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CKSx > Gen Sx > Flashcards

Gen Sx Flashcards

1
Q

Cx of GERD

A

damage that might have been done to the lower esophagus (peptic esophagitis) and the possible development of Barrett’s esophagus

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2
Q

When to do Sx for GERD

A

• Appropriate in long-standing symptomatic disease that cannot be controlled by medical
means (using laparoscopic Nissen fundoplication)
• Necessary when complications have developed (ulceration, stenosis) (using laparoscopic
Nissen fundoplication)
• Imperative if there are severe dysplastic changes (resection is needed)

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3
Q

where solids are swallowed with less difficulty than liquids.

A

Achalasia

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4
Q

_______ is typically done first to evaluate for an obstructing lesion

A

Barium swallow

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5
Q

Xray of achalasia

A

X-rays show megaesophagus.

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6
Q

Tx of achalasia

A

balloon dilatation done by endoscopy, however recurrence is high and many patients ultimately require an esophagomyotomy (Heller).

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7
Q

Cancer of the esophagus shows the classic progression of dysphagia starting with ________

A

meat, then other solids, then soft foods, eventually liquids, and finally (in several months) saliva

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8
Q

________ is seen in people with long-standing gastroesophageal reflux

A

Adenocarcinoma

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9
Q

_________ also results from prolonged, forceful vomiting but leads to esophageal perforation

A

Boerhaave’s syndrome

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10
Q

______is a mucosal laceration typically at the junction of the esophagus and stomach

A

Mallory-Weiss tear

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11
Q

_______ of the esophagus is by far the most common reason for esophageal perforation

A

Instrumental perforation

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12
Q

Tx of gastric lymphoma

A

treatment is chemotherapy.

Surgery is only indicated if perforation is feared as the tumor melts away.

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13
Q

Low-grade lymphomatoid transformation (MALTOMA) can

be reversed by _______

A

eradication of H. pylori

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14
Q

_________ is more common in the elderly.

Symptoms include:
• Anorexia
• Weight loss
• Vague epigastric distress or early satiety
• Occasional hematemesis
A

Gastric adenocarcinoma

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15
Q

SSx of SBO

A

Early on, high-pitched bowel sounds coincide with the colicky pain (after a few days there is silence

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16
Q

patient develops fever, leukocytosis, constant pain, signs of peritoneal irritation, and ultimately full-blown peritonitis and sepsis

A

Strangulated obstruction

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17
Q

________ is seen in patients with a small bowel carcinoid tumor with liver metastases.

It includes diarrhea, flushing of the face, wheezing, and right-sided heart valvular damage
(look for prominent jugular venous pulse

A

Carcinoid syndrome

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18
Q

How to get 5 IAA in pts with suspected carcinoid

A

Whenever syndromes produce episodic attacks or spells, the offending agent will be at
high concentrations in the blood only at the time of the attack. A blood sample taken afterward
will be normal. Thus, a 24-hour urinary collection is more likely to provide the diagnosis.)

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19
Q

___________ typically presents with anemia (hypochromic, iron deficiency) in the right age group (age 50–70). Stools will be 4+ for occult blood.

Colonoscopy and biopsies are diagnostic; surgery (right hemicolectomy) is treatment of choice

A

Cancer of the right colon

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20
Q

_________ typically presents with bloody bowel movements and obstruction.

Blood coats the outside of the stool, there may be constipation, stools may have narrow caliber.

A

Cancer of the left colon

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21
Q

Dx of left colon CA

A

Flexible proctosigmoidoscopic exam (45 or 60 cm) and biopsies

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22
Q

Colonic polyps may be premalignant. In descending order of probability for malignant degeneration are:

A 
familial polyposis (and variants such as Gardner’s),
 f amilial multiple inflammatory polyps, villous adenoma, and adenomatous polyp
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23
Q

Polyps that are not premalignant include

A

juvenile, Peutz-Jeghers, isolated inflammatory, and hyperplastic.

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24
Q

UC surgery indications

A

present >20 years
severe interference with nutritional status,
multiple hospitalizations,
need for high-dose steroids or immunosuppressants,
or development of toxic megacolon

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25
Q

Definitive surgical treatment of CUC requires______

A

removal of affected colon, including all of the rectal mucosa (which is always involved).

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26
Q

Pseudomembranous enterocolitis Tx

A

Metronidazole is the treatment of choice (oral or IV), with vancomycin (oral) an alternative.

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27
Q

A virulent form of Pseudomembranous enterocolitis, unresponsive to treatment, with WBC >50,000/μL and serum lactate above 5mg/dL, requires ___________

A

emergency colectomy

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28
Q

Hemorrhoids typically bleed when they are_______ (can be treated with rubber band ligation), or hurt when they are _______ (may need surgery if conservative treatment fails). Internal hemorrhoids can become painful and produce itching if they are ____

A

internal

external

prolapsed

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29
Q

WHat can complicate anal fissures?

A

Tight sphincter

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30
Q

Tx of anal fissures

A

stool softeners, topical nitroglycerin, local injection of botulinum toxin, steroid suppositories, or lateral internal sphincterotomy

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31
Q

Anal fissure

_____________s such as
________ ointment 2% TID topically for 6 weeks have had an 80-90% success rate, as compared
to only 50% success for botulinum toxin

A

Calcium channel blocker

diltiazem

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32
Q

It starts with a fissure, fistula, or small ulceration, but the diagnosis should be suspected when the area fails to heal and gets worse after surgical
intervention

A

Crohn’s disease

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33
Q

________develops in some patients who have had an ischiorectal abscess drained.

A

Fistula-in-ano

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34
Q

Fistula-in-ano MOA

A

Epithelial migration from the anal crypts (where the abscess originated) and from the perineal
skin (where the drainage was done) form a permanent tract

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35
Q

Tx of FIA

A

treat with fistulotomy.

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36
Q

_________of the anus is more common in HIV, and in patients with receptive sexual practices

A

Squamous cell carcinoma

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37
Q

Tx of squamous cell CA of anus

A

Treatment starts with the Nigro chemoradiation protocol,

followed by surgery if there is residual tumor

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38
Q

General statistics of GI bleeding show that 3 of 4 cases originate in the _______

A

upper GI tract (from

the tip of the nose to the ligament of Treitz).

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39
Q

Vomiting blood always denotes a source in the ____

A

upper GI tract.

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40
Q

Similarly, melena (black, tarry stool) always indicates digested blood, thus it must originate
high enough to undergo digestion. Start workup with _________

A

upper GI endoscopy.

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41
Q

In the work up for blood in the rectum, if there is no blooed per NGT decompression and with white output (no bile)_______

A

the territory from the tip of the nose to the
pylorus has been excluded, but the duodenum is still a potential source and upper GI endoscopy
is still necessary.

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42
Q

Active bleeding per rectum

If the bleeding >2 mL/min (1 unit of blood every 4 hours), an angiogram is useful as it has a very good chance of finding the source and may allow for ______

A

angiographic embolization

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43
Q

Active bleeding per rectum

If the bleeding is slower, i.e. <0.5 mL/min, wait until the bleeding stops and then do a_______

A

colonoscopy

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44
Q

Patients with a recent history of blood per rectum, but not actively bleeding at the time of presentation, should start workup with______ if they are young (overwhelming
odds);

but if they are old they need both an ______

A

upper GI endoscopy

upper and a lower GI endoscopy (typically performed during the same session).

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45
Q

Blood per rectum in a child is most commonly a _________ start workup with a technetium scan looking for the ectopic gastric mucosa in the distal ileum.

A

Meckel’s diverticulum;

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46
Q

Post op recommended pH

A

above 4

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47
Q

Acute abdominal pain caused by ______ has sudden onset and is constant, generalized, and very severe

A

perforation

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48
Q

__________ confirms the diagnosis of perforation

A

Free air under the diaphragm on upright x-rays

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49
Q

Acute abdominal pain caused by ___________) has sudden onset of colicky pain, with typical location and radiation according to source.

A

obstruction of a narrow duct (ureter, cystic, or common bile

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50
Q

Acute abdominal pain caused by_______has gradual onset and slow buildup (at the very least a couple of hours, more commonly 6-12 hours).

A

inflammatory process

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51
Q

_________ should be suspected in the child with nephrosis and ascites, or the adult with ascites who has a “mild” generalized acute abdomen with equivocal
physical findings, and perhaps some fever and leukocytosis.

A

Spotaneous bacterial peritonitis (SBP)

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52
Q

_______ should be suspected in the alcoholic who develops an “upper” acute abdomen.

A

Acute pancreatitis

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53
Q

__________ should be suspected in the obese multiparrous female patient ages 30-50
(“fat, female, forty, fertile”) who presents with right upper quadrant abdominal pain

A

Biliary tract disease

54
Q

Dx for ureterolothiasis

A

Non-contrast CT scan is the best diagnostic test.

55
Q

_______ is one of the very few inflammatory processes giving acute abdominal pain in the left lower quadrant (in women, the fallopian tube and ovary are other potential sources).

A

Acute diverticulitis

56
Q

Dx of Acute diverticulitis

A

• CT scan with oral and IV contrast is diagnostic

57
Q

Tx of Acute diverticulitis

A

• Treatment is NPO, IV fluids, and antibiotics

58
Q

_______ is indicated around 6 weeks after an episode of diverticulitis to rule out
an underlying malignancy

A

Colonoscopy

59
Q

Why not do endoscopy in the first 6 weeks

A

(endoscopy earlier in the presence of active inflammation

increases the likelihood of perforation and decreases the diagnostic sensitivity).

60
Q

Xrays of volvulus

A

X-rays are diagnostic, as they show air-fluid levels in
the small bowel, very distended colon, and a huge air-filled loop in the right upper quadrant
that tapers down toward the left lower quadrant with the shape of a “parrot’s beak

61
Q

Volvulus

_______ resolves the acute problem and asses for mucosal ischemia; leaving a rectal tube allows for complete decompression and prevents immediate recurrence

A

Proctosigmoidoscopic exam

62
Q

Marker for primary hepatoma

A

α-fetoprotein (AFP).

63
Q

______ may arise as a complication of birth control pills, and is important because it has a tendency to rupture and bleed massively inside the abdomen

A

Hepatic adenoma

64
Q

______ is seen most often as a complication of biliary tract disease, particularly acute ascending cholangitis

A

Pyogenic liver abscess

65
Q

_______ of the liver favors men, all of whom have a “Mexico connection.” (It is very
common there, and seen in the U.S in immigrants.)

A

Amebic abscess

66
Q

Hemolytic jaundice is usually low level (bilirubin of 6-8 mg/dL, but not 35 or 40), and all the elevated bilirubin is______

A

unconjugated (indirect), with no elevation of the conjugated (direct) fraction

67
Q

_____ has elevation of both fractions of bilirubin, and very high levels of transaminases with only a modest elevation of the alkaline phosphatase

A

Hepatocellular jaundice

68
Q

Obstructive jaundice has elevations o______, modest elevation of _______, and very high levels of alkaline phosphatase

A

of both fractions of bilirubin

transaminases

69
Q

The first step in the workup is an ________ as well as further clues as
to the nature of the obstructive process.

A

U/S looking for dilatation of the biliary ducts,

70
Q

Obstructive jaundice caused by stones should be suspected in the obese, fecund woman in her forties, who has
1
2
3

A

high alkaline phosphatase, dilated ducts on sonogram,

and nondilated gallbladder full of stones.

71
Q

Mx of Gallstones

The next step in that case is an _____
to confirm the diagnosis,

perform a _____, and remove the common duct stone.

Cholecystectomy should usually follow during the same hospitalization

A

endoscopic retrograde cholangiopancreatography (ERCP)

sphincterotomy

72
Q

Obstructive jaundice caused by a tumor could be caused by
1
2
3

A

adenocarcinoma of the head of the pancreas, adenocarcinoma of the ampulla of Vater, or cholangiocarcinoma arising in the common duct itself.

73
Q

Once a tumor has been suspected by the presence of dilated gallbladder in the sonogram, the next test should be ____

A

CT scan

74
Q

If no tumor is seen in the CT, next step is

A

ERCP

75
Q

Ampullary cancers or cancers of the common duct by virtue of their strategic location produce obstruction when they are still very small, and therefore may not be seen on CT, but ______ will show ampullary cancers and the ________ will show intrinsic tumors arising from the duct (apple core) or small pancreatic cancers.

A

endoscopy

cholangiography

76
Q

_______should be suspected when malignant obstructive jaundice coincides with anemia and positive blood in the stools

A

Ampullary cancer

77
Q

Reason for anemia in ampullary cancer

A

Can bleed into the lumen like any other mucosal malignancy, at the same time that it can obstruct biliary flow by virtue of its location.

78
Q

Pancreatic cancer is seldom cured, even when resectable by the _________

A

Whipple operation (pancreatoduodenectomy).

79
Q

____ and _____ have a much better prognosis

about 40% cure

A

Ampullary cancer and cancer of the lower end of the common duct

80
Q

________ occurs when a stone temporarily occludes the cystic duct.

A

Biliary colic

81
Q

_________starts as a biliary colic, but the stone remains at the cystic duct until an inflammatory process develops in the obstructed gallbladder

A

Acute cholecystitis

82
Q

HIDA scan of acute cholecystitis

A

In equivocal cases, a radionuclide scan (HIDA) might be needed, and would show tracer uptake in the liver, duct, and duodenum, but not in the occluded gallbladde

83
Q

Acute cholecystitis

__________ may be the best temporizing option in the very sick with a prohibitive surgical risk

A

Emergency percutaneous cholecystostomy

84
Q

_________ is a far more deadly disease, in which stones have reached the
common duct producing partial obstruction and ascending infection

A

Acute ascending cholangitis

85
Q

Charcot triad+ mental status and evidence of sepsis (most commonly, hypotension)

A

Reynolds Pentad

86
Q

Tx of ascending cholangitis

A

IV antibiotics and emergency decompression of the common duct is lifesaving; this is performed ideally by ERCP, alternatively percutaneous through the liver by percutaneous transhepatic cholangiogram (PTC), or rarely by surgery

87
Q

_______ is seen when stones become impacted distally in the ampulla, temporarily obstructing both pancreatic and biliary ducts

A

Biliary pancreatitis

88
Q

Acute pancreatitis may be
1
2
3

A

edematous, hemorrhagic, or suppurative (pancreatic abscess).

89
Q

Late complications of Acute pancreatitis include _____

A

pancreatic pseudocyst and chronic pancreatitis.

90
Q

________ Can Be seen in Acute Pancreatitis

A

Grey-Turner Sign

91
Q

Acute edematous pancreatitis occurs in the______ or _______

A

alcoholic or the patient with gallstones

92
Q

Dxtics for acute edematous pancreatitis

A

Serum amylase and lipase are elevated, and often serum hematocrit levels are high due hypovolemia

93
Q

It starts as the edematous form does, but an early lab clue is lower hematocrit (the degree of amylase elevation does not correlate with the severity of the disease)

A

Acute severe pancreatitis

94
Q

Acute severe pancreatitis DX

A

Ransons criteria

95
Q

Organism and ABx for late severe pancreatitis

A

If drained fluid is positive for bacteria (often gram-negative), the antibiotic of choice is IV carbopenem (imipenem or meropenem)

96
Q

__________ is the best way to deal with necrotic pancreas, but timing is crucial

A

Necrosectomy

97
Q

Timing for Necrosectomy

A

Patients do far better by waiting at least 4 weeks before debridement of the dead pancreatic tissue

98
Q

_______may become evident in someone who
was not getting CT scans, because persistent fever and leukocytosis develop ~10 days after
the onset of pancreatitis and sepsis develops.

A

Pancreatic abscess (acute suppurative pancreatitis)

99
Q

Timing of discovery of pseudocyst

A

In either case, ~5 weeks elapses between the original problem and the discovery of the pseudocyst

100
Q

Cysts ≤6 cm or those that have been present <6 weeks are not likely to have complications and can be __________

A

observed for spontaneous resolution

101
Q

People who have repeated episodes of pancreatitis
(usually alcoholic) eventually develop calcified burned-out pancreas, steatorrhea, diabetes, and constant epigastric pain. What condition is this?

A

Chronic pancreatitis

102
Q

Hernias that dont need to be repaired

A
  • Asymptomatic umbilical hernia in patients age <5 (they typically close spontaneously)
  • Esophageal sliding hiatal hernias (not “true” hernias)
103
Q

As a regular screening exam, mammography should be started at age________

A

40 (earlier if there is family history).

104
Q

_______ is seen in young women (late teens, early twenties) as a firm, rubbery mass
that moves easily with palpation

A

Fibroadenoma

105
Q

Dx of Fibroadenoma

A

Fine-needle aspirate (FNA) or core biopsy is sufficient to

establish diagnosis.

106
Q

_________ is seen in very young adolescents, where it has very rapid growth. Removal is needed to avoid deformity and distortion of the breast

A

Giant juvenile fibroadenoma

107
Q

_________ (fibrocystic disease, cystic mastitis) is seen in the 30s and 40s (goes away
with menopause), with bilateral tenderness related to menstrual cycle (worse in the last 2
weeks) and multiple lumps that seem to come and go (they are cysts) also following the menstrual
cycle

A

Mammary dysplasia

108
Q

_______ is seen in young women (20s–40s) with bloody nipple discharge. Mammogram is needed to identify other potential lesions, but it will not show the papilloma

A

Intraductal papilloma

109
Q

Breast cancer during pregnancy is diagnosed exactly as if pregnancy did not exist, and is treated
the same way with the following exceptions:

1
2

A
  • No radiotherapy during the pregnancy

* No chemotherapy during the first trimester

110
Q

____ has higher incidence of bilaterality, but not high

enough to justify bilateral mastectomy in all cases

A

Lobular Breast CA

111
Q

_______ is a clinical presentation of advanced breast cancer. It has a much worse prognosis and is treated with chemotherapy prior to surgery

A

Inflammatory cancer

112
Q

Inflammatory breast cancer is also one of the few times where ______

A

radiation is added following a total mastectomy

113
Q

______is the common standard form of breast cancer

A

Infiltrating ductal carcinoma

114
Q

___________ cannot metastasize (thus no axillary sampling is needed) but has very
high incidence of recurrence if only local excision is done

A

Ductal carcinoma in situ

115
Q

Tx for Ductal carcinoma in situ

A

Total mastectomy is recommended for
multicentric lesions throughout the breast; because of the possibility of missing an invasive focus in
multicentric disease, many practitioners add a sentinel node biopsy in those patients

116
Q

Chemotherapy

  • Premenopausal women receive _____
  • Postmenopausal women receive an ____
  • Frail, old women with less-aggressive tumors and women with small, low-risk tumors may be offered hormonal therapy alone if their tumors are ____
A

tamoxifen

aromatase-inhibitor (e.g. anastrozole)

estrogen-receptor positive

117
Q

Most hyperthyroid patients are treated with radioactive iodine, but those with a _______have the option of surgical excision of the affected lobe

A

“hot adenoma”

118
Q

True about hyperparathyroidism

  • Asymptomatic patients become symptomatic at a rate of ______ thus elective intervention is justified.
  • Ninety percent have single adenoma.
  • Removal is curative (_____ may help localize the culprit gland before surgery
A

20% per year;

sestamibi scan

119
Q 
\_\_\_\_\_\_\_\_\_ shows up as virulent peptic ulcer disease, resistant to all usual therapy (including eradication of Helicobacter pylori), and more extensive than it
should be (several ulcers rather than one, ulcers extending beyond first portion of the duodenum)
A

Zollinger-Ellison syndrome (gastrinoma)

120
Q

Dx of ZES

A

Measure gastrin and do a secretin test; if values
are equivocal, locate the tumor with CT scan (with contrast) of the pancreas and nearby
areas and resect it

121
Q

______ produces CNS symptoms because of low blood sugar, always when the patient is fasting

A

Insulinoma

122
Q

________ produces severe migratory necrolytic

dermatitis, resistant to all forms of therapy, in a patient with mild diabetes, mild anemia, glossitis, and stomatitis.

A

Glucagonoma

123
Q

In Glucagonoma,______ and ______ can help those with metastatic, inoperable disease.

A

Somatostatin and streptozocin

124
Q

________ can be caused by an adenoma or by hyperplasia. In both cases the key finding is hypokalemia in a hypertensive (usually female) patient who is not on
diuretics

A

Primary hyperaldosteronism

125
Q

DX of Primary hyperaldosteronism

A

Aldosterone levels are high, whereas renin levels are low

126
Q

Appropriate response to postural changes (more
aldosterone when upright than when lying down) suggests ______ (which is treated medically), whereas lack of response (or inappropriate response) is diagnostic of ______

A

hyperplasia

adenoma

127
Q

________ is seen in thin, hyperactive women who have attacks of pounding headache, perspiration, palpitations, and pallor (i.e., extremely high but paroxysmal BP).

A

Pheochromocytoma

128
Q

Pheochromocytoma Dx

A

Start the workup with a 24-hour urinary determination of vanillylmandelic acid
(VMA), metanephrines (more specific), or free urinary catecholamines

129
Q

Other dx Pheochromocytoma

A

Follow with a CT scan of the adrenal glands and retroperitoneum; if negative, a radionuclide
study may be necessary to identify extra-adrenal sites.

130
Q

Surgery requires careful pharmacologic preparation with ________ then _____

A

alpha-blockers, followed by

beta-blockers

131
Q

CoA

Chest x-ray shows_________. CT angiogram (CTA) is diagnostic and surgical correction is curative

A

scalloping of the ribs (erosion from large collateral intercostals)

132
Q

Renovascular hypertension is seen in 2 distinct groups:
1
2

A

young women with fibromuscular dysplasia, and old men with arteriosclerotic occlusive diseas

CKSx (12 decks)

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