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Surgery Clerkship > Ramahi > Flashcards

Ramahi Flashcards

1
Q

Tx for hyperkalemia

A

Ca gluconate
Insulin, albuterol, kayexalate
Dialysis

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2
Q

Most common lung cancer of non-smokers =

A

Adenocarcinoma

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3
Q

Most common location of lung adenocarcinoma =

A

Peripheral lung

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4
Q

Most common sites of met for lung adenocarcinoma =

A

Liver
Bone
Brain
Adrenals

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5
Q

Pleural effusion characteristics of lung adenocarcinoma =

A

Exudative effusion with high hyaluronidase

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6
Q

Location of SCC lung cancer =

A

Central

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7
Q

Paraneoplastic syndrome of SCC lung cancer =

A

Parathyroid like hormone causing low parathyroid levels and high calcium

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8
Q

Features of Pancoast Tumor

A 
Caused by small cell SCC
Shoulder pain
Ptosis
Constricted Pupils
Facial Edema
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9
Q

Lambert Eaton Syndrome

A

Paraneoplastic syndrome from small cell carcinoma causing ptosis improving after 1 minute of upward gaze

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10
Q

Dx in old smoker with Na 125, moist mucus membranes, and no JVD =

A

SIADH from SCLC

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11
Q

Features of NSCLC =

A

Very aggressive
Peripheral location
Cavitation

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12
Q

Tx for small cell and non small cell lung cancer:

A

Small cell = chemoradiation

Non-Small Cell = surgery

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13
Q

Causes of ARDS:

A 
Gram negative Sepsis
Gastric Aspiration
Trauma
Low Perfusion
Pancreatitis
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14
Q

Dx of ARDS:

A

Bilateral
PaO2/FiO2 > 200 (means it’s acute)
PCWP is <18 (meaning pulmonary edema is non-cardiac)

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15
Q

Tx for ARDS:

A

PEEP

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16
Q

Systolic ejection murmur, louder with squatting, and softer with valsalva:

A

Aortic Stenosis

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17
Q

Murmur for HOCM:

A

Systolic ejection murmur which is louder with valsalva and softer for squatting or hard-grip

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18
Q

What does valsalva do?

A

Decreases preload

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19
Q

Murmur features of mitral valve stenosis:

A

Late systolic murmur with a click
louder with valsalva and hand-drip
Softer with squatting

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20
Q

Features of mitral regurg murmur:

A

Holosystolic murmur

Radiates to axilla

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21
Q

Holosystolic murmur with late diastolic rumble =

A

VSD

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22
Q

Continuous machine like murmur =

A

PDA

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23
Q

Wide Fixed and Split S2 =

A

ASD

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24
Q

Rumbling diastolic murmur with an opening snap, LAE, and A-fib =

A

mitral stenosis

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25
Q

Blowing diastolic murmur with widened pulse pressure =

A

Aortic Regurg

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26
Q

Dx with bad breath and snacks left over in mouth in the morning:

A

Zencker’s

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27
Q

Zenker’s a true or false diverticulum =

A

False–only has mucosa

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28
Q

Achalasia has dysphagia to??

A

Liquids and solids

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29
Q

Dx in patient with dysphagia worse with hot and cold liquids and chest pain that feels like an MI with no regurgitation =

A

Diffuse esophageal spasm

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30
Q

Tx of diffuse esophageal spasm =

A

CCB or nitrates

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31
Q

Medical therapy for gastric varices:

A

Octreotide

Somatostatin

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32
Q

When to band esophageal varices:

A

Only when they are symptomatic

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33
Q

Acid reflux pain after eating and when lying down with no risk factors for GERD =

A

Look for hiatal hernia

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34
Q

Treatment for hiatal hernia =

A 
Sliding = tx symptomatically
Paraesophageal = treat with surgery
35
Q

Work up for patient with MEG pain worse with eating and takes NSAIDs:

A

Gastric ulcers:
Barium swallow first
EGD with biopsy second

36
Q

When surgery is indicated for gastric ulcers =

A

Persistence following maximal medical treatment

37
Q

Blummer’s Shelf =

A

Mets felt on DRE

often gastric cancer

38
Q

Gastric lymphoma (not MALT) associated with:

A

HIV patients

39
Q

Dx in patient with foamy pee, enlarged rugae, and edema =

A

Mentrier’s Disease (protein losing enteropathy)

40
Q

Gastric varices caused by:

A

Splenic vein thrombosis

which is common after chronic pancreatitis

41
Q

H pylori most associated with which ulcers?

A

Duodenal

42
Q

Best dx test for HP?

A

CLO test following EGD

43
Q

Treatment of duodenal ulcers positive for HP?

A

PPI
Clarithromycin
Amoxicillin
for 2 wks

44
Q

What to suspect if duodenal ulcer doesn’t heal with maximal therapy?

Next Steps?

A

ZES

Secretin stimulation test / octreotide testing

45
Q

Syndrome gastrinomas are associated with?

A

MEN1

46
Q

Features of MEN1?

A

Parathyroid adenoma
Pancreatic NE tumors
Pituitary

47
Q

Dx in patient with bilious vomiting, post-prandial pain, and recently lost 200lbs on Biggest Loser =

A

SMA syndrome

48
Q

Pathophys of SMA syndrome =

A

3rd part of duodenum compressed by AA and SMA

49
Q

Tx for SMA syndrome =

A

restoring weight and nutrition

Can do roux-en-y

50
Q

Complications of pancreatitis:

A

Hemorrhage
Abscess
ARDS
Pseudocyst

51
Q

Whipple for panc cancer is indicated when…

A

No mets outside of abdomen
No extension into SMA or portal vein
No liver mets
No peritoneal mets

52
Q

What is Whipple’s Triad:

A

Associated with insulinoma

Hypoglycemic Sx
BS < 45
Sx resolve with glucose

53
Q

Labs for insulinoma:

A

C-peptide

54
Q

Sx associated with glucagonoma:

A

Hyperglycemia
Diarrhea
Weight loss
Necrolytic migratory erythema

55
Q

Symptoms and issue with somatostatinoma:

A

commonly malignant
Malabsorption
Steattorhea
(Exocrine pancreas malfunction)

56
Q

VIPoma sx:

A

Watery Diarrhea
Flushing
Hypokalemia

57
Q

Tx of VIPoma:

A

Octreotide

58
Q

Tx of carcinoid syndrome:

A

Octreotide

59
Q

Dx, w/u, and tx in patient with RUQ pain, fever, jaundice, decreased BP, and AMS:

A

Ascending cholangitis
US / ERCP
Tx with ECRP and cholecystectomy

60
Q

2 most important types of choledochal cysts and how to tx:

A

Type 1 - Fusiform dilation or CBD; tx with excision of cyst

Type 4 - the worst kind; “Caroli’s Dz,” cysts in the intrahepatic ducts; tx with liver transplant

these are peds dz’s

61
Q

Risk factors for cholangiocarcinoma:

A

Slerosing Cholangitis

Liver flukes

62
Q

Tx for cholangiocarcinoma:

A

Tx with surgery +/- radiation

63
Q

Sign of EtOHic hepatitis:

A

AST is 2x ALT

64
Q

LFTs associated with viral hepatitis:

A

ALT > AST and both are in the 1000’s

65
Q

Elevated AST and ALT following CT surgery:

A

Shock liver

66
Q

Tx of hepatic encephalopathy:

A

Lactulose

67
Q

Risk factors for hepatocellular carcinoma:

A

Chronic HepB > HepC
Cirrhosis for any reason
Aflatoxin
Carbon tetrachloride

68
Q

Dx of HCC:

A

High AFP

Follow up with CT/MRI

69
Q

Tx of HCC:

A

Resection if single

Rads or cryoablation for palliation of mutliple

70
Q

Tx of hepatic adenoma:

A

Stop OCP

Resect if large, causing hemorrhage, or pregnancy is desired.

71
Q

Focal nodular hyperplasia tx =

A

None

72
Q

3 most common organisms of pyogenic liver abscess:

A

E coli
Bacterioides
Enterococcus

73
Q

Ptn presents with RUQ pain, profuse sweating and rigors, and palpable liver:

A

Entamoeba histolytica

74
Q

Cansoni Skin Test:

A

Positive skin test seen in patients with Echinococcal liver cysts due to high levels of IgE

75
Q

Tx for echinococcal cysts:

A

Albendazole and surgery to remove entire cyst since rupture can cause anaphylaxis

76
Q

Post splenectomy tx:

A

Aspirin if platelets high
Prophylactic PCN
3 vaccines

77
Q

Signs, dx, and tx of hereditary spherocytosis:

A

sxs of hemolytic anemia, elevated retic count, and osmotic frag test. prone to gallstones.

spherocytes on smear,

Splenectomy

78
Q

Nutritional deficit in patients with serotonin syndrome:

A

Niacin (5HT and niacin both made from tryptophan)

79
Q

symptoms of niacin deficiency:

A

Diarrhea
Dementia
Dermatitis

80
Q

Surgery to perform if tumor in serotonin syndrome is >2cm, at the base of the appendix, or with positive lymph nodes:

Otherwise…

A

Hemicolectomy

appendectomy

81
Q

Threshold for treatment of Ogilvie’s =

A

> 10cm distension

Decompression with NG tube and neostigmine or colonic decompression

82
Q

Side effect of neostigmine:

A

Bradycardia (cholinergic)

83
Q

Imaging of sigmoid volvulus =

A

Coffee bean

Surgery Clerkship (12 decks)

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