General Surgery: Study Guide 2 Flashcards
1
Q
What is the most common type of prostate cancer?
A
Acinar adenocarcinoma
2
Q
How does prostate cancer typically present?
A
asymptomatic until nodule is found with PSA or DRE
3
Q
PSA greater than _____ is concerning
A
4 ng/mL
4
Q
Cystic collection of fluid in testicle leading to testicular mass. Most common cause of painless scrotal swelling
A
Hydrocele
5
Q
Varicoceles are more common on the left or right?
A
Left
because the left spermatic vein enters the left renal vein at a 90 degree angle
6
Q
“bag of warms” should make you think of?
A
varicocele
7
Q
Biggest risk factor for testicular cancer?
A
Cryptochidism
8
Q
Immobility, recent surgery, tobacco use, estrogen use, and increased age with comorbidities are all risk factors for?
A
VTE (aka DVT)
9
Q
If VTE is suspected, first diagnostic tool used should be?
A
Venous doppler
10
Q
Sudden shortness of breath, pleuritic CP, fever, sudden hypoxemia, tachycardia, and cough/hemoptysis are all symptoms of?
A
Pulmonary embolism
11
Q
How do we diagnose a PE?
A
CT angiogram
12
Q
What is Virchow’s Triad?
A
- Hypercoagulability
- Hemodynamic changes
- Endothelial injury/dysfunction
13
Q
Common complication of acute arterial occlusion?
A
Compartment syndrome
14
Q
What size abdominal aortic aneurysm requires surgery?
A
5.5cm or greater
according to UpToDate
15
Q
what are four indications for surgery for peripheral arterial disease?
A
STIR
Severe claudication that affects life
Tissue Necrosis
Infection
Rest pain
16
Q
Where are the two most common places to have internal gangrene?
A
Appendix and colon
17
Q
What patients require antibiotic prophylaxis prior to dental procedures?
A
- A prosthetic heart valve
- Valve repair with prosthetic material
- A prior history of infective endocarditis
- Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
- Completely repaired congenital heart defects with prosthetic material or device during the first six months of the procedure
- Repaired congenital heart disease with residual defects at the site or adjacent to the site of the prosthetic patch or prosthetic device
18
Q
Most common pathogen causing infective endocarditis?
A
Strep viridans
19
Q
90% of POD fevers day 1 are due to?
A
atelectasis
20
Q
Atelectasis usually resolves within _____ hours. If its been 72 hours think _______.
A
48
pneumonia
21
Q
What are some of the best ways to prevent atelectasis?
A
Incentive spirometry, mobility, and stop smoking at least 2 weeks prior to surgery
22
Q
DVTs are most likely to occur in what type of surgeries?
A
pelvic, general, and orthopedic surgeries
23
Q
A benign subcutaneous tumor (adipose tissue) between skin and underlying muscle layer
A
Lipoma
24
Q
Benign subcutaneous cyst filled with cells and waxy material called sebum. Comes from a blocked sweat gland.
A
Sebaceous cyst
25
what is the source for a "clean" wound infection?
patient skin, environment, or surgical team
26
is the contaminant for a "clean" wound more likely to be gram positive or negative
positive
27
What is a "clean-contaminated" wound?
Surgical wound that enters the GI, respiratory, or GU tract without significant spillage
28
What is a "contaminated" wound?
surgical wound in which extensive spillage from GI tract occurs; fresh traumatic wound, wound in which major break in sterile technique occurs
29
What is a dirty wound?
wound that contains dirt, fecal material, purulence, or other foreign material
high risk of infection
30
All tissues, including skin, are closed with suture material after completion of the operation -- what kind of intention?
Primary intention
31
The wound is left open and closes naturally overtime without sutures (can have a dressing to collect fluids) -- what kind of intention?
Secondary intention
32
Wound is left open for a number of days and then closed if it is found to be clean -- what type of intention?
Third
33
What two bacteria cause fever and wound infection in the first 24 hours of surgery?
Streptococcus and clostridium
34
How long does it take for a wound to begin to epithelize?
24-48 hours
35
What can be given to patients taking steroids to promote wound healing?
Vitamin A
36
What are the four boundaries of the axilla for dissection?
Superior boundary -- axillary vein
Posterior boundary -- long thoracic nerve
Lateral boundary -- lattisimus dorsi muscle
Medial boundary -- lateral to, deep to, or medial to pectoral minor muscle, depending on level of nodes taken
37
What are the four nerves that you must be aware of during an axially dissection?
1. Long Thoracic Nerve
2. Thoracodorsal Nerve
3. Medial pectoral Nerve
4. Lateral pectoral Nerve
38
Cutting the _____ nerve will result in winged scapula?
thoracic
39
suspensory breast ligaments are called?
cooper's ligament
40
Nulliparity, early age of menarche, late age of menopause, cancer of the breast (in self or family) or pregnancy with first child greater than 30 are all risk factors for?
breast cancer
41
Most common site for breast cancer to occur?
Upper outer quadrant
42
What is the most common type of breast cancer?
Infiltrating ductal carcinoma
43
Pre-op staging workup for breast cancer consists of?
bilateral mammogram -- cancer in one breast is risk factor for cancer in contralateral breast
CxR -- to assess for lung mets
LFTs -- to assess for liver mets
Serum calcium and alk phos -- assess for bone mets
44
What staging system is used for breast CA?
TMN -- tumor/metastases/nodes
45
Where is the most common site for breast cancer to metastasize to?
Lymph nodes
Then lung, liver, bones, brain
46
Women in her mid-30s presents to clinic with a painful, tender, mass in her breast. She states it comes and goes with her cycle. Think of?
Fibrocystic disease
47
Most common breast tumor in women less than 30. Benign tumor of breast consisting of stromal overgrowth collagen arranged in swirls
Fibroadenoma
48
What is the most common cause of cancer death in both males and females in the US?
Bronchogenic carcinoma
49
What type of lung cancer arises in non-smokers?
Adenocarcinoma
50
Change in chronic cough, weight loss, hemoptysis, chest pain, dyspnea, pleural effusions, and clubbing are all symptoms of?
lung cancer
51
What kind of lung cancer spreads early and cannot be treated with surgery?
Small cell lung cancer. Aka "oat cell" carcinoma
52
What are the three types of non-small cell lung cancer
1. Squamous
2. Adenocarcinoma
3. Large cell
53
Presents with periumbilical pain that migrates to the RLQ. Often accompanied with nausea and vomiting.
Appendicitis
54
Does pain precede nausea/vomiting in appendicitis or vice versa?
Pain, then nausea/vomiting
Gastroenteritis is nausea/vomiting, then pain
55
Does a positive UA rule out appendicitis?
No. Mild hematuria and pyuria is common in appendicitis with pelvic inflammation resulting in inflammation of the ureter
56
What are common CT findings for someone with appendicitis?
periappendiceal fat stranding, appendiceal diameter >6mm, periappendiceal fluid, fecolith
57
treatment for non-perforated acute appendicitis?
prompt appendectomy to prevent perforation, 24 hours of abx, d/c usually on POD #1
58
What bacteria are most commonly associated with cholecystitis?
E. coli, klebsiella
59
What is the initial test of choice when suspecting gallstones?
Ultrasound
60
What is the gold standard for diagnosing cholecystitis?
HIDA scan
61
What is the difference between acute and chronic cholecystitis?
Acute is sudden inflammation of the gallbladder that causes marked abdominal pain, often with nausea, vomiting, and fever.
Chronic is a lower intensity inflammation of the gallbladder that lasts a long time. It may cause intermittent abdominal pain, or no symptoms at all.
62
what is the difference between primary and secondary peritonitis?
Primary peritonitis is an infection that develops in the peritoneum
Secondary peritonitis usually develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum (ruptured appendix, diverticulum, stomach ulcer, etc)
63
Severe abdominal pain out of proportion to physical exam. Pain is usually poorly localized. N/V/D.
Acute mesenteric ischemia
64
Gold standard for diagnosing acute mesenteric ischemia?
CT angiogram
65
What is the most common type of neoplastic polyp?
Tubular adenomas -- usually pedunculated
66
What is the most dangerous type of neoplastic polyp?
Villous adenomas - usually sessile and look like brocooli heads
67
Where are most colon polyps found?
Rectosigmoid
68
Are gastric or duodenal ulcers more likely to be bothersome immediately after eating?
Gastric
69
What is Ranson's criteria?
Helps assess the severity of pancreatitis
70
What is the APACHEII?
Used to assess the severity of pancreatitis
71
What is the most common hernia?
Indirect inguinal
72
Where is the most common place for diverticulitis to occur?
Sigmoid colon
73
what must be done 6 weeks after a diverticulitis flare?
colonoscopy
74
What is a Hartmann's procedure?
Surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy. Used to treat colon cancer or inflammation
75
What are the two most common causes of pancreatitis?
Alcohol and gallstones
76
what is the best imaging option for pancreatitis?
CT
77
Treatment for pancreatitis?
NPO, no EtOH, supportive care (fluids, pain control)
78
Why is it important to repair hernias?
Should be repaired to avoid complications of incarceration/strangulation, bowel necrosis, SBO, pain
79
Is a small hernia or a large hernia more dangerous?
small because it is at an increased risk of strangulation
80
What is the difference between incarcerated and strangulated?
Incarcerated -- swollen or fixed within the hernia sac; may cause interstitial obstruction
Strangulated -- incarcerated hernia with resulting ischemia
81
Is a direct hernia within or not within Hesselbach's triangle?
Within
82
What is the most common type of hernia in kids?
Direct inguinal
83
what type of hernias have the highest risk of stranglulation?
femoral
indirect are more at risk than direct
84
what is a temporary absence of the normal contractile movements of the intestinal wall?
ileus
85
what are common causes of ileus?
abdominal surgery and drugs (opioid and anticholinergics) that interfere with intestinal movements
86
Treatment for ileus?
NPO, IV fluids, NG tube (to help relieve pressure)
87
Dilated loops of bowel on x-ray should make you think of?
Bowel obstruction
88
Twisting of the intestine in on itself
Volvulus
89
What is the most common site to experience an volvulus?
sigmoid and cecum because they are "floppy"
90
What is a coffee bean sign on x-ray? kidney bean sign?
coffee bean -- sigmoid volvulus
kidney bean -- cecal volvulus
91
Engorgement of the venous plexuses of the rectum
Hemorrhoids
92
if patient has excruciating anal pain and history of hemorrhoids, the most likely diagnosis is?
thrombosed external hemorrhoid
93
What disease is contraindicated for hemorrhoidectomy ?
crohn's disease
94
what must be ruled out with a lower GI bleed believed to be caused by hemorrhoids?
colon cancer
