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Surgery > Jeopardy > Flashcards

Jeopardy Flashcards

1
Q

Critical maneuver in the surgical treatment of Zenker’s diverticulum

A

Zenker’s diverticulum = esophageal diverticulum, sac-like outpouching thru a weakness in the muscle

Critical maneuver = cricomyectomy/cricopharyngeal myotomy = cutting of the cricopharyngeal muscle

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2
Q

Most common cause of lower GI bleed

A

Diverticular disease

2nd = AVM

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3
Q

Most common nerve injured during an inguinal hernia repair

A

Ilioinguinal nerve

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4
Q

62 yo M w/ hematuria, flank pain, and right renal mass

(a) Dx
(b) Tx

A

(a) renal cell carcinoma until proven otherwise

(b) remove kidney

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5
Q

Most cause of portal HTN in the US

A

Alcoholic cirrhosis

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6
Q

Makeup of NS

A

Normal saline has Na and Cl: 154 of both

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7
Q

Margins for a 3mm thick melanoma

A

2 cm

-all melanomes of 2 mm or more depth get 2cm margins

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8
Q

If pt w/ APC mutation of chromosome 5 gets colon removed at age 20, what further maintenance is required

A

APC mutation on chromosome 5 = FAP (familal adenomatous polyposis)

After prophylactic complete colectomy at 20, still need yearly EGD to screen for duodenal carcinoma

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9
Q

3 buckets of etiologies for mesenteric ischemia

A
  1. Arterial embolism/thrombosis- if have an emboli or clot that blocks the splanchnic blood supply
    - ex: cardiac embolism, atherosclerotic disease, thrombosed mesenteric aneurysm, aortic/mesenteric dissection
  2. Venous thrombosis- hypercoagulable state, malignancy, prior abdominal surgery
  3. Nonocclusive mesenteric ischemia- from splanchnic hypoperfusion and vasoconstriction (ex: hypovolemic shock)
    - most commonly affects watershed areas of the colon that have limited collateralization
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10
Q

Type of IBD w/ transmural involvement

A

Chron’s

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11
Q

Beck’s triad

(a) What does it indicate?
(b) Name the three parts

A

Beck’s triad = cardiac tamponade

(b) Distended neck veins, hypotension, muffled heart sounds

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12
Q

Tx for hydrogen fluoride burn

A

Calcium gluconate

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13
Q

2 genetic syndromes that carry organ removal early on in life for cancer prophylaxis

A

MEN2- prophylactic thyroid removal due to 100% risk of medullary thyroid cancer

FAP (APC mutation)- ppx colon removal at age 20

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14
Q

Immediate actions to prevent rhabdo

A

Tons of IV fluids

-alkalinize urine

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15
Q

First line in mgmt of anal fissures

A

Physical exam: if posterior and midline w/o perianal skin tags, can start first line tx of

  • constipation relief: fiber, stool softener
  • topical analgesia
  • topical nifedipine or topical nitroglycerin

If Not midline, presence of perianal skin tags- must work up for Chron’s

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16
Q

Peritoneal-lined abdominal wall defect

A

Omphalocele
-50% cardiac defects

While without peritoneal lined = gastrochiesis

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17
Q

Most common valvular abnormality secondary to an MI

A

Mitral valve prolapse

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18
Q

Vitamin that reverses effect of steroids on wound healing

A

Steroids hinder wound healing, thought that vitamin A reverses that effect

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19
Q

Which has a better prognosis: gastrochiesis or omphalocele?

A

Gastrochesis has better outcome b/c omphalocele (peritoneal lined) has almost 50% chance of concomitant cardiac defect

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20
Q

What is Eisgenmenger’s syndrome?

A

When a congenital left to right shunt causes pulmonary HTN and eventual reversal of the shunt into a cyanotic right to left shunt

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21
Q

Pulsatile right groin mass 4 hrs s/p cardiac cath

Dx

A

Pseudoaneurysm of femoral vein
-from blood collection when catheter removed too gradually from femoral vein

Tx = inject thrombin

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22
Q

Workup when suspecting mesenteric ischemia

A

Patient HDS? Yes- Abdominal CT, if suspicious for mesenteric ischemia do mesenteric arteriogram

If HDUS, resuscitate w/ IVF, empiric abx, get plain abdominal film to look for free air/signs of advanced ischemia

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23
Q

What UV ray is associated w/ melanoma

A

UV B

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24
Q

Treatment plan for rectal cancer 1cm above the dentate line

A

APR = abdominal peritoneal resection w/ neoadjuvant chemo

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25
Q

Which anorectal entity can be treated w/ botox

A

Anal fissure- if fails conservative medical management (topical analgesia and nifedipine, relief of constipation), can turn to surgery or botulinum toxin

-botulinum toxin over surgery in pts at high risk for incontinence (multiparous F and older pts)

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26
Q

First branch of the abdominal aorta

A

Phrenic artery

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27
Q

General goal of fluid resuscitation in burn victim used over Parkland formula

A

Usually give fluids until urine output is about 1-1.5cc per ml of fluid (LR) given

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28
Q

Shortcut for maintenance fluids

A

Just add 40 to wt if pt is over 20 kg

Ex: maintenance fluids for 70 kg pt = 110 cc/hr

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29
Q

What is priaprism?

A

Erection lasting 8 or more hours

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30
Q

Where is the blood coming from if: Pringle maneuver being performed but the pt is still bleeding from the liver

A

Pringle maneuver = compression of the portal triad = compressing portal vein, hepatic artery, and CBD

So if still bleeding blood is coming from the hepatic vein (only one not compressed)

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31
Q

Why does TPN have to be administered thru a central line?

A

B/c it’s hyperosmolar- if put directly into small veins in the arm it would cause direct sclerosis

-central line or PICC line

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32
Q

Most common type of breast cancer

A

Invasive ductal carcinoma

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33
Q

Cause of pneumaturia in pt w/ acute sigmoid diverticulitis

A

Vesical fistula = fistula btwn bladder and colon

-pneumaturia = air in the urine

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34
Q

Most common endocrine tumor of the pancreas

A

Insulinoma = most common

If gastrinoma, suspect MEN1 (much less common)

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35
Q

What is the urachus?

A

Urachus = fibrous remnant of the allantois, connection btwn bladder and umbilicus

36
Q

Pt w/ hematemesis morning after binge drinking

A

Mallory-Weiss tear 2/2 repetitive wretching during vomiting

37
Q

Calf pain and associated ABIs, what happens under the following ABC (ankle brachial index)

under .9
under .5
under .3

A

Under .9 = intermittent clauddication
Under .5 = rest pain
Under .3 = ulcers/skin break down

38
Q

Features of MEN2B

A
  1. Medullary thyroid cancer
  2. Pheochromocytoma
  3. Marfanoid habitus
  4. Mucosal neuromas in 100%
39
Q

Features of MEN1

A

3 P’s: pancreatic, parathyroid, pituitary

  1. Pancreatic tumor- gastinoma
  2. Parathyroid gland hyperplasia
  3. Pituitary tumor = prolactinoma
40
Q

When to suspect hemobilia

A

Hemobilia = bleeding into biliary tree (GI bleed) b/c of fistula btwn artery and bile duct
-suspect it when pt presents w/ jaundice, GI bleed w/ recent liver injury or instrumentation (ex: TIPs, biopsy, trauma)

41
Q

Gene associated strongly w/ male breast cancer

A

BRCA2

BRCA2- 10% risk of breast cancer in male

42
Q

Cardiac chamber most commonly injured by penetrating trauma

A

Right ventricle

-sits the most anteriorly

43
Q

What artery is involved if a duodenal ulcer is bleeding?

A

Gastroduodenal artery

-from the common hepatic artery of the celiac trunk

44
Q

72 yo F w/ loop of bowel medial to the femoral vein on CT

Dx?

A

Femoral hernia

Mneumonic for lateral to medial is NAVAL: nerve, artery, vein, ___ (space where hernia goes), lymphatics

45
Q

Mgmt of 83 yo M w/ sigmoid volvulus

A

Immediately: flexible sigmoidoscopy to reduce it, then definitive surgery to prevent recurrence
-sigmoidectomy (removal of sigmoid colon) a few days after once stabilized, or immediately if can’t reduce w/ sigmoidoscopy

46
Q

32 yo M in MVA
HR 40, BP 80/38

What type of shock is he in?

A

Neurogenic shock

  • hypovolemic/septic would have tachycardia if BP was so low
  • low HR shows spinal cord injury
47
Q

In Budd-Chiari, what part of the liver can continue to drain into the IVC

A

Budd-Chiari = hepatic vein thrombosis
-caudate lobe is basically it’s own separate lobe, it has it’s own vein draining into the IVC, so it will maintain drainage in Budd-Chiari

48
Q

Mediastinal tumor associated w/ myasthenia gravis

A

Thymoma

49
Q

83 yo M w/ LBO and dilated U-shaped area of colon

Dx?

A

Sigmoid volvulus

‘coffee-bean’ shape on abdominal plain film

50
Q

Most common form of anal cancer

A

Squamous cell

51
Q

Most common site of lower extremity atherosclerotic occlusion

A

Superficial femoral artery

52
Q

Hemorrhoids

(a) Which causes pain
(b) Which causes BRB per rectum

A

Hemorrhoids

(a) Only external hemhorroids are painful (unless internal prolapse) b/c internal are above the dentate/pectinate line
(b) Internal hemorrhoids bleed

53
Q

Name for transient monocular blindness

A

Amaurosis fugax

54
Q

Most common organ injured in blunt trauma

A

Spleen

55
Q

Embryonic malformation causing midgut volvulus

A

Malrotation

56
Q

Acute left shoulder pain upon passive elevation of legs

Dx

A

= Kher’s sign- sign of blood or air in peritoneal cavity

-classically a sign of splenic rupture

57
Q

Which brachial plexus do the parathyroid glands come from

A

Inferior parathyroids come from the third brachial plexus

Superior parathyroids come from the fourth brachial plexus

58
Q

Vitamin needed for collagen cross linking

A

Vitamin C

59
Q

Clinical significance of PCWP

A

Pulmonary capillary wedge pressure- measured by Swan Ganz catheter into pulmonary arteries, is used as an indirect measure of left atrial pressure

  • diagnostic for LV failure, MS, cause of acute pulmonary edema
    ex: acute pulmonary edema w/ normal PCWP = ARDS
60
Q

Features of MEN2A

A
  1. Medullary thyroid cancer (100%)
    - ppx remove thyroid at 6 mo
  2. Pheochromocytoma
  3. Parathyoid hyperplasia
    - 4 gland hyperplasia
61
Q

Predominant type of collagen present 6 weeks after surgery

A

Type I collagen

62
Q

75 yo F w/ symptomatic 79% ICA stenosis

Next step?

A

Carotid endarterectomy

-for anything above 70% stenosis and below 99% (already fully occluded at 99%…)

63
Q

Maintenance fluids for a 60 kg pt

A

60 kg pt- 100 cc/hr of maintenance fluids

4-2-1 rule, or shortcut of just adding 40 to wt

64
Q

Cell type

(a) First to the scene for wound healing
(b) Most important for wound healing
(c) Deposits collagein

A

Cell type

(a) Platelets are first on the scene
(b) Macrophages are the most important for wound synthesis
(c) Fibroblasts deposit collagen

65
Q

Name the 2 watershed areas of the colon

A

Splenic flexure and rectosigmoid junction

-have minimal collateral blood supply => fastest to be affected by splanchnic hypoperfusion

66
Q

Most common source of emboli to the lower extremity

A

The hearttttt

67
Q

Treatment for squamous cell anal cancer

A

Nigro protocop = pre-operative use of chemotherapy and medical radiation for squamous cell carcinoma of the anus
-tx NOT excision

68
Q

2 weeks s/p liver trauma pt presents w/ jaundice and hematemesis

Dx?

A

Hemobilia = bleeding into the biliary tree b/c of fistula btwn splanchnic vessel and a bile duct

  • consider after liver injury or instrumentation
  • artery anastamoses to bile duct => bleeding into the duodenum
  • jaundice 2/2 hemolysis
69
Q

Tonicity of fluids for the first 24 hrs post-op

A

Isotonic

70
Q

Liver tumor in 25 yo F w/ RUQ pain and intraabdominal hemorrhage

A

Hepatic adenoma

-RF = OCP use

71
Q

Where does the thoracic duct drain into?

A

Left subclavian vein

72
Q

An isolated lower extremity crush injury puts what organ system at risk of failure?

A

Kidneys
Nephrotoxicity from rhabdo: all blood gets crushed in the trapped limb => hemolysis => rhabdo
-damage to kidneys from myoglobin

73
Q

Pt presents w/ Charcot’s triad

(a) First line
(b) Next step if don’t improve w/ first line therapy

A

Charcot’s triad = fever, RUQ pain, jaundice = presentation of cholangitis

(a) Give abx and fluids, then if pt improves schedule elective choley
(b) If pt doesn’t improve w/ abx and fluids, assumption that stone is in CBD => do ERCP to remove stone in the common bile duct

74
Q

What is the definitive tx for anal sphincters

A

Lateral sphincter removal (lateral internal sphincterectomy)
-only once medical management has been failed and endoscopy has ruled out Chron’s

75
Q

G-cells

(a) Location
(b) Function

A

G-cells

(a) antrum of the stomach
(b) Secrete gastrin to stimulate secretion of HCl

76
Q

What solution is used for fluid resuscitation in burn victims?

A 
Use LR (not NS!!!!) 
-NS in super high volumes can cause hyperchloremic metabolic acidosis (b/c has 154 Cl)
77
Q

52 yo M w/ epigastric pain and free air in the abdomen on plain film

A

Ruptured gastric ulcer

78
Q

Most common bladder cancer

A

Transitional cell carcinoma- arising from transitional epithelium
-most common cancer of the GU system, second most common cancer of the kidney

79
Q

62 yo M p/w severe epigastric pain, diaphoresis, dyspnea, and rales

Dx?

A

Acute MI

80
Q

Percent of body surface burned if both arms are affected

A

18%

-each arm is 9% in an adult

81
Q

32 yo F w/ cecal volvulus

Treatment

A

Cecal volvulus = rotation/torsion of a mobile cecum and ascending colon, which can progress to ischemia, necrosis, perforation

Tx for cecal volvulus = right hemicolectomy

82
Q

Most common solid tumor in children

(a) Under 2 yo
(b) Over 2 yo

A

Solid tumors in children

a) Under 2 yo = neuroblastoma
(b) Over 2 yo = nephroblastoma (Wilm’s

83
Q

Treatment for testicular torsion

A

Untwist and hope it reperfuses…

If you go to the OR to untwist, do bilateral untorsion and fixation b/c other side is at high risk

84
Q

Pancreatic tumor associated w/ necrotizing skin process

A

Glucagonoma

  • necrolytic migratory erythema strongly associated w/ glucagonoma
  • red patches commonly affecting limbs and skin around the mouth
85
Q

Procedure for resolved gallstone pancreatitis

A

Lap choley

-40% cases of pancreatitis caused by gallstones, so once acute phase is calmed down, tx w/ lap choley

86
Q

Keloid vs. hypertrophic scar

(a) Biggest differentiator
(b) Prognosis

A

Keloid = tissue extends beyond the border of the original wound, while they don’t extend in hypertrophic scar

Hypertrophic scars may spontaneously resolve, while keloids are unlikely to

87
Q

64 yo M w/ postprandial abdominal pain w/ bloody diarrhea

A

Mesenteric ischemia- classically have pain out of proportion to physical exam

Surgery (10 decks)

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