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Surgery > PPP EOR Topics > Flashcards

PPP EOR Topics Flashcards

1
Q

Most common presentation of PAD

A

Intermittent claudication

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2
Q

Leriche’s syndrome

A

Thigh or buttock claudicayiob, impotence, decreased femoral pulses

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3
Q

Livedo reticularis

A

Mottling of skin

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4
Q

Bruits in a peripheral vessel indicate occlusion is this bad

A

50% occlusion

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5
Q

ABIs with PAD

A

Normal 1-1.2
PAD <0.90
Severe PAD < 0.50
Rest pain/limb ischemia <0.4

*ABI of at least 0.85 needed to heal ulcers in diabetics

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6
Q

Thx of intermittent claudication

A

Cilostazol

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7
Q

Where do most AAAs occur?

A

Infrarenally

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8
Q

At what size is AAA rupture more likely?

A

> 5cm

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9
Q

Which bp med should a pt with an AAA be on to prevent aneurysm growth?

A

BB

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10
Q

When is immediate surgical intervention indicated for an AAA?

A

> 5.5cm or >0.5cm expansion in 6 months

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11
Q

Describe monitoring/referral guidelines for AAAs <5.0cm

A

3-4cm US annually
4-4.5cm US every 6 months
>4.5cm vascular surgery referral

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12
Q

Where do most aortic dissections occur?

A

65% in ascending

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13
Q

Most important predisposing factor for aortic dissection (present in 80% pts)

A

Hypertension

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14
Q

Sudden onset of severe tearing ripping knife-like chest pain

A

Aortic dissection

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15
Q

DeBakey classification of aortic dissection

A

Type I originate in ascending and propagates distally

Type II isolated to ascending

Type III originates in descending and propagates proximally

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16
Q

Stanford aortic dissection classification

A

A - involves ascending aorta and/or aortic arch

B - isolated descending aorta

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17
Q

Trousseau syndrome

A

Migratory thrombophlebitis associated with malignancy

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18
Q

Tx of superficial thrombophlebitis

A

Supportive with extremity elevation, warm compressed, NSAIDs and elastic supportive compression stockings

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19
Q

Asymmetric calf swelling >3cm should make you think of this

A

DVT

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20
Q

Cerulea alba

A

Milky white pallor with occlusion of deep venous system

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21
Q

Cerulea dolens

A

Cyanosis and swelling of limb with sudden pain associated with superficial and deep venous system compression

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22
Q

Antidote for heparin toxicity

A

Protamine sulfate

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23
Q

If someone has a VTE what is the minimum time frame to treat with anticoagulants?

A

3 months

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24
Q

Compare and contrast skin changes in peripheral venous v. Arterial dz

A

Venous-stasis dermatitis, brownish pigmentation, edema

Arterial- atrophic changes such as thin shiny skin, loss of hair thick nails, pallor, dry skin, livedo reticularis(mottled appearance)

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25
Q

Cheyne-Stokes

A

Smooth increases in respiration’s followed by gradual decrease and apnea

Caused by hypercapnia

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26
Q

Biot’s breathing

A

Quick shallow breaths of equal depth followed by a period of apnea

Seen with brain stem damage and opioid use

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27
Q

Kussmaul’s respirations

A

Deep rapid continuous respirations

Associated with metabolic acidosis

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28
Q

Vomiting/NG SUCTION, chronic diarrhea, and loop diuretics cause this kind of acid base imbalance

A

Metabolic alkalosis

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29
Q

Normal blood pH

A

7.35-7.45

> 7.45 alkalosis
<7.35 acidosis

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30
Q

Normal Pco2

A

35-45

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31
Q

Normal HCO3

A

22-26

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32
Q

Parietal cells secrete ________ and are stimulated by ______, _______, and ________.

A

HCl

Gastrin
Histamine
Ach/vagus nerve

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33
Q

Most common cause of noncardiac chest pain

A

GERD

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34
Q

Lifestyle modifications for GERD

A

Elevate head of bed 6in

Avoid recumbent for 3hr postprandiallly

Small meals

Avoid spicy/acidic/caffeine foods

Smoking cessation

35
Q

Compare and contrast dysphasia in achalasia, esophageal webs/rings, and esophageal neoplasm

A

Achalasia- doilies and liquids
Webs/rings- solids
Neoplasms-solids progressing to liquids

36
Q

MC type of hiatal hernia

A

Sliding/type I

37
Q

Lab testing for Zollinger-Ellison syndrome

A

Fasting gastrin > 1000pg

Increased gastrin release with secretin administration

38
Q

Linitis plastica

A

Diffuse thickening of stomach wall due to gastric cancer infiltration

39
Q

Dubin-Johnson syndrome

A

Hereditary decreased hepatocyte excretion of conjugated bilirubin

Dubin, Direct bilirubinemia, Dark glossy liver

No treatment needed

40
Q

Crigler-Najjar syndrome

A

Hereditary indirect hyperbilirubibemia

phototherapy may be needed in neonates if severe presentation

41
Q

Describe biliary colic

A

Episodic abrupt RUQ/epic Astrid pain that resolves slowly lasting 30min-hrs

42
Q

Lab marker of hepatocellular carcinoma

A

Alpha feta protein

43
Q

Common causes of actue pancreatitis

A

Gallstones and ETOH

Scorpion nite more common in SW

44
Q

Abd and back pain better with leaning forward, new onset DM, painless jaundice, weight loss, courvoisier’s sign

A

Pancreatic carcinoma

MC in head of pancreas. Poor 5yr survival rate, most pass by 6mo

45
Q

Colon dilation >6cm and signs of systemic toxicity

A

Toxic megacolon

46
Q

Toxic megacolon etiology

A

UC, CD, pseudomembranous colitis, infection, radiation, ischemia

47
Q

Toxic megacolon management

A

DECOMPRESSION

bowel rest, electrolyte depletion, Bria’s spect abx?

Colostomy only for refreactory cases

48
Q

Opioid agonist got to of diarrhea

A

Diphenoxulate/atropine (lomitil)

Loperamide

49
Q

Serotonin receptor blocker antiemetics

A

Ondansteron
Granistron
Dolasteron

50
Q

Dopamine blocker antiemetics

A

Procholorperazine
Promethazine
Metoclopramide

51
Q

Bulk forming laxitives

A

Psyllium
Methylcellulose
Polycarbophil
Wheat dextran

52
Q

Osmotic laxatives

A

Polyethylene glycol
Lactulose
Sorbitol
Milk of magnesia

53
Q

Stimulant laxitives

A

Biscodyl

Senna

54
Q

Describe the hypothalamus-pituitary-thyroid axis

A

Hypothalamus releases TRH which stimulates pituitary to release TSH which stimulates the thyroid to release T3 and T4

55
Q

Describe the hypothalamus-pituitary-adrenal axis

A

Hypothalamus releases CRH stimulating pituitary to release ACTH which stimulates the adrenal glands to secrete cortisol

56
Q

Describe the hypothalamus-pituitary-gonadal

A

The hypothalamus secretes GnRH, which stimulates the pituitary to secrete FSH and LH with stimulates release of testosterone, estrogen and progrsterone from gonads

57
Q

Pituitary adenoma

A

Cushings dz

58
Q

Labs go in _____________ direction when the problem is the target organ

A

Opposite

59
Q

Cold intolerance, weight Gavin with decreased appetite, dry thickened skin, loss of outer 1/3 eyebrow, hypoactivity, constipation, hoarseness, bradycardia and pericardial effusion

A

Hypothyroidism

60
Q

Heat intolerance, weight loss with increased appetite, hyperactivity, diarrhea, tachycardia, HF

A

Hyperthyroidism

61
Q

Tx for thyroid storm

A

IV PTU or methinmazole

BB for symptoms

IV glucocorticoids

Cooling blankets

(AVOID ASA)

62
Q

Tx for myxedema coma

A

IV levothyroxine

Passive warming

63
Q

Pretoria last myxedema is associated with

A

Grave’s disease

64
Q

SE of both PTU and methimazole

A

Agranulocytosis

65
Q

Toxic adenoma often presents with these type of symptoms

A

Compressive sx

Dyspnea, dysphasia, strider, hoarseness

66
Q

Painful tender thyroid with elevated ESR

A

De quervain’s/granulomatous thyroiditis

67
Q

Medications that cause thyroid issues

A

Amiodarone, lithium, alpha interferon

68
Q

Risk factor for development of a thyroid nodule

A

Hx of year or neck irradiation

69
Q

MC type of thyroid nodule

A

Follicular adenoma(colloid)

> 90% are benign

70
Q

Cold thyroid nodules on RAIU should make you suspicious for this

A

Malignancy

71
Q

MC and least aggressive type of thyroid carcinoma

A

Papillary = popular

Local cervical mets common

72
Q

Type of thyroid carcinoma associated with distant Mets

A

Follicular

73
Q

Thyroid cancer associated with MEN2 and calcitonin secretion

A

Medullary

74
Q

Worse prognosis/ most aggressive for thyroid cancer, may invade trachea making a tracheostomy necessary

A

Anaplastic

75
Q

MC cause of primary hyperparathyroidism

A

Parathyroid adenoma (80%)

Will occur in 20% of pts taking lithium

76
Q

MC cause of secondary hyperparathyroidism

A

CKD

77
Q

MEN 1 is associated with this

A

Hyperparathyroidism

Pituitary tumors

Pancreatic tumors

78
Q

MEN 2A is associated with this

A

Hyperparathyroidism

Pheochromocytoma

Medullary thyroid carcinoma

79
Q

Clinical manifestation and dx of hyperparathyroidism

A

Stones, bones, abd groans, and psych moans

Decreased DTR

Hypercalcemia, elevated PTH, low phosphate, elevated urine Ca

Osteopenia on bone scan

80
Q

Adrenal aldosteronoma

A

Cobb’s syndrome

Primary hyperaldostetonism leading to hypokalemia and hypertension

81
Q

Tx for Conn’s syndrome

A

Excision if mass and spironolactone

82
Q

Dx studies suggestive of Conns

A

Hypokalemia with metabolic acidosis (u wave on ekg)

ARR >20

Plasma aldosterone >20

83
Q

Management of pheochromocytoma

A

Complete adrenalectomy

Phenoxybenzamine of phentolamine followed by bb

Surgery (5 decks)

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