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Surgery > Online Med Ed > Flashcards

Online Med Ed Flashcards

1
Q

Minute ventilation equation

A

TV X RR

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2
Q

Goal for ET CO2

A

40 = adequate tube placement

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3
Q

Blood pressure in shock

A

MAP under 60

SBP under 90

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4
Q

Urine output in shock

A

less than 0.5 cc/kg/hr

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5
Q

MAP equation

A

CO x SVR

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6
Q

CO equation

A

HR x SV

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7
Q

Stroke volume equation

A

preload x contractility

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8
Q

What causes shock by altering SVR (4)

A

sepsis
anaphylaxis
anesthesia
spinal trauma

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9
Q

What causes shock by altering preload

A 
hemorrhage 
obstruction (TPTX, pericardial tamponade, PE)
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10
Q

What causes shock by altering preload?

A

MI
contusion
CHF

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11
Q

Escalating steps in airway treatment

A

O2 –> bag valve mask –> ETT –> cric (ED) –> trach (OR)

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12
Q

What form of shock causes FLAT neck veins?

A

most = engorged, flat in hemorrhage due to loss of volume

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13
Q

Shock + tracheal deviation –> next step

A

needle decompression

this is tension pneumo

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14
Q

JVD + pulses paradoxus –> next step

A

needle decompression

this is tamponade

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15
Q

Structures in zone 1 of neck

A

esophagus trachea arteries

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16
Q

structures in zone 3 of neck

A

arteries

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17
Q

Interventions in trauma to each zone of the neck

A

3- arteriogram
2- straight to surgery
1- ateriogram, esophagram, bronchoscopy

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18
Q

Penetrating neck injury –> decision to operate depends on?

A

hard signs
hard signs –> opeate
soft signs –> angio
asx –> observe

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19
Q

What are “hard signs”

A

gurgling, stridor, loss of airway
expanding hematoma, pulsatile bleeding, shock
stroke

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20
Q

What are “soft signs”

A

dysphonia/dysphagia
subQ air or emphysema
mild hard signs

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21
Q

Spinal cord- main pathways in anterior/middle/posterior sections of spinal cord

A

posterior- DCLMS (proprioception and vibratory sense)
middle- motor
anterior- ALS (pain and temp)

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22
Q

Cord lesions- which symptoms are ipsilateral? contralateral?

A

ipsi- proprioception and motor

pain and temp- contra (cross at level of entry)

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23
Q

Anterior cord injury:

defecit and typical cause?

A

lose all but proprioception

spinal artery occlusion

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24
Q

central cord injury:

typical deficit and cause?

A

loss of pain and temp in cape like distribution

hyperextension/ syringomyelia

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25
Q

cord compression:

symptoms & dx/ tx

A

focal neuro symptoms
urinary or bowel dysfunction
treatment: dexa
dx: MRI

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26
Q

Two signs of basilar skull fractures

A

battlers eyes

clear rhinorrhea

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27
Q

Epidural hematoma

dx and tx

A

lens shaped well defined hematoma on CT

emergent craniotomy

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28
Q

Subdural hematoma

dx and tx

A

same as epidural but hematoma is crescent shaped

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29
Q

What must be done before subdural hematoma craniotomy

A

correct INR/ give FFP and platelets

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30
Q

How to decrease ICP

A

hyperventilate
mannitol
elevate bed

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31
Q

Diffuse axonal injury:
cause
dx
tx

A

angular injury
grey white blurring on CT
no treatment, fatal

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32
Q

Treatment for broken ribs

A

pain control x 6 weeks (otherwise get PNA)

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33
Q

hemothorax dx and tx

A

horizontal shadow on CXR

thoracostomy (rapid bleeding to OR)

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34
Q

Sucking chest wound treatment

A

occlusive dressing

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35
Q

Expect underlying organ damange in what blunt injuries

A

scapular fracture
sternal fracture
flail chest

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36
Q

Flail chest see sx and tx// assc condition

A

multiple broken ribs, paradoxical motion
use binder, weights
risk pulm contusion

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37
Q

Pulmonary contusion appearance on xray & tx

A
  • 24-48 hours later get white out on xray
  • give colloids, blood, albumin
  • diurese
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38
Q

Appropriate ventilation in case of pulmonary contusion

A

high PEEP to push fluid back into capillaries

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39
Q

Myocardial contusiuon:

treatment and risk

A

MONA BASH

risk tamponade

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40
Q

When to take knife wound to abdomen to OR

A

peritoneal signs, shock, evisceration

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41
Q

Blunt trauma to abdomen eval

A

FAST and CT

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42
Q

MC abdominal bleed

A

liver lac

compress pacreatoduodenal ligament

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43
Q

ruptured spleen intervention

A

just resect

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44
Q

sign of ruptured diapgraghm

A

bowel sounds in chest

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45
Q

Air under diaphragm –> next step

A

exploratory lap

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46
Q

pelvic fracture

signs and treatment

A

+ hip rock test

need ex fix risk uretheral and other injuries

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47
Q

Sign of urethral injury

A

blood at meatus

high riding prostate

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48
Q

1-2-3rd degree burn skin findings

A

1- erythema (like sunburn)
2- blisters
3- full thickness, white, no feeling

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49
Q

Chemical burn to skin- first step in management

A

irrigate

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50
Q

Chemical ingection –> first step

A

serial exams/ EGD

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51
Q

Chemical inhalation –>

A

monitor O2/ feak flow
do bronch
intubate PRN

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52
Q

circumferential burns – risk and management

A

risk compromising vascular supply

cut the eschar

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53
Q

Electrical burns- labs to order

A

CK and Cr

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54
Q

Three risks assc with electrical burn

A

arrhythmia
rhabdo
posterior shoulder dislocation

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55
Q

Rule of 9s for burns

A

each limb= 9% of body surface
front chest/back chest and front abdomen/back= 9 each
head= 9 each side
genitals = 1

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56
Q

FLuid dose for burns

A

4 x kg x %BSA burnt
give half first 8 hours
half over next 16 hours

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57
Q

antidote for methanol/ethylene ingestion

A

fomepizole

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58
Q

acetaminophen antidote

A

NAC

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59
Q

salicylates antidote

A

alkalinize urine

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60
Q

organophosphates antidote

A

atropine –> 2PAM if early

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61
Q

Carbon monoxide treatment

A

hyperbaric O2

**need ABG, SpO2 is normal

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62
Q

Cyanide ingestion sign and treatment

A

cherry red sign/ nitroprusside dosing

thiosulfates

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63
Q

When to give rabies vaccine following dog bite

A

only with signs and symptoms –> give rabies Ig and vaccine

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64
Q

TReatment of bee sting without anaphylaxis

A

just remove pincer

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65
Q

Black widow appearance and treatment +risk

A

red hour glass on belly
give IV ca
risk pancreatitis

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66
Q

Brown recluse clue and treatment

A

attic/old boxes/in south –> get necrotic bite –> need to debride

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67
Q

Appropriate antibiotics for dog or cat bite

A

augmentin

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68
Q

Human bite appropriate treatment

A

irrigate, augmentin, Ig and tetanus toxoid

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69
Q

What xrays must be ordered for fracture

A

2 views, perpendicular to one another

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70
Q

when to take fracture to surgery

A

open, angular, comminuted

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71
Q

cause of posterior shoulder dislocation

A

lightning
seizures
massive trauma

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72
Q

colles fracture is at the ____

A

wrist

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73
Q

anterior shoulder dislocation damages what nerve?

arm is held in what position?

A

axillary nerve

adduction, external rotation (hand shake)

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74
Q

monteggia and galezzia fractures:

define

A 
monteggia= ulna broken, displaced radius 
galezzua= radius broken, ulna displaced
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75
Q

Scahpoid fracture:
mechanism of injury
management

A

FOSH

cast even with normal xray if pain at anatomic snuff box

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76
Q

boxers fracture= what digits fractures

A

4-5th

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77
Q

management of hip fracture

A

femoral head- prosthesis
intertrochanteric- plates
shaft- rods
open- washout/emergent surgery

traction always helps

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78
Q

ACL/ PCL mechanism of injury + management

A

anterior blow- posterior tear and vice versa

MRI –> cast or surgery depending on need to get back on leg

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79
Q

MCL/ LCL injury mechanism + management

A 
valgus stress (lateral) causes medial injury 
varus stress (medial) causes lateral injury

MRI –> cast or surgery

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80
Q

meniscal tear presentation

A

knee pain and click with extension

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81
Q

stress fracture

mechanism of injury and management

A

weekend warrior / tibial pain

xray will be normal, cast and crutch anyways

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82
Q

Tib/fib fractures

mechanism of injury and management

A

fall from height and massive trauma

xray –> cast vs surgery

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83
Q

Achilles tendon

presentation and management

A

gap where tendon should be

clinic dx –> cast vs surg

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84
Q

ankle fracture: presentation

A

these guys CANNOT WALK don’t xray unless not walking

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85
Q

carpal tunnel digits affected

A

1st three

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86
Q

two tests for carpal tunnel

A

flexion worsens= phalens

tapping over tunnel worsens= tinels

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87
Q

What should be ruled out before diagnosing carpal tunnel?

A

RA

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88
Q

What is a felon and how is it treated?

A

abscess at pulp of finger caused by penetrating injury

need incision and drainage

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89
Q

Dequervains tenosynovitis

presentation
management

A

weight lifter/ mom lifting baby pain with fist-thumb-twist
no surgery just splint/NSAIDs
(inflammatory)

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90
Q

Duptuyrens Contracture
patient
presentation
management

A

EtOH or Scandinavian
nodules at palm preventing extension
surgical release

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91
Q

Jersey Mallet Trigger fingers: describe

A

Jersey- torn flexor tendon
mallet- torn extensor tendon
trigger- mallet + a POP

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92
Q

Treatment for jersey, mallet, trigger fingers

A

splinting
NSAIDs
intraarticular steroids

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93
Q

Developmental dysplasia of the hip:

management

A

harness

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94
Q

Legg Calves Perthes
age
presentation
management

A

insidious antalgic age @ ~ 6 years

cast

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95
Q

SCAFE
age
presentation
management

A

fat teen
hip pain
frog leg xray –> surgery

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96
Q

how to dx septic arthritis

A

more than 50k WBC on arthro

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97
Q

Oscgood schlatters location of swelling

A

tibial

kid just needs to sit out

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98
Q

test for scoliosis

A

adams –> bend over look for one shoulder higher than other

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99
Q

Childhood bone tumors –> management

A

xray –> MRI –> bx –> resect

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100
Q

Ewings/ osteosarcoma genetic changes

A

t(11,22)

Rb

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101
Q

Ewings/osteosarcoma location

A

ewings: shaft
osteo: distal femur

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102
Q

Ewings/ osteo appearance

A

osteo- sunburt

ewings- onion skin

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103
Q

Bone cancer worrisome sign

A

focal bone pain without trauma

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104
Q

Special reason to operate on fracture in a kid

A

growth plate injured

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105
Q

BPH:
path
DRE findings
diagnosis

A

enlarged prostate obstructs urethra
large and smooth prostate on exam
empiric dx, do not order PSA

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106
Q

Treament BPH

A

a blockers for symptoms (tamsulosin)

5a reductase inhibitors (finasteride)

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107
Q

ED workup

A

night time tumescense to delineate psych from organic

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108
Q

Treatment of organic ED

A

pumps/ prosthesis if trauma

PDEi if 2/2 crap blood flow

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109
Q

What cannot be given with PDEi?

A

nitrates

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110
Q

Prostatitis presentation

A

old man with pyelo symptoms

exquisitely tender on DRE

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111
Q

Testicular torsion presentation

A

horizontal lie
pain on elevation
no cremasteric reflex

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112
Q

Treatment of torsion

A

bilateral orchipexy

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113
Q

Epididymitis

path

A

STD if young (ceftriaxone + azithro)

ecoli if old (FQ)

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114
Q

PResentation epididymitis

A

sudden pain
vertical lie
better with elevation
normal Doppler

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115
Q

Dx of epididymitis/ torsion

A

ultrasound look for flow on Doppler

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116
Q

Kidney stones diagnostic workup

A

non con CT –> US +/- UA

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117
Q 
Treatment of stones:
0.5 or less cm
0.5-1.5 cm
1.5+ cm 
7+ cm
A

less than 1/2 cm just fluids and pain control
1/2 cm –> 1.5 cm add CCV
1.5 and up stenting and lithotripsy
above 7 cm need surgery

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118
Q

Microhematuria in kids:

management

A

watch and wait

CT only in trauma

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119
Q

Macrohematuria in kids:

w/ casts workup

A

UA and kidney biopsy

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120
Q

Macrohematuria w/o casts workup

A

US; cystoscopy; CT or MRI

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121
Q

Ectopic ureter presentation

A

female with constant leak (attaches below ext sphincter in females)

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122
Q

Ectopic ureter workup

A

US no hydro
VCUG no reglux
radionucleotide scan = ectopic ureter

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123
Q

Treatment of ectopic ureter

A

surgically re-implant

124
Q

Constant hypo and epi spadias

A 
epi= pees on EYE (dorsal, upper side)
hypo= ventral = under side

*don’t circumcise, save foreskin for reconstruction

125
Q

posterior urethral valve presentation

A

no urine output

possible oligo on prenatal screen

126
Q

how to dx posterior urethral valve

A

US shows hydro –> VCUG shows no reflux

127
Q

how to tx posterior urethral valve

A

cath then surg when can

128
Q

UPJO presentation

A

obstruction with increased flow (ie following heavy alcohol drinking)

129
Q

Dx and Tx for UPJO

A

US shows hydro VCUG shows no reflux –> surgery

130
Q

Vesicoureteral reflux presentation

A

recurrent UTI/pyelo in kid
dx = hydro on US + reflux on VCUG
treatment with suppressive abx and then surgery

131
Q

Dx of prostate cancer

A

firm large nodular prostate
high PSA
++ transrectal bx

132
Q

treatment of prostate cancer

A

resection –> rads –> brachy +++ meds

133
Q

meds for prostate cancer

A

anti-androgen = flutamine

GnRH analog = leuprolide

134
Q

carcinogens assc with bladder cancer

A

B alanine dye; smoking

135
Q

Bladder cancer treatment

A

transurethral resection

BCG/cisplatin chemo

136
Q

renal cell carcinoma dx/tx

A

nephrectomy, don’t bx because risk bleeding

137
Q

Clue to renal cell cx

A

erythrocytosis

138
Q

testicular cancer
path
age
presentation

A

germ cell
18-25
does not transluminate

139
Q

testicular cancer

dx and tx

A

US –> orchiectomy no bx because seeding

140
Q

Marker for:
seminoma
ylk sac
chorio

A

seminoma LDH
yolk sac AFP
chorio BHCG

141
Q

SAH dx

A

CT –> LP –> MR/CTA

142
Q

Early treatment of SAH

A

Keep BP under 140/90

coiling/ clipping

143
Q

Treatment of hydrocephalus

A

LP serial/ VP shunt

144
Q

Late complications of SAH + management

A

seizures (give levitiracetam)
high ICP (give mannitol, hyperventilate)
vasospasm (give CCB and ^^^ BP)

145
Q

IPH presentation

A

high BP
FND
H/A and N/V –> coma

146
Q

Most common sources of brain mets (3) + location

A

lung, breast, GI

found at grey white junction

147
Q

How commonly are brain lesions primary?

A

30%, single lesion

148
Q

Where are adult vs pediatric primary tumors located

A

adult- anterior fossa

peds- posterior fossa

149
Q

Two adult/ anterior fossa tumors

A

glioblastoma (butterfly crossing midline)

meningioma (dural tail)

150
Q

Two peds/ posterior fossa tumors + management

A 
medulloblastoma = resection + rads 
ependymom= resection only
151
Q

Specific location of ependymoma

A

IV ventricle

152
Q

craniopharyngioma appearance

A

calcified sella

153
Q

Appearance of basal cell vs squamous cell vs melanoma

A

basal cell- pearly lesion
squamous cell- red nodule
melanoma- jet black

154
Q

Dx and tx of basal/squamous cell

A

excisional biopsy
mohs for face
limb just he ex bx unless aggressive –> amputate

155
Q

Melanoma outcome based on

A

depth

156
Q

Ambylopia definition and cause

A

cortical blindness

strabismus, cataracts

157
Q

Two causes of kiddo cataracts

A

at birth –> TORCH

after birth –> galactosemia

158
Q

Retinopathy of prematurity = baby at risk for what other complications

A

bronchopulmonary dysplasia
IVH
necrotizing enterocolitis

159
Q

Cause of chemical conjunctivitis in babes + appearance

A 
silver nitrate (will be bilateral within **24 hours
** no pus), use emycin instead
160
Q

gonorrhea conjunctivitis time of onset in babes + appearance

A

2-7 days, bilateral, purulent

161
Q

chlamydia conjunctivitis time of onset in babes + appearance

A

5-14 days, unilateral –> bilateral

162
Q

Closed angle glaucoma cause

A

1) low light –> dilation
2) no flow out
3) pressure, pain, rigid eye/ non reactive and dilated

163
Q

Treatment of closed angle glaucoma

A

laser, a agonist, b blocker

164
Q

What drug to always avoid in closed angle glaucoma patients

A

atropine

165
Q

Orbital cellulitis treatment

A

if EOMI give abx

if no EOMI need surg for RETROorbital abscess

166
Q

Cause of orbital cellulitis in DM

A

mucormycosis

167
Q

Retinal detachment presentation

A

instant floaters/ veil/ curtain

does not come and go

168
Q

Treatment retinal detachment

A

laser

169
Q

CRAO presentation

A

painless acute loss of vision in one eye without other focal defects

170
Q

Eye appearance in CRAO

A

cherry red spots on fovea

171
Q

Treatment of CRAO

A

intra aterial tpa

hyperventilation

172
Q

cataracts presentation

A

loss of night vision

old diabetic

173
Q

macular degeneration two types

A 
wet = 20% = can treat 
dry= 80% = no treatment
174
Q

Appearance of wet vs dry MD

A 
wet= hemorrhages 
dry= drussen/ pigment
175
Q

Dx of AAA

A

US

176
Q

Management of AAA based on size

A
  1. 5 screen q12
  2. 5 screen q6
  3. 5 or rapidly growing need surg
177
Q

Classic dissection presentation

A

widened mediastinum

different BP in each arm

178
Q

two patients at risk for dissection

A

marfans

syphilis

179
Q

two types of dissection

A

A before great vessels B after

180
Q

Dx of dissection and treatment?

A

CTA/ TEE–> MRI

operate if ascending, medical management If descending

181
Q

PVD leg appearance

A

shiny
loss of hair
change in temp

182
Q

How to dx PVD

A

ABI –> US –> CTA

183
Q

ABI that is normal/ diagnostic of PVD

A

normal- 1-1.4

PVD- under 0.9

184
Q

Treatment of PVD

A

stent if above the knee or small
bypass for others
if cannot do surg can used cilostazol or pentoxyphylline to decrease pain

185
Q

Medical therapy for PVD

A

ACEi
BBer
statin
antiplatelet

186
Q

Acute limb ischemia three causes

A

cholesterol emboli after cath
clot from afib
thrombus from worsening PVD

187
Q

Dx/ Tx acute limb ischemia

A

US/ angio –> embolectomy or TPA

188
Q

3 L –> R shunt lesions

A

ASD
VSD
PDA

189
Q

Three R –> L shunt lesions

A

transposition
tetralogy
coarctation

190
Q

Risk assc with L –> R shunt

A

eisenmengers, becomes the worse R –> L shunt

191
Q

When to repair VSD

A

at 1 year or with CHF

192
Q

Transposition is assc with ?

A

maternal DM (at week 8 so regular not gestational)

193
Q

Tetraology is assc with?

A

downs (endocardial cushion defect)

194
Q

Aortic stenosis murmur location + dx + tx

A

2nd ICS (R)
echo
replace valve

195
Q

mitral regurg location + two causes

A

apex –> axilla

infection or infarction

196
Q

Aortic Regurg 3 causes

A

infection
infarction
dissection

197
Q

Location of aortic regurg murmur

A

4th R ICS, blowing

198
Q

Dx and tx of AR

A

echo –> replacement or CABG

199
Q

Compare bovine and mechanical valves

A

bovine lasts less than 10 years but doesn’t need anticoag

mechanical lasts more than 10 years but needs anticoag

200
Q

mitral stenosis murmur clue

A

opening snap

201
Q

Cath findings:
when to stent
when to CABG

A

stent if 2 or less vessels involved

CABG is 3 or left main

202
Q

Vessels used for CABG

A

left internal mammary

saphenous

203
Q

High aldo manifestation

A

HTN and low K

204
Q

Five causes of surgical HTN

A 
Conns 
RAS 
Pheo 
Cushings 
Coarctation
205
Q

Conns- define

A

primary hyperaldo

206
Q

Conns dx and tx

A 
aldo:renin above 20
salt suppression test failure 
adrenal vein sampling 
CT/MRI 
resect
207
Q

RAS dx

A

aldo : renin under 10
US w/ Doppler
angiogram

208
Q

RAS tx

A

stent in young person with FMD

medical treatment for atherosclerosis

209
Q

Coarctation dx ad tx

A

angiogram –> resect and re-anastamose

210
Q

Treatment of pheo

A

a block –> b block –> resect

211
Q

Cushings evaluation

A

low then high
low dose dexa, acTHEN, high dose dexa

low dose = syndrome
then= primary adrenal
high= cushing disease/ ectopic tumor

212
Q

Primary adrenal cushings –> further dx

A

imaging and vein sampling

213
Q

cushing disease management

A

MRI and resect

214
Q

common source of ectopic ACTH

A

lung cancer

215
Q

Thyroid nodule first step in dx

A

TSH (low= low risk) (normal = high risk)

216
Q

Management of thyroid nodule with normal TSH

A

US –> FNA is over 1 cm, W & W if under 1 cm

217
Q

Management of low risk (low TSH) nodule

A

RAIU scan

if hyperfunctioning Tx and resect, if nonfunctioning US and FNA

218
Q

Dx of gastrinoma

A

gastrin level –> secretin stim –> somatostatin receptor scintography

219
Q

Tx of gastrinoma

A

resect, because benign but leads to gastric cancer

220
Q

Insulinoma dx

A

insulin, C peptide, sulfonylurea level

221
Q

Glucagonoma clue

A

migratory necrolytic dermatitis

222
Q

Hyperparathyroidism

dx and tx

A

sestamibe scan

resect (but will risk low Ca post op)

223
Q

Most common type of TE fistula

A

type C (proximal atresia distal fistula)

224
Q

Presentation of TE fistula

A

NG tube coiling

225
Q

Imperforate anus dx

A

xray

226
Q

Gastroschisis/ omphalocele location

A

Gastro- R sided

Omphalocele- midline

227
Q

Treatment for gastro/omphalocele

A

silo

228
Q

Extrophy of bladder appearance

A

midline, no bowl, shining red structure

229
Q

Congenital diaphragmatic hernia two types

A

posterior- bochladek

anterolateral- orgagni

230
Q

Pt presentation CDH

A

scaphoid abdomen

bowel sounds in chest

231
Q

Treatment (2) for CDH

A

surgery + surfactant

232
Q

Biliary emesis –> first step in dx

A

xray (to look for double bubble)

233
Q

Four causes of newborn bilious emesis

A

1) malrotation
2) duodenal atresia
3) annular pancreas
4) intestinal atresia

234
Q

2 Causes of intestinal atresia

A

1) in utero infarct

2) cocaine

235
Q

Malrotation exams beyond xray

A

contrast enema

UGI series

236
Q

Treatment for all causes bilious emesis

A

surgery

237
Q

NEC presentation and dx

A

bloody BM with first feed, acidotic

babygram shows pneumatosis intestinalis

238
Q

Treatment NEC

A

NPO, TPN

239
Q

Meconium ileus presentation, dx/ tx

A

FTPM
bilious emesis
baby gram= ground glass, loops of bowel
tx- gastrograffin

240
Q

Hirschsprungs dx and tx

A

KUB and surg

241
Q

Obstruction pain characteristics

A

colicky
no fever
no leukocytosis

242
Q

Inflammatory pain characteristics

A

constant
fever
leukocytosis

243
Q

Perforation pain characteristics

A

SAS
MOTIONLESS
constant
free air on KUB

244
Q

Lower quadrant structures

A 
colon/appendix 
kidneys 
ureters 
testes
ovary
245
Q

Structure found in both upper quadrants

A

lung + diaphragm

246
Q

Anal cancer
dx
tx

A

anal pap

chemo and rads, no cutting

247
Q

How frequent are colonoscopies completed?

A

q10 if clean
q5 with polyps
q3 with carcinoma in situ
q1 with dysplasia

248
Q

Familial adenomatous polyposis treatment

A

prophylactic colectomy

249
Q

“Bad” polyp appearance

A

villous
sessile
large

250
Q

Dx and tx of hemorrhoids

A

anoscopy
external- resect
internal- band

251
Q

Anal fissure treatment

A

lateral internal sphincterotomy

NG paste

252
Q

Pilonidal cyst treatment

A

I&D –> surgery

253
Q

When to start colonoscopies in UC

A

8 years post dx, prophylactic colectomy at first sign of dysplasia

254
Q

Cholelithiasis dx/tx

A

RUQ US –> elective chole

255
Q

Cholecystitis dx/ tx

A

RUQ US –> HIDA –> ERCP/elective chole

256
Q

Choledocolithiasis dx/tx

A

RUQ US –> MRCP –> ERCP (urgent)/chole elective

257
Q

Cholangitis dx/ tx

A

RUQ US –> STAT ERCP CHOLE LATER

258
Q

Abx for gallbladder disease

A

Cipro + metro

259
Q

How to dx pancreatitis

A

lipase –> only need CT if labs aren’t sufficient

260
Q

Management of pancreatitis

A

NPO
IVF
Analgesia

261
Q

Pseudocyst management

A

drain if above 6 weeks or 6 cm

262
Q

Chronic pancreatitis management

A

insulin
enzymes
pain control

263
Q

Dx SBO

A

upright abdominal film

264
Q

When to operate on SBO

A

complete = urgent surgery
peritoneal signs = emergent surgery
incomplete= surgery if not better in a few days

265
Q

Initial management of all SBO

A

NG tube, IVF

266
Q

Appendicitis dx/tx

A

clinical –> straight to surgery

267
Q

Carcinoid syndrome= tumor must be?

A

metastatic/ in liver

268
Q

Carcinoid dx/ tx

A

5HIAA —> CT scan –> resect

269
Q

When to operate on hernia

A

strangulated –> emergent surgery
reducible –> urgent surgery
reducible –> elective surgery

270
Q

Achalasia:
what is absent?
dx/tx?

A

auerbach

barium –> manometry –> EGD/bx –> myotomy

271
Q

GERD spectrum management

A

GERD PPi
Metplasia High dose PPi
Dysplasia ablation
adenocarcinoma resect

(all can get nissen)

272
Q

Esophageal cancer:
sx
dx/tx?

A

progressive dysphagia

EGD/bx –> resection

273
Q

Mallory Weiss tear management

A

supportive

274
Q

Boerhaaves dx/treatment

A

air in mediastinum

gastrograffin –> barium –> EGD –> surgery

275
Q

Pre-hepatic jaundice two types

A

hemolysis

hematoma

276
Q

Two causes of intrahepatic jaundice

A

genetic

hepatitis

277
Q

Three causes of posthepatic jaundice

A

strictures
cancer
gallstones

278
Q

Obstructive jaundice –> next step in dx?

A

CT scan: obstruction in biliary tree, pancreas, or ampulla of vater?

279
Q

Obstructive jaundice in biliary tree: cause?

A

stone or cholangiocarcinoma

280
Q

Clue to pancreatic cancer as cause of obstructive jaundice

A

migratory thrombophlebitis

281
Q

List four stages of skin ulcers

A

1: erythema/epidermis
2: epidermis + dermis
3: exposed fascia
4: exposed bone & muscle (osteo)

282
Q

Path of diabetic vs aterial insufficiency ulcers

A

DM- microvascular changes

Arterial insufficiency- macrovascular

283
Q

Location of diabetic vs arterial vs venous ulcers

A

diabetic- heels/balls of feet
arterial- tips of toes
venous- medial malleolus

284
Q

Arterial insufficiency vs venous insufficiency skin appearance

A

arterial- shiny, hairless, pulseless

venous- edema, pigmented

285
Q

Marjolin ulcer is caused by?

treatment?

A

SCC

wide resection

286
Q

Dx and tx of arterial insufficiency

A

ABI/arteriogram –> stent/bypass/graft

287
Q

Mammograms- whats the board answer for now?

When do we MRI?

A

50 q2

MRI only with BRCA or prior cancer

288
Q

Management of a breast lump in patient under 30

A

watch and wait x 2 cycles –> US/ FNA if still there

FNA blood= cx, pus = abscess, fluids = cyst

289
Q

Lump in a patient over 30 (or with prior mass/ bleeding)

A

mammogram and core bx

290
Q

Which of the SERMs increases endometrial cancer risk?

A

tamoxifen

291
Q

What are the systemic chemo drugs for bcx? targeted?

A

doxo/dauno +/-cyclophosphamide and paclitaxel

targeted- trastuzumab, tamoxifen, aromatasei

292
Q

What severe ADR is assc with trastuzumab

A

CHF

293
Q 
Post op fever:
immediately post op 
day 1 
day 2
day 3
day 5 
day 7 
2 weeks
A 
immediately- bacteremia 
day 1- atelectasis 
day 2- PNA 
day 3- UTI 
day 5- DVT/ PE 
day 7- cellulitis 
2 weeks -abscess

(wind, water, walking, wound)

294
Q

Treatment of post op DVT/PE

A

heparin –> warfarin

295
Q

Ddx AMS post op

A

1) hypoxemia
2) delirium tremens at 48-72 hours post admission
3) sundowning
4) Na/Ca changes

296
Q

Treatment of delirium tremens

A

BDZ

297
Q

Normal urine output

A

0.5 cc/kg/hr

298
Q

Oliguria three types

A

urge + = obstruction (scan)

urge - = mechanical (0 urine) or renal disease (some)

299
Q

3 causes of post op abdominal distention

A

ileus
obstruction
ogilive syndrome

300
Q

Ileus, obstruction, ogilive: KUB findings + which gets surgery

A 
ileus= whole bowel distended 
ogilive= whole LARGE bowel distended in elderly 
obstruction= proximal dilation/distal narrowing

only obstruction gets surgery

301
Q

ileus management

A

IVF, K get out of bed

302
Q

Treatment ogilive syndrome

A

rectal tube
stigmine
colonoscopy

303
Q

Evisceration management

A

warm saline dressing, never push back in, emergency surg

304
Q

Cardiac reasons to avoid surgery

A

EF under 35%
MI in last six months
JVD

305
Q

How to dx malnutrition

A

prealbumin

Surgery (4 decks)

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