Gen Surg Rosh Review Flashcards
1
Q
What is the first step in management of a small bowel obstruction?
A
NG tube decompression
2
Q
What is the most common cause of SBO?
A
Adhesions
3
Q
What is the BEST imaging for SBO?
A
CT with contrast
4
Q
What is the initial imaging for SBO?
A
Abdominal XR
5
Q
Name some common radiologic findings in SBO.
A
Dilated loops of bowel
Air fluid level on upright or decubitus films
String of pearls sign
Stack of coins sign
6
Q
What type of cholecystectomy are dropped gallstones more common with?
A
Laproscopic cholecystectomy.
7
Q
What type of bowel sounds do you expect in SBO?
A
High pitched early in SBO, hypoactive later in SBO.
8
Q
Where are stones stuck in choledocolithiasis?
A
In the common bile duct.
9
Q
How long does it take for biliary colic to resolve?
A
Within 6 hours of onset
10
Q
Abdominal pain, fever, and jaundice is known as what triad? What diagnosis is it seen in?
A
Charcot triad, seen in ascending cholangitis.
11
Q
What other two symptoms added to charcot triad makes reynolds pentad?
A
Confusion and hypotension
12
Q
What is the term for gallstones in the galbladder?
A
Cholelithiasis
13
Q
What is the initial imaging for suspected choledocholithiasis?
A
Transabdominal ultrasound
14
Q
What is the treatment for choledocholithiasis?
A
ERCP
15
Q
What is the number 1 cause of pancreatitis in the US?
A
Gallstone obstruction of the pancreatic duct
16
Q
What is the most specific lab marker for pancreatitis?
A
Elevated lipase
17
Q
What do you expect to see on US in cholelithiasis?
A
Acoustic shadowing
18
Q
Which sign is characterized by a palpable gallbladder on physical examination from a dilated gallbladder?
A
Courvoisier sign.
19
Q
What are the risk factors for cholelithiasis?
A
Female, 40-50 years old, pregnancy, obesity, rapid weight loss
20
Q
How does pain from cholelithiasis change with eating?
A
Pain begins suddenly after eating a fatty or large meal.
21
Q
What are gallstones most commonly made of?
A
Cholesterol
22
Q
What is the most appropriate IV fluid for a preoperative patient who is NPO?
A
lactated ringer solution`
23
Q
Is albumin considered a crystalloid or colloid?
A
Colloid.
24
Q
A skin lesion described as an irregular, erythematous plaque with a hemorrhagic crust is most consistent with what diagnosis?
A
Squamous cell carcinoma.
25
A skin lesion described as a dome-shaped, waxy papule with central umbilication is most consistent with what diagnosis?
Molluscum contagiosum
26
A skin lesion described as a pearly, translucent lesion with rolled borders is most consistent with what diagnosis?
Basal cell carcinoma
27
What type of skin lesion can develop into squamous cell carcinoma?
Actinic keratosis
28
What two viruses are associated with squamous cell carcinoma?
Epstein-Barr virus and human papillomavirus.
29
Which physical exam finding is highly suggestive of mesenteric ischemia?
Abdominal pain that is out of proportion to the exam.
30
What section of the colon is most prone to colonic ischemia?
The splenic flexure and rectosigmoid junction.
31
Why is the splenic flexure more common to colonic ischemia?
It has limited collateral blood flow
32
What is the most common presentation of adrenal crisis due to autoimmune primary adrenal insufficiency?
Shock.
33
What are the two types of cells that make up the thyroid, and what are their functions?
Follicular cells, which secrete thyroid hormones T3 and T4, and parafollicular cells (also known as C cells), which secrete calcitonin.
34
What are the categories of results for radionuclide scanning of the thyroid?
Hot nodules, warm nodules, and cold nodules.
35
What is a normal finding of radionuclide scanning?
Warm nodules indicate normal thyroid activity.
36
Cold nodules on radionuclide scanning indicate what?
It is a nodule made up of low functional or nonfunctional thyroid tissue.
37
What type of thyroid nodules have the highest risk of malignancy?
Cold nodules
38
What test has the highest sensitivity and specificity for determining the diagnosis of a thyroid nodule?
US guided FNA
39
What do you expect on a radionuclide scan of a patient with graves disease?
Diffuse increased uptake in both thyroid lobes.
40
NAFLD increases risk for what type of cancer?
Hepatocellular carcinoma
41
True or false: death rates due to hepatocellular carcinoma in both men and women are increasing.
True.
42
Describe the typical patient that presents with a primary spontaneous pneumothorax.
Tall, thin man between 20-40 who smokes.
43
What is pleurodesis?
A procedure in which an irritant (talc being the most commonly used agent) is introduced into the pleural space to collapse it and prevent recurrence of pneumothorax.
44
When should vitamin K be administered to patients with acute cholangitis?
If the patient has hypoprothrombinemia as a result of liver damage secondary to cholangitis.
45
What is the most common pathogen causing bacterial infection in choledocholithiasis?
E. coli
46
What is the first line agent for primary prophylaxis of variceal hemorrhage in patients with cirrhosis?
Nonselective beta blockers such as propanolol
47
What are some causes of cirrhosis?
Alcoholic liver disease, nonalcoholic steatohepatitis, hepatitis B, hepatitis C, and schistosomiasis.
48
What is the most common cause of upper gastrointestinal bleeding?
Peptic ulcer.
49
What is the most common cause of lower GI bleeds?
Diverticular bleeding from diverticulosis
50
What postoperative prophylactic is used to prevent postoperative pulmonary complications?
Incentive spirometry
51
Most major surgeries are not preformed if platelet count is
50k
52
What is the first line treatment for patients with immune thrombocytopenia for non-emergent and elective surgeries?
Steroids and IVIg
53
True or false: thrombocytopenia can be a manifestation of acute hepatitis.
True.
54
What medication is indicated at potassium >6.5mmol/L?
calcium chloride (calcium gluconate)
55
What is the progression of EKG changes as K rises?
Peaked T waves
Dropped P waves
Widened QRS complexes
Sine waves
56
What medications can be given to quickly lower K levels?
IV insulin with dextrose, sodium bicarb, and albuterol
57
True or false: a hemolyzed specimen will result in an elevated serum potassium level.
True, potassium is primarily an intracellular ion.
58
What grading system is used to evaluate patients with prostate cancer?
Gleason grading system
59
High intake of dietary _______ increases risk for prostate cancer.
fat
60
PSA level >_____ is associated with advanced disease.
40ng/mL
61
What zone of the prostate does prostate cancer most commonly arises from?
The peripheral zone.
62
What is the best diagnostic tool for diagnosis of achalasia?
Esophageal manometry
63
What is the expected result of a barium swallow study in a patient with achalasia?
Bird-beak appearance
| but barium swallow is not the best diagnostic because it is normal in 1/3 of people who have achalasia
64
What is an important cause of achalasia worldwide?
Chagas disease
65
What results on esophageal manometry confirms achalasia?
Incomplete relaxation of the lower esophageal sphincter
66
What treatment is appropriate to give a patient with well controlled asthma prior to surgery to reduce postop pulmonary complications?
A rapid acting beta agonist
67
What should the peak expiratory flow rate be for patients with asthma before elective surgery?
Greater than 80% of their predicted value.
68
What is the best treatment option for moderate to severely active ulcerative colitis?
Infliximab
69
What class of medications is infliximab in?
TNF-blocking agent
70
What is the appropriate skin margins for an excisional biopsy for superficial spreading melanoma?
2mm
71
What is the most common site for metastasis of melanoma?
Lymph nodes.
72
What is the major concern of anal fissure surgical repair?
Irreversible fecal incontinence
73
Name 5 surgeries with high intrinsic cardiac risk.
```
Laparoscopic total abdominal colectomy with ileostomy
Breast reconstruction with free flap
Open cholecystectomy
Open ventral hernia repair
Whipple procedule, pylorus sparing
```
74
What is the Hamman sign?
The mediastinal crunching sound that correlates with diastole of the heart, indicating esophageal perforation.
75
What is the best test to diagnose a Zenker diverticulum?
Barium swallow.
76
What is the anatomic area of muscular weakness where the Zenker diverticulum is located?
Killian triangle.
77
What is the triad of symptoms in Wernicke encephalopthy?
Confusion, ataxia, and ophthalmoplegia.
78
What condition can unresolved Wernicke encephalopathy lead to?
Korsakoff psychosis
79
What are the symptoms of Korsakoff psychosis?
Anterograde and retrograde amnesia and confabulation
80
What would you expect to see on brain MRI of a patient with Wernicke encephalopathy?
Signal abnormality within the mamillary bodies
81
What is the treatment for Wernicke encephalopathy?
IV thiamine infusion
82
What is the gold standard for diagnosis of renal artery stenosis?
Renal arteriography
83
What is the preferred initial test in a work up for renal artery stenosis?
Ultrasound
84
In renal artery stenosis, peak systolic velocity of the renal arteries should be >_____
200cm/second
85
What is the surgical treatment for renal artery stenosis?
Endovascular stent placement
86
What are the two causes of renovascular stenosis?
Atherosclerosis of renal arteries
Fibromuscular dysplasia
87
What are some other common causes of secondary hypertension?
Primary kidney disease, primary aldosteronism, and sleep apnea syndrome.
88
Limb ischemia from an acute arterial occlusion is associated with increased risk of limb loss if duration is >___
6 hours
89
True or false: an acute arterial embolism in the brain presents as sudden, painless onset of neurologic deficits.
True.
90
What complication of pancreatitis typically occurs more than 4 weeks after an episode of acute pancreatitis, can can present with abdominal pain, weight loss, early satiety, jaundice, or be asymptomatic?
Pancreatic pseudocyst
91
What is the preferred imaging modality to diagnose a pancreatic pseudocyst?
MRI
92
Describe the imaging findings of a pancreatic pseudocyst?
Well-circumscribed oval or round fluid collection, typically extrapancreatic, with homogenous fluid density, no solid components, and a well-defined wall that completely encapsulates the fluid.
93
What is the treatment for symptomatic pancreatic pseudocysts?
Endoscopic drainage.
94
What makes a pancreatic pseudocyst a pseudocyst rather than a cyst?
It is lined with granulation tissue rather than epithelial tissue
95
What is a retention cyst?
Small dilated pancreatic duct side branches arising due to obstruction
96
What is the most common cause of acute pancreatitis?
Gallstones.
97
What is the best place to insert a central venous catheter?
Subclavian vein due to the lowest risk of infection.
98
If the subclavian vein cannot be accessed for a central line, where is the second and third options for central line placement?
Second: Internal jugular vein (Double the risk of infection compared to subclavian)
Third: femoral vein (highest risk of infection)
99
Which internal jugular vein follows a direct path to the superior vena cava?
The right internal jugular vein. The left internal jugular vein drains into the brachiocephalic vein.
100
How does a patient typically describe the vision loss caused by amaurosis fugax from carotid artery stenosis?
A curtain being pulled and descending over their visual field causing vision loss.
101
What is the goal standard for diagnosis of carotid artery stenosis?
Contrast angiography
102
What is the preferred anticoagulant when cancer is a factor in VTE?
LMWH
103
What anticoagulants require initial parenteral therapy?
Warfarin, dabigatran, and edoxaban
104
What anticoagulant should be avoided in the setting of coronary artery disease?
Dabigitran
105
What blood gas findings do you see in respiratory acidosis?
PaCO2 elevated >45mm Hg
| pH < 7.35
106
What changes to blood gasses do you see in chronic respiratory acidosis?
PaCO2 elevated > 45 but pH can be normal or near normal with an elevated serum bicarbonate.
107
What is the most common cause of respiratory alkalosis?
Hysterical hyperventilation.
108
What is seen on peripheral blood smear in DIC?
Increased fibrin degradation products and schistocytes.
109
What is the most common cause of DIC?
Infection - often sepsis from gram-negative organisms
110
What is the most common artery affected by PAD?
Distal superficial femoral artery
111
Where would you suspect claudication in PAD of the distal superficial femoral artery?
Calf pain
112
Where would you suspect claudication in PAD of the deep femoral artery?
Thigh and lower leg
113
Where would you suspect claudication in PAD of the common iliac artery?
Buttocks and thigh
114
Where would you suspect claudication in PAD of the popliteal artery?
behind knee and calf
115
What medications can reduce elevated intracranial pressure?
Intravenous mannitol and hypertonic solution
116
How long after a meal would pain be expected to occur for a duodenal ulcer?
3 hours
117
What medications are part of quadruple therapy for Helicobacter pylori infection?
Bismuth subsalicylate, a proton pump inhibitor, metronidazole, and tetracycline.
118
What is Zollinger-Ellison disease?
A gastrin-secreting cancer that results in acid hypersecretion in the stomach.
119
What is the best initial test for a suspected pheochromocytoma?
24 hour urine collection for fractionated catecholamines
120
What is the classic triad of symptoms for a pheochromocytoma?
Episodic headaches, sweating, and tachycardia
121
Which familial syndromes increase the risk of pheochromocytoma?
Multiple endocrine neoplasia type 2, neurofibromatosis type 1, and von Hippel-Lindau.
122
What is the Parkland formula used for?
Used to determine the fluid requirements in the first 24 hours for burn patients. Half of the required fluid is given in the first 8 hours, and the remaining fluid is given over the next 16 hours.
123
What is the Parkland formula?
The Parkland formula (4 mL/kg x body weight in kg x percent of body surface area burned)
124
Does choledocholithiasis cause conjugated hyperbilirubinemia or unconjugated hyperbilirubinemia?
Conjugated hyperbilirubinemia
125
what are common differential diagnoses of upper GI bleed?
1. Esophageal varices
2. duodenal ulcers
3. Gastric ulcers
4. mallory weis tear
5. Acute gastritis
126
What is the initial tx for upper GI bleed?
1. IVF
2. NGT suctioning
3. Water lavage
127
What is the choice of imaging for upper GI bleed?
EGD
128
What is the most common cause of upper GI bleed?
PUD
129
What labs should be performed for upper GI bleed?
1. Chem-7
2. Type and Cross
3. LFTs
130
What test can help find the source for a massive GI bleed if endoscopy is clear?
selective mesenteric angiography
131
Why is BUN elevated in upper GI bleed?
because of absorption of blood by the GI tract
132
What artery is involved in bleeding from a duodenal ulcer
gastroduodenal artery
133
What causes a duodenal ulcer?
increased secretion of gastrin
134
what test should you do to evaluate for zollinger-ellison syndrome
Gastrin levels and secretin stimulation test
135
what is the cause of gastric ulcers?
decreased cytoprotectin which causes a decrease in bicarbonate and mucus production
136
What are some risk factors for gastric ulcers?
Smoking, alcohol, NSAIDs, male gender, advanced age,
137
What is the most common location for a gastric ulcer?
70% are on the lesser curvature
138
How do you diagnose a gastric ulcer?
EGD and should get a biopsy to rule out cancer
139
What diagnostic would be indicated in a patient with a history of PUD who presents with acute onset of epigastric pain?
A CXR looking for free air under the diaphragm indicating a perforated peptic ulcer
140
What other procedure must be performed along with a truncal vagotomy when treating a perforated peptic ulcer?
a Drainage procedure
pyloroplasty
antrectomy
gastrojejunostomy
141
What is a truncal vagotomy?
resection of 1-2cm of each vagal trunk as it enters the abdomen on distal segment of the esophagus. this help decrease gastric acid secretion
142
What are the causes of a mallory-weis tear
increased gastric pressure, often aggravated by a hiatal hernia
143
gold standard imaging for diagnoses mallory weis tear?
EGD
144
What is macklers triad and what diagnoses is it used for?
1. emesis
2. lower chest pain
3. cervical emphysema (subQ air)
used for boerhaaves syndrome
145
What is the most common location for boerhaaves syndrome
posterolateral aspect of the esophagus 3-5 cm above the GE junction
146
what type of cancer develops in barretts esophagus?
adenocarcinoma
147
What is barretts esophagus
columnar metaplasia from the normal squamous epithelium
148
When is surgery indicated for GERD? what surgery?
1. failure to respond to medications
2. respiratory problems as a result of esophageal disfunction resulting in aspiration
Surgery would be LAP NISSEN
149
What type of blood is associated gastric cancer?
Type A there is an A in gastric
150
What are the symptoms for gastric cancer
1. Weight loss
2. Emesis
3. Anorexia
4. Pain/epigastric pain
5. Obstruction
6. Nausea
WEAPON
151
What is a surveillance laboratory finding in gastric cancer
CEA which you can monitor
152
What is the histology of gastric cancer?
adenocarcinoma
153
What is the most common sign of an anastomotic leak after gastric bypass surgery?
Tachycardia
154
what is a petersens hernia?
a hernia seen after gastric bypass, internal herniation of small bowel through the mesenteric defect from the roux-en-y Limb
155
What condition commonly mimics a SBO
paralytic ileus (on AXR you will see gas distention including the colon)
156
What are classic electrolyte abnormalities seen with proximal SBO?
hypovolemic, hypochloremic, hypokalemia, alkalosis
157
What tumor classically causes SBO due to mesenteric fibrous?
carcinoid tumor
158
What are the possible complications of meckels diverticulum?
1. intestinal hemorrhage
2. intestinal obstruction
3. inflammation
159
what heterotropic tissue is most often found with meckels diverticulum?
Gastric mucosa
160
How do you treat a appendiceal abscess that is found preoperatively?
Percutaneous drainage then appendectomy 6 weeks later
161
Carcinoid tumors arise from what cells?
Neuroendocrine cells
162
What kind of sin changes does a carcinoid tumor cause?
Pellagra- this is due to it causing a niacin deficiency
163
Where do carcinoid tumors typically occur
1. Appendix
2. ileum
3. Rectum
164
What chemical do carcinoid tumors secrete?
Seretonin and vasoactive peptides
165
What will be elevated in someones urine if they have a carcinoid tumor?
5-HIAA (hydroxyindoleacetic acid)
166
What is it called when you have communication from the GI tract to the skin?
Enterocutaneous fistula
167
What is the Tx for enterocutaneous fistula?
NPO; TPN
168
What are causes of enterocutaneous fistula?
Anastomotic leak, Crohns, diverticulitis,
169
What type of fistula would you expect in someone with a history of diverticulosis and frequent UTIs?
Colovesical fistula
170
What is the most common colonic fistula and most common cause of colonic fistulas?
1. Colovesical fistula
| 2. Diverticulitis
171
How do you Dx a colonic fistula?
Barium enema or cystoscopy
172
What are the risk factors for colorectal carcinoma?
Diet- low in fiber high in fats
Genetics
IBD: ulcerative colitis > crohns
173
What are the reccomendations for colorectal cancer screening in patients with a first degree relative with colon cancer before age 60?
Start at age 40 or 10 years before the age of the youngest first degree relative with colon cancer
then every 5 years after that
174
What are the recommended screenings for colon cancer in patients with no family history of colon cancer?
```
One of the following:
Colonoscopy at 50 then every 10 years
Double contrast barium enema Q5years
CT colonography Q5years
Flex sigimoid Q5years
```
175
What is the most malignant adenomatous polyps
Villous> tubovillous> Tubular
Villous think villain
176
Polyps greater than what size have a high risk of malignancy?
>2cm
177
What are the most common causes of colonic obstruction in adult population?
colorectal cancer
Diverticular disease
colonic volvulus
178
Where are most polyps founds?
Rectosigmoid
179
What other tumor must be looked for in patients with FAP
duodenal tumors
180
What is gardners syndrome
Neoplastic polys of the small bowel and colon, 100% of patients will have cancer by 40 if not found
181
What are associated finding with Gardeners syndrome?
1. Desmoid tumors- in abdominal wall or cavity
2. Osteomas of skull
3. sebaceous cysts
Can be remembered with SOD
182
Most common site for diverticulosis?
Sigmoid colon
183
Diagnostic approach in the patient with pain and signs of inflammation?
CT scan of abdomen and pelvis
184
Tx for diverticulosis?
high fiber diet
185
What is the best test for diverticulitis
CT scan
186
what is initial therapy for diverticulitis?
1. NPO
2. IV fluids
3. Broad spectrum antibiotics
187
What is the Tx for diverticular abscess?
Percutaneous drainage
188
What is the most common type of colonic volvulus?
Sigmoid volvulus
189
What are signs of necrotic bowel in colonic volvulus?
Free air, pneumatosis
190
Imaging for suspected colonic volvulus?
CT scan or sigmoidscopy
191
Tx for sigmoid volvulus?
sigmoidscopic reduction
192
How do you Dx a cecal volvulus?
AXR- seeing dilated ovoid colon with large air/fluid level in RLQ forming the classic coffee bean shape
193
Tx for cecal volvulus
emergent surgery
194
what is the most common carcinoma of the anus?
squamous cell
195
What disease is commonly associated with anal fistula
Chrons
196
what is the Tx If an anal fistula goes through the sphincter muscle?
seton placement
