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Written Boards - Final > Miscellaneous Surgical Specialties > Flashcards

Miscellaneous Surgical Specialties Flashcards

1
Q

what surgeries are high risk for urinary retention

A

rectal, inguinal, spinal, palvic

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2
Q

4 post op general conditions that can be altered to prevent urinary retention

A

opioids, fluid overload, immobility and pain

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3
Q

4 layers of the scrotum and importance of the 3rd deepest

A

Skin
Dartos muscle
Tunica vaginalis (parietal) hydrocele sac
Tunica vaginalis (visceral) and tunica albuginea of testis

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4
Q

Depiction of hydrocele comm vs non comm

A
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5
Q

Between which two layers does a hydrocele form

A

parietal and visceral layers of the tunica vaginalis

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6
Q

4 history points for hydrocele

A

Gradual onset
Painless
Involved hemi-scrotum
Noncommunicating are nonreducible
Transilluminates

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7
Q

10 ddx for painful swelling testicles

A

testicular torsion
epididymitis/orchitis
Fournier gangrene
torsion of the appendix testis
trauma
testicular rupture
testis cancer
inguinal hernia
IgA vasculitis (formerly Henoch-Schönlein purpura)
Mumps

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8
Q

Hx differentiating comm from non comm hydrocele

A

fluctuation over time

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9
Q

Mng of adult vs pediatric hydrocele

when is the time to operate for peds

A

Lord plication, plicate sac

Jaboulay -evert sac and sew behind cord

12m

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10
Q

test for testicular torsion

A

color doppler

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11
Q

two tests for epididymitis

A

urinalysis and doppler — thickened epidid

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12
Q

Goal tx time in testicular torsion and salvage rate

A

6h
5%

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13
Q

doppler or no for testicular torsion

A

only if no delay

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14
Q

op for testicular torsion?

A

mid raphe incision, detorse, pexy both

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15
Q

epididymitis tx

A

nsaids, supportt, ice

abx if urinalysis dirty

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16
Q

left vs right varicocele characteristics

A

left more common as left gonadal goes into left renal vein

right would be concerning for RP mass

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17
Q

varicocele grading

A

1 non palp unless valsalve
2 palp
3 visible

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18
Q

when to treat varicocele

A

low perm count

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19
Q

3 peaks for testicular cancer

PE pres

A

30m, 30y, 60y

painless mass

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20
Q

3 labs prior to orchiectomy

A

bhcg, afp and ldh

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21
Q

NEVER do what for testicular mass

A

bx through scrotum

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22
Q

staging for testicular mass

A

CT CAP

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23
Q

go to operation for testicular mass

A

radical inguinal

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24
Q

spermatoceles otherwise known as…

A

epididymal cyst

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25
Q

order of renal hilum

A
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26
Q

ureter and ureteral artery relative positions

A

artery anterior

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27
Q

3 ureteral layers

A

Mucosa: transitional epithelium
Middle smooth muscle
Adventitia

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28
Q

Majority of testicular tumors are ….

more specifically

A

germ cell

seminomas

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29
Q

2 types of germ cell tumors

A

seminoma and non

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30
Q

3 non germ cell tumors

A

leydig, sertol, gonadoblastoma

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31
Q

4 non sem tumors

A

teratoma, embryonal cell, choriocarcinoma and mixed

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32
Q

choriocarcinoma mets by ….

A

hem

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33
Q

risk factors for RCC

who gets this

A

smoking, hypertension, obesity, chronic kidney disease, occupational exposure, and familial conditions such as von Hippel-Lindau syndrome.

Men 60-80

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34
Q

bladder and ureteral cancer risks 2

A

smoking and arsenic

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35
Q

MC GU ca and 2nd leading killer in men

3 risk factors

A

prostate

African-American race, older age (> 40 years), family history (first-degree relative diagnosed before age 65), and BRCA mutation.

36
Q

screening for prostate ca

A

Although early screening in African-American men or men with a family history of prostate cancer is widely accepted (beginning at age 40-45 years), screening of all men is more controversial (beginning at age 50 years).
Screening involves determining the prostate-specific antigen (PSA) value alone every 1 to 2 years. Men with a PSA level greater than 7 ng/mL should be referred to a urologist.

37
Q

What is elevated in non sem

sem?

A

afp and bhcg

maybe bhcg

38
Q

T staging for rcc

A

T1: ≤ 7 cm in largest dimension
T2: >7 cm in largest dimension
T3: extension into the renal vein or perinephric tissues but not beyond the Gerota fascia
T4: extension beyond the Gerota fascia, including direct extension into ipsilateral adrenal gland

39
Q

MC site of ectopic

A

fallopian tube 96%

40
Q

normal bhcg increases

what if it is slow

A

In normal pregnancy, hCG should increase more than 35% in 48 hours or double in 72 hours.

ectopic

41
Q

Rh neg women who are bleeding from ectopic need what

A

anti D

42
Q

quick imaging modality for suspected ectopic rupture

A

FAST

43
Q

discriminatory zone for bhcg

what if no IUP visualized

A

2500

ectopic

44
Q

MTX mech

A

folic acid antag

45
Q

preferred tx for ectopic and indications

contraindications

A

Indications include:

Hemodynamic stability
No contraindications to MTX

Serum hCG less than 5000 mIU/mL

No fetal cardiac activity
detected by transvaginal ultrasound
Patient ability to comply with posttreatment follow-up and access to emergency medical care in case of treatment failure and rupture

Contraindications include:

Co-occurring intrauterine pregnancy
Ruptured ectopic pregnancy or hemodynamic instability
Renal insufficiency
Immunodeficiency
Breastfeeding
Hypersensitivity to MTX

46
Q

operative ectopic preg

A
47
Q

follow up for ectopic preg

A

hcg intervals
Rh if needed

48
Q

PID empiric treatmetn

A

cefoxitin plus doxy or clinda plus gent for 14 days

49
Q

risk factor with PID

A

ovarian cancer

50
Q

3 ovarian hereditary syndromes

A

BRCA and lynch

51
Q

4 endometrial cancer RFs

A

Lynch/Cowden, obesity, unopposed estrogen

52
Q

MC gyn cancer

A

endo

53
Q

what is a classic presentation for endometrial cancer

A

uterine bleeding post men

54
Q

BRCA 1 risk %s

A

breast 65
ovarian 40-60

55
Q

besides surgery for brca1 what else can decrease ovarian risk

A

ocp

56
Q

3 additional steps in ovarian tumor resection

A

peritoneum bx
resection of omentum
lymphadenectomy of pelvis

57
Q

locally advanced cervical ca is treated with….

A

chemorads

58
Q

what is a FAMM flap for

A

oral/nasal cavity

59
Q

first line strategy for large facial defect from skin ca surgery

2nd line

A

partial primary with full thickness

pec muscle flap

60
Q

case control study starts with an ____ and looks back for _____

A

outcome; exposure

61
Q

Observational studies, randomized controlled trials, and cohort studies begin with _____ and study the _____; in observational studies and cohort studies the exposures are _____ but measured; in randomized controlled trials, the exposure is ______ (interventional study).

A

exposure
outcome
natural
assigned

62
Q

levels of evidence quality by study type ranked

A

syst review rcts> rcts> cohort studies> case control

63
Q

worst thing to have as hx for cardiac complications

A

aortic stenosis

64
Q

is accepting a patients medical decisions as writing during ventilation ok?

A

sure

65
Q

length time bias is for…

A

slow growing tumor screens

66
Q

lead time bias is from early…

A

detection

67
Q

dg delerium with CAM

A

he diagnosis of delirium requires the change in mental status to be of acute onset with a waxing and waning course and inattention. It also requires either disorganized thinking or an altered level of consciousness

68
Q

what analysis is used for non compliance, withdrawal and crossover subject in an RCT

A

intention to treat analysis

69
Q

mcc after lap hyterectomy

A

bladder injruy

70
Q

2 components affecting the CI

A

sample size and SD

71
Q

pressor support for withdrawal of care?

A

yes for palliative med circulation

72
Q

what is the primary mechanism of PID

A

cervical mucus barrier breakdown

73
Q

thoracic outlet structure order

A

SCV, phrenic, ant scalene, SCA, B plex, middle scalene

74
Q

MC head and neck

rfs

A

SCC

ETOH smoking, hpv

75
Q

Tx Stage 1 and 2 for HNN scc

3&4

A

rads +- surgery

surgery with neck dissection then chemorads

76
Q

order of malignancy for salivary glands

A

partid>submandibular>sublingual

77
Q

MC malignant salivary gland tumor

Tx

A

mucoepidermoid

Radical resection +/- chemorads

78
Q

adenocystic salivary tumor tx

very senstive to

A

resection with nerve preservation – less aggressive

rads sens

79
Q

MC benign salivary gland tumor

Tx

A

pleiomorphic

superficial parotidectomy

80
Q

warthrin tumor tx – other name?

A

watch

papillary cystadenoma lymphomatosum,

81
Q

2nd most common salivary tumor

A

warthrin

82
Q

MC location of unknown hnn primary

A

tonsils then tongue

83
Q

always do this investigation with your hnn w/u of unknown primary
definitive tx if still cant find it

A

ipsilateral tonsillectomy

bilateral tonsillectomy
b/l rads
ipsilateral neck

84
Q

nasopharyngeal ca tx

asoc virus

A

XRT

EBV

85
Q

gustatory sweating following parotidectomy

caus3

A

frey

auriculotemporal nerve injury and crossover

86
Q
A

Written Boards - Final (21 decks)

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