High Yield: Surgery 2 Flashcards
1
Q
Describe: Fistula of the GI tract (3)
A
- can have enterocutaneous fistula
- succus entericus (intestinal contents), color green
- tx: replacing electrolytes, lactacted ringer fluids
2
Q
What’s the workup of dysphagia? (3)
A
- barium swallow
- except if older with alarm sx (microcytic anemia that points to chronic bleeding, weight loss): with dysphagia, use endoscopie
- if iron deficiency anemia + older patient: colosnocopy
3
Q
Differentiate Mallory-Weiss and Boerhaave syndrome (3)
A
- Mallory-Weiss:
- Tear of the mucosa of the esophagus at the lower oesophagal sphincter, superficial, happens with people who vomit a lot
- Boerhaave syndrome
- super severe, complete transmural perforation of the esophagus, releases air in mediastinum, called pneumomediastinum (on chest x-ray widened mediastinum + crepitus)
- #1 cause: endoscopy
4
Q
Describe dx and tx: Mallory-Weiss (2)
A
- dx: endoscopy
- if actively bleeding, ablate it. if not bleeding, leave it alone
5
Q
Describe dx and tx: Boerhaave syndrome (2)
A
- dx: gastrografin swallow
- tx: surgery
6
Q
H.pylori can cause 2 types of cancers, name them
A
- Gastric adenocarcinoma
- Malt lymphoma
- if you tx and eradiate malt lymphoma, the malt lymphoma will go away
7
Q
Name the two most common causes of stomach ulcers
A
- NSAID
- H.Pyloric
8
Q
Name two most common causes of bowel obstructions
A
- Hernia
- Adhesions secondary to surgery
9
Q
Describe tx: Small bowel distension (4)
A
Bowl rest regimen
- NG suction
- NPO
- IV fluids
- If no improvement: surgery
10
Q
Describe: Pseudomembranous colitis (5)
A
- caused by C.Diff
- caused by atb broad spect use.
- fever
- leucocytosis
- diarrhea
11
Q
Name most common atb broad spect that causes: Pseudomembranous colitis (2)
A
- cephalosporin
- clindamycin
12
Q
Describe dx and tx: Pseudomembranous colitis (2)
A
- dx: stool toxin A and B
- tx: ORAL vancomycin
13
Q
Ulcerative colitis is associated with what? (2)
A
- Associated with toxic megacolon and primary sclerosing cholangitis
14
Q
What’s first line tx of anal fissure? (3)
A
- Topical nitroglyceren
- Calcium channel blockers
- Sitz Bath
15
Q
Describe: Perforated bowel (4)
A
- pneumoperitonium
- board-like rigidity
- suden onsent
- not want to move
16
Q
Describe: Acute mesentaric ischemia (3)
A
- like an MI of the mesentaric acteries
- pain out of proportion to physical exam (worst abdominal pain, but physical exam no tenderness, no peritonitis or rigidity)
- RF atherosclerosis disease: HTA, smoking, DLP, DB
17
Q
Describe dx: Acute mesentaric ischemia (1)
A
CT angiogram
18
Q
Describe: Pyogenic liver abscess (3)
A
- secondary to acute ascending cholangitis
- dx: CT
- tx: percutaneous drainage
19
Q
Describe: Acute ascending cholangitis (4)
A
Charcot’s triad
- jaundice
- fever
- right upper quadrant abdominal pain
- Renald’s pentad: Charcot’s triad + AEC + hypotension
20
Q
Describe: Entamoeba histolytica (4)
A
- can cause Amebic liver abscess
- Vignette of patient
- from south America
- RUQ pain
- diarrhea
21
Q
Describe tx: Entamoeba histolytica (1)
A
metronidazole
22
Q
Describe: Echinococcus (4)
A
- Associated with south america
- Dogs
- US: Abscess in liver with multiple little cysts
- needs to be removed surgically
23
Q
Name first step: Cholecystitis
A
RUQ ultrasound (2/3 criteria)
- Gallbladder wall thickening > 4mm
- pericholecystic fluid
- Gallstone
24
Q
Describe tx: Cholecystitis
A
Cholecystectomy within 72h
25
If on RUQ of suspected cholecystitis, only less than 2/3 criteria are met? (2)
* Dx unclear
* Next step: HYDA scan
26
Describe labs and ultrasound: Choledolythiasis (3)
* ⬆️ Alkaline Phosphatase (ALP)
* ⬆️ Direct bilirubin
* RUQ ultrasound: dilation of the common bile duct **\> 6 mm**
27
How to tx: Choledolythiasis (1)
ERCP
28
Name complications: Choledolythiasis (2)
* Ascending cholangitis (and a complication of Ascending cholangitis is pyogenic liver abscess)
* jammed in sphincter of Oddi -\> backflow of pancreatic juices -\> gallstone pancreatitis
29
Describe sx : Pancreatitis (1)
* Epigastric pain radiates to back
30
Describe labs: Pancreatitis (2)
* ⬆️ **amylase**
* **⬆️** **lipase**
31
Describe dx: Pancreatitis (1)
**RUQ ultrasound (not CT)**
* to find source of pancreatitis, most common is **gallstone** and **alcohol** use -\> cholecystectomy during hospital visit
32
Name common complication and what to do: Pancreatitis (2)
* few weeks later, **pancreatic pseudocyst**
* postprandial fullness
* early satiety
* abdominal distension
* vague abdominal pain
* CT of the abdomen will show pancreatic pseudocyst
* leave this alone unless **bigger than 6 cm (drain)**
33
Name greatest RF for breast cancer? And osteoporosis? Stroke?
* Breast cancer, osteopororis: Age
* Stroke: HTA
34
How to dx pheochromocytoma (2)
* Metanephrines
* Follow up with CT scan of adrenal glands to look for mass
35
Describe: Pheochromocytoma (4)
* Due to hypercatecholaminia
* Paroxysmal hypertension
* Nerveness
* Headache
36
Name cases where you'd do a bowel rest regimen (4)
* Panceatitis
* Small bowel obstruction
* Volvulus
* Diverticulitis
37
Describe the difference between direct hernia, indirect and femoral
* direct:
* "old man hernia"
* acquired most of the time
* least likely to incarcenate
* **medial to the inferior epigastric arteria**
* indirect:
* usually congenital
* due to patent processus vaginalis, intestines will herniate in inguinal ring, down to scrotum
* **lateral to the inferior epigastric arteria** femoral:
* femoral
* usually females
* (lateral to medial) nerve -\> artery -\> vein -\> empty space -\> lymphatics
* occupy the empty, medial to the vein
* most likely to incarcerate
38
Describe: Ombilical hernia in kid (1)
* Usually reassurance, it'll go away before 5 yo
39
Describe tx: Acalculus cholycistitis
* ICU patients who have been on Total parenteral nutrition (TPN) for a long time or due to systemic ischemia
* tx: cholecystostomy tube
40
Describe: Congenital diaphragmatic hernias (3)
* Bowel in the left lung usually
* **First thing to do: Intubate patient (for a few days to let lungs mature)**
* Surgery later
41
Describe: Mid gut volvulus (3)
* Double bubble sign with air distal to that
* Distal air can also present with corkscrew sign
* Imagerie: Upper GI study (barrium swallow with x-ray)
42
Describe: Necrotizing enterocolitis (4)
* Associated with premature kid that feeds too early
* Hematochizea
* pneumatosis intestinalis (air in bowel wall) -\> surgical intervertion
* otherwise, IV ATB + fluids
43
Describe: Meconium ileus (2)
* **Fecal** **plug** at the terminal ileum, due to cystic fibrosis where stool too dry and gets stuck -\> proximal backflow with small bowel obstruction
* **Dilated loops of small bowel + ground glass appearance** in lower abdomen
44
Describe dx and tx: Meconium ileus (3)
* dx and tx: gastrografin enema
45
Describe: Interception (3)
* causes ischemia of telescoped part
* **jelly stool**
* **colicky pain** (comes and go) vs volvulus (constant pain + no/ billius vo)
46
Describe tx: Interception (1)
**air enema**
47
## Footnote
Describe: Meckel's diverticulum (3)
* retained remnant of the embryonic vitelline duct
* sx due to to ectopic gastric and pancreatic tissue in RLQ
* **Painless hematochizia**
48
Describe: Cryptorchidie (2)
* Increased risk of malignancy and infertility
* tx: orchidopexie by age 1 (reduces risk of infertility but not reduce risk of malignance)
49
When to do aortic stenosis valve replacement? (3)
When they have sx
* CHF
* Angina
* Syncopie
50
When to do coronary artery bypass graft (CABG)? (2)
* if there's 3 vessel disease or
* proximal left anterior descending artery has 70% stenosis
51
If you do chest x-ray and there's a new nodule, what's the best next step? (2)
* look for old xray to compare
* if no old x-ray, chest CT of the chest and abdomen
52
What do you have to measure before you do lung surgery? (2)
* FEV1: amount of air you can force from your lungs in one second
* after lung surgery, there has to be at least 800 ml of FEV1, otherwise you can't do it
53
Who's at an increased risk of aspiration? (5)
* On ventilator
* Alcoholics
* Epilepsia
* Dementia
* Stroke
leads to right lower lobe pneumonia or abscesses
54
Describe tx: Aspiration pneumonia
* usually colonized anaerobic bacteria -\> Clindamacine
55
Describe: Subclavian steal syndrome (4)
* due to stenosis of the proximal subclavian artery
* use one arm (ex: left) and do bicep curls, suddenly feel lightheaded + dizziness, only when using the affected arm
* dx: duplex scanning
* tx: bypass surgery
56
Describe: Abdominal aortic aneuvrysm (4)
* Repair it if \> 5 cm
* or growing \> 1 cm /year
* tx: percutaneous stent
* screening : 65 y.o. who has smoked with abdominal ultrasound
57
Describe dx and tx: Peripheral artery disease (3)
* dx: ankle brachial index
* 0.4 - 0.9: peripheral artery disease -\> exercise
* \< 0.4: severe -\> stent or bypass
* medically: aspirin + statin
58
Describe: Aortic dissection (5)
* widened mediastinum on chest xray
* tearing chest radiating to back
* dx: CT angio or transesophageal echo or MRI echo (for renal disease)
* type A dissection: proximal to left subclavian (ascending arch is involved) -\> tx surgery
* Anterior Pain, Ascending Arch
* type B dissection: distal to left subclavian -\> tx beta blocker
* Back Pain
59
Differentiate: Basal cell carcinoma vs Squamous cell carcinoma
* Basal cell carcinoma: Pearly telangiectasias
* Squamous cell carcinoma
60
Describe importance of tx of strabismus (2)
* if young child: needs to be correct amblyopia (permanent vision loss = loss of vision from under stimulation of the retina and visual cortex during the early years)
* older: refractory difficulty, tx is glasses
61
Describe: Acute angle glaucoma (4)
* severe eye pain
* halo around lights
* pupil is dilated and fixed
* eye rock hard
62
Describe tx: Acute angle glaucoma (4)
* laser beams that drills through iris for aqueous humour drainage
* betablocker (minimise aqueous humour production)
* pilocarpine (induce miosis, allow more myosis)
* Carbonic Anhydrase Inhibitors (ex: acetazolamide)
63
Describe: Orbital cellulitis (5)
* Preseptal (Periorbital):
* Anterior to the septum of the eyelid
* no blurry vision or pain
* Postseptal (Orbital)
* blue vision + pain
* emergency
* Dx: Emergency CT scan if postseptal
64
If Squamous cell carcinoma of the head and neck in old men who smokes, drinks and has rotten teeth, what do you do? (3)
* Triple endoscopy looking for primary tumors (in pharynx, trachea, and oesophegas), CT to check for spread of sx
* Persistent hoarsness -\> laryngeal cancer
* Persistent painless ulcer in floor of mouth -\> Squamous cell carcinoma of mouth
* Persistent unilateral earache -\> Cancer in pharynx that is blocking the eustachian tube
65
If the internal carotid artery is stenosed greater than 70% with sx, what's the best next step?
Carotid endarterectomy
66
With sx of stroke, what's the next best step? (3)
* Head CT WITHOUT contrast to r/o hemorrhage
* If not hemorrhage, proceed with Thrombolytic therapy
* If hemorrhage, blood pressure control with calcium channel blocker (ex: nifedipine)
67
What's tx of prolactionma? (2)
* Carbergoline or bromocriptine (dopamine agonists, dopamine suppresses prolactin release)
68
Describe dx of acromegaly or gigantism (1)
* ⬆️ IGF-1 levels (what's released by live after growth hormone stimulates it)
69
Describe: Brain abscess (3)
* Fever
* Brain tumor sx: HA, projectile vomiting, nausea, eye pressure, etc
* Usually caused by ENT infections near by (ex: bacterial sinusitis that progresses to the brain)
70
Describe dx and tx: Brain abscess (2)
* Dx: CT head **WITH** **contrast**
* Tx: Resection or incision+Drainage
71
If sx brain tumor (worsening headache, morning headache, projectile vomiting), name imgary
MRI brain
72
Differentiate epididymitis (4) and testicular torsion (4)
* epididymitis :
* fever, pyuria, tender cord
* main causes:
* young: gono, clam
* old: E.colo
* testicular torsion :
* no fever, no tender cord
* no cremasteric reflex
73
Describe tx: Epididymitis (2)
* young: ceftriaxone + arithro
* old: fluoroquinolone
74
Describe dx and tx: Testicular torsion (2)
* dx: **doppler** scrotum to check for blood flow
* tx: **surgical** emergency -\> **BILATERAL** orchiopexy bc increased risk of torsion of the other testical
75
If someone has kidney stone and leads to fever, what's next step?
**Percutaneous nephrostomy tube (emergency)**, to allow fluid to drain out so it doesn't worsens hydronephrosis
76
If you have sx of Pneumaturia (“gas” in the urine), what's most likely cause? (2)
* Diverticulitis, bc can cause fistulas from bowel to bladder (enterovesical fistula), can cause air to be urinared, can also cause fecaluria
* Crohn's disease (also associated with fistula)
77
Name types of transplant rejection (4)
1. Hyperactuce rejection = **minutes**
* due to performed antibodies = vascular **thrombosis** = type 2 hypersensitivity
2. Acute rejection = **days to months**, organ function failuare
* tx = steroid bolules
* dx = biopsy
3. Chronic rejection = **years**
* organ function failure
* tx: retransplant
4. Graft versus host disease (GvHD) = **multiple areas of body affected**
* CD8 T killer cells response against host
* immune system from donated organ starts attacking the host
* very systemic (elevated LFT, creat, rash, diarrhea, etc)
78
Describe: Red blood cell transfusion reactions
Timing is key
1. 30 s = IgA def, anaphylaxis
* tx: IM epinephrine + fluids
2. 30 mins = ABO incompatibility, flank pain, hypotension
* Tx: IVF, discontinue transfusion
* iatrogenic mistake
3. 3 hours = febrile = cytokines in blood transfusion = prevent with leukoreduction
* tx: self-limited
4. 3 days = delayed hemolytic = jaundice
* tx: self-limited
