General surgery

Question 1

what % of appy are perforated at presentation?

Answer 1

25%

Question 2

what is the alvarado score for appendicitis?

Answer 2

pre-test probability:
migratory right iliac pain
N/V
anorexia
tenderness on exam in right iliac fossa
rebound tenderness
fever
leucocytosis
left shift

Question 3

how do you manage perforated appy?

Answer 3

IV abx until afebrile

Question 4

who gets pyloric stenosis

Answer 4

2 week to 2 month
male 4;1
first born
Fhx esp in mom

Question 5

How do we dx pyloric stenosis

Answer 5

must rule out other etiology for emesis
AUS - length > 14 mm, thickness > 4 mm
UGIS - string sign

Question 6

what is the electrolyte abnormality in pyloric stenosis

Answer 6

hypochloremic metabolic alkalosis
loss of H and Cl in the emesis
kidneys try to balance by excreting Na and HCO3

then kidneys try to reabsorb Na at the expense of H and K = paradoxical aciduria

Question 7

what type of intussuception can not be reduced radiologically?

Answer 7

jejuno-ileal - too far and can’t get enough pressure

Question 8

who gets intussuception?

Answer 8

3 mo to 3 yrs
males 3:1
recurrence 3-11%

Question 9

what is the most common type of intussuception?

Answer 9

ileocolic - 85%

Question 10

what are absolute contraindications for pneumatic reduction of intussusception?

Answer 10

peritonitis
persistent hypotension
pneumoperitoneum

Question 11

what are the rules of 2 for Meckel’s diverticulum?

Answer 11

2% of population
2;1 M
2-6% asymptomatic
within 2 feet of ileocecal valve
2 inces long
2 types of mucosa - gastric or pancreatic

Question 12

what are CF of Meckel’s ?

Answer 12

MC - bleeding, painless, episodic

diverticulitis - inflammation, pain, perforation

Question 13

how do you Dx Meckel’s?

Answer 13

99Tc scan

give ranitidine before helps make it more sensitive

Question 14

T or F. prenatal Dx of CDH is associated with better outcome than post natal Dx

Answer 14

True

Question 15

what chromosomal abnormality of most commonly associated with CDH

Answer 15

Trisomy 18

Question 16

what are important mgnt steps for a CDH?

Answer 16

1. intubate on first breath
2. NG to decompress
3. stabilize
4. RO other abnormalities - ECHO and genetics
5. wait until stable to operate

Question 17

if you are suspicious for TEF, what might help Dx? and if found, what other investigations are warranted

Answer 17

insert 8-10F NGT - will block at 10 cm if TEF

Need ECHO for ? VACTERL
need to look for anal atresia

Question 18

which upper GI abnormality may show up with no air on abdo Xray

Answer 18

esophageal atresia

Question 19

what is the mc typeof esophageal atresia?

Answer 19

EO with distal TEF

Question 20

what is the best test for volvulus Dx

Answer 20

upper GI series

US is a screen only - mesenteric vessel orientation

Question 21

what is the DDx for billious emesis in a neonate?

Answer 21

1. Mid gut volvulus
2. malrotation
3. duodenal atresia
4. Hirshsprung
5. ileus - NEC

Question 22

when does malrotation and vulvulus tend to present?

Answer 22

first month - 65%

firts year - 13%

Question 23

how do we Dx Hirschsprung?

Answer 23

screen- contrast enema looking for transition zone seen in 80-% might not see in early presentation
classic is rectosigmoid
Gold - suction rectal Bx - no ganglion, hypertrophic nerves and incraesed ACh-esterase stain(seen in all constipation
(can do rectal manometry in older)

Question 24

How do Pt with Hirschsprung present

Answer 24

abdo distension
bilious emesis
failure to pass mec in 24 hrs
enterocolitis - fever, lethargy, HD un stable

Question 25

how do you manage Hirschsprung?

Answer 25

rectal decompression with saline irrigation | Sx early - definitive pull-through

Question 26

which of these has associated malrotation - omphalocele and gastroschisis

Answer 26

BOTH!!!

Question 27

what is the MC cardiac malformation associated with omphaloceles?

Answer 27

TOF

Question 28

if baby found to have omphalocele, what other investigations are required?

Answer 28

ECHO - TOF genetics for BWS, T13, T18 multiple and isolated congenital anomalies (musculoskeletal, 24%; urogenital, 20%; cardiovascular, 15%; and central nervous system, 9%)

Question 29

where is the defect in gastroschisis?

Answer 29

Right of umbilicus

Question 30

what are the issue with gastroschisis?

Answer 30

atresia volvulus prolonged ileus

Question 31

doe omphaloceles have bowle atresia?

Answer 31

not usually bowel works well 50% have associated abnormalities

Question 32

what age group gets inguinal hernias?

Answer 32

most common in < 1 year olds

Question 33

when should an inguinal hernia be repaired?

Answer 33

if strangulated - right away otherwise - within 2 weeks bc risk of incarceration is 30-40% and inc if wait CL exploration only if ex-prem

Question 34

how do you manage an incarcerated inguinal hernia?

Answer 34

attempts manual reduction with sedation | followed by OR 24-48 hours later

Question 35

what are complications of inguinal hernia repair?

Answer 35

``` scrotal swelling scrotal hematoma - resolves 10-14 d iatrogenic undescended testicle recurrence - esp if incarcerated or prem testicular atrophy ```

Question 36

why do we do orchidopexies?

Answer 36

1. fertility 2. malignancy 3. risk of torsion/hernia/trauma

Question 37

how can you tell apart an incarcerated hernia from a acute hydrocele?

Answer 37

incarcerate - patient looks a bit sicker, emesis, abdo pain, no poops

Question 38

what are CF of UC

Answer 38

``` tenesmus urgency crampy abdo pain norcturnal BM Bloody stool/diarrhe anorexia/wgt loss ```

Question 39

what defines fulminant colitis

Answer 39

fever > 5 bloody stools X 5 days severe anemia hypoalbuminemia

Question 40

what are extra Gi manifestations of Crohn's

Answer 40

``` apthous ulcers arthritis EN clubbing renal stone/gallstones delayed puberty ```

Question 41

what are the typical CF of Crohn's

Answer 41

weight loss - can be the only sign abdo pain diarrhea fatigue

Question 42

how do we Dx Crohn's

Answer 42

bc can have small bowel disease UGI/SBFT colonoscopy for Dx