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General Surgery > General Surgery Boards > Flashcards

General Surgery Boards Flashcards

1
Q

Types of Rectus sheath hematomas? (3 Types)

A

Type 1: Doesn’t cross midline and contained to muscle. Observe
Type 2: Crosses to other side and along transversalis fascia. Reverse AC
Type 3: Free rupture. Angio and embolizaiton

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2
Q

Primary Sclerosing Cholangitis. Which cancers do you need to keep an eye for and how to do surveillance:

A

Billiary/Liver: MRCP and US q6-12 months
CA 19-9: q 12 months
C-Scope: q 1-2 years

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3
Q

While histologic layer do you need to remember for GB cancer?

A

T1a: invasion into lamina propria.
T1b: invasion into muscularis propria

T2: beyond Muscularis propria

T3: Beyond serosa

T4: into vasculature or more than one extrahepatic structure

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4
Q

How many lymph nodes do you need when doing lymphadenectomy for GB cancer? And which nodes?

A

6

Porta-hepatis.
Retro-duodenal
Gastro-hepatic

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5
Q

Do you send frozen sections in GB cancer resection?

Which margins do you need to check if you take out cancer incidentally?

A

Liver margin and cystic duct margin to determine if you need to do a reconstruction

Always check the margins. Best to bget R0 resection.

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6
Q

Bismuth-Corlette Criteria

A

Type 1: Common hepatic duct
Type 2: Involves hepatic bifurcation
Type 3: Extending into a single (L or R) hepatic duct.
Divided into Type 3a or type 3b (depending on the side)
Type 4: Involves bilateral (L + R) hepatic ducts
Type 5: Involves secondary hepatic ducts on both sides

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7
Q

Types of Choledochal Cysts

A

Type 1:
Fusiform dilation of the CBD. I.e, dilation of the extrahepatic biliary tract. Treatment is chole, resection of cysts and H-J after getting negative margins and cholecystectomy

Type 2: Diverticulum of the bile duct. Diverticulectomy

Type 3: Dilation within the duodenal wall. Don’t have malignant potential risk. if small, sphincterotmoy. if large, transduodenal excision

Type 4: Extra and intra hepatic. or simply extrahepatic. Always resect w/ HJ. Can do lobectomy if lobe invovled.

Type 5: purely intrahepatic. If focal, resect. If multiple, liver transplant.

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8
Q

When is best time to fix CBD injury?

A

If in OR, then fix then. < 50% fix over T-Tube. > 50%, HJ

< 72 h - Fix
> 72 h: Get CTA to r/o vascular injury. get control w/ ERCP, PTC, drain.

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9
Q

Which stage anal squamous cell carcinoma can be excised?

A

T1, which is < 2cm. Need 1 cm margin as long as no sphincter involvement.

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10
Q

How do you stage anal squamous cell CA?

A 
HIV
CT C/A/P
MRI of pelvis can help u determine if there any adjacent structure involvement 
Colposcopy 
Colonoscopy
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11
Q

Nigro protocol?

A

Mitomycin + RT + 5FU

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12
Q

T1 Colon Cancer

A

T1 = Invasion into submucosa

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13
Q

T2 colon cancer

A

T2 = muscularis propria

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14
Q

T3 colon cancer

A

T3 = subserosa

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15
Q

T4 colon cancer

A

t4 = invasion into serosa or adjacent organ

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16
Q

T1 colon cancer

A

n1 1-3

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17
Q

N2 colon cancer

A

> 4 modes

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18
Q

N3 colon cancer

A

distant nodes

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19
Q

if patient has N0 disease with colon ca, what stage can they be maximum?

A

Stage 1 or 2

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20
Q

if pt has N1 - N2 disease, what stage are they with colon cancer?

A

Stage 3

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21
Q

Stage 1 and stage 2 colon cancer treatment

A

Stage 1 = Resection

Stage 2 = Resection and chemotherapy if high risk features (less than 12 nodes, lymphovascular invasion, MSH instability

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22
Q

What are the margins needed for rectal cancer?

A

High rectal: 5 cm

Middle or low: 2cm ideal. However 1cm if close to the anal sphincter.

If doing trans-anal excision: 3mm

23
Q

How do you manage T1 lesions if High or low rectum?

A

High rectum: LAR

Low rectum, can do transanal excision (3mm margin) if mobile, less than 3cm, less than 30% of circumfrential wall, and

24
Q

how do you manage a T2 rectal cancer lesion?

A

High T2 = LAR

Low T2 (i.e., within 5cm of the anal verge) - these patients can get neoadjuvant chemoRT to try and downstage for either transanal excision or LAPR/APR

25
Q

how do you manage T3/4 or N1 rectal cancer?

A

Always do Neoadjuvant first

26
Q

• Which appendix carcinoid tumors need right hemicolectomy?

A

o If > 2cm, at the base, lymphovascular invasion, invasion into meso-appendix, intermediate to high-grade.

27
Q

• How do you manage < 1cm rectal carcinoid tumor?

A

o Endoscopic removal

28
Q

• How do you manage a 1 – 1.9cm rectal carcinoid tumor?

A

o If confined to submucosa, then local full thickness excision.
o If invades into muscularis propria or lymph nodes meds, then need MSE
o 7 lymph nodes

29
Q

• How do you manage > 2cm rectal carcinoid tumor?

A

o MSE. 7 lymph nodes

30
Q

• STK11 Gene causes which syndrome?

A

o Peutz-Jeghers

31
Q

• MUTYH gene mutation causes which syndrome?

A

o 10 or more synchronous colonic adenomas

32
Q

• Muir-Torre Syndrome:

A

o AD hereditary syndrome
o Cause tumors of sebaceous glands (adenoma, carcinoma, keratoacanthoma)
o Will also cause GI cancer

33
Q

• MADH4

A

o utosomal dominate

o Will cause juvenile polyps in the rectum and can cause hepatic and GI AVM

34
Q

• PTEN Mutation:

A

o Causes COWDEN Syndrome:
 This leads to hammartamosa and colonic polyps
 Similar to normal population colon CA risk
 Increased risk of endometrial/breast/thyroid cancer

35
Q

• Familial Adenomatous Polyposis (FAP)

A 
o	APC gene mutation
o	Autosomal Dominant 
o	> 100 adenomas 
o	Prophylactic colectomy by age 20
o	Surveillance of rectal mucosa 
o	And EGD
36
Q

• What is Obstructive Defecation?

A

o Rectal intussusception.

o Tx: Best to avoid surgery if you can. Goal is to do biofeedback as first line

37
Q

• What is the first and second line treatments for Grad 1 – 3 internal hermorrhoids?

A

o Stool softners, fiber supplementation, liberal water intake and sitz baths.
o Second line is rubber band ligation, sclerotherapy, infrared coagulation

38
Q

• Who are LOW-risk group with C-Scope surveillance?

A

o Any number of hyperplastic polyps – 10- years

o Up to 2 less than 1cm adenomas – 5 years

39
Q

• Who are HIGH-risk group with C-scope surveillance?

A 
o	3-10 adenomas (< 1cm) 
o	Any adenoma > 1cm 
o	Any adenoma w/ high-grade features 
o	Villous adenoma 
o	Any Serrated polyp
40
Q

• How do you manage cancerous colon polyps?

A

o If removed w/ a 2mm margin completely, then repeat C-scope in 1 year

41
Q

What size esophgaeal leiomyoma can be safely monitored?

What size esophgeal leiomyoma becomes symptomatic?

A

Monitor them if < 2cm

symptomatic at 4 cm generally

Do not biopsy if you can .

42
Q

What are the most common causes of esophgeal stricture?

A

GERD

43
Q

What size do you want goose to be at end of serial dilation?

A

14mm

44
Q

How often can you dilate the goose?

A

3mm every 2 weeks for a total of 4 sessions.

if the stricture comes back w/i 4 weeks, then recurrent stricture

if teh stricure cannot be dilate to 14mm, then refractory stricture

45
Q

what is the 6+2 rule?

A

When doing a heller myotomy, 6cm proximal goose myotomy, distally on the stomach, 2cm distally.

46
Q

T staging for esophgeal cancer:

T1

A

T1a: Lamina propria

T1b: submucosa

47
Q

TNM staging esophgeal cancer

A

T2 - muscularis propria

48
Q

TNM staging esophgeal cancer. T3

A

T3 - Adventitia

49
Q

TNM staging esophageal cancer. T4

A

T4 = surrounding strucgture.

50
Q

how many lymph nodes do you need for esophgeal cancer?

A

15 nodes

51
Q

how do you manage T1 stage esophgeal cancer w/o nodes?

A

T1a - EMR, ablation, ER and ablation, or esophgeaectomy

T1b - if smaller than 2cm and no evidnece of lymphovascular invasion - EMR, otherwise esophagectomy

52
Q

How do you manage T2 and/or N1 diseaes - esophgea cancer?

A

no proben benefit to Neoadjuvant chemoRT, but generally given cuz most are upstaged later on.

53
Q

How do you manage varacies in patients with Childs A?

< 5mm and > 5mm

A

< 5mm - nothing to do

> 5mm - beta blocker. can also do banding if the pt cannot tolerate beta blockers

54
Q

How do you manage varacies in patients with Childs B/C?

A

< 5mm - Beta Blockers

> 5mm - Beta Blockers AND endoscopic banding

General Surgery (1 decks)

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