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EOR - Gen Surg > Missed shit > Flashcards

Missed shit Flashcards

1
Q

Sx of acute mesenteric ischemia

A

Severe abdominal pain out of proportion to exam

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2
Q

Sx of chronic mesenteric ischemia

A

Postprandial pain

Fear of eating

Weight loss

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3
Q

Dx studies for workup of mesenteric ischemia

A

Initial study = CT angio of abd/pelvis

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4
Q

MCC of small bowel carcinaom

A

Diet high in salt cured foods

Familial herediatary/denocarcinoma

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5
Q

First line abx tx for suspected cellulitis

A

Bactrim due to MRSA sensitivities

(Appropriate alternatives include: clindamycin, trimethoprim/sulfamethoxazole, or tetracyclines (doxycycline or minocycline).

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6
Q

Which complication is MC from clindamycin abx?

A

C.diff

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7
Q

Most useful serum marker for pancreatic cancer

A

CA 19-9

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8
Q

The decrescendo diastolic murmur at the right sternal border heard with aortic dissection is characteristic of what type of valvular abnormality?

A

Aortic regurge

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9
Q

What Gram-negative bacteria most commonly cause burn wound infection?

A

Pseudomonas

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10
Q

Chronically untreated dyspepsia can lead to which of the following pathologic changes in the esophagus?

A

Metaplastic columnar epithelium aka causing Barrett Esophagus which is from chronic GERD and increases pts risk of adenocarcinoma

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11
Q

What topical therapies are available for the treatment of anal fissures?

A

Nitroglycerin, nifedipine, lidocaine

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12
Q

Tx of esophageal varices

A

Ocreotide

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13
Q

In what time frame should endoscopy be performed in patients who present with bleeding esophageal varices?

A

Within 12hrs of perforation

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14
Q

Patients with pancreatitis as a result of gallbladder disease may experience referred pain to the

A

Right shoulder

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15
Q

Which gastrointestinal procedure is often associated with the development of acute pancreatitis?

A

Endoscopic retrograde cholangiopancreatography (ERCP)

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16
Q

hyperreflexia, goiter, exophthalmos, pretibial edema

A

Hyperthyroid

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17
Q

When can you use PTU in pregnancy?

A

PTU in the first trimester of pregnancy

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18
Q

What is the most common cause of inherited unconjugated hyperbilirubinemia?

A

Gilbert

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19
Q

What is the most common indication for an inferior vena cava filter?

A

Presence of a venous thromboembolism with a contraindication to anticoagulation.

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20
Q

What are the clinical features of Löfgren syndrome?

A

Combination of erythema nodosum, hilar adenopathy, migratory polyarthralgia, and fever, which, when present, has a 95 percent diagnostic specificity for sarcoidosis.

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21
Q

What is the initial adjuvant immunotherapy used for patients with melanoma with lymph node involvement?

A

Nivolumab

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22
Q

What is the gold standard for diagnosing and staging of bladder cancer?

A

Cystoscopy with biopsy

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23
Q

Cardiac output is the product of what?

A

Heart rate x stroke volume

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24
Q

What oral medication speeds healing of venous ulcers?

A

Aspirin

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25
Q

What are the three most common causes of massive hemoptysis?

A

TB, bronchiectasis, lung abscess

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26
Q

gold standard method for diagnostic evaluation of peptic ulcer disease?

A

Histologic tissue eval

27
Q

What is the prognosis of stage 3 pressure injuries with appropriate wound care?

A

50% will resolved in 6 months

28
Q

Which lab marker is most specific for acute pancreatitis?

A

Lipase

(LIKE lipase; Lipase lasts LONGER - easier to see elevation with if its present longer than amylase)

29
Q

Most common inherited colorectal cancer susceptibility syndrome.

A

Lynch syndrome

Lynch syndrome, often called hereditary nonpolyposis colorectal cancer (HNPCC), is an inherited disorder that increases the risk of many types of cancer, particularly cancers of the colon (large intestine) and rectum, which are collectively referred to as colorectal cancer

30
Q

Which condition presents with burning lower extremity pain worsened by walking and relieved with rest?

A

Vascular claudication

31
Q

6 Ps of arterial occlusion, which one presents last?

A

Pain (out of proportion to exam)

Pallor

Pulselessness

Paraesthesia

Poikilothermia

Paralysis (This would present last)

32
Q

Tx/management of arterial occlusion

A

Surgical emergency

Antiocoag (heparin)

Surgical (embolectomy, thrombolysis, bypass, angioplasty)

33
Q

Which nerve arises from the L1 nerve root and runs superior to the spermatic cord through the superficial inguinal ring in men?

A

The ilioinguinal nerve arises from L1 and provides sensory innervation to the scrotum in men and the labium majus canal in women.

34
Q

Dx of acute diverticulitis

A

CT scan

(localized bowel wall thickening >4mm, pericolonic fat stranding, colonic diverticula)

Not as specific (US, MRI)

35
Q

Uncomplicated diverticulitis tx

A

IV abx ( Cipro + Metronidazole)

Clear liquid diet

*If severe sx → IV abx, bowel rest, percutaneous abscess drainage, potential surgery

36
Q

What physical exam findings are present in Courvoisier sign?

A

Enlarged, painless gallbladder on palpation and jaundice

37
Q

Choledocolithiasis labs

A

Mildly elevated serum amylase, lipase, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and conjugated bilirubin are noted on lab analysis. Ultrasound reveals a dilated common bile duct of 0.6 cm but normal gallbladder wall thickness and no gallstones in the lumen. What is the most likely diagnosis?

38
Q

Choledocolithasis sx

A

Right upper quadrant abdominal pain, nausea, and vomiting are common symptoms. Tenderness to palpation of the right upper quadrant and epigastrium is a common sign.

Jaundice may be noted. Lab analysis may reveal elevated alanine aminotransferase, aspartate aminotransferase, bilirubin, alkaline phosphatase, and gamma-glutamyl transferase. Transabdominal ultrasound is recommended as an initial exam. Common bile duct stones are often not directly visualized on ultrasound, however, common bile duct dilation may be seen, suggesting distal occlusion. Additional tests may include magnetic resonance cholangiopancreatography (MRCP)

39
Q

Which of the following is the most common cause of small bowel obstruction in patients with no prior surgical history?

A

Hernia

Hernias are the most common cause of small bowel obstruction in patients in resource-rich regions without a history of prior abdominal surgery, accounting for 20%. In resource-limited countries, hernias are the leading cause of small bowel obstruction, accounting for 30–40%. Other causes on the differential would be a malignancy, inflammatory bowel disease, radiation enteritis, intussusception, and gallstone ileus.

40
Q

When malignancy is the cause of small bowel obstruction, is it usually a primary small bowel malignancy or metastatic disease?

A

Metastatic disease

41
Q

Cardiac functional status to establish metabolic equivalents

A

The ability to walk up a flight of stairs, walk 4 mph, walking a golf course, doing yard work, and cycling are examples of moderate functional capacity (4–10 METs). Jogging, playing singles tennis, swimming, and skiing are examples of excellent functional capacity (greater than 10 METs). One specific indicator of increased risk of postoperative cardiopulmonary complications is the inability to climb two flights of stairs or walk four blocks.

42
Q

A CT scan of the abdomen reveals the presence of a thickened colon wall and associated fat stranding around a collection of contrast in the region. No perforation or abscess formation is seen. Which one of the following is the next best step in the management of this patient?

What is the best tx?

A

IV abx

Uncomplicated diverticulitis

43
Q

What behavior is associated with an increased incidence of diverticulitis with complications, such as abscess, perforation, or fistula formation?

A

Smoking

44
Q

A 44-year-old man with a history of GERD presents complaining of worsening dysphagia with solid foods. The patient is diagnosed with esophageal stricture and is status post dilation. Which of the following therapies is most important to prevent recurrence of peptic esophageal strictures?

A

PPI

45
Q

What are the components of quadruple therapy for H. pylori?

A

Bismuth subsalicylate, metronidazole, tetracycline, and a proton pump inhibitor.

46
Q

A 64-year-old woman presents to the emergency department complaining of a yellow tint to her eyes and skin. She states that this began approximately one month prior and has become progressively worse. She also has constant gnawing upper abdominal pain, which is worse at night. Additionally, she reports a 15-pound weight loss over the past few months, generalized weakness, dark urine, and pruritus. Physical exam confirms the presence of diffuse jaundice, scleral icterus, and pain on palpation of the epigastrium and right upper quadrant. Laboratory tests reveal elevated serum bilirubin and alkaline phosphatase levels. Bedside transabdominal ultrasound is performed and reveals a pancreatic mass.

Which of the following is the most appropriate next step to assess disease extent and resectability?

A

CT enhanced abdominal

47
Q

Pancreatic cancer tx

A
  • Management:
    • Resectable disease: Whipple procedure (pancreaticodudenectomy) + adjuvant chemo
    • Unresectable disease: FOLFIRINOX or gemcitabine-based chemo
48
Q

A 52-year-old man with COPD who is a current cigarette smoker presents for preoperative consultation. He reports worsening shortness of breath and productive cough over the past month. He reports no chest pain or dependent edema. Vital signs include a resting room air pulse oximetry of 97%. Physical exam reveals expiratory wheezing bilaterally. Which of the following diagnostic studies is indicated?

A

CXR

Pulmonary function tests (D) are only indicated if exam alone does not reveal if baseline pulmonary function is optimal and for all patients undergoing lung resection. Typically PFTs simply confirm the clinical impression of disease severity.

49
Q

A 65-year-old man with a history of benign prostatic hyperplasia presents to the urologist for removal of a Foley catheter. The catheter was placed to decompress the bladder due to acute urinary retention. What type of medication could be prescribed prior to catheter removal that would relax the smooth muscle of the bladder neck and prostatic capsule and thereby relieve the obstruction and prevent early recurrence of retention?

A

Alpha-1- adrenergic antagonist (- zosin, tamsulosin)

50
Q

An elderly man with a history of atrial fibrillation presents with sudden onset of severe periumbilical pain that is out of proportion to physical examination. A CT scan will most likely show lack of flow in which visceral vessel?

A

Superior mesenteric artery

51
Q

A 56-year-old woman with stage IV breast cancer presents to the emergency department complaining of dyspnea and cough that started one hour ago. She was first diagnosed with breast cancer five years ago and had a lumpectomy with adjuvant radiation. She was diagnosed with metastatic disease six months ago. She also has a history of hypertension, hypothyroidism, and gastroesophageal reflux disease. Her pulse is 102, blood pressure is 115/76 mm Hg, respiratory rate is 16, and temperature is 98.3°F. Which of the following is the most likely diagnosis?

A

Pulmonary embolism

52
Q

Virchows triad

A

Thrombosis, endothelial injury, hypercoaguable state

53
Q

A 54-year-old man presents to the clinic complaining of difficulty swallowing food for the past two years, which has been gradually worsening. He has no problem swallowing liquids. He has had uncontrolled gastroesophageal reflux for several years. He has no history of tobacco use and has not had any head or neck radiation therapy. Which of the following is the best initial test for this patient?

A

Upper endoscopy

54
Q

How are peptic strictures managed?

A

dilation during endoscopy and acid-suppressive therapy with proton-pump inhibitors to prevent recurrence.

55
Q

Schatzki rings are almost always associated with what other upper gastrointestinal pathology?

A

Hiatal hernia.

56
Q

A 65-year-old man with a past medical history of tobacco abuse and hypertension presents to the clinic with leg pain during exercise that is relieved by rest. Physical exam is significant for lower extremity hair loss and weak pulses over the dorsalis pedis and posterior tibial arteries. An ankle-brachial index test is performed and calculated as 0.8. Which of the following is the most appropriate treatment option?

A

Aspirin

Anticoagulation is not used because: no benefit has been found over aspirin and the risk of bleeding is higher. Anticoagulation may be indicated following certain types of revascularization procedures, however it would not be used as initial therapy.

57
Q

A 57-year-old woman with a history of recurrent nephrolithiasis presents to the clinic for evaluation of ongoing nausea, constipation, loss of appetite, generalized bone pain, and depressed mood. Laboratory results include elevated serum calcium, elevated parathyroid hormone levels, and decreased phosphate levels. A sestamibi scan performed was suspicious for a right inferior parathyroid gland adenoma. During the surgical excision of the parathyroid adenoma, which of the following should be measured intraoperatively to confirm the cause of the primary hyperparathyroidism has been removed?

A

Parathyroid hormone level

58
Q

A septic patient is noted to have respiratory alkalosis. What electrolyte disturbance is commonly associated with this patient presentation?

A

Hypokalemia

Alkalosis can result in hypokalemia and an intracellular acidosis from the shift of potassium from the serum into the intracellular space. I

59
Q

A 66-year-old woman with a past medical history of uncontrolled diabetes mellitus, obesity, and rheumatoid arthritis who is on methotrexate presents to the emergency department complaining of redness, drainage, and pain at her incision site. She had an umbilical hernia repair approximately six days prior. On exam, you note the patient has a fever of 100.6°F and the incision site is erythematous and warm with a small amount of purulent drainage noted. There are no signs of wound dehiscence and no areas of fluctuance noted. Which of the following is the most likely diagnosis?

A

Cellulitis

60
Q

An obese 68-year-old woman with hypertension is admitted to the hospital due to acute hypoxia. She is a lifelong nonsmoker with no history of lung disease. A chest radiograph reveals a moderate pleural effusion. Which of the following is the best next step in the management of this patient?

A

Thoracentesis

A new pleural effusion is an indication for diagnostic thoracentesis. Therapy is directed at the underlying etiology.

61
Q

What is lights criteria for pleural effusions

A

Transudate = CHF, cirrhosis, nephrotic syndrome, PE (protein >0.5, LDH >0.6)

Exudative = Pus → Pneumonia, malignancy, TB, PE, pancreatitis, esophageal rupture

62
Q

When is surgery considered appropriate for patients with peptic ulcer disease?

A

In patients with ulcers > 3 cm in size (due to the high rate of complications and the high rate of failure with medical treatment), in patients with complications resulting from ulcers (bleeding, perforation or obstruction) or those refractory to medical therapy.

63
Q

A 39-year-old man presents for his annual physical. On exam, a painless mass is palpated on his left testicle. Which of the following is the most likely next step in diagnosis?

*

A

Transcrotal ultrasound

Needle biopsy is not used in testicular cancer as, once an ultrasound confirms the presence of a mass, inguinal radical orchiectomy is performed, which confirms the tumor histology as well as size and presence of invasion.

EOR - Gen Surg (6 decks)

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