Surgery Flashcards
What is Charcot’s triad and reynold’s pentad and what is its indication? tx?
RUQ pain/jaundice/fever
all 3 plus HoTN/AMS
Ascending cholangitis
ERCP with cipro + metro
Tx for follicular, medullary, papillary thyroid carcinoma?
Follicular/medullary - total thyroidectomy
Papillary - lobectomy
Follicular - I2 ablation
What electrolyte abnormalities would you see from mineralocorticoid deficiency?
Hyponatremia and hyperkalemia
Under what GCS score do you intubate? what does GCS evaluate?
8
Eye opening/motor/verbal
Management of abdominal gunshot wound?
Exploratory laparotomy
A patient who has a fake eye of missing toe from a cancer 20 years ago now have multiple masses in the liver, what is it?
Metastatic melanoma (metastasize 20+ years after the onset)
Management of Colle’s fracture?
Closed reduction and short arm cast
Difference seen on barium swallow in pt with achalasia vs. cancer?
Achalasia - massive dilation (bird’s beak)
Cancer - no massive dilation/just focal narrowing
What is the criteria for lumpectomy vs. mastectomy for breast cancer?
Size of 4cm
Under 4 - lumpectomy
Over 4 - mastectomy
Dx of mesenteric ischemia?
CT
What is cushing’s triad? and its management?
Increase ICP
Irregular breathing/HTN/bradycardia
Elevate head of the bed/give mannitol/hyperventilate/craniotomy
When do you do an endoscopy for GERD pt?
anyone with alarming symptoms such as dysphagia/bleeding/odynophagia
Or pt>50 with more than 5 years of GERD
What would you worry about a pt post brain surgery with AMS?
DI - hypernatremia
Elderly pt with hx of atherosclerosis/recent hypotension complains of sudden abdominal pain, what is it and what do you see on angiography?
non occlusive mesenteric ischemia from vasoconstriction
“string of sausages”
What would a penetrating trauma to the groin cause?
AV fistula causing venus HTN — edema and varicose veins
What test is used first for peripheral vascular disease? and how to interpret it?
ABI
normal 1 - 1.3
Under 1 - ischemia
Over 1.3 - calcified (DM or vasculitis)
What are afferent loop and dumping syndrome?
Post gastrojejunostomy
Dumping syndrome - too much food in small intestine too fast - nausea/vomiting/diarrhea/dizziness/fatigue tx - smaller meals and less fat
Afferent loop syndrome - mechanical obstruction of the afferent loop - abdominal pain 1-2 hours after eating, relieved by vomiting
Difference between incarcerated and strangulated bowel hernia
Incarcerated - just tender
Strangulated - tender/fever/elevated WBC - urgent surgery
What is the bacteria number in u/c for bacteriuria?
over 100,000
What score system is used to grade prostate cancer?
Gleason score
What does CVP measure and what is its normal range?
Venous filling pressure aka volume level
2- 6 mm Hg
What does contrast highlight?
Blood vessels
What causes nephrogenic DI?
Demeclocycline and Li+
Normal value of BUN/Cr, FENa and urine osm? what happens in intrarenal disease?
BUN/Cr = 15 FENa <1% Urine osm >500 BUN/Cr <15 (decrease reabsorption) FENa >2% (decrease reabsorption) Urine osm <500 (can't concentrate)
What causes hypokalemia?
Loop/thiazide/Bartter’s syndrome
What electrolytes abnormalities does diarrhea and vomiting cause?
They both cause hypokalemia
Vomiting cause alkalosis
Diarrhea cause acidosis
Why does aldosterone cause alkalosis?
Aldosterone increase Na reabsorption and K/H+ secretion
Why does aortic regurg causes widen pulse pressure?
Pulse pressure = systolic - diastolic pressure
Aortic regurg - blood flows back into ventricles during diastole - increase ventricular volume thus systolic pressure - decrease aortic volume thus diastolic pressure
How does beta blocker increase K+?
It blocks renin
Prevent cellular uptake of potassium
What electrolyte abnormalities do VIPoma cause?
Hyperglycemia/hypercalcemia/hypokalemia
What other electrolyte is affected by low Mg?
Low Mg – low PTH— low Ca
When cant you do endocraft to fix AAA?
When the neck is <15mm
such as juxtarenal/suprarenal AAA
When cant you do endocraft to fix AAA?
When the neck is <15mm
Which IBD has nonceasating granuloma?
Crohn’s
Which use Mg2+ for acute asthma?
Inhibit smooth muscle contraction/ACh release
What are the 3 signs for appendicitis?
Rovsing/Psoas/obturator
Appendicitis is dx with contrast or noncontrast CT?
Contrast CT
What size of the carcinoid tumor that we dont care about?
<2 cm
Common etiology of big bowel obstruction?
Volvulus/diverticulitis
How to decompress sigmoid volvulus?
Sigmoidoscopy
Biliary air in liver with signs of SBO, what is it?
Gallstone ileus
What would be urine pH be with dehydrated patients?
Aciduria
Caused from aldosterone reabsorbs Na and excrete K and H+
A breast cancer mass is tend to feel rubbery or hard?
It is hard
Which biopsy method is preferred for breast cancer?
Core needle biopsy
What kind of adjuvant therapy should triple negative breast cancer pt receive?
Chemotherapy
What is Marjolin’s ulcer?
SSC of the skin with previous trauma or burn
What kind of feeding method is used for pt with a large burn or pancreatitis?
Enteral feeding vis either NG or NJ (nasojejunal) tubes
What kind of feeding method is used for pt with a large burn?
Enteral feeding
Frostbite limb with no pulse, what is happening?
Thrombosed arteries, need tPA
You found a bulb at the carotid bifurcation, what could it be and what’s the tx?
Carotid body tumor
take it out
What is acute peripancreatic fluid collection and when does it become pseudocyst?
Fluid around the pancreas in a sack (wait till it becomes pseudocyst)
If it’s over 4 weeks then it’s pseudocyst
80% of stenosis at external carotid, what to do next?
Wait and see
External carotid stenosis does not cause stroke
What should be the diet for CKD pt?
Restrict protein/K/Mg/Ph cuz kideny get filter them out thus lead to accumulation in blood stream
What is ACE inhibitor’s effect on kidney and why is it used for CKD patients?
Decrease efferent arterial constriction/decrease GFR/lessen hyperfiltration/decrease protein filtration thus proteinuria
Difference between stye and chalazion?
Stye is infection of a hair follicle and chalazion is blockage of sebaceous gland
Both can be tx with warm compresses to increase drainage
Tx for CO and cynaide poisoning?
100% O2/cobolamine and thiosulfate
Signs of diverticulitis with what else would make it a complicated one?
UTI - might be a fistula
What could the pt do to alleviate the pain from pancreatitis?
lean forward
Does the presence of gallstone enough to establish the dx as gallstone pancreatitis?
If there are no other factors then yes
What is acute peripancreatic fluid collection and when does it become pseudocyst?
Fluid around the pancreas in a sack
If it’s over 4 weeks then it’s pseudocyst
MRI findings of PML/Toxo/CNS lymphoma
PML - multiple non enhancing lesions
Toxo - multiple ring enhancing lesions
CNS lymphoma - solidary ring enhancing lesion
Why hyperventilation decreases cerebral edema?
Hyperventilation – decrease PaCO2 — arterial vasoconstriction – decrease cerebral blood flow —- decrease cerebral edema
The only STD ulcers that is painful? and the only STD ulcer associated LAD that is not painful?
Painful STD ulcers - HSV/chancroid
Nonpainful STD LAD - syphilis
Why does rhabdomyolysis causes hypocalcemia?
Release phosphate — phosphate precipitates Ca — decrease Ca
What does Prussian blue stain?
Iron
When do you have target cells?
Post splenectomy/beta or alpha thal minor
Tx for SIADH
ASX - water restriction/NS + loop/Li/demeclocycline
SX - hypertonic saline
What’s in Lactated ringer that is not in NS? and why does surgeons prefer LR and medicine prefer NS?
LR has K that is not in NS
Large amount of NS infusion can cause acidosis but not LR
You use a lot of fluid in surgery thus you dont wanna give pt acidosis so LR is better
Medicine ppl dont wanna volume overload pt so they wont give large amount of fluid so LR is not needed (besides K in LR can worsen CKD or heart failure)
What are the two condition with increased MCHC? and what should be giving to these pt?
Sickle cell/herediatry spherocytosis
Folate
what are the three conditions that have spherocytes?
Herediatry spherocytosis/warm autoimmune hemolytic anemia/G6PD def
What is the triad in PNH and what is the tx?
Anemia/pancyotpenia/venous thrombosis
Eculizumab - against factor C5
Hypothyroidism causes?
Joint pain/increase lipid/macrocytic anemia
Symptom and causes of central cord syndrome? prognosis?
Hyper extension of the neck
Loss of motor function and burning pain in upper extremities
Eventually recovery on its own
What causes warm autoimmune hemolytic anemia? and what kind of hemolysis?
Cancer/drug/SLE
Extravascular
Medical management of pul contusion
Use diuretics/fluid restrict
What’s the cause of aortic rupture and what’s the dx?
Deceleration injury
Spiral CT aka CT angio
What is the complications of HIT?
PE and DVT
Why liver disease causes coagulopathy?
Decrease clotting factor/cholestasis decrease Vit K absorption/hyperslenishm (from portal HTN) - thrombocytopenia
Adverse effect of heparin
Osteoporosis/alopecia
Subtypes of Hodgkin’s and Non-Hodgkin’s lymphoma?
Hodgkin’s - ones like lymphocyte depleted
NHL - Burkitt’s/Mycosis fungoides
What kind of bladder rupture can be fixed, intra or extraperitoneal?
Intraperitoneal
What is alpha blocker’s role in kidney stone?
Relax the smooth muscle of distal ureter
What mimics testicular torsion?
Appendages torsion
What to do next with a young guy with ball mass?
Take it out, don’t bx
Phimosis vs. paraphimosis?
Phimosis- can’t pull back foreskin - seen normally in young boys
Paraphimosis - foreskin pulled back too long - emergency - reduce it back
What kind of inguinal hernia can be sliding hernia and what is the risk of repairing it?
Indirect inguinal hernia usually on the left side/colonic injury
What is the MC type of hernia in men and women?
Indirect inguinal hernia
What is femoral hernia associated with and where is it located?
Multiple births
Empty space in NAVEL (nerve, artery, vein, empty and lymphatics)
What drug is associated with post op ileus?
Opioid
What is Richter’s hernia?
Only one wall of bowel is strangulated or incarcerated
without associated symptoms
When should we fix an infant’s umbilical hernia? and what size can it usually be healed by itself?
Delayed till 4 years old
If under 2cm then it usually heal on its own
What causes ischemic orchitis and what is the tx?
Thrombosis of pampiniform plexus
Self limited
What does the genital and femoral branch of genitofemoral nerve innervate and what about ilioinguinal?
Genital branch of genitofemoral - scrotum and cremastic reflex
Femoral branch - proximal medial thigh
Ilioinguinal - lower abd and medial thigh
What is closed loop SBO?
A segment of bowel is obstructed both proximally and distally
Management of postop NSTEMI?
Medical management
What is dressler syndrome?
Post MI pericarditis
What is the access hormone in pheo?
Epi/norepi
Found a 8cm mass on adrenal gland, what to do next? and what if its 3cm?
Take it out
Any adrenal tumor that is over 6cm - take it out and don’t bx
3cm - check biochemical marker to see if the tumor is functional or not, if not observe
see laryngeal cancer, think what other cancer?
Lung cancer
What is the MC organism that causes otomycosis and what populations are most susceptible?
Aspergillus
Pt with hx of AML and DKA pts
What can causes mastoiditis and what is the dx and tx?
Otitis media
CT/surgery
Tx for acalculus cholecystitis
Abx and percutaneous cholecystectomy if critically ill
What to do with pt with ASX gallstones?
Observe
What is the complication of AAA repair and what is the dx?
Ligate IMA - ischemic colitis
Flexible sigmoidoscopy
What is the screening for kids with FAP?
Sigmoidoscopy since the age of 10
What does diffuse axonal injury results in?
Unconsciousness and then vegetative state
MC site of PE?
Left common iliac vein
Fever, painful, purple swollen leg, increased RR and HR, what is it?
Necrotizing fasciitis
What kind of shock causes vasodilation?
Septic and anaphylactic
Tx for ITP?
Steroid and then IVIG
If pt is likely on Well’s criteria, can you give heparin before confirm the diagnosis?
Yes
What are the 4 classes of wounds?
Class I - clean (not entering cavities)
Class II - clean contaminated (entering but do so surgically like c section)
Class III - contaminated - trauma
Class IV - dirty infected (like abscess, perforation)
What area of bleeding can’t FAST detect?
Retroperitoneal
Management of pancreatic injury with duct disruption
Surgery
Management of blunt carotid injury?
Heparin only
Hemodynamically stable GSW pt, what to do?
Get a CT first to assess
