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ABSITE > General and Pediatric Surgery > Flashcards

General and Pediatric Surgery Flashcards

1
Q

What are the three types of gastric carcinoids?

A

Type I: most common, pernicious anemia and strophic gastritis

Type II: MEN 1 and zollinger-Ellison, intermediate malignant potential

Type III: aggressive solitary lesions with normal gastrin levels. 33% five year survival vs 85% for type I and II

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2
Q

What is the most common presentation of nasopharyngeal carcinoma?

A

A painless neck mass

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3
Q

What is a common metabolic abnormality after pancreas transplant?

A

Systemic hyperinsulinemia

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4
Q

What were the key findings of the NECSTEPS trial?

A

No difference in 90-day mortality, LOS, TPN dependence between Laparotomy and peritoneal drainage

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5
Q

What is the most common location for an alimentary tract duplication?

A

Jejunum and Ileum

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6
Q

What cardiac abnormality is commonly associated with osmium premum ASD?

A

Mitral insufficiency

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7
Q

Which type of benign tumors is Gardner syndrome associated with?

A

Desmoid tumors

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8
Q

What is Cowden’s syndrome?

A

PTEN mutation

Hamartomas/cancers in skin, mucosa, breast, thyroid, endometrium, colon, brain

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9
Q

What are the findings of the ECST and NASCET trials?

A

Benefit to carotid endarterectomy with 70-90% stenosis, and symptomatic pts with 50-69%

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10
Q

What is a Billroth I reconstruction?

A

Gastroduodenostomy

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11
Q

When do skull fractures require intervention?

A

Epidural Hematoma
Severely depressed
Dural disruption

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12
Q

What is likely to be seen on contrast enema for Hirschprung’s in the neonatal period?

A

Normal contrast enema

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13
Q

What does a microcolon imply about intestinal atresia?

A

That it is a distal atresia

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14
Q

What forms the inguinal ligament?

A

External oblique fascia

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15
Q

What forms the cremasteric muscle?

A

Internal oblique

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16
Q

What forms the inguinal canal floor?

A

Transversalis muscle and conjoined tendon (aponeurosis of internal and transversalis)

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17
Q

Where is Cooper’s ligament?

A

Posterior to the femoral vessels and lies along the bone

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18
Q

What is the relationship of the vas deferent to the cord structures?

A

It is medial

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19
Q

What is a sliding hernia?

A

When a retroperitoneal organ makes up part of hernia sac (ovaries, sigmoid, bladder)

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20
Q

What is a coopers ligament repair?

A

Approximation of conjoined tendon and transversals fascia to Cooper’s ligament + relaxing incision in external abdominal oblique fascia

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21
Q

What is the most common cause of pain after hernia?

A

Compression of ilioinguinal nerve

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22
Q

What are the symptoms of ilioinguinal nerve injury?

A

Loss of cremasteric reflex, numbness on ipsilateral penis and scrotum and thigh

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23
Q

Where is the ilioinguinal nerve usually injured?

A

near the external ring

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24
Q

Where is the genitofemoral nerve usually injured?

A

During laparoscopic repairs

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25
Q

Where does a spigelian hernia occur?

A

Between muscle fibers of internal oblique and insertion of external oblique aponeurosis into the sheath

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26
Q

What is the Howship-Romberg sign?

A

Inner thigh pain with internal rotation

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27
Q

What is Fothergill’s sign?

A

Increased mass prominence and pain with rectus muscle flexing -> Rectus Sheath Hematoma

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28
Q

What is the medical treatment for unresectable Desmoid Tumors?

A

Sulindac and Tamoxifen

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29
Q

What is main symptoms of retroperitoneal fibrosis?

A

Obstructed ureters and lymphatics

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30
Q

What is a characteristics of benign vs. malignant mesenteric tumors?

A

Root of mesentery -> Malignant (Liposarcoma, leiomyosarcoma)

Peripheral -> Benign

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31
Q

What shouldn’t you do to omental tumors?

A

Biopsy, they can bleed

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32
Q

What worsens the effects of pneumoperitoneum?

A

Hypovolemia and PEEP

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33
Q

What is the signs of CO2 embolus?

A

Sudden rise in ETCO2 and Hypotension

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34
Q

What is the difference between vortex and dacron?

A

Dacron allows fibroblast ingrowth

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35
Q

What is the definition of low birth weight?

A

< 2.5 kg

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36
Q

What is the bolus amount for kids?

A

Fluid: 20 cc/kg
Blood: 10 cc/kg

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37
Q

What is the best indicator of shock in kids?

A

Tachycardia:
Neonate > 150
Infant > 120
Rest > 100

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38
Q

What are the anatomic features of a pulmonary sequestration?

A

Anomalous systemic arterial supply
Extra-lobar -> systemic venous drainge
Intra-lobar -> pulmonary vein drainge
Do NOT communicate with the tracheobronchial tree

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39
Q

How does a pulmonary sequestration present and what is the Tx?

A

Infection

Tx: Lobectomy

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40
Q

What is the defect in congenital lobar emphysema?

A

Cartilage fails to develop -? air trapping

LUL most common

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41
Q

What is the treatment for congenital lobar emphysema?

A

Lobectomy

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42
Q

What is the anatomy of congenital cystic adenoid malformations?

A

Communicate with the airway

Lung tissue is present but poorly developed

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43
Q

What is the effect and treatment for congenital cystic adenoid malformations?

A

Sx: respiratory compromise, recurrent infections
Tx: lobectomy

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44
Q

What is the characteristics of a bronchogenic cyst?

A

Mediastinum posterior to carina
Extra-pulmonary formed from bronchial tissue and cartilage
Mediastinal mass with milky liquid
Tx: Resect cyst

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45
Q

What is the differential of a mediastinal mass in children?

A

Neurogenic Tumors (most common)
Anterior -> T cell lymphoma, Teratoma, thyroid CA, other germ cell tumors
Middle -> T cell lymphoma, teratoma, cyst
Posterior -> T cell lymphoma, neurogenic tumor

46
Q

What symptoms are common to all mediastinal masses in children?

A

Respiratory symptoms

Dysphagia

47
Q

What is the cause of choledochal cysts?

A

Reflux of pancreatic enzymes into biliary system in utero

48
Q

What are the types of choledochal cyst?

A

I -> fusiform dilation of CBD and CHD
II -> Diverticulum off CBD
III -> Dilation of distal CBD including Oddi
IV -> multiple cysts intra and extrahepatic
V -> Caroli’s disease (intrahepatic cysts)

49
Q

What is the treatment for choledochal cyst by type?

A 
I: resection, hepaticoJ
II: Resection, hepaticoJ if needed
III: Resection, choledochoJ
IV: Resection, lobectomy, possible TXP
V: Resection, lobectomy, possible TXP
50
Q

What do you do with fluctuant LAD in children?

A

FNA, culture, and abx

Chronic: cat scratch, atypical mycobacteria

51
Q

What is the workup of asymptomatic LAD in kids?

A

Abx for 10 days, excision biopsy if no improvement

52
Q

Where is a cystic hygroma (lymphanioma) usually located?

A

Lateral to the SCM

53
Q

What are a Bochdalek’s and Morgagni’s hernia?

A

Bochdalek -> located posteriorly

Morgagni -> located anteriorly

54
Q

Where are the three different branchial cleft cysts located?

A

1st: angle of mandible (associated with facial nerve)
2nd: anterior border of mid SCM (goes to tonsilar pillar)
3rd: lower neck, medial or through lower SCM

55
Q

What is elevated in most neuroblastoma?

A

Catecholamines, VMA, HVA, metanephrines

56
Q

What is seen on AXR with neuroblastoma?

A

Stippled calcification in the mass

57
Q

What characteristics of neuroblastoma are worse prognosis?

A

NSE, LDH, HVA, diploid tumors, N-myc amplification (> 3 copies)

58
Q

What marker is increased in all patients with metastases?

A

NSE

59
Q

What is neoadjuvant therapy for neuroblastoma?

A

Doxorubicin

60
Q

What is the staging for neuroblastoma?

A 
I - complete excision
II - Incomplete excision, does not cross midline
III - Crosses midline +/- regional nodes
IV - Distant mets
IVs - Localized tumor with distant mets
61
Q

What is the mean age at diagnosis of neuroblastoma vs. Wilm’s tumors?

A

Neuroblastoma 1-2 years

Wilm’s 3 years old

62
Q

What is prognosis based on for Wilm’s tumors?

A

Grade (anapestic and sarcomatous worse)

63
Q

What is differentiating feature of Wilm’s from neuroblastoma on CT?

A

Wilm’s replaces renal parenchyma and does not displace it

64
Q

Who gets adjuvant chemo for Wilm’s tumor?

A

All patients unless Stage I and < 500 g tumor

65
Q

What is adjuvant chemo for Wilm’s tumor?

A

Actinomycin and Vincristine

66
Q

What is the staging for Wilms Tumor?

A 
I - Kidney, completely excised
II - Beyond kidney but completely excised
III - Residual nonhematogenous tumor
IV - Hematogenous metastases
V - Bilateral renal involvement
67
Q

What marker is increased in hepatoblastoma?

A

AFP

68
Q

What are signs of hepatoblastoma?

A 
Fractures
Precocious puberty (bHCG release)
69
Q

What is the treatment of hepatoblastoma?

A

Resection

Can downstage with doxorubicin + cisplatin

70
Q

What is the best histology for hepatoblastoma?

A

Fetal Histology

71
Q

What are the most common malignancies in children?

A 
#1 overall: Leukemia (ALL)
#1 solid tumor: CNS tumors
#1 General Surgery Tumor: Neuroblastoma
 Child < 2 years: Neuroblastoma
  Child > 2 years: Wilm's tumor
#1 Liver tumor: hepatoblastoma
#1 lung tumor: carcinoid
72
Q

What is the #1 cause of painless LGIB in children?

A

Meckel’s

Painful: benign anorectal

73
Q

What are ultrasound characteristics of pyloric stenosis?

A

> 4 mm thick

> 14 mm long

74
Q

How should you resuscitate children with pyloric stenosis?

A

NS till making urine then D5NS + 10 of K
Avoid K containing in hypovolemia
Avoid non-salt containing in infants as can be hyponatremic

75
Q

What are max acceptable pressure for attempting reduction of intussusception?

A

120 mmHg of air

1 meter of barium

76
Q

How should you reduce intussusception in the OR?

A

Place traction on the distal limb

77
Q

What ist he cause of intestinal atresia?

A

Intrauterine vascular accidents

78
Q

What is duodenal atresia associated with?

A

Cardiac, renal and other GI anomalies

Polyhydramnios in mother

79
Q

What are the two most common types of TEF?

A

Type C - Proximal esophageal atresia and distal TE fistula

Type A - Esophageal atresia and no fistula (gas-less abdomen on AXR)

80
Q

What is the repair approach for TE fistula?

A

Right extra-pleural thoracotomy

81
Q

What is the Tx for TEF in premature < 2,500 g infants?

A

Place Replogle tube, treat respiratory symptoms and place G-tube
DELAY REPAIR

82
Q

What causes bilious vomiting in malrotation?

A

Duodenal obstruction from Ladd’s bands

83
Q

What blood vessel is compromised in volvulus from malrotation?

A

SMA

84
Q

What study should any child with bilious vomiting get?

A

UGI to r/o malrotation

85
Q

What do you see on a UGI with malrotation?

A

Duodenum does not cross midline

Duodenal-Jejunal junction displaced to the right

86
Q

What is the treatment for malrotation?

A

Resect Ladd’s bands, counterclockwise rotate
Place cecum in LLQ
Place duo in RUQ
Appendectomy

87
Q

Where is the obstruction located with meconium ileus?

A

Distal ilium

88
Q

What test must be ordered for a meconium ileus?

A

Sweat chloride test

89
Q

What do you see on AXR for meconium ileus?

A

Dilated loops without AFLs

90
Q

What is the treatment of meconium ileus?

A

Gastrografin enema or NAC enemas

91
Q

What is the classic presentation of NEC?

A

Blood stools after first feeding in a premature neonate

92
Q

What do you need to obtain prior to taking down NEC ostomy?

A

Barium enema to r/o stenosis

93
Q

What are surgical indications for congenital vascular malformations?

A

Hemorrhage, ischemia, CHF
non-bleeding ulcers
Functional impairment
Limb-length discrepancy

94
Q

What syndrome should you think of with imperforate anus?

A

VACTREL

95
Q

What is the treatment for imperforate anus?

A

Above Levators -> Colostomy and then posterior sagittal anoplasty

Below Levators -> posterior sagittal anoplasty

96
Q

What are the characteristics of gastroschisis?

A

Right of midline
No peritoneal sac
Stiff bowel
Origin: Intrauterine rupture of umbilical vein

97
Q

What is the cantrell pentology?

A

Cardiac defects
Pericardium defects (usually along diaphragm)
Sternal cleft or absence of lower sternum
Diaphragmatic septum transverse absence
Omphalocele

98
Q

What is the #1 cause of colonic obstruction in infants?

A

Hirschprung’s disease

99
Q

What do you see on biopsy for Hirschprung’s disease?

A

Absence of ganglion cells in the myenteric plexus

100
Q

What does Hirschprung’s colitis present as?

A

Distention and foul-smelling diarrhea

Tx: Rectal irrigation to empty colon

101
Q

What are indications for umbilical hernia repair?

A

Age > 5
Incarceration
VP shunt

102
Q

When should you consider a contralateral groin exploration during IHR?

A

< 1 year
Left sided (right is more common, 10% bilateral)
Female

103
Q

What is the typical presentation of biliary atresia?

A

Progressive jaundice persisting > 2 weeks after birth

104
Q

What do you see on liver bx with biliary atresia?

A

Periportal fibrosis
Bile plugging
Progressive cirrhosis

105
Q

What is first treatment for biliary atresia?

A

Kasai procedure before 3 months of age

106
Q

What serum markers are increased in teratoma?

A

AFP and bHCG

107
Q

Where is the most common site of teratoma in neonates and adolescents?

A

Neonates -> sacrococcygeal

Adolescents -> Ovarian

108
Q

What is the key time point for sacrococcygeal teratomas?

A

< 2 months -> usually benign

> 2 months -> usually malignant

109
Q

At what age should you treat undescended testes?

A

2 years

110
Q

What if you cannot get the testicles to come down during an orchiopexy?

A

Close incision and wait 6 months prior to trying again

If still not successful, divide spermatic vessels

111
Q

What is the surgery for tracheomalacia?

A

Aortopexy

112
Q

What is the natural history of laryngeal papillomatosis?

A

Usually involutes after puberty

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