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Surgery > Pretest > Flashcards

Pretest Flashcards

1
Q

How does losing the ileum put someone at increased risk of nephrolithiasis?

A

Ileum reabsorbs FAs. WIthout ileum, more fatty acids reach the colon where they combine with Ca2+, leaving free oxalate to be reabsorbed. Excess oxalate is excreted by kidneys forming calcium oxalate stones

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2
Q

Aspirin toxicity can lead to metabolic acidosis. It also leads to resp alkalosis?

A

resp alkalosis -hyperventilation (increase pH, decrease pCO2) driven by direct stimulation of respiratory center

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3
Q

Someone presents with bleeding, normal PT, PTT and bleeding time, but decrease fibrinogen & plt count hours after surgery. What to suspect

A

suspect error in surgical control of blood vessels in bleeding during early postop period

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4
Q

Acute mesenteric ischemia without peritoneal signs –> next step? Acute mesenteric ischemia w/ peritoneal signs –>

A

Acute mesenteric ischemia w/o signs –> angiography

Acute mesenteric ischemia w/ peritoneal signs –> celiotomy

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5
Q

Worry about what when you have large blood tx without FFP and plts

A

dilutional thrombocytopenia & deficiency in factors V and VIII

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6
Q

What are the 3 metabolite disturbances when you start refeeding someone who is super malnourished. Why does this happen

A

refeeding –> rise in insulin in response to carbs –> electrolytes are shifted intracellularly –> hypokalemia, hypomagnesemia, hypophosphotemia.

-most common cause of death is cardiac arrhythmia

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7
Q

Factors that predispose to fistula formation and poor healing

A 
Foreign body
Radiation
Inflammation or Infection
Epithelization
Neoplasm
Distal obstruction
Steroids

Also output > 500 cc/day

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8
Q

Billroth I vs Billroth II

A

Billroth I: operation in which the pylorus is removed and the proximal stomach is anastomosed directly to the duodenum

Billroth II: operation in which the greater curvature of the stomach is connected to the first part of the jejunum in end-to-side anastomosis.

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9
Q

After sigmoid resection, 10 d later, pt develops left flank pain, decreased urine output, leukocytosis. CT shows left hydronephrosis but not abscess. Suspect and do what?

A

IV pyelogram for suspected ureteral injury

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10
Q

Post-thyroidectomy w/ tingling sensation in hands, anxious, muscle cramps. What to suspect? How to treaT?

A

parathyroidectomy

treat with IV calcium

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11
Q

+ chovstek sign, prolonged QT on EKG, trosseau sign -suspect

A

hypocalcemia

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12
Q

if you give someone too much Normal saline, what kind of metabolic disturbance can you get?

A

NS actually has 154 mEq/L of both Na+ and Cl-

When given in large amts, can overload kidneys’ ability to excrete Cl- ion –> acidosis

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13
Q

How to manage someone with large ostomy outputs?

A

LIke large outputs from NG tube, worry about metabolic disturbances like hypokalemia, acidosis so manage with fluid replacement and stool bulking agent

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14
Q

Stresses increase metabolic rate. How much do these following situations increase metabolic rate?

  • multiple organ failure
  • 3rd degree burns involving 60% of BSA
  • postoperative
A
  • multiple organ failure - 1.5x
  • 3rd degree burns involving 60% of BSA - 2.0x
  • postoperative -1.1x
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15
Q

Pt with a trach who develops significant bleeding from tracheostomy. Most likely a sentinel blood from which artery? What to do about it?

A
  • sentinel bleed from tracheoinominate artery fistula with greater than 50% mortality rate
  • attempt to reintubate pt –> OR
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16
Q

List 5 situations that make for reasonable attempt at extubating a pt

A
  • rapid shallow breathing index btw 60-105 *** RR/Vt
  • negative inspiratory force should be at least greater than 20 cm H20
  • wean pt to 5 cm H20 PEEP
  • minute ventilation
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17
Q

Which inhalational anesthetic to avoid bc of accumulation in air-filled cavities during general anesthesia

A

nitrous oxide (low solubility, less dense than air)

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18
Q 
ARDS:
what you find on CXR
what is PaO2/FiO2
pulmonary wedge pressure
What are the 3 major physiologic alterations
A

CXR: b/l pulm infiltrates
PaO2/FiO2: less than 200
pulm wedge pressure normal at

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19
Q

What does low, mod, high doses of dopamine do?

t1/2 of dopamine is about 1 min so often given as an IV drip

A

@ all doses, dopamine increases coronary blood flow

low: vasodilation of renal and mesenteric vasculature, mild vasoconstriction of peripheral bed redirecting blood flow to kidneys and bowel
mod: B1 receptor activity predominates –> increased inotropy –> increased CO and BP
high: a1 receptor –> peripheral vasoconstriction shifting blood from extremities to organs, decrease kidney function, HTN

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20
Q

What’s the pharm agent of choice for a failing heart in that it can increase CO without creating too high a myocardial oxygen demand?

A

dobutamine is an inotropic agent of choice in cardiogenic shock as a b agonist it improves cardiac performance in pump failure both by increasing inotropy and peripheral vasodilation with minimal chronotropic effects

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21
Q

An epidural catheter for pain relief can cause respiratory acidosis, increased somnolence. What to do?

A

d/c epidural catheter

can also treat with iv naloxone

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22
Q

For local anesthetic, what’s the maximal safe total dose of lidocaine? What does epinephrine do?

A

4.5 mg/kg

epinephrine can double the infiltration anesthesia, and increase maximal safe total dose by 1/3 by decreasing rate of absorption

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23
Q

Neurogenic shock (hypotensive and bradycardic) -what to do?

A

fluid then vasoconstrictors like dopamine or phenylephrine

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24
Q

What’s a reliable indicator of alveolar ventilation?

A

PaCO2 b/c highly efficient at diffusing

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25
Q

Alveolar hypoventilation has what ABG finding

A

resp acidosis, hypoxemia and hypercarbia

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26
Q

Pts with PE, pulmonary edema, signficant atelectasis have what ABG findings

A

significant hypoxemia but normal pCO2 or hypocarbia b/c can hyperventilate to compensate so a resp alkalotic picture

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27
Q

Malignant hyperthermia is characterized by fever, tachycardia, increased O2 consumption, increased CO2 production, hyperkalemia, myoglobinuria, acidosis, rigidity. How to treat?

A

termination of surgery
100% oxygen
IV dantrolene
Urine alkalinization

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28
Q

Someone develops hyperkalemia after induction. What’s the suspect?

A

succinylcholine -a depolarizing NM blocker can increase K+ up to 1.0 mEq/L w/in a few min

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29
Q

Pancuronium is a muscle relaxant and is assoc with what side effect

A

tachycardia

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30
Q

If someone needs volume status to be monitored and assess for need of dobutamine. What can be used to monitor

A

pulmonary artery catheter

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31
Q

Wasting of intrinsic muscles of hands, weakness and pain at wrist -which nerve is involved

A

ulnar

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32
Q

briefly go thru the 3 processes of wound healing

A

1) inflammation: rapid influx of neutrophils then 2 d by mononuclear cells.
2) proliferation: angiogenesis and collagen formation fibroblasts enter in day 3)
3) remodeling: @ 2-3 wks, type 3 –> type 1 collagen

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33
Q

Mohs surgery vs wide local excision -any differences in cure rate?

A

no difference

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34
Q

When should you excise areas of third/deep second degree burns?

A

3-7d after injury

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35
Q

There are 3 main topical agents used to treat burns. List then and their assoc side effects

A

1) silver nitrate: electrolyte abnormalities, methemoglobinemia (hyponatremia, hypokalemia, hypocalcemia, hypochloremia)
2) silver sulfadiazine: neutropenia
3) mafenide: metabolic acidosis 2/2 to inhibition of carbonic anhydrase

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36
Q

Clefts of the lip and palate -may need speech therapy. When is the rough time period in which these should be fixed?

A

lip repair in 1st 3 months

palate at 12-18 months

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37
Q

what is a marjolin ulcer?

A

a squamous cell carcinoma that develops in a chronic wound such as previous burn scars or a sinus tract

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38
Q

Compartment syndrome -what pressure is diagnostic

A

> 30 mmHg

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39
Q

What are 3 wounds that should not be closed?

A

1) elapsed time to presentation > 6 hrs
2) dirty wounds or contaminated (animal bites)
3) traumatic wounds (puncture, gunshot, crush)

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40
Q

Skin lesion that is described as rolled, with pearly borders that doesn’t have a precursor lesion, has slow growth rate

A

basal cell

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41
Q

Someone presents with painless ulceration over left medial malleolus with surrounding brawny induration. What is it and how to treat?

A

venous stasis ulcers

treat with leg elevation, compression stockings and local wound care

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42
Q

Trauma with CXR showing air fluid level in LLL field. You put in NG tube and it coils upward into the left chest. What to suspect

A

acute diaphragmatic rupture –> OR for lap

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43
Q

If someone has complete transection of common bile duct, what to do?

A

If pt is stable –> choledochojejunostomy

If pt is unstable –> can place a T tube

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44
Q

What are things that require formal neck exploration?

A
  • acute signs of airway distress (stridor, hoarseness, dysphonia)
  • visceral injuries (subcut air, hemoptysis, dysphonia)
  • hemorrhage (expanding hematoma, unchecked external bleeding)
  • neuro deficits
  • hemodyn unstable with neck injury
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45
Q

Blunt abd trauma with upper abd pain, n/v. UGI series shows total obstruction of duodenum with a COILED SPRING APPEARANCE in 2nd and 3rd portions. This is classic for? How to manage?

A

Classic for duodenal hematoma that presents as a proximal bowel obstruction w/ abd pain and sometimes a palpable mass.

Initial management is observation and NG suction; usu self-resolves

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46
Q

30 male is stabbed in the arm without evidence of vascular injury. Which structure is most likely injured if pt cannot flex his 3 radial digts?

A

median nerve

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47
Q

someone with CO poisoning with throbbing headache, n/v, dizziness, visual disturbance. Get carboxyhb level and it’s at 31% what to do?

A

100% oxygen until COHb

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48
Q

Dobutamine is the inotropic agent of choice for cardiogenic shock, but what if pt is refractory. What to do next

A

mechanical circulatory support with intra-aortic balloon pump

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49
Q

Why do you have to worry about the eyes in someone with electrical burns

A

can result in cataract development

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50
Q

Any gunshot wounds below T4 should have exp lap b/c often assoc with intraabd injuries. When should you do exp thoracotomy?

A

1) 1500 mL of blood removed on initial chest tube placement

2) persistent bleeding at rate of 200 ml/h for next 4 hrs or 100 ml/h for 8 hrs

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51
Q

If there’s crepitus in soft tissue, suspect anaerobic infections. What to do?

A

prompt surgical debridement and IV abx

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52
Q

Cardiac contusion from MVC is most common of all cardiac injuries, usu in persons who sustain direct blow to sternum. How to manage

A

Get EKG, put on tele for 24-48 hrs, ECHO

If hemo stable, no need for ICU

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53
Q

Tension pneumo is treated first with needle decompression where?

A

2nd intercostal space mid-clavicular

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54
Q

Lactate in LR is metabolized to what by the liver

A

bicarb

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55
Q

What is pneumatic anti-shock gargment (PASG)?

A

inflatable overalls with 3 compartments (2 for legs, 1 for the abdomen) used to elevate BP by increasing PVR. beneficical for controlling bleed from pelvic fractures by decreasing pelvic volume and immobilization to restrict fracture movement.

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56
Q

Absence of sepsis, how to manage enterocutaneous fistulas

A

initially treated non-operatively with bowel rest, TPN and correction of electrolyte abnormalities

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57
Q

How come small bowel fistulas (stomach to mid-ileum) are less likely to close than distal fistulas?

A

b/c they tend to produce a high output and therefore less likely to close

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58
Q

In repairing a vascular problem (for ex, GSW to left thigh causing 5 cm portionof fem artery to be destroyed), when do you do primary anastomosis vs vein graft?

A

if 5 cm is destroyed, it’s impossible to perform tension free primary anastomosis and therefore a vein graft is repair of choice

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59
Q

Diagnostic peritoneal lavage has largely been replaced by FAST in assessing for intraabd injuries. What 4 conditions of DPL necessitate exp lap?

A

1) aspiration of 10 cc of gross blood initially
2) > 100,000/microL of RBC
3) > 500/microL WBC
4) increased amylase, bilirubin or alk phosp

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60
Q

Pulm contusion wont show up on CXR initially. It is hemorrhage and edema of lung parechynma without parencyhmal disruption. How to manage?

A

supportive

  • pain management
  • pulm toilet
  • maintenance of good O2
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61
Q

Tracheobronchial injuries can lead to

A 
pneumothorax
subcut emphysema
pneumomediastinum
hemoptysis
resp distress
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62
Q

If someone has laryngeal obstruction, what’s the choice of intubation?

A

cricothyroidotomy

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63
Q

What’s the principle cytokine mediator in gram neg shock and sepsis related organ damage that is produced by activated macrophages, monocytes

A

TNF

64
Q

Someone had a liver tx 5 years ago, now presenting with increased bilirubin. Liver biopsy shows paucity of bile ducts. What is this called?

A

vanishing bile duct syndrome due to immune-mediated injury to biliary epithelium.

Treatment should be re-transplantation

65
Q

What is the purpose of performing a cross match before organ transplantation?

A

whether recipient has circulating antibodies against donor HLA antigens

so you take donor lymphocytes and mix with recipient serum complement

66
Q

How does cyclosporine work?

A

calcineurin inhibitor that inhibits IL-2 production affecting T cell actions

67
Q

If during transplant, the kidney turns blue and swollen, what to suspect and what to do?

A

suspect hyperacute rejection and should get intraop biopsy to confirm

68
Q

Size and ABO type matter for heart transplant, and not tissue typing why?

A

Tissue typing takes time. In heart tx, time from outside body (ischemia) is a significant predictor of poor outcome

69
Q

4 wks following cadaveric kidney tx, pt has hypertensive nephropathy w/ cre of 3.1. Renal US shows mild edema with normal flow in both renal arteries and veins. What’s next step?

A

Do biopsy and treat with high dose steroids, immunoglob therapy b/c most likely acute rejection (1 wk -3 mo post transplant)

70
Q

CMV infection post-transplant peaks when? Classic signs?

A

peaks at 6 weeks

  • classic signs: fever, malaise, myalgia, arthralgia, leukopenia.
  • other signs: pneumonitis, ulceration, hemorrhage in stomach, duodenum, colon, heptatis, esophagitis, retinitis, pancreatitis, encephalitis
71
Q

MELD score is sued for?

A

end stage liver disease at greatest risk of mortality within 3 months

  • helps base liver allocation on objective variables like
    1. total bilirubin
    2. INR
    3. creatinine
72
Q

What is OKT3?

A

monoclonal antibody against CD3 antigen complex on T cells with side effects including noncardiogenic pulmonary edema, encephalopathy, aseptic meningitis, nephrotoxicity

73
Q

Pheo is assoc with which 4 conditions

A

MEN 2a
MEN 2b
VHL disease
NF-1

74
Q

how does radiation therapy damage cancer cells?

A

mostly in mitotic phases and directly and most commonly from free oxygen radicals

75
Q

Cardiac allograft have cold preservation time of 4-5 hrs making what impractical in comparison to renal allografts

A

tissue typing

76
Q

List side effects assoc with these chemo drugs:

1) doxorubicin
2) cyclophosphamide
3) bleomycin
4) vincristine
5) cisplatin
6) 5-FU

A

1) doxorubicin -cardiomyopathy
2) cyclophosphamide -hemorrhagic cystitis
3) bleomycin -pulmonary fibrosis
4) vincristine -peripheral neuropathy
5) cisplatin -ototoxicity, neurotoxicity, nephrotoxicity
6) 5-FU -mucositis, dermatitis, cerebellar dysfunction

77
Q

What is post-transplant lymphoproliferative disorders

A

post-tx malignancies assoc with viruses like EBV, HPV, HIV, hep

78
Q

Thyroid scan shows a single focus of increased isotope uptake. What is it most likely?

A

hypersecreting adenoma

79
Q

Graves shows what on thyroid scan

A

diffuse uptake of radioactive uptake iodine

80
Q

Several hrs after post-thyroidectomy, pt develops progressive swelling under the incision, stridor, difficulty breathing. Intubate and then what?!

A

wound exploration bc highly suspicious of wound hematoma

81
Q

Inflammatory breast cancer can present with peau d’ orange. Can see neoplastic cells in dermal lymphatics. How to treat?

A

multimodality with surgery, chemo and radiation

82
Q

15F with negative b hcg with galactorrhea. What to suspect? What are other symptoms? How to manage?

A
  • prolactinoma
  • bitemp hemianopsia, amenorrhea, lack of libido, impotence, infertility

if asymp –> observation
if symp –> dopamine agonists
surgery only if symp persist despite medical therapy and/or pt doesn’t want to be on life-long dopamine agonists

83
Q

A sestamibi parathyroid scan is a procedure in nuclear medicine which is performed to localize parathyroid adenoma. If it shows persistent uptake in parathyroid gland, what to suspect

A

parathyroid adenoma

84
Q

Adrenal adenomas should be resected if they’re functioning and if non-functional but greater than 6 cm. After adrenlectomy of a functioning adenoma, what therapy is necessary?

A

steroid replacement may be required for up to 6-12 months even with a normal functioning contralateral adrenal gland.

85
Q

FNA of LNs in someone with thyroid mass showing calcified clumps of sloughed cells. what to suspect and what to do

A

papillary thyroid carcinoma

do total thyroidectomy with modified neck dissection, may need radioactive iodide treatment post-surg

86
Q

LCIS is a risk factor for

A

invasive breast cancer most commonly ductal carcinoma

confers a > 5x increased risk in both breasts

87
Q

breast mass –> firm, lobulated with whorl-like pattern in 14 yr old girl, suspect

A

fibroadenoma

88
Q

Paget disease of breast presents with nipple eczema & erosion. How to treat?

A

radical masectomy b/c up to 20% have assoc breast cancer likely infiltrating ductal carcinoma

89
Q

How to prevent thyroid storm in operating room in someone with Graves?

A

give drops of lugol iodide solution daily beginning 10 days preop

90
Q

What is osteitis fibrosa cystica?

A

condition assoc with hyperparathyroidism characterized by severe demineralizaton with subperiosteal bone resorption, bone cysts and tufting

91
Q

How to treat thyroid storm?

A

rapid fluid replacement, anti-thyroid meds, b blockers, iodine solutions and steroids

92
Q

plasma aldosterone/plasma renin of 25-30/1 is strongly suggestive of

A

primary hyperaldosteronism aka Conn syndrome

93
Q

Breast biopsy shows cystosarcoma phyllodes a tumor that is most often seen in younger women. Describe its characteristics and how to manage?

A

can grow to enormous size & ulcerate thru skin, but decreased propensity towards metastasis

treatment is wide local excision w/ a rim of normal tissue

94
Q

Hurthle cell carcinoma

A

is a type of follicular cancer except it is often mutlifocal and bilateral, more likely to spread with increased risk of mortality. Best to do total thyroidectomy and central LN dissection

95
Q

Cushing disease is hypersecretion of ACTH by pituitary gland. 90% due to?

A

pituitary adenoma makes up 90% of the cases while 10% is due to hyperplasia

96
Q

Insulinoma is evenly distributed btw head, body and tail of pancreas. If it’s unresectable, what can you give pt?

A

streptozocin -a potent abx that can selectively destroy islet cells in unresectable cases.

97
Q

Proctocolectomy for UC can do what for the extraintestinal manifestations (arthritis, aklyosing spondylitis, primary sclerosing cholangitis)

A

can relieve or resolve extraintestinal manifestations, however, risk of primary sclerosing cholangitis still remains

98
Q

Whats the most common serious complication of an end colostomy

A

parastomal herniations

99
Q

Someone with PUD had antrectomy with vagotomy and present with bloating, cramping, diarrhea, weakness, flushing, palpitations, diaphoresis, and dizziness, what does he have? How to manage

A

dumping syndrome

initial management includes reassurance, and dietary measures (avoid large amts of sugars, eat freq small meals, and separate fluids and solids)

100
Q

type II and III gastric ulcers are assoc with hypersecretion of acid. Where are they located

A

type ii -body of stomach

type iii -prepyloric

101
Q

Peutz jeghers syndrome

A

intestinal polyposis and melanin spots of oral mucosa. These polyps are hamartomas with no malignant potential

102
Q

Gallstone ileus presents why? What will you see on x-ray

A

someone with chronic cholechothiasis can cause erosion of gallbladder into GI tract (usually fistula forms btw gallbladder and duodenum). Stone will pass thru this fistula to duodenum and can lodge at terminal ileum causing SBO. X-ray will show air in biliary tract

103
Q

HOw to dx biliary dyskinesia?

A

CCK-HIDA scan -usu CCK causes contraction of gallbladder with normal EF

In biliary dyskinesia, gallbladder contraction with CCK is low at 15%. Can cure with lap cholec

104
Q

What to do if you see gallbladder polyps

A

observe with serial ultrasonds

105
Q

old person with sudden sharp pain with abdominal mass that doesn’t change with contraction of rectus musle.

A

hematoma of rectus sheath usu 2/2 to trauma, sudden muscular exertion or anticoag

106
Q

Liver abscess that is non-rim enhancing with + serology for entamoeba histolytica. how to treat

A

metronidazole

only in pyogenic hepatic abscesses, do you treat with percut drainage and iv abx

107
Q

You find femoral hernia in someone. What to do next

A

elective surgical repair bc femoral hernia has the highest risk of strangulation

108
Q

what is a pilonidal abscess

A

from infected pilonidal cyst that typically presents as a painful fluctuant mass located btw gluteal clefts.

109
Q

Ischemic colitis can present with hematochezia, fever, abd pain. What will colonscopy show? How to manage?

A

Colonoscopy will show “dusky appearing mucosa”

manage depending on colonoscopy results:
if not full thickness involvement –> IV fluids, NPO, supporive care

If full thickness involvement –> surgery

110
Q

Acute mesenteric ischemia should be suspected when?

A
  • abd pain out of proportion of physical exam finding
  • h/o of Atrial fib
  • emergent surgery
111
Q

T/F: pts can undergo resection of a large fraction of colon and suffer little long-term changes in bowel habits

A

True

112
Q

What does the colon absorb

A

absorb electrolytes, water, short chain fatty acids and vitamins

right colon absorbs more salt and water than left colon

113
Q

When do you surgically remove hepatic adenomas?

A

usu found in women on OCPs and stopping OCPS can cause them to shrink, but consider surgical removal if planning pregnancy and or > 4 cm

114
Q

Focal nodular hyperplasia doesn’t have risk of hemorrhagic rupture or malignancy like hepatic adenoma. How to distinguish btw them if CT is inconclusive

A

nuclear medicine
hot lesion –> FNH
cold lesion –> hepatic adenoma

115
Q

What’s the best surgical treatment of biliary stricture?

A

roux-en-y (end to side) choledochojejunostomy

116
Q

How does secretin stimulation test work to diagnose ZES

A

1) fasting gastrin level is measured
2) administer secretin
3) measure gastrin levels at 2, 5, 10, 20 min after

A rise > 200 pg/ml confirms ZES

117
Q

ZES is usu found within gastrinoma triangle. What is the triangle made of

A

1) junction of 2nd and 3rd duodenum
2) junction of neck and body of pancreas
3) junction of cystic and common bile duct

118
Q

List the 5 ranson criteria on admission to hospital for acute pancreatitis

A

1) age > 55
2) WBC count > 16K
3) LDH > 350
4) AST > 250
5) glucose > 200

119
Q

List the 6 ransons criteria to assess severitiy of acute pancreatitis within 48 hrs of admission

A

1) hct fall by 10%
2) BUN elevation by 5
3) serum Ca2+ 4
5) fluid sequestration
6) arterial pO2

120
Q

Ogilive syndrome is massive colonic dilation in absence of mech obstruction. Must do colonoscopy to rule out mech obstruction. how to manage

A

1) if bowel rest, NG suction, correction of metabolic abnormalities, d/c meds that diminish GI motility like opioids
2) if > 10 cm, endoscopic colonic decompression or sympatholytic agent like neostigmine

121
Q

Hemobilia is blood in bile duct that is most commonly caused iatrongenically. What to do to dx? what re 3 symptoms

A
  • abd pain in RUQ, jaundice, GI bleeding

- dx with angiography and endoscopy

122
Q

When do you do right hemicolectomy with appendectomy in surgical treatment of carcinoid?

A

1 cm carcinoid at tip of appendix –> no need for hemicolectomy

> 2cm –> do hemicolectomy

123
Q

Choledochal cyst is a congenital cystic dilataion of extrahepatic biliary duct. what is the classic triad of symptoms. What imaging to do?

A

Classic triad: epigastric pain, abdominal mass, jaundice

US or ERCP can show cysts
Surgery is advised in all cases –> do complete resection and roux en y choledochojejunostomy

124
Q

Caroli disease

A

intrahepatic cystic dilation

125
Q

Stress ulcers that occur after shock, sepsis, major surgeries, trauma or burns tend to be superficial and involve multiple sites. what’s the pathophys

A

-Not due to increased gastric acid secretion as much as it’s due to decreased splanchnic blood flow –> ischemic damage to mucosa

126
Q

Pseudocysts can self-resolve, but after 6 weeks, and it still hasn’t self-resolved, consider intervention as the complications include

A

gastric outlet obstruction, extrahepatic biliary obstruction, spontaneous rupture

127
Q

What is a Dieulafoy lesion?

A

It can cause upper GI bleed. This lesion is usu located distal to GE junction and is an abnormally large submucosal artery that protrudes thru a small, solitary mucosal defect

128
Q

What are some side effects of total pancreactectomy (also removes duodenum, distal CBD, gallbladder)

A
  • weight loss
  • malabsorption/diarrhea
  • hypocalcemia
  • hypophosphatemia
  • diabetes
  • iron deficiency bc duodenum is removed which is impt in iron reasborption
  • pernicious anemia bc pancreas secretes factor to help with absorption
129
Q

What’s the most common benign liver tumor

A

hemangioma

130
Q

Someone with colon cancer s/p resection in remission presents with super high CEA levels, suspect?

A

liver mets or peritoneal spread

131
Q

Why is vasopressin contraindicated in CAD

A

b/c it causes coronary vasoconstriction exacerbating CAD symptoms

132
Q

what does abdominoperineal resection entail

A

removing rectum, anus w/ formation of a permanent end colostomy

133
Q

thoracentesis of pleural fluid revealing thick purulent fluid with glucose

A

empyema

134
Q

3/4 of SVC syndrome are caused by?

A

bronchogenic carcinoma invading vena cava

135
Q

What to do in someone with esophageal malignancy presenting with air in mediastinum –> esophageal perf?

A

left thoracotomy w/ esophagectomy

136
Q

How to treat lung abscess?

A

initial treatment: systemic abx for up to 12 wks if necessary

if not improved, then drainage

137
Q

prolonged high amp contractions in body of esophagus points to diffuse esophageal spasm. What is medical therapy?

A

CCB

can do myotomy if that fails

138
Q

Several days post-esophagectomy, pt complains of dyspnea, chest tightness, large pleural effusion. Thoracentesis shows milky fluid consistent with chyle. How to initially manage? what if no improvement? How does the management defer if problem was noticed during surgery?

A

initial management involves putting in chest tube and low fat diet. If no improvement, then right thoracotomy and ligation of thoracic duct from diaphragm to T6

during surgery, can ligate the thoracic duct

139
Q

What are 5 ways to prevent spinal cord ischemia/paraplegia during cardiothoracic surgery?

A
  1. minimize cross clamp time
  2. hypothermia
  3. moderate systemic heparinization
  4. CSF drainage via lumbar drain
  5. left heart bypass

surprisingly, postop steroids do not reduce risk

140
Q

zenker is an outpouching btw

A

lower pharyngeal constrictor and cricopharyngeus that is tonically contracted

141
Q

Pt has pain and numbness in right arm and hand exacerbated when arm is raised. What is part of ddx

A

thoracic outlet syndrome either compression of brachial plexus or subclavian vessels in space bounded by 1st rib, clavicle and scalene muscles.

142
Q

If continuous infusion of dopamine fails to relieve pt’s hypotension, what to do next

A

treat with NE

143
Q

Cardiac arrest in ICU should be treated with

A

epinephrine but not for long-term, only good for short-term use b/c long term use can lead to renal and splanchnic vasoconstriction, cardiac dysrhythmias and increased heart demand.

  • low dose: b1 adrenergic effects predominate –> increase HR, SV and contractility
  • high dose: a adrenergic effects –> increased BP and SVR
144
Q

Leriche syndrome

A

total occlusion of the aorta at the aortoiliac bifurcation –> claudication of hips, buttocks, thighs, absent femoral pulses, impotence

145
Q

T/F: negative duplex for DVT is pretty good at r/o DVT.

A

True

146
Q

Describe the 3 types of urinary incontinence

A
  • stress: previous birth, aging, neuro injuries (treat wtih estrogen therapy, kegels, timed voiding); treat with SLING
  • urge: anticholinergic
  • overflow: from bladder outlet obstruction
147
Q

Hypospadia is often assoc with chordee. Define chordee

A

ventral curvature of the penis

148
Q

Treatment for stage A transitional cell carcinoma of bladder.

A

transurethral resection

intravesicular chemo

149
Q

How fast should testicular torsion be treated? What to do with the c/l testis?

A

within 4-6 hrs

orchiopexy both testes

150
Q

When will you consider surgical intervention for someone with BPH

A

1- refractory to medical therapy

2 - recurrent UTIs

151
Q

What’s a classic example that can lead to meniscal tear?

A

a football player running and getting hit. It’s caused from flexion and rapid rotation.

152
Q

What are the physiologic steps involved in compartment syndrome

A

1) decreased capillary blood flow –> loss of O2 delivery to tissues and increased ext edema b/c of increased cap permability
2) compromised venous and lymph flow
3) arterial supply is compromised

153
Q

Open vs closed reduction, which shortens the period of immobilization

A

open

154
Q

Monteggia fracture

A
  • radial head is dislocated

- proximal 1/3 of ulna is fractured

155
Q

severe pain in left femur that is relieved by aspirin with X-ray showing lucent lesion surrounded by marked reactive sclerosis.

A

osteoid osteoma -can gradually regress but can excise if causing symptoms

156
Q

12M pain in left leg worse at night with weight loss. X-ray shows aggressive lesion with permative pattern of bone lysis and periosteal rxn of ROUND cell type.

A

Ewing’s sarcoma (“onion skinning”)

157
Q

T/F: depressed or compound require surgical treatment

A

True

Surgery (6 decks)

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