General Surgery Flashcards
What is the most common type of colorectal cancer?
Adenocarcinoma
What is a lab finding that may suggest colorectal cancer?
Iron deficiency anemia
What tumor marker is used in determining the prognosis of patients with colorectal cancer?
Carcinoembryonic antigen
Left-sided colonic ischemia may follow what procedure?
Abdominal aortic aneurysm repair
What is the treatment for ischemic colitis?
Most cases resolve with supportive care
What symptoms make up Charcot’s triad?
Abdominal pain (RUQ)
Jaundice
Fever
Charcot’s triad is commonly seen in what problem?
Acute cholangitis
What symptoms are added to Charcot’s triad to become Reynolds pentad?
Hypotension
Confusion
(Severe cholangitis)
What is the management for acute cholangitis?
Broad-spectrum abx (zoysn)
Biliary drainage (ERCP)
What size abdominal aortic aneurysm should have repeat imaging every year versus every 6 months?
Annual: 4 - 4.9cm
Every 6 months: 5 - 5.4cm
What size abdominal aortic aneurysm would be considered for surgery?
> 5.5cm
What does the USPSTF recommend for screening for AAA?
One-time ultrasound in men 65-75 who have ever smoked
What symptom is more commonly associated with a right-sided origin of colorectal cancer?
Melena
What procedure is both diagnostic and therapeutic for choledocholithiasis (gallstones in the common bile duct)?
ERCP
What is is used to prevent gallstone formation in patients with rapid weight loss?
Ursodeoxycholic acid
What is the treatment for cholelithiasis (gallstones)?
Observation (if asymptomatic)
Cholecystectomy
Where do internal hemorrhoids arise from?
Above the dentate line from the superior hemorrhoidal cushion
Where do external hemorrhoids arise from?
Below the dentate line and the internal hemorrhoidal plexus
What dermatologic manifestations are seen in Crohn’s and ulcerative colitis?
Crohn’s: erythema nodosum
UC: pyoderma gangrenosum
What is the treatment for ulcerative colitis?
Mild-moderate: mesalamine, topical or oral steroids, 5-ASA
Severe: IV steroids +/- topical steroids initially, then anti-TNF or anti-integrin
Colectomy for refractory cases (curative)
What are the 2 most common reasons for preoperative dialysis?
Volume overload
Hyperkalemia > 6.5
What is the classic triad of symptoms in pheochromocytoma?
Episodic headaches
Sweating
Tachycardia
What are the 4 subtypes of breast cancer?
Luminal A
Luminal B
HER2 positive
Triple negative (basal)
Of the 4 subtypes of breast cancer, which has the worst prognosis?
Triple negative
What is the most common lesion of the breast?
Fibrocystic changes
What are the signs/symptoms of fibrocystic breast changes?
Intermittent breast pain and tenderness that peak before each menstruation
What are the signs/symptoms of a posterior cerebral artery ischemic stroke?
LOC
Nausea or vomiting
CN dysfunction
Ataxia
Visual agnosia (homonymous hemianopia)
What is the gold standard for diagnosing cholecystitis?
Cholescintigraphy (HIDA scan)
*ultrasound is typically done first, but is not the gold standard
What is the ratio of pleural and serum protein in a transudative vs exudative cause of a pleural effusion?
Transudate: <0.5
Exudate: >0.5
If you have a ratio of pleural protein to serum protein that is < 0.5, what is most likely the cause of the effusion?
Heart failure
If you have a ratio of pleural protein to serum protein that is > 0.5, what is the most likely cause of the effusion?
Malignancy or bacterial/viral pneumonia
When performing an excisional biopsy of melanoma, what margin of unaffected skin should also be included in the biopsy?
2mm
What are the risk factors for esophageal adenocarcinoma?
Male
Chronic GERD (Barrett’s)
Tobacco/alcohol use
HPV infection
What serum marker is most useful in monitoring pancreatic cancer?
CA 19-9
What medication is used as primary prophylaxis for the prevention of variceal hemorrhage?
Non-selective beta blockers (propranolol)
What are the categories of a thyroid scintigraphy?
Warm: normal thyroid
Cold: low or non-functional thyroid tissue
Hot: take up more of the radioactive isotope and autonomously function
What protein measurement best assesses short-term nutritional status?
Prealbumin
What is the preferred form of vascular access in patients requiring long-term hemodialysis?
Upper extremity arteriovenous fistulas (AVFs)
How is a diagnosis of Hodgkin lymphoma made?
Lymph node biopsy showing Reed-Sternberg cells (owl’s eyes)
What diabetic medication should be held 24 hrs prior to surgery?
Metformin
What ankle-brachial index (ABI) indicates > 50% stenosis in a patient with PAD?
< 0.9
What are the signs/symptoms of Wernicke syndrome?
Encephalopathy (disoriented)
Ocular motor dysfunction (nystagmus)
Ataxia
What is the treatment for Wernicke’s syndrome?
Aggressive thiamine (B1) repletion
Replace thiamine BEFORE glucose
What is the most appropriate IV fluid for a preoperative patient who is NPO?
Lactated ringer
What is the difference between central and nephrogenic diabetes insipidus?
Central: decreased secretion of antidiuretic hormone (ADH)
Nephro: decreased sensitivity to ADH in the kidneys, leading to decreased urine concentration
What hormones are produced in the anterior pituitary gland?
FSH
LH
Adrenocorticotropic hormone
TSH
Prolactin
Growth hormone
What is recommended for patients undergoing colorectal surgery as prophylaxis for DVT or PE?
Intermittent pneumatic compression (SCDs) and low-molecular-weight heparin
What is the most common benign cause of large bowel obstruction?
Volvulus
What is the most common location of a large bowel obstruction?
Sigmoid colon
Why is surgery reserved as a last option treatment for anal fissures?
Because of the risk of irreversible fecal incontinence
What is Virchow’s triad?
A triad of risk factors for DVT: hypercoagulability, endothelial injury, and venous stasis
What is the recommended initial treatment for sigmoid volvulus without signs of perforation or bowel ischemia?
Sigmoidoscopy
Which type of aortic dissection is a surgical emergency?
Stanford A which involves the ascending aorta
What is the most common childhood malignancy of the abdomen?
Wilms tumor
What is the initial imaging test of choice if a Wilms tumor is suspected?
Ultrasound
Should you perform a skin biopsy in a patient you suspect has cellulitis?
Only if the patient is immunocompromised or if an unusual organism is suspected
What is the best test for H. pylori if a patient is undergoing endoscopy, has no active bleeding, and has not had any recent PPI or antibiotic treatment?
Biopsy urease test
What is the best test for H. pylori if the patient has active bleeding or recent PPI or antibiotic use?
Stool antigen test or breath urease test
What is the most appropriate treatment in a patient who presents with a breast mass where the overlying skin shows no signs of pressure necrosis or ischemia?
Needle aspiration
How does a chronic subdural hematoma will appear on a noncontrast CT scan?
As a concave, crescent-shaped hypodensity
How does an acute subdural hematoma will appear on a noncontrast CT scan?
As a concave, crescent-shaped hyperdensity
What gland is responsible for the production of catecholamines?
Adrenal medulla
What is an indication for surgical treatment of primary hyperparathyroidism in an asymptomatic individual?
Kidney stones
Patients with a history of previous surgery, such as an open cholecystectomy, are more at risk for developing what?
Incisional hernia
Individuals with a known family history of familial adenomatous polyposis should begin screening with either colonoscopy or flexible sigmoidoscopy at what age?
10
What is needed to confirm the diagnosis of achalasia?
Esophageal manometry
What thyroid cancer is the most common type of thyroid cancer overall and is associated with head/neck radiation exposure?
Papillary
What thyroid cancer is associated with multiple endocrine neoplasia type 2 (medullary thyroid cancer, hyperparathyroidism, and pheochromocytoma)?
Medullary
What is the most common cause of bloody, unilateral nipple discharge?
Intraductal papilloma
When managing an unruptured AAA, what is indicated if the aneurysm is > 5.5 cm or if the patient is symptomatic?
Endovascular stent-graft placement
What reading(s) on peripheral smear are consistent with the diagnosis of DIC?
Increased fibrin degradation products and schistocytes
Kidney stones are most commonly composed of what?
Calcium oxalate
What is the first test of choice to evaluate patients (especially pregnant women and children) when presenting with a fever following an abdominal surgery?
Abdominal ultrasound
Where do perianal abscesses typically arise from?
The anal crypt gland
What is a Hamman crunch sign?
Mediastinal crackling with each heartbeat seen/heard on physical exam in a patient with Boerhaave Syndrome
What types of patients with diverticulitis should be treated inpatient?
Perforation
Abscess
Obstruction
Fistula
Sepsis
Immunosuppression
High fever
Leukocytosis
Diffuse peritonitis
> 70 years old
Severe comorbidities
What is the Chvostek sign?
Contraction of the ipsilateral face muscles elicited by tapping the facial nerve just anterior to the ear
Seen in pts with hypocalcemia
What initial lab should be drawn in patients with suspected hypothyroidism?
TSH
Where are femoral hernias found?
Protruding through femoral ring inferior to inguinal ligament
What is a “bird beak” sign of the sigmoid colon?
Gradual narrowing/tapering of the sigmoid colon up to the level of obstruction during contrast or barium insertion to the rectum or on CT scan
In patients with PUD, what locations of the ulcers are relieved and aggravated by ingesting food?
Duodenal: pain alleviated by ingesting food
Gastric: aggravated by ingesting food
What is a description of a lesion that would be associated with squamous cell carcinoma?
Irregular, erythematous plaque with a hemorrhagic crust on a sun-exposed area
What lesions are described as extremely painful with a deep, “punched out” appearance?
Arterial ulcers
What is the gold standard for determining whether a peripheral lung lesion is malignant or infectious?
open lung biopsy (surgical excision biopsy)
What is the preferred technique used to biopsy most breast lesions that are suspicious for malignancy?
Core-needle biopsy
What is considered the first-line diagnostic study for PE?
CT pulmonary angiography (CTPA)
What compartment pressure is consistent with compartment syndrome and would like require an immediate fasciotomy?
> 30mmHg
Which type of adenomatous polyps has the greatest risk of malignancy?
Villous
Which laboratory value is the most specific for pancreatitis?
Lipase
What is a common presentation for patients with chronic mesenteric ischemia?
Postprandial abd pain
Fear of eating
Weight loss
What type of bile duct stone is most likely to be found in the primary form of choledocholithiasis?
Pigmented
Patients who are symptomatic and have what % of occlusion should receive a CEA?
70-99%
If a patient is hemodynamically unstable and you suspect an aortic dissection, what is the preferred initial imaging to get?
TEE
A patient with PAD that experiences pain (intermittent claudication) in the thigh and buttock region likely has an occlusion of what artery?
Common iliac artery
What is the Howship-Romberg sign?
Most specific physical exam finding associated with obturator hernia
Positive when pain extends down the medial aspect of the thigh with movement of the knee
What is a rare type of hernia and is most common in older women between the ages of 70 and 90 years?
Obturator hernia
What is the tumor marker most often used to detect and monitor pancreatic carcinoma?
CA 19-9
What grading system is used to evaluate patients with prostate cancer?
Gleason
An apple core sign in the ascending colon and is indicative of what?
Colorectal carcinoma
What is the treatment of pulmonary embolism (PE) in hemodynamically stable patients who have failed or cannot tolerate anticoagulation?
Inferior vena cava filter
How does diverticulosis present?
Painless hematochezia
What are the signs/symptoms of idiopathic intracranial hypertension (pseudotumor cerebri)?
Female
Obese
Diffuse headache
Visual blurring
Peripheral vision loss
Bilateral papilledema
Elevated opening pressure on LP
What is the treatment for idiopathic intracranial hypertension (pseudotumor cerebri)?
Acetazolamide
Serial LPs
Weight loss
What is the gold standard for diagnosing diverticulitis?
CT scan w/contrast
What is a pancreatic pseudocyst?
An encapsulated, mature fluid collection occurring outside the pancreas that have a well-defined wall with minimal or no necrosis
What are the signs/symptoms of hypoparathyroidism?
Recent thyroid surgery
Extremity and perioral paresthesias, tetany, and lethargy
Labs will show low PTH, low calcium, high phosphorus
What are the five parameters of the Ranson criteria that are assessed at initial presentation of acute pancreatitis?
Age > 55
WBC > 16
Glucose > 200
LDH > 350
AST > 250
If you suspect a patient has a subarachnoid hemorrhage, but they have a negative CT scan, what is the next test you order and what would it show if it were positive for an SAH?
Lumbar puncture
Grossly bloody fluid in all four tubes or xanthochromia (CSF) indicates SAH
What is a calcium channel blocker that should be given to every patient with an aneurysmal subarachnoid hemorrhage within 4 days of symptom onset and continued for 21 days?
Nimodipine
What occurs in a patient with a type 1 sliding hiatal hernia?
The proximal stomach (known as the gastric cardia), herniates proximally through the diaphragm in the direction of the esophagus
What occurs in a patient with a type 2 paraesophageal hernia?
The superior-lateral aspect of the stomach (known as the gastric fundus) herniates through a defect in the phrenoesophageal membrane adjacent to the esophagus. This herniation does not displace the phrenoesophageal membrane, and the GE junction remains level with the diaphragm
What are some dietary risk factors for gastric carcinoma?
High-salt diet
Diet rich in nitroso compounds (found in tobacco smoke, processed meats, and fried foods)
Diet low in folate
What is pernicious anemia?
Condition caused by a lack of intrinsic factor (IF), resulting in vitamin B12 (cobalamin) deficiency and megaloblastic anemia
What is the classic triad of symptoms for pernicious anemia?
Weakness
Sore tongue
Paresthesias
What is the most common site for ulcerative colitis?
Rectum (it is always involved in UC)
The presence of hematuria with red cell casts associated with hemoptysis suggests what 2 diagnoses?
Vasculitis or Goodpasture syndrome
What is seen on plain film and CT in a patient with a cecal volvulus?
Plain film: coffee bean
CT: whirl sign
What is the most common location of an anal fissure?
Posterior midline
What is the minimal platelet count for a thrombocytopenic patient who is undergoing a major surgical procedure?
50,000
What is recommended for complicated diverticulitis with pericolonic abscess > 4 cm?
Percutaneous drainage
What is the most common skin cancer?
Basal cell carcinoma
Where should IVC filters be inserted?
At the inflow of the renal vein
What tumor marker is associated with hepatic carcinoma?
Elevated alpha-fetoprotein (AFP)
What will present classically with painless gross hematuria?
Bladder cancer
What is the most common type of bladder cancer?
Transitional (urothelial) cell carcinoma
What is the treatment for patients with esophageal variceal hemorrhage who fail initial endoscopic management?
Balloon tamponade
What is the most common type and location of pancreatic cancer?
Adenocarcinoma in the head of the pancreas
How long after a meal would you expect a patient with a duodenal ulcer to experience epigastric pain?
2-5 hours
What condition might show a corkscrew esophagus on barium swallow imaging?
Esophageal spasm
What is the most common cause of hematochezia in patients > 60 yo?
Diverticulosis
Which type of head bleed present after head trauma with a brief period of unconsciousness followed by a lucid interval?
Epidural hematoma
