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Clerkship > Surgery > Flashcards

Surgery Flashcards

1
Q

Management of peds umbilical hernia

A

> 90% spontaneous resolute, rarely symptomatic
Surgery if persists @ 3-5 yrs

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2
Q

What acid-base abnormality would be likely to result from pyloric stenosis?

A

Hypochloremia, hypokalemic metabolic alkalosis

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3
Q

Age of pyloric stenosis typically?

A

3 weeks - 3 months

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4
Q

Fluids for pyloric stenosis

A

NS with potassium at 2x maintenance

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5
Q

Most common cause of bowel obstruction in early childhood (<2yo)

A

Intussusception

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6
Q

Intussusception most often occurs near…

A

The ileocecal junction (ileo-colic)

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7
Q

What is a meckel diverticulum

A

Congenital sacculation of the antimesenteric border of the distal ileum
TRUE diverticulum (contains all layers of the intestinal wall)
May contain heterotopic tissue (usually gastric, sometimes pancreatic or other)

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8
Q

Symptoms of Meckel diverticulum

A

Obstruction –> pain, N/V
Meckel Diverticulitis –> similar pain to appendicitis. vomiting
Repeat episodes of BRBPR

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9
Q

Currant jelly stool is a sign of what? Other symptoms?

A

Inruccusception
Episodes of inconsolable crying
Vomit once obstruction progresses

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10
Q

Meckel’s rule of 2s (6 things)

A

2% of population
Present @ 2 yrs
2 inches in length
Within 2 ft of ileocecal valve
Males:females 2:1
2% develop complication

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11
Q

Complications of Meckel’s

A

OHIP:
Obstruction (most common complication in adults)
Hemorrhage (most common complication in children)
Inflammation
Perforation

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12
Q

Ultrasound sign of intussuception

A

Target sign

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13
Q

Treatment for intussusception

A

Air/CO2 enema (diagnostic & therapeutic)
85% success rate, 5-10% recurrence

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14
Q

Drooling baby should raise concern for…

A

Esophageal atresia & tracheoesophageal fistula

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15
Q

Meconium should be passed within…

A

24 hours

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16
Q

“Double bubble” sign on ultrasound typically indicates…

A

Duodenal atresia (bubbles = stomach + duodenum)

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17
Q

How to tell SBO & LBO apart on X-ray

A

LBO: peripheral, haustration (don’t go fully across), diameter up to 8cm
SBO: plicae cicrulares (AKA valvulae conniventes), central, diameter up to 5cm

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18
Q

Congenital absence of ganglion cells in rectum/distal colon =

A

Hirschsprung’s disease

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19
Q

Normal transition zone between normal & abnormal bowel in Hirschsprung’s disease is…

A

Rectosigmoid junction

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20
Q

Diagnosis & treatment of hirschsprung’s disease

A

Rectal biopsy
Pullthrough procedure (bringing normally innervated bowel to the anus with preservation of the anal sphincters)

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21
Q

When should an asymptomatic meckel’s be reseted?

A

Narrow opening
Palpable gastric mucosa

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22
Q

Most common GI emergency in neonates

A

Necrotizing enterocolitis

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23
Q

Cystic hygroma = a common peds subtype of…

A

Lymphangioma

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24
Q

Lump in sternomadoid of 3-6 week old baby with their head turned away from it is typically…
Treatment?

A

Congenital muscular torticollis
Typically treated with passive stretching exercises, rarely surgery

25
Q

Ddx for painless abdominal mass in child <5 yrs

A

Neuroblastoma (usually suprarenal, sick pt, mets, poor prognosis)
Wilms’ tumor = nephroblastoma (renal, no mets, good prognosis)

26
Q

Atresia of jejunum or ileum is thought to occur due to what?
Duodenal?

A

Vascular accident in utero–> necrosis + reabsorption of fetal intestine (e.g. with cocaine use/tobacco)
vs duodenal is associated with chromosomal abnormalities

27
Q

Hallmark x-ray finding of necrotizing enterocolitis

A

Air in the bowel wall = Pneumatosis intestinalis
Portal venous air also common due to transmigration of gas from bowel wall to mesenteric & portal veins
Pneumoperitoneum can be see if there’s a perf

28
Q

Neuroendocrine tumors usually in distal SI, proximal colon, and lung, with strong propensity for mets to liver. What can result from mets to liver

A

Carcinoids
Carcinoid syndrome

29
Q

Pts on warfarin needing emergency surgery should receive what for reversal?

A

Prothrombin complex concentrate
IV Vitamin K

30
Q

How long should ASA be held before/after surgery

A

72 hours before
Restart 8-10 days after major surgery

31
Q

Maintenance fluid rule. Target urine output?

A

4:2:1 rule (per Kg per HOUR)
To maintain 0.5mg/kg/hr for adults, 1mL/kg/hr for kids

32
Q

Contents of normal saline

A

154 mEq/L Na
154 mEq/L Cl

33
Q

Electrolyte contents of Ringers

A

130 mEg/L Na
109 mEq/L Cl
4 mEq/L K
28 mEqL HCO3-

34
Q

Admission orders mnemonia

A

Admit to
Diagnosis
Diet
Activity
Vitals
Ins/Outs
IVs/fluids
Investigations
Drugs, Drains, Dressings

35
Q

How to estimate maintenance fluid requirements based on operative losses

A

hrs NPO x maintenance req

+ # hrs case x maintenance
+ operative blood loss
+ insensible losses (varies based on extend of procedure)

36
Q

Cause of post-op fever in the first 48 hours?

A

Atelectasis
Necrotizing infections
Med reactions/blood products
Malignant hyperthermia

37
Q

Causes of post-op fever days 3-5

A

Pneumonia
UTI
IV site infection
Early wound infections? (usually ~day 5+)

38
Q

Causes of post-op fever day 5+?

A

Anastomotic leak
Abscess formation
Wound infx
Infx related to catheters/foreign bodies

39
Q

When does function typically resume for each part of the GI tract post op after paralytic ileus?

A

Small bowel - 24h
Colon - 24-48h
Gastric - 48-72h

40
Q

Practice guidelines recommend biopsy for all BI-RADS _____ lesions

A

4 & 5 (for 3 do short-interval followup with mammogram q6-12 month and biopsy if it grows)

41
Q

What is Prehn’s sign? Name 2 diagnoses where it would be positiev and 1 where it would be negative

A

Relief of pain with lifting of testicle, e.g. in epididymitis & orchitis
NEGATIVE in testicular torsion

42
Q

Rule out testicular torsion with…

A

U/S doppler

43
Q

Crohn’s tends to have ___ on microscopy, whereas UC will have ____

A

Crohns –> granulomas
UC –> crypt abscesses

44
Q

Most common CRC mets

A

Liver (usually first), peritoneum, lung
*from rectum can “skip” liver and go to lungs bc it drains into IVC not portal veins

45
Q

___ lymph nodes are required for staging CRC

A

12+

46
Q

What autosomal dominant disease (APC gene mutation) has 100% colon cancer rate by 40s

A

Familial adenomatous polyposis

47
Q

Normal thickness of GB wall & CBD

A

Wall <3mm
CBD <7mm

48
Q

Normal appendix thickness

A

1cm

49
Q

Recurrence of appy with non-surg management

A

30% in 1 year
40% in 5 yrs

50
Q

___% of hernias managed by “watchful waiting” are converted to surgical repair annually (i.e. become symptomatic)

A

10%

51
Q

Lichtenstein repair for inguinal hernia AKA

A

Open or “tension-free”

52
Q

Diagnostics for pancreatitis

A

2/3 of: biochemical (lipase), radiological, clinical (Sx)

53
Q

In infants, delay elective procedures until when?

A

60 wks postconceptual age

54
Q

Breast cancer usually originates in the…

A

Ducts

55
Q

Breast cancer screening guideline Ontario for regular-risk pts

A

Mammogram q2 years from age 50-74

56
Q

Core needle biopsy vs FNA?

A

FNA has high false-neg rate so can’t rule out
Core needle is more accurate

57
Q

Is surgical management indicated in acute pancreatitis?

A

NOT USUALLY, VERY HIGH M&M
Only if pt has infected pancreatic necrosis and hasn’t responded to perc drain using step-up approach

58
Q

Is urine acidic or alkaline in pyloric stenosis

A

Paradoxic aciduria due to rental retention of Na, exchanged for K+ & H+

59
Q

Positive pyloric stenosis ultrasound

A

Pylorus with length of 14mm+ and wall thickness of 4mm+

Clerkship (6 decks)

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