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LMCC > Surgery > Flashcards

Surgery Flashcards

1
Q

Sclerotherapy

A

Varicose vein treatment
Inject superficial vein lumen with sclerosing substance (hypertonic saline, detergent solutions ie. sodium tetradecyl sulfate and corrosive agents ie. glycerin) which reacts with vascular endothelium and seals the vein leading to its permanent collapse

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2
Q

Up to ___ deg angulation is acceptable in fifth metacarpal fractures

A

40

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3
Q

Up to ___ deg angulation is acceptable in second metacarpal fractures

A

10

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4
Q

Up to ___ deg angulation is acceptable in third metacarpal fracutres

A

20

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5
Q

Boxer’s fracture

A

Acute angulation of neck of 5th metacarpal into palm

Ulnar gutter x 4-6wks

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6
Q

Major predictors of increased perioperative CV risk

A

Unstable coronary syndromes
Acute or recent MI with evidence of important ischemic risk by clinical symptoms or noninvasive study
Unstable or severe angina
Decompensated HF
Significant arrhythmias
High grade AV block
Symptomatic ventricular arrhythmias with underlying heart disease
Supraventricular arrhythmias with uncontrolled ventricular rate
Severe valvular disease

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7
Q

Treatment of tension pneumothorax

A

Needle thoracostomy at 2nd ICS mid clavicular line

then chest tube in 5th ICS anterior axillary line

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8
Q

Treatment of hemothorax

A

Tube thoracostomy

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9
Q

Most common neoplasm found in ventricular system of brain, esp in children

A

Ependymomas

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10
Q

2 most commonly injured knee structures

A

Medial collateral ligament

Anterior cruciate ligament

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11
Q

Open pneumothorax treatment

A

Air tight dressing sealed on 3 sides (allows air to escape during expiratory phase but seals itself during inspiratory)
Chest tube
Surgery

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12
Q

Incarcerated hernia

A

Can’t be reduced

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13
Q

Strangulated hernia

A

Vascular supply of bowel is compromised

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14
Q

Internal hernia

A

Sac protrudes through fascial defect within abdo cavity or diaphragm

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15
Q

Richter’s hernia

A

Only part of bowel wall is affected

Can lead to strangulation of that part –> gangrene –> perforation

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16
Q

Spigelian hernia

A

AKA lateral ventral hernia

Sac protrudes through defect in linea semilunaris

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17
Q

Littre’s hernia

A

Involves meckel’s diverticulum

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18
Q

Most common type of inguinal hernia

A

Indirect

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19
Q

Investigation of choice to dx Meckel’s diverticula in children

A

Technetium-99m pertechnetate scan
Radionuclide binds to plasma protein and accumulates in functional gastric mucosa –> focus of increased activity often mid abdo or in RLQ

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20
Q

Pyloric stenosis

A

2-8wks of age
1st born male
Non-bilious vomiting PPP
Palpable olive, visible gastric peristalsis
Volume depleted - hypoK, hypoCl, metabolic alkalosis

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21
Q

Intussusception

A

3mo to 3yrs of age
Adenovirus, rotavirus, mostly idiopathic
Some have lead points (meckel’s, polyp, tumour)
10% recurrence

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22
Q

Pneumotosis intenstinalis on AXR

A

Necrotizing enterocolitis

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23
Q

Bleeding meckel’s diverticulum is typically painless vs painful

A

Painless

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24
Q

Gastroschisis

A

Tissues exposed outside of abdo wall

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25
Q

Omphalocele

A

Tissues covered outside of abdo wall

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26
Q

Risks a/w succinylcholine

A

Malignant hyperthermia

Hyperkalemia

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27
Q

Malignant hyperthermia

A 
Genetic dz 
Auto dominant with reduced penetrance 
Mutations with ryanodine receptor 
Chromosome 19 
Pts with diseases (central core disease, minicore myopathy, King-denborough syndrome) that affect chromo 19 are at high risk of developing MH if exposed to triggering agents
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28
Q

Postcholecystectomy syndrome

A

Persistent abdo pain, dyspepsia after chole
Caused by changes in bile flow due to loss of reservoir function in gallbladder
Can lead to: continuous increase of bile flow into upper GI tract leading to esophagitis and gastritis or related to lower GI tract where diarrhea and colicky lower abdo pain may result

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29
Q

Fothergill sign

A

Mass does not change in shape or cross midline with rectus sheath flexon, suggests rectus sheath hematoma

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30
Q

Epidural hematoma

A

Lenticular shaped bleed on NCCT
Most often caused by severe trauma rupturing middle meningeal artery
Admit, serial CTs if stable (<30mL, <15mm thick, minimal midline shift, GCS < 8, no focal deficit)
Otherwise, urgent craniotomy to evacuate clot

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31
Q

Subdural hemorrhage

A 
Crescent shaped bleed 
Rupture of vessels that bridge subarachnoid space 
Serial CTs if stable/improving 
Craniotomy if clinically symptomatic 
More likely to present subacute/chronic
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32
Q

Peptic stricture

A

Endstage of chronic reflux esophagitis
Often a/w hiatal hernias
Heartburn, dysphagia, odynophagia, food impaction, weight loss, chest pain
Progressive with solids then liquids

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33
Q

Achalasia

A

Failure of peristalsis of esophagus and LES failure
Rare
Simultaneous difficulty in swallowing solids and liquids

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34
Q

Risk factors a/w colonic volvulus

A 
Chronic constipation 
Advancing age (usually 70-80yo) 
Institutionalized pts with neuropsych d/o
Use of psychotropic drugs 
High fiber diet
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35
Q

Most common cause of fever first 48h post-op

A

Atelectasis

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36
Q

Biliary atresia

A

Conjugated bilirubinemia
Shrunken gallbladder on U/S
Biopsy that reveals portal fibrosis and bile duct proliferation

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37
Q

Tx for biliary atresia

A 
Kasai proecdure (most successful procedure is Roux-en-Y hepatoportojejunostomy done before 60d of age)
Ursodeoxycholic acid may be useful to promote bile flow in patent extrahepatic biliary system (done AFTER kasai procedure) 
Liver transplant is definitive tx
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38
Q

Top 3 causes of SBO

A

From most common to least

  1. Adhesions
  2. Bulge (hernias)
  3. Cancer
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39
Q

Triad of findings in AXR for SBO

A
  1. Dilated small bowel (>3cm)
  2. Air fluid levels on upright
  3. Scare air in colon
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40
Q

Imaging sign of ischemic bowel

A

Pneumatosis intestinalis (free air in bowel wall)

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41
Q

Inguinal hernia anatomy

A

MDs don’t LIe
Medial to the inferior epigastric artery = Firect inguinal hernia
Lateral to the inferior epigastric artery = Indirect inguinal hernia

42
Q

Borders of Hesselbach’s Triangle

A

Lateral: Inferior epigastric artery
Inferior: Inguinal ligament
Medial: Lateral margin of rectus sheath
Direct inguinal hernias protrude through this triangle

43
Q

Post-op complications from hernia repair

A

Recurrence
Scrotal hematoma (painful swelling from compromised venous return of testes)
Nerve entrapment - ilioinguinal N –> numbness of inner thigh or lateral scrotum; genital branch of genitofemoral N –> in spermatoc cord
Stenosis of femoral vein –> acute leg selling
Ischemic colitis

44
Q

Hernia most likely to become strangulated

A

Femoral

45
Q

Most common hernia in women secondary to pregnancy

A

Femoral

46
Q

Crohn’s disease surgery options

A

Resection and anatomosis

Stricutroplasty

47
Q

UC surgery options

A

Proctocolectomy and ileal pouch-anal anatomosis

Proctocolectomy with permanent end ileostomy

48
Q

Hartmann procedure

A

Proctosigmoidectomy - resection of rectosigmoid colon with closure of anorectal stump and formation of an end colostomy
Anastomosis in ~3mo

49
Q

Top causes of LBO in order

A

Cancer
Diverticulitis
Volvulus

50
Q

Ogilvie’s syndrome

A

Acute pseudo-obstruction
Distention of colon without mechanical obstruction in distal colon
Usually conservative mgmt only

51
Q

Outpt treatment of LBO

A

Clear fluids

Ancef + Flagyl 7-10d

52
Q

Most common non-neoplastic polyp

A

Hyperplastic

53
Q

Malignant potential of polyps

A

Villous (sessile) > tubulovillous > tubular (pedunculated)

54
Q

Familial adenomatous polyposis

A

Auto dominant
colorectal adenomas –> virtually 100% lifetime risk of colon CA
If no polyposis found: annual flex sig from puberty to age 50, then routine screening
Tx: Sx indicated by 17-20yo, total proctocolecotmy with ileostomy or total colectomy with ielorectal anastomosis + chemo

55
Q

Hereditary non-polyposis colorectal Cancer

A

AKA Lynch syndrome
Auto dominant
R>L

56
Q

HNPCC I

A

Hereditary site-specific colon CA

57
Q

HNPCC II

A

Cancer family syndrome - high rates of colon, endometrial, ovarian, hepatobiliary, small bowel CA

58
Q

Amsterdam Criteria to dx hereditary non-polyposis colorectal CA

A
  • 3 or more relatives with verified Lynch syndrome associated cancers and 1 must be 1st degree relative of other 2
  • 2 or more generations involved
  • FAP excluded
59
Q

Angiodysplasia most common location

A

Right colon of pts >60yo

60
Q

Volvulus types in order of frequency

A

Sigmoid > cecum > transverse colon > splenic flexure

61
Q

UC vs CD for more likely to cause toxic megacolon?

A

UC

62
Q

1st degree hemorrhoids

A

Bleed but don’t prolapse

Tx: high fibre, sitz baths, steroid cream, parmoxine (Anusol), rubber band ligation, sclerotherapy, photocoagulation

63
Q

2nd degree hemorrhoids

A

Bleed, prolapse with straining, spontaneous reduction

Tx: Rubber band ligation, photocoagulation

64
Q

3rd degree hemorrhoids

A

Bleed, prolapse, requires manual reduction

Tx: Same as 2nd degree, may require close hemorrhoidectomy

65
Q

4th degree hemorrhoids

A

Bleed, permanently prolapse, can’t be manually reduced

Tx: Closed hemorrhoidectomy

66
Q

Tx for anal fissures

A

Stool softeners, increased fibre intake, sitz baths
Topical nitro or CCB
Lateral internal anal sphincterectomy (most effective) - NOT POSTERIOR (causes keyhole deformity)
Botox

67
Q

Most common neoplasm of anal canal

A

SCC of anal canal

ABOVE dentate line

68
Q

Most common benign hepatic tumour

A

Cavernous hemangioma

69
Q

Most common malignant hepatic tumour

A

Metastases (colorectal)

70
Q

Definitive mgmt of acute cholangitis

A

ERCP and sphincterotomy

71
Q

Most common gallbladder cancer

A

Adenocarcinoma

72
Q

Cholangiocarcinoma

A

Malignancy of extra or intrahepatic bile ducts

73
Q

whipple procedure

A

pancreaticoduodenectomy

Remove: CBD, gallbladder, duodenum, head of pancreas, sometimes distal portion of stomach

74
Q

Most clearly established risk factor for pancreatic CA

A

smoking

75
Q

Most common location for pancreatic CA

A

Head of pancreas

76
Q

Most useful serum marker of pancreatic CA

A

CA 19-9

77
Q

Most common type of pancreatic CA

A

Ductal adenocarcinoma

78
Q

Two greatest risk factors for breast CA

A
  1. Gender

2. Age

79
Q

Most common type of breast CA Found in men and women

A

Invasive ductal carcinoma

80
Q

Triple test for breast CA Dx

A
  1. Clinical breast exam
  2. Imaging (U/S <30yo, mammography + U/S if >30yo)
  3. Pathology (U/S or mammography guided core needle biopsy preferred over excisional)
81
Q

Lobular carcinoma in situ vs ductal carcinoma in situ tx

A

DCIS needs lumpectomy with wide excision margins + radiation vs LCIS which does NOT need wide excision s

82
Q

Paget’s disease of breast

A

Ductal carcinoma that invades nipple with scaling and eczematoid lesion

83
Q

Tamoxifen

A

SERM

regular gyne f/u if on it for breast CA tx b/c of increased risk of endometrial CA

84
Q

Most common sites of metastasis for breast CA

A

Bone > lungs > pleura > liver > brain

85
Q

Best predictor of primary adrenal carcinoma

A

Size > 6cm

86
Q

Pheochromocytoma investigation

A

24h urine epinephrine, norepinephrine, metanephrine, normetanephrine, vanillylmandelic acid

87
Q

Cushing’s investigation

A

24h urine cortisol or 1mg O/N dexa suppression test

88
Q

Treatment of adrenal gland tumours

A

Functional –> resect

Non-functional: >4cm –> resect, <4cm –> F/U imaging in 6-12mo, resect if >1cm enlargement

89
Q

Vasoactive intestinal peptide secreting tumour

A

Commonly located in distal pancreas
Most are malignant when diagnosed
Severe watery diarrhea, dehydration, weakness, lyte imbalance
Dx: serum VIP, CT, U/S
Tx: Somatostatin analogues, surgical resection

90
Q

Peds hydrocele

A

Most resolve spontaneously by 1 yr

Surgical repair if persist >2yr, painful, infection

91
Q

Umbilical hernias

A

Repair if not spontaneously closed by age 5

92
Q

Hirschprung’s disease rectal biopsy

A

Gold standard for dx

Look for aganglionosis and neural hypertrophy

93
Q

Cryptorchidism

A

Most spontaneously descend by 6mo
Tx: hCG to stimulate T production (descent mediated by descendin which is created in response to testosterone)
Orchidopexy if undescended by age 6mo-2yr
No effect on malignant potential on testicle

94
Q

Most common cause of bowel obstruction btwn 6-36mo

A

Intussusception

95
Q

Peds inguinal hernias

A

ALL INDIRECT
Incarceration more common in female
Low birth weight and male sex increases risk
Dx: PHYSICAL EXAM (U/S only if uncertain by P/e)
Tx: manual reduction in ED and repair within few weeks if <1yr vs elective if >1yr
If incarcerated –> emergency repair

96
Q

Metastatic disease from testicular cancer most likely to spread to ____ lymph nodes

A

Retroperitoneal/para-aortic

97
Q

Metastatic disease from lung cancer most likely to spread to ____ lymph nodes

A

Mediastinal

98
Q

Metastatic disease from small/large bowel CA most likely to spread to _____ lymph nodes

A

Mesenteric

99
Q

Acute cholangitis treatment

A

Endoscopic sphincterectomy

100
Q

3 most common causes of acute dyspnea in postoperative period

A 
Laryngospasm (stridor)
Bronchospasm
Aspiration PNA (crackles/rhonchi in RLL)
101
Q

Malignant hyperthermia treatment

A 
Discontinue volatile agents and succinylcholine, hyperventilate 
Dantrolene IV 
Bicarb 
Coll patients if core temp >39
Manage hyperkalemia

LMCC (22 decks)

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