Surgery Flashcards
What is the treatment of recurrent esophageal varices bleeding
Atenolol
Variceal bleeding case. What to give initially after resuscitation
Octeotide
small (β€3 cm) appendiceal abscess
appendectomy
Larger (>3 cm) abscesses
intravenous antibiotics and percutaneous drainage first
PSC do and tx
MRCP, Ursodeoxycholic acid
Tumors in the lower rectum (ie, tumors within 5 cm of the anal verge)
abdominal perineal resection
Young patient with breast lump. On examination, an oval mass with smooth surface 2*2cm. what is the most likely diagnosis?
cyst
Klatskin tumor
cholangiocarcinoma
Patient post cholecystectomy on day 8 (or 9) develops right mouth corner pain and fever 38.5o C. What is the management?
Antibiotic
Malleolar ulcer, edema, irregular border
Venous
Distal points, necrotic Eschar, weak pulse
Arterial
After appendectomy, a patient got abdominal infection by enterococcus faecium. He is allergic to penicillin. what are you going to give him?
vancomycin
Repair of AVF is indicated for patients with
- claudication or distal limb ischemia
- Significant edema or venous insufficiency
- Heart failure
- Progressive enlargement under ultrasound surveillance
Case of severe Clostridium difficile diarrhea. What is the management?
Oral vancomycin
Urethral trauma with bleeding post MVC. What is the next step?
Retrograde urethrogram
Classic hydatid cyst scenario. What is the management?
treatment for cysts < 5 cm: albendazole
Goal: resect the whole cyst to prevent spillage of its content
- Indications: > 10 cm, complicated cysts
Low anterior resection surgery complicated with sudden bleeding
Clamp infra-renal aorta
Prenatally diagnosed CDH
antenatal glucocorticoids
Case of congenital diaphragmatic hernia. What is the management after stabilization?
Surgical repair
Patient who had recent abdominal surgery presented with fever and other symptoms. what is the most probable cause?
Subphrenic abscess
The primary cause of postoperative fever that is unique to abdominal surgery is The primary cause of postoperative fever that is unique to abdominal surgery is
deep abdominal abscess.
45 years with history of bilateral varicose veins f
Endovascular laser ablation
Patient with GIST tumor. What is the most accurate management?
<2: observe
>2: wide local excision
Stomach tumor with positive secretin stimulation test:
Gastrinoma
Post-operative prophylaxis of DVT
Enoxaparin
In patients with cirrhosis of the liver or chronic hepatitis B/C infection, ___ is used as a screening test for HCC!
AFP
Case is acute pericarditis ECG treatment
colchicine plus NSAID
Newborn with bilateral inguinal hernia management?
Herniotomy
Posterior shoulder dislocation, the shoulder was flat, adducted, and internally rotated.
Subacromial
Indication of parathyroid surgery:
Impaired renal function
Medullary carcinoma in left lobe and the right was normal. What to do?
Total thyroidectomy
Breast mass behind areolar BIRADS (5). What investigation to order?
Core tissue biopsy
Patient cannot move distal phalanx
Profundus muscle
Chance fracture
perforated duodenum
Patient with a history of MI 2 weeks back after 24 hours form discharge from hospital the pt Presented to the emergency department with sudden onset of pain and loss of sensation on the right leg. On examination, the right leg is pale , cold , with absent pulse . What is the diagnosis ?
Acute embolic ischemia
Structure entrapped in flat foot
Spring ligament
Patient with atrial fibrillation on warfarin hematoma that required evacuation? INR, 3.9
Vit-K + fresh frozen plasma
Small incisional hernia repair
Primary repair
Large incisional hernia repair
Hernioplasty
Child with otitis media , what antibiotic should be used?
Amoxicillin
Neurogenic shock tx
Fluid
Atropine
If fluid fails and bradycardiac epinephrine
If fluid fails and not bradycardiac phenylephrine
Lower lobe left parathyrodectomy after 4 month pt complaining of tetany, fatigue ,high calcium + high PTH?
Missed adenoma < 6
Recurrent > 6
Patient young age k/c of lower limb AV malformation, which of the following will indicate intervention?
Claudication
Gray turner sign
Hemorrhagic and necrotizing pancreatitis
Ulcer with intact skin how to manage and what grade
1, transparent film
Ulcer with partial thickness loss how to manage and what grade
2, dressings
Ulcer with necrosis loss how to manage and what grade
4, debridement of necrotic tissue, and appropriate dressings.
Ulcer with tendon showing how to manage and what grade
3, debridement of necrotic tissue, and appropriate dressings.
The presentation of hypercalcemia includes stones bones thrones groans, and psychiatric overtones.
The presentation of hypercalcemia includes stones (nephrolithiasis), bones (bone pain, arthralgias), thrones (increased urinary frequency), groans (abdominal pain, nausea, vomiting), and psychiatric overtones (anxiety, depression, fatigue). Note that these are also the findings of vitamin D overdose!
Pt 56 year old with none specific lower abdominal pain . Normal hormonal levels. On ultrasound, there is a 5 cm adrenal mass , no other signs. What to do ?
Laparoscopic adrenalectomy
Empirical antibiotic therapy Indications:
Erythema and induration extending > 5 cm from the wound edge
Fever > 38.5Β° C
Heart rate > 110/min
WBC count > 12,000 cells/mm3
Empirical antibiotic therapy of choice
Low risk of MRSA: cefazolin High risk of MRSA, or individuals allergic to beta-lactams: vancomycin
WBC in septic arthritis
> 50,000
Septic arthritis triad
Fever warmth redness
AAA rupture testing
CT with contrast
After breast cancer surgery, pt came with numbness , which never most likely injured?
intercostobrachial nerve (ICBN)
After appendectomy , you found a carcinoid tumor >2, what to do ?
right hemicolectomy
After appendectomy , you found a carcinoid tumor <2 , what to do ?
simple appendectomy alone is adequate
Gold standard diagnostic modality for an ulcer in peripheral arterial disease ?
Digital subtraction angiography (DSA)
colon cancer most common site
Rectosigmoid
65 Left illiac fossa pain
Divertcular disease
Old male, Blunt abdomen, urgent to urinat, and painful urination , which diagnostic modality to use ?
retrograde cystourethrography
Questions about pt with toxic nodular goiter , presents with exophthalmos , proptosis , asking for management?
Depends on the other side, total vs hemi
Elderly ICU patient with fluid behind gallbladder. What is the treatment
Percutaneous chole
Case of deep vein thrombosis, 74 year old who is diabetic, hypertensive and has left lower limb pain. On examination, left femoral pulse is intact. Left popliteal + left dorsalis are absent. Best treatment:
Catheter thrombolysis
If a fib consider embolectomy
Patient fell on his leg with skin loss and vascular structure appear and ask about treatment
Debridement and secondary skin graft
young man with back and Buttock pain , improves with movement?
Ankylosing spondylitis
Surgery for hernia with mesh, after 3 weeks came to ER c/o pain and discharge x-ray shows 3x3 cm collection of fluid. high WBC. What is the NEXT?
Open and remove mesh
Localized pain without gastrointestinal upset
Rectus sheath hematoma
mass and tenderness in the right iliac fossa after minor trauma
Rectus sheath hematoma
Case of bilateral multiple breast masses increased in size w mensuration?
Fibrocystic is related to menstruation
OCP increase the risk of thromboembolic events, so should be stopped at least ____ before surgery
1 month
Beckβs triad
Hypotension
Muffled heart sounds
Increased jvp
Hashimotoβs thyroiditis, found malignant cells, dx:
lymphoma
Management of angiodysplasia:
Endoscopic Cauterization. 2nd: Embolization. 3rd: Right hemicolectomy
X ray shows thumb print sign.
Bowel ischemia
How to prevent hypercalciuria that causes stones:
thiazide
Someone with GERD endoscopy shows esophagitis
nissen fundoplication
Question about renal impairment with arteriovenous anastomoses or shunt:
radio cephalic
What is the first symptom to be found in compartment syndrome?
Pain
posterior acoustic enhancement on US
Phylloid
TSH low, next step?
Thyroid scan
TSH high or normal, next step?
US/FNA
Most common site of volvulus
Elderly sigmoid
Children cecum
GIST with mets?
Imatinib (tki)
Dcis
Lump and radiation
Mast and slnb
Paget
Mastectomy and slnb
Diffuse breast calcification
Mastectomy and slnb
Phylloid
WLE and radio
2.6-2.9 AAA Screen after
5 years
3-3.4 AAA Screen after
3 years
3.4-4.4 AAA Screen after
12 m
4.4-5.4 AAA Screen after
6 m
Smoking increase lung ca by __ folds
30
Smoking latency period
20 years