general surgery Flashcards
what comprises the border of hesselbach’s triangle (hernia)?
inguinal ligament
inferior epigastric vessels
border of rectus femoris muscles
what is a richter hernia?
only partial circumference of bowel is incarcerated or strangulated; the gangrenous piece may spontaneously reduce and perforate inside of the abdomen
what is the most common cause of small bowel obstruction?
post-operative adhesions
What is the most common cause of large bowel obstruction?
tumor (cancer)
patient has a large bowel obstruction that requires surgical correction. You need to start them on empiric antibiotics. Which do you choose?
Tazobactam/piperacillin (Zosyn)
You see an abdominal XRAY showing multiple air-fluid levels and a “coiled spring” sign. What is the dx
small bowel obstruction
what is charcot’s triad?
cholangitis:
fever, jaundice, biliary colic
an appendix with a diameter > ___ mm is indicative of appendicitis?
> 6 mm
you are working up a patient for biliary colic; US is not able to visualize sludge. What do you order next?
HIDA scan
What are the 2 types of esophageal cancer and where are they located
Squamous - proximal 2/3 esophagus
Adenocarcinoma - distal 1/3 (barrets)
First line therapy for GERD
Lifestyle modifications
How do you diagnose ZES?
Secretin test >200 pg/mL
Which 2 lymph nodes may be indicative of gastric adenocarcinoma that has spread?
Supraclavicar (virchow node)
Umbilical (sister Mary Joseph node)
pancreatic beta cells secrete ______
insulin
what are the 3 digestive enzymes secreted by the pancreatic acinar cells?
Lipase - digests fats
Amylase: digests starch
Protease - digests proteins
what enzyme causes the gallbladder to relax?
glucagon
you perform US for suspected gallstones. Common bile duct diameter measures 6 mm. Is this considered dilated and concern for stone?
YES - anything >5 mm is indicative of obstruction.
what enzyme causes the gallbladder to contract?
cholecystokinin
what enzyme causes the gallbladder to relax?
glucagon
what labs will be markedly elevated in cholelithiasis?
AST
ALT
Total Bilirubin
what medication can you apply topically to the anus in a patient with anal fissure?
Topical Nifedipine
the liver actually has a dual blood supply that feeds it. What are the 2 vessels?
Hepatic Artery (20%) Portal Vein (80%)
what labs will be markedly elevated in cholelithiasis?
AST
ALT
Total Bilirubin
what medication can you apply topically to the anus in a patient with anal fissure?
Topical Nifedipine
what antibiotic do you use to empirically treat bowel obstruction on admission?
piperacillin/tazobactam (Zosyn)
what is Paget carcinoma
itchy dermatitis of the nipple with overlying ulceration, often associated with underlying ductal carcinoma
what is the antibiotic regimen for diverticulitis?
metronidazole (Flagyl) + Fluoroquinolone (Cipro)
at what levels of bilirubin do you start to see jaundice?
> 2
this type of breast cancer is often confused with mastitis
inflammatory (entire breast is red, swollen) - the most malignant form
what is the antibiotic regimen for diverticulitis?
metronidazole (Flagyl) + Fluoroquinolone (Cipro)
at what levels of bilirubin do you start to see jaundice?
> 2
this type of breast cancer is often confused with mastitis
inflammatory (entire breast is red, swollen) - the most malignant form
what is the most common, least aggressive form of thyroid cancer?
papillary
what is the most concerning and fastest growing thyroid cancer?
medullary
what is the thickness needed on US for diagnosing pyloric stenosis?
> 4 mm
what is the age range for pyloric stenosis?
2-6 weeks
what is the antibiotic that most commonly causes CDIFF
CLINDAMYCIN
penicillins
cephalosporins
can pregnant people have warfarin?
no - contraindicated
what are the W’s of post-operative fever?
Wind - atelectasis water - uti wound - infection walking - DVT wonder drug - drug induced fever
in what type of cancer will you likely see sister mary node and virchows node?
gastric cancer
most common cause of polycythemia (increased RBC?)
hypoxia
secondary to pulmonary disease (COPD)
what is administered for quickest response in a person with hyperkalemia that is having peaked T waves?
Calcium gluconate (30 min onset)
which antibiotics cover MRSA?
clindamycin
Bactrim
tetracyclines
what is the management for ascending aortic dissection?
emergent open heart surgery
what is the management of descending aortic dissection
BP control and monitoring
patient with longstanding smoking history presents with painless jaundice, epigastric pain, and unintentional weight loss. What are you worried about?
Pancreatic cancer
patient with resistant HTN is found to have an adrenal mass (primary adrenal insufficiency). Prior to adrenalectomy, which medications should be administered in preparation?
phenoxybenzamine (alpha blocker) for 10 days
propranolol (beta blocker) for 3 days
THEN surgery!
what is indicative of a right-sided sausage shaped mass?
intussusception
why do you not perform colonoscopy during acute diverticulitis?
risk of perforation is high! Get a CT w/ contrast
which medication should be started prior to endarterectomy in a patient with carotid stenosis?
aspirin. Continue for 3 months following surgery
what is the most common type of breast cancer?
ductal carcinoma
what is the triad of pheochromocytoma?
headache
diaphoresis
tachycardia/HTN
what is nitroprusside (Nitropress) used for?
acutely lowering symptomatic hypertensive crisis
