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Surgery > OME - Gen Surg > Flashcards

OME - Gen Surg Flashcards

1
Q

When does a pancreatic pseudocyst appear?

Why is it named this way?

A

Late sequelae of pancreatitis

No endothelial lining

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2
Q

Why would you order a UA if a pt has malignant hyperthermia?

A

Look for myoglobinuria

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3
Q

How do you treat Anal cancer?

A

Nigro protocol (chemo/radiation)

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4
Q

What causes SBO?

Symptoms?

A

Adhesions or hernias

Colicky ABD pain w/progressive distention of the ABD

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5
Q

What things cause Fistulas?

A 
FRIEND
Foreign body
Radiation
Inflammation/infection/IBD
Epithelization
Neoplasm
Distal obstruction
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6
Q

What causes boring epigastric pain radiating to the back which is relieved by leaning forward?

Caused by what?

A

Acute pancreatitis

Gallstones and EtOH

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7
Q

What is an abscess of an infected follicle found on the small of the back of a hair butt called?

A

Pilonidal cyst

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8
Q

Post op pt w/SOB and some chest pain that is pleuritic and sudden onset dyspnea think what?

What other signs may be present?

A

PE

ABG w/Hypoxic hypocapnia
S1Q3T3 EKG
Clear CXR

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9
Q

What is a treatment for PSC?

A

Ursodeoxycholic acid

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10
Q

What is the definitive tx for anal fissures?

What about initial treatment?

A

Lateral internal sphincterotomy

Topical lidocaine, sitz baths, Botox

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11
Q

Casts in the urine in a post op pt indicate what?

A

Had Pyelonephritis BEFORE surgery

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12
Q

When how to treat pancreatic pseudocyst?

A

If < 6 cm and < 6 weeks old —

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12
Q

What kind of pain does obstruction cause?

How does perforation present?

A

Colicky

Sudden onset, vague, persistent

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13
Q

How do you treat compartment syndrome of the ABD?

A

Leave ABD open (cover w/temporary absorbable mesh), let swelling go down and closes later

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15
Q

Bilirubin in the 20’s means what?

In the 6-8?

A

Cancer

Cholecystitis

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16
Q

Pt comes in w/SBO and it is non-toxic what is the 1st step?

A

NG tube
IVF
Serial ABD exams

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16
Q

How do you diagnose a pt w/choledocolithiasis that has probably passed a stone?

A

Serial LFTs

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17
Q

What are the 5 W’s of Post-Op fever?

A 
Wind
Water
Walking
Wound
Wonder drugs
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18
Q

What is the best prognostic indicator for pulmonary risk in surgery?

Next?

What is the most important factor?

A

FEV1/FVC ratio

ABG

Ventilation > O2

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19
Q

In evaluation of jaundice, after the PE, what is the next step?

A

US

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20
Q

Pt w/dyspnea, ascites, early satiety and pancreatitis has what?

Dx how?

A

Pancreatic pseudocyst

CT scan

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21
Q

Painful jaundice w/dilated biliary tree, no obstruction stone means what?

A

Cholelithiasis (gall stones)

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22
Q

Pt w/obstructive jaundice and/or pancreatitis what test to do first?

A

MRCP then ERCP

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23
Q

When does Atelectasis occur in post op fever?

Diagnose how?

Prophylax how?

A

1st day

CXR, maybe UA and BCx

Incentive Spirometry

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24
Q

How is malnutrition identified?

A

Loss of Body Weight > 20% in a Fe months
Albumin < 3
A nervy to skin Ags

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26
Q

When does UC turn malignant?

How often do you need to watch it w/colonoscopy?

A

> 8 years

Q1yr

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27
Q

Ulcer located above the medial malleolus, what condition does the pt have?

Skin appears how?

Treat how?

A

Venous insufficiency

Edematous, infuriated, hyperpigmented

Compression stockings

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28
Q

Obstructive jaundice causes elevation in what?

A

Conjugated bilirubin

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29
Q

Post op delirium can be caused by what? Simple fix?

What else?

A

Hypoxia - give O2

Electrolyte imbalance and hypoglycemia

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30
Q

Pt went to Mexico and has a liver abscess, what is the cause?

A

E. Histolytica

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30
Q

When should a sentinel LN dissection be performed?

A

BEFORE ALND

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32
Q

What is a common cause of paralytic ileus?

Dx how?

A

Hypokalemia

Upright and flat KUB

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32
Q

Elderly sedentary pts who become immobilized after surgery are at risk for what?

What does this mean?

Dx how?

A

Ogilvie Syndrome

ONLY the colon is dilated

KUB

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34
Q

When does Wound infection occur in post op fever?

Diagnose how?

Prophylax how?

A

Day 7

US

Good closure and wound care

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34
Q

Low urine output post-op means what?

Do what 1st?

If the urine output improves this means what?
If not?

A

Prerenal or Intrinsic Renal Failure

500cc bolus challenge

Dehydrated (pre-renal cause) - give IVF
Intrinsic renal problem

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34
Q

What are the 2 main types of treatment for breast cancer?

A

Lumpectomy + ALND + Radiotherapy

Mastectomy + ALND

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36
Q

How do you Dx cholangiocarcinoma?

A

ERCP w/Bx

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37
Q

Pts w/BRCA 1/2 gene should get what prophylacticlly?

If they don’t when should they get screened?

Who else needs this type of screening?

A

Mastectomy and b/L Salpingo-oophorectomy

Annual MRI and Mammogram

Pts w/PMHx of Hodgkin Lymphoma

39
Q

Pt w/Ogilvie syndrome, after you have the KUB what should you do?

Treat how?

A

Colonoscopy to r/o cancer

Decompress ABD and leave rectal tube in place

39
Q

Fever, leukocytosis, Hamman’s Crunch with prolonged retching = ?

Diagnose how?

A

Boerhaave syndrome

Gastrograffin 1st

41
Q

When does DVT/PE occur in post op fever?

Diagnose how?

Prophylax how?

A

Day 5

Exam 2 cm greater on 1 leg compared to the other
US

Early mobilization and heparin

41
Q

Femoral hernias pass through what?

A

Under inguinal ligament

41
Q

Incarcerated hernia means what?

Treatment?

A

Irreducible

Urgent surgery

42
Q

What is included in the Child-Pugh score?

If any 1 is abnormal, it means what?

A

Ascites, Albumin, Bilirubin, Encephalopathy, INR

40% mortality risk

43
Q

What presents w/FOBT+ but with a Negative Colonoscopy?

Diagnose how?
Then what?

A

Ampulla of Vater cancer

MRCP, then ERCP/EUS
CT scan to stage

44
Q

What is the worst prognostic indicator of the Goldman Index?

What else?

A

JVD

MI w/in 6 mo, arrhythmia, age > 70

44
Q

When does a pancreatic abscess appear? Diagnose how?

Treatment?

A

5th day, CT scan

Percutaneous drainage

44
Q

What does a + HIDA scan show?

A

Unfilled tracer in the gallbladder due to obstruction

46
Q

Does doxorubicin or Trastuzumab cause reversible CHF?

A

Trastuzumab

47
Q

No urine output post op is NOT concerning until when?

A

6+ Hours

47
Q

A thin walled, dilated GB walls free of inflammation w/Distal obstruction means what?

A

Cancer

48
Q

Post op pt w/constantly decreasing urine volume, what is the best next step?

A

Assess w/fluid challenge

49
Q

Zero urine output post op means what?

Do what?

A

Mechanical obstruction or post-renal failure

Unkind the CATH

50
Q

What causes crescendo ABD pain that becomes constant and localized?

Etiology?

A

Inflammation

Pyelonephritis, cholecystitis

51
Q

Acute ABD where there are + peritoneal findings, what is the next step?

What will show + peritoneal findings?

What will you see?

A

Ex-LAP

Upright XRay

Free AIR under the diaphragm

52
Q

What is the best measure of acute pancreatitis?

What is the single most USEFUL prognostic lab test?

A

Lipase

BUN

54
Q

Post op a pt feels the need to void but cannot, what is the next step?

A

In and Out CATH after 6 hours of no voiding

55
Q

What chemo drugs can cause CHF?

A

Doxorubicin causes DOSE-dependent

Trastuzumab

56
Q

What are the only things that can put AST/ALT into the 1000’s?

A 
Acetaminophen OD
Acute viral hepatitis
Autoimmune hepatitis
Shock Liver (HoTN ischemia)
Budd-Chiari
Afla-Toxin
58
Q

What is pathognomonic for pancreatic cancer?

A

Migratory thrombophlebitis

60
Q

What 2 things are contraindicative for non-cardiac surgery?

A

EF < 35%

MI w/in 6 months

61
Q

When is a Nissan Fundoplication used to treat GERD?

A

After 24-hour pH probe is +

62
Q

1st step in evaluation of jaundice?

What generally means cancer?

What about cholecystitis?

A

PE

Palpable NT gallbladder

Tender gallbladder (+ Murphy sign)

63
Q

Pt w/ulcer at the tip of their toes think of what?

Seen in what condition?

Diagnose with what 1st?
If + do what?

Treat how?

A

Arterial insufficiency

Peripheral vascular disease

US Doppler
CT Angiogram

Cilostazol

65
Q

On imaging if you see the entire bowel decompressed, what is the Dx?

Tx?

A

SBO

NG tube, Surgery

67
Q

What is the treatment for an acute episode of cholecystitis?

A

Cholecystectomy

68
Q

How do you diagnose pancreatic cancer?

Treatment?

A

EUS w/Biopsy

Whipped procedure

69
Q

When and how often should women be screened for breast cancer?

What is the best screen?

A

Mammogram 40 y/o, q2 yr

MRI

70
Q

What causes flank pain radiating to the groin and the UA shows no hematuria, there is no mass?

A

Nephrolithiasis

72
Q

Thick-walled rigid GB means what?

A

Chronic inflammation - cholecystitis

73
Q

What causes a progressive dysphasia that is often preceded by GERD?

A

Cancer of esophagus

74
Q

Post op if both the skin and fascia fail after a pt strains means what?

What can happen?

Treatment?

A

Evisceration

Bowel pops out

Cover w/warm saline go to OR

77
Q

Pt with ulcers that are ugly, deep, and have heaped margins that do not heal has what?

Treat how?

A

Marjolin’s Ulcer (SCC)

Biopsy, then wide excision

78
Q

Suspected choledocolithiasis what is the best step?

Next?

A

US

MRCP —> ERCP to treat

79
Q

When does UTI occur in post op fever?

Diagnose how?

Prophylax how?

A

Day 3

UA and UCx

Can’t

80
Q

A CT scan to diagnose a PE would be indicated if the pt met Wells criteria, what is included in this?

A

SOB
Tachypnea
Tachycardic
Clinical evidence

82
Q

When is an EGD performed in pts with GERD?

A

PPI trial fails

Alarm symptoms present

83
Q

A paralytic ileus that hasn’t resolved by day 5-7 post-op what is the next step?

Will see what?

Treatment?

A

Flat and upright KUB

Dilated loops of bowel and Air-fluid Levels w/decompressed bowel beyond the obstruction

Back to OR

84
Q

Premenopausal woman w/ER/PR+ breast cancer treat with what?

Postmenopausal?

A

Tamoxifen/Raloxifen

Anastrozole (Aromatase inhibitor)

85
Q

When does PNA occur in post op fever?

Diagnose how?

Prophylax how?

Treat how

A

2nd day

CXR

Incentive Spirometry

Give Vanco/Zosyn bc it is a HOSPITAL Acquire PNA

86
Q

What causes perforation of the ABD?

A

PUD
Cancer
Trauma

87
Q

When does Abscess occur in post op fever?

Diagnose how?

Prophylax how?

A

2 weeks

CT scan

Do good surgery

90
Q

When do you use an IVC filter for a PE?

A

If there is a CI to anticoagulation

92
Q

What is the only way to get an acute onset of elevated UNconjugated bilirubin?

Diagnose how?

A

Hemolysis

Blood smear

94
Q

Skin that is intact but the fascia has failed is what?

Treatment?

A

Dehiscence

Bind the ABD, limit mvmt

97
Q

Direct hernias pass through what structure?

Lateral or medial to inferior epigastric vessels?

A

Transversalis fascia

Medial

98
Q

What kind of pts are at high risk to get SBP of the ABD?

What confirms diagnosis?

Treatment?

A

Alcoholics —> ascites

Paracentesis w/250 polys

Ceftraixone

105
Q

How to treat acute pancreatitis?

A

IVF
NPO
Morphine

That’s it, you can’t do anything

106
Q

What causes sudden onset of ABD POOP to the PE?

Etiology?

A

Ischemia of visceral organs

CAD, AFib, Mesenteric ischemia

109
Q

What is a pyogenic abscess?

Complication of what?

Treat how?

A

Bacterial abscess in the liver

Ascending cholangitis

Percutaneous drainage

110
Q

Right-sided cancers ____ while left-sided cancers ______

Of the colon

A

Bleed

Obstruct

112
Q

When do you give Abx for pancreatitis?

What kind?

A

FNA-proven infection —> Necrotizing pancreatitis

Meropenem

119
Q

Pt that presents w/chronic pain, DM, steatorrhea, and malabsorption has what?

Treat how?

A

Chronic pancreatitis

Can’t do anything, just treat the pain

120
Q

What is the 1st test done for SBO?

Then what?

A

KUB

CT or small bowel series

Surgery (4 decks)

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