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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
Q

Indications for hormonal therapy in breast cancer?

A
  • 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
Q

Indications for chemotherapy in breast cancer?

A
  • 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
Q

Indications for radiation in breast cancer?

A
  • After lumpectomy
  • After mastectomy in stage IIIB disease
  • Axillary node involvement
28
Q

Tumor lysis syndrome? (metabolic oncologic emergency)

A

TRIAD: hyperuricemia, hyperkalemia, hyperphosphatemia

- rapid release of tumor cell intracellular contents into blood stream

29
Q

Hypercalcemia of malignancy?

A

Metabolic oncologic emergency

- disorder of Ca metabolism because alterations in Ca regulation pathway re: PTH, calcitonin, Vit D

30
Q

SVC syndrome?

A

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
Q

Neutropenic fever in oncology patient

A
  • 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
Q

DIC of malignancy

A
  • bleeding, thromboembolism, liver dysfunction, kidney failure, respiratory distress, change in CNS exam
  • thrombocytopenia
  • MAHA (microangiopathic hemolytic anemia) on blood smear
33
Q

Delayed onset pain in thoracic trauma?

A

Flail chest

34
Q

Classification of hemorrhage re: physiologic changes

A

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
Q

Cardiac tamponade sx

A

Beck triad

  • Elevated JVP
  • Decreased BP
  • Muffled heart sounds
36
Q

Acute aortic rupture sx

A

Chest or midscapular pain
Dyspnea
Hoarseness
Dysphagia may be asymptomatic

37
Q

Investigations re: thoracic trauma

A

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
Q

Indications for transfusion of pRBCs in trauma

A

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
Q

FAST - what are you assessing and where?

A

Assess for free fluid in 4 Ps:perisplenic, perihepatic, pelvic, pericardial

40
Q

Arterial insufficiency 6Ps

A 
Pain
Pallor
Polar (cold)
Pulseless
Paresthesias
Paralysis
41
Q

Compartment syndrome

A

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
Q

API

A

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
Q

Vascular injury dx test

A
  • 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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