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PESTANA > GENERAL SURGERY > Flashcards

GENERAL SURGERY Flashcards

1
Q

Esophageal cancer

A

Progressive dysphagia and weight loss

Squamous cell carcinoma - men with long history of smoking and drinking

Adenocarcinoma - long standing GERD

Do barium swallow before endoscopy

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2
Q

Carcinoid syndrome

A

Small bowel carcinoid tumor with liver mets

Diarrhea, flushing, wheezing, right sided heart valvular damage (prominent JVP)

24 hour HIAA

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3
Q

Right vs left sided colon cancer

A

RIGHT
Iron deficiency anemia in an old person
4+ occult blood in stool

LEFT
Bloody bowel movements

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4
Q

Which colonic polyps are premalignant? Which are not?

A

PREMALIGNANT
Villous adenoma
Adenomatous polyps

NOT 
Juvenile
Peutz Jeghers 
Isolated inflammatory 
Hyperplastic
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5
Q

Pseudomembranous enterocolitis

A

Overgrowth of c diff in patients who have been on clindamycin or cephalosporins

Watery diarrhea, crampy abdominal pain, fever, leukocytosis

Tx with metronidazole or oral vancomycin

If resistant to treatment you need a colectomy or a fecal enema

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6
Q

Anal fissure

A

Young women

Pain with pooping
Avoid bowel movements and get constipated

Might have a tight sphincter problem

Tx with topical diltiazem ointment and that should work

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7
Q

Should you do surgery in crohn of the anus

A

No

Treat with remicade

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8
Q

What qualifies as the upper GI tract

A

Tip of nose to ligament of Treitz (connects duodeno jejunal flexure to esophagus)

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9
Q

Abdominal perforation

A

Sudden onset abdominal pain that is constant, generalized and severe

Peritoneal irritation - tenderness, guarding, rebound, silent bowel sounds

Most common is peforated peptic ulcer

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10
Q

Inflammatory process acute abdomen

A

Buildup of several hours

Constant and ill defined pain at first
Then location to where problem actually is

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11
Q

Acute pancreatitis

A

Rapid onset inflammatory process acute abdomen in an alcoholic

Constant epigastric pain that radiates to the back
Nausea and vomiting

Diagnose with serum or urinary amylase or lipase

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12
Q

Hepatic adenoma

A

Complication of birth control pills

Can rupture and bleed and that would be bad

Dx with CT scan

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13
Q

Amebic abscess of liver

A

Men with a Mexico connection

Do serology but treat empirically with metronidazole

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14
Q

Hemolytic jaundice

A

Elevated indirect bilirubin

No bile in urine

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15
Q

Hepatocellular jaundice

A

Both bilirubins are elevated

Very high LFTs

Modest increase in alkaline phosphatase

Look for hepatitis

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16
Q

Obstructive jaundice

A

Both bilirubins are elevated
Modest LFTs
Very high alkaline phosphatase

ERCP to look for stone
Fat, female, fertile, forty

US to look for tumor (gallbladder will be thin walled and dilated)

17
Q

Acute ascending cholangitis

A

Stone has reached the common bile duct

Temperature spikes up to 105 and very high alkaline phosphatase

IV abx and ERCP with eventual cholecystectomy

18
Q

Edematous vs hemorrhagic pancreatitis

A

Edematous - elevated hematocrit

Hemorrhagic - low hematocrit

19
Q

What do you use to image the breast

A

Young woman - US

Over 30-40 - mammography

20
Q

Intraductal papilloma

A 
Young women (20-40)
Bloody nipple discharge

Galactogram for diagnosis

21
Q

Breast abscess

A

Only in lactating women

Incision and drainage
Keep breastfeeding

22
Q

Radiology of breast cancer

A

Irregular speculated mass
Asymmetric density
Architectural distortion
Fine microcalcifications

23
Q

Which breast cancer has the highest incidence of laterality

A

Lobular (infiltrating ductal carcinoma)

24
Q

What makes a breast cancer inoperable?

A

Local extent - not mets!

25
Q

Breast cancer mets spots

A

Bone and brain

Persistent headache and backache are bad signs

26
Q

Does thyroid cancer usually affect thyroid function?

A

No

27
Q

Thyroid cancers

A

Papillary - slow growing, resection depends on mets

Follicular - total thyroidectomy

Medullary - c cells that release calcitonin, aggressive so do radical surgery and do pheochromocytoma workup (MEN 2)

Anaplastic - old people that’s really bad

28
Q

Hyperparathyroidism

A

High serum calcium in blood tests (maybe stones, bones, groans, etc…)

Look for low phosphorous and rule out bone cancer

Probably an adenoma that will be cured with removal

29
Q

Zollinger Ellison syndrome

A

Gastrinoma

Virulent peptic ulcer disease resistant to usual therapies
Watery diarrhea

Measure gastrin and do secretin test

Look for pancreatic tumor

30
Q

Nesidioblastosis

A

Hypersecretion of insulin in newborn

Remove pancreas

31
Q

Glucagonoma

A

Severe migratory necrolytic dermatitis

Mild diabetes

Anemia, glossitis, stomatitis

32
Q

Primary hyperaldosteronism

A

Adenoma or hyperplasia

HYPOKALEMIA in hypertensive female patient

Low renin levels

Hyponatremia and metabolic alkalosis

Adrenal CT

33
Q

Renovascular hypertension

A

Young women with fibromuscular dyaplasia
Old men with arteriosclerotic occlusive disease

Bruit over the flank

PESTANA (13 decks)

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