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MCC Part 1 > General Surgery > Flashcards

General Surgery Flashcards

1
Q

How do you determine the etiology of ascites?

A

Paracentesis:
Serum to fluid albumin ratio >11 g/L = transudative (e.g. portal HTN, CHF)
Serum to fluid albumin ratio <11 g/L = exudative etiology (e.g. peritoneal carcinomatosis, peritonitis, infection, pancreatitis/ serositis)
Note: g/L = mmol/L
Note: ascites >1.5L for clinical dx

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2
Q

Ddx abdominal distension

A

Ascites
Bowel dilatation - mechanical obstruction, pseudo-obstruction, paralytic ileus
Abdominal/ pelvic mass

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3
Q

Causes of mechanical obstruction

A 
Adhesion
Volvulus
Malignancy 
Intussusception
Constipation
Incarcerated/strangulated hernia
Bowel stricture (Crohn or recurrent diverticulutitis)
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4
Q

Signs cirrhosis

A 
Increased portal venous HTN
Caput medusae
Spider nevi
Palmar erythema
Jaundice
Icterus
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5
Q

Liver enzymes

A

AST
ALT
ALP
GGT

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6
Q

LFTs

A

Bilirubin
INR
Albumin

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7
Q

Pancreatic blood test (amylase vs. lipase)

A

Lipase

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8
Q

Lab for ischemic bowel

A

Lactate

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9
Q

Bowel dilatation maximum diameters (3-6-9)

A

30mm small bowel
60mm large bowel
90mm cecum

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10
Q

Serum tumour markers

A 
Colon - CEA
Pancreatic - CEA, CA 19-9
Hepatoma - AFP
Ovarian CA- 125
Germ line tumours - b-hCG, AFP
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11
Q

Why are indirect inguinal hernias more common in males?

A

Failure in processes vaginalis closure during embryogenesis

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12
Q

Renal cyst size cut-off for follow-up

A 
<3cm = no further intervention
>3cm = imaging follow up because 5-10% malignancy risk
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13
Q

Direct vs. indirect inguinal hernia

A

Direct (1/3) = hernia sac parallels spermatic cord
Indirect (2/3) = hernia sac within spermatic cord
- at superficial inguinal ring (external inguinal ring)

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14
Q

Ddx groin mass

A 
Undescended testicle
Femoral aneurysm
Lymphadenopathy
Hydrocele (swollen tunica vaginalis)
Spermatocele (swollen epididymal head)
Varicocele (dilated pampiniform venous plexus)
Testicular tumor
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15
Q

Define visceral pain

A

Originates from triggering the autonomic NS innervating the visceral peritoneum - dull, vague, deep

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16
Q

Define parietal pain

A

Originates from triggering the spinal somatic nerves innervating the parietal peritoneum - sharp, stabbing, localized

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17
Q

Ranson criteria

A

Prognosis re: pancreatitis

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18
Q

Charcot triad (cholangitis)
vs.
Reynold’s pentad (cholangitis)

A

Triad: jaundice, fever, RUQ pain
Pentad: jaundice, fever, RUQ pain, signs pf CNS depression, hypotension

19
Q

Kehr sign (spleen)

A

Acute pain in tip of left shoulder with splenic rupture

20
Q

Ddx breast lump

A

Breast cancer - invasive (ductal, lobular, other), vs. non-invasive (ductal, lobular)
Non-breast specific malignancy (sarcoma, lymphoma)
Benign breast disease - infectious vs. non-infectious

21
Q

Risk factors for breast cancer

A 
Age >50
Female
Hx breast or ovarian cancer
Prior breast biopsy
Prior radiation therapy at site
Family hx breast or ovarian cancer in 1/2 degree relative
Hx prolonged hormone exposure (nulliparty, first pregnancy >30, menarche <12, menopause >55, HRT >5yr, obesity)
Excessive EtOH
22
Q

Breast cancer screening

A

Mammography

  • 40-49 = no evidence to include or exclude
  • 50 - 69 = every 1-2yr
  • Fam hx in 1st degree relative = every 1-2 yr starting 10yr before youngest age of presentation

BSE
- no evidence

Genetic Testing
- Ashkenazi Jewish women - any 1st degree or two 2nd degree relatives from same side of family with breast or ovarian cancer
Other women genetic testing
- patient <35 at diagnosis of breast cancer
- patient or 1st degree relative with both breast and ovarian cancer (regardless of age at dx)
- patient or 1st degree relative with bilateral breast cancer
- patient with strong family hx breast and/or ovarian cancer (two 1st degree, one age <50 at dx OR three 1st degree regardless of age at dx; combination of two or more 1st or 2nd degree relatives with ovarian cancer regardless of age at dx)
- hx breast cancer in male relative

23
Q

In situ breast cancer management

A

Lumpectomy + radiotherapy achieves same survival benefit as mastectomy with in situ stage I and II disease

24
Q

When do you do additional staging tests with breast cancer (asx pt)?

A

If tumor >5cm and axillary LN positive - CXR, bone scan, CT abdo

25
Indications for hormonal therapy in breast cancer?
- Tumor size >1cm, ER/PR positive following surgery - Premenopausal: tamoxifen or ovarian ablation, or ovarian ablation and aromatase inhibitor (anastrozole, letrozole) - Post-menopausal: tamoxifen, or aromatase inhibitor
26
Indications for chemotherapy in breast cancer?
- Most pt with stage II or III - Stage I with HER2/neu positive tumor - Trastuzumab (Herceptin) should be used in all HER2/ neu overexpressing tumors
27
Indications for radiation in breast cancer?
- After lumpectomy - After mastectomy in stage IIIB disease - Axillary node involvement
28
Tumor lysis syndrome? (metabolic oncologic emergency)
TRIAD: hyperuricemia, hyperkalemia, hyperphosphatemia | - rapid release of tumor cell intracellular contents into blood stream
29
Hypercalcemia of malignancy?
Metabolic oncologic emergency | - disorder of Ca metabolism because alterations in Ca regulation pathway re: PTH, calcitonin, Vit D
30
SVC syndrome?
Mechanical oncologic emergency - cough, dyspnea, dysphagia, swelling and discolouration of neck, face, upper extremities, possible vocal cord paralysis and Horner syndrome - b/c increase in central venous pressure from vena naval obstruction
31
Neutropenic fever in oncology patient
- Neutrophil count <0.5 x 10^9 or <1 x 10^9 and expected to decline below <0.5 soon - Fever = single temp or 38.3 or 30 lasting over 1hr
32
DIC of malignancy
- bleeding, thromboembolism, liver dysfunction, kidney failure, respiratory distress, change in CNS exam - thrombocytopenia - MAHA (microangiopathic hemolytic anemia) on blood smear
33
Delayed onset pain in thoracic trauma?
Flail chest
34
Classification of hemorrhage re: physiologic changes
Class I - blood loss <15% - HR <100, BP normal, pulse pressure normal, RR normal - u/o >30mL/h - slightly anxious Class II - blood loss 15-30% - HR >100, BP normal, pulse pressure decreased, RR 20-30, u/o 20-30 - mildly anxious Class III - blood loss 30-40% - HR >120, BP decreased, pulse pressure +decreased, RR 30-40, u/o 5-15 - anxious, confused Class IV - blood loss >40% - HR >140, BP +decreased, pulse pressure ++decreased, RR >35, u/o scant - confused, lethargic
35
Cardiac tamponade sx
Beck triad - Elevated JVP - Decreased BP - Muffled heart sounds
36
Acute aortic rupture sx
Chest or midscapular pain Dyspnea Hoarseness Dysphagia may be asymptomatic
37
Investigations re: thoracic trauma
Labs - CBC, lytes, PTT, INR, cross match for pRBCs, ABG, b-hCG - CXR (pneumothorax, hemothorax, widened mediastinum) +/- CT head, neck, spine, chest, abdo, pelvis, or extremities depending on patient stability and injury
38
Indications for transfusion of pRBCs in trauma
Absolute: Hgb <80g/L Relative: - Hb <100g/L in pt with known CV disease - suspected or known massive hemorrhage - persistent hypotension following 2L of IV crystalloids - evidence of end-organ dysfunction secondary to hypoxia
39
FAST - what are you assessing and where?
Assess for free fluid in 4 Ps:perisplenic, perihepatic, pelvic, pericardial
40
Arterial insufficiency 6Ps
``` Pain Pallor Polar (cold) Pulseless Paresthesias Paralysis ```
41
Compartment syndrome
Pain out of proportion to physical exam, pain on passive stretch or active flexion of compartment, parasthesia in distal peripheral nerves that cross the compartment - Compartment pressure >30mmHg of patient's DPB leading to vascular occlusion and tissue ischemia
42
API
ratio of SBP distal to arterial injury site to SBP measured in contralateral uninjured limb, normally >0.9 - if <0.9 requires angiography/ investigation (NOT ABI)
43
Vascular injury dx test
- CBC, if hemorrhage - Plain XR (fractures, FB) - U/S +/- duplex - Handheld doppler - API - Angiography - Surgical exploration

MCC Part 1 (22 decks)

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