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Step 2 > Surgery > Flashcards

Surgery Flashcards

1
Q

Amyand’s hernia

A

Inguinal hernia with appendix

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2
Q

Littre’s hernia

A

Meckel’s diverticulum hernia

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3
Q

Maydl’s hernia

A

2 small bowel loops in one sac

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4
Q

Morgangni hernia

A

abd contents in thorax

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5
Q

Pantaloon hernia

A

direct + indirect hernia

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6
Q

Richter’s hernia

A

sidewall of bowel

increased strangulation

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7
Q

Spigelian hernia

A

lat ventral wall hernia

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8
Q

Levels of axillary LNs

A

1- lat to pec minor
2- deep to pec minor
3- medial to pec minor

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9
Q

Systemic therapy for breast cancer

A

trastuzumab if HER2 +

docetaxel, adriamycin and cyclophosphamide

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10
Q

Presentation of Boerhave syndrome

A

L sided pleural effusion
subq emphysema
c/p and leukocytosis

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11
Q

Dx of Boerhave syndrome

A

water soluble contrast esophagogram

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12
Q

Staging for Melanoma

A

Clark method by level of invasion into dermal layers

Breslow method dept of invasion (better)

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13
Q

Causes of obstructions in adults (5)

A 
adhesions
hernia
Crohns
gallstone ileus
tumor
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14
Q

Causes of carpal tunnel (5)

A 
DM
hyperthyroid
acromegaly
pregnancy
myxedema
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15
Q

Tx for carpal tunnel

A

splint
NSAIDs
steroid injections q4 mo

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16
Q

Indication for cholecystectomy with acalculous gallbladder

A

<35% emptying of gallbladder

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17
Q

US findings with choledocholithiasis

A

common bile duct > 5mm

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18
Q

Dieulafoy erosions

A

bleeding from aberrant submucosal arteries in stomach

can cause significant bleeding

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19
Q

Upper GI bleeding causes

A 
Variceal veins (most common)
duodenal/gastric ulcers
Mallyr Weiss
neoplasm
AV malformation
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20
Q

Causes of acute lower GI bleeds

A 
Diverticulosis
angiogysplasia
neoplasm
hemorrhoids
IBD
ischemic bowel
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21
Q

Dx of lower GI bleed

A

colonoscopy if stable
mesenteric angiography
labeled RBC scan

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22
Q

Asscs with GI angiodysplasia

A

over 50 yrs
cardiac disease hx
aortic stenosis

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23
Q

Lobular carcinoma of breast risk

A

not seen well on mammography

resembles fibrocystic changes

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24
Q

Mgt of head trauma

A

Intubation
fluid/blood resuscitation
hyperventilation and mannitol for ICP decrease

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25
Q

Lucid interval assc

A

Epidural hematoma

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26
Q

Mgt of burns

A

airway/intubation
IV fluid resuscitation
4mL/kg/%burn in 24 hrs, half within 8hrs

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27
Q

PVD classification

A
  1. ABI 0.8-1.0
  2. ABI 0.41-0.8 (claudication)
  3. ABI 0.2-0.4 (rest pain)
    4-6. ABI < 0.2 with ulceration/gangrene
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28
Q

Stab wound mgt

A

primary assessment
upright CXR
FAST exam
dx laparoscopy for diaphragm injury

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29
Q

Dx methods for stab wounds

A

local wound exploration
diagnostic peritoneal lavage
CT with contrast
dx laparoscopy

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30
Q

Use of FAST exam

A

pericardial blood

abd injury

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31
Q

CT vs US in dx

A

CT better for abd pathology

US better for pelvic pathology

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32
Q

CRC chemo regimen

A

FOLFOX4 is name

5FU, leucorovin, oxaliplatin

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33
Q

Presentation of soft tissue sarcoma

A

lg nontender mass in extremity

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34
Q

DDx of acute abd (8)

A 
AAA
mesenteric ischemia
GI perforation
bowel obstruction
volvulus
ectopic pregnancy
MI
splenic rupture
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35
Q

Medullary thyroid carcinoma assc

A

MEN2

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36
Q

Types of thyroid malignancies

A

Follicular-iodine uptake, Hurthle cells
Papillary-common, Psammoma bodies, Orphan Annie eyes
Medullary-calcitonin, MEN2, CEA marker

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37
Q

MEN2A neoplasms

A 
Medullary thyroid
parathyroid
Pheochromocytoma
Lichen planus amyloidosis
Hirschsprungs
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38
Q

MEN2B neoplasms

A 
Medullary thyroid
pheochromocytoma
Mucosal neuromas
ganglioneuromatosis of GI
Marfan habitus
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39
Q

Dx of thyroid nodule

A

Fine needle aspiration

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40
Q

Risks for spontaneous pneumothorax

A

subpleural blebs
COPD
TB/malignancy

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41
Q

Phases of wound healing

A

Inflammatory- secretion of growth factors (0-3 days)
Proliferative- collagen/fibrin deposition (3-28 days)
Remodeling- capillary regression (3wks to 1yr)

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42
Q

Nutrition important in wound healing

A

Vit C increases collagen
Vit A increases epithelialization
B6 increases cross linking

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43
Q

Abx for intraabdominal infections

A

standard=aminoglycoside +metronidazole/clindamycin

single agent options=ceftriazone, ampicillin-sulbactam, piperacillin-tazobactam, imipenem-cilastin

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44
Q

Fever within 24hrs post op

A

atelectasis

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45
Q

Causes of short bowel syndrome

A

Crohns
mesenteric infarction
necrotizing entercolitis (infants)
volvulus

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46
Q

Assc with hepatic adenoma

A

OCPs

hemorrhage

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47
Q

Focal nodular hyperplasia

A

central scar pattern on CT
women of reproductive years
benign

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48
Q

Hemangioma of liver

A

most common benign liver tumor

do not bx due to hemorrhage

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49
Q

AFP tumor marker

A

HCC

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50
Q

CA 50 tumor marker

A

pancreatic

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51
Q

Neuron-specific enolase tumor marker

A

SCLC

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52
Q

CA 15-3 tumor marker

A

Breast cancer

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53
Q

Ferritin tumor marker

A

HCC

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54
Q

Tx for hepatic adenoma

A

excision due to hemorrhage risk

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55
Q

Indications for colon resection with diverticulitis

A

> 4 recurrent episodes

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56
Q

Most common area for AAA

A

infrarenal

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57
Q

Risk reduction for AAA

A

beta blocker
statin therapy
smoking cessation

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58
Q

Surgical tx indication for AAA

A

> 5.5cm diameter in women

>5.0cm diameter in men

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59
Q

Dx of AAA

A

US or CT

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60
Q

Tx for shock

A

fluids 1st
vasopressors (NE, DA, epi)
correct underlying problem

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61
Q

Definition of aneurysm

A

> 2x normal vessel diameter

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62
Q

Definition of ectasia

A

< 2x normal vessel diameter

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63
Q

Contents of triangle of Calot

A

Lund’s node/Mascagni’s node

cystic artery

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64
Q

Ann Arbor Staging

A

for lymphoma

4 stages

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65
Q

Sloan Kettering LN classification

A

for LN of the head/neck

6 stages

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66
Q

Dx of pancreatitis

A

CT scan

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67
Q

Tx for necrotizing pancreatitis

A

imipenem-cilastatin

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68
Q

Most common cause of unilateral bloody discharge of breast

A

intraductal papilloma

ductal ectasia is #2

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69
Q

DDx for nipple discharge (7)

A 
pregnancy
abscess
galactorrhea
fibrocystic changes
intraductal papilloma
diffuse papillomatosis (increased cancer risk)
carcinoma
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70
Q

Tx for TIA due to carotid stenosis

A

tx side of TIA irregardless of stenosis %

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71
Q

Paraneoplastic syndromes with SCLC

A 
Lambert-Eaton
ACTH/Cushings
Hypercalcemia
SIADH
paraneoplastic cerebellar degeneration
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72
Q

Courvoisier Sign

A

from biliary obstruction due to malignancy
painless jaundice
palpable gallbladder
nontender

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73
Q

DDx for hypercalcemia (7)

A 
hyperparathyroid
malignancy (mets or PTHrP)
milk alkali syndrome
thiazides
Pagets
Familial hypocalciuric hypercalcemia
granulomatous diseases
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74
Q

Tx for hyperparathyroid

A

parathyroidectomy

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75
Q

Sx of chronic mesenteric ischemia

A

postprandial pain

wt loss

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76
Q

Revised Cardiac Risk Index

A 
risk statification for peri-op carid morbidity
1) ischemia heart disease
2) CHF
3) Cerebral vascular disease
4) High risk surgery
5) Insulin dependent DM
6) Cr >2mg/dL
If RCRI >2, use beta blocker
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77
Q

Types of gastric ulcers

A

I) Lesser curvature, (70% of ulcers)

2) Assc with duodenal ulcer
3) Prepyloric region
4) High on lesser curvature
5) NSAIDs caused

78
Q

FAST exam

A 
ultrasound
four views (subxiphoid, R&LUQ, pelvic)
for ID of intraperitoneal fluid or pericardial fluid
79
Q

Assc with myasthenis gravis

A

thymoma

80
Q

Dx of MG

A

Edrophonium Tensilon test

81
Q

Acute exacerbation tx of MG

A

plasmapheresis

82
Q

Mediastinal tumors and location

A

ant-thymoma
middle-lymphoma
post-neurogenic tumors

83
Q

Risk for testicular cancer

A

cryptorchidism

84
Q

DDx for anal pain

A

anal fissure (post midline)
hemorrhoids
fistula-in-ano
perirectal abscess

85
Q

DDx for adrenal mass

A 
adrenal adenoma
pheochromocytoma
mets
ganglioneuroma
carcinoma
86
Q

Indications for adrenal tumor surgery

A

> 4cm
<4cm but enlarging
solitary adrenal met

87
Q

Dx of pheochromocytoma

A

24hr urine VMA/metanephrines
plasma free metanephrines
confirm with iodine-131 metaiodobenzylguanidine scan (MIBG)

88
Q

Femoral hernia boundaries

A

Inguinal ligament superiorly
Femoral vein laterally
Piriformis/pubic ramus medially

89
Q

Spigelian hernia

A

lateral to rectus sheath

along lower post rectus sheath

90
Q

Obturator hernia

A

Mass on medial thigh

91
Q

Necrotizing soft tissue infections

A

beta-hemolytic strep commonly
no skin abnormalities
edema and pain beyond erythema

92
Q

Fournier gangrene

A

scrotal gangrene/perineum and groin

anaerobic strep and gram negative bugs

93
Q

Wilm’s tumor

A

peak age 1-5 years
abd or flank mass
hematuria

94
Q

Abd mass with calcifications on XR in children

A

cystic meconium ileus

neuroblastoma

95
Q

1 renal mass in neonate

A

hydronephrosis

96
Q

1 renal mass in children >1yr

A

neuroblastoma

97
Q

Complications of gastric bypass surgery

A

B12/iron/folate deficiency
osteoporosis
anemia

98
Q

Dx of ITP

A

hypercellular megakaryocyte in marrow
peripheral Plt destruction
assc with IgG antiplatelet by spleen

99
Q

Indications for splenectomy

A 
congenital hemolytic anemias (thalassemia/spherocytosis)
Myeloproliferative disorders
ITP
Hodgkins Lymphoma
Splenic injury
100
Q

Complications with splenectomy

A

abscesses
postsplenectomy sepsis (in children <4yrs)
encapsulated bug infections (need pneumovax)

101
Q

Cauda equina syndrome

A

compression of sacral nerve bundle
bladder/bowel dysfxn
saddle paresthesias
pain/weakness in legs

102
Q

Mgt of herniated disc

A 
bed rest
heat/ice
NSAIDs
muscle relaxants
PT
103
Q

DDx for neonatal jaundice

A 
hepatitis
TORCH infections
A1AT deficiency
CF
choledochal cyst/biliary atresia
104
Q

Neonatal jaundice workup if over 2 weeks

A

abd US
HIDA scan
Percutaneous liver bx

105
Q

Unconjugated hyperbilirubinemia in neonates

A

hemolytic disease
Crigler-Najjar
Gilberts
Physiologic (resolved by 1 week)

106
Q

Conjugated hyperbilirubinemia in neonates

A

biliary atresia
insipissated bile syndrome
TORCH infection/sepsis

107
Q

Complications of biliary atresia surgery

A

Will develop portal HTN eventually

108
Q

CKD stages

A 
1- >90 GFR
2- 60 to 90 GFR
3- 30 to 60 GFR
4- 15 to 30 GFR
5- <15 GFR
109
Q

Common causes of CKD

A

DM #1
HTN
glomerulonephritis

110
Q

Transplant rejection meds

A 
corticosteroids
cyclosporin
tacrolimus
sirolimus
mycophenolate mofetil/AZA
111
Q

Infections post-transplant

A

CMV (especially)
Pneumocystis carinii
toxoplasmosis
aspergillosis

112
Q

Maligancies post-transplant

A 
Lymphomas #1
SCC and cervical (HPV)
Kaposi sarcoma
NHL
HCC
113
Q

Empiric therapy for diabetic foot ulcer

A

Amoxicillin-clavulanic acid
ciprofloxacin
vancomycin
long term IV 4-6 weeks

114
Q

Charcot neuroarthropathy

A

destruction of well perfused and insensate foot
extensive bone/joint remodeling
similar presentation as diabetic foot ulcer

115
Q

Wagner ulcer classification

A 
1-superficial
2-involves ligament, tendon or fascia
3- abscess or osteomyelitis
4-gangrene of distal foot
5-extensive gangrene
116
Q

Lucid interval assc

A

epidural hematoma

117
Q

Sx of chronic subdural hematoma

A

change mental status worsening over 1-4 weeks

due to trauma

118
Q

Basilar skull fracture presentation

A

raccoon eyes
fluid dripping from nose/ears
ecchymosis behind ears

119
Q

Mgt of hypovolemic shock from gunshot

A

Lg bore IV lines
exploratory lap to control bleeding
IV fluids after lap

120
Q

Mgt of tension pneumothorax

A

chest tube placement prior to CXR

Lg bore IV

121
Q

Vessels causing excess blood with hemothorax

A

intercostal arteries

tx with thoracotomy for ligation

122
Q

Mgt of flail chest

A

fluid restriction/diuretics
respiratory support
r/o other causes

123
Q

Presentation of diaphragmatic rupture

A

no breath sound on L side

124
Q

Presentation of Aortic rupture

A

widened mediastinum

dx with arteriogram

125
Q

Dx of intra-abd bleeding

A

periotneal lavage
sonogram
CT if stable

126
Q

Mgt of bladder/urethral blood in trauma

A

retrograde urethrogram

127
Q

Sx of fractured tunica albuginea

A

lg penile shaft hematoma

surgical emergency

128
Q

Mgt of electrical burns

A

IV fluids and diuretics for myoglobinuria

surgical debridement

129
Q

Complications of circumferential burns

A

circulatory compression/compromise

escharotomy needed

130
Q

Mgt of 2nd degree burns

A

silvadene (silver sulphadiazine)

131
Q

Fluids for burn pts

A

4cc/kg/% burned (up to 50%)
1/2 in first 8 hrs
rest in remaining 16 hrs
urinary output goal 1cc/kg/hr

132
Q

Lg breast mass with slow growth

A

cystosarcoma phyllodes

bx and resection for mgt

133
Q

Leukocoria in kids

A

retinoblastoma

cataracts

134
Q

Mgt of acute glaucoma

A

mannitol
pilocarpine
acetazolamide

135
Q

Mgt of Barrett’s esophagus

A

Nissen fundoplication

136
Q

Mgt of Boerhave Syndrome

A

gastrographin swallow to confirm

emergency surgery

137
Q

Mgt of small bowel obstruction

A

NG tube and suction
IV fluids
observation

138
Q

Dx of carcinoid syndrome

A

5-hydroxy-indoleacetic acid

139
Q

Mgt of melena in unstable/hypotensive pt

A

NG tube, if no blood then emergency angiogram

140
Q

Bloody stool in children

A 
#1 Meckel's diverticulum
dx with technetium scan
141
Q

Acute abd and free air under diaphragm

A

most likely duodenal perforation

tx with exploratory lap

142
Q

Dx of ureteral colic

A

KUB xray of abd

sonogram or IV pyelogram

143
Q

Acute abd with elderly Afib pts

A

mesenteric artery occlusion

blood in stool and acidosis seen

144
Q

Mgt of CRC mets to liver

A

one lobe-resection

both lobes-chemo

145
Q

Amebic abscess mgt

A

tx with metronidazole
serology titers
DO NOT drain
assc with Mexico

146
Q

Mgt of hemorrhagic pancreatitis

A

serial CT for abscesses
drainage of abscesses
support

147
Q

Thyroid mass with normal histology

A

no such thing
metastatic follicular carcinoma
thyroid scan to look for primary

148
Q

Mgt of Cushing’s

A

AM and PM cortisols
dexamethasone suppression test
MRI
removal of adenoma

149
Q

Mgt of gastrinoma

A

serum gastrin
CT of pancreas
removal of tumor

150
Q

Sx of glucagonoma

A

stomatitis
DM
migratory necrolytic dermatitis

151
Q

Borchardt’s triad

A

epigastric pain
retching w/o vomiting
inability to pass NG tube
for gastric volvulus

152
Q

ASA classification

A 
American Society of Anesthesiologists
1) Healthy
2) Mild systemic disease
3) Severe systemic disease
4) Extreme systemic disease
5) Emergency that is 1 or 2
6) Emergency that is 3 or 4
For surgery risk
153
Q

Revised cardia risk index interpretation

A

0= 0.4% cardiac death, MI during surgery
1= 0.9%
2=6.6%
3>or = 11%

154
Q

HTN unresponsive to meds

A

fibromuscular dysplasia

tx with balloon dilitation

155
Q

DDx for bilary emesis in newborn

A

duodenal atresia
annular pancreas
malrotation

156
Q

Cause of intestinal atresia in neonates

A

vascular accident in utero

157
Q

Mgt of meconium ileus

A

gastrografin enema

surgery if enema ineffective

158
Q

Mgt of intussusception

A

barium enema

lap if enema ineffective

159
Q

Midline neck mass mgt

A

Likely thyroglossal duct

Sistrunk operation

160
Q

Lateral neck mass mgt

A

Likely branchial cleft cyst

surgical removal

161
Q

Fluid filled mass at base of neck

A

likely cystic hygroma

CT of neck and surgical removal

162
Q

Mgt of enlarged LN

A

reschedule in 3 weeks and reassess
if resolved-infection
if persistent-workup and bx

163
Q

Mgt of metastatic SCC of head/neck

A

triple endoscopy

FNA

164
Q

Ludwig’s angina

A

abscess of floor of the mouth

tracheostomy and drainage

165
Q

CN VII palsy after trauma

A

if immediate-temporal bone transection

if gradual-edema from trauma (no tx)

166
Q

Indications for aortic valve replacement

A

gradient over 50mmHg
CHF from AS
angina/syncope

167
Q

Murmur echoing to axilla

A

mitral regurg

168
Q

Lung surgery qualifications

A

need FEV1 at least over 800

169
Q

Subclavian steal syndrome presentation

A

claudication of nondominant arm
post brain neuro sx
mgt with angiography and surgery

170
Q

Mgt of aortic dissection

A

beta blockers and IV nitrates for BP control
surgery for ascending AD
ICU medical mgt for descending

171
Q

Sx of brain tumors

A

progressive neuro sx
emesis from increased ICP
morning HA’s
tx=mannitol/hyperventilation/steroids/surgery

172
Q

Bitemporal hemianopsia in children

A

Craniopharyngioma with calcifications

dx with MRI

173
Q

Foster Kennedy syndrome

A

from frontal lobe tumors
optic atrophy/papilledema
central scotoma
anosmia

174
Q

Mgt of spinal cord syndromes

A

high dose corticosteroids

175
Q

Sx of disc herniation

A

Positive straight leg raise
muscle spasm
pain down leg

176
Q

Causalgia

A

reflex sympathetic dystrophy
follows crush injury
cold/cyanotic/moist extremity
tx with surgical sympathectomy

177
Q

Mgt of congenital hip dysplasia

A

abduction splinting

178
Q

Leggs-Perthes disease

A

avascular necrosis of capital femoral epiphysis
lat and AP XR for dx
tx with casting and crunches

179
Q

Slipped capital femoral epiphysis

A

ortho surgery needed

groin pain/limp

180
Q

Post shoulder dislocation

A

easily missed on XR

axillary and scapular lat XR view needed

181
Q

Risk with post hip dislocation

A

avascular necrosis of femoral head

182
Q

Mgt of femur fractures

A

femoral neck-metal prosthesis (due to blood supply)

intertrochanteric-pinned together

183
Q

Mgt of stress fractures

A

not seen on XR for 2 weeks

return in 2 weeks and repeat XR and cast

184
Q

Mgt of priapism

A

alpha agonist injection into corpora

185
Q

Low implantation of ureter

A

seen in females
ureter empties into vagina
IVP and surgery for mgt

186
Q

Mgt of painless, gross hematuria

A

IV pyelopgram first
cystoscopy
possible CT afterwards

187
Q

Mgt of prostate mass

A

trans-rectal needle bx

surgical resection

188
Q

Mgt of prostate mets

A

LH agonist
flutamide
orchiectomy

189
Q

Mgt of prostate cancer over 75yrs

A

if asymptomatic, no tx

190
Q

Mgt of testicular mass

A

radical orchiectomy (rarely benign)
LN dissection
Platinum based chemo
AFP and beta-hCG for monitoring

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