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Surgery > Lange > Flashcards

Lange Flashcards

1
Q

Hidraenitis supperativa

A

infection of apocrine glands and surrounding subcutaneous tissue and fascia involing axilla, groin, perineum, and perianal region. Usu with staph or strep.
can treat with local hygeine and tetracycline.

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2
Q

Aromatase inhibitors or tamixofen/raloxifene -which one is better in post-menopausal women in preventing breast cancer recurrence

A

aromatase inhibitors

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3
Q

fine or coarse calcifications on mammogram -which has more likelihood of benign pathology?

A

coarse calcifications

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4
Q

If you suspect pagets disease of breast due to eczematous changes, what to biopsy?

A

nipple biopsy will show large vacuolated cells

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5
Q

In breast cancer, radiation therapy is required whenever breast conserving surgery is undertaken. When do you give hormones and/or chemo?

A

hormones if ER+/PR+

chemo if tumor is > 1 cm

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6
Q

How to treat someone who’s pregnant with breast cancer

A

chemo can be given after 1st trimester
radiation therapy is not allowed
so breast conserving surgery is not appropriate if radiation is not allowed

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7
Q

Bone is the most common metastasis from breast cancer. usu lytic or blastic?

A

lytic

can be treated with bisphosphonates

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8
Q

Breast cancer with linear “indian file” arrangement of tumor cells and a tendency to grow circumferentially around ducts and lobules.

A

Infiltrating lobular carcinoma

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9
Q

WHich vessel is at risk when doing a tracheostomy?

A

anterior jugular vein

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10
Q

dysphagia and aspiration can result from disruption of which nerve

A

internal branch of superior laryngeal nerve leading to sensory loss of larynx

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11
Q

Most common cause of primary mediastinal tumor is

A

neurogenic tumor usu arising from an intercostal nerve or sympathetic ganglion

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12
Q

How does spinal anesthesia work

A

induces venous vasodilation b/c of sympathetic blockade

Venous pooling can seriously impair venous return and decrease CO therefore it is impt that pt has adequate volume

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13
Q

Which cancer accounts for 70-80% of SVC syndrome

A

bronchogenic carcinoma

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14
Q

Knife at above second rib at level of inferior margin of fourth thoracic vertebrae.

A

arch of the aorta

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15
Q

Nonfunctioning lung tissue that is disconnected from the remaining lung with a separate blood supply

A

bronchopulmonary sequestration

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16
Q

Nasopharygneal cancer affects Asians with high titers of EBV. whats the first CN to be affected which will indicate cranial met

A

CNVI -abducens nerve

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17
Q

Carotid body tumor is the most common type of paraganglioma int he head and neck region. They may secrete? Supplied by which artery?

A

secrete catecholamines
supply by external carotid artery
arise from structures that respond to changes in PO2

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18
Q

Most common site for foreign bodies in head and neck

A

ear

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19
Q

epistaxis in children vs elderly involves

A

children -anterior septum

elderly -posterior septum

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20
Q

After thyroid surgery, cannot sing high pitch anymore. What’s affected

A

external larygneal nerve which supplies the cricothyroid muscle responsible for tensing the cords

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21
Q

EKG -low voltage precordially
Exam reveals pulsus paradoxus
What test is good to assess problem

A

ECHO for pericardial effusion/tamponade

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22
Q

SOmeone with MI, CHF, and PVCs may benefit from

A

internal cardiac defibrillator as most freq cause of death in this pop is ventricular arrhythmia

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23
Q

When do you have to do surgery or percutaneous balloon valvuloplasty (now used as initial approach) for pulmonary stenosis

A

moderate to severe stenosis (right ventricular/pulmonary gradient of 50-80 mmHg)

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24
Q

When will you perform gastrectomy in someone with peptic ulcer disease?

A

not common so if done, due to hemorrhage, obstruction, perforation and intractable pain

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25
Q

A gastric ulcer that fails to respond to medical therapy requires

A

surgical intervention -partial gastrectomy

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26
Q

Preferred treatment for non-hodgkin’s lymphoma in the stomach

A

radiation and chemotheraphy

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27
Q

Gastric ulceration with a donut sign

A

GIST (usually can resect; no chemo/radiation)

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28
Q

Acute gastric distension can occur after surgery with symptoms of pallor, sweating, bradycardia, hypotensin, abd pain. What to do

A

NG tube

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29
Q

When you do a vagotomy, it can result in stasis. A gastric drainage procedure should be done with it. What are three

A
  • pyloroplasty
  • gastrojejunostomy
  • antrectomy

*drainage procedure is not necessary if you do a highly selective vagotomy

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30
Q

Pts with pernicious anemia have increased risk of developing which malignancy

A

gastric

31
Q

Epiphrenic diverticulum aka supradiaphragmic diverticulum is a pulsion diverticulum assoc with which 4 conditions. It is located with 10 cm of the cardia. and is usu asymptomatic

A
  • hiatal hernia
  • achalasia
  • DES
  • miscellaneous
32
Q

Plummer-Vinson syndrome is described as an upper esophageal web leading to dysphagia, atrophic oral mucosa, spoon-shaped brittle nails, and iron def anemia. There is an increased risk of developing esophageal cancer. Once, endoscopy reveals the esophageal web, what should be the next step

A

dilatation of the web

iron therapy

33
Q

Schatski’s ring is a thin, circumferential scar in the lower esophagus, more common in men 65 or greater. It is acquired, most likeyl from repeated trauma leading to chronic inflam and fibrosis. How to treat

A

endoscopic dilation

PPI or H2 blockers can help as GERD can be assoc

34
Q

How does asking a patient to attempt sitting up help evaluate a mass whether its from abdominal wall or the abdominal cavity

A

An abdominal mass will still be palpable while an intraabdominal one may not be. This is called fothergill’s sign

35
Q

Why has prostaglandin E (misoprostol) which is effective in protecting gastric mucosa has not been useful in managing erosive gastritis

A

bc of diarrhea as side effect

36
Q

T/F: gastric bypass patients can initially lose up to 2/3rds of the weight.

A

True

37
Q

Pts with impaired gastric emptying from previous gastric surgeries, or with diabetes can develop bezoars. Phytobezoars (undigested vegetable matter) or trichobezoars (hair). How to make the dx and how to treat

A

dx by upper endoscopy or barium swallow
Nonop management is often successful. Recommended to ingest meat tenderizer (contains papain) and repeat endoscopy to further fragment and remove the bezoar

38
Q

Vascular rings are congenital. They can encircle the trachea and esophagus to cause compressive symptoms. What are the two most common types and how to treat

A
  • double aortic arch and right aortic arch

- surgery involves division of the ring

39
Q

Elderly nursing pt with recent onset abd pain, distension and obstipation. x-ray showed markedly distended loop mainly in RUQ. Likely diagnosis is?

A

sigmoid volvulus

std initial therapy is rigid sigmoidoscopy with placement of rectal tube

40
Q

Massive resection occurs if more than 75-80% is resected leaving less than 1 m of small bowel left. What are the 4 most common indications for small bowel resection

A
  1. ischemia
  2. Crohns
  3. volvulus
  4. trauma
41
Q

Tenderness in region one-third of the distance from the anterior superior iliac spine to the umbilicus signifies

A

Mcburney’s point -appendicitis

42
Q

Blind loop syndrome (BLS), commonly referred to in the literature as small intestinal bacterial overgrowth (SIBO) or bacterial overgrowth syndrome (BOS), is a state that occurs when the normal bacterial flora of the small intestine proliferates to numbers that cause significant derangement to the normal physiological processes of digestion and absorption. Usu. due to surgical operations involving jejunoileal bypass as well as IBD. What are some symptoms

A
  • steatorrhea
  • malabsorption (weight loss)
  • macrocytic anemia
  • diarrhea
  • unintentional weight loss
43
Q

Clinical picture of recurrent bright rectal bleeding not assoc with abdominal pain in the elderly is most commonly assoc with?

A

diverticulosis

44
Q

Common cause of lower GI bleeding that is recurrent and painless in elderly when diverticolosis is not present is? What to do to diagnose

A

angiodysplasia

do angiography

45
Q

Hemobilia should be suspected with history of trauma to the liver and guaiac positive stools and RUQ abdominal pain. What can be diagnostic and therapeutic

A

angiography can identify source of bleeding and embolize it

46
Q

VIPoma is a pancreatic tumor characterized by

A

WDHA -watery diarrhea hypokalemia and achlorhydria

the diarrhea is secretory, treatment is excision

47
Q

US showing an anechoic mass on liver indicates

A

hepatic cyst

48
Q

A ratio of plasma insulin/glucose > 0.3 is diagnostic of what

A

insulinoma

49
Q

What’s the imaging of choice to localize ZES since it can be really small?

A

somatostatin receptor scintigraphy

50
Q

Biliary dyskinesia can manifest similarly to gallstone related pathologies but symptoms persist after cholecystecomy. how to manage

A

medically with CCB, but best with spincterotomy

51
Q

Malignancy causing obstructive jaundice leads to what typical gallbladder manifestaton

A

enlarged –> Courvoisier’s sign

52
Q

ALK phosp vs bilirubin, which one is more commonly elevated in obstructive jaundice

A

alk phosp

53
Q

CT or MRI with contrast of liver shows initial centripetal enhancement followed by decrease in dye over 10 minutes from without to within. What is it

A

hemangiomas! -most common benign tumor of liver

54
Q

orthotopic vs heterotopic transplant

A

orthotopic requires replacing recipient liver with donor liver.

heterotopic: doesn’t remove recipient’s organ but sew in the donor’s

55
Q

Normal portal venous pressure is

A

5-10 mmHg

56
Q

Someone with ITP is treated with splenectomy, but 2 yrs later, develops skin purpura and low plts. What to do?

A

radioactive technetium scan to see if an accessory spleen is present called splenunuclus

57
Q

TTP is characterized by which 5 clinical symptoms. How to treat?

A
  • hemolytic anemia
  • neurologic changes
  • renal problems
  • fever
  • purpura

Treat with steroids, plasmapheresis and splenectomy

58
Q

Felty’s syndrome. What can splenectomy do?

A

Rheumatoid arthritis with splenomegaly, neutropenia. Splenectomy helps with the leukocyte count but doesn’t change clinical course of RA.

59
Q

What type of hernia refers to a hernia sac that is not independent of the bowel wall.

A

Sliding

60
Q

What to worry about during femoral hernia repair

A

femoral vein lies immediately lateral to the fem canal so careful attn to this is essential

61
Q

After hernia repair, a pt has burning severe pain on lateral side of ipsilateral thigh due to damage of which nerve

A

lateral femoral cutaneous nerve

62
Q

spigelian hernia

A

occurs at lateral edge of linea semilunaris

63
Q

Woman with triad of ascites, pleural effusion leading to SOB and abdominal distension from an ovarian tumor (brenner tumor, fibroma) has?

A

Meigs’ syndrome

It resolves after resecton of tumor

64
Q

How to treat vulvar cancer

A

radical vulvectomy and b/l groin disection

65
Q

3 side effects of cisplatin

A

ototoxicity
nephrotoxicity
peripheral neuropathy

66
Q

Tender uterosacral ligament is a sign of

A

endometriosis

67
Q

Greater omentum is supplied by which artery

A

gastroepiploic arteries

68
Q

T/F: The ureter enters the pelvis immediately distal to the bifurcation of the common iliac artery. It then passes towards the bladder where it is inferior to the uterine artery

A

True

69
Q

testicular cancer -worry abt spread to which lymph nodes

A

para-aortic

70
Q

Where does donor kidney get placed usually

A

Right iliac fossa

71
Q

T/F Tamsolusin is assoc with ejaculatory dysfunction

A

True

72
Q

cardiac tamponade from trauma usu due to ruputre of what?

A

myocardial rupture or coronary artery laceration

73
Q

Bleeding from GSW thru left thorax leading to hemothorax requiring thoractomy usu damage of what vessels

A

intercostal or internal thoracic/mammary

Surgery (6 decks)

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