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Shelf Exams > Surgery > Flashcards

Surgery Flashcards

1
Q

when should you suspect traumatic aortic injury and how is it diagnosed?

A

Suspect when there are fractures of bones that are hard to break: sternum, first rib, scapula. Or if there is a widened mediastinum.

Dx with spiral CT/CT angio

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2
Q

What does subperiosteal bone resorption suggest?

A

Hyperparathyroidism

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3
Q

Type of diverticuli

A

True: mucosa, submucosa, muscularis
Ex. Meckel diverticulum
False: no muscularis
Ex. diverticulosis

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4
Q

Where does colon cancer metastasize to?

A

Liver

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5
Q

Most common fistula seen in diverticulitis

A

Colovesicular fistula
(Between colon and bladder)

Presentation: pneumaturia (air in urine), fecaluria (stool in urine), or recurrent urinary infections

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6
Q

If patient has a medullary thyroid carcinoma what should you screen them for?

A

Pheochromocytoma

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7
Q

Treatment of PE

A

Heparin

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8
Q

Most common site of diverticulitis

A

Sigmoid colon

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9
Q

What is the only absolute contraindication to oral intubation?

A

Massive facial trauma

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10
Q

What kind of fluid loss occurs in SBO?

A

Third space fluid losses

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11
Q

What study is used to diagnose esophageal rupture

A

Water soluble contrast esophagram

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12
Q

Median Nerve
Ulnar nerve
Radial nerve

A

Median: make fist
Ulnar: finger abduction/adduction
Radial: wrist extension

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13
Q

Dumping syndrome

A

N/V/D and abdominal cramps with palpitations and diaphoresis that is a common postgastrectomy complication

Caused by loss of the normal action of the pyloric sphincter due to injury or surgical bypass

Manage patients with dietary modifications

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14
Q

Most common cause of esophageal perforation

A

Iatrogenic: instrument perforation of the esophagus

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15
Q

Why do patients with Zollinger Ellison get steatorrhea?

A

The increase in gastric acid inactivates the pancreatic enzymes

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16
Q

What deficiency is seen in carcinoid syndrome?

A

Niacin deficiency due to inc production of serotonin (niacin is a precursor)

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17
Q

Abdominal CT for SBO… with or without contrast?

A

With contrast

Need to assess intestinal distribution and intestinal wall perfusion

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18
Q

What is the most common cause of fever within the first day of surgery?

A

Atelectasis

Emphasize the importance of incentive spirometry

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19
Q

What part of the GI tract are retroperitoneal

A

Duodenum
Ascending and descending colon
Pancreas

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20
Q

Preservation of which of the following, ileum or jejunum, is associated with better nutritional outcomes?

A

Ileum: absorption of B12 and bile salts

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21
Q

What muscle makes the inguinal ligament?

A

The external oblique

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22
Q

What fracture is associated with a calcaneous fracture?

A

T or L spine (usually from a fall)

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23
Q

Where can there never be diverticuli? Why?

A

Rectum: two layers of muscle

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24
Q

Child with an abdominal mass in the right abdomen that moves up and down with respiration

A

Malignant liver tumor (hepatoblastoma or hepatocellular carcinoma)

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25
Q

Tension pneumothorax causes what effect on the heart?

A

Dec in venous return to the heart –> hypotension and cardiac arrest

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26
Q

Presentation of right sided colon cancer vs left sided

A

Right sided = bleeding (anemia)

Left sided = obstruction (because the lumen is smallest in the left sided colon)

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27
Q

Difference between esophagus and rest of the GI tract?

A

Esophagus does not have serosa

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28
Q

MEN2A

A

MEN 2A: 2 P’s

  • Parathyroid
  • Pheochromocytoma
  • Medullary thyroid carcinoma
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29
Q

Gastrectomy causes what deficiency?

A

Vitamin B12 (loss of intrinsic factor)

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30
Q

Diameter of the large intestine

A

Ascending: 9 cm
Transverse: 6 cm
Descending: 3 cm

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31
Q

Vomiting causes what electrolyte abnormality

A

Hypokalemic hypochloremic metabolic alkalosis

Hypokalemia occurs because of the loss of HCl causes K+ to enter cells when H+ exits cells

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32
Q

What electrolyte abnormality causes ileus?

A

Hypokalemia

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33
Q

What is the lethal triad?

A
  1. Acidosis
  2. Coagulopathy
  3. Hypothermia
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34
Q

Where are the blood vessels on a rib?

A

Vein, Artery, Nerve (VAN)

Underneath a rib (thus, need to place chest tubes and thoracentesis needles above the rib)

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35
Q

Skin manifestations of ulcerative colitis

A

Erythema nodosum

Pyoderma gangrenosum

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36
Q

Patient with worsening jaundice with an US that shows a thin walled, dilated gallbladder and has with lab evidence of obstruction (inc alk phos, liver enzymes, direct bilirubin) suggests….

A

Courvoisier-Terrier sign

Obstructive jaundice caused by tumor (adenocarcinoma of the head of the pancreas, adenocarcinoma of the ampulla of Vater, cholangiocarcinoma of the common bile duct)

37
Q

Hemorrhoid locations

A

Right anterior
Right posterior
Left lateral

38
Q

Patient with worsening jaundice with evidence of obstruction on labs (inc alk phos) and who has a nondilated gallbladder on US suggests…

A

Obstructive jaundice caused by stones

ERCP used to confirm diagnosis and to remove stone, followed by cholecystectomy

39
Q

Trauma patient has subcutaneous emphysema in the upper chest… what do you suspect?

A

Traumatic rupture of the trachea or major bronchus

Dx with bronchoscopy

40
Q

Electrolyte abnormality associated with SBO

A

Hypokalemia

Need to give them IV fluids with K+ added

41
Q

Electrolyte abnormalities associated with refeeding syndrome

A

Hypokalemia
Hypomagnesemia
Hypophosphatemia

42
Q

Management of penetrating extremity injuries

A
  1. No major vessels in vicinity: clean wound and give tetanus
  2. Near major vessels but pt is asymptomatic: doppler or CT angio
  3. Obvious vascular injury (absent distal pulses, expanding hematoma): surgical exploration and repair
43
Q

Signs of pathologic nipple discharge

A

Spontaneous
Unilateral
From a single duct

44
Q

What is the medical management for a patient with a prolactinoma?

A

Dopamine agonists (Bromocriptine)

Dopamine blocks prolactin

45
Q

If you suspect diaphragmatic rupture, what do you do?

A

Laparoscopy!

46
Q

Resuscitation for massive trauma and massive blood loss

A

1:1:1 ratio

PRBCs
FFP
Platelets

47
Q

Maintenance fluid for an adult

A

mass in kg + 40 = X ml/hour

48
Q

How to determine a patient’s airway is intact?

A

If they can talk, airway is intact

49
Q

Normal urinary output

A

1-2 ml/kg/hour

50
Q

Treatment of hypercalcemia

A

Normal saline (and calcitonin)

51
Q

What is the strongest layer of the bowel?

A

Submucosa

52
Q

Posterior knee dislocation can cause what?

A

Injury to the popliteal artery

53
Q

What does every patient with diverticulitis need?

A

A colonoscopy to rule out colon cancer

54
Q

Refeeding syndrome

A

Hypophophatemia
Hypomagnesemia
Hypokalemia

55
Q

PTH site of action and effects

A

The kidney –

  • inc calcium reabsorption in the DCT
  • dec phosphate reabsorption in the PCT
  • inc activation of vitamin D
56
Q

What antibiotic is given to patients with variceal bleeding?

A

IV ceftriaxone

57
Q

Gerota’s fascia

A

Fascia surrounding the kidney

58
Q

Hesselbach’s triangle

A

Inferior epigastric vessels
Inguinal ligament
Lateral border of the rectus sheath

Floor consists of the internal oblique and the transversus abdominis muscle

59
Q

MEN2B

A

MEN2B: 1 P

  • Pheochromocytoma
  • Medullary thyroid carcinoma
  • Marfinoid body habitus
  • Mucosal neuromas
60
Q

Air embolism management

A

Put patient in trendelenburg position

61
Q

At what GCS should a person be intubated?

A

GCS of 8 or lower

62
Q

Nonoperative management of small bowel obstruction

A

NPO
NG tube
Intravenous fluid resuscitation

63
Q

3 most common causes of SBO

A
  1. Adhesions
  2. Hernia
  3. CA
64
Q

Portal triad

A

portal vein, hepatic artery, common hepatic bile duct (splits into left and right)

65
Q

Which thyroid tumor produces calcitonin?

A

Medullary carcinoma (arises from the parafollicular C cells)

66
Q

Causes of post-op fever (sequentially)

A

Atelectasis (1 day), pneumonia (1-3 days), UTI (3), DVT (5), wound infection (day 7)

67
Q

MEN1

A

MEN1: 3 P’s

  • parathyroid (hypercalcemia)
  • pituitary (prolactinoma)
  • pancreatic endocrine tumors (Zollinger Ellison, Glucagonoma)
68
Q

Liver mass with central scar

A

Focal nodular hyperplasia (benign tumor of the liver)

69
Q

Workup for esophageal motility problems

A

Barium swallow esophagram

Manometry

70
Q

Calot’s triangle

A

Cystic duct
Common hepatic duct
Liver edge

(Cystic artery/Calot’s lymph node are within the triangle)

71
Q

Lab diagnosis of carcinoid syndrome

A

24 hour urine 5-HIAA (serotonin metabolite)

72
Q

What is the classic triad in renal cell carcinoma?

A

Flank pain
Hematuria
Palpable renal mass

73
Q

Mets to the liver are most commonly seen in….

A

colorectal cancers

74
Q

Medical management of anal fissures

A

Nifedipine
Nitroglycerin (has more systemic effects)
Botox
Myotomy

75
Q

Upper GI bleed workup and treatment

A

Upper GI endoscopy
Fluid resuscitation

Endoscopic hemostasis: epinephrine injections, thermal application techniques, and clip applications

76
Q

Antibiotic treatment of intra-abdominal infections

A

Dual agent
3rd generation cephalosporin + flagyl or clindamycin
Fluoroquinolone + flagyl or clindamycin

Single agent
Ceftriaxone or Ampicillin-Silbactam

77
Q

What paraneoplastic syndromes is RCC associated with?

A

PTHrP (hypercalcemia)

EPO (inc hemoglobin)

78
Q

Hepatic risk (Child Pugh)

A 
Bilirubin
Albumin
INR
Encephalopathy 
Ascites
79
Q

Patient reports mucous like discharge in his underwear. What do you suspect?

A

Fistula in ano

80
Q

Best method of determining fluid status in a post op patient

A

Urine output

81
Q

Pyloric stenosis electrolyte abnormality

A

Hypokalemic
Hypochloremic
Metabolic alkalosis

82
Q

Dx of urethral injury

A

Retrograde urethrogram

83
Q

Parkland formula

A

Fluid resuscitation for burn victims

4 x mass in kg x %of body burned = mL given in first 24 hours

84
Q

Ogilvie syndrome

A

o Paralytic ileus of the colon: colon dilation without a mechanical obstruction
o Classically seen in elderly sedentary patients who have become further immbolized owing to surgery elsewhere (broken hip, prostatic surgery, etc)
o Tx
• Colonoscopy to suck out the air and to place a rectal tube
• IV neostigmine: stimulates colon motility but has a lot of side effects and can be lethal if inadvertently given to someone whose colon is actually mechanically obstructed

85
Q

Liver manifestation of ulcerative colitis

A

Primary sclerosing cholangitis

86
Q

Diagnosis of Zollinger Ellison
Lab
Histo

A

Highly elevated gastrin levels, positive secretin stimulation test

Histo: parietal cell hyperplasia and enlargement of the gastric folds

87
Q

Colon mets vs lower rectal mets

A

Colon/upper rectum– portal circulation, mets to liver

Lower rectum- vena cava, lung mets

88
Q

What drug should a patient with esophageal varices be placed on?

A

Non cardioselective beta blocker (propranolol)

Shelf Exams (8 decks)

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