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Surgery Clerkship - De Virgilio > Summary of Essentials Ch. 1- > Flashcards

Summary of Essentials Ch. 1- Flashcards

1
Q

Location of femoral hernia?

A

Posterior and inferior to the inguinal ligament and medial to the femoral vein

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2
Q

Cause of indirect vs. direct inguinal hernia?

A

Indirect - congenital (patent processus vaginalis)

Direct - acquired weakness in Hesselbach’s triangle?

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3
Q

Location of indirect inguinal hernia?

A

Lateral to inferior epigastric vessels, through the deep and superficial ring

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4
Q

Location of direct inguinal hernia?

A

Medial to inferior epigastric vessels, through the superficial ring only

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5
Q

Imaging for hernia?

A

Clinical diagnosis, none needed

CT scan only if dx unclear (as in morbid obesity)

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6
Q

Asymptomatic hernias can be observed - exceptions?

A

Femoral hernias, inguinal hernias in infancy

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7
Q

Management of symptomatic indirect and direct hernias?

A

Indirect - open the sac, reduce, perform high ligation

Direct - do NOT open, reinforce floor with mesh

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8
Q

Rx incarcerated hernia?

A

Attempt reduction, then repair semi-electively

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9
Q

Rx strangulated hernia?

A

Urgent surgery

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10
Q

Rx umbilical hernia in children?

A

Repair if persistent >age 4, if defect >2 cm, if progressive enlargement after age 2

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11
Q

Describe physical exam of a breast mass suspicious for cancer

A

Firm with irregular borders

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12
Q

When is nipple discharge suspicious for breast cancer?

A

Bloody, spontaneous, unilateral, uniductal, associated with a mass, >40 y/o

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13
Q

Most common cause of palpable breast mass?

A

Fibrocystic disease

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14
Q

Most common malignancy neoplasm of the breast?

A

Invasive ductal carcinoma

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15
Q

Most common breast neoplasm in premenopausal women?

A

Fibroadenoma

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16
Q

Work-up of all new breast masses?

A

Triple test -> physical exam, imaging, tissue sample

If 30 or younger - U/S
If >30 - mammogram + U/S
Tissue diagnosis if clinically suspicious regardless of imaging findings
Core needle biopsy better than FNA

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17
Q

Drug for HER-2 + breast cancer?

A

Trastuzumab

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18
Q

Drug for premenopausal ER+ breast cancer?

A

Tamoxifen

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19
Q

Rx post-menopausal ER+ breast cancer?

A

Anastrozole (aromatase inhibitor)

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20
Q

Type of calcification suspicious for cancer on mammogram?

A

Fine, linear, branching, pleomorphic microcalcifications

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21
Q

DCIS vs. LCIS in terms of progression?

A

DCIS can progress to invasive cancer if left unresected

LCIS is only a marker for the development of future ipsilateral AND contralateral invasive breast cancer

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22
Q

Manage DCIS?

A

Lumpectomy to negative margin

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23
Q

Manage LCIS found on excisional biopsy?

A

Depends on risk factors
If low risk -> observation or tamoxifen
High risk -> prophylactic bilateral mastectomy

24
Q

Manage LCIS found on core biopsy?

A

Excision biopsy to rule out adjacent or associated ductal or lobular cancer

25
Q

Which coronary artery is most commonly affected in ACS? What does it supply and what EKG changes are seen?

A

LAD

Anterior wall of left ventricle, anterior 2/3 of intraventricular septum - V2, V3, V4

26
Q

Initial management of ACS?

A

Aspirin, clopidogrel, Gp2b3a antagonist, heparin, beta-blocker, nitro, statin, orphine

27
Q

Management of STEMI?

A

Cath suite within 90 minutes for PCI

Systemic thrombolysis if PCI not immediately available

28
Q

Management of NSTEMI?

A

Most do not require PCI

Elective cardiac cath on selective basis

29
Q

Indications for urgent/emergent CABG?

A

Cardiogenic shock
Failed PCI
Presenting >12 hours after initial insult

30
Q

Indications for elective CABG?

A

Left main CAD
Multivessel disease of other coronaries
Failed PCI or not amenable to PCI

31
Q

Systolic crescendo-decrescendo murmur loudest at the upper right sternal border + S4?

A

Aortic stenosis

32
Q

What happens to murmur as aortic stenosis worsens?

A

Flow across the valve decreases and the murmur will become quieter and be heard later

33
Q

Rx aortic stenosis?

A

Surgical valve replacement; if poor candidate, valvuloplasty or transcatheter valve replacement

34
Q

Dx aortic dissection?

A

CXR (widened mediastinum)
CT chest with IV contrast
Unstable - OR with TEE

35
Q

Management of aortic dissection (immediate)?

A

Immediate control of BP - beta-blocker preferred unless suspected tamponade or severe aortic regurgitation

36
Q

Manage type A dissection (involves ascending)

A

Immediate operative repair

37
Q

Manage type B dissection?

A

Admit to ICU for BP control; surgery only if evidence of malperfusion or ongoing pain

38
Q

Work-up of incidental adrenal mass noted on CT?

A

24-hour urine free cortisol level or low-dose dexamethasone suppression test -> hypercortisolism

Serum aldosterone/plasma renin ratio >30 -> hyperaldosteronism

Catecholamine or metanephrine levels -> pheo

39
Q

Management of functional adenoma?

A

Adrenalectomy

40
Q

Management of non-functional adenoma?

A

<4 cm - observe
4-6 cm - adrenalectomy if good surgical risk
>6 cm - adrenalectomy

Do NOT biopsy

41
Q

Cause/Dx of primary hyperparathyroidism?

A

Excess PTH secretion -> hypercalcemia and osteopenia

Elevated Ca2+ with high or inappropiaitely normal PTH level

42
Q

Cause/Dx of secondary hyperparathyroidism?

A

Decreased serum Ca2+ with increased PTH

43
Q

Indications for parathyroidectomy in asymptomatic patients with primary HPT?

A

Serum Ca2+ level 1.0 mg/dL greater than upper limit of normal
Creatinine clearance <60 mL/min
T-score

44
Q

Indications for parathyroidectomy in secondary PTH?

A

High PTH despite bmedical management, bone pain, pruritis, progressive renal disease, osteopenic fractures, calciphylaxis

45
Q

What can be done to localize a solitary adenoma?

A

Sestamibi scan + thyroid U/S

46
Q

Manage pheochromocytoma?

A

Medical conditioning with alpha-blockade for at least 2 weeks (phenoxybenzamine)
Beta-blockade if tachycardia and/or arrhythmia
Adrenalectomy

47
Q

Most important initial test for thyroid mass?

A

TSH

48
Q

Thyroid nodules should be evaluated with ___. If TSH is elevated, get a ___.

A

U/S; radioactive iodine scan

49
Q

What type of thyroid nodules have low risk of malignancy?

A

Iodine-avid and hot

50
Q

Thyroid nodules that should undergo FNA?

A

Size >1 cm or suspicious or increasing in size

51
Q

Management of FNA results if inadequate?

A

Repeat FNA

52
Q

Management of FNA results if benign?

A

Observe

53
Q

Management of FNA results if AUS/FLUS?

A

Repeat FNA

54
Q

Management of FNA results if suspicious for follicular neoplasm?

A

Diagnostic thyroid lobectomy; if malignant, complete thyroidectomy

55
Q

Management of FNA results if suspicious for malignancy?

A

Diagnostic or total thyroidectomy

56
Q

Management of FNA results if malignant?

A

Total thyroidectomy, possible neck dissection

57
Q

What must be excluded prior to surgery in all patients with an FNA diagnosis of medullary thyroid carcinoma?

A

Pheochromocytoma

Surgery Clerkship - De Virgilio (9 decks)

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