Pretest Flashcards
1
Q
What is first tx for ITP?
A
steroids
+ IVIG if bleeding
2
Q
What is tx for appendiceal andeocarcinoma?
A
R hemicolectomy if > 2cm
appendectomy if
3
Q
What is tx for achalasia?
A
esophagomyotomy
if want to do surgery: modified heller myotomy
4
Q
What is tx for pancreatic pseudocyst infection?
A
percutaneous catheter drainage and abx
5
Q
What is tx for pancreatic cystadenocarcinoma?
A
surgical resection
6
Q
What imagin for pancreatic Ca?
A
contrast CT
7
Q
What is tx for perforated ulcer?
A
if no hx of PUD –> close w/ omental patch
if long hx –> also do vagotomy
8
Q
What is dumping syndrome? how long do you expect it to last?
A
last
9
Q
What is definitive tx for variceal bleeds?
A
TIPS
10
Q
What is tx for persistent ulcer?
A
distal gastrectomy w/ gastroduodenostomy or gastrojejunostomy
11
Q
What is diagnostic test to assess for hpylori eradication?
A
urea breath test
12
Q
What is peutz jegher?
A
intestinal harmatomatous polyps all over + melanin spots on oral mucosa
13
Q
What is tx for cecal volvulus?
A
R hemocolectomy
14
Q
What is tx for echinoccocal cyst?
A
surgical resection
15
Q
What is tx for amoebic liver cyst?
A
metronidazole
16
Q
What type of diaphragm hernia requires surgery?
A
para-esophageal b/c at risk of strangulation or obstruction
17
Q
What is ogilvie presentation? tx?
A
massive cecal and colon dilation
tx: stop any anti-motility meds
if needed can decompress w/ neostigmine
18
Q
What is presentaiton of hemobilia? tx?
A
RUQ pain, GI bleed, jaundice
tx = transarterial embolization
19
Q
What is next step if pt w/ small bowel bleed?
A
do technitium scan for meckel
20
Q
What is tx if pt w/ extrahepatic cystic dilation of biliary duct?
A
resect cyst w/ cholecystectomy and roux en y hepaticojejunostomy
21
Q
What is presentation of stress ulcer?
A
superficial ulcer, multiple, in body/fundus
22
Q
What is tx for pancreatic pseudocyst?
A
watch for 6 weeks before surgical drainage
23
Q
What is dieulafoy lesion? tx?
A
abnormally large submucosal artery in stomach
tx = wedge resection
24
Q
What is tx if polypoid lesion in gallbladder?
A
remove if sx
25
What is next step if asymptomatic hepatic hemangioma?
just observe
26
What is surgical tx for UC?
total proctocolectomy w/ end ileostomy or J pouch
27
What is surgical tx for toxic megacolon?
subtotal colectomy w/ end ileostomy
28
What is tx for squamous ca of anus that recurs after chemo?
abdominal perineal resection if recurs after chemo
29
What is tx for proximal and midrectal squamous CA?
low anterior resection
30
What is tx for distal rectal CA?
if very close to sphincter do abdominal perineal resection
31
What is tx for gallstone ileus?
ileotomy and stone removal
32
What is tx for diverticular abscess?
percutaneous darinage
33
What is tx for perforated diverticulitis?
hartman = sigmoid resection w/ end colostomy then primary anastomosis later
34
How do you dx biliary dyskinesia?
CCK HIDA scan
35
What is tx for gallbladder polyps
just do serial US
36
What is presentation and tx for ischemic colitis?
present: hematochezia, fever, ab pain
tx: IVF, bowel rest, supportive care
37
What is tx for biliary stricture?
roux en y
38
What is tx if pt w/ CIS in polyp?
polypectomy is sufficient
39
Where do you usually see gastrinoma?
in triangle between junction of 2nd and 3rd duodenum, neck/body of pancreas, junction of cystic and common bile duct
40
What are ranson criteria on admission? 48 hrs later?
admission: age, WBC, LDH, AST, glucose
48H: hct, bun, Ca, base deficit, fluid sequestration
41
What is tx for insulinoma?
excision
42
What is tx for epidermoid ca of anal canal?
combined radiation chemo
43
What is presentation of tumor lysis syndrome?
mediated by cytotoxic T cells
| high K and phos, low Ca
44
What is tx for acute kidney rejection?
steroids
| then anti T cell antibody
45
What is involved in MELD score?
TBili, INR, Cr
46
What is WAGR?
wilms tumor
aniridia
GU abnormalities
mental retardation
47
What is beckwith wiedemann?
macroglossia
hypoglycemia
gigantism
hemihypertrophy
48
Whats in MEN2A?
neduallary thyroid Ca
pheo
hyperparathyroidism
49
What is MEN2B?
medullary thyroid
pheo
marfan body
neuromas
50
What is MEN2B?
pituitary
parathyroid
pancreatic
51
What is tx for seminoma?
orchiectomy + radiation
52
What are criteria for HNPCC?
3 relatives w/ CRC
one is 1st degree of others
invole 2 gens, dx
53
What are screening guidelines for pt w/ HNPCC family hx?
20-25 yo or 10 yrs before 1st relative cancer
54
What is tx for GIST?
imatinib = tyrosine kinase inhibitor
55
What is infliximab used for?
TNFa inhibtor, for IBD
56
What is trastuzumab used for?
HER2 antibody
| for her2+ cancer
57
What is side effect of doxorubicin?
dilated cardiomyopathy
58
What is side effect of cyclophosphamide?
hemorrhage cystitis
59
What is side effect of bleomycin?
pulm fibrosis
60
What is side effect of cisplatin?
nephro, neuro, ototoxicity
61
What are screening guidelines for BRCA+?
biannual mammo starting at 25 yo
62
What is underlying cause of post transplant lymphoproliferative d/o?
EBV
63
What should you think if hypercalcemia after transplant?
tertiary hyperparathyroidism
| resect most of parathyroid and reimplant a piece in arm
64
What is major side effect of azathioprine?
BM toxicity (low WBC)
65
What is major side effect of cyclosporine?
high creatinine
66
What nerve is responsible for intrinsic hand muscles?
ulnar
67
What is tx for alkali chemical skin burns?
large volume water lavage
68
What is tx for pyoderma gangrenosum?
ulcerations associated w/ IBD
| tx: systemic steroids + cyclosporine
69
What is tx for frostbite?
rapid warming in H2O
70
What is tx for burns?
topical silver nitrate, silver sulfadiazine, and mafenide acetate
71
What does it mean if wound heals w/ secondary intention?
left open
72
What is tx for leukoplakia?
oral hygeine and avoid irritants
| bx only if thick or does not resolve
73
What is presentation of ischemic ulcer?
peripheral vascular dz sx
| on dorsum of foot or lateral 1st or 5th toes
74
What is presentation of diabetic ulcer?
on plantar surface
75
What is GCS?
eyes:
- none (1), pain (2), verbal (3), spontaneous (4)
verbal:
- none (1), incomprehensible (2), inappropriate (3), disoriented (4), oriented (5)
motor:
- none (1), decerebrate (2), decorticate (3), withdrawal (4), purposeful movement (5), follows commands (6)
76
What is presentation of glioblastoma? tx?
cerebral hemisphere tumor, peripheral ring enhanced
crosses corpus callosum
tx: surgery + chemo + radiation
77
What is MCC brain mass in immune competent?
metastatic lesion
78
What is tx for CSF leak?
fix dura right away
79
What is tx for craniopharyngioma?
excise
80
What is tx for brain contusion?
prophylactic anticonvulsants
81
What is tx for meningioma?
surgery + adjuvant radiation
82
How do you dx brain abscess?
contrast CT or MRI
83
What time of hemorrhage can present multiple days later
subdural hematoma
84
What is tx for nasopharyngeal carcinoma?
chemoradiation + radical neck dissection for LN mets
85
What is tx for infected branchial cleft cyst?
I&D, excise when resolved b/c can recur
86
What is tx for thyroglossal duct cyst?
excise cyst + central portion of hyoid
87
What is tx for squamous CA of tongue?
excise
| if > 2cm do LN neck dissection
88
What nerve might be injured if pt w/ voice hoarseness? what about with change in pitch/weak voice?
hoarse = U/L recurrent laryngeal
| voice: superior laryngeal
89
What is next step if pt presents in resp distress w/ epiglottitis?
ET intubation in OR in case need to do tracheostomy
90
What is next dx step for persistent neck mass?
FNA
91
What is presentation of osteosarcoma? tx?
distal femur, proximal tibia
circumscribed sclerotic lesion
tx: wide surgical excision w/ ajduvant chemo + radiation
92
What is presentation of osteoid osteoma? tx?
severe pain relieved by ASA
| tx = surgery
93
What is presentation of ewing sarcoma? tx?
round cell
kid 5-15, in diaphysis, periosteal reaction, pain at night
tx: chemo + radiation
94
What is tx for tibial shaft fracture?
surgical fixation and intramedullary nailing
95
What is tx for recurrent infection in BPH?
do surgery
96
When do you just let kidney stone pass? when do you do lithotripsy?
1cm extracorporeal lithotripsy
97
What does it mean if pt w/ seatbelt sign?
serious trauma --> worry about enteric/mesenteric injury
| observe pt even if negative CT
98
What is next step if pt w/ rib fracture?
epidural catheter or PCA
| needs pain control so not at risk for atelectasis
99
What is tx for traumatic CBD injury?
complete transection:
- unstable: do T tube
- stable: roux en Y
partial transection: can do primary repair
100
What is tx for duodenal hematoma?
NGT and observe
101
What is presentation of duodenal hematoma?
proximal obstruction w/ pain, palpable RUQ mass, coiled spring appearance
102
What is tx for blunt carotid injury?
systemic anticoagulation
103
What is tx for flail chest?
analgesia
| ventilate if resp compromise
104
What is tx for pancreatic duct injury?
distal pancreatectomy
105
What type of injury are you at risk for in knee dislocation? next step?
at risk for popliteal injury
| get ABI to assess
106
What is tx for enterocutaneous fistula?
TPN, bowel rest
107
What is tx for extraperitoneal bladder injury?
initial catheter drainage and repeat imaging
108
What is tx for imperforate anus?
perineal operation
109
What is tx for ileal atresia?
small bowel resection and primary anastomosis
110
What is tx for annular pancreas?
bypass duodenoduodenectomy
111
What is tx for intussusception?
therapeutic air contrast enema
112
What is presentation of omphalocele? tx?
central covered in sac
| tx: broad ABx, gastric decompression, prevent hypothermia
113
What is next step if suspect meconium ileus?
contrast enema to dx and tx
| operation if contrast fills
114
What is tx for biliary atresia?
laparotomy w/ kesai hepatoportoenterstomy
115
When do you surgically treat VSD?
> 5yo persistent VSD
| or CHF sx w/ increased PVR
116
What is tx for small cell lung cancer?
chemoradiation
| don't do surgery
117
What is tx for empyema that is not draining w/ chest tube?
thoracotomy and decortication
118
What is major cause of SVC syndrome?
bronchogenic CA > lymphoma
119
What is major tx goal for aortic dissection?
decrease BP rapidly
120
What is tx for lung abscess?
systemic abx
121
What should you think if pt w/ high amplitude contractions of esophageal manometry? tx?
diffuse esophageal spasm
| tx: lung myotomy
122
What are major types of masses in anterior, middle, and posterior mediastinum?
anterior: thymoma > lymphoma > germ
middle: cysts
posterior: neurogenic
123
What is tx for thoracic outlet syndrome?
PT
124
What pressors do you use for septic shock? for cardiogenic?
septic: NE + dopamine
cardiogenic: dobutamine
125
What is next step if suspect colon ischemia?
sigmoidoscopy
126
What should you suspect if pt w/ ab pain after AAA repair?
ischemic colitits
127
What are indications for arterial surgery in PVD?
rest pain + gangrene
128
What is subclavian steal syndrome?
occlusion of subclavian A: extremity gets relative ischmia as flow reverses through vertebral A
129
What is best test to predict periop MI?
dipyridamole-thallium nuclear stress test
130
What is next step if pt w/ tracheoinnominate artery fistula?
if bleeding stops: fiberoptic expolraiton
| if ongoing bleed: inflate balloon, reintubate w/ ET tube, remove tracheostomy and anterior compression
131
What is next step if suspect pt is having hemolytic reaction?
stop transfusion, insert foley, alkalinize urine to prevent precipitation of myoglobin
132
What is presentation of TRALI? tx?
resp distress hypoxemia, B/L pulm infiltrates
| tx: resp support w/ mechanical ventilation
133
What is side effect of NO?
less dense than air so can accumulate in air-filled cavities
134
What are characteristics of lungs in ARDS?
PaO2: FiO2
135
What is effect of dopamine?
increased coronary eprfusion
136
What is effect of dobutamine?
peripherally vasodilates, increased inotropy w/ minimal increase in myocardial O2 consumption
137
What happens to CVP, CO, SVO2, SVR in hypovolemic shock?
decreased CVP, decreased CO, decreased SVO2
| increased SVR
138
What happens to CVP, CO, SVO2, SVR in neurogenic shock?
decrease CVP, decreased CO, decreased SVO2, decreased SVR
139
What happens to CVP, CO, SVO2, SVR in cardiogenic shock?
increased CVP, decreased CO, decreased SVO2, increased SVR
140
What happens to CVP, CO, SVO2, SVR in septic shock?
up or down CVP, hyperdynamic
141
What is tx for malignant hyperthermia?
hyperventilate w/ O2 and give dantrolene
142
What is next step for aspiration pneumonitis?
do bronchoscopy
| do not give ppx abx
143
What are indications for ECMO?
meconium aspiration, PNA, sepsis, congenital diaphragm hernia
144
What precautions for pt w/ VWD about to undergo surgery?
ppx w/ cryoprecipitate
145
What is resp quotient?
rate CO2 produced / O2 uptake
| depends on composition of nutritional support
146
What is presentation of cholesterol embolization syndrome?
eosinophilia, hematuria, proteinuria, increased ESR, extremity or bowel or myocardial ischemia, AKI
147
What lab findings in adrenal insufficiency?
decreased Na, glucose, increased K
148
What is presentation of fat embolism?
acute resp failure, AMS, petechia
149
What is side effect of succinylcholine?
hyperkalemia
150
What is side effect of midazolam?
decreased resp rate
151
What things measured in PT?
II, V, X, fibrinogen
| VII
152
What things measured in PTT?
II, V, X, fibrinogen
| VII, IX, XI, XII
153
what is tx for inflammatory breast CA?
neoadjuvant chemo + radiation + surgery
154
What is presentation of glucagonoma? tx?
rash, DM, anemia, wt loss, increased glucagon
| tx: distal pancreatectomy
155
What type of thyroid cancer has psammoma bodies? tx?
papillary thyroid ca
| tx: thyroidectomy w/ LN dissection if suspect +LN
156
What is next step for LCIS?
risk factor for invasive cancer
| just watch serially
157
What is next step if suspect paget?
do mammo and bx
158
what should you do to decrease risk of thyroid storm post op?
drops of lugol iodine solution
159
What is tx for cystosarcoma phyllodes?
excise w/ adequate margins
| low propensity to met doesnt need chemo/radiation
160
What is tx for hurthle cell cancer?
radio-iodine ablation = type of follicular thyroid cancer
