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1
Q

What is first tx for ITP?

A

steroids

+ IVIG if bleeding

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2
Q

What is tx for appendiceal andeocarcinoma?

A

R hemicolectomy if > 2cm

appendectomy if

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3
Q

What is tx for achalasia?

A

esophagomyotomy

if want to do surgery: modified heller myotomy

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4
Q

What is tx for pancreatic pseudocyst infection?

A

percutaneous catheter drainage and abx

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5
Q

What is tx for pancreatic cystadenocarcinoma?

A

surgical resection

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6
Q

What imagin for pancreatic Ca?

A

contrast CT

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7
Q

What is tx for perforated ulcer?

A

if no hx of PUD –> close w/ omental patch

if long hx –> also do vagotomy

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8
Q

What is dumping syndrome? how long do you expect it to last?

A

last

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9
Q

What is definitive tx for variceal bleeds?

A

TIPS

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10
Q

What is tx for persistent ulcer?

A

distal gastrectomy w/ gastroduodenostomy or gastrojejunostomy

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11
Q

What is diagnostic test to assess for hpylori eradication?

A

urea breath test

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12
Q

What is peutz jegher?

A

intestinal harmatomatous polyps all over + melanin spots on oral mucosa

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13
Q

What is tx for cecal volvulus?

A

R hemocolectomy

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14
Q

What is tx for echinoccocal cyst?

A

surgical resection

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15
Q

What is tx for amoebic liver cyst?

A

metronidazole

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16
Q

What type of diaphragm hernia requires surgery?

A

para-esophageal b/c at risk of strangulation or obstruction

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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

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18
Q

What is presentaiton of hemobilia? tx?

A

RUQ pain, GI bleed, jaundice

tx = transarterial embolization

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19
Q

What is next step if pt w/ small bowel bleed?

A

do technitium scan for meckel

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20
Q

What is tx if pt w/ extrahepatic cystic dilation of biliary duct?

A

resect cyst w/ cholecystectomy and roux en y hepaticojejunostomy

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21
Q

What is presentation of stress ulcer?

A

superficial ulcer, multiple, in body/fundus

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22
Q

What is tx for pancreatic pseudocyst?

A

watch for 6 weeks before surgical drainage

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23
Q

What is dieulafoy lesion? tx?

A

abnormally large submucosal artery in stomach

tx = wedge resection

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24
Q

What is tx if polypoid lesion in gallbladder?

A

remove if sx

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25
Q

What is next step if asymptomatic hepatic hemangioma?

A

just observe

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26
Q

What is surgical tx for UC?

A

total proctocolectomy w/ end ileostomy or J pouch

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27
Q

What is surgical tx for toxic megacolon?

A

subtotal colectomy w/ end ileostomy

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28
Q

What is tx for squamous ca of anus that recurs after chemo?

A

abdominal perineal resection if recurs after chemo

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29
Q

What is tx for proximal and midrectal squamous CA?

A

low anterior resection

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30
Q

What is tx for distal rectal CA?

A

if very close to sphincter do abdominal perineal resection

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31
Q

What is tx for gallstone ileus?

A

ileotomy and stone removal

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32
Q

What is tx for diverticular abscess?

A

percutaneous darinage

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33
Q

What is tx for perforated diverticulitis?

A

hartman = sigmoid resection w/ end colostomy then primary anastomosis later

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34
Q

How do you dx biliary dyskinesia?

A

CCK HIDA scan

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35
Q

What is tx for gallbladder polyps

A

just do serial US

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36
Q

What is presentation and tx for ischemic colitis?

A

present: hematochezia, fever, ab pain
tx: IVF, bowel rest, supportive care

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37
Q

What is tx for biliary stricture?

A

roux en y

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38
Q

What is tx if pt w/ CIS in polyp?

A

polypectomy is sufficient

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39
Q

Where do you usually see gastrinoma?

A

in triangle between junction of 2nd and 3rd duodenum, neck/body of pancreas, junction of cystic and common bile duct

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40
Q

What are ranson criteria on admission? 48 hrs later?

A

admission: age, WBC, LDH, AST, glucose
48H: hct, bun, Ca, base deficit, fluid sequestration

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41
Q

What is tx for insulinoma?

A

excision

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42
Q

What is tx for epidermoid ca of anal canal?

A

combined radiation chemo

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43
Q

What is presentation of tumor lysis syndrome?

A

mediated by cytotoxic T cells

high K and phos, low Ca

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44
Q

What is tx for acute kidney rejection?

A

steroids

then anti T cell antibody

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45
Q

What is involved in MELD score?

A

TBili, INR, Cr

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46
Q

What is WAGR?

A

wilms tumor
aniridia
GU abnormalities
mental retardation

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47
Q

What is beckwith wiedemann?

A

macroglossia
hypoglycemia
gigantism
hemihypertrophy

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48
Q

Whats in MEN2A?

A

neduallary thyroid Ca
pheo
hyperparathyroidism

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49
Q

What is MEN2B?

A

medullary thyroid
pheo
marfan body
neuromas

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50
Q

What is MEN2B?

A

pituitary
parathyroid
pancreatic

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51
Q

What is tx for seminoma?

A

orchiectomy + radiation

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52
Q

What are criteria for HNPCC?

A

3 relatives w/ CRC
one is 1st degree of others
invole 2 gens, dx

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53
Q

What are screening guidelines for pt w/ HNPCC family hx?

A

20-25 yo or 10 yrs before 1st relative cancer

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54
Q

What is tx for GIST?

A

imatinib = tyrosine kinase inhibitor

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55
Q

What is infliximab used for?

A

TNFa inhibtor, for IBD

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56
Q

What is trastuzumab used for?

A

HER2 antibody

for her2+ cancer

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57
Q

What is side effect of doxorubicin?

A

dilated cardiomyopathy

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58
Q

What is side effect of cyclophosphamide?

A

hemorrhage cystitis

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59
Q

What is side effect of bleomycin?

A

pulm fibrosis

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60
Q

What is side effect of cisplatin?

A

nephro, neuro, ototoxicity

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61
Q

What are screening guidelines for BRCA+?

A

biannual mammo starting at 25 yo

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62
Q

What is underlying cause of post transplant lymphoproliferative d/o?

A

EBV

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63
Q

What should you think if hypercalcemia after transplant?

A

tertiary hyperparathyroidism

resect most of parathyroid and reimplant a piece in arm

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64
Q

What is major side effect of azathioprine?

A

BM toxicity (low WBC)

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65
Q

What is major side effect of cyclosporine?

A

high creatinine

66
Q

What nerve is responsible for intrinsic hand muscles?

67
Q

What is tx for alkali chemical skin burns?

A

large volume water lavage

68
Q

What is tx for pyoderma gangrenosum?

A

ulcerations associated w/ IBD

tx: systemic steroids + cyclosporine

69
Q

What is tx for frostbite?

A

rapid warming in H2O

70
Q

What is tx for burns?

A

topical silver nitrate, silver sulfadiazine, and mafenide acetate

71
Q

What does it mean if wound heals w/ secondary intention?

72
Q

What is tx for leukoplakia?

A

oral hygeine and avoid irritants

bx only if thick or does not resolve

73
Q

What is presentation of ischemic ulcer?

A

peripheral vascular dz sx

on dorsum of foot or lateral 1st or 5th toes

74
Q

What is presentation of diabetic ulcer?

A

on plantar surface

75
Q

What is GCS?

A

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
Q

What is presentation of glioblastoma? tx?

A

cerebral hemisphere tumor, peripheral ring enhanced
crosses corpus callosum

tx: surgery + chemo + radiation

77
Q

What is MCC brain mass in immune competent?

A

metastatic lesion

78
Q

What is tx for CSF leak?

A

fix dura right away

79
Q

What is tx for craniopharyngioma?

80
Q

What is tx for brain contusion?

A

prophylactic anticonvulsants

81
Q

What is tx for meningioma?

A

surgery + adjuvant radiation

82
Q

How do you dx brain abscess?

A

contrast CT or MRI

83
Q

What time of hemorrhage can present multiple days later

A

subdural hematoma

84
Q

What is tx for nasopharyngeal carcinoma?

A

chemoradiation + radical neck dissection for LN mets

85
Q

What is tx for infected branchial cleft cyst?

A

I&D, excise when resolved b/c can recur

86
Q

What is tx for thyroglossal duct cyst?

A

excise cyst + central portion of hyoid

87
Q

What is tx for squamous CA of tongue?

A

excise

if > 2cm do LN neck dissection

88
Q

What nerve might be injured if pt w/ voice hoarseness? what about with change in pitch/weak voice?

A

hoarse = U/L recurrent laryngeal

voice: superior laryngeal

89
Q

What is next step if pt presents in resp distress w/ epiglottitis?

A

ET intubation in OR in case need to do tracheostomy

90
Q

What is next dx step for persistent neck mass?

91
Q

What is presentation of osteosarcoma? tx?

A

distal femur, proximal tibia
circumscribed sclerotic lesion
tx: wide surgical excision w/ ajduvant chemo + radiation

92
Q

What is presentation of osteoid osteoma? tx?

A

severe pain relieved by ASA

tx = surgery

93
Q

What is presentation of ewing sarcoma? tx?

A

round cell
kid 5-15, in diaphysis, periosteal reaction, pain at night
tx: chemo + radiation

94
Q

What is tx for tibial shaft fracture?

A

surgical fixation and intramedullary nailing

95
Q

What is tx for recurrent infection in BPH?

A

do surgery

96
Q

When do you just let kidney stone pass? when do you do lithotripsy?

A

1cm extracorporeal lithotripsy

97
Q

What does it mean if pt w/ seatbelt sign?

A

serious trauma –> worry about enteric/mesenteric injury

observe pt even if negative CT

98
Q

What is next step if pt w/ rib fracture?

A

epidural catheter or PCA

needs pain control so not at risk for atelectasis

99
Q

What is tx for traumatic CBD injury?

A

complete transection:

  • unstable: do T tube
  • stable: roux en Y

partial transection: can do primary repair

100
Q

What is tx for duodenal hematoma?

A

NGT and observe

101
Q

What is presentation of duodenal hematoma?

A

proximal obstruction w/ pain, palpable RUQ mass, coiled spring appearance

102
Q

What is tx for blunt carotid injury?

A

systemic anticoagulation

103
Q

What is tx for flail chest?

A

analgesia

ventilate if resp compromise

104
Q

What is tx for pancreatic duct injury?

A

distal pancreatectomy

105
Q

What type of injury are you at risk for in knee dislocation? next step?

A

at risk for popliteal injury

get ABI to assess

106
Q

What is tx for enterocutaneous fistula?

A

TPN, bowel rest

107
Q

What is tx for extraperitoneal bladder injury?

A

initial catheter drainage and repeat imaging

108
Q

What is tx for imperforate anus?

A

perineal operation

109
Q

What is tx for ileal atresia?

A

small bowel resection and primary anastomosis

110
Q

What is tx for annular pancreas?

A

bypass duodenoduodenectomy

111
Q

What is tx for intussusception?

A

therapeutic air contrast enema

112
Q

What is presentation of omphalocele? tx?

A

central covered in sac

tx: broad ABx, gastric decompression, prevent hypothermia

113
Q

What is next step if suspect meconium ileus?

A

contrast enema to dx and tx

operation if contrast fills

114
Q

What is tx for biliary atresia?

A

laparotomy w/ kesai hepatoportoenterstomy

115
Q

When do you surgically treat VSD?

A

> 5yo persistent VSD

or CHF sx w/ increased PVR

116
Q

What is tx for small cell lung cancer?

A

chemoradiation

don’t do surgery

117
Q

What is tx for empyema that is not draining w/ chest tube?

A

thoracotomy and decortication

118
Q

What is major cause of SVC syndrome?

A

bronchogenic CA > lymphoma

119
Q

What is major tx goal for aortic dissection?

A

decrease BP rapidly

120
Q

What is tx for lung abscess?

A

systemic abx

121
Q

What should you think if pt w/ high amplitude contractions of esophageal manometry? tx?

A

diffuse esophageal spasm

tx: lung myotomy

122
Q

What are major types of masses in anterior, middle, and posterior mediastinum?

A

anterior: thymoma > lymphoma > germ
middle: cysts
posterior: neurogenic

123
Q

What is tx for thoracic outlet syndrome?

124
Q

What pressors do you use for septic shock? for cardiogenic?

A

septic: NE + dopamine
cardiogenic: dobutamine

125
Q

What is next step if suspect colon ischemia?

A

sigmoidoscopy

126
Q

What should you suspect if pt w/ ab pain after AAA repair?

A

ischemic colitits

127
Q

What are indications for arterial surgery in PVD?

A

rest pain + gangrene

128
Q

What is subclavian steal syndrome?

A

occlusion of subclavian A: extremity gets relative ischmia as flow reverses through vertebral A

129
Q

What is best test to predict periop MI?

A

dipyridamole-thallium nuclear stress test

130
Q

What is next step if pt w/ tracheoinnominate artery fistula?

A

if bleeding stops: fiberoptic expolraiton

if ongoing bleed: inflate balloon, reintubate w/ ET tube, remove tracheostomy and anterior compression

131
Q

What is next step if suspect pt is having hemolytic reaction?

A

stop transfusion, insert foley, alkalinize urine to prevent precipitation of myoglobin

132
Q

What is presentation of TRALI? tx?

A

resp distress hypoxemia, B/L pulm infiltrates

tx: resp support w/ mechanical ventilation

133
Q

What is side effect of NO?

A

less dense than air so can accumulate in air-filled cavities

134
Q

What are characteristics of lungs in ARDS?

A

PaO2: FiO2

135
Q

What is effect of dopamine?

A

increased coronary eprfusion

136
Q

What is effect of dobutamine?

A

peripherally vasodilates, increased inotropy w/ minimal increase in myocardial O2 consumption

137
Q

What happens to CVP, CO, SVO2, SVR in hypovolemic shock?

A

decreased CVP, decreased CO, decreased SVO2

increased SVR

138
Q

What happens to CVP, CO, SVO2, SVR in neurogenic shock?

A

decrease CVP, decreased CO, decreased SVO2, decreased SVR

139
Q

What happens to CVP, CO, SVO2, SVR in cardiogenic shock?

A

increased CVP, decreased CO, decreased SVO2, increased SVR

140
Q

What happens to CVP, CO, SVO2, SVR in septic shock?

A

up or down CVP, hyperdynamic

141
Q

What is tx for malignant hyperthermia?

A

hyperventilate w/ O2 and give dantrolene

142
Q

What is next step for aspiration pneumonitis?

A

do bronchoscopy

do not give ppx abx

143
Q

What are indications for ECMO?

A

meconium aspiration, PNA, sepsis, congenital diaphragm hernia

144
Q

What precautions for pt w/ VWD about to undergo surgery?

A

ppx w/ cryoprecipitate

145
Q

What is resp quotient?

A

rate CO2 produced / O2 uptake

depends on composition of nutritional support

146
Q

What is presentation of cholesterol embolization syndrome?

A

eosinophilia, hematuria, proteinuria, increased ESR, extremity or bowel or myocardial ischemia, AKI

147
Q

What lab findings in adrenal insufficiency?

A

decreased Na, glucose, increased K

148
Q

What is presentation of fat embolism?

A

acute resp failure, AMS, petechia

149
Q

What is side effect of succinylcholine?

A

hyperkalemia

150
Q

What is side effect of midazolam?

A

decreased resp rate

151
Q

What things measured in PT?

A

II, V, X, fibrinogen

VII

152
Q

What things measured in PTT?

A

II, V, X, fibrinogen

VII, IX, XI, XII

153
Q

what is tx for inflammatory breast CA?

A

neoadjuvant chemo + radiation + surgery

154
Q

What is presentation of glucagonoma? tx?

A

rash, DM, anemia, wt loss, increased glucagon

tx: distal pancreatectomy

155
Q

What type of thyroid cancer has psammoma bodies? tx?

A

papillary thyroid ca

tx: thyroidectomy w/ LN dissection if suspect +LN

156
Q

What is next step for LCIS?

A

risk factor for invasive cancer

just watch serially

157
Q

What is next step if suspect paget?

A

do mammo and bx

158
Q

what should you do to decrease risk of thyroid storm post op?

A

drops of lugol iodine solution

159
Q

What is tx for cystosarcoma phyllodes?

A

excise w/ adequate margins

low propensity to met doesnt need chemo/radiation

160
Q

What is tx for hurthle cell cancer?

A

radio-iodine ablation = type of follicular thyroid cancer

Surgery Clerkship (5 decks)

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