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Surgery > Other surgery stuff > Flashcards

Other surgery stuff Flashcards

0
Q

most common benign tumor of the liver?

A

hemangioma

it’s usually asymptomatic

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1
Q

how do you dx and tx focal nodular hyperplasia of the liver?

A

dx with angiography
no need to tx. it has no malignant potential
“central scar” on CT

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2
Q

liver mass assoc with estrogen/OCP use

how do you tx it?

A

hepatic adenoma

excise it b/c risk of hemorrhage and malignant potential

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3
Q

most common met to the liver?

A

colorectal cancer

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4
Q

what must you r/o before biopsying a liver mass

A

hemangioma b/c risk of bleeding

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5
Q

most common cause of GI tract fistulas

A

diverticulitis

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6
Q

what’s the 3:1 rule?

A
  • administer 3 cc of crystalloid for every 1 cc of blood lost
  • this is b/c at equilibrium, only 1/3 of isotonic crystalloid remains in the intravascular space
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7
Q

amylase and lipase levels correlate with the prognosis for acute pancreatitis (T/F)

A

F

they are only good for diagnosing

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8
Q

what should you r/o first in a woman with nipple discharge

A

pregnancy

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9
Q

which increases your risk of breast ca?

  • fibrocystic changes
  • diffuse papillomatosis
  • intraductal papilloma
A

diffuse papillomatosis

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10
Q

2 most common severe complications following CEA

A

MI

stroke

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11
Q

in working up carotid stenosis, if duplex results are equivocal –> get this study

A

MRI

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12
Q

when to do a Whipple procedure

A

localized malignancies near the ampulla of vater

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13
Q

most common cause of incidental finding of hypercalcemia and how to tx it?

A

primary hyperparathyroidism

usually tx with surgery

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14
Q

common cause (besides primary hyperparathyroidism) of hypercalcemia in a hospitalized patient

A

malignancy

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15
Q

what electrolyte imbalances do you see in hyperparathyroidism

A 
hypercalcemia
hypercalcinuria
low serum phosphate
high serum chloride
low serum bicarbonate
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16
Q

patient with perforated ulcer, signs of sepsis, ischemic changes on ECG. what do you do?

A

abx, invasive monitoring, early surgical intervention

-a perfed ulcer is a surgical emergency!!! the ECG changes are most likely secondary to the sepsis

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17
Q

dobutamine stress test is highly sensitive or specific

A

sensitive

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18
Q

how to evaluate preop risk in this patient:

-underwent coronary stenting 4 years ago and has had no recurrence of sxs

A

H&P, labs, ECG

stress test is not needed

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19
Q

you suspect PUD. what do you do next?

A

EGD… see if there’s H Pylori

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20
Q

medical therapy for PUD

A 
antacids
H2 antagonists
PPI
sucralfate
prostaglandins
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21
Q

what should be done in the work up for PUD?

A

endoscopy

+ biopsy if it’s a gastric ulcer due to risk for malignancy

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22
Q

CT scans are great for solid organ and retroperitoneal injuries but not so great for _______

A

hollow viscus injuries

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23
Q

what is myasthenia gravis assoc with and how do you tx it?

A

thymoma –> tx with complete resection

-staging takes place at the time of surgery via macroscopic inspection

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24
Q

XY gonadal dysgenesis is associated with testicular cancer (T/F)

A

T

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25
Q

are testicular cancers more commonly derived from germ cells or stromal cells?

A

germ cells, half of which are seminomas

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26
Q

if you palpate a supraclavicular mass in someone with testicular cancer…

A

think metastasis (Virchow node)

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27
Q

mass in the testis of a young man… what do you do?

A

US or transilluminate to find out if it’s solid

  • if it’s solid, then get CXR and get beta-HCG and AFP levels
  • perform radical inguinal orchiectomy for dx and tx
  • if it’s cancer, then obtain CT abd/pelvis for met workup
  • depending on what kind of cancer it is, tailor your tx
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28
Q

which testicular cancer is really sensitive to XRT and chemo?

A

seminoma

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29
Q

anal skin tag assoc with what?

A

anal fissure

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30
Q

how to examine someone suspected of having an anal fissure?

A

exam under anesthesia, anoscopy, proctoscopy

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31
Q

how to conservatively manage anal fissures

A

increasing dietary bulk, sitz baths, stool softeners, nitroglycerin ointment

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32
Q

nonhealing anal fissure or anal fissure located anywhere but directly posterior… include these 2 things in your ddx

A

Crohn’s or malignancy

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33
Q

how to tx thrombosed external hemorrhoids not responding to meds

A

excisional thrombectomy (NOT I&D)

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34
Q

3 lab values for pheochromocytoma

A

VMA, metanephrine, normetanephrine

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35
Q

what to do to work up an adrenal incidentaloma

A
  • H&P
  • functional assessment: get various labs for pheo, hyperaldo, hypercortisolism
  • CT or MRI (PET if h/o malignancy) for anatomic assessment
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36
Q

how to tx an adrenal mass

A
  • functional: remove it

- nonfunctional: remove if > 4 cm OR if < 4 cm but growing OR if it looks sketchy on imaging

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37
Q

most common met to the adrenal glands is _______

A

lung carcinoma

-others include: breast, colon, kidney, stomach, melanoma

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38
Q

pheo 10% rule

A

10% are bilateral, extra-adrenal, multiple, malignant, familial

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39
Q

what imaging is used to see pheo?

A

CT or MRI initially

MIBG has higher specificity so you confirm with this

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40
Q

in doing surgery for pheo, what must you be sure to do?

A

alpha blockade before beta blockade to prevent a hypertensive crisis
-also just be aware that BP may be low after tumor excision due to massive vasodilation… just support them with a pressor then they will be fine in the end

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41
Q

adrenal incidentalomas are usually functional (t/f)

A

F

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42
Q

when do you biopsy an adrenal mass?

A

only when you think it’s a met

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43
Q

what is hesselbach’s triangle?

A

direct inguinal hernias go through it

-rectus sheath, inferior epigastric vessels, inguinal ligament

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44
Q

femoral hernia occurs below the _______

A

inguinal ligament

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45
Q

where does indirect hernia occur?

A

lateral to the epigastrics

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46
Q

scrotal or labial swelling… what kind of hernia?

A

indirect inguinal hernia

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47
Q

medial thigh hernia in old women

A

obturator hernia

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48
Q

nec fasc after
-water contact
-trauma
what species?

A
  • vibrio

- clostridial

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49
Q

presentation of wilm’s tumor?

how to tx wilm’s tumor?

A

presentation- usually appear healthy, has abdominal mass and hematuria

tx

  • depends on imaging
  • in most cases, nephrectomy then chemo
  • if tumor is really big and invading, then neoadjuvant chemo before nephrectomy
  • XRT only if tumor spillage occurs
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50
Q

pediatric adrenal mass with failure to thrive… what is it?

A

neuroblastoma

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51
Q

how to tx adrenal neuroblastoma in kids?

A

biopsy –> neoadjuvant chemo –> surgery

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52
Q

most common enlarged renal mass in neonate

A

hydronephrosis

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53
Q

-young woman with easy bruising and bleeding, petechiae, thrombocytopenia, lots of megakaryocytes on bone marrow bx
what is it?

A

idiopathic thrombocytopenia purpura (ITP)

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54
Q

what causes ITP?

A

idiopathic…

but it’s due to production of anti-platelet IgG by the spleen

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55
Q

how to tx ITP?

A

start with steroids

splenectomy solves the problem if steroids don’t work

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56
Q

what does the spleen do?

A

produce antibodies

remove erythrocytes after 120 days

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57
Q

overwhelming post splenectomy sepsis (OPSS) is more common in adults (T/F)

A

F

it’s more common in children and it can have mortality > 50%

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58
Q

the people with ITP who respond the best to steroid therapy will respond the ______ to splenectomy

A

best

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59
Q

patient with Crohn’s disease presents with disease exacerbation… what tests do you want?

A

CT
small bowel follow through
colonoscopy

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60
Q

you manage most things in Crohn’s medically (T/F)

what’s the exception

A

T- surgery is reserved for sxs that are refractory to medical management
-exception is fibrotic strictures, which will not improve with medications alone

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61
Q

surgery option for pts with refractory UC involving their whole colon

A

proctocolectomy with ileal pouch-anal anastamosis

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62
Q

you find high grade dysplasia in the colon of someone with UC.. what do you do?

A

total proctocolectomy

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63
Q

main indications for surgery in UC:

A

-fulminant colitis or toxic megacolon, dysplasia or cancer, intractable disease

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64
Q

extra intestinal manifestations of UC

A 
ankylosing spondylitis
uveitis 
scleroderma
PSC
arthritis 
dermatomyositis
hypercoagulable state
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65
Q

most common area for herniated disk?

A

L4-L5

L5-S1

66
Q

ways to dx biliary atresia

A

US and HIDA are pretty good

the only definitive way to dx it is intra-operative cholangiogram

67
Q

treatment for babies with biliary atresia

A

before 120 days, Kasai procedure

after 120 days, list for liver transplant

68
Q

jaundice in neonates after ______ is rarely physiologic, esp if it’s mainly conjugated bilirubin

A

2 weeks

69
Q

most common complication of portoenterostomy (Kasai) for biliary atresia

A

cholangitis –> tx with abx and steroids

others include cessation of bile flow and portal hypertension

71
Q

apple core lesion on barium enema means

A

colon cancer

72
Q

pneumobilia (air in biliary tree) and SBO seen on KUB

A

gallstone ileus (which is really an obstruction, not an ileus)

73
Q

KUB: bent inner tube, coffee bean, parrot’s beak

A

sigmoid volvulus

74
Q

CXR: looks like air in the cardiac silhouette

how to dx it?

A

hiatal hernia

dx with Ba swallow

75
Q

“white out” of the lungs

3 causes

A

CHF
ARDS
pulmonary contusion

76
Q

most common kind of melanoma

A

superficial spreading

77
Q

a few days post-op: if someone looks like they’re in sepsis (fever, AMS) but they have hypertension (rather than hypotension), think about this….
and how do you tx it?

A

alcohol withdrawal

tx with ativan/serax

78
Q

when to operate for carotid stenosis

A

> 70% if symptomatic

> 80% if asymptomatic

79
Q

foot drop and numb dorsum of foot (1st and 2nd toes)… what injury is this?

A

deep peroneal nerve (anterior compartment)

80
Q

which local anesthetic has higher rate of allergy

A

esters and PABA allergy

81
Q

know classes of hemorrhagic shock…

A

ok

82
Q

preop coronary concern… what tests do you get?

A

stress/cath

83
Q

valve concern or CHF concern, what test?

A

echo

84
Q

mitral stenosis caused by….

A

rheumatic fever

85
Q

ARDS criteria

A

bilateral infiltrates
PCWP < 18
PaO2/fiO2 < 200

86
Q

MI 5 days ago and acute decompensation…. 3 possible causes

A
  1. papillary muscle rupture/mitral regurg
  2. VSD: new harsh and loud holosystolic murmur
  3. LV rupture
87
Q

4 Ts of cyanotic congenital heart issues

A

tetralogy of fallot
truncus arteriosus
TGA
tricuspid valve

88
Q

co-arctation associated with _______ syndrome

A

Turner

  • rib notching
  • variable BP/pulses
89
Q 
when to operate for aneurysms:
thoracic 
abdominal 
iliac
distal/visceral
A 
7 (lower threshold to operate on ascending) 
5 
3
2 
or acute increases or symptomatic
90
Q

how to tx claudication

A

exercise, no smoking –> ABI –> duplex –> arteriogram

91
Q

ABI limits for claudication, rest pain, and ulcers

A

claudication < 0.9
rest pain < 0.6
ulcers < 0.5

92
Q

know the lung volumes

A

ok

93
Q

SOB after central line placement is most likely ________

A

Ptx

94
Q

tachycardia, R heart strain, desaturation is most likely a ______

A

PE

95
Q

ship yard/asbestos exposure puts you at risk for what

A

mesothelioma

96
Q

how to work up zenker’s diverticulum

A

Ba swallow and upper GI –> cut the cricopharyngeus

97
Q

hiatal hernia:
_________ does not need repair
_________ needs the OR

A

type 1- sliding

type 2- paraesophageal

98
Q

chronic cough + high BMI may be ______

A

GERD

99
Q

EGD shows Barrett’s…. what do you do?

A

tx with anti-acid and anti-reflux

-do not do esophagectomy until high grade dysplasia/cancer

100
Q

central stellate scar in the liver… what is it and what do you do?

A

focal nodular hyperplasia

-no need to resect or treat

101
Q

cholecystitis causes jaundice (t/f)

A

F!!!!!

102
Q

how to work up and tx acute cholecystitis

A

dx with US

tx with supportive measures (ex. NPO, IV fluids, abx) and interval cholecystectomy

103
Q

high alk phos and T bili
US shows dilated CBD
what is it and how to tx?

A

choledocolithiasis

tx with ERCP and sphincterotomy and interval cholecystectomy

104
Q

RUQ pain, fever, jaundice +/- septic
dilated CBD, high alk phos and T bili
what is it and how to tx?

A

acute cholangitis

tx with abx and ERCP decompression

105
Q

how to tx gallstone pancreatitis?

A

cholecystectomy once the patient and his/her amylase levels stabilize

106
Q

PSC vs. PBC

  • intra and extrahepatic ducts = ________
  • intra hepatic ducts, antimitonchondrial Ab = __________
A

PSC

PBC

107
Q

SBO…. indications for OR?

A

complete SBO
incarcerated hernia
fever, high WBC

108
Q

ileum resection causes diarrhea… why?

A

less bile salt absorption/less fat absorption

109
Q

non bilious vomiting in a first born male… what is it and what’s the tx?

A

pyloric stenosis

tx with pyloromyotomy

110
Q

malrotation causing bilious vomiting is an emergency (t/f)

A

T

111
Q

abdominal pain, currant jelly stool, “knees drawn up”

what is it and what’s the tx?

A

intussusception
tx with air or gastrograffin enema
if peritonitic, go to the OR
in adults, it could be cancer

112
Q

if someone has ulcerative colitis and you see colonic dysplasia, what do you do?

A

total colectomy

113
Q

someone complains of diarrhea but there is hard stool by DRE/KUB… what do you do?

A

enema b/c this is usually fecal impaction

114
Q

3 common causes of anal pain

A

anal fissure
thrombosed external hemorrhoid
perirectal abscess

115
Q

unless your patient has CHF, keep UO above approximately _____

A

30 cc/hr

116
Q

normal urine gravity range

A

1.010 to 1.025

117
Q

indications for dialysis

A 
AEIOU
acidosis
electrolyte issues (esp hyperkalemia)
ingestion of toxins 
overload of volume
uremia
118
Q

when operating on a pheochromocytoma, what MUST you do?

A

alpha blockade before beta blockade

otherwise, they’ll go into hypertensive crisis

119
Q

blood in urine:

  • pain = _____
  • painless = _______
A

stone

most likely cancer

120
Q

renal transplant failure in a few hours post-op

what’s the cause and what do you do?

A

poor blood flow vs. ATN

get ultrasound of renal vasculature

121
Q

2 important transplant meds

A
  1. azathioprine/mycophenylate (imuran/cellcept)
    - inhibit purine synthesis, inhibit T cells
  2. cyclosporine/program (FK-506/Tac)
    - inhibit genes for cytokine synthesis
122
Q

hyper Ca
presentation: ______________
____ QT

A

bones, stones, groans, psychiatric moans

short

123
Q

hypo Ca
________ signs on clinical exam
_____ QT

A

Chvostek’s and Trousseau’s

long

124
Q 
hyper K
ECG findings (3): \_\_\_\_, \_\_\_\_\_, \_\_\_\_\_
A

wide QRS, peaked T, sine wave

125
Q

hypo K
ECG findings (3): ____, ______, _______
GI finding: _______

A

flat T, long QT, U wave

constipation

126
Q

neonates with biliary atresia or choledocal cysts should be assessed for ________ before surgery

A

coagulopathy

127
Q

woman with blunt abdominal injury, stable vitals, abdomen has guarding and rebound… what to do?

A

ex lap

128
Q

woman picks up grocery bag and her arm snaps in the middle of her humerus… what is it?

A

metastatic osteolytic cancer

129
Q

cirrhotic man with bill 3.5, PT 28, albumin 2.5, ascites, and encephalopathy needs surgery

A

he’s not a surgical candidate

130
Q

how to dx mets to the spine from breast cancer

A

MRI

131
Q

man with GERD who is non compliant with meds and now has esophagitis, Barrett’s, and mild dysplastic changes… tx?

A

Nissen fundoplication

esophagectomy reserved for severe dysplastic changes

132
Q

man with sudden severe abdominal pain that is constant and has rebound
-negative CXR, EKG, lipase, and CT
what is it?

A

perforation of a hollow viscus due to the sudden nature of severe pain

133
Q

blunt abdominal trauma that is successfully resuscitated…no peritoneal irritation
what to do next?

A

CT

134
Q

when to remove adrenal masses

A

> 5 cm or when they are functional

135
Q

what’s the secretin test used for?

A

ZES- gastrinoma

when you give secretin, gastrin levels stay inappropriately high

136
Q

what does coumadin affect?

how to monitor and reverse?

A

vitamin K dependent factors: II, VII, IX, X; protein C and S
monitor with PT/INR
reverse with vitamin K or FFP (immediate)

137
Q 
how does heparin work? 
\_\_\_\_\_\_\_\_ for tx
\_\_\_\_\_\_\_\_ for prophylaxis
how do you monitor?
what does heparin cause in certain ppl and how do you treat it?
A 
binds ATIII
IV
SubQ
PTT
HIT (prothrombotic) --> tx with lepirudin or argatroban
138
Q

how does aspirin work?

how to reverse?

A
  • inhibits platelets

- technically irreversible but can give plts if immediate surgery is needed

139
Q

how does plavix work?

A

inhibits platelets

140
Q

consumptive coagulopathy
“bleeding from IV sites”
increased PTT and INR
decreased platelets and fibrinogen

A

DIC

141
Q

multiple blood transfusions can cause _________ (electrolyte issue)

A

hypocalcemia

142
Q

gastroesophageal varices with normal liver

A

pancreatitis –> splenic vein thrombosis –> gastroesophageal varices –> hematemesis
-tx with splenectomy

143
Q

jowell holly bodies usually indicate what?

also, what do they look like?

A

they indicate a damaged spleen

they look like a RBC with a basophilic dot inside

144
Q

absence of jowell holly bodies s/p splenectomy means what?

what do you do?

A

accessory spleen

need a spleen scan… most common location is splenic hilum

145
Q

post splenectomy sepsis prophylaxis and tx?

also, what 3 vaccines to give?

A

prophylaxis = PCN, tx = vanco/cefepime

vaccines: pneumococcus, meningococcus, H flu

146
Q

what to do for spleen autoinfarcts in sickle cell

A

no need for resection

147
Q

HIV and bloody diarrhea… what causes it?

A

CMV

148
Q

3 microbes of nec fasc

A

group A strep
clostridium
polymicrobial

149
Q

artificial heart valve prophylaxis with what abx?

A

amoxicillin

150
Q

fungus in a blood culture can be a contaminant (t/f)

A

F (esp in PICC line pts getting TPN)

151
Q

diarrhea, WBC > 30, abdominal pain

what is it and how to tx?

A

c diff
d/c other abx
tx with metronidazole or vanc

152
Q

what to do with undescended testes?

A

fix them down by age 1

-still increased cancer risk but you can do better surveillance

153
Q

direct inguinal hernia goes through _____________

A

Hesselbech’s triangle (epigastric vessels, rectus abdominus, inguinal ligament)

154
Q

acute testicular pain… what to do? 2 possible dxs

A

US

-testicular torsion vs. acute epididymitis

155
Q

if you suspect ovarian torsion, first dx test?

A

pelvic ultrasound

156
Q

DCIS is ________and often found on _________
dx with ______
tx with ___________

A

precancerous, mammography
core needle bx
lumpectomy and XRT if localized
simple mastectomy +/- sentinel node biopsy if multicentric

157
Q

LCIS is _______ NOT __________

A

a breast CA risk factor, not a precancerous lesion

158
Q

infiltrating ductal carcinoma

2 surgical approaches: ________ or ________

A

modified radical mastectomy or lumpectomy + postop XRT
may need chemo and/or tamoxifen
sentinel node biopsy +/- axillary dissection

159
Q

how to tx inflammatory breast CA

A

chemo and radiation and then possible mastectomy

160
Q

________ increased risk of breast ca, endometrial ca, ovarian ca
________ increased risk of breast ca, male breast ca

A

BRCA 1

BRCA 2

161
Q

what to do with breast cyst –> _______
if bloody –> ______
if recur –> ______

A

drain it
send for cytology
excise

162
Q

how to dx and tx Paget’s disease of breast (scaly nipple)

A

dx: biopsy of nipple skin
tx: resection

163
Q

metformin is a risk for _______

A

metabolic acidosis

164
Q

anion gap acidosis causes?? mnemonic

A

MUDPILES

methanol, uremia, DKA, propylene glycol, infection, lactic acidosis, ethylene glycol, salicylates

Surgery (5 decks)

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