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PANCE prep JQ > Surg/GI/nutrition/endo > Flashcards

Surg/GI/nutrition/endo Flashcards

1
Q

Virchow triad

A

Stasis/immobility, endothelial injury, hypercoagulability

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2
Q

UFH DVT prophylaxis

A

80U/kg bolts followed by 18U/kg infusion. Check aPTT at 6hr and q 2hr till 1.5x control achieved

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3
Q

LMWH DVT prophylaxis

A

1mg/kg SC. Bid. Therapeutic peak 0.6-1 of anti Xa

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4
Q

Arixta DVT prophylaxis

A

2.5mg SC daily go up to 10 d

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5
Q

Risk factors for DVT

A 
Recent surgery
Acute medical illness
Immobilization
Central venous cath
Prior VTE
Pregnant or postpartum 
Active malignancy
Obesity
Estrogen/testosterone 
IBD
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6
Q

HITT treatment

A

Direct thrombin inhibitor

Acova 2mvg/kg/min IV over 3hr

If PCI bivalirudin 0.75mg/kg IV Nokia then 1.75mg/kg/hr IV

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7
Q

SCIP abx guidelines

A

Abx should be administered 1hr before incision (2hr for vanco)

First or second gen cephalosporins preferred for most procedures

Dc abx 24hr post surgery

Hair not removed or cut with clippers

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8
Q

Cefazolin

A

DOC surg prophylaxis

1-2g preop
0.5-1g q6-8hr post op

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9
Q

Vanco

A

Surg abx if beta lactam sensitivity

GI/GU: 1g IV over slow 1hr infusion

Other procedures: 15mg/kg IV over 1-2hr

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10
Q

Metronidazole

A

Anaerobic coverage that should be added for colon surgery

15mg/kg IV over 30-60min followed by 7.5mg/kg IV at 6 and 12 hr

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11
Q

Most common locations for hemorrhoids

A

R anterior, R posterior, and lateral

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12
Q

Grade 3 internal hemorrhoid

A

Prolapse and manual reduction

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13
Q

Grade 4 hemorrhoid

A

Prolapse that can not be manually reduced

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14
Q

Most common annal carcinoma?

A

SCC

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15
Q

What is the incidence of anal cancer?

A

Rare (1% colon cancers)

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16
Q

What is paget’s dz if the anus?

A

Adenocarcinoma in situation of the anus

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17
Q

Risk factors for anal cancer?

A

STDs, chronic inflammation, immunosuppression, MSM, cervical/vaginal cancer, smoking

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18
Q

Most common sx of anal carcinoma?

A

Anal bleeding

Other sx include pain, mass, priritus. 25% asx

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19
Q

Describe lymphatic drainage of anus.

A

Above dentate line to pelvic chains

Below dentate line to inguinal lymph nodes

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20
Q

Margin cancer

A

Anal verge out 5cm into perianal skin

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21
Q

Canal cancer

A

Proximal to anal verge up to the border of internal sphincter

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22
Q

Nigro protocol

A

Used to to anal carcinoma

1chemo(5FU or mitomycin C)
2radiation
3postradiation scar bx at 8wk

90%response rate to protocol

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23
Q

Tx of anal melanoma

A

Wide excision with abdolominoperineal resection with possible chemo

Poor prognosis

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24
Q

What is Goodsall’s rule?

A

Anal fistula originating anterior to the transverse line Will course straight and fistula that originate posteriorly with have a curved course.

(Think of a dog nose and tail)

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25
Q

What percentage of perirectal abscesses develop into fistula?

A

About 50%

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26
Q

Anorectal fistula management

A

Marsupialization of tract, wound care, and seton if fistula through muscle

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27
Q

Where do perirectal abscesses originate?

A

Crypt glands in dentate line

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28
Q

What is a sentinel pile?

A

Thicker mucosa/skin at the distal end of an anal fissure that is often confused with a sm hemorrhoid

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29
Q

What dz processes must be considered with a chronic anal fissure?

A

IBD, STDs, and anal cancer

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30
Q

Treatment for perianal warts

A

Topical podophyllin, imiquimod

resection or ablation if not responsive to conservative methods.

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31
Q

Excruciating anal pain and history of hemorrhoids should make you think of this.

A

Thrombosis external hemorrhoid

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32
Q

What are the dreaded complications of hemorrhoidectomy?

A

Exsaguination ( bleeding pools proximally in lumen of colon without signs of bleeding), pelvic infection (may be extensive and fatal), and inconsistence from anal sphincter damage

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33
Q

What dz is a contraindication to a hemorroidectomy?

A

Crohns

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34
Q

Hyperplastic polyp

A

Usually pale benign polyp found in distal colon and rectum

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35
Q

Sessile polyp

A

Flat polyp that is more difficult to remove

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36
Q

Pedunculated polyp

A

Mushroom appearance/stalk and cap

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37
Q

APR

A

Abdominal perineal resection

Tx for low-lying rectal cancer

Rectum and anus removed leaving pt with a permanent colostomy

38
Q

LAR

A

Low anterior resection

Tx for rectal cancer above levator muscles

Resection of rectum and lower sigmoid preserving continence

39
Q

When should the average person start colorectal cancer screening?

A

45-50

40
Q

When should a pt with FAP start getting colonoscopies?

A

10-12

41
Q

When should an HNPCC pt start getting colonoscopies?

A

20-25 or 10yr before youngest relative was dx

Repeat q1-2yr

42
Q

Most common colonic polyp

A

Tubular adenoma

43
Q

Colonic polyp associated with the highest risk of cancer

A

Villous adenoma

*think VILLous is VILLanous

44
Q

What is the most common site for colon cancer metastasis?

A

Liver

45
Q

Most common site for lower rectal cancer metastasis?

A

The lungs

Colon venous drainage is portal so mets to liver but rectum venous drainage is IVC so lungs

46
Q

Describe rectal blood supply

A

Superior rectal from IMA

Middle rectal from internal iliac

Inferior rectal branch of pudendal(off internal iliac)

47
Q

What is another name for lynch syndrome?

A

Hereditary nonpolyposis colon cancer (HNPCC)

48
Q

What does microcytic anemia on a postmenopausal woman indicate until proven otherwise?

A

Colon cancer

49
Q

TNM stage III

A

Colon cancer with nodal involvement

Adjuvant chemo needed after resection

50
Q

90% of colon cancers recur within…

A

3yrs of surgery/resection

51
Q

What is the 5yr survival rate of unresectable colon cancer with liver metastasis?

A

0%

52
Q

What are the subtypes of neoplasticism colon polyps?

A

Tubular adenomas
Tubulovillous adenomas
Villous adenomas

53
Q

HCl is secreted by these cells in the stomach

A

Parietal cells

*HCl dissolves food, activates pepsin, and kills bacteria

54
Q

Pepsin is secreted by these cells in the stomach

A

Chief cells

*pepsin digest protein into peptides

55
Q

Parietal cells are stimulated to secrete HCl by these 3 things:

A

Gastrin released by G cells which stimulate ECL cells to secrete

Histamine

Acetylcholine released by the vagus nerve (parasympathetic nervous system)

56
Q

Somatostatin

A

Inhibitory hormone released by pancreatic D cells.

Decreases GI hormones

57
Q

Vitamins produced by colonic bacteria (2).

A

Vit k

Biotin

58
Q

Secretin

A

Hormone released by the duodenum which inhibits release of gastrin and causes the release of bicarbonate from the pancreas

59
Q

Cholecytokinin (CCK)

A

Hormone released by the duodenum in response to fat

Stimulates pancreases to release bicarb and digestive enzymes. Also stimulates gallbladder to contract release bile

60
Q

If someone has infectious esophagitis you should be looking for this?

A

Cause of immunocompromise

61
Q

Multiple corrugated rings in the esophagus

A

Suggestive of eosinophilia esophagitis

62
Q

What do you expect to see on EGD if pt has pull induced esophagitis?

A

Small well-defined ulcers of varying depths

63
Q

Risk factors for pill-induced esophagitis

A

Prolonged supination after pill ingestion

Chronic use of NSAIDs, bisphosphonates, potassium chloride, iron pills, vit C, BB, and CCBs

64
Q

GERD alarm symptoms

A

Dysphagia
Odynophagia
Weight loss
Bleeding

65
Q

Tx options for achalasia

A

Botox injection
Nitrates
CCBs
Pneumatic dilation of LES

66
Q

Compare achalasia and diffuse esophageal spasm esophograms

A

Achalasia- birds beak

Diffuse esophageal spasm - corkscrew

*both could be treated with nitrates or CCBs

67
Q

2 MC causes of Boerhaave syndrome

A

Bulimia

Perforation on EGD

68
Q

UGI bleed from longitudinal mucosal laceration of gastroesophageal junction or gastric cardia

A

Mallory-Weiss tear

*MC after ETOH binge with persistent retching/vomiting

69
Q

What is Schatzki ring associated with?

A

Sliding hiatal hernias

70
Q

If a child has esophageal varies you should consider this

A

Portal vein thrombosis - clotting disorders

71
Q

These two things seen on EDG with esophageal varies are suggestive of increased bleeding risk

A

Red whale marking

Cherry red spots

72
Q

Management of acute active esophageal varice bleed

A

Stabilize with 2 lrg bore IVs and fluids

Endoscopic ligation

Octreotide (DOC) or somatostatin

Balloon tamponade or TIPS in refractory cases

73
Q

Preventing rebleed of esophageal varices

A

Nonselective BB like propranolol or nadolol is DOC

Long acting nitrates can also help

74
Q

Compare squamous cell and Adenocarcinoma of the esophagus

A

Squamous cell: MC worldwide, upper 1/3, associated with tobacco/ETOH use, increased incidence in African Americans

Adenocarcinoma: MC in US, lower 1/3, associated with GERD, seen in younger obese caucasians

75
Q

Medication that is good for preventing NSAID ulcers

A

Misoprostol (Cytotec)

76
Q

Complete this 8-12wk after starting thx for peptic ulcer dz to document healing and r/o malignancy

A

EGD

77
Q

Correlate sx with location of a GI ulcer

A

Gastric: pain for 1-2 hr after eating and weight loss (older pts ass. With malignancy)

Duodenal: pain before meals relived with food, classically associated with nocturnal sxs (4x MC, seen in younger pts)

78
Q

How do you dx ZES?

A

Fasting gastrin levels is the best screening

Confirm with secretin test

Localized tumor with somatostatin receptor scintigraphy

79
Q

Linitis plastica

A

Leather bottle appearance of stomach due to cancer infiltration of stomach

Associated with worse prognosis

80
Q

LAD associated with GI malignancy

A

Virchows node- left supraclavicular

Sister many Joseph’s- umbilical

Blumer’s shelf- rectal

Irish sign - left axillary

81
Q

Krukenburg tumor

A

Ovarian Mets from GI tumor

82
Q

Compare squamous cell and Adenocarcinoma of the esophagus

A

Squamous cell: MC worldwide, upper 1/3, associated with tobacco/ETOH use, increased incidence in African Americans

Adenocarcinoma: MC in US, lower 1/3, associated with GERD, seen in younger obese caucasians

83
Q

Medication that is good for preventing NSAID ulcers

A

Misoprostol (Cytotec)

84
Q

Complete this 8-12wk after starting thx for peptic ulcer dz to document healing and r/o malignancy

A

EGD

85
Q

Correlate sx with location of a GI ulcer

A

Gastric: pain for 1-2 hr after eating and weight loss (older pts ass. With malignancy)

Duodenal: pain before meals relived with food, classically associated with nocturnal sxs (4x MC, seen in younger pts)

86
Q

How do you dx ZES?

A

Fasting gastrin levels is the best screening

Confirm with secretin test

Localized tumor with somatostatin receptor scintigraphy

87
Q

Linitis plastica

A

Leather bottle appearance of stomach due to cancer infiltration of stomach

Associated with worse prognosis

88
Q

LAD associated with GI malignancy

A

Virchows node- left supraclavicular

Sister many Joseph’s- umbilical

Blumer’s shelf- rectal

Irish sign - left axillary

89
Q

Krukenburg tumor

A

Ovarian Mets from GI tumor

90
Q

Increased bilirubin without increased LFTs should make you think of this

A

Familial bilirubin disorders and hemolysis

PANCE prep JQ (15 decks)

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