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Surgery Clerkship > General Surgery > Flashcards

General Surgery Flashcards

1
Q

What are the indications for a Nissen Fundoplication?

A
  • longstanding, medicine resistant GERD
  • GERD complications
  • dysplasia
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2
Q

What is the classic motility issue seen with achlasia?

A

More difficulty swallowing liquids than solid food

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3
Q

Esophageal cancer generally presents with these symptoms?

A

Dysphagia, weight loss, alcohol or smoking history (SCC), longstanding GERD ( adenocarcinoma)

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4
Q

How is the diagnosis made for a Mallory-Weiss test? For Boerhaave Syndrome?

A

Mallory Weiss: EGD with photocoagulation

Bowrhaave: gastrografin contrast study

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5
Q

How are each of the following gastric cancers treated:

  1. Adenocarcinoma
  2. Lymphoma
  3. Maltoma
A
  1. Surgery
  2. Chemotherapy or radiation
  3. Eradication of H. Pylori
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6
Q

What is the number one cause of small bowel obstruction? How is it treated?

A

Adhesions

Try NG tube decompression while NPO. If this fails after 24 hours, surgery is needed.

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7
Q

In a patient suspected of SBO with fever, leukocytosis, and peritoneal pain, what should be suspected?

A

Strangulated obstruction

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8
Q

A patient with a carcinoid tumor and liver metastasis will present with these defining symptoms?

A

Diarrhea, flushing, wheezing, right sided heart failure

*do a 24 hour urine 5HIAA

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9
Q

Colon cancer will present in what way if right sided? Left sided?

A

Right: anemia in elderly
Left: bloody bowel movements and narrow caliber stools

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10
Q

What are the indications for colostomy in a patient with ulcerative colitis?

A
  • disease >20 years
  • severe nutritional depletion
  • multiple hospitalizations or multiple high dose steroid packs
  • toxic megacolon
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11
Q

What are the two most common antibiotic classes associated with C. Difficile?

A

Clindamycin and cephalosporins

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12
Q

What is the cause of anal fissure?

A

Tight sphincter

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13
Q

What will help healing of a fistula in a patient with Crohn’s disease?

A

Remicade

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14
Q

What patient population would likely present with SCC of the anus? How do you treat?

A

HIV+

Nigro chemoradiation

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15
Q

In a patient with blood in the stool, how should this be evaluated?

A

Rule out upper bleeds first with a NG aspirate and EGD. Than perform an angiogram for large amounts of lower GI bleeding or a colonoscopy if the blood stops.

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16
Q

Blood per rectum in a child is likely? What scan should you do? What does it look for?

A

Meckel diverticulum

Technetium scan for ectopic gastric mucosa

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17
Q

A 54-year-old male is brought into the ED with extreme pain radiating to the back and extreme nausea and vomiting. He’s still retching when you go to examine him. He’s stable, so you order a stat CT to rule out AAA. His daughter pulls you aside to tell you that her father has a history of alcohol abuse and was drinking heavily last night. How do you diagnose and treat?

A

Diagnose with serum amylase and lipase. Treat with GI rest.

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18
Q

What is the diagnostic imaging modality for elderly patients with volvulus? Treatment?

A

X-ray: shows “parrot’s beak” bowel

Rectal tube decompression

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19
Q

An acute abdomen in a patient with a recent MI or constant A-fib is likely due to?

A

Acute mesenteric ischemia

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20
Q

HCC can be detected via this blood marker?

A

AFP

21
Q

What patient population will likely have a hepatic adenoma? Why do these patients need emergent surgery?

A

Females on long term OTC’s. They have a tendency to rupture and bleed.

22
Q

How could you differentiate between hepatocellular jaundice and obstructive jaundice?

A

Hepatocellular is due to hepatitis and will have highly elevated transaminases, but low APP.

Obstructive is usually due to stones or cancer and will have highly elevated APP.

23
Q

Obstructive jaundice due to stones should be treated with?

A

ERCP to do sphincterotomy and remove stone

24
Q

Colicky, RUQ Abdominal pain that is easily aborted by anti-cholinergics is likely?

A

Biliary colic

25
Q

An older male with RUQ pain, high fever, high WBC, and extremely elevated APP should be evaluated for? How is it treated?

A

Acute ascending cholangitis

IV antibiotics and ERCP decompression

26
Q

A patient with signs of acute pancreatitis, but a low hematocrit likely has? How can the severity be calculated?

A

Acute hemorrhagic pancreatitis

Ranson criteria: leukocytosis, increased blood glucose, low calcium, high BUN, metabolic acidosis, Low arterial pO2

27
Q

Why might a patient with acute hemorrhagic pancreatitis need daily CT scans?

A

To check for and get immediate drainage of abscesses

28
Q

Pancreatic pseudocysts develop how long after the original aggravating episode?

A

5 weeks

29
Q

What size pancreatic cyst will need surgical drainage?

A

> 6 cm

30
Q

Patients with chronic pancreatitis generally have these symptoms?

A

Steatorrhea, diabetes, and chronic epigastric pain

31
Q

Which organs receive most metastatic disease?

A

Liver, lungs, bone, brain

32
Q

What is the major complication for each of the following chemotherapy agents:

1) adriamycin
2) bleomycin
3) cyclophosphamide
4) platinum agents

A

1) cardio toxicity
2) pulmonary fibrosis
3) hemorrhagic cystitis
4) neurotoxic

33
Q

What is the best way to biopsy a breast mass?

A

Mammogram guided multiple core biopsies

34
Q

A firm, rubbery mass in the breast of a 19-year old girl is likely?

A

A fibroadenoma

35
Q

Why must cystosarcoma phyllodes breast tumors be removed?

A

Their potential to become malignant sarcomas

36
Q

With mammary dysplasia, or fibrocystic changes of the breast, how would your patient present? How would you diagnose?

A

A patient in their late 30’s with a mass that appears with their menstrual cycle. Aspiration of clear fluid with mass regression.

37
Q

How would an intraductal papilloma be diagnosed?

A

Patients present with bloody nipple discharge, which is generally diagnostic. However, a galactogran could also diagnose.

38
Q

Breast cancer found during pregnancy should be treated via?

A

Chemotherapy after the first trimester, and surgery if needed.

39
Q

What breast cancer treatment requires adjuvant radiation?

A

Lumpectomy

40
Q

What is the difference between DCIS and ductal carcinoma?

A

DCIS cannot metastasize

41
Q

What adjuvant therapy should be used in all breast cancer cases? What therapies are used for receptor positive tumors?

A

Chemotherapy

Hormone therapy with tamoxifen if pre-menopausal or anastrozole if post-menopausal

42
Q

Breast cancer metastasis to bone favors this area?

A

Vertebral pedicles in the spine

43
Q

Charcot’s triad of acute cholangitis includes?

A
  • RUQ pain
  • fever
  • jaundice
44
Q

Adjuvant therapy would be required in a patient with pancreatic adenocarcinoma if?

A

Node positive

45
Q

The division of the right and left lobes of the liver is?

A

Cantlie’s line: imaginary line between GB to IVC

46
Q

Milan criteria for liver transplant includes:

A
  • one tumor <5 cm
  • <3 tumors all <3 cm
  • no metastasis
  • no vascular invasion
47
Q

In a patient with invasive HCC could get palliative treatment with?

A

Nexavar

48
Q

The best test to check for an accessory spleen is?

A

Radionucleotide RBC test

49
Q

What percent of ITP patients benefit from splenectomy?

A

70%

Surgery Clerkship (14 decks)

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