Midpoint surgery

Question 1

clinical presentation-Crohns

Answer 1

age
chronic worsening abdominal pain
non-bloody diarrhea
malnutrition/weight loss
barium enema findings

Question 2

characteristics-Crohns

Answer 2

transmural inflammation
skip lesions
granulomas
distribution in GI from mouth to anus

Question 3

radiographic features-Crohns

Answer 3

thumb printing
string sign
ulcers/fistulas/fissures

Question 4

indications for surgery-Crohns

Answer 4

intestinal obstruction
symptomatic fistulas or disabling perineal disease
GI perforation/abscess
intestinal hemorrhage
intestinal carcinoma

Question 5

clinical presentation-Ulcerative Colitis

Answer 5

frequent diarrheal stools
defecation urgency
tenesmus

Question 6

characteristics-Ulcerative colitis

Answer 6

limited distribution (colon, rectum)
superficial
no granulomas
rectal involvement 100% of the time

Question 7

radiographic features-ulcerative colitis

Answer 7

loss of haustra
pseudopolyposis
lead pipe appearance

Question 8

indications for surgery-ulcerative colitis

Answer 8

toxic megacolon
intestinal obstruction
hemorrhage 
perforation
colorectal carcinomas

Question 9

etiology-pancreatitis

Answer 9

gallstones
ethanol
trauma
hypercalcemia
hyperlipidemia
drugs
tumor, anatomic abnormalities
infection

Question 10

importance of ranson criteria

Answer 10

determines prognosis and severity (>3 to ICU, >7 dead)

Question 11

at admission-Ranson

Answer 11

age>55
WBC>16k
Glucose>200
LDH>350
SGOT>250

Question 12

at 48 hrs

Answer 12

Hct >10 pt decrease
BUN>5 increase
calcium <8
PO2<60
base excess>4
estimated fluid sequestration >6kmL

Question 13

complications pancreatitis

Answer 13

pseudocyst
pancreatic ascites
hemorrhage
necrosis/infection/abscess
respiratory failure/ARDS/MSOF
splenic vein thrombosis
GI tract obstruction

Question 14

initial management-pancreatitis

Answer 14

IV hydration
NPO/NGT
analgesia
foley

Question 15

physical findings bowel obstruction

Answer 15

abdominal distention
tenderness to palpation with possible guarding 
high pitched bowel sounds
rule out hernia
empty rectal vault

Question 16

etiologies bowel obstruction

Answer 16

adhesions from prior surgery
hernia, inguinal, abdominal wall
carcinomas
colonic volvulus

Question 17

associated lab abnormalities bowel obstruction

Answer 17

elevated WBC
hemoconcentraiton
hyponatremia
hypokalemia
elevated BUN, creatinine, and urine specific gravity

Question 18

radiographic studies bowel obstruction

Answer 18

flat and upright abdomen
chest x-ray
CT scan/contrast studies

Question 19

appropriate fluid for resuscitation bowel obstruction

Answer 19

normal saline

lactated ringers

Question 20

complications of bowel obstruction

Answer 20

strangulation with intestinal necrosis

perforation

Question 21

evaluation for breast cancer

Answer 21

history
mammography
FNA
open biopsy

Question 22

treatment options for breast carcinoma

Answer 22

segmental mastectomy with axillary node dissection and radiation
modified radical mastectomy
radical mastectomy
simple mastectomy

Question 23

axillary node dissection

Answer 23

precise pathological staging

Question 24

TMN staging

Answer 24

determines prognosis and need for adjunctive therapy
size of lesion
axillary lymph node status
distant mets

Question 25

physical exam findings indicating poor prognosis for breast cancer

Answer 25

``` edema of skin of breast skin ulceration tumor fixed to chest wall massive axillary lymph node enlargement supraclavicular lymph node satellite skin nodules arm edema inflammatory carcinoma size ```

Question 26

DCIS

Answer 26

ductal carinoma in situ | treatment options include lumpectomy with radiation and simple mastectomy

Question 27

upper GI bleed

Answer 27

occurs from oropharynx to ligament of Treitz

Question 28

causes of uper GI bleeding

Answer 28

``` gastritis duodenal ulcers gastric ulcers mallory weiss esophagitis hemobilia varices tumor ```

Question 29

differential diagnosis of epigastric pain

Answer 29

``` peptic ulcer GERD gastritis cholelithiasis ischemic heart disease pancreatitis ```

Question 30

diagnostic procedure GI bleeding

Answer 30

EGD (sensitivity, specificity, biopsy can be obtained) | contrast study

Question 31

medical therapy GI bleeding

Answer 31

PPI, H2 blockers, sucralfate, non-prescription antacids, lifestyle modifications

Question 32

complications of duodenal ulcer disease

Answer 32

bleeding perforation gastric outlet obstruction intractability

Question 33

signs and symptoms of perforated peptic ulcer

Answer 33

sudden onset of severe abdominal pain abdominal rigidity absent bowel sounds

Question 34

diagnosis of perforated peptic ulcer

Answer 34

upright CXR/CT scan

Question 35

organ systems in preop eval

Answer 35

cardiac pulmonary renal

Question 36

cardiac history preop

Answer 36

past MI, age of MI, prior ACB, cardiac meds, chest pain, history of rheumatic fever, arrhythmias, CHF, murmur, and hypertension

Question 37

pulmonary history preop

Answer 37

smoking, asthma, obesity, chronic bronchitis, COPD, occupational lung disease, cough, wheeze, exertional dyspnea

Question 38

metabolic/endocrine abnormalities

Answer 38

DM, thyroid disease, liver dysfunction, adrenal insufficiency and malnutrition

Question 39

renal history preop

Answer 39

hypertension, leg edema, stones, DM

Question 40

bleeding tendency

Answer 40

anti-coagulants, aspirin, chronic alcohol use and sever malnutrition