Hernia & General

Question 1

What technique should be used for femoral hernia repair

Answer 1

McVay/Cooper because it closes the femoral canal defect without incorporating mesh

Question 2

Management of dialysis-related peritonitis

Answer 2

Give empiric intraperitoneal antibiotics; if sepsis, give IV (catheter removal only indicated if no response after 5d or relapsing peritonitis)

Question 3

Patient with PD catheter presenting with dialysate retention and watery diarrhea

Answer 3

Bowel wall erosion

Question 4

Operative repair of rectus diastasis

Answer 4

Plicate the broad midline aponeurosis

Question 5

Absolute contraindications to laparoscopic hernia repair

Answer 5

Active infection, strangulated hernia, and inability to tolerate pnemoperitoneum

Question 6

Most common trimester for appendicitis in pregnancy

Answer 6

2nd trimester

Question 7

Risk of fetal loss with appendicitis in pregnancy

Answer 7

Non-perforated: 2%
Complicated: 6%

Question 8

Most common hernia in males and females

Answer 8

Indirect Inguinal hernia

Question 9

Richter hernia

Answer 9

Contains antimesenteric border of bowel (usually distal ileum)

Question 10

Littre hernia

Answer 10

Contains meckels diverticulum

Question 11

Cause of direct Inguinal hernia

Answer 11

Weakness in floor of Inguinal canal (transversalis fascia)

Question 12

Most commonly injured nerves in laparoscopic Inguinal hernia repair

Answer 12

Genitofemoral and lateral femoral cutaneous

Question 13

Borders of triangle of doom

Answer 13

Vas deferens, spermatic vessels

Question 14

Borders of hernia triangle of pain

Answer 14

Spermatic vessels, iliopubic tract, and peritoneal fold

Question 15

Symptoms and physical exam in obturator hernia

Answer 15

Pain from Inguinal crease to anterimedial aspect of thigh, exacerbated by medial rotation of thigh
Loss of adductor reflex, positive patellar reflex

Question 16

Region for spigelian hernia

Answer 16

At the level of the arcuate line, between semilunar line and lateral border of rectus abdominis

Question 17

Grynfeltt hernia

Answer 17

Superior lumbar hernia: between latissmus Dorsi, serratus posterior, and posterior border of internal oblique

Question 18

Hernia of petit

Answer 18

Inferior lumbar hernia: latismuss dorsi, iliac crest, and posterior border of external oblique

Question 19

Management of parastomal hernia

Answer 19

Transabdominal repair with mesh underlay (primary repair has high recurrence rates)

Question 20

Most common etiology of a mesenteric cystic mass

Answer 20

Cystic lymphangioma

Question 21

Management of Chylothorax

Answer 21

If low output (<1L/d) conservative management
If >1L/d or refractory: thoracic duct ligation or embolization

Question 22

Most common cause of chylous ascites in West

Answer 22

Lymphoma (TB in developing countries)

Question 23

SAAG for portal hypertension

Answer 23

> 1.1
(Serum albumin-ascites albumin)

Question 24

Desmoid tumor genetic syndromes

Answer 24

FAP and Gardner syndrome

Question 25

Management of desmoid tumor

Answer 25

If >7cm and symptomatic: wide local excision with frozen section

Question 26

Effect of pneumoperitoneum on urine output

Answer 26

Decreased due to decreased renal perfusion and increase in ADH

Question 27

Effect of pneumoperitoneum on brain

Answer 27

Increased cerebral blood flow and MAP

Question 28

Effect of pneumoperitoneum on lungs

Answer 28

Decreased pulmonary compliance

Question 29

How to assess celiac lymph node basin intraop

Answer 29

Place US probe on left lobe of liver or on hepatoduodenal ligament

Question 30

Types of rectus sheath hematomas

Answer 30

1: small, does not cross midline or dissect fascia planes
2: confined to rectus but crosses midline/fascial planes
3: below actuate line, large, blood in prevesical space