sugery- de virgilio

Question 1

elective surgery after MI?

Answer 1

postpone for 4 weeks

-perform stress test at that time

Question 2

major predictors of adverse cardiac event after elective surgery (4)

Answer 2

within one month:

• MI
• unstable angina
• decomp CHF
• sig arrythmia –> work it up!

Question 3

order of cardiovascular risk (most to least)

Answer 3

CAD, CHF, TIA/stroke, DM, creatine >2

Question 4

dresslers syndrome

Answer 4

acute pericarditis following MI

global ST elevation and PR depression

Question 5

timing of post MI complications

Answer 5

48 hr- arrythmia
5 days - vent septal rupture
weeks- months - dresslers

Question 6

whatsmore accurate, MUGA or echo?

Answer 6

MUGA! nuc stress test, but more cost prohib

Question 7

Stanford A

Answer 7

ascending aorta –> involves inominate! can lead to tamp, MI, AI, stroke

urgent OR

Question 8

Stanford B

Answer 8

invovles descneding aorta

• can involve celiac, renal, common iliacs
• can usually be managed medically unless signs of malperfusion (inc Cr, abd tenderness, dec pulses)

Question 9

post op R side MI management?

Answer 9

Fluids! help with preload.

avoid nitrates!!

Question 10

hammon’s crunch post CABG? with inc WBC

Answer 10

acute mediastinitis

Question 11

equalization of central pressures is associated with what cardiac phenom?

Answer 11

tamponade (blood compresses heart and decreases diastolic filling volume)

Question 12

t/f: Type A aortic dissection can present as acute MI

Answer 12

true.

thrombolysis is a big nono. Check for wide mediastinum on CXR

Question 13

beta blockade or alpha blockade before pheo surgery?

Answer 13

ALPHA for10-14 days

beta can cause unopposed alpha blockade and precip HTN crisis

Question 14

percutaneous bx for adrenal mass?

Answer 14

NO. no histo markers specific and risk seeding

Question 15

what is the indication/ rec for adrenal tumor resection?

Answer 15

> 6cm

OPEN to get margins if malig is expected

Question 16

moth eaten appearance on xray

Answer 16

osteitis fibrosa cystica

PTH overload, inc bone pain, inc fractures

Question 17

management of adrenal incidentaloma <6cm?

Answer 17

blood tests for hormonal activity

-24 hour urine for cats, cortisol, sodium

Question 18

name some causes of hypercalcemia

Answer 18

malignancy
paget’s
immobility
thiazides

Question 19

MEN2a

Answer 19

pheo –> plasma metanephrines, chromogranin A
hyperPTH
medullary thyroid–> Calcitonin

Question 20

raise in BP and temp following induction of surgery. Ddx? Differentiate

Answer 20

pheo–> pressure INC with beta blocker (unopposed alpha)

malig hyperthermia –> inc temp, inc pressure, inc etCO2 –>dantrolene

thyrotoxicosis –> inc pressure that responds to beta blockade

Question 21

thryoglossal duct cyst vs branchial. Which elevates?

Answer 21

thyroglossal

remove bc can cause recurrent infx

Question 22

how do you assess for metastatic pheo

Answer 22

metastasis in areas normally devoid of chromograffin tissue

Question 23

neck mass FNA?

Answer 23

> 1cm

Question 24

feared complication of thyroidectomy within 24 hours?

Answer 24

hematoma –> compresses airway

open and evacuate hematoma at bedside, securing airway via ETT may be difficult

Question 25

superior laryngeal nerve can be damaged when mobilizing thyroid which could effect.....

Answer 25

singing **cutting one rec laryngeal would cause hoarseness, cutting both could cause need for trach

Question 26

indications for parathyroidectomy

Answer 26

1. CA >1 overnormal 2. CrCl<60 3. T score

Question 27

chole liks sx in trauma patient? tx?

Answer 27

acalculous cholecystitis abx, percutaenous cholecystostomy if can't tolerate lap chole

Question 28

lab values seen in gallstone pac?

Answer 28

elevated ALT, amylase

Question 29

nutrition for someone with complicated pancreatitis past 5-7 days?

Answer 29

enteral feeding via NJ past LOT

Question 30

what should you test in white drainage after whipple?

Answer 30

amylase. if pos, make pt NPO

Question 31

porcelian galbladder mgmt?

Answer 31

get it out

Question 32

management of bloody diarrhea and LLQ pain after descending aortic aneurysm repair?

Answer 32

ischemic colitis --> risk bc IMA is occluded during surgery dx: flex sig--> friable mucosa tx: IV abx, IVF

Question 33

FAP colon cancer risk/ screening

Answer 33

100% cancer by age 50 flex sig start at age 10 --> colectomy as soon as polyp arises.

Question 34

colon cancer screening in UC

Answer 34

begin colonoscopy 8 years after dx with RANDOM BIOPSIES

Question 35

biggest complication of sphincterotomy?

Answer 35

fecal incontinence

Question 36

ogilve's syndrom

Answer 36

colonic psuedo obstruction who: old, demented, bedridden patients with recent surgery and opiates dx: xray will NOT show signs of obs tx: remove drugs, replacelytes, decompress with COLONOSCOPY AND NEOSTIGMINE cecum is most likely to rupture

Question 37

cecal vs sigmoid volvulus. which requires urgent colectomy?

Answer 37

cecal --> failure to adhere to R colon cannot be decompressed with scope

Question 38

t/f: smoking falsely elevates CEA?

Answer 38

yes, 4 hours before testing CEA used for colon cancer tx progress

Question 39

most common cause of appendicitis in adults vs kids

Answer 39

adults= fecalith kids= lymphoid hyperplasia (think recent viral illness)