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Surgery > General Sugery > Flashcards

General Sugery Flashcards

0
Q

Tx for GERD that cannot be controlled by medical means or presence of ulcers, stenosis

A

Laparoscopic Nissen fundoplication

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1
Q

Dx of GERD

A

pH monitoring and correlation with symptoms

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2
Q

Dysphagia of liquids but not solids

A

Achalasia

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3
Q

Definitive dx of dysphagia

A

Manometry

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4
Q

Tx of achalasia

A

Balloon dilatation by endoscopy

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5
Q

Progressive dysphagia
Weight loss
Hx smoking drinking or GERD

A

Esophageal cancer

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6
Q

Type of esophageal cancer in smokers and drinkers

A

Squamous cell

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7
Q

Type of esophageal cancer in GERD

A

Adenocarcinoma

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8
Q

Dx for esophageal cancer

A

Barium swallow, endoscopy and biopsy

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9
Q

Tx of Mallory-Weiss tear

A

Endoscopy and photocoagulation

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10
Q

Tx of Boerhaave syndrome (prolonged forceful vomiting leading to esophageal perforation)

A

Contrast swallow

Emergency surgical repair

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11
Q

Wrenching epigastric pain
Fever, leukocytosis
Subcutaneous emphysema in neck

A

Perforation of esophagus

Most commonly by endoscopy

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12
Q

Elderly

Anorexia, weight loss, epigastric discomfort, early satiety

A

Gastric cancer

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13
Q

Dx and tx for gastric adenocarcinoma

A

Endoscopy and biopsy, CT

Surgery

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14
Q

Tx of gastric lymphoma

A

Chemotherapy, radiotherapy

Surgery if perforation

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15
Q

Tx of MALToma

A

Eradicate H. pylori

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16
Q

Signs of small bowel obstruction

A

Progressive distention
No gas or feces
High pitched bowel sounds coinciding with colicky pain

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17
Q

Tx of small bowel obstruction

A

NPO, NG suction, IV fluids

Surgery if strangulated or after several days without spontaneous resolution

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18
Q

Tx for incarcerated hernia

A

If irreducible and strangulated, emergent surgery

If reducible then elective surgery

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19
Q

Diarrhea, facial flushing, wheezing, right sided heart valve damage, prominent jugular venous pulse

A

Carcinoid syndrome

Result of liver mets

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20
Q

Dx of carcinoid syndrome

A

24 hour urine collection for 5-hydroxyindoleacetic acid

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21
Q

Elderly person with anemia and 4+ occult blood

A

Right sided colon cancer

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22
Q

Dx and tx for cancer of right colon

A

Colonoscopy and biopsy

Right hemicolectomy

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23
Q

Bloody bowel movements

Narrow caliber

A

Left sided colon cancer

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24
Q

Dx of cancer of left colon

A

Flexible proctosigmoidoscopy and biopsy
Full colonoscopy
CT for operability and extent

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25
Q

Initial tx of large rectal cancers

A

Chemotherapy, radiotherapy

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26
Q

Familial polyposis
Familial multiple inflammatory
Villous adenoma
Adenomatous polyp

A

Premalignant polyps

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27
Q

Juvenile polyp
Peutz-Jeghers
Isolated inflammatory polyp
Hyperplastic polyp

A

Benign polyps

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28
Q

Surgical indications for ulcerative colitis

A 
Disease >20 yrs
Poor nutritional status
Multiple hospitalizations
Need for high dose steroids, immune suppressants 
Toxic megacolon
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29
Q

Surgical tx of ulcerative colitis

A

Removal of affected colon and all rectal mucosa

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30
Q

Abdominal pain, fever, leukocytosis
Epigastric tenderness, massively distended transverse colon
Gas within wall of colon

A

Toxic megacolon

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31
Q

Etiology of pseudomembranous colitis

A

Cephalosporins most commonly
Clindamycin
Any antibiotic

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32
Q

Tx of pseudomembranous colitis

A

Metronidazole
Or vancomycin

Emergency colectomy if unresponsive and WBC >50k

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33
Q

Difference between internal and external hemorrhoids

A

Internal bleed. Only painful if prolapsed. Tx with ligation

External are painful. May need surgery

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34
Q

Blood streaked stool
Fear of pain causes avoidance of bowel movement and constipation
Young women

A

Anal fissure

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35
Q

Common location and tx of anal fissure

A

Posterior midline

Calcium channel blocker ointment
Botox
Lateral internal sphincterotomy

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36
Q

Unhealing fissure, fistula or ulcer in the anal area

A

Crohn’s disease

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37
Q

Tx for Crohn’s disease fistula

A

Drainage with setons

Remicade

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38
Q

Perirectal pain, unable to sit or have bowel movement

Inflammation lateral to anus

A

Ischiorectal abscess

Tx is I&D

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39
Q

Hx ischiorectal abscess with drainage

Fecal soiling

A

Fistula in ano

R/o draining tumor

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40
Q

Homosexual
Fungating mass grows out of anus
Inguinal nodes felt

Tx?

A

Squamous cell carcinoma of anus

Chemoradiation then surgery which is rarely required

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41
Q

Most common sites of GI bleeding

A

Upper GI between nose and ligament of Treitz

Look in nose and mouth, endoscopy indicated

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42
Q

Causes of lower GI bleeding

A

In elderly

Angiodysplasia, polyps, diverticulosis, cancer, hemorrhoids

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44
Q

Dx of cause of vomiting blood or melena

A

Upper GI endoscopy

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45
Q

Where may red blood per rectum arise

How do you dx where

A

Anywhere, upper or lower

Pass NG tube, if you get normal bile without blood then assume lower. If blood or no bile, do endoscopy

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46
Q

Dx of location of active lower GI bleed

A
  1. Anoscopy (r/o hemorrhoids)
  2. Angiogram if bleeding >2 mL/min
    Wait for hemostasis then colonoscopy if <0.5 mL/min
    Tagged red-cell study 0.5-2 mL/min

Capsule endoscopy being used more frequently

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47
Q

Dx of location of blood per rectum w/o active bleeding

Young and elderly

A

Young: upper GI endoscopy
Old: upper and lower GI endoscopy

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48
Q

Blood per rectum in peds pt

Dx?

A

Meckel diverticulum

Technetium scan

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49
Q

Tx for massive upper GI bleed/stress ulcer

A

Angiographic embolization

50
Q

Sudden onset, constant, severe, generalized abdominal pain

generalized signs of peritoneal irritation

A

Perforation

51
Q

Dx of perforation
Most common cause?
Tx?

A

Free-air under diaphragm on upright X-ray
Perforated peptic ulcer most common
Emergency surgery required

52
Q

Sudden onset, colicky pain with localization and radiation

Pt moves constantly seeking position of comfort

A

Obstruction

i.e. ureter, cystic duct, etc

53
Q

Gradual onset, starts ill-defined then localizes
typical radiation patterns
localized signs of peritoneal irritation

A

Inflammatory process

Fever, leukocytosis common (except pancreatitis)

54
Q

Severe abdominal pain

Blood in gut lumen

A

Ischemia

55
Q 
Child: ascites, nephrosis
Adult: ascites
Mild generalized acute abdomen
Possible fever, leukocytosis
Dx? Tx?
A

Primary peritonitis
Dx by ascitic culture
Tx with antibiotics

56
Q

What needs to be ruled out before exploratory laparotomy on generalized acute abdomen (6)

A

MI, pneumonia, PE

Primary peritonitis, pancreatitis, nephrolithiasis

57
Q

Alcoholic
acute upper abdomen with constant pain radiating to back
nausea, vomiting, retching
Dx? Tx?

A

Acute pancreatitis
Dx by serum (1-2 d) or urinary (3-6 d) amylase, lipase
Tx by NPO, NG suction, IV fluids

58
Q

LLQ abdominal pain
fever, leukocytosis, peritoneal irritation
Dx? Tx?

A

Acute diverticulitis
Dx by CT
NPO, IV fluids, antibiotics
Percutaneous drainage if abscess, surgical resection if 2 or more attacks

59
Q

Elderly, signs of obstruction
distended colon
huge air filled loop in RUQ that tapers down to LLQ in the shape of a “parrot’s beak”
Dx? Tx?

A

Sigmoid volvulus
Xray
Tx by rigid proctosigmoidoscopy and rectal tube
Recurrence warrants elective sigmoid resection

60
Q

Acute abdomen predominantly in elderly
Associated A-fib or recent MI
Signs of acidosis, sepsis, blood in gut lumen

A

Mesenteric ischemia

If caught early, try arteriogram and embolectomy

61
Q

Cirrhosis
Vague RUQ discomfort, weight loss
Tx?

A

Primary hepatocellular carcinoma

Resection if possible

62
Q

Blood marker for hepatocellular carcinoma

A

AFP

63
Q

Most common liver tumor

A

Metastasis

64
Q

Hepatic lesion caused by birth control pills

A

Hepatic adenoma

May rupture and bleed requiring emergency surgery

65
Q

Fever, leukocytosis, liver tenderness
hx acute ascending cholangitis
Dx? Tx?

A

Pyogenic liver abscess
Ultrasound or CT
Percutaneous drainage

66
Q

Immigrant
fever, leukocytosis, liver tenderness
Tx?

A

Amebic abscess of liver

Metronidazole or drainage

67
Q

Unconjugated hyperbilirubinemia

Normal conjugated

A

Hemolytic jaundice

68
Q

Elevated conjugated and unconjugated bilirubin
Elevated liver enzymes
modestly elevated alk phos
Dx?

A

Hepatocellular jaundice
Most commonly hepatitis
dx by serology

69
Q

Elevated conjugated and unconjugated bilirubin
modestly elevated liver enzymes
very high all phos level
Dx?

A

Obstructive jaundice
most commonly by gallstones
dx by ultrasound

70
Q

Next steps after obstructive jaundice from stones is confirmed

A

ERCP
sphincterotomy to remove stone
cholecystectomy

71
Q

Tumors that could cause obstructive jaundice (3)

A

adenocarcinoma of head of pancreas
adenocarcinoma of ampulla of Vater
cholangiocarcinoma of common bile duct

72
Q

Workup of obstructive jaundice without stones

A

CT, percutaneous biopsy if tumor suspected

if CT negative, ERCP and biopsy

73
Q

Obstructive jaundice
anemia
positive blood in stools
dx?

A

Ampullary cancer
dx by endoscopy

(may not be seen on CT as they can obstruct while still being very small)

74
Q

Colicky RUQ pain
self-limited up to 30 minutes
triggered by fatty foods, associated nausea, vomiting
no peritoneal irritation

A

Biliary colic

Elective cholecystectomy if stones confirmed

75
Q

RUQ pain with signs of peritoneal irritation
fever, leukocytosis
Dx? Tx?

A

Acute cholecystitis
ultrasound or HIDA scan
NPO, NG suction, IV fluids, antibiotics
elective cholecystectomy

76
Q

What is Tx for acute cholecystitis when patient is poor surgical candidate

A

Transhepatic cholecystostomy

77
Q

High spiking fevers, very high leukocytosis
Very high alk phos
Tx?

A

Acute ascending cholangitis
IV antibiotics
Emergency decompression of common duct via ERCP
Eventual cholecystectomy

78
Q

Causes of acute pancreatitis (2)

A

Alcohol, gallstones

79
Q

What is pancreatic rest

A

Tx for pancreatitis which includes

NPO, NG suction, IV fluids

80
Q 
Epigastric midabdominal pain radiating to back
nausea, vomiting, retching
elevated amylase, lipase
elevated hematocrit
Tx?
A

Acute edematous pancreatitis

Tx is pancreatic rest

81
Q 
Epigastric midabdominal pain radiating to back
nausea, vomiting, retching
elevated amylase, lipase
decreased hematocrit
Tx?
A

Acute hemorrhagic pancreatitis
Tx is ICU admission, drainage of pancreatic abscesses, daily CT scans

Poor prognosis

82
Q 
Elevated WBC count
Elevated blood glucose
Low serum calcium
Low, decreasing hematocrit
Increased BUN
Decreased PO2
A

Ranson’s criteria for pancreatitis

83
Q

Tx for necrotic pancreas

How long do you wait

A

Necrosectomy

Wait 4 weeks before debridement

84
Q

Signs of suppurative pancreatitis

When does it become evident

A

Persistent fever, leukocytosis
10 days after pancreatitis begins
Abscess on CT

85
Q

Etiology of pancreatic pseudocyst

Where does pancreatic juice collect?

A

5 weeks after acute pancreatitis or pancreatic trauma

Juice collects in lesser sac

86
Q

What are options for drainage of >6cm pseudocyst

A

Percutaneous
Surgically into GI tract
Endoscopically into the stomach

87
Q

Symptoms of chronic pancreatitis

A

Calcified pancreas, steatorrhea, diabetes, constant epigastric pain

88
Q

Tx of chronic pancreatitis

A

Insulin- diabetes
Pancreatic enzymes- steatorrhea
Pain- unresponsive to most therapies
ERCP and stenting if pancreatic duct is obstructed

89
Q

Which hernias do not require surgery

A

Umbilical hernias in ages 2 to 5

Sliding hiatal hernias (not true hernias)

90
Q

Gold standard for breast cancer diagnosis

A

Mammographically or sonographically guided multiple core biopsies

Need tissue to diagnose breast ca

91
Q

Young woman
mobile, firm, rubbery breast mass
Dx, Tx?

A

Fibroadenoma
FNA or sonogram
Removal optional

92
Q

Rapidly growing breast tumor in very young adolescents

A

Giant juvenile fibroadenomas

93
Q

Late 20’s
Grow to be very large over years distorting breast
Dont invade or become fixed
Benign but can become malignant

A

Cystosarcoma phyllodes

Core or incisional biopsy is necessary

94
Q

30’s-40’s
Bilateral breast tenderness related to menstrual cycle
Multiple lumps that come and go

A

Fibrocystic disease (mammary dysplasia)

95
Q

If cystic mass is drained in suspected fibrocystic disease what is next step if
Clear fluid, cyst goes away
Cyst persists
Blood is aspirated

A

Goes away- nothing
Persists- biopsy
Blood- sent for cytology

96
Q

20’s-40’s
Bloody nipple discharge
Dx? Tx?

A

Intraductal papilloma
Galactogram
Surgical resection

97
Q

Tx for breast abscess

A

I&D, biopsy of abscess wall

Cancer until proven otherwise

98
Q

Approach to breast cancer during pregnancy

A

Same if non-pregnant except
no radiotherapy
no chemotherapy during first trimester

99
Q

Tx of resectable breast cancer

A

lumpectomy, axillary sampling, plus radiation
or
modified radical mastectomy with axillary sampling

100
Q

Tx after breast surgery with positive nodes

A

Chemotherapy
Hormonal therapy
(Premenopause- tamoxifen, post- anastrozole)

101
Q

Headache, tender back pain
hx breast cancer
Dx?

A

Metastases

MRI

102
Q

Work-up for thyroid nodules

If benign? If malignant?

A

FNA
benign- follow
malignant- thyroid lobectomy

103
Q

Which thyroid cancer requires total thyroidectomy

Why?

A

Follicular cancers

So radioactive iodine can be used for mets

104
Q

Thyroid nodule in hyperthyroidism

What test? Tx?

A

Nuclear scan
if hot adenoma- surgical excision
if nothing found- radioactive iodine

105
Q

Workup for suspected hyperparathyroidism

A

repeat Ca2+, look for low phos, r/o cancer with bone mets
check PTH
sestamibi scan may locate culprit gland

106
Q

Tx for hyperparathyroidism

A

Surgical excision of culprit gland

107
Q

Workup for Cushing’s disease

A

Overnight low-dose dexamethasone suppression test
If no suppression- 24 hour urine cortisol
If elevated- high-dose dexamethasone suppression test
If suppressed- pituitary adenoma
If unsuppressed- adrenal adenoma

108
Q

Extensive peptic ulcers
resistant to usual therapies
watery diarrhea
dx? tx?

A 
Zollinger-Ellison (gastrinoma)
measure gastrin, secretin
CT scan to locate tumor
Surgical resection of tumor
Omeprazole for symptoms if mets present
109
Q

Dx and Tx of insulinoma

A

Measure insulin, c-peptide (both high)

CT to locate tumor and then resection

110
Q

Hypersecretion of insulin in the newborn requiring 95% pancreatectomy

A

Nesidioblastosis

111
Q

Severe migratory necrolytic dermatitis
mild diabetes
anemia, glossitis, stomatitis
Dx, Tx?

A

Glucagonoma
CT to locate and then resection
If mets- somatostatin and streptozocin

112
Q

Hypertension
hypokalemia, not taking diuretics
modest hypernatremia, metabolic alkalosis
low renin

A

Primary hyperaldosteronism

113
Q

How to differentiate adrenal hyperplasia versus adenoma in hyperaldosteronism

A

Hyperplasia- responds appropriately to postural changes (more aldosterone when upright)
Adenoma- inappropriate or lack of response

114
Q

Tx of primary hyperaldosteronism

A

Hyperplasia- medical treatment

Adenoma- CT and the resection

115
Q

Dx of pheochromocytoma

A

24 hour urinary VMA, metanephrines, or free catecholamines

CT scan for adrenals, radionuclide for extra-adrenal sites

116
Q

Tx of pheochromocytoma

A

Resection after careful preparation with alpha and beta blockers

117
Q

What is seen on CXR in coarctation of the aorta

A

Scalloping of the ribs

Erosion of ribs from collateral intercostals

118
Q

Dx and Tx of coarctation of the aorta

A

CT angiogram

Surgical correction

119
Q

Medication resistant hypertension
Faint bruit over flank
Dx, Tx?

A

Renovascular hypertension
Duplex scanning of renal vessels, CT angiogram
Balloon dilatation and stenting of renal arteries

120
Q

Most common etiology of renovascular hypertension for men, women

A

Men- atherosclerotic disease

Women- fibromuscular dysplasia

121
Q

Medical Tx for portal vein hypertension

A

Octreotide (somatostatin analogue)

Or vasopressin but contra in elderly and CAD

122
Q

Common historical component in hepatic adenoma

A

Oral contraceptive use

Surgery (17 decks)

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