Surgery Flashcards
Most common place to find inflammation of the GI tract with Crohn’s disease?
Terminal ileum
Name 4 things you will see on lab work after vomiting
Hypokalemia, hypochloremia, metabolic alkalosis, aciduria
Four Fs of cholecystitis
Female, Fat, Forty, Fertile
Inspiratory arrest when palpating the RUQ is what famous sign
Murphy’s sign = cholecystitis
Name two places of referred pain for acute cholecystitis
Right back/flank and right shoulder
Main difference btw acute and chronic pancreatitis
No elevated lipase/amylase in chronic and will show calcifications on pancreas
What antibiotic can cause biliary sludge?
Ceftriaxone
Where are anal fissures most commonly found?
Posterior midline
Pt presents with tearing rectal pain with bowel movements that last for hours after. Blood on tissue after BM. What is the dx and tx
Anal fissure. Conservative tx = sitz baths, high fiber diet, stool softeners. Next: nifediine ointment, nitro ointment, topical diltiazem, botox. Last resort: lateral internal sphincterotomy
Sentinel pile refers to
Skin tag associated with anal fissure
Abd pain, bilious vomiting, hyperactive (high pitch) bowel sounds, dilated loops of bowel on radiograph all point to what dx
Small bowel obstruction
Treatment for small bowel obstruction
NPO, place NG tube, IV fluids
If strangulated or peritoneal signs = emergency surgery
First 2 weeks post op, pt presents with abd pain, vomiting, current jelly (bloody mucous) stools, and a sausage like mass on exam. What is most likely the dx?
Intussusception
What should you order for a pt with intussusception?
Labs, ultrasound: US will show target sign, place NG tube, and give IVF.
Pt presents with obstipation, abdominal pain, vomiting 3 days post-op. Radiographs show dilated loops of bowel. What is dx and tx
Paralytic ileus
NPO, NG tube, IVF, stop opiates
Pt feels full after eating small amounts of food with stomach pain and nausea. What is dx and tx
Gastroparesis. Treat with high fiber diet and Regalen/Metaclopramide (D2 antagonist)
Pt presents with diarrhea after major surgery and abscess. MCC and diagnosis?
C-diff from broad spectrum abx such as penecillins, cephalosporins, or FQs
Dx and Treatment for C-diff
Stool culture. Treat with flagyl or PO Vanc (remember this is the only use for oral vanc)
MCC of large bowel obstruction in older adults
Carcinoma of the colon or diverticulitis
MCC of SBO in adults
Adhesions from surgery
4 cardinal signs for bowel strangulation
fever, leukocytosis, tachycardia, localized abd tenderness
If hemorrhoids are painful, are they internal or external?
External
If a patient has internal hemorrhoids, but notices pain when a “lump” protrudes out of her anus, what is causing the pain?
Prolapse
Bright red painless bleeding per rectum in a young person is most commonly
Internal hemorrhoids
Name the grades of internal hemorrhoids
I: no prolapse
II: prolapses with defecation but reduces spontaneously
III: prolapses with BMs but must be manually reduced
IV: Irreducible and could be strangulated
Hemorrhoidectomy is reserved fro what grade of hemorrhoids
Stage IV
Treatment for mild to moderate IBD?
Sulfasalazine or 5-ASA
String sign of the terminal ileum on radiographs or cobblestoning and skin lesions on endoscopy should make you think of
Crohn’s disease
The lead pipe or tubular appearance on radiographs
Ulcerative colitis
Bloody diarrhea and continuous inflammation should make you think of what IBD?
UC
A pt with IBD that is taking sulfasalazine should be on what supplement?
Folate
What part of the colon is diverticulosis MC?
Sigmoid
Treatment for uncomplicated diverticulitis?
Cipro/Levo + Metronidazole
What type of imaging is CI in acute diverticulitis
Barium enema and colonoscopy
Two MC organisms involved in diverticulitis
E. Coli and B. Fragilis
Toxic megacolon is usually caused by
UC or C. Diff
Pt with UC presents with fever, tachycardia, abd pain, abd distention, and bloody diarrhea. Colon is dilated >6 cm. Dx is most likely
toxic megacolon
MCC for esophageal stricture
GERD
Shatzki ring is usually present with
hiatal hernia
shatzki ring can cause dysphagia with solids
Plummer-Vinson Syndrome is
Triad: dysphagia + esophageal webs + iron deficiency anemia
Elderly man with dysphagia, weight loss, and sig hx of smoking and alcohol use. What imaging modality should you use
Esophagoscopy
GERD is associated with what type of esophageal cancer
Adenocarcinoma
Smoking and drinking is associated with what esophageal cancer
SCC
Abd pain that improved with meals is most likely a
Duodenal ulcer
What is triple and quadruple therapy for H. Pylori?
Tetracycline + Metronidazole + PPI ( + Bismuth for quad)
Left-sided (distal) colorectal cancer lesions are associated with
Streptococcus bovis endocarditis
A nodule on the thyroid that does not take up any iodine is most likely
Cancer
Thyroid nodules that take up iodine are
Benign
Ascending aortic dissection is
a surgical EMERGENCY! Need open repair stat
How can you treat aortic dissection prior to sugery
Lower the BP: BBs, nitro, pain control
Patient presents with “ripping” or tearing chest pain that radiates to the back. What do you expect to see on x-ray?
Widened mediastinum
Severe iron deficiency anemia post gastric by-pass may present with symptoms like
Cheilosos, koilonychia, pallor, dry skin
Labs with iron deficiency anemia will show
Low iron and ferritin but high TIBC
Two main RF for gastric cancer
Smoking and H. Pylori
A man who smokes, lost 20lbs in 6months, and has intermittent abd pain most likely has
Gastric cancer, adenocarcinoma
Barretts esophagus leads to what type of cancer
Esophageal; adenocarcinoma
Smoking and drinking leads to what type of esophageal cancer
SCC
Usually, a patient with Crohn’s will present with bloody or non-bloody diarrhea?
Non-bloody
What specific labs are we looking for with Crohn’s
ASCA positive; p-ANCA negative (UC)
After assessing ABCDE a pt with 2nd or 3rd degree burns, what do you do?
Give 4L of LR over 8 hrs
Gram neg bacteria associated with wound burns
Pseudomonas aeruginosa
Transudate fluid for a pleural effusion is usually from
CHF
Exudate fluid in a pleural effusion is usually from
Lung inflammation
Some skin lesions must be excised with 1 or 2cm margins. When do you do each
If the biopsied lesion is <1mm thick = 1cm margin
If >1mm thick = 2cm margins
What size AAA needs operated on
5.5cm or greater
Who should get at least one abd US for AAA rupture prevention
Men 65-75 y/o with smoking history
MCC of inherited colorectal cancer
Lynch Syndrome; also increases risk for endometrial cancer
RLQ pain with neg rebound or guarding + bloody stools should make you think
colorectal cancer with lynch syndrome
When should an IVC filter be placed
Pt has evidence for VTE and cannot take anticoagulant (anticoagulation is CI in pts that are actively bleeding)
A hernia medial to the inferior epigastric is a
Direct inguinal hernia
A pt with a pituitary adenoma will likely show what visual deficits
Diminished temporal fields or hemianopsia
Pts with DVT and cancer should receive what
Low molecular weight heparin
Cortisol-secreting adrenal carcinoma is surgically removed. What should be given immediately after to prevent hypotension
IV hydrocortisone
Classic triad for pheochromocytoma
Headaches, sweating, tachycardia
What happens when a person has pheochromocytoma
Chronically high catecholamines
What drug should be given preop for pheochromocytoma
Phenoxybenzamine to control BP and HR
What type of skin lesion has telangiectasia within papule
BCC; Tx: MOHs surgery
Ulcerated lesions with raised edges
SCC
Alkalosis = what electrolyte imbalance
Hypokalemia (K+ is shifting INTO the cells through H+K_ pump)
Acidosis = what electrolyte imbalance
Hyperkalemia
When is wound debridement required fro healing?
Stage 3 and 4. Into the hypodermis (3) or bone/soft tissue (4) with fat or eschar present
MC type of testicular cancer
Seminomatous germ cell tumor
Low BP, abd pain, and hematochezia should suggest
Ischemic colitis
What two areas are known for ischemic colitis
Splenic flexure and rectosigmoid junction
2/3 of volvulus affects what part of the colon
Sigmoid (bent inner tube on x-ray)
Treatment for sigmoid volvulus
Flex sig and then sigmoidectomy electively
Cecal volvulus is normally found in a different population than sigmoid, what pop
Younger, 30s-50s. Look for coffee bean sign
What is the FIRST LINE drug for hyperkalemia with peaked T waves
10% Calcium gluconate to stabilize the membrane; THEN you can give albuterol or insulin or bicarb
What should be measured intraoperatively to confirm the parathyroid adenoma is causing the problem
PTH
In hyperparathyroidism the phosphorus levels will be
Low
Hemophilia A and B affect what part of the coag cascade
A = 8 B = 9
What promotes drug factor VIII and VWF
Desmopressin; use in hemophilia 8 and VWF disease
Thickened colon and fat stranding should indicate
Diverticulitis. Start IV ABX
Free air on CXR calls for
Ex lap
What is the first thing you should order on a pt with syncope
ECG
What long term treatment should be administered after a Roux-en Y bypass
Micronutrient supplementation
“worst HA of my life” is mc caused by
a ruptured aneurysm
What do you expect to see on lumbar puncture in a SAH?
Xanthrochromia = degredation of Hb (bilirubin = yellowish)
Post-prandial abd pain, diarrhea, and weight loss on a pt with sig CVD and smoking hx is at major risk for
Mesenteric ischemia
A lentil or biconvex shape hematoma in the brain is indicative of
Epidural hematoma
Lunar shaped hematoma is indicative of
Subarachnoid hematoma
Most SENSITIVE test for cholecystitis
HIDA
First test for cholecystitis
RUQ US
Excisional hemorrhoidectomy is reserved for
Grade IV
MC thyroid cancer
Papillary
Most aggressive thyroid cancer
Anaplastic
A gastrin secreting tumor (gastrinoma) that leads to diarrhea and PUD should make you think
Zollinger-Ellison Syndrome
With a GI bleed, on BMP you might see
Elevated BUN/Cr
Pneumothorax affecting <15% of lung space =
Supplemental O2 only
What is Courviosier sign and what does it mean
Palpable gallbladder with jaundice = pancreatic cancer
MC non-infectious cause of post-op fever is
Medications
Painless hematuria in a pt with smoking hx should make you think
Bladder cancer
What would CBC show with megaloblastic anemia
Elevated MCV but low Hb and HCT. Usually B12 deficiency