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Surgery EOR > Rosh Material #1 > Flashcards

Rosh Material #1 Flashcards

1
Q

types of thyroid cancers mc to lc and their most significant rf

A

-papillary -> head/neck xrt
-follicular -> iodine deficiency
-medullary -> MEN2 (medullary thyroid ca, hyperparathyroid, pheocromocytoma)
-anaplastic -> presents w. dyshpagia/hoarseness

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2
Q

tx for AAA based on size

A

4.0-4.9 cm: annual US
5.0-5.4 cm: US q 6 mos
>5.5 cm or rapid expansion: elective surgery

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3
Q

what is ogilvie syndrome

A

massive dilation of the colon w.o mechanical obstruction

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4
Q

ogilvie syndrome is due to _ dysfxn

A

autonomic

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5
Q

3 rf for ogilvie syndrome

A

older age
bedbound
comorbidities
epidural anesthetics
meds

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6
Q

4 meds associated w. ogilvie syndrome

A

anticholinergics
antipsychotics
dopaminergics
opioids

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7
Q

supportive care can be used for ogilvie syndrome if the cecal diameter is < _

A

12 cm

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8
Q

supportive care for ogilvie syndrome

A

colonic decompression
neostigmine
due to opioids: methylnaltrexone

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9
Q

gs imaging for ogilvie syndrome

A

CT

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10
Q

major risk of anal fissure surgery

A

irreversible fecal incontinence

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11
Q

2 common indications for 1/2 NS

A

hypernatremia
DKA

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12
Q

2 s.e of 1/2 NS

A

fluid overload
pulmonary edema

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13
Q

most appropriate IVF for pre op pt who is NPO

A

LR

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14
Q

what are the vit K clotting factors

A

II
VII
IX
X

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15
Q

management of warfarin based on INR

A

-greater than goal, but < 5: skip next dose
-5-10, no bleeding risk: skip next 1-2 doses
->10, no bleeding or mod risk of bleeding: hold warfarin, give vit K
-> 10, serious bleeding or high risk for bleed: hold warfarin, give vit K and 4 factor prothrombin complex
-life threatening bleed: hold warfarin, give ffp and IV vit K

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16
Q

4 meds that cause pseudotumor cerebri

A

vit A derivatives
OCPs
steroids
tetracyclines

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17
Q

tx for pseudotumor cerebri

A

low Na diet
wt loss
acetazolamide
optic n sheath fenestration
shunt

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18
Q

dx for pseudotumor cerebri (2)

A

MRI w. venography
LP

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19
Q

how is hydrostatic reduction performed for intussusception (2)

A

barium enema
pneumatic reduction

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20
Q

best test for h. pylori if a pt has an actively bleeding ulcer, a recent ppi, or recent abx use (2)

A

stool antigen
vs
urea breath

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21
Q

best h. pylori testing if the pt is undergoing endoscopy, has a bleeding ulcer, or has recent ppi or abx use

A

biopsy urease during the procedure

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22
Q

slow growing neuroendocrine ca that arises from enterochromaffin cells of the digestive tract - commonly arise from SI, bronchus/lung, rectum

A

carcinoid tumor

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23
Q

5 sx of carcinoid tumor

A

diarrhea
flushing
wheezing
hemodynamic instability
metabolic acidosis

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24
Q

24 hr urine collection findings of carcinoid tumor

A

elevated 5-HIAA (5 hydroxyindoleacetic acid)

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25
Q

tumor marker for carcinoid tumor

A

chromogranin A

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26
Q

when performing excisional or shave bx of a suspected melanoma a _ margin should be maintained to minimize skin loss and reduce risk for missed dx

A

2 mm

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27
Q

when would you order ionized Ca if you suspect hyperparathyroidism

A

if Ca is normal

if it is high, then order PTH

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28
Q

gs dx for peripheral lung lesion

A

open lung bx

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29
Q

order of imaging for wilms tumor

A
  1. US - initial
  2. CT vs MRI
  3. bx - definitive
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30
Q

what is this showing

A

mediastinal air -> boerhaave syndrome

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31
Q

what is boerhaave syndrome

A

spontaneous perforation of the esophagus from sudden increase in intraesophageal pressure -
ex sudden onset of coughing/forceful vomiting

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32
Q

boerhaave syndrome mc involves the

A

left posterolateral aspect of the distal intrathoracic esophagus

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33
Q

hallmark PE finding of boerhaave syndrome

A

hamman crunch -> mediastinal crackling w each heartbeat

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34
Q

gs dx for boerhaave syndrome

A

esophagram w. water-soluble contrast

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35
Q

tx for boerhaave syndrome

A

emergent surgical consult
broad spectrum abx

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36
Q

what meds decrease mortality in STEMIs

A

-ASA
-P2Y12 receptor blockers (tigagrelor/prasugrel)

not clopidogrel

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37
Q

only tx for adrenocortical carcinoma

A

surgery

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38
Q

management of breast pain based on age

A

< 30: US of painful breast
30-39: US PLUS focused or bilat mammogram
>40: US PLUS bilat mammogram

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39
Q

tx for SAH

A

nimodipine (decreases vasospasm)

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40
Q

79 yo F w. hx htn and hypercholesterolemia - month long hx of worsening, dull, aching, generalized abd pain that lasts 30 mins and is worse after eating - she is avoiding eating and has lost 8 lb x 3 weeks

A

chronic mesenteric ischemia

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41
Q

2 types of necrotizing fasciitis

A
  1. polymicrobial - aerobic and anaerobic
  2. GAS
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42
Q

tx for necrotizing fasciitis

A

surgical debridement
abx

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43
Q

mc form of intestinal ischemia

A

ischemic colitis

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44
Q

2 mc locations for ischemic colitis

A

splenic flexure
rectosigmoid junction

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45
Q

ischemic colitis is caused by a

A

global low flow state:
CHF
MI
sepsis
hemorrhage

(unlike embolic w. mesenteric ischemia)

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46
Q

3 HPI clues for ischemic colitis

A

atherosclerotic dz
aortoiliac surgery
cardiopulmonary bypass

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47
Q

tx for ischemic colitis

A

supportive

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48
Q

what is paget-schroetter syndrome

A

primary upper DVT

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49
Q

5 hpi clues for paget-schroetter syndrome

A

-muscular
-repetitive overarm hyperabduction/external rotation
-strenuous activity
-central line placement
-hypercoagulable state

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50
Q

paget-schroetter syndrome is caused by

A

compressive anomaly at the thoracic outlet

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51
Q

tx for paget-schroetter syndrome

A

NSAIDs
alteplase
heparin
venoplasty
compression stockings

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52
Q

which type of adenomatous polyps have the greatest risk of malignancy

A

villous

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53
Q

PLT transfusion thresholds for pt’s w. thrombocytopenia

A

CNS/ocular bleeding: <100,000
active bleeding: < 50,000
nonbleeding: < 10,000

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54
Q

direct visualization tests for colon ca screening and frequency they need to be performed

A

colonoscopy: q 10 yr
CT colonography: q 5 yr
flexible sigmoidoscopy: q 5 yr
flexible sigmoidoscopy PLUS FIT annually: 1 10 yr

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55
Q

what are the 3 accepted stool based tests for colorectal ca screening and frequency they need to be performed

A

gFOBT: annually
FIT: annually
FIT-DNA: q 1-3 yr

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56
Q

what is this showing

A

drug induced exanthem

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57
Q

what is this showing

A

uticaria

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58
Q

what is this showing

A

cuataneous small vessel vasculitis

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59
Q

what is thsi showing

A

exfoliative dermatitis: chronic erythema/scale involving > 90% of the body surface

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60
Q

what is this showing

A

SJS

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61
Q

what is this showing

A

erythema multiforme

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62
Q

what is this showing

A

erythematous/edematous plaques w. grayish center or frank bullae -> fixed drug rxn

63
Q

tx for drug induced exanthems

A

topical tiramcinolone
PO hydroxyzine

64
Q

most aggressive type of breast ca

A

triple negative

65
Q

what is this showing

A

achalasia: loss of inhibitory neurons in the distal 2/3 of the esophagus -> absent peristalsis and increased tone in the LES

66
Q

4 sx of achalasia

A

dysphagia to liquids and solids
CP
weight loss
regurgitation

67
Q

dx for achalasia: initial vs gs

A

initial: EGD
gs: esophageal manometry

68
Q

tx for achalasia (3)

A

graded pneumatic dilation
esophageal botulism
surgical myotomy

69
Q

types of dysphagia and associated conditions

A

odynophagia: infectious esophagitis
progressive: stricture/ring/web/tumor
intermittent: eosinophilic esophagitis
liquid: dysmotility (infective vs achalasia)
halitosis/regurgitation of undigested food: zenker
abrupt onset: pill or chemical esophagitis

70
Q

chest discomfort precipitated by activity
sx abate after activity

A

stable angina

71
Q

ischemic sx suggestive of acute coronary syndrome
+/- ECG changes indicative of ischemia

A

unstable angina

72
Q

troponin elevation
subendocardial ischemia
ECG w. ST depressions

A

NSTEMI

73
Q

troponin elevation
transmural ischemia
ECG w. ST elevation

A

STEMI

74
Q

what is this showing

A

diffuse increased iodine uptake in both thyroid lobes -> graves dz

75
Q

what is this showing

A

normal thyroid

76
Q

what is this showing

A

toxic multinodular goiter -> plummer dz

77
Q

what is this showing

A

toxic adenoma

78
Q

what is this showing

A

thyroiditis

79
Q

management of thyroid nodules

A

benign: monitor q 12 mos
intermediate nodules: repeat FNA, molecular testing, diagnostic lobectomy
suspicious nodules: surgery

80
Q

what is this showing

A

aortic dissection

81
Q

abi < 0.9 indicates:
abi < 0.4 indicates

A

< 0.9 = > 50% stenosis
< 0.4 - ischemia

82
Q

order of dx studies for PAD

A
  1. resting ABI
  2. toe-brachial
  3. exercise ABI (if dx unsure)
83
Q

tx of hypoglycemia in diabetic pt’s based on BG

A

asymptomatic w. BG </= 70: repeat test, avoid driving, eat CHO, adjust meds
symptomatic: fast acting CHO (tabs/juice), followed by long acting CHO
severe/unconcious: glucagon, IV dex

84
Q

3endoscopic features of a peptic ulcer suggestive of malignancy

A

-ulcerated mass protruding into lumen
-nodular/clubbed/fused folds surrounding ulcer
-overhanging, irregular, or thickened margins

85
Q

mc type of gastric ca

A

adenocarcinoma

86
Q

tx for toxic megacolon

A

subtotal colectomy w.end ileostomy

87
Q

what is boas sign

A

hyperaesthesia, increased or altered sensitivy below the right scapula -> cholecystitis

88
Q

what type of cholecystitis occurs in critically ill pt’s

A

acalculous

89
Q

gs dx for cholecystitis

A

HIDA (cholescintigraphy)

90
Q

pharm management of esophageal varices (3)

A

ocretotide -> decreases bleeding
vasopressin -> reduces portal pressure
bb -> secondary bleeding prophylaxis (not for acute)

91
Q

endoscopic management of esophageal varices

A

banding ligation - preferred
sclerotherapy - high rate of rebleeding

92
Q

downsides of balloon tamponade for esophageal varices

A

only temporary
many complications: aspiration death, perforation
pt needs to be intubated

93
Q

indications for TIPS for esophageal varices

A

refractory
rebleeding

94
Q

surgery for esophageal varices

A

PCS (esophageal transection or portacaval shunt)

95
Q

2 abx for esophgeal varices

A

ceftriaxone
norfloxacin

96
Q

order of tx for esophageal varices

A
  1. endoscopic band ligation vs sclerotherapy
  2. balloon tamponade (if endoscopic fails)
97
Q

tx for cdiff

A

vanco vs fidaxomicin

98
Q

what is this showing

A

corkscrew esophagus -> esophageal spasm

99
Q

impairment of inhibitory innervation to the esophagus -> leads to both premature and rapidly prolonged or simultaneous contractions in the distal esophagus

A

esophageal spasm

100
Q

dx for esophageal sapsm

A

esophageal manometry

101
Q

tx for esophageal spasm

A

ccb
tca
isodorbide-sildenafil
botulinum

102
Q

first line surgical tx for achalasia

A

laparascopic heller myotomy

103
Q

what is this showing

A

apple core lesion -> colorectal ca

104
Q

what is this showing

A

bcc

105
Q

basophilic staining cells with peripheral palisading nuclei

A

bcc

106
Q

grades of hepatic encephalopathy

A

I: disordered sleep, dpn, irritability, mild cognitive dysfxn
II: lethargy, confusion, personality changes, disorientation, asterixis
III: somnolence, confusion, inability to follow commands, disorientation
IV: coma

107
Q

tx for hepatic encephalopathy

A

lacutlose
rifamixin

108
Q

_ correlates w. severeity of hepatic encepalopathy

A

CSF glutamine

109
Q

t/f: atelectasis is mc asymptomatic unless the pt develops hypoxemia or pna

A
110
Q

2 types of choledocholithiasis

A

primary: stone originates in cbd
secondary: stone originates in gallbladder -> cbd

111
Q

types of stone mc found in primary vs secondary choledocholithiasis

A

primary: pigmented (brown)
secondary: cholesterol vs mixed

112
Q

what is this showing

A

u-shaped bent inner tube -> sigmoid volvulus

113
Q

4 rf for sigmoid volvulus

A

ltc pt’s
advanced age
bedridden
chronic constipation

114
Q

tx for sigmoid volvulus

A

flexible sigmoidoscopy -> reduces volvulus
surgery -> prevents recurrence

115
Q

management of asthma patients pre op

A

SABA vs nebulizer 30 min prior to surgery if intubation is needed

116
Q

what is this showing

A

pyloric stenosis

117
Q

duodenum w. a corkscrew appearance

A

volvulus

118
Q

whirlpool sign noted w. craniocaudal movement of US transducer

A

volvulus

119
Q

string sign

A

pyloric stenosis

120
Q

breast bx options

A

core needle -> preferred initiallyl
FNA -> intraprocedural
surgical
skin punch -> consider for paget’s/inflammatory

121
Q

6 rf for incisional hernia

A

old age
obesity
smoking
malnutrition
immunosuppressive therapy
connective tissue d.o

122
Q

imaging for aortic dissection

A

hemodynamically unstable: TEE
hemodynamically stable: CTA vs MRA

123
Q

mc location from which hemorrhoids arise

A

superior hemorrhoidal cushion

124
Q

mcc of larg bowel obstruction: benign vs non-benign

A

benign: volvulus
non-benign: colorectal ca

125
Q

mc location for large bowel obstruction

A

sigmoid colon

126
Q

clotting labs associated w. DIC

A

elevated: PT, PTT, thrombin clotting time, fibrin split products
low: PLT, fibrinogen

127
Q

post prandial pain w. duodenal ulcers occurs _ after eating food

A

2-5 hr

128
Q

location of PAD based on pain

A

calf -> distal superficial femoral a
behind knee, into calf -> popliteal a
thigh/lower leg -> deep femoral a (uncommon)
thigh/buttocks -> common iliac a

129
Q

irregular erythematous plaque w. a hemorrhagic crust

A

scc

130
Q

2 mc indications for preop dialysis

A

hyperkalemia
fluid overload

131
Q

what is this showing

A

aortic dissection

132
Q

sx of type A vs type B aortic dissection

A

type A: chest pain radiating to the back, syncope
type B: HTN

133
Q

order of managemetn for aortic dissection

A
  1. bb - labetalol vs esmolol
  2. nitroprusside for further bp control
  3. morphine
  4. type A: emergent surgery
134
Q

indication for surgery for type B aortic dissection

A

end organ damage
htn refractory to meds

135
Q

what surgery is preferred for type B aortic dissection

A

thoracic stent graft repair

136
Q

mc presentation of an obturator hernia

A

female 70-90 yo
SBO

137
Q

what PE sign is associated w. obturator hernias

A

howship-romberg: pain extends down the medial aspect of the thigh w. movement of the knee

138
Q

3 sites for central line access based on risk of infxn: low to high

A

subclavian
interna jugular
femoral

139
Q

which presentation is chronic GERD mc associated w. in terms of metaplasia

A

columnar metaplasia of the squamous epithelium

140
Q

where do adenocarcinomas of the esophagus mc occur

A

distal 1/3 of the esophagus near the gastroesophageal junction

141
Q

where does squamous cell carcinoma of the esophagus occur

A

proximal 2/3 of the esophagus

142
Q

2 mc rf for adenocarcinoma of the esophagus

A

barrett esophagus
obesity

143
Q

2 mc rf for squamous cell carcinoma of the esophagus

A

chronic etoh
tobacco

144
Q

cobblestoning
skip lesions
transmural inflammation

A

crohn dz

145
Q

what is the recommended minimum pre op PLT count based on procedure

A

-transfuse if <10,000: hematologic malignancies, allogenic hematopoietic cell transplant, solid tumors
-transfuse if < 40,000-50,000: major procedures
-transfuse if <20,000: bone marrow aspirate, insertion/removal of a central line

146
Q

normal ALP/ALT/AST with jaundice

A

gilbert syndrome
crigler-najjar syndrome

147
Q

elevated ALP elevation greater than ALT/AST elevation

A

intrahepatic cholestasis
biliary obstruction

148
Q

eleavted GGT and ALP

A

cholestasis

149
Q

5 causes of AST elevation

A

etoh
APAP
NSAIDs
ACEI
abx

150
Q

AST:ALT > 2

A

etoh hepatitis

151
Q

AST: ALT < 1

A

hepatocellular necrosis

152
Q

causes of ALP elevation

A

hepatocellular dz
cholestatic dz
may be normal in healthy kids and pregnant

153
Q

causes of elevated GGT

A

etoh
phenobarbital
warfarin

Surgery EOR (17 decks)

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