatient diverticulitis
metronidazole + fluoroquinolone for 10-14 days
66
When can a colonoscopy be safely performed in diverticulitis?
6-8 weeks later for cancer screening
67
What are 2 complications of diverticulitis?
Diverticular abscess, colo-vesicle fistula
68
A patient with diverticulitis, now has fever, chills, sweats, and sepsis?
Diverticular abscess
69
What is the txt for diverticular abscess?
percutaneous drainage
70
A pt with diverticulitis, now has pneumouria, and recurrent UTI?
Colo-vesicle fistula
71
What is the txt for colo-vesicle fistula?
segmental colectomy and bladder repair
72
What is the 2 surgical txt for diverticulitis?
Segmental resection w/ anastomosis OR
| Segmental colectomy with diversion (colostomy)
73
Where does lower GI bleeds start?
below Ligament of Treitz
74
T/F Lower GI bleeds are painful?
FALSE
75
What diagnostic test are used for LGI bleeds?
Fecal Occult Blood (FOBT)
NGT suction/ EGD
Colonoscopy
76
What is the txt for Lower GI bleed?
admin, resuscitation
77
What are 3 surgical considerations for LGI bleed?
Patient deteriorates
Persistent bleeding (>3 U PRBC)
Recurrent bleeding
78
How can you determine where a LGI bleed is coming from prior to surgery?
Mesenteric angiogram
79
Most common colorectal cancer?
adenocarcinoma
80
What are Risk factors for colorectal cancer?
```
Adenomatous polyp
Villous polyp
UC and Crohn's
Hereditary non-polyposis
Familial Adenomatous Polyposis
```
81
When does colorectal cancer screening start?
at 40 (50) or 10 years prior to dx in a first degree relative
82
Autosomal dominant, almost 100% risk of colorectal cancer lesions at 40yr
Familial Adenomatous Polyposis
83
Most common cause of colon obstruction?
colorectal cancer
84
Most common side of colon cancer?
left
85
Pt has tenesmus the need to have a bm but can't evacuate?
rectal cancer
86
Where does colon cancer commonly mets?
liver
87
Iron deficiency anemia in patients is what until proven otherwise?
colon cancer
88
What is curative resection?
removes all tumor and nodes prior to mets
89
What is palliative resection?
remove tumor burden to avoid obstruction and bleeding
90
What prophylactic can be done in pts w/ familial polyposis?
a colectomy
91
What are the stages of colon cancer?
Stage 0- Stage IV
92
What is the most common cause of colon obstruction?
colon cancer
93
T/F a pt w/ a colon obstruction CAN'T pass stool but may pass flatus initially?
True
94
Can be both diagnostic and therapeutic for a colon obstruction?
Barium enema
95
Apple core lesion is highly suggestive for?
colon cancer
96
Twisting of cecal or sigmoid colon?
volvulus
97
Presents in children, with massive amounts of stool in dilated colon?
Hirschprung's
98
Arthritis, iritis, erythema nodosum, liver dysfunction is associated with?
Ulcerative colitis
99
Limited to colon (cecum to rectum) and contiguous, with bloody diarrhea
Ulcerative colitis
100
Where are internal hemorrhoids located?
above dentate line are NOT innervated by sensory nerves (painless)
101
Where are external hemorrhoids located?
below dentate line and ARE innervated by sensory nerves (painful)
102
What can be used to identify internal hemorrhoids?
anoscope
103
Txt for hemorrhoids?
stool softener (colace, metamuicil)
sitz bath
Topical anesthetic-lidocaine jelly 2%
wipes
104
What surgical procedure is contraindicated for external hemorrhoids?
rubber band ligation
105
What surgical txt can be used for thrombosed hemorrhoids?
incise and drain
106
Sentinel tag, painful ulcer or slit-like opening on anus?
anal fissure
107
Txt for anal fissure?
stool softener, sitz baths, topical anesthetics, surgery
108
Very sick pt, pelvic/posterior heaviness, and septic shock?
PeriRECTAL (ischio-rectal) abscess
109
Txt for perirectal abscess?
SURGERY!!!
110
"Never let the sun go down on a ???
periRECTAL abscess
111
Tender, fluctuant mass on the anal verge?
perianal abscess
112
Txt for perianal abscess?
I&D
113
Truck driver, a pilot presents with a raised pit in the gluteal cleft that has tracts of hair?
pilonidal disease
114
Txt for pilonidal disease?
bascom cleft lift
115
Txt for rectal foreign body?
peri-anal block anesthesia
116
RLQ, Periumbilical pain, n/v?
Appendictitis
117
pain may slightly improve, but it will not completely resolve and will soon become consistent with perionitis?
perforation of appendix
118
Imaging used for appendicitis?
CT
MRI (children)
US (preggo)
119
What IV abx are used to treat appendicitis?
2nd or 3rd gen cephalosporin w/ Metronidazole
120
If a pregnant woman has appendicitis is a appendectomy still needed?
Yes
121
What are the 2 types of perforations?
Generalized peritonitis
| Localized abscess
122
What is the treatment for a generalized perforated appendix?
Operate ASAP!!
123
What is the treatment for a localized perforated appendix?
abx and percutaneous drainage then appendectomy (after 6 wks)
124
What is the overall goal of treating appendicitis early?
prevent septic shock and perforation
125
Whom has a higher rate of appendix perforation due to a delay in diagnosis?
children, developmentally delayed and elderly
126
Inguinal hernia originates where?
above the inguinal ligament
127
Femoral hernia originates where?
below the inguinal ligament
128
Incarcerated hernia are?
non-reducible
129
Strangulated hernia's are?
incarcerated and ischemic
130
Where are indirect inguinal hernia's located?
internal inguinal ring and are lateral to the inferior epigastric artery
131
Where are direct inguinal hernia's located?
through Hesselbach's triangle
132
What makes up Hesselbach's triangle?
inguinal ligament inferiorly, inferior epigastric vessel lateral and rectus muscle medially
133
Where is the femoral hernia located?
empty space at the medial aspect of femoral canal, inferior to inguinal ligament
134
What causes a congenital hernia?
patent processus vaginalis
135
Most common hernia in both sexes?
indirect inguinal (congental) hernia
136
What imaging confirms a hernia?
CT
137
What is the first imaging done for a hernia?
US
138
What surgical repair i done for a bilateral hernia?
Laparoscopic
139
What surgical repair is doen for a unilateral hernia?
Open
| then Laparoscopic if failed
140
What causes a direct inguinal hernia?
Acquired weakened floor of inguinal canal
141
What is placed over the inguinal canal to reinforce the floor?
mesh
142
Hernia more common in women?
femoral hernia
143
What makes up the femoral triangle?
Inguinal ligament
Sartorius
Adductor longus
144
What symptom is seen in a femoral hernia as opposed to the others?
constipation
145
Not a true hernia?
Sports hernia and Diastasis recti
146
What are 3 indications for sport's hernia?
lifestyle limiting pain
failure of conservative tx > 8wks
Exclusion of other dx
147
Fluid filled sac next to testis, and it transilluminates?
Hydrocele
148
Acute onset testicular pain, associated w/ prostatitis or vasectomy?
Epididymitis
149
Txt for epididymitis in young men?
scrotal support and abx for STI
150
TX for epididymitis in older men?
scrotal support, abx for gm neg rods
151
Fluid fill mass attached to epididymis, non tender?
Spermatocele
152
Imaging and txt for a spermatocele?
US and surgery
153
"Bag of worms"?
Variocele
154
Txt for varicocele?
surgery for infertility
155
solid painless firm non-tender mass on testicle?
Testicular cancer
156
Imaging for testicular cancer?
US
157
Extreme testicular pain, n/v, sweating after strenous activity?
testicular torsion
158
Imaging for testicular torsion?
Urgent US w/ Doppler
159
Txt for testicular torsion?
orchiopexy if viable
| Orchiectomy if not
160
Protrusion through the linea alba above the umbilicus?
Epigastric hernia
161
Nontender mass, normally easily reducible, no ileus or obstruction?
Epigastric hernia
162
Txt for epigastric hernia?
routine surgery or abdominal corset
163
When does a umbilical hernia close in a newborn/child?
prior to school age
164
When is a umbilical hernia needed for surgery in a child?
at age 5 if it persists
165
T/F Children umbilical hernia are rare to incarcerate?
True
166
T/F Adults umbilical hernia may incarcerate?
True
167
Herniation through previous operative site?
incisional hernia
168
Dehiscence through the facial closure w/ intact skin?
incisional hernia
169
Yellow-pink (salmon) colored fluid indicates?
Wound dehiscence (peritoneal fluid)
170
Txt for a wound dehiscence?
Surgery ASAP for fascial closure
171
Txt for acute fascial dehiscence?
Urgent surgical evaluation
172
Txt for delayed fascial dehiscence?
routine surgery
173
Widening of the linea alba?
Diastasis recti
174
What can cause diastasis recti?
pregnancy
obesity
increased intra-abdominal pressure
175
Prominent midline bulge when pt raises head?
Diastasis recti
176
When does epithelialization start?
within one day
177
A full thickness burn has no?
epithelialization or hair follicles
178
Rule of 9's?
calculating Burn Surface Area
179
Commonly referred to as first degree burn?
superifical burns
180
Injury limited to the dermis
superifical burns
181
Txt for superifical burns?
Acetaminophen/ NSAIDS
| Hydrating lotions- avoid alcohol based
182
Commonly referred to as second degree burn?
Partial thickness
183
Injury extends into dermis?
partial thickness
184
Txt for partial thickness burn?
initially- cover and protect
Tetanus
Narcotics
185
What topical abx is used for parital thickness burn?
silvadine cream
| silver wraps
186
Less expense cream for burns?
bacitracin
187
Pt should protect the skin from trauma and sunlight for ??
1 year
188
Injury extends to SQ fat, muscle, tendon, bone
Full thickness
189
Commonly referred to as 3 and 4 degree burn?
full thickness
190
Txt for full thickness burn?
IV abx
| agressive fluid intake
191
What is the formula for burn fluid resuscitation?
2-4ml x TBSA x Weight (kg)
192
How much fluid is given in the first 8 hrs?
1/2
| and the remaining over 16 hrs
193
Txt for pain out of proportion to exam in circumferential burns?
escharotomy
194
How often should dressing on full thickness burns be changed?
24-48 hrs
195
How should extremities be splinted?
in position of function (NOT COMFORT)
196
A wound contraction in the direction of comfort can be treated with?
Z-plasty
197
Autograft?
Allograft?
Xenograft?
self
same species
another species
198
Sheet graft?
```
only skin (no fenestration)
covers smaller area
reserved for bone, tendon, vessels
```
199
Split thickness skin graft
Covers other surfaces
healthy skin grafted from donor
meshed
200
Electrical burns over >1000v is seen in?
industrial/ lightning
201
Cardiac monitoring in a electrical burn is due to ?
cellular damage and leaking K+ (peak T waves)
202
Txt for cord biting?
no immediate surgery/debridement
| reconstruction of mouth after healing
203
Chemical burn that can cause coagulation necrosis?
acids
204
chemical burn that can cause liquefaction necrosis?
alkaline
205
What burns go to the burn center?
>20% TBSA
exposed tendon, bone
face, genitalia, hands, feet, mouth
inhalation injury
206
What should UOP be maintained at for burns?
>0.5 ml/kg/hr
207
What swallowed objects must be removed?
batteries, multiple magnets and sharp objects
208
Where is Boerhaave's syndrome mostly located?
left posterior esophagus
209
Presents with mediastinal crunch of Hamman, chest/back pain, and presents in neck
Boerhaave's syndrome
210
Partial erosion of the esophageal mucosa?
Mallory Weiss tear
211
Txt for UGI bleed due to Mallory Weiss tear?
resolves spontenously
212
Txt for Mallory Weiss tear?
EGD
213
Battery acid, toliet bowl cleaner?
acids
214
drain cleaners, oven cleaners, and concentrated detergents?
alkali
215
Cause coagulation necrosis injuries?
acids
216
Causes liquefaction necrosis injuries?
alkali
217
Injure stomach > esophagus?
acids
218
Injure esophagus > stomach?
alkali
219
What txt should NOT be preformed in esophageal injuries?
induce emesis, blindly neutralize chemical or insert a NG tube
220
Associated with EtOh, tobacco, nitrosiamines, hot drinks?
Squamous cell carcinoma of the esophagus
221
Associated with Barretts, GERD, obesity and tobacco?
Adenocarcinoma of the esophagus
222
Normal txt for esophageal cancer?
palliative care- chemo, rads, stent to allow swallowing
223
Curative txt for esophageal cancer?
esophagoectomy
224
Txt for refractory GERD?
surgery
225
Up to 80% associated with pts with symptomatic GERD?
Sliding Type I
226
Much less common hiatal hernia?
para-esophageal hiatal hernia (Type II-IV)
227
Dx and Txt for hiatal hernia?
UGI
| Linx device or Nissen Fundoplication
228
Txt for Zenker's diverticulum?
Cricopharyngeal myotomy
229
Often aggravated by meals?
gastric ulcers
230
Txt for gastric cancer?
isolated- endoscopic mucosal resection (EMR)
| transmural- gastric resection w/ regional lymph nodes
231
Ulcer is refractory to PPI tx although pt is compliant?
ZES
232
85% sensitive for ZES?
Somatostatin receptor scintigraphy
233
What is the TOC for ZES?
Surgical resection
234
Associated with hyperacidity, not with cancer?
Duodenal ulcers
235
gnawing epigastric pain, worse w/ fasting, relieved with anti-acids and foods?
Duodenal ulcer
236
Txt and Dx for a duodenal ulcer?
EGD
| UGI if unsuccessful
237
Projectile vomiting of non-bilious emesis?
pyloric stenosis
238
Txt for pyloric stenosis?
pylormyotomy
239
When can feedings be resumed after a pylormyotomy?
24 hrs
240
Txt for Bezoar?
Endoscopy
| surgery if fail
241
Early satiety, n/v, undigested material?
Bezoar
242
Air fluid levels on upright abdominal xray (KUB) suggests?
Small bowel obstruction
243
Prior intra-abdominal surgery can cause?
adhesions
244
Txt for adhesions?
most resolve spontaneously or surgery
245
Txt for incarcerated hernia?
SURGERY ASAP!
246
No air fluid levels, acute onset colicky pain, abdominal distention, n/v?
Volvulus
247
Telescoping of the small bowel into the colon at the ileocecal junction?
Intussusception
248
Dx of choice for intussusception?
Barium enema
249
Bucket handle tear?
internal hernia
250
What can cause a internal hernia?
high speed MVC
251
Truly an obstruction?
gallstone ileus
252
What are the -/+ of a capsular endoscopy?
```
no anesthesia needed
camera can obstruct
expensive
not readily available
only diagnostic
```
253
Crohn's txt?
5-ASA drugs, Steroids, Abx
| Surgery is palliative
254
Isolated colon/rectum, bloody diarrhea?
ulcerative colitis
255
UC txt?
non-op, surgery (colectomy)
256
What is used to look for a pneumoperitoneum?
3 way abdomen- flat/ upright, cxr
257
A CT slices what 3 views?
axial, sagittal, coronal
258
Where does most of the air in the GI tract come from?
swallowed air
259
If no air is seen in the small intestine what must be r/o?
ileus or obstruction
260
Altered motility of GI tract, normally after surgery?
Ileus
261
Medical txt for Ileus?
Alvimopan (pro-motility drug)
262
Txt for obstruction?
ng tube decompression, fluids, surgery
263
N/v, abdominal discomfort, absent bowel sounds?
Ileus
264
fever, peritoneal signs, shock, present high-pitched bowel sounds?
obstruction
265
What should be checked prior to giving contrast agents?
BUN/CREATININE
266
What contrast is more water soluble and is used for suspected perforations?
Gastrografin
267
For lower GI, what contrast study is both therapeutic and dx?
Barium enema
268
Good for fluid filled and semi-solid structures. Good to detect free air/fluid
US
269
Non-ionizing rad, used for seeing soft tissues?
MRI
270
Free air sounds?
hypertympanic
271
Pain out of proportion in older CAD pt suggest?
bowel ischemia and suspect mesenteric ischemia
272
Acronym for admission?
ADC-VAN-DISMEL
273
Emergent surgery "Done now or they will die"?
blunt trauma
penetrating trauma
ruptured aneurysm
aortic transection
274
Urgent surgery <24hrs?
Appendicitis
Ectopic pregnancy
Incarcerated hernia
275
Acute pancreatitis is usually?
mild, self limiting (90%)
276
What is the most common cause of acute pancreatitis?
gallstones
277
Mid-epigastric boring pain, radiating to the back, w/ tachy?
acute pancreatitis
278
Amylase rises within?
6-12 hr and lasts <48h
279
Lipase rises within?
4-8hr and lasts 1-2 weeks
280
What marker is more sensitive for EtOH induced pancreatitis?
Lipase
281
What imaging is used for acute pancreatitis?
CT with contrast
282
Diagnostic criteria for acute pancreatitis?
2/3:
acute, persistent sever epigastric pain
high serum amylase or lipase
findings on US, CT or MRI
283
What two things shows a good prognosis in acute pancreatitis?
normal HCT and Creatinine
284
Ranson Criteria?
prognostic for acute pancreatitis
285
Txt for acute pancreatitis?
ERCP
286
Most common cause of EtOH abuse?
Chronic pancreatitis
287
Clinical tetrad for chronic pancreatitis?
Abdominal pain
Weight loss
Diabetes
Steatorrhea
288
Occurs 4 weeks after infection or trauma?
pancreatic pseduocyst
289
Persistent elevation of amylase and early satiety?
pseudocyst
290
a acute pseudocyst resolves in?
4-6 weeks
291
a chronic pseudocyst persists pass?
>6 weeks
292
Txt for pseudocyst?
Percutaneous
| Internal-cyst-gastrostomy
293
Txt for pancreas trauma?
mild- no surgery and self limited
| severe- surgery
294
Painless jaundice, weight loss, new onset DM?
Pancreatic cancer
295
Risk factor for pancreatic cancer?
smoking, DM, high fat/low fiber diet
296
5 year survival rate for pancreatic cancer?
<10%
297
Treatment for pancreatic cancer?
Whipple Procedure for head adenocarcinoma (pancreaticoduodenectomy)
298
Most common pancreatic endocrine tumor?
insulinoma
299
Whipple's triad?
symptomatic, fasting hypoglycemia
Serum glucose <50mg/dl
Relief of symptoms after glucose
300
Most insulinoma's are?
90% benign and solitary
301
Txt for insulinoma?
surgery (excellent long term prognosis)
302
What causes a insulinoma?
beta cells produce too much insulin
303
Most common gastrinoma malignancy?
PNET in MEN-1
304
Persisten PUD refractory to aggressive PPI therapy?
gastrinoma
305
What is Passaro's triangle seen in?
gastrinoma
306
Where are gastrinoma typically located?
Passaro's triangle
307
What makes up Passaro's triangle?
junction of cystic and CBD
junction of 2-3rd portions of duodenum
Neck of pancreas
308
What dx is used to detect a gastrinoma?
Somatostatin receptor scintigraphy
309
Txt for gastrinoma?
surigical resection
310
What are the 3 functions of spleen?
filtration of blood
host immune defense
storage of blood and lymphocytes
311
What is the difference between hypersplenism and splenomegally?
Hypersplenism- overactive function by spleen
| Splenomegally- spleen enlargement
312
Second most common site of aneurysm?
splenic artery aneurysm
313
Txt for spleen trauma?
NON-operatively if pt remains HDS
314
What does OPSI stand for?
Overwhelming Post Splenectomy infection
315
What is the OPSI for a splenectomy?
2 weeks prior to elective surgery
2 weeks after em surgery
3 moths after chemo/rad
316
What organisms are vaccines targeted for in OPSI?
Strep pneumoniae, H. flu, Meningococcus
317
When are prophylaxis abx given pre-op?
within 1 hr of surgery
| < 24 hrs after
318
ASA Categories?
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
How long should surgery be postponed after a MI?
> 6 mo
320
What criteria is used to determine liver dysfunction?
Child's score
321
T/F elevated creatinine is correlated w/ increased mortality in surgery pts?
True
322
What is optimum gluocose pre-op?
80-110mg/dl
323
Addisonian crisis/
Hypotension, Hyponatremia, hyperkalemia
324
Albumin <3g/dl suggests?
chronic malnutrition
325
Prealbumin < 16 mg/dL suggests?
acute malnutrition
326
What is the goal of electrolyte repletion
Mg- 2 mEq/L
PO4- 3 mg/dl
K- 4 mEq/L
327
Where is the box located in sterile?
between xyphoid and waist
328
When can Avagard be used?
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
One of the most common complications of general anesthesia?
atelectasis
330
Due to CHF, volume overload, and Diuretics makes it better?
Pulmonary edema
331
Non-cardiogenic pulmonary edema, DOES NOT get better with diuretics?
Acute Respiratory Distress Syndrome (ARDS)
332
Txt for ARDS?
Mechanical ventilation and PEEP
333
What are the settings for mechanical ventilatoin for ARDS?
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
Associated w/ long bone/pelvic fx?
fat embolus
335
Presents 6-24 hrs after injury, respiratory insufficiency, neuro changes, petechiae?
fat embolus
336
txt for fat embolus?
supportive care
337
Screening criteria for PE?
Wells score
| PERC
338
What is seen on EKG for PE?
new onset a fib or RBBB
339
What is Virchow's Triad associated with?
Deep Vein Thrombosis (DVT)
340
Virchow's Triad?
Venous stasis
Endothelial injury
Hypercoagulability
341
Prolonged immobility on air, bus, long car ride are at risk for what?
Deep Vein thrombosis (DVT)
342
Pain out of proportion/ loss of function, distal pluses, long bone fracture?
Compartment syndrome
343
Txt for compartment syndrome?
Fasciotomy
344
What two drugs can cause ototoxicity?
aminoglycosides, vancomycin
345
What is the most common cause of antibiotic associated diarrhea?
Pseudomembranous colitis
346
What bacteria causes Pseudomembranous colitis?
Clostridium difficle
347
What abx cause C. dif?
Clindamycin, cephalosporins, floroquinolones
348
> 3 loose stools in 24hrs might have?
C. dif
349
Txt for Pseudomembranous colitis?
oral vanc or metronidazole
| fecal transplant, subtotal colectomy
350
Consider first in post operative patient?
Pre-renal - dehydration/ hypovolemia
351
Consider in pts who received IV contrast, abx and diuretics
Intra-renal
352
Consider in pts who have Prostate hypertrophy, obstructed bladder catheter, urethral injury, neurogenic bladder
Post-renal
353
Most common complication- UTI?
Bladder catheterization
354
What nerve injury can happen during a hernia repair?
ilio-inguinal nerve- skin numbness
355
What nerve injury can happen during a mastectomy?
long thoracic nerve- winged scapula
356
What nerve injury can happen during a carotid endaretectomy?
hypoglossal nerve- deviated tongue
357
What must be considered first in mental status changes?
hypoxia/ hypovolemia
358
Lethal Triad of Hypothermia?
Metabolic acidosis
Coagulopathy
Hypothermia
359
What should be considered after a long abdominal case with manipulation or trauma which required massive fluids?
Abdominal compartment syndrome
360
What is most common nosocomial infection?
surgical site infection (36%)
361
SIRS?
Temp (101.5F)
Tachycardia
Tachypnea
Leukocytosis
362
Crampy RUQ pain, correlated with meals, n/v anorexia?
Cholelithiasis
363
Transient colicky, post prandial RUQ pain, normal labs, WITHOUT thickened gallbladder wall?
Biliary colic
364
Inflammation of gallbladder due to infection, thickened gallbladder wall >4mm
Cholecystitis
365
Txt for cholecystitis?
IV abx and surgery (24-48hr)
366
What is Murphy's sign seen in?
Acute cholecystitis
367
Gallbladder infection not caused by stones?
Acalculous cholecystitis
368
Diagnostic imaging of choice for cholecystitis?
Ultrasound
369
Mickey Mouse sign?
Portal vein (Head), CBD and hepatic artery (ears)
370
Pt appears jaundiced and has acholic "clay colored stools"
Common bile duct obstruction
371
Most serious complication of cholelithiasis?
Cholangitis
372
Lethal if not treated ASAP?
Cholangitis
373
Charcot's Triad?
Fever, Jaundice, RUQ pain
374
Reynolds Pentad?
Fever, Jaundice, RUQ pain, confusion, shock
375
What does ERCP stand for?
Endoscopic Retrograde Cholangio-Pancreatogram
376
What does MRCP stand for and used for?
Magnetic Resonance Cholangoi-Pancreatogram
dx only
good test for CBD obstruction
377
What surgery can be used for a frail old lady who can't have ERCP/IOC?
Percutaneous gall bladder drainage
378
Common in all ages, with smooth walled, well circumscribed?
Congenital liver cysts
379
When multiple cyst invade and replace normal hepatocytes?
Polycystic liver disease
| autosomal dominant
380
Most common solid hepatic tumor?
Hepatic hemangioma
381
"Cold" nodule, associated w/ estrogen therapy?
Hepatic adenoma
382
"hot" nodule, most asymptomatic?
Focal nodular hyperplasia
383
Most common cuase of new liver dysfunction in the US?
Non-Alcoholic SteatoHepatitis (NASH)
384
Primary cancer of the liver rare in western society but common ww?
Hepatocellular carcinoma
385
Most come malignant liver tumor in the US
Metastatic liver tumor
386
What may prevent first bleed in chronic liver disease?
beta blockers
387
Thrombosis of hepatic veins near IVC , mostly in women in hypercoagulable state?
Budd-Chiari syndrome
388
Most common type of breast cancer?
infilitrating Ductal carcinoma
389
Most rare type of breast cancer?
lobular carcinoma
390
Most common organism of acute mastitis?
staph aureus or Strep
391
Txt for acute mastitis?
abx, continue to drain
392
40-60yr woman, with thick, green black sticky discharge from nipple
Breast abscess
393
txt for breast abscess?
stop nursing, IV abx, I& D in OR
394
Bra straps digging in shoulder, no longer find fitting clothing, upper back pain
Macromastia
395
Txt for Macromastia?
reduction mammoplasty
396
extra nipple
supernumerary nipple
397
T/F 80% of breast masses are benign?
True
398
Most common benign breast lesion?
Fibroadenoma
399
Woman approaching menopause with a smooth lobulated mass?
Fibroadenoma
400
Bilateral breast pain, nipple discharge and pain correlates with menses
Fibrocystic changes
401
Txt for fibrocystic breast?
caffeine free
support bras
NSAIDS
Vitamin E/ Primrose oil
402
Bilateral milky discharge in non-lactating women?
Galactorrhea
403
Young male, with one big boob
Unilateral gynecomastia
404
Txt for unilateral gynecomastia?
regress with time, but can do a subcutaneous mastectomy
405
Man that has decreased androgen production and decreased testosterone and also is on meds?
Bilateral gynecomastia
406
Txt for bilateral gynecomastia?
reassurance and consult to surgery
407
What is BI-RADS used for?
Breast imaging-reporting and data system
408
BI- RADS
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
Those with dense breast can use what imaging?
breast MRI
410
Usually painless, unilateral w/o nipple discharge, hard mass w/ irregular margins?
Breast cancer
411
Spring loaded needle biopsy?
core bx
412
Used for a non-palpable mass seen on MMG/US?
Needle localized Bx (has the wire)
413
Incisional bx
piece of mass taken for bx
414
What are the benefits of a incision bx?
a excision or mastectomy can be performed in OR
415
Excisional bx?
Entire mass removed and suture placed
416
What are the benefits of a incision bx?
can remove in situ in one surgery
417
Breast cancer that's only treated with chemotherapy?
Triple negative
418
"Fried egg appearance"?
Paget's disease
419
Nipple itching/burning/ eczematoid/crusted lesion on nipple
Paget's disease
420
Erythema and edema of breast tissue usually without palpable mass. Doesn't respond to abx, especially in non-lactating women
Inflammatory breast cancer
421
Highly malignant breast cancer, with a rapid onset!
Inflammatory breast cancer
422
Breast cancer associated with male breast cancer
BRCA 2
423
Modified Radical Mastectomy (MRM)
remove all breast tissue, nipple, axillary nodes
424
Radical Mastectomy
removes all of the breast, overlying skin, pectoralis muscles and lymph nodes
425
What is the most prognostic variable in breast cancer?
whether the tumor has metastasized to axillary lymph nodes
426
Injury to long thoracic nerve
winged scapula
427
Injury to thoracodorsal nerve
latissimus dorsi
428
Cosmetic surgery done for breast cancer surgery?
TRAM (Transverse Rectus Abdominus Muscle)
429
1:1:1
PRBC: FFP: PLT
430
Formula for CPP?
CPP= MAP-ICP
431
ICP needs to be?
20mmHg
