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High Yield Surgery-Emma Holliday > High Yield Surgery > Flashcards

High Yield Surgery Flashcards

1
Q

Absolute CI to surgery?

Poor nutrition CI to surgery?

Severe liver failure criteria as CI to surgery?

A

Diabetic coma and DKA

Albumin <3, transferrin <200, weight loss <20%

Bili >2, PT >16, NH3 > 150 or encephalopathy

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2
Q

Goldmans index:

  • If CHF, what should you check?
  • If MI within 6 mo, what should you check?
A

CHF: check EF, if <35, no surgery

MI: EKG –> stress test –> cardiac cath –> revasc.

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3
Q

type of vent used in ARDS or CHF and why?

A

PEEP –> pressure given at the end of cycle to keep alveoli open

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4
Q

best test to evaluate management of a patient on a vent?

What do you do if PaO2 is low? High?

What do you do if PaCO2 is low (pH is high)? PaCO2 is high (pH is low)?

A

Get an ABG

PaO2 is low=Increase FiO2

PaO2 is high=Decrease FiO2

PaCO2 is low (pH high)=Decrease rate or TV

PaCO2 is high (pH is low)=increase rate or TV

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5
Q

causes of non-gap acidosis?

A

diarrhea
diuretics
RTAs

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6
Q

tx for hyponatremia? what If hypovolemic?

A

Tx-Fluid restriction and diuretics

If hypovolemic-Norma saline

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7
Q

Tx for hypernatremia? What would you worry about?

A

Tx-Replace w/D5W or hypotonic fluid

Worry about cerebral edema

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8
Q

Numbness, + Chvostek or Trousseaeu sign, prolonged QT interval?

A

Hypocalcemia

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9
Q

Bones, stones, groans, psycho moans. Shortened QT interval?

A

Hypercalcemia

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10
Q

Paralysis, ileum, ST depression, U waves? Tx?

A

Hypokalemia

Give K+, max 40 mEq/hr

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11
Q

Peaked T waves, prolonged PR and QRS, sine waves? Tx?

A

Hyperkalemia

Give CaGluconate –> then insulin plus glucose –> then Kayexalate, albuterol and NaHCO3

Last resort=dialysis

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12
Q

Formula for Maintenance IVFs and fluids to use?

A

Use D5 1/2 NS + 20 KCl (if peeing)

1st 10 kg=100 ml/kg/day
Next 10 kg=50 ml/kg/day
Above 20=20 ml/kg/day

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13
Q

tx for circumferential burns?

A

consider echarotomy

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14
Q

pt with confusion, HA, cherry red skin? Best test? Tx?

A

CO poisoning

Best test=Check carboxyHb (pulse ox=worthless)

Tx=100% O2 (hyperbaric if CO-Hb is increased significantly)

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15
Q

clotting, edema, HTN, and foamy pee?

A

nephrotic syndrome

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16
Q

clotting in a post op pt, low platelets? Tx how?

A

HIT (if hearing within 5-14 days)

Tx with leparudin or argatroban

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17
Q

bleeding and an isolated decrease in platelets?

A

ITP

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18
Q

bleeding with normal platelets but increased bleeding time and PTT?

A

vWD

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19
Q

Bleeding, low plts, increased PT/PTT/BT, low fibrinogen, high D-dimer, and schistocytes?

A

DIC

Caused by GN sepsis, carcinomatosis, OB stuff

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20
Q

Parkland formula for burn fluid replacement? fluid type?

A

Kg x %BSA x 3-4

LR or NS

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21
Q

Name the topical solution for burn tx:

  • Doesnt penetrate eschar and can cause leukopenia?
  • Pentetrates eschar but hurts like hell?
  • Doesnt penetrate eschar and causes hypoK and hypoNa?
A

Silver sulfadiazine

Mafenide

Silver nitrate

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22
Q

best 1st step in an electrical burn? if abnormal?

A

EKG

48 hrs of telemetry (also if LOC)

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23
Q

in a burn pt, if affected extremity is extremely tender, numb, white, cold with barely dopplerable pulses? tx?

A

compartment syndrome –> 5 Ps or compartment pressure >30 mm Hg

Tx=Fasciotomy

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24
Q

Name some scenarios that require intubation in a trauma pt?

A
  • Unconscious
  • GCS < 8
  • Stung by bee, develops stridor, tripod posturing
  • Stabbed in neck, GCS=15, expanding mass in lateral neck
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25
Q

Airway for guy stabbed in neck, crackly sounds w/palpating anterior neck tissues?

A

fiberoptic bronchoscope

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26
Q

Airway for guy with huge facial trauma, blood obscures oral and nasal airway, and GCS of 7?

A

cricothyroidotomy

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27
Q

a pt has inward movement of the right ribcage on inspiration? Tx?

A

Flail chest = >3 consecutive rib fx

Tx=O2 and pain control

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28
Q

pt has confusion, petechial rash in chest, axilla, and neck, and acute SOB? When do you suspect this?

A

Fat embolism

After long bone fx (i.e., femur)

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29
Q

a pt dies suddenly after a 3rd yr med student removes a central line? when else can you suspect this dx?

A

air embolism

lung trauma, vent use, during heart vessel surgery

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30
Q

muffled heart sounds, JVD, electrical alternans, pulsus paradoxus? Confirmatory test? Tx?

A

Pericardial tamponade

FAST scan

Needle decompression, pericardial window or median sternotomy

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31
Q

Decreased breath sounds on one side, tracheal deviation away from collapsed lung? Next best step?

A

tension pneumothorax

needle decompression followed by chest tube

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32
Q

hypotensive, tachycardic, diaphoretic, cool and clammy extremities. Type of shock and tx?

A

Hypovolemic

Crystalloid resuscitation

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33
Q

AMS, hypotensive, warm, dry extremities (early), later hypotensive, tachycardia, cool and clammy. Type of shock and tx?

A

Vasogenic

Fluid resuscitation and tx offending org

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34
Q

Hypotensive, bradycardic, warm, dry extremities, absent reflexes and flaccid tone. Type of shock and tx?

A

Neurogenic

If adrenal insuff, tx with dexamethasone and taper over several weeks

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35
Q

Hypotensive, tachycardic, JVD, decreased heart sounds, normal breath sounds, pulsus paradoxus. Type of shock and tx?

A

Cardiocompressive (tamponade)

Tx is pericardiocentesis

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36
Q

SOB, clammy extremities, rales b/l, S3, pleural effusion decreased breath sounds, ascites, peripheral edema. Type of shock and tx?

A

Cardiogenic

Give diuretics up front, tx the HR to 60-100, then address rhythm. Give vasopressor support if necessary

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37
Q

Penetrating trauma to the following zones dx and/or tx:

Zone 1
Zone 2
Zone 3

A

Zone 1=Aortography and triple endoscopy

Zone 2=2D doppler +/- exploratory surgery

Zone 3=Aortography

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38
Q

Next best step in GSW to abdomen?

A

ex-lap + tetanus ppx

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39
Q

next best step if stab wound to abdomen, pt unstable, with rebound tenderness and rigidity, or w/evisceration?

A

ex-lap + tetanus ppx

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40
Q

next best step in abd stab wound but pt is stable?

A

FAST exam. DPL if FAST is equivocal

Ex-lap if either are positive

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41
Q

next best step in blunt abd trauma pt with hypotension/tachycardia?

A

ex-lap

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42
Q

next best step if you see air under the diaphragm in a chest/abd X-ray?

A

directly go to ex-lap

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43
Q

next best step if blunt abd trauma and unstable?

A

ex-lap

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44
Q

next best step if blunt abd trauma and stable?

A

abdominal CT

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45
Q

blunt abd trauma, lower rib fx plus bleeding into abdomen?

A

spleen or liver laceration

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46
Q

blunt abd trauma, lower rib fx plus hematuria?

A

kidney laceration

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47
Q

blunt abd trauma, kehr sign and viscera in thorax on cxr?

A

diaphragm rupture

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48
Q

blunt abd trauma and handle bar sign?

A

pancreatic rupture

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49
Q

blunt abd trauma, stable with epigastric pain. Next best test? what if retroperitoneal fluid is found?

A

abdominal CT

consider duodenal rupture

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50
Q

pelvic trauma, hypotensive, tachycardia. Next best step?

A

FAST and DPL to r/o bleeding in abd cavity

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51
Q

blood at urethral meatus and high riding prostate. next best test?

A

Retrograde urethrogram. Consider pelvic fx w/urethral or bladder injury

If retrograde urethrogram is normal, do a retrograde cystogram to evaluate bladder

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52
Q

tx for exztraperitoneal extravastation from bladder rupture? What about intraperitoneal?

A

extra=Bed rest + foley

intra=Ex-lap and surgical repair

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53
Q

how do you manage the following fx’s:

  • Depressed skull fx
  • Severely displaced or angulated fx
  • Open fx (bone sticking out of skin)
  • Femoral neck or intertrochanteric fx
A

Go to the OR

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54
Q

Shoulder pain s/p seizure or electrical shock?

A

post shoulder dislocation

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55
Q

arm outwardly rotated and numbness over deltoid?

A

ant should d/l

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56
Q

old lady FOOSH, distal radius displaced?

A

Colles fx

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57
Q

Punched a wall?

A

metacarpal neck fx (Boxers fx)

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58
Q

Where is the clavicle most commonly broken? how to tx?

A

between middle and distal 1/3

figure of 8 device

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59
Q

fever post-op day 1, MC cause, low five (<101) and nonproductive cough? How to dx and tx?

A

atelectasis

Dx with CXR-b/l lower lobe fluffy infiltrates

Tx with mobilization and incentive spirometry

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60
Q

fever post-op day 1, high fever (>101), very ill appearing?

A

nec fasc

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61
Q

pattern of spread of nec fasc in a pt post-op day 1? Common bugs? Tx?

A

SubQ along Scarpas fascia

GABHS or C perfringens

IV PCN, go to OR and debride skin until it bleeds

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62
Q

fever post-op day 1, high fever (>104), muscle rigidity? what is it caused by? genetic defect? tx?

A

Malignant hyperthermia

Succinylcholine or Halothane

Ryanodine receptor gene defect

Dantrolene Na (blocks RYR and decreases IC Ca)

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63
Q

fever POD 3-5, productive cough, diaphoresis, lobe infiltrate? tx?

A

pneumonia

check sputum sample for culture, cover with moxi to cover S pneumonia in mean time

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64
Q

fever POD 3-5, dysuria, frequency, urgency, pt has a foley? Next best test? Tx?

A

UTI

UA (nitrite and LE) and culture

Change foley and tx with wide-spec abx until culture returns

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65
Q

Fever POD 7, pain and tenderness at IV site? tx?

A

Central line infx

Blood cx from the line. Pull it. Abx to cover staph

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66
Q

Fever POD 7, pain at incision site, edema, induration? Tx?

A

Cellulitis

Blood cx and start abx

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67
Q

Fever POD 7, pain at incision site, induration with drainage? tx?

A

Simple wound info

Open wound and repack. No abx necessary

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68
Q

Fever POD 7, pain with salmon colored fluid from incision? Tx?

A

Dehiscence

surgical emergency! Go to OR, IV abx, primary closure of fascia

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69
Q

Unexplained fever POD 7? Dx? Tx?

A

Abdominal abscess

CT w/oral, IV, and rectal contrast to find it. Diagnostic lap

Drain it! Percutaneously, IR-guided, or surgically

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70
Q

SubQ destruction into the muscle. What ulcer stage?

A

3

4=involvement of joint or bone
1=skin intact but red. blanches with pressure
2=blister or break in the dermis

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71
Q

How to tx stage 1-2 ulcers?

A

get special mattress, barrier protection

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72
Q

how to tx stage 3-4 ulcers?

A

get flap reconstruction surgery

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73
Q

RA, TB, and malignant or PE cause what type of pleural effusion?

A

transudative

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74
Q

transudative pleural effusion and low pleural glucose?

A

RA

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75
Q

transudative pleural effusion and high lymphocytes?

A

TB

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76
Q

translative pleural effusion and bloody?

A

malignant or PE

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77
Q

What is Light’s criteria?

A

Translative pleural effusion if:

  • LDH <200
  • LDH eff/serum < 0.6
  • Protein eff/serum < 0.5
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78
Q

MC CA in non-smokers?

A

AdenoCA

Occurs in scars of old pneumonia

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79
Q

Where does lung CA MC metastasize?

A

bone, brain, liver, adrenals

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80
Q

characteristic of effusion in pt with lung CA?

A

exudative with high hyaluronidase

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81
Q

Pt with kidney stones, constipation and malaise, low PTH and central lung mass?

A

Squamous cell CA

Paraneopastic syndrome 2/2 secretion of PTH-rP. Low PO4, High Ca

82
Q

Pt with weight loss, cough, dyspnea, hemoptysis, repeated pneumonia. Has shoulder pain, ptosis, constricted pupil and facial edema?

A

Superior sulcus syndrome from Small Cell CA. A Central CA

83
Q

Pt with lung CA sx, ptosis that is better after 1 min of upward gaze?

A

Lambert eaton syndrome from Small Cell CA. Ab to pre-synaptic Ca channels

84
Q

Pt with lung CA sx, old smoker presenting with Na=125, moist mucous membranes, no JVD?

A

SIADH from small cell CA. Produces euvolemic hyponatremia

Fluid restrict +/- 3% saline in <112

85
Q

Pt with lung CA sx, CXR showing peripheral cavitation and CT showing distant mets?

A

Large cell CA

86
Q

tx for ARDS?

A

Mechanical ventilation with PEEP

87
Q

SEM, cresc/decresc, louder with squatting, softer w/ valsalva

A

AS

88
Q

SEM, louder with valsalva, softer with squatting or handgrip

A

HOCM

89
Q

Late systolic murmur with click, louder with valsalva and handgrip, softer with squatting

A

MV prolapse

90
Q

Holosystolic murmur radiates to axilla with left atrial enlargement

A

mitral regurgitation

91
Q

Holosystolic murmur with late diastolic rumble in kiddos

A

VSD

92
Q

continuous machine-like murmur

A

PDA

93
Q

wide, fixed, and split S2

A

ASD

94
Q

Rumbling diastolic murmur with an opening snap, left atrial enlargement, and A fib

A

Mitral stenosis

95
Q

blowing disastolic murmur with widened pulse pressure and eponym parade

A

aortic regurgitation

96
Q

Bad breath and snacks in the AM? Tx? True or false diverticulum?

A

Zenkers diverticulum
Surgery
False

97
Q

Dysphagia to liquids and solids, birds beak appearance? Tx?

A

Achalasia

Tx with CCB, nitrates, botox, or Heller myotomy

98
Q

Dysphagia worse with hot and cold liquids plus chest pain that feels like MI w/ nighttime regurg? Tx?

A

Diffuse esophageal spasm

Tx with CCB or nitrates

99
Q

Epigastric pain worse after eating or when laying down, cough, wheeze, hoarseness? Most sensitive test? What if danger signs? Tx? Indications for surgery?

A

GERD

Most sensitive test=24 hr pH monitoring.

Danger signs=Endoscopy

Tx=Behavior modification 1st, then antacids, H2 block, PPI

Surgery=bleeding stricture, Barretts, incompetent LES, max dose PPI w/ still sx, or no want meds

100
Q

If hematemesis (blood occurs after vomiting, w/ subQ emphysema), can see pleural effusion with increased amylase? Next best test? Tx?

A

Boerhaave’s –> esoph rupture

CXR, Gastrograffin esophagram. NO ENDOSCOPY

Tx with surgical repair if full thickness

101
Q

If gross hematemesis unprovoked in a cirrhotic w/portal HTN?

A

gastric varices

102
Q

what if ruptured gastric varices and in hypovolemic shock? Tx of choice?

A

do ABCs, NG lavage, medical tx with octreotide or SS. Balloon tamponade only if you need to stabilize for transport

Endoscopic sclerotherapy or banding

103
Q

How to tx asymptomatic gastric varices?

A

B blockers

104
Q

Best 1st test if suspecting esophageal carcinoma?

A

barium swallow, then endoscopy with biopsy, then staging CT

105
Q

Work up for MEG pain worse with eating (gastric ulcer)?

A

Double-contrast barium swallow - punched out lesion with regular margins

EGD with bx can tell H pylori, malignant/b9

106
Q

Surgery for gastric ulcer if?

A

lesion persists after 12 wks of tx

107
Q

MEG pain better with eating? Biggest association? Dx? Tx?

A

Duodenal ulcer

95% assoc with H pylori

Dx with blood, stool, or breath test for H pylori but Endoscopy with biopsy (CLO test) is BEST b/c it can also exclude CA

Tx is PPI, clarithromycin, and amoxicillin for 2 weeks. Breath or stool test can be test of cure

108
Q

What to suspect if MEG pain/ulcers don’t resolve? Best test? Tx? What else to look for?

A

ZE syndrome

Secretin stim test (find inappropriately high gastrin)

surgical resection of pancreatic/duodenal tumor

Look for pituitary and parathyroid problems

109
Q

Pt has bilious vomiting and post-prandial pain. Recently lost 200 lbs on “Biggest loser”? Pathophys? Tx?

A

SMA syndrome

3rd part of duodenum compressed by AA and SMA

Restore weight/nutrition. Can do Roux-en-Y

110
Q

large, nontender GB, itching and jaundice, migratory thrombophlebitis should suspect what?

A

Pancreatic adenoCA

111
Q

Tx pancreatic adenoCA with Whipple if?

A

no mets outside abdomen, no extension into SMA or portal vein, no liver mets, no peritoneal mets

112
Q

sweaty, tremors, hunger, seizures, blood glucose <45, and sxs resolve with glucose administration? What will labs show?

A

insulinoma

increased insulin, C peptide, and pro-insulin

113
Q

hyperglycemia, diarrhea, weight loss, and necrolytic migratory erythema?

A

glucagonoma

114
Q

Malabsorption, steatorrhea, ect from exocrine pancreas malfx?

A

somatostatinoma

115
Q

watery diarrhea, hypoK, dehydration, and flushing? Tx?

A

VIPoma (looks like a carcinoid)

Octreotide can help sxs

116
Q

Res for cholangiocarcinoma?

A

PSC (UC)
Liver flukes
thorotrast exposure

Tx with surgery +/- radiation

117
Q

AST=2x ALT is ___

AST > ALT (high 1000’s) is __

AST and ALT high s/p hemorrhage, surgery, or sepsis is ___

A

alcoholic hepatitis (reversible)

viral hepatitis

Shock liver

118
Q

RFs for HCC?

Dx with what?

Tx?

A

Chronic Hep B > Hep C
Cirrhosis for any reason
Aflatoxin
CCl4

Dx with high AFP (in 70%), CT/MRI

Tx: can surgically remove solitary mass, use rads or cryoablation for palliation of multiple

119
Q

RUQ pain, profuse sweating and rigors, palpable liver? Tx?

A

entamoeba histolytica

Tx with MTZ. DONT DRAIN!

120
Q

Pt from Mexico has RUQ and large liver cysts found on U/S has what? Mode of transmission? Labs? Tx?

A

Echinococcus

Hydatid cyst parasite from dog feces

Eosinophilia + Casoni skin test

Albendazole and surgery to remove entire cyst, rupture —> anaphylaxis

121
Q

Isolated thrombocytopenia (bleeding gums, petechiae, nosebleeds), decreased plt count, incr megakaryocytic in marrow, no splenomegaly?

A

ITP

Tx with steroids 1st. If relapse –> splenectomy

122
Q

Hemolytic anemia (jaundice, incr indir bili, LDH, der haptoglobin, elev retic count) + round RBCs on smear and + osmotic fragility test and prone to gallstones?

A

Hereditary spherocytosis

Tx with splenectomy

123
Q

Aside from the diarrhea and wheezing, what else to look out for in carcinoid syndrome?

A

diarrhea, dermatitis, dementia

124
Q

If carcinoid is >2 cm at base of appendix or w/ + nodes….next best step? Otherwise?

A

Hemicolectomy

Otherwise, appendectomy is good enough

125
Q

1st test in a SBO? Tx?

A

1st test=upright CXR to look for free air. CT can show point of obstruction

Tx with IVF, NG tube

Surgery if peritoneal signs, incr WBC, no improvement within 48 hrs

126
Q

If a pt has ogilvies syndrome, >10 cm colonic distention, what should you do?

A

need decompression with NG tube and neostigmine (watch for bradycardia) or colonoscopies decompression

127
Q

where do you see indirect inguinal hernias?

A

through inguinal ring, lateral to epigastric vessels in spermatic cord

R>L
More often congenital –> patent processus vaginalis

128
Q

where do you see direct inguinal hernias?

A

through Hasselbecks triangle, medial to epigastric vessels

More often acquired weakness

129
Q

Which IBD involves terminal ileum?

Which IBD is continuous involving rectum?

A

Crohns. Mimics appendicitis. Fe deficiency

UC. Rarely ill backwash but never higher

130
Q

Which IBD increases risk for PSC?

Which IBD is fistulae more likely?

A

UC. PSC leads to higher risk of cholangiocarcinoma

Crohns. Give MTZ

131
Q

Which IBD do you see granulomas on bx?

Which IBD is transmural inflammatory?

A

Crohns for both

132
Q

Which IBD is cured by colectomy?

Which IBD do smokers have lower risk?

A

Both UC

UC needs colonoscopy 8-10 yrs after dx

Smokers have higher risk for crohns

133
Q

Which IBD has highest risk of colon CA?

Which IBD assoc with p-ANCA?

A

Both UC

134
Q

What is tx to maintain remission of IBD?

What is tx to induce remission of IBD?

A

ASA, Sulfasalazine to maintain remission

Corticosteroids to induce remission

135
Q

What should you give to a crohns pt for any ulcer or abscess? What about severe dz?

A

Give MTZ for ulcer or abscess

Azathioprine, 6MP, and MTX for severe dz

136
Q

What is best way to evaluate for abscess in diverticulitis?

A

CT=best imaging

NO BARIUM ENEMA!

137
Q

Tx for diverticulitis?

A

NPO
NG suction
IVF
Broad spec abs and pain control

Do colonoscopy 4-6 wks later

138
Q

when is surgery indicated in diverticulitis?

A

multiple episodes, age <50. Elective is better than emergency (can do primary anastomosis)

139
Q

in colorectal CA, which sided bleeds and which side obstructs?

A

right=bleeds

left=obstructs

140
Q

who gets screened for AAA?

A

men 65-75 who have ever smoked. do abdominal US

141
Q

Tx for AAA <5 cm and asx?

A

monitor growth every 3-12 mos

142
Q

surgery indicated for AAA when?

A

> 5 cm, growing <4 mm/yr

143
Q

1 cause of death from post-op complications of AAA repair? Other complications?

A

MI=#1 cause of death

Bloody diarrhea-Ischemic colitis

Weakness, decreased pain w/ preserved vibr, prop=ASA syndrome

1-2 yrs later if have brisk GI bleeding=Aortoenteric fistula

144
Q

Pt has acute abd pain w/ A fib, sub therapeutic on warfarin or pt s/p high dose vasoconstrictors (shock, bypass). Dx? Workup? Tx?

A

Acute mesenteric ischemia=Surgical emergency

Work up is angiography (aorta and SMA/IMA)

Tx is embolectomy. If thrombus, or aortomesenteri bypass

145
Q

__ is a slow progressing stenosis (req stenosis of 2.5 vessels –> Celiac, SMA, IMA). Pt has severe MEG pain after eating, food fear and weight loss (pain out of proportion to exam). How to dx? How to tx?

A

Chronic mesenteric ischemia

Dx with duplex or angiography

Tx w/ aortomesenteric bypass or trans aortic mesenteric endarterectomy

146
Q

Best test for claudication?

Normal=?
Claudication & ulcers=?
Limb ischemia=?
Gangrene=?

A

ABI

Normal > 1

Claudication and ulcers= 0.4-0.8, use med mgmt

Limb ischemia= 0.2-0.4, surgery indicated

Gangrene= <0.2, may require amputation

147
Q

how to dx DVT? Tx? Complications?

A

Dx with duplex US and also check for PE

Tx w/ heparin then overlap with warfarin for 5 days, then continue warfarin for 3-6 mos

Complications- Post-phlebotic syndrome= chronic valvular incompetence, cyanosis, and edema

148
Q

Right heart strain on EKG, sinus tach, decr vascular markings of lungs on CXR, wedge infarct, ABG with low CO2 and O2 indicates what?

A

PE

149
Q

If suspect PE, what should you do?

A

give heparin 1st

Then work up w/ V/Q scan then spiral CT

Pulm angiography is gold standard

150
Q

When to use IVC filter in pt with PE?

A

contraindications to chronic coagulation

151
Q

you check the TSH in a pt with a thyroid nodule and it is low. Next best step?

A

Do RAIU to find “hot nodule”. Excise or radioactive I-131

152
Q

You check the TSH in a pt with a thyroid nodule and it is normal. Next best step?

A

FNA

153
Q

You check the TSH in a pt with a thyroid nodule and it is normal, and FNA is b9. Next best step? What if it is malignant? what if indeterminate?

A

b9=leave it alone

malignant=surgically excise and check pathology

indeterminate=re-biopsy or check RAIU

154
Q

What to do if you have cold thyroid nodule?

A

surgically excise and check pathology

155
Q

This thyroid CA is MC type, spreads via lymph, psammoma bodies

A

Papillary

156
Q

This thyroid CA spreads via blood, must surgically excise the whole thyroid

A

follicular

157
Q

this thyroid CA assoc with MENII (look for pheo, hyperCa). Amyloid/Calci.

A

medullary

158
Q

This thyroid CA has 80% mortality within 1st year

A

Anaplastic

159
Q

fibrocystic change –> cysts that are painful and change with menses. Fluid is typically green or straw colored. Ways to tx or prevent?

A

restrict caffeine
Vitamin E
Supportive bra

160
Q

Tx for DCIS?

A

either excision with clear margins
OR
Simple mastectomy if multiple lesions (no node sampling) plus adjuvant RT

161
Q

if a pt has infiltrating ductal/lobular carcinoma and is small and away from the nipple….tx?

A

lumpectomy with axillary node sampling. Adjuvant RT.

Chemo if node +

Tamoxifen or Raloxifen if ER+

162
Q

Dx and tx of BCC of skin?

A

Shave or punch bx then surgical removal (Mohs)

163
Q

Precursor lesion for SCC? How to tx?

A

Actinic keratosis

Excisional bx at edge of lesion, then wide local excision

164
Q

which melanoma has best prognosis/most common? Poor prognosis?

A

Superficial spreading=Best/MC

Nodular=Poor

165
Q

Melanoma of palms, soles, mucous membranes in darker complected races?

A

Acrolintiginous

166
Q

Melanoma of head and neck that has good prognosis?

A

Lentigo maligna

167
Q

Dx of melanoma?

Tx of melanoma if:
<1 mm thick __
1-4 mm thick __
>4 mm thick__

A

Dx with full thickness bx b/c depth is #1 prog

1 cm margin if <1 mm thick

2 cm margin if 1-4 mm thick

3 cm margin if >3 mm thick

168
Q

midline neck mass that moves with the tongue? tx?

A

thyroglossal duct cyst

surgical removal

169
Q

neck mass anterior to SCM?

A

brachial cleft cyst

170
Q

neck mass that is spongy, diffuse and lateral to SCM?

A

cystic hygroma (turners, downs, klinefelters)

171
Q

most frequent oral cancer? who do you see it in? tx?

A

Squamous cell

smokers and drinkers

Tx with radiotherapy or radical dissection (jaw/neck)

172
Q

MC salivary gland tumor, usually on parotid?

A

pleomorphic adenoma

173
Q

papillary cyst adenoma lymphomatosum. Benign on parotid gland, can injury facial n. (look for palsy sxs)?

A

warthlins tumor

174
Q

baby is born w/ resp distress, scaphoid abdomen? Biggest concern? Best tx?

A

diaphragmatic hernia

Pulm hypoplasia

If dx prenatally, plan delivery at place with ECMO. Let lungs mature 3-4 days then do surgery

175
Q

baby is born with resp distress w/ excess drooling? Best dx test?

A

TE-fistula

place feeding tube, take X-ray, see it coiled in thorax

176
Q

defect lateral (usually right) of midline, no sac? Assoc with other d/o’s? complications?

A

Gastroschisis (will see high maternal AFP)

Not usually assoc with other d/os

may be athletic or necrotic requiring removal. Short gut syndrome

177
Q

Defect in the midline covered by sac?

A

omphalocele

178
Q

Defect in the midline, no bowel present? assoc with other d/o’s? tx?

A

Umbilical hernia

ASsoc with congenital hypothyroidism and big tongue

repair not needed unless persists beyond age 2-3

179
Q

1 wk old baby with bilious vomiting, draws up his legs, has abd distention? pathophys?

A

malrotation and volvulus (Ladd’s bands can kink the duodenum)

Doesn’t rotate 270 degrees ccw around SMA

180
Q

dx and tx of meconium ileus? gold standard dx of hirschsprungs?

A

gastrograffin enema

bx showing no ganglia

181
Q

5 day old former 33 weaker develops bloody diarrhea? what do you see on X-ray? tx? RF’s?

A

necrotizing enterocolitis

Pneumocystis intestinalis

NPO, TPN (if nec) , abc and resection of necrotic bowel

Premature gut, introduction of feeds, formula

182
Q

2 mo old baby has colicky abd pain and currant jelly stool with sausage shaped mass in RUQ? Dx and tx?

A

Intussusception

Barium enema for dx and tx

183
Q

medical tx for BPH?

A

tamsulosin or finasteride

184
Q

you feel nodules on DRE and have elevated/rising PSA levels. Next best step?

A

transracial US and bx. Bone scan looks for blastic lesions

185
Q

tx for prostate ca?

A

surgery
radiation
leuprolide or flutamide

186
Q

best test for a kidney stone? tx for <5 mm? Tx if >5 mm? Tx if >2 cm?

A

CT is best test

<5 mm=hydrate and let pass

> 5 mm=shock wave lithotripsy

> 2 cm=surgical removal

187
Q

acute pain and swelling with high riding testis? best test? tx?

A

Testicular torsion

Do STAT doppler US –> no flow

Surgically salvage if <6 hrs. Do orchiopexy to BOTH balls

188
Q

4-5 y/o with a painless limp?

A

leg-calve-perthes dz (avascular necrosis)

189
Q

12-13 yo kid with knee pain or sickle cell pt?

A

SCFE (avascular necrosis)

190
Q

Codmans triangle and sunburst appearance seen in distal femur, proximal tibia at metaphysis, around the knee?

A

osteosarcoma

191
Q

seen at diaphysis of long bones, night pain, fever, and elevated ESR. Lytic bone lesion, “onion skinning”, neuroendocrine (small blue) tumor?

A

Ewing sarcoma

192
Q

hyperactute rejection occurs with vascular thrombosis within minutes and caused by __

A

preformed Abs

193
Q

Acute rejection is due to what cells?

A

T cells

194
Q

Tx for acute transplant rejection?

A

steroid bolus and anti lymphocyte agent (OKT3)

195
Q

Chronic rejection due to what cells? tx?

A

T cells

Cant tx it. need re-transplantation

196
Q

Why give epi with lidocaine?

A

to prevent systemic absorption –> numb tongue, seizures, hypotension, bradycardia, arrythmias

197
Q

places to not give lidocaine with epi?

A

fingers
nose
penis
toes

198
Q

caution using meperidine anesthetic in who?

A

pts with renal failure –> can lower seizure threshold

199
Q

who to not use succinylcholine?

A

not for burn or crush victim since it can cause hyperK and malignant hyperthermia

200
Q

this anesthetic can cause malignant hyperthermia and liver toxicity

A

halothane

give dantrolene Na

High Yield Surgery-Emma Holliday (1 decks)

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