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Surgery EOR > Surgery > Flashcards

Surgery Flashcards

1
Q

Most common place to find inflammation of the GI tract with Crohn’s disease?

A

Terminal ileum

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2
Q

Name 4 things you will see on lab work after vomiting

A

Hypokalemia, hypochloremia, metabolic alkalosis, aciduria

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3
Q

Four Fs of cholecystitis

A

Female, Fat, Forty, Fertile

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4
Q

Inspiratory arrest when palpating the RUQ is what famous sign

A

Murphy’s sign = cholecystitis

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5
Q

Name two places of referred pain for acute cholecystitis

A

Right back/flank and right shoulder

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6
Q

Main difference btw acute and chronic pancreatitis

A

No elevated lipase/amylase in chronic and will show calcifications on pancreas

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7
Q

What antibiotic can cause biliary sludge?

A

Ceftriaxone

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8
Q

Where are anal fissures most commonly found?

A

Posterior midline

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9
Q

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

A

Anal fissure. Conservative tx = sitz baths, high fiber diet, stool softeners. Next: nifediine ointment, nitro ointment, topical diltiazem, botox. Last resort: lateral internal sphincterotomy

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10
Q

Sentinel pile refers to

A

Skin tag associated with anal fissure

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11
Q

Abd pain, bilious vomiting, hyperactive (high pitch) bowel sounds, dilated loops of bowel on radiograph all point to what dx

A

Small bowel obstruction

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12
Q

Treatment for small bowel obstruction

A

NPO, place NG tube, IV fluids

If strangulated or peritoneal signs = emergency surgery

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13
Q

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?

A

Intussusception

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14
Q

What should you order for a pt with intussusception?

A

Labs, ultrasound: US will show target sign, place NG tube, and give IVF.

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15
Q

Pt presents with obstipation, abdominal pain, vomiting 3 days post-op. Radiographs show dilated loops of bowel. What is dx and tx

A

Paralytic ileus

NPO, NG tube, IVF, stop opiates

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16
Q

Pt feels full after eating small amounts of food with stomach pain and nausea. What is dx and tx

A

Gastroparesis. Treat with high fiber diet and Regalen/Metaclopramide (D2 antagonist)

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17
Q

Pt presents with diarrhea after major surgery and abscess. MCC and diagnosis?

A

C-diff from broad spectrum abx such as penecillins, cephalosporins, or FQs

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18
Q

Dx and Treatment for C-diff

A

Stool culture. Treat with flagyl or PO Vanc (remember this is the only use for oral vanc)

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19
Q

MCC of large bowel obstruction in older adults

A

Carcinoma of the colon or diverticulitis

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20
Q

MCC of SBO in adults

A

Adhesions from surgery

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21
Q

4 cardinal signs for bowel strangulation

A

fever, leukocytosis, tachycardia, localized abd tenderness

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22
Q

If hemorrhoids are painful, are they internal or external?

A

External

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23
Q

If a patient has internal hemorrhoids, but notices pain when a “lump” protrudes out of her anus, what is causing the pain?

A

Prolapse

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24
Q

Bright red painless bleeding per rectum in a young person is most commonly

A

Internal hemorrhoids

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25
Q

Name the grades of internal hemorrhoids

A

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

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26
Q

Hemorrhoidectomy is reserved fro what grade of hemorrhoids

A

Stage IV

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27
Q

Treatment for mild to moderate IBD?

A

Sulfasalazine or 5-ASA

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28
Q

String sign of the terminal ileum on radiographs or cobblestoning and skin lesions on endoscopy should make you think of

A

Crohn’s disease

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29
Q

The lead pipe or tubular appearance on radiographs

A

Ulcerative colitis

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30
Q

Bloody diarrhea and continuous inflammation should make you think of what IBD?

A

UC

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31
Q

A pt with IBD that is taking sulfasalazine should be on what supplement?

A

Folate

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32
Q

What part of the colon is diverticulosis MC?

A

Sigmoid

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33
Q

Treatment for uncomplicated diverticulitis?

A

Cipro/Levo + Metronidazole

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34
Q

What type of imaging is CI in acute diverticulitis

A

Barium enema and colonoscopy

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35
Q

Two MC organisms involved in diverticulitis

A

E. Coli and B. Fragilis

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36
Q

Toxic megacolon is usually caused by

A

UC or C. Diff

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37
Q

Pt with UC presents with fever, tachycardia, abd pain, abd distention, and bloody diarrhea. Colon is dilated >6 cm. Dx is most likely

A

toxic megacolon

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38
Q

MCC for esophageal stricture

A

GERD

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39
Q

Shatzki ring is usually present with

A

hiatal hernia

shatzki ring can cause dysphagia with solids

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40
Q

Plummer-Vinson Syndrome is

A

Triad: dysphagia + esophageal webs + iron deficiency anemia

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41
Q

Elderly man with dysphagia, weight loss, and sig hx of smoking and alcohol use. What imaging modality should you use

A

Esophagoscopy

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42
Q

GERD is associated with what type of esophageal cancer

A

Adenocarcinoma

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43
Q

Smoking and drinking is associated with what esophageal cancer

A

SCC

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44
Q

Abd pain that improved with meals is most likely a

A

Duodenal ulcer

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45
Q

What is triple and quadruple therapy for H. Pylori?

A

Tetracycline + Metronidazole + PPI ( + Bismuth for quad)

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46
Q

Left-sided (distal) colorectal cancer lesions are associated with

A

Streptococcus bovis endocarditis

47
Q

A nodule on the thyroid that does not take up any iodine is most likely

A

Cancer

48
Q

Thyroid nodules that take up iodine are

A

Benign

49
Q

Ascending aortic dissection is

A

a surgical EMERGENCY! Need open repair stat

50
Q

How can you treat aortic dissection prior to sugery

A

Lower the BP: BBs, nitro, pain control

51
Q

Patient presents with “ripping” or tearing chest pain that radiates to the back. What do you expect to see on x-ray?

A

Widened mediastinum

52
Q

Severe iron deficiency anemia post gastric by-pass may present with symptoms like

A

Cheilosos, koilonychia, pallor, dry skin

53
Q

Labs with iron deficiency anemia will show

A

Low iron and ferritin but high TIBC

54
Q

Two main RF for gastric cancer

A

Smoking and H. Pylori

55
Q

A man who smokes, lost 20lbs in 6months, and has intermittent abd pain most likely has

A

Gastric cancer, adenocarcinoma

56
Q

Barretts esophagus leads to what type of cancer

A

Esophageal; adenocarcinoma

57
Q

Smoking and drinking leads to what type of esophageal cancer

A

SCC

58
Q

Usually, a patient with Crohn’s will present with bloody or non-bloody diarrhea?

A

Non-bloody

59
Q

What specific labs are we looking for with Crohn’s

A

ASCA positive; p-ANCA negative (UC)

60
Q

After assessing ABCDE a pt with 2nd or 3rd degree burns, what do you do?

A

Give 4L of LR over 8 hrs

61
Q

Gram neg bacteria associated with wound burns

A

Pseudomonas aeruginosa

62
Q

Transudate fluid for a pleural effusion is usually from

A

CHF

63
Q

Exudate fluid in a pleural effusion is usually from

A

Lung inflammation

64
Q

Some skin lesions must be excised with 1 or 2cm margins. When do you do each

A

If the biopsied lesion is <1mm thick = 1cm margin

If >1mm thick = 2cm margins

65
Q

What size AAA needs operated on

A

5.5cm or greater

66
Q

Who should get at least one abd US for AAA rupture prevention

A

Men 65-75 y/o with smoking history

67
Q

MCC of inherited colorectal cancer

A

Lynch Syndrome; also increases risk for endometrial cancer

68
Q

RLQ pain with neg rebound or guarding + bloody stools should make you think

A

colorectal cancer with lynch syndrome

69
Q

When should an IVC filter be placed

A

Pt has evidence for VTE and cannot take anticoagulant (anticoagulation is CI in pts that are actively bleeding)

70
Q

A hernia medial to the inferior epigastric is a

A

Direct inguinal hernia

71
Q

A pt with a pituitary adenoma will likely show what visual deficits

A

Diminished temporal fields or hemianopsia

72
Q

Pts with DVT and cancer should receive what

A

Low molecular weight heparin

73
Q

Cortisol-secreting adrenal carcinoma is surgically removed. What should be given immediately after to prevent hypotension

A

IV hydrocortisone

74
Q

Classic triad for pheochromocytoma

A

Headaches, sweating, tachycardia

75
Q

What happens when a person has pheochromocytoma

A

Chronically high catecholamines

76
Q

What drug should be given preop for pheochromocytoma

A

Phenoxybenzamine to control BP and HR

77
Q

What type of skin lesion has telangiectasia within papule

A

BCC; Tx: MOHs surgery

78
Q

Ulcerated lesions with raised edges

A

SCC

79
Q

Alkalosis = what electrolyte imbalance

A

Hypokalemia (K+ is shifting INTO the cells through H+K_ pump)

80
Q

Acidosis = what electrolyte imbalance

A

Hyperkalemia

81
Q

When is wound debridement required fro healing?

A

Stage 3 and 4. Into the hypodermis (3) or bone/soft tissue (4) with fat or eschar present

82
Q

MC type of testicular cancer

A

Seminomatous germ cell tumor

83
Q

Low BP, abd pain, and hematochezia should suggest

A

Ischemic colitis

84
Q

What two areas are known for ischemic colitis

A

Splenic flexure and rectosigmoid junction

85
Q

2/3 of volvulus affects what part of the colon

A

Sigmoid (bent inner tube on x-ray)

86
Q

Treatment for sigmoid volvulus

A

Flex sig and then sigmoidectomy electively

87
Q

Cecal volvulus is normally found in a different population than sigmoid, what pop

A

Younger, 30s-50s. Look for coffee bean sign

88
Q

What is the FIRST LINE drug for hyperkalemia with peaked T waves

A

10% Calcium gluconate to stabilize the membrane; THEN you can give albuterol or insulin or bicarb

89
Q

What should be measured intraoperatively to confirm the parathyroid adenoma is causing the problem

A

PTH

90
Q

In hyperparathyroidism the phosphorus levels will be

A

Low

91
Q

Hemophilia A and B affect what part of the coag cascade

A 
A = 8
B = 9
92
Q

What promotes drug factor VIII and VWF

A

Desmopressin; use in hemophilia 8 and VWF disease

93
Q

Thickened colon and fat stranding should indicate

A

Diverticulitis. Start IV ABX

94
Q

Free air on CXR calls for

A

Ex lap

95
Q

What is the first thing you should order on a pt with syncope

A

ECG

96
Q

What long term treatment should be administered after a Roux-en Y bypass

A

Micronutrient supplementation

97
Q

“worst HA of my life” is mc caused by

A

a ruptured aneurysm

98
Q

What do you expect to see on lumbar puncture in a SAH?

A

Xanthrochromia = degredation of Hb (bilirubin = yellowish)

99
Q

Post-prandial abd pain, diarrhea, and weight loss on a pt with sig CVD and smoking hx is at major risk for

A

Mesenteric ischemia

100
Q

A lentil or biconvex shape hematoma in the brain is indicative of

A

Epidural hematoma

101
Q

Lunar shaped hematoma is indicative of

A

Subarachnoid hematoma

102
Q

Most SENSITIVE test for cholecystitis

A

HIDA

103
Q

First test for cholecystitis

A

RUQ US

104
Q

Excisional hemorrhoidectomy is reserved for

A

Grade IV

105
Q

MC thyroid cancer

A

Papillary

106
Q

Most aggressive thyroid cancer

A

Anaplastic

107
Q

A gastrin secreting tumor (gastrinoma) that leads to diarrhea and PUD should make you think

A

Zollinger-Ellison Syndrome

108
Q

With a GI bleed, on BMP you might see

A

Elevated BUN/Cr

109
Q

Pneumothorax affecting <15% of lung space =

A

Supplemental O2 only

110
Q

What is Courviosier sign and what does it mean

A

Palpable gallbladder with jaundice = pancreatic cancer

111
Q

MC non-infectious cause of post-op fever is

A

Medications

112
Q

Painless hematuria in a pt with smoking hx should make you think

A

Bladder cancer

113
Q

What would CBC show with megaloblastic anemia

A

Elevated MCV but low Hb and HCT. Usually B12 deficiency

Surgery EOR (1 decks)

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