General Surgery Flashcards
1
Q
Tissue based hernia repair: Name
A
McVay Repair
2
Q
What kinds of hernias can you repair with the McVay technique?
A
indirect
direct
femoral
3
Q
patient with previous Billroth II, presents with abdominal pain, distention, excessive flatulance, and macrocytic anemia. Whats going on?
A
blind loop syndrome with excessive bacterial overgrowth
4
Q
which anti-nausea medication will increase the risk of post-op delirium
A
Promethazine
5
Q
thickness of a split-thickness skin graft?
A
0.010 - 0.014 inches in depth
6
Q
initial treatment for H. Pylori infection
A
- PPI
- amoxicillin
- clarithromycin
7
Q
how long should patient be on liquid diet after nissen fundoplication?
A
1-2 weeks, if dysphagia persists beyond that then you should investigate
8
Q
at what intra-abdominal pressure should a patient have a decompressive laparotomy?
A
> 25 mmHg
9
Q
Standard antibiotic regimen for nec fasc
A
Vancomycin
Clindamycin
Piperacillin-tazobactam
10
Q
when can you not use methotrexate in an ectopic pregnancy
A
- hemodynamic instability
- fluid in abdomen
- B-HCG > 5000 u
- mass > 4 cm
11
Q
first line therapy for suspected giant cell arteritis
A
high dose corticosteroids
- 40-60 mg daily to start
12
Q
48 yr old female with 2 day history of transient vision loss, headache, and jaw claudication…leading diagnosis
A
giant cell arteritis
13
Q
grade 1 cholecystitis per Tokyo guidelines
A
- acute cholecystitis
- no organ dysfunction
- limited biliary disease e.g. low risk for surgery
14
Q
grade 2 cholecystitis per Tokyo guidlines
A
- acute cholecystitis
- no organ dysfunction
- extensive biliary disease increasing surgical risk
15
Q
grade 3 cholecystitis per Tokyo guidelines
A
- acute cholecystitis with organ dysfunction
16
Q
How do you diagnose cholecystitis per Tokyo guidelines
A
- one local sign of inflammation (murphy sign, mass/pain/tenderness in RUQ)
PLUS
- systemic sign of inflammation (fever, elevated WBC, elevated CRP)
17
Q
what typically characterizes grade 2 acute cholecystitis
A
- elevated WBC
- palpable tender mass in RUQ
- disease duration greater than 72 hours
- imaging showing extensive gall bladder disease
18
Q
Antibiotic treatment for dog bite if allergic to penicillin
A
- levofloxacin + metronidazole
19
Q
what two things must you use to treat bites
A
- tetanus
- Abx coverage (augmentin typically)
20
Q
most common complication following hysterectomy
A
bladder injury
21
Q
24 hour fecal fat > 20 g in the setting of malnutrition
A
points to pancreatic insufficiency
22
Q
24 hour fecal fat < 20g in the setting of malnutrition
A
points to intestinal etiology
23
Q
empiric treatment for C. Diff
A
PO Vancomycin
24
Q
patient with peptic ulcer disease, diarrhea, and abdominal pain…
A
Zollinger-Ellison syndrome, hyper gastrin secretion
25
what causes surgical site infections when related to skin flora
gram positive cocci
26
how long should your alimentary limb be during a roux-en-y
| before your asoprtive limb
40 cm
27
what is the roux limb in a roux-en-y
alimentary limb
28
how much spleen do you need left over to safely perform an elective partial splenectomy?
one third needs to remain
29
man found to have erythema, crepitus, and blistering around a dog bite, what should be done and why
aggressive operative debridement, he has necrotizing soft tissue infection
30
best imaging modality to assess gastrointestinal leak
Water soluble upper GI series
31
during lap cholecystectomy you perform IOC and see a common bile duct stone, what can you do to help flush the stone
- give IV glucagon to relax the sphincter of Oddi to help flush the stone
32
Adduct
limb moves toward midine
33
Abduct
limb moves away from midline
34
risk of post-ERCP pancreatitis
5%
35
antibiotic of choice for bacterial overgrowth of the small intestine?
14 day course of rifaximin
36
mechanism of action of rifaximin
inhibitor of DNA-dependent RNA polymerase
37
what organisms are you immunizing against before a splenectomy
- pneumococcus
- meningococcus
- haemophilus influenza B
38
when possible on which side of the finger should you make you incision for an abscess?
- thumb and fifth digit on the radial side
- 2nd-4th digit on the ulnar side
39
what is the pulp of a finger?
the finger pad
40
When a patient has a pacemaker, what kind of pacing should it be set to for surgery to minimize interference with electro-cautery?
- an asynchronous setting (marked by OO in documentation)
- put a magnet over it
reasoning is that sensing of the electrical activity of the heart by the pace maker is hampered by the electrical signals from electrocautery
41
what should all women who have had an ectopic pregnancy get tested for?
Rh type screening, with anti-D immunoglobulin given to Rh negative women within 72 hours of suspected breach
42
most common type of hernia in both men and women
indirect inguinal hernia
43
what kind of physiologic impairment prevents you from using Methotrexate to abort an ectopic pregnancy?
renal insufficiency
- unable to clear MTX
44
at what level of pre-albumin is the patient considered to be in poor nutritional status
< 15 mg/dL
45
at what level of transferrin is a patient considered to be in a potential state of poor nutritional status
< 200 mg/dL
46
female with bilateral milky discharge from her breast, what blood tests do you order?
HCG
prolactin
TSH
47
boundaries of ostomy triangle
- anterior superior iliac spine
- pubic tubercle
- umbilicus
48
where should you place an ostomy on an obese patient
above the umbilicus
49
Fitz-Hugh-Curtis syndrome
migration of bacteria to peritoneum from PID, resulting in adhesions between liver and peritoneal lining
50
treatment for non-severe C. Diff (think outpatient treatment)
- 125 mg 4 times a day of Vancomycin
OR
- 200 mg Twice a day of Fidaxomicin if failed 1st line treatment
51
what is the physiologic cut off for nephrectomy
if kidney has < 15% of function then nephrectomy should be considered
52
which patients should get a prophylactic cholecystectomy
patients with the following:
- sickle cell anemia
- porcelain gall bladder
- stone > 2.5 cm
- polyp > 1 cm
53
most common complication for a cholecystostomy tube
bile leak
54
what percentage of patients have left over prescribed narcotics after surgery
72%
55
what defines the medial border of the axilla
long thoracic nerve
56
what defines the lateral border of the axilla
thoracodorsal nerve
57
what does the long thoracic nerve innervate
serrates anterior muscle
58
patient with winged scapula, what was injured
long thoracic nerve, which innervates the serrates anterior
59
what does the thoracodorsal nerve innervate
latissimus dorsi
60
benefit of posterior component separation vs anterior component separation for ventral hernia
reduced wound complications for posterior approach
61
how many patients can expect improvement in symptoms after a cholecystectomy if they have functional gall bladder disorder?
75%
62
what pre-op antibiotics should you give for uterine procedures?
Cefazolin (ancef) and Azithromycin
63
30 year old female 3 whose LMP was 3 weeks ago presents with acute onset pain in lower abdomen, vaginal bleeding, and 6 cm complex adnexal mass. what does she likely have?
ovarian torsion
64
what differentiates a Fowler-Stephens orchiopexy from a Dartos?
FS orchiopexy requires division of the testicular vessels as they don't reach to the scrotum
65
what is the Homan sign?
palpable cord with warmth and erythema
sign of a DVT
66
HIV positive patient presents with a positive screening for anal dysplasia, next step
refer to center with high resolution anoscopy for formal biopsy
67
what home treatment can be given for an anal condylomatous lesion found on exam?
Podofilox
68
Where is a Grynfeltt hernia located
between the following:
- 12th rib
- paraspinal muscles
- internal oblique
69
what hernia is located between the 12th rib, para-spinal muscles, and the internal oblique muscle
Grynfeltt hernia
70
where is a lumbar hernia of Petit located
between the following structures:
- latissimus dorsi
- iliac crest
- external oblique
71
what hernia is located between the external oblique, latissimus dorsi, and the iliac crest
lumbar hernia of Petit
72
Where is the space of Retzius
Posterior to pubic symphysis and anterior to bladder
73
Where is morison’s pouch
Space between the liver and right kidney
74
What is the Foramen of Winslow
Communication between the greater sac and lesser sac
75
Anatomically, where is the foramen of Winslow
To the right of the hepatoduodenal ligament
76
rate of gallstone pancreatitis recurrence if no cholecystectomy is done after 1st episode
25% in 3 months
77
what is the first step for suspected urinary retention from a blood clot
large foley with manual bladder irrigation
78
what study would you use on a obese patient you suspect has a hernia, but cannot be visualized or palpated on exam?
Ultrasound of the abdominal wall
79
what is the colonic diameter threshold for operative intervention when dealing with C. Diff colitis
> 12 cm for cecum
> 6 cm for rest of colon
80
Littre hernia
hernia with a Meckel’s diverticulum through the sac
81
treatment for patient with PD catheter that has presented with intra-peritoneal infection and sepsis
intra-peritoneal gentamicin and ceftriaxone
82
Most common fistula in gallstone ileus
gall bladder to duodenum
83
Condylomata Acuminata appearance
pale, cauliflower like lesions running in radial pattern around anus
84
What is condylomata acuminata associated with
HPV
human papillomavirus
85
Condylomata lata appearance
pale, smooth, and flat
86
What is condylomata lata associated with
Syphilis
87
What area of the aortic valve would warrant pre-operative evaluation by a cardiologist?
if Aortic valve area is less than 1.0 cm squared...this represents severe aortic stenosis
88
what test do you perform for suspected B12 deficiency
check Methylmalonic acid levels
89
what kind of insect gives the following kind of bite
- annular erythema
- central clearing
- "target lesion"
- muscle cramps (can include abdominal muscles and mimic rigid abdomen)
black widow spider
90
treatment for black widow spider bite
- opioids for pain
- benzodiazepines for muscle spasms
91
what is composes the medial wall of the femoral canal
lacunar ligament
92
what is the Mnemonic for the borders of the femoral canal
SLIP
Septa of the femoral vein (lateral)
Lacunar ligament (medial)
Inguinal ligament (anterior)
Pectineus ligament (flush on the pubic bone, posterior)
93
lateral wall of the femoral canal
septa of the femoral vein
94
anterior wall of the femoral canal
inguinal ligament
95
posterior wall of the femoral canal
pectineus ligament (on pubic bone)
96
if you could only use one antibiotic to treat the most common bacteria for an intra-abdominal infection, which would it be?
ertapenem
97
What tissue layer is incised during an anterior component separation?
external oblique 2 cm lateral to semilunar line
98
which uterotonic agent is contraindicated in women diagnosed with preeclampsia
Methergine
- smooth muscle contractor used to provide tone to uterus to avoid blood loss during C-section...but can cause vasoconstriction
99
how long do you hold Warfarin for prior to surgery
5 days
100
Which gastroenterotomy type is most commonly associated with blind loop syndrome
antecolic billroth II
101
Characteristics of Visceral Pain
- dull localization
- deep aching
- no positional component
- often there is "referred" pain to superficial structures
102
rapidly spreading rash that is erythematous, warm, with a well demarcated raised border...what is this?
Erysipelas
103
What typically causes Erysipelas
group A streptococcus
104
Simple in office adjunct to the physical exam you can perform to confirm the presence of a ventral hernia
POC ultrasound
105
hypocalcemia presents how on EKG
prolonged QT interval
106
You see a round anehoic structure on ultrasound, what is that consistent with?
Cyst
107
Patient with biliary colic, gall bladder is intact, no stones on imaging, and normal gall bladder ejection fraction…what percentage of patients will have improvement in their symptoms with cholecystectomy?
Surprisingly, 70% or more
108
After a CCK-stimulated cholescintigraphy, what gall bladder ejection fraction is considered abnormal
less than 35-40%
109
risk of UTI for indwelling foley catheter
3-10% per day it is in
110
risk of death in medical management versus surgical management of acute umbilical hernia rupture in cirrhotics with ascites?
medical - 60-80% mortality
surgical - 6-20% mortality
111
Littre's hernia
hernia sac containing a Meckel's diverticulum
112
Stercoral colitis
Chronic constipation leading to fecal Impaction which can cause perforation
113
what does a whorled appearance for the vascular pedicle of the spleen suggest anatomically, and what diagnosis can it suggest
long splenic pedicle
- Wandering spleen
114
Methegrine
smooth muscle constrictor that acts mostly on the uterus
115
in who should you NOT use methegrine
in women with hypertension and preeclampsia as it can cause vasoconstriction and worsen the above
116
Amyand hernia
hernia that contains the appendix
117
number of bacterial cells needed to say a wound is infected
10^5 (100,000)
118
femoral triangle boundaries
adductor longus (medial)
sartorius (lateral)
inguinal ligament (superior)
119
risk of venous thromboembolism in patients getting general abdominal surgery with no other risks
1.5%
- only need SCDs
