Surgery Flashcards by Kringkring B

Most common cause of esophageal perforation?

Iatrogenic

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Most common type of esophageal diverticula?

Pharyngoesophageal ( Zenker’s Diverticula)

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Most potent physiologic stimulus for pepsinogen release?

Food

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The highest perforation rate after a caustic esophageal injury occurs during?

Ulceration and granulation phase

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Surgical management of uncomplicated Barrett’s esophagus?

Anti-reflux procedure

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The most effective surgical treatment for GERD?

Nissen fundoplication

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Surgical treatment for ACHALASIA?

Heller’s myotomy +/- Partial fundoplication

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Most common primary esophageal motility disorder?

Nutcraker/Supersqueezer esophagus

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The only tumor virtually restricted to the Parotid gland?

Warthin’s tumor (Papillary cystadenoma lymphomatosum)

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Where are foreign bodies in the head and neck most commonly found?

Ear

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A deep neck infection may extend down to the mediastinum through?

Substernal space of Burns

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Most common malignant tumor of the parotid gland?

Mucoepidermoid carcinoma

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Most common malignant tumor of the minor salivary glands?

Adenoid cystic carcinoma

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Most common brachial cleft anomaly?

2nd brachial cleft

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Most common type of malignancy arising from a thyroglossal duct cyst?

Papillary carcinoma

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Highest perforation rate after a caustic esophageal injury occurs during?

Ulceration and granulation phase

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Surgical treatment of uncomplicated Barrett’s esophagus?

Anti-reflux procedure

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Most effective surgical treatment for GERD?

Nissen fundoplication

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Gold standard in the diagnosis of GERD?

24 hour pH monitoring

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Most common organism responsible for acute otitis externa?

Pseudomonas aeruginosa

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Most common primary tumor of the middle ear?

Glomus jugulare/ glomus tympanicum

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Nasopharyngeal carcinoma is best treated by?

Chemo-radiotherapy (Cisplatin/5-FU)

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Structures preserved in a modified radical neck dissection?

Sternocleidomastoid muscle

Internal jugular vein

Spinal accessory nerve

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A “butterfly shaped” ulcer involving the hard palate?

Necrotizing sialometaplasia

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Otologic meningitis is usually due to?

H. Influenza type B

Painless mass of the jaw associated with an impacted teeth?

Ameloblastoma (Adamantinoma)

Form of mucus retention cyst that involves th sublingual gland?

Ranula

Single most important predictor of survival in breast cancer?

Axillary lymph node metastasis

Breast cancer type confirmed by the presence of intracytoplasmic mucin?

Lobular CA "Indian file configuration"

Paget's disease may be confused with type of melanoma?

Superficial spreading melanoma

Most frequent site of metastasis for breast cancer?

Bone (vertebra)

Most important risk factor in the development of breast CA?

Gender

The level of axillary lymph nodes are based on this structure?

Pectoralis minor

Chronic inflammatory condition of the nipple areola complex that originates from areolar glands?

Hidradenitis suppurativa

Epidemic puerperal mastitis is most often transmitted via?

Suckling neonate

Kaposi's sarcoma is treated primarily by?

Radiation

A rare but aggressive cutaneous malignancy arising from neuroendocrine cells?

Merkel cell carcinoma

Tumors arising from areas of previous radiation/lymphedema?

Angiosarcoma (Stewart-Treves Syndrome)

Mainstay of treatment for severe necrotizing soft tissue infections?

Wide debridement

Gold standard in the diagnosis of Pulmonary Embolism?

Pulmonary Angiogram

Most dreaded complication of placing a Swan Ganz catheter?

Pulmonary artery rupture

Most common cause of graft loss post kidney transplant?

Recipient death (Cardiovascular causes) - 1st Allograft nephropathy - 2nd

A lethal and rapidly progressive soft tissue infection caused by microaerophilic streptococcus?

Meleney's synergistic gangrene

Microsatellite instability is the hallmark of what hereditary cancer syndrome?

Lynch Syndrome (HNPCC)

Organism most elevated in primary liver cancer and germ cell tumors?

AFP

Most commonly mutated gene in human cancer?

P53

Earliest known genetic alteration in colorectal cancer?

APC gene

The sudden multiple appearance of seborrheic keratoses?

Lesser Trelat sign

Stressed induced hyperglycemia is primarily due to?

Peripheral resistance to insulin

Basic caloric requirement of a normal healthy adult?

25 kcal/kg per day

Reduced REE is characteristic of this phase of surgical metabolism?

Ebb phase

The primary source of energy during the stressed state?

Fat (50-80%)

Stressed induced hyperglycemia is primarily due to?

Peripheral resistance to insulin

Basal caloric requirement of a normal healthy adult?

25 kcal/kg per day Mild stress - 25-30 Moderate stress - 30 Severe stress - 30-35 Burns - 35-40

A 60-year-old man with carcinoma of the esophagus is admitted with severe malnutrition. Nutritional support is to be initiated. What should be his daily caloric intake?

30 kcal/kg body weight/day

Reduced REE (resting energy expenditure) is characteristic of this phase of surgical metabolism?

EBB phase

The primary source of energy during the stressed state?

Fat (50-80%)

How many kilocalories does Liter of D5LR provides?

170kcal

Systemic proteolysis following injury is mediated primarily by?

Glucocorticoids

Development of dry, scaly dermatitis and alopecia while on prolonged par enteral treatment is most likely due to?

EFA deficiency Differentiate VS Zinc deficiency -----"Eczematoid rash", diffuse/intertrigenous areas

A 42 y/o man with small-bowel fistula has been receiving TON within standard hypertonic glucose-amino acid solution for 3 weeks. The patient is noticed to have scaly, hyperpigmented lesions over the acral surfaces of elbows and knees, similar to enterohepatic acrodermatitis. What is the most likely cause of the condition?

Zinc deficiency

The most common fluid disorder in surgical patients?

Extracellular volume deficit

A 30 y/o man with a history of Crohn's disease of the small bowel is admitted with enterocutaneous fistula. The daily output from the fistula is 2L. The approximate composition of the fluids in mEq/L is which of the following?

Na - 140 K - 5 Cl - 104 HCO3 - 30

In cases of persistnt hypocalcemia/hypokalemia, one should request for?

Serum magnesium levels

The most important treatment of metabolic acidosis?

Restore perfusion with volume resuscitation

Characteristic early acid base picture of sepsis?

Respiratory alkalosis

Following an infection, a 68 y/o woman developed gram-negative septicemia. Which statement is true for gram-negative bacterial septicemia?

Adverse changes can be accounted for lipid A release

IVF of choice for patients with closed head injuries?

Hypertonic saline

The earliest stage of hemostasis?

Vascular constriction

The average lifespan of platelets?

7-10 days

Inherited platelet disorder of adhesion?

Bernard-Soulier syndrome

A 75 y/o man is found to have prolonged bleeding from intravenous puncture sites. Platelet aggregation is inhibited by which of the following?

Aspirin

The most common abnormality of hemostasis in surgical patients?

Thrombocytopenia

Treatment of choice for patients with Von Willebrand's disease?

Intermediate purity Factor 8/ DDAVP

A 24 y/o woman is scheduled for an elective cholecystectomy. The best method of identifying a potential bleeder is which of the following?

A complete history and physical examination

The most common indication for blood transfusion in surgical patients?

Volume replacement

After undergoing a transurethral resection of the prostate, a 65 y/o man experiences excessive bleeding attributed to fibrinolysis. It is appropriate to administer which of the following?

Aminocaproic acid

A 22 y/o man is brought into the emergency department in profound shock after a fall from the fourth floor of a building. After resuscitation, small bowel resection and hepatic segmentectomy are performed at laparotomy. He receives 15 U of packed RBCs, 4 U of fresh-frozen plasma, and 8 L of Ringer's lactate. On closure, diffuse oozing of blood is noted. What is the most likely cause?

Platelet deficiency

Most important management of immediate transfusion reaction?

Stop the transfusion

A 64 y/o woman undergoing radical hysterectomy under general anesthesia is transfused with 2 U of packed RBCs. A hemolytic transfusion reaction during anesthesia will be characterized by which of the following?

Bleeding and hypotension

Shock that occurs in the setting of adequate intravascular volume?

Cardiogenic shock

A 30 y/o man is brought to the emergency department following a high-speed car accident. He was the driver, and the windshield of the car was broken. On examination, he is alert, awake, oriented, and in no respiratory distress. He is unable to move any of his four extremities; however, his extremities are warm and pink. His vital signs on admission are HR 54 bpm and BP 70/40 mmHg. What is the diagnosis?

Neurogenic shock

The preferred test in the diagnosis of cardiac tamponade?

Echocardiography

Persistently elevated base deficit in a trauma patient is usually due to?

Ongoing bleeding

First priority in the treatment of trauma?

Ensuring an adequate airway

A 32 y/o female falls from the tenth floor of her apartment building in an apparent suicide attempt. Upon presentation, the patient has obvious head and extremity injuries. Primary survey reveals that the patient is totally apneic. By which method is the immediate need for a definitive airway in this patient best provided?

Orotracheal intubation

The most common indication for intubation?

Altered mental status

Surgical airway of choice in patients with laryngeal fractures?

Tracheostomy

An 85 y/o ventilator-dependent male was endotracheally intubated 10 days ago. He remains unresponsive and is not a candidate for early extubation. The intensive care unit (ICU) attending elects to perform tracheostomy at the bedside. During the procedure, copious dark bold is encountered. This is most likely due to transection of which of the following:

Anterior jugular vein

Tracheostomy is performed uneventfully in a 79 year old ventilator-dependent encephalopathic male. After several spontaneous breaths, however, the patient stops breathing. The anaesthesiologist continues to assist the patient's breathing for several minutes, after which the patient again breathes spontaneously. The most likely cause of apnea is:

Preoperative respiration was driven by hypoxia

Immediate management of patients with tension pneumothorax?

Needle thoracostomy (2nd ICS MCL)

Thoracostomy

4th or 5th ICS MAL

``` Tube thoracostomy is employed in each of the following conditions EXCEPT: A. Total right pneumonectomy B. Chylothorax C. Hemothorax from rib fracture D. Spontaneous pneumothorax E. After an Ivor-Lewis procedure ```

A. Total right pneumonectomy

A 70 y/o man is brought into the emergency department following his injury as a passenger in a car crash. He complains of right side chest pain. Physical examination reveals a respiratory rate of 42 breaths per minute and multiple broken ribs of a segment of the chest wall that moves paradoxically with respiration. What should the next step be?

Needle thoracostomy

Trauma patients with hypotension have lost approximately how much of blood volume?

30-40% (Class III shock)

The most reliable indicator for organ perfusion during resuscitation?

Urine output

The most common cause of cardiogenic shock/cardiac failure in trauma patients?

Tension pneumothorax

Prior to catheterization in stable patients at risk for urethral injury, one should perform?

Urethrogram

Gold standard in the diagnosis of presence of intra-abdominal injuries?

DPL

Hemobilia is characterized by the triad of?

RUQ pain UGIB Jaundice QUINCKE's triad

Most commonly injured part of the diaphragm?

Left hemidiaphragm

Duodenal hematoma is best diagnosed by?

Barium/contrast study (coiled spring sign)

A 60 y/o man is attacked with a baseball bat and sustains multiple blows to the abdomen. He presents to the emergency department in shock and is brought to the operating room (OR), where a laparotomy reveals massive hemoperitoneum and a stellate fracture of the right and left lobes of the liver. Which of the following, techniques should be used immediately?

Packing the liver

The Pringle maneuver is used to control bleeding coming from?

Liver

A 33 y/o man presents to the emergency department with a gunshot injury to the abdomen. At laparotomy, a deep laceration is found in the pancreas just to the left of the vertebral column with severance of the pancreatic duct. What is the next step in management?

Distal pancreatectomy

Left sided medial visceral rotation

Mattox maneuver

Right sided medial visceral rotation

Catell Maneuver

Anatomic structure violated in penetrating neck injuries?

Platysma

Neck region easiest to evaluate?

Zone II

The most sensitive CXR finding suggesting tear of the aorta?

Widened mediastinum

The safest way to lower down ICP?

Ventriculostomy

Single most important factor predicting burn related mortality?

Burn size

Burns that extend into the reticular layers of the dermis?

2nd degree (Deep Partial Thickness Burn)

The standard technique for determining burn depth?

Clinical observation

Recommended fluid resuscitation solution for burns?

PLR

Management of patients with significant intra oral/pharyngeal burns?

Immediate ET intubation

The definitive diagnosis of burn wound sepsis can be made by?

Wound culture Tx: parenteral antibiotics Early wound excision and grafting

Early signs of sepsis

Sudden glucose intolerance Hypothermia Thrombocytopenia

Predominant organism causing fatal burn wound infection?

Pseudomonas sp. Differentiate VS Melting graft wound syndrome Melting graft wound syndrome is due to STAPHYLOCOCCUS AUREUS

Antidote for chemical burns caused by hydrofluoric acid?

Calcium

Malignancy most commonly developing from a Marjolin's ulcer?

Squamous Cell CA

Impaired wound healing due to Zinc deficiency is called?

Acrodermatitis Enteropathica

Major cell responsible for wound contraction?

Myofibroblast

The first cells to enter the wound site during wound repair?

Neutrophils

The mechanical strength of a scar is regained after?

NEVER

Non-absorbable sutures

- not biodegradable and permanent NYLON PROLENE STAINLESS STEEL SILK (Natural, can break down over years)

Absorbable sutures

- Degraded via inflammatory response ``` VICRYL MONOCRYL PDS CHROMIC CAT GUT (natural) ```

NATURAL SUTURES

- biological - cause inflammatory reaction CATGUT (intestine of cow or sheep) SILK (silkworm fibers) CHROMIC CATGUT

SYNTHETIC SUTURES

- synthetic polymers - do not cause inflammatory response ``` NYLON VICRYL MONOCRYL PDS PROLENE ```

MONOFILAMENT SUTURES

- single stranded of suture material - minimal tissue trauma - smooth tying but more knots needed - examples: NYLON, MONOCRYL, PROLENE, PDS

MULTIFILAMENT (braided)

- fibers are braided or twisted together - more tissues resistance - easier to handle - fewer knots needed - examples: VICRYL, SILK, CHROMIC

The layer of the GIT that imparts the greatest tensile strength and greatest suture holding capacity?

Submucosa

The main characteristic that distinguishes the healing of fetal wounds?

Lack of scar formation

Pressure ulcer stage when there is partial thickness skin loss?

Stage II Stages: I - nonblanchable erythema of intact skin II - full thickness skin loss, not thru fascia III - FT skin loss + muscle and bone involvement

Suture removal

Average time frame is 7-10 DAYS. ``` Face: 3-5 DAYS Neck: 5-7 DAYS Scalp: 7-12 DAYS Upper extremity, trunk: 10-14 DAYS Lower extremity: 14-28 DAYS Soles, palms, back or over joints: 10 DAYS ``` (Note: any suture with pus or signs of infections should be removed immediately)

Virus implicated in the development of Burkitt's lymphoma?

EBV

The most common arrhythmia seen during laparoscopy procedures?

Bradycardia

Organism most commonly implicated in human bite wounds?

Eikenella corrodens Differentiate VS Animal bites Animal bites (Pasteurella multocida)

Taxanes blocks tumor growth at mitosis through?

Formation of excess microtubule polymerization

A lethal and rapidly progressive soft tissue infection caused by microaerophilic Streptococcus?

Meleney's synergistic gangrene Differentiate VS Fournier's Gangrene (Fournier's gangrene - polymicrobial, involves genitalia, perineum or abdominal wall)

Most common complication after placing a central venous line?

Arrhythmia

``` An 85 y/o male is admitted to the ICU in septic shock. A pulmonary artery (PA) catheter is placed. The PA catheter does not directly measure which one of the following? A. PA systolic pressure B. PCWP C. Systemic vascular resistance D. Right ventricular diastolic pressure E. Right atrial pressure ```

C. Systemic vascular resistance

A 68 y/o man has a history of myocardial infarction. He undergoes uneventful left hemicolectomy for carcinoma of the colon. In the recovery room, he is hypotension and given a fluid bolus of 500mL Ringer's lactate over 30 minutes. He is intubated, and his neck veins are distended. His HR is 130bpm, his BP is 80/60mmHg, and his urine output is 20mL over the last hour. What should be the next step in his management?

Insertion of a Swan-Ganz catheter

The sudden multiple appearance of seborrheic keratoses?

Lesser Trelat sign

A 29 y/o female develops a pigmented lesion on the right thigh. With reference to a pigmented lesion, there is an increased risk of developing melanoma if it is identified with which of the following?

Congenital nevocellular nevi

Type of nevus that most often occur in a "bathing trunk" distribution?

Giant hairy nevus (congenital)

Most common skin malignancy?

Basal Cell CA

A method of serially excising a tumor until it is entirely removed?

Moh's micrographic surgery

A 65 y/o light complexioned male presents with a solitary scaly plaque like lesion on his forearm present for many years. The lesion is 0.5 cm in diameter. Shave biopsy reveals intraepithelial squamous cell carcinoma. (Bowen's disease) incompletely excised.

Excision and repair of this area, ensuring clear surgical margins

Type of melanoma with the best prognosis?

Lentigo maligna

Treatment of melanoma?

Surgical

Extent of lymph node dissection Groin? Axilla? Face, ear, anterior scalp?

Groin - removal of SUPERFICIAL (inguinal) and DEEP (iliac) nodes Axilla - removal of LEVELS I, II, III Face, Ear, Anterior scalp - plus SUPERFICIAL PAROTIDECTOMY and MRND

A 40 y/o premenopausal patient has a biopsy showing focal lobular carcinoma in situ (LCIS) in the area of calcification. With regard to the LCIS, you should tell the patient which of the following?

She should just be observed closely

A 46 y/o woman presents to you for evaluation of a breast mass. The patient does not perform breast self-examination and she had never noticed the mass prior to this time. Her past medical history is unremarkable. She has no prior history of breast complaints or trauma. The findings from the physical examination is unremarkable except for the breast examination. A hard, nontender 4 cm mass in the upper outer quadrant of her left breast. The left axilla is without abnormalities. Examination of the right breast without abnormalities. Examination of the right breast reveals no dominant mass or axillary adenopathy. What is your next step?

Bilateral diagnostic mammogram

Form of mucus retention cyst that involves the sublingual gland?

RANULA Differentiate VS Epulis (Congenital Epulis - MAXILLA) (Epulis Gravidarum - GINGIVA, RESOLVES POST PARTUM)

A 41 y/o patient presents to your office with a biopsy proven invasive ductal cancer in the upper outer aspect of her left breast, a suspicious palpable left axillary lymph node, and diffuse calcifications throughout the rest of the breast proven to be DIC on stereotactic biopsy. The best surgical option is:

Modified radical mastectomy

A 36 y/o woman presents with a substantial unilateral breast enlargement. She had presumed that this was normal, but on examination, a large, firm tumor is palpated by the attending physician. There is early erosion on the skin. A favourable outlook can be anticipated if the lesion is which of the following?

Cystosarcoma phyllodes

A 62 y/o man undergoes excision of a cylindroma of the submandibular gland. He is most likely to have an injury to which?

Lingual nerve

Painless mass of the jaw associated with an impacted teeth?

Ameloblastoma (Adamantinoma) X-ray appearance: "soap bubble sign"

A 58 y/o woman undergoes excision biopsy of a tumor in the left posterior triangle of her neck. Histology suggests that this is a metastatic cancer. What is the most likely site of the primary tumor?

Piriform fossa

A 16 y/o boy complains of difficulty in breathing through his nose. Endoscopy reveals a tumor infiltrating the nasopharynx. Histology reports this as a juvenile nasopharyngeal angiofibroma. The boy's anxious mother requests information concerning the lesion. What should she be told?

It may proceed to destroy surrounding bone

A 9 month old girl is brought to the physician's office for noisy breathing. The child is otherwise healthy, and her gestation and delivery were uncomplicated. On physical examination, mild inspiratory stridor is heard. What is the most likely cause of stridor in an infant?

Laryngomalacia

Triad of ACHALASIA

Hypertensive LES Aperistalsis of esophageal body Failure of LES to relax

Adenocarcinoma is the predominant malignant lesion in which of the following?

Hard palate

There is immune mediated destruction of myelin confined to the CNS leading to slowing of conduction and neurological dysfunction

MULTIPLE SCLEROSIS

There is immune mediated destruction of myelin in the PNS; illness is often triggered by an infection

Gullain-Barré syndrome

Gold standard in the diagnosis of GERD?

24 hour pH monitoring

Surgical treatment of choice for ACHALASIA?

Heller's myotomy +/- partial fundoplication

A 48 year old man presents for evaluation of burning epigastric and substernal pain that has recurred almost daily for the past 4 months. He says that these symptoms seem to be worse when he lies down and after meals. He denies difficulty swallowing or weight loss. The patient has been taking a proton pump inhibitor regularly over the past 12 weeks with partial resolution of his symptoms. His past medical history is significant for frequent early morning wheezing and hoarseness that have been present for the past few months. The patient has no other known medical problems and he has had no prior surgeries. He consumes alcohol occasionally but does not use tobacco. On examination, he is moderately obese. No abnormalities are identified on the cardiopulmonary or abdominal examination. What is the most likely diagnosis?

Barrett's esophagus

A 43 year old man presents to the ER with severe abdominal pain and substernal chest pain. The symptoms began 12 hours earlier after he consumed a large amount of alcohol. Subsequently, he vomited several times and then went to sleep. A short time thereafter, he was awakened with severe pain in the upper abdomen and substernal area. On PE, the patient appears uncomfortable and anxious. His temperature is 38.8C, Pr 120 b/min, BP 126/80 and RR 36/min. The lungs are clear bilaterally with decreased breath sounds on the left side. The cardiac examination reveals tachycardia and no murmurs. The abdomen is tender to palpitation in the epigastric region, with involuntary guarding. Laboratory studies reveal that his WBC is 26,000 and that his Hgb, Hct, and electrolyte levels are normal. The serum amylase, Bilirubin, AST, ALT, and alkaline phosphatase values are within normal limits. A 12-lead ECF shoes sinus tachycardia. His chest radiograph reveals moderate left pleural effusion, a left pneumothorax, and pneumomediastinum. What is the most likely diagnosis?

Boerhaave's syndrome

The highest perforation rate after a caustic esophageal injury occurs during?

Ulceration and granulation phase

Most frequent encountered surgical disorder of the small intestine?

Mechanical small bowel obstruction

Diagnosis of small bowel obstruction

CT scan - 70-90%

Standard treatment for small bowel obstruction

Expeditious surgery

Post operative ileus is said to be prolonged when the duration exceeds

3 days

To distinguish post operative ileus from post operative SBO, it is best request for

CT scan

Initial test in the diagnosis of intestinal fistulas?

CT scan with contrast

Spontaneous closure of fistulas usually occurs in?

2-3 months

Most common presentation of Meckel's Diverticula in adults?

Intestinal obstruction

Hallmark clinical presentation of acute mesenteric ischemia?

Abdominal pain

A 66 year old man is admitted to the coronary care unit because of new-onset atrial fibrillation. After 24 hours, he develops acute onset of abdominal pain and distention, and on examination he is found to have diffuse peritonitis. The patient undergoes exploratory laparotomy with resection of necrotic bowel. Post operative treatment for this patient?

Systemic heparinization

Most common cause of obscure GI bleeding in adults

Small intestinal dysplasia

The most sensitive test in the diagnosis of iatrogenic duodenal perforation

CT scan with contrast

Earliest lesion characteristic of Crohn's disease?

Aphthous ulcer

The area of colon most susceptible to ischemia

Splenic flexure (Griffith's point)

The transition point between columnar rectal mucosa and squamous anoderm

Dentate line/ Pectinate line

Predominant bacterial isolate in the colon

Anaerobes

A 62 year old man presents to the ER with a 1-week history of left lower quadrant abdominal pain and diarrhea. He complains of increased pain, nausea, vomiting and fever. He has had two prior episodes of similar left lower quadrant pain that resolved with antibiotic treatment alone. He has no cardiac or pulmonary risk factors. On examination, his blood pressure is 140/180, heart rate 100/min and temperature 37C. His abdomen is soft and mildly distended with left lower quadrant tenderness to palpation. He does not have evidence of generalized peritonitis. His write blood cell count is 20,000/mm3. How would you confirm the diagnosis?

Whole abdominal CT scan

Most common site of diverticulitis

Sigmoid colon

The safest procedure to perform on unstable patients with St. IV diverticulitis

Sigmoid colectomy with end colostomy

Most common complication of colostomy

Parastomal hernia

A "lead pipe" colon is characteristic of?

Advanced ulcerative colitis

Surgical procedure of choice for chronic ulcerative colitis

Restorative pronto elections with ideal-pouch anastomosis

Poplyposis syndrome with melanin spots on lips and buccal mucosa

Puts-Jeghers Syndrome

Colorectal carcinomas most commonly metastasize to the?

Liver

First line of treatment for anal epidermoid carcinoma?

Chemo-radiotherapy

Primary peritonitis is diagnosed by?

Peritoneal aspiration GSCS

At open operation a normal appendix is found. What is the most common procedure a surgeon should do if he finds a normal appendix

Removal of appendix

Most common cause of appendicitis in children

Lymphoid hyperplasia

The most accurate way of diagnosing acute appendicitis

None. History and PE must be at least 85% accurate CT scan and ultrasound

The single most sensitive test of liver function

INR/FVII/F5 - coagulation function

Vitamin K is most effective in what type of jaundice?

Post-hepatic cause (obstructive)

Rare cause of post-sinusoidal cirrhosis due to hepatic vein thrombosis?

Budd Chiari Syndrome

A 42 year old woman with a known history of esophageal varices secondary to hepatitis and cirrhosis is admitted with severe hematemesis from esophageal varices. Bleeding persists after pitressin therapy. What would the next step in management involve?

Transjugular intrahepatic portasystemic shunt ( TIPS)

The risk of first variceal bleeding is best prevented by?

B-blockers

The most critical treatment of acute variceal bleeding

Prompt endoscopic intervention

Selective shunt that is contraindicated in patients with as cites

Distal splenorenal shunt (Warren Shunt)

A 43 year old woman prevents with a sudden onset of abdominal pain. She denies abdominal complaints. Her systolic blood pressure is 88mmHg on evaluation and becomes stable at 120mmHg after the infusion of 2 L of intravenous fluid. The abdominal examination demonstrates no peritoneal signs. Her bowel sounds are hypoactive and there is mild right upper quadrant tenderness. The hematocrit value is 22%. A computed tomography (CT) scan is performed and demonstrates free intraabdominal blood and a 5-cm solid mass in the right hepatic lobe with evidence of recent bleeding into the mass. The patient denies recent trauma, weight loss, a change in bowel habits, hematemesis, or hematochezia. No prior history of oral contraceptive pills intake. What is the most likely diagnosis

Liver hematoma with hemorrhage

Most common benign tumor of the liver

Simple hepatic cyst

Benign solid liver tumor associated with a central scar

Focal modular hyperplasia (FNH)

Hepatocellular cancer variant with the best prognosis

Fibrolamellar variant

Recommended treatment for solitary pyogenic liver abscesses

Percutaneous drainage

Maximum amount of diseased liver that can be resected

60%

Initial imaging modality of choice in patients with biliary tract disease

Ultrasound

Gallstones that occurs in patients with cirrhosis/hemolytic disorders

Black pigment stones

Most common indication for cholecystectomy

Recurrent biliary colic

A 46 year old woman presents with a 5-hour history of abdominal pain that began approximately 1 hour after a large dinner. The pain initially began as dull ache in the epigastrium but then localized in the RUQ. She describes some nausea but no vomiting. Since her presentation to the emergency department, the pain has improved significantly to the point of her being nearly pain free. She describes having had similar pain in the past with all previous episodes being self-limited. Her past medical history is significant for type II diabetes mellitus. On physical examination, her temperature is 38C, and the rest of her vital signs are normal. The abdomen is non distended with minimal tenderness in the RUQ. Findings from liver examination appear normal. The rectal and pelvic examinations reveal no abnormalities. Her CBC reveals a WBC count of 13,000 serum chemistry studies demonstrate total bilirubin 0.8 mg/dL, direct bilirubin 0.6mg/dL, alkaline phosphatase 100 UIL, AST 45 UIL, and ALT 30 U/L. Ultrasonography of the RUQ demonstrates stones in the gallbladder, a thickened gallbladder wall, and a common bile duct diameter of 4.0 mm. What should you tell the patient?

She should be scheduled for an elective laparoscopic cholecystectomy

Gold standard in the diagnosis of choledocholithiasis?

ERCP

A CBD stone diagnosed 1 year after cholecystectomy is classified as?

Retained stone

Initial treatment of patients with cholangitis

IV antibiotics and fluid resuscitation (85% response) Elective decompression

Most dreaded complication of laparoscopic cholecystectomy

CBD injury

Surgical management of choice for acute acalculous cholecystitis

Percutaneous US/CT guided cholecystostomy

Cholangiocarcinoma most commonly involves

Hepatic duct bifurcation "Klatskin tumor"

Most common cause of acute pancreatitis worldwide

Gallstones

Most specific serum marker for acute pancreatitis

Serum lipase

Gold standard test for the assessment of severity of acute pancreatitis

CT scan with contrast

Most common cause of death in acute pancreatitis

Infection

Most common cause of chronic pancreatitis

Alcohol consumption and abuse

Most common complication of chronic pancreatitis

Pseudocyst

Most commonly mutated gene in pancreatic adenocarcinoma

K-ras

A palpable nontender gallbladder seen in patients with peri-ampullary tumor?

Courvossier's gallbladder

The current diagnostic and staging test of choice for pancreatic cancer?

Spiral CT scan with contrast

Etiology for the severe pain experienced by patients with pancreatic cancer

Invasion of retroperitoneal nerve

Drug used for palliative treatment of advanced pancreatic cancer

Gemcitabine

Most dreaded complication of Whipple's procedure

Disruption of the pancreatic-jejunostomy

Most common pancreatic endocrine neoplasm

Insulinoma

Endocrine tumor of the pancreas with necrolytic migratory erythema

Glucagonoma

Most common islet cell tumor after insulinoma

Non functioning Islet-cell tumor

Most common anomaly of the spleen

Accessory spleen

The process by which the spleen removes intracellular substances

Pitting

The most common indication for splenectomy

Trauma

Test that will distinguish auto-immune from other hemolytic anemias

(+) direct Coombs tests

Gold standard in the diagnosis of GERD?

24 hour pH monitoring

Surgical treatment of choice for ACHALASIA?

Heller's myotomy +/- partial fundoplication

Barrett's esophagus

Boerhaave's syndrome

The highest perforation rate after a caustic esophageal injury occurs during?

Ulceration and granulation phase