Surgery Flashcards
What are the 2 most common causes of acute pancreatitis?
Alcohol
Gallstones
What is the next best test in diagnosing acute pancreatitis?
Serum lipase then abdominal CT
What is the leading risk factor for aortic dissection?
Longstanding hypertension
What are the 2 types of aortic dissections and how are they managed?
Stanford Type A – ascending, require surgery
Stanford Type B – descending, may be managed medically
What is the first step in treating an acute dissection?
IV beta blocker to decrease HR and BP
What is the best imaging test for aortic dissection?
Chest CT with IV contrast
What 3 nerves does C7 give rise to?
Musculocutaneous
Radial
Median
What nerve root radiculopathy results in pain and numbness in index and middle fingers, weak elbow and wrist flexion, and diminished triceps reflex?
C7
What nerve root radiculopathy results in neck and shoulder pain, numbness on lateral arm, weakness in abduction and ext rotation, elbow flexion and supination and decreased biceps reflex?
C5
What nerve root radiculopathy results in pain and numbness of lateral arm, forearm and first and second digits?
C6
What nerve root radiculopathy results in pain and numbness of medial forearm and fourth and fifth digits, weakened wrist extension and finger extension and abduction?
C8
What nerve root radiculopathy results in pain and numbness of medial forearm and weakened thumb flexion and abduction and finger Ab/adduction?
T1
What is the likely etiology of acute hyperglycemia in a patient started on TPN several days prior?
Sepsis
Treatment of symptomatic aortic stenosis
Surgery, NOT medicine
What aortic valve area denotes severe aortic stenosis and is the cut off for surgical intervention?
<0.8 cm^2
What is the likely diagnosis in a patient with angina, syncopal episodes, dyspnea, SOB and peripheral edema?
Aortic stenosis with CHF
What is a complication of splenectomy that results in fever, leukocytosis, pleuritic chest pain and shoulder pain?
Subphrenic abscess
What is the next best test for diagnosing subphrenic abscess?
CT abd
What is the first line treatment of subphrenic abscess?
Percutaneous drainage
Next best test in suspected acute myelopathy
MRI spine to look for structural or compressive etiologies
What are the four features of transverse myelitis?
Weakness of arms and legs
Back pain
Sensory loss in legs
Bowel and bladder Dysfunction
Central T2 hyperintensity over 2+ segments of the spinal cord with >2/3 cord area involved
Transverse myelitis
What is the next best test in suspected cholecystitis?
RUQ US (stones, sludge, pericholecystic fluid, thickened wall, gas in gallbladder)
If RUQ US is unequivocal and cholecystitis is suspected, what is the next best test?
HIDA scan
What is the treatment of acute cholecystitis?
- IV abx (cover enterics, GNRs)
- IVF and electrolytes
- Non-emergent cholecystectomy
Watery diarrhea, hypokalemia, achlorhydria
VIPoma
What are the symptoms of a VIPoma?
Watery diarrhea, hypokalemia, achlorhydria
What are the major functions of vasoactive intestinal peptide?
- Increases secretion of water and lytes into GI tract
2. Relaxes GI tract smooth muscle and sphincters
What is the best diagnostic test for VIPoma?
CT abd
What is the treatment of a VIPoma?
- Octreotide
2. Surgical resection
Which GI tumor causes decreased insulin and glucagon causing diabetes, cholelithiasis, weight loss, diarrhea and hypochlorhydria
Somatostatinoma
What is the presentation of a gastrinoma?
Recurrent peptic ulcer disease
What is the Whipple Triad and what is it associated with?
Diagnosing insulinomas
- Low blood glucose
- Sx of hypoglycemia
- Resolution of sx once blood sugar normal
