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ABSITE Flash Cards > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Tissue based hernia repair: Name

A

McVay Repair

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2
Q

What kinds of hernias can you repair with the McVay technique?

A

indirect
direct
femoral

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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

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4
Q

which anti-nausea medication will increase the risk of post-op delirium

A

Promethazine

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5
Q

thickness of a split-thickness skin graft?

A

0.010 - 0.014 inches in depth

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6
Q

initial treatment for H. Pylori infection

A
  • PPI
  • amoxicillin
  • clarithromycin
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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

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8
Q

at what intra-abdominal pressure should a patient have a decompressive laparotomy?

A

> 25 mmHg

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9
Q

Standard antibiotic regimen for nec fasc

A

Vancomycin
Clindamycin
Piperacillin-tazobactam

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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
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11
Q

first line therapy for suspected giant cell arteritis

A

high dose corticosteroids

  • 40-60 mg daily to start
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12
Q

48 yr old female with 2 day history of transient vision loss, headache, and jaw claudication…leading diagnosis

A

giant cell arteritis

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13
Q

grade 1 cholecystitis per Tokyo guidelines

A
  • acute cholecystitis
  • no organ dysfunction
  • limited biliary disease e.g. low risk for surgery
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14
Q

grade 2 cholecystitis per Tokyo guidlines

A
  • acute cholecystitis
  • no organ dysfunction
  • extensive biliary disease increasing surgical risk
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15
Q

grade 3 cholecystitis per Tokyo guidelines

A
  • acute cholecystitis with organ dysfunction
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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)
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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
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18
Q

Antibiotic treatment for dog bite if allergic to penicillin

A
  • levofloxacin + metronidazole
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19
Q

what two things must you use to treat bites

A
  • tetanus
  • Abx coverage (augmentin typically)
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20
Q

most common complication following hysterectomy

A

bladder injury

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21
Q

24 hour fecal fat > 20 g in the setting of malnutrition

A

points to pancreatic insufficiency

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22
Q

24 hour fecal fat < 20g in the setting of malnutrition

A

points to intestinal etiology

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23
Q

empiric treatment for C. Diff

A

PO Vancomycin

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24
Q

patient with peptic ulcer disease, diarrhea, and abdominal pain…

A

Zollinger-Ellison syndrome, hyper gastrin secretion

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25
Q

what causes surgical site infections when related to skin flora

A

gram positive cocci

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26
Q

how long should your alimentary limb be during a roux-en-y

before your asoprtive limb

A

40 cm

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27
Q

what is the roux limb in a roux-en-y

A

alimentary limb

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28
Q

how much spleen do you need left over to safely perform an elective partial splenectomy?

A

one third needs to remain

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29
Q

man found to have erythema, crepitus, and blistering around a dog bite, what should be done and why

A

aggressive operative debridement, he has necrotizing soft tissue infection

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30
Q

best imaging modality to assess gastrointestinal leak

A

Water soluble upper GI series

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31
Q

during lap cholecystectomy you perform IOC and see a common bile duct stone, what can you do to help flush the stone

A
  • give IV glucagon to relax the sphincter of Oddi to help flush the stone
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32
Q

Adduct

A

limb moves toward midine

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33
Q

Abduct

A

limb moves away from midline

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34
Q

risk of post-ERCP pancreatitis

A

5%

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35
Q

antibiotic of choice for bacterial overgrowth of the small intestine?

A

14 day course of rifaximin

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36
Q

mechanism of action of rifaximin

A

inhibitor of DNA-dependent RNA polymerase

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37
Q

what organisms are you immunizing against before a splenectomy

A
  • pneumococcus
  • meningococcus
  • haemophilus influenza B
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38
Q

when possible on which side of the finger should you make you incision for an abscess?

A
  • thumb and fifth digit on the radial side
  • 2nd-4th digit on the ulnar side
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39
Q

what is the pulp of a finger?

A

the finger pad

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40
Q

When a patient has a pacemaker, what kind of pacing should it be set to for surgery to minimize interference with electro-cautery?

A
  • 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

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41
Q

what should all women who have had an ectopic pregnancy get tested for?

A

Rh type screening, with anti-D immunoglobulin given to Rh negative women within 72 hours of suspected breach

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42
Q

most common type of hernia in both men and women

A

indirect inguinal hernia

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43
Q

what kind of physiologic impairment prevents you from using Methotrexate to abort an ectopic pregnancy?

A

renal insufficiency

  • unable to clear MTX
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44
Q

at what level of pre-albumin is the patient considered to be in poor nutritional status

A

< 15 mg/dL

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45
Q

at what level of transferrin is a patient considered to be in a potential state of poor nutritional status

A

< 200 mg/dL

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46
Q

female with bilateral milky discharge from her breast, what blood tests do you order?

A

HCG
prolactin
TSH

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47
Q

boundaries of ostomy triangle

A
  • anterior superior iliac spine
  • pubic tubercle
  • umbilicus
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48
Q

where should you place an ostomy on an obese patient

A

above the umbilicus

49
Q

Fitz-Hugh-Curtis syndrome

A

migration of bacteria to peritoneum from PID, resulting in adhesions between liver and peritoneal lining

50
Q

treatment for non-severe C. Diff (think outpatient treatment)

A
  • 125 mg 4 times a day of Vancomycin
    OR
  • 200 mg Twice a day of Fidaxomicin if failed 1st line treatment
51
Q

what is the physiologic cut off for nephrectomy

A

if kidney has < 15% of function then nephrectomy should be considered

52
Q

which patients should get a prophylactic cholecystectomy

A

patients with the following:
- sickle cell anemia
- porcelain gall bladder
- stone > 2.5 cm
- polyp > 1 cm

53
Q

most common complication for a cholecystostomy tube

A

bile leak

54
Q

what percentage of patients have left over prescribed narcotics after surgery

A

72%

55
Q

what defines the medial border of the axilla

A

long thoracic nerve

56
Q

what defines the lateral border of the axilla

A

thoracodorsal nerve

57
Q

what does the long thoracic nerve innervate

A

serrates anterior muscle

58
Q

patient with winged scapula, what was injured

A

long thoracic nerve, which innervates the serrates anterior

59
Q

what does the thoracodorsal nerve innervate

A

latissimus dorsi

60
Q

benefit of posterior component separation vs anterior component separation for ventral hernia

A

reduced wound complications for posterior approach

61
Q

how many patients can expect improvement in symptoms after a cholecystectomy if they have functional gall bladder disorder?

A

75%

62
Q

what pre-op antibiotics should you give for uterine procedures?

A

Cefazolin (ancef) and Azithromycin

63
Q

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?

A

ovarian torsion

64
Q

what differentiates a Fowler-Stephens orchiopexy from a Dartos?

A

FS orchiopexy requires division of the testicular vessels as they don’t reach to the scrotum

65
Q

what is the Homan sign?

A

palpable cord with warmth and erythema

sign of a DVT

66
Q

HIV positive patient presents with a positive screening for anal dysplasia, next step

A

refer to center with high resolution anoscopy for formal biopsy

67
Q

what home treatment can be given for an anal condylomatous lesion found on exam?

A

Podofilox

68
Q

Where is a Grynfeltt hernia located

A

between the following:
- 12th rib
- paraspinal muscles
- internal oblique

69
Q

what hernia is located between the 12th rib, para-spinal muscles, and the internal oblique muscle

A

Grynfeltt hernia

70
Q

where is a lumbar hernia of Petit located

A

between the following structures:
- latissimus dorsi
- iliac crest
- external oblique

71
Q

what hernia is located between the external oblique, latissimus dorsi, and the iliac crest

A

lumbar hernia of Petit

72
Q

Where is the space of Retzius

A

Posterior to pubic symphysis and anterior to bladder

73
Q

Where is morison’s pouch

A

Space between the liver and right kidney

74
Q

What is the Foramen of Winslow

A

Communication between the greater sac and lesser sac

75
Q

Anatomically, where is the foramen of Winslow

A

To the right of the hepatoduodenal ligament

76
Q

rate of gallstone pancreatitis recurrence if no cholecystectomy is done after 1st episode

A

25% in 3 months

77
Q

what is the first step for suspected urinary retention from a blood clot

A

large foley with manual bladder irrigation

78
Q

what study would you use on a obese patient you suspect has a hernia, but cannot be visualized or palpated on exam?

A

Ultrasound of the abdominal wall

79
Q

what is the colonic diameter threshold for operative intervention when dealing with C. Diff colitis

A

> 12 cm for cecum
6 cm for rest of colon

80
Q

Littre hernia

A

hernia with a Meckel’s diverticulum through the sac

81
Q

treatment for patient with PD catheter that has presented with intra-peritoneal infection and sepsis

A

intra-peritoneal gentamicin and ceftriaxone

82
Q

Most common fistula in gallstone ileus

A

gall bladder to duodenum

83
Q

Condylomata Acuminata appearance

A

pale, cauliflower like lesions running in radial pattern around anus

84
Q

What is condylomata acuminata associated with

A

HPV

human papillomavirus

85
Q

Condylomata lata appearance

A

pale, smooth, and flat

86
Q

What is condylomata lata associated with

A

Syphilis

87
Q

What area of the aortic valve would warrant pre-operative evaluation by a cardiologist?

A

if Aortic valve area is less than 1.0 cm squared…this represents severe aortic stenosis

88
Q

what test do you perform for suspected B12 deficiency

A

check Methylmalonic acid levels

89
Q

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)

A

black widow spider

90
Q

treatment for black widow spider bite

A
  • opioids for pain
  • benzodiazepines for muscle spasms
91
Q

what is composes the medial wall of the femoral canal

A

lacunar ligament

92
Q

what is the Mnemonic for the borders of the femoral canal

A

SLIP

Septa of the femoral vein (lateral)
Lacunar ligament (medial)
Inguinal ligament (anterior)
Pectineus ligament (flush on the pubic bone, posterior)

93
Q

lateral wall of the femoral canal

A

septa of the femoral vein

94
Q

anterior wall of the femoral canal

A

inguinal ligament

95
Q

posterior wall of the femoral canal

A

pectineus ligament (on pubic bone)

96
Q

if you could only use one antibiotic to treat the most common bacteria for an intra-abdominal infection, which would it be?

A

ertapenem

97
Q

What tissue layer is incised during an anterior component separation?

A

external oblique 2 cm lateral to semilunar line

98
Q

which uterotonic agent is contraindicated in women diagnosed with preeclampsia

A

Methergine

  • smooth muscle contractor used to provide tone to uterus to avoid blood loss during C-section…but can cause vasoconstriction
99
Q

how long do you hold Warfarin for prior to surgery

A

5 days

100
Q

Which gastroenterotomy type is most commonly associated with blind loop syndrome

A

antecolic billroth II

101
Q

Characteristics of Visceral Pain

A
  • dull localization
  • deep aching
  • no positional component
  • often there is “referred” pain to superficial structures
102
Q

rapidly spreading rash that is erythematous, warm, with a well demarcated raised border…what is this?

A

Erysipelas

103
Q

What typically causes Erysipelas

A

group A streptococcus

104
Q

Simple in office adjunct to the physical exam you can perform to confirm the presence of a ventral hernia

A

POC ultrasound

105
Q

hypocalcemia presents how on EKG

A

prolonged QT interval

106
Q

You see a round anehoic structure on ultrasound, what is that consistent with?

A

Cyst

107
Q

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?

A

Surprisingly, 70% or more

108
Q

After a CCK-stimulated cholescintigraphy, what gall bladder ejection fraction is considered abnormal

A

less than 35-40%

109
Q

risk of UTI for indwelling foley catheter

A

3-10% per day it is in

110
Q

risk of death in medical management versus surgical management of acute umbilical hernia rupture in cirrhotics with ascites?

A

medical - 60-80% mortality
surgical - 6-20% mortality

111
Q

Littre’s hernia

A

hernia sac containing a Meckel’s diverticulum

112
Q

Stercoral colitis

A

Chronic constipation leading to fecal Impaction which can cause perforation

113
Q

what does a whorled appearance for the vascular pedicle of the spleen suggest anatomically, and what diagnosis can it suggest

A

long splenic pedicle

  • Wandering spleen
114
Q

Methegrine

A

smooth muscle constrictor that acts mostly on the uterus

115
Q

in who should you NOT use methegrine

A

in women with hypertension and preeclampsia as it can cause vasoconstriction and worsen the above

116
Q

Amyand hernia

A

hernia that contains the appendix

117
Q

number of bacterial cells needed to say a wound is infected

A

10^5 (100,000)

118
Q

femoral triangle boundaries

A

adductor longus (medial)
sartorius (lateral)
inguinal ligament (superior)

119
Q

risk of venous thromboembolism in patients getting general abdominal surgery with no other risks

A

1.5%

  • only need SCDs

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