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Step 3 > Surgery > Flashcards

Surgery Flashcards

1
Q

What chronic disease can mimic acute appendicitis?

A

IBD - Crohns

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2
Q

How to w/u appendicitis?

A

CBC, CMP, KUB, CXR (look for fecalith), UA

US for kids and women

CT scan if unsure

clinical dx in 80% of cases

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3
Q

How to manage acute appendicitis?

A

NPO, prophylactic IV abx (24 hrs)*CTX, appendectomy

*continue abx if concerns that arise in surgery

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4
Q

What are complications and tx of them for Appendicitis?

A

wound infection -abx

intra-abdominal abscess - dx with CT, do CT guided drainage or open drainage

enterocutaneous fistula - might need right ehmicolectomy

small bowel obstruction

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5
Q

Ddx of abd distention, vomiting, and not passing gas?

A

large bowel obstruction d/t cancer/mass

diverticulitis

pseudo obstruction (functional obstruction - anticholinergic effect of meds)

sigmoid volvulus

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6
Q

What are the most common causes of small bowel obstruction?

A
  1. adhesions!
  2. hernia
  3. tumors
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7
Q

How to treat large bowel obstruction?

A

inpt

NPO

IV hydration

manage electrolyte disturbances with repletion

NG tube if bowel is dilated

gastrograffin or barium enema, colonoscopy and emergent ex lap

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8
Q

How to dx colon cancer?

A

bowel prep with golytely and abx (oral and IV)

must have colonoscopy and biopsy - entire colon must be evaluated

stage with CXR and CT scan

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9
Q

What does a barium enema show when colon cancer is present?

A

“apple core lesion”

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10
Q

How do you treat pseudo-obstruction?

A

correct electrolytes, stop anticholinergic meds

colonoscopy can be dx and tx

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11
Q

How to dx and tx colonic volvulus?

A

dx with ct scan

dx/tx with colonoscopy or contrast enema

surgery only for recurrent or nonviable bowel (acute abdomen)

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12
Q

How to dx/tx diverticulitis?

A

CT scan

IV abx, IV fluids, bowel rest

if acute abdomen - surgical emergent laparotomy

barium enema or colonoscopy *not in acute stage d/t risk for perforation to make sure not colon cancer!

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13
Q

Initial w/u of suspected small bowel obstruction?

A

CBC, CMP, LFTs, amylase/lipase

KUB

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14
Q

How to tx small bowel obstruction?

A

NG tube to decompress

IV fluids

foley catheter

serial abdominal exams and xrays

bowel rest

monitor and replete electrolytes

*if turns to complete obstruction (no flatus or gas in rectum, no bowel movement for 12 hrs, peritonitis) -emergent surgery!

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15
Q

What is the difference between ilues and obstruction?

A

ileus doesn’t have pain like an obstruction

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16
Q

How to work up and treat concern for an acute arterial embolus in an extremity?

A

start hepain

angiogram - to dx

surgical embolectomy to remove the clot

*if compartment syndrome - fasciotomy

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17
Q

How do you work up and tx cholecystitis?

A

RUQ U/S

HIDA scan if US doesn’t dx the cholecystitis

NPO

IV abx

cholecystecomy if symptoms worsen or do not improve in 24-72 hours with abx

*if symptoms improve acutely, f/u with elective cholecystectomy in 6-8 wks

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18
Q

What is long term counseling for a pt without a gall bladder?

A

avoid large meals amounts of fatty food!

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19
Q

What abdominal dx has the hallmark sign of pain out of proportion to exam?

A

mesenteric ischemia

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20
Q

What do labs show in mesenteric ischemia?

A

lactic acidosis - ph acidic

guaiac pos stool

no other significant findsing than pain

hx of a fib

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21
Q

How to tx mesenteric ischemia?

A

can do supportive treatment with IV NS and anticoagulation with heparin if pt doing ok

otherwise. ..
1. mesenteric angiography
2. surgical exploration for embolectomy and possible bowel resection if peritonitic

22
Q

What are the 2 most common causes of pancreatitis?

A

alcohol or gallstones

23
Q

How to work up and tx testicular torsion?

A

*clinical - go straight to surgery

if unsure…

doppler US of testicle for blood flow

order KUB to look for signs of incarcerated hernia

tx: emergent surgery to detorse with bilateral orchiopexy (goal within 4 hrs)

24
Q

How to evaluate and tx stab to abdomen?

A

CBC, type and cross, floey catheter placement (look for blood), KUB and CXR)

  1. abdominal CT scan with IV contrast (looking for free air or fluid)

If penetrates fascia (into peritoneum) - surgical exploration

If does not penetrate - close the wound

IF SIGNS OF SHOCK GO STRAIGHT TO OR

25
Q

How do you manage a penetrating abdominal gunshot wound?

A

ABCs

OR

26
Q

How to work up and tx suspected esophageal perforation?

A

CBC, EKG, CXR, KUB

upper gi wtih gastrograffin contrast showing contrast leak into chest

tx: IV fluid, broad spectrum Abx

OR exploration and repair if leakage into thorax

*if cervical loaction, can watch without OR if doing well

27
Q

What is the difference between an omphalocele and gastroschisis?

A

omphalocele - encased in a peritoneal wall

gastroschisis - no peritoneal wall

28
Q

How to manage an omphalocele?

A

surgical repair

29
Q

How to manage gastroschisis?

A

surgery with silo procedure (bowel inflammed and can not be closed)

NICU, IV abx

30
Q

When do you repair umbilical hernias in children?

A

if still there when child is over 5 years old

31
Q

How to assess and manage a diabetic foot ulcer?

A

intiial labs - CBC, xray

MRI to look for osteomyelitis

*if present, surgical debridement/poss amputation and broad spectrum abx, send tissue for culture

IV abx long term if osteomyelitis

*if no osteo, Abx, glucose control, bed rest, wound care

32
Q

What are the indications for surgery with an abdominal aortic aneurysm?

A

size > 5 cm

growth > 0.5 cm per year

symptomatic

rupture

33
Q

How to evaluate/work up AAA?

A

CBC, electrolytes

EKG

CXR

CT scan with IV contrast (for initial dx!)

*US can be used for f/u surveillance

34
Q

What is the ddx of bloody nipple discahrge?

A

intraductal papilloma (most common)

breast carcinoma

trauma

breast abcess

35
Q

How to work up and dx breast mass?

A

mammography

U/S

excisional biopsy of mass for dx

36
Q

What are the types of breast cancer and how to tx?

A
  1. ductal carcinoma in situ

*tx with mastectomy or radiotherapy + 2 yrs hormonal tx if receptor +

  1. lobular carcinoma in situ

*tx with close watch or bilat mastectomy if high risk (BRCA1 +)

  1. ductal carcinoma infiltrative

*surgery (mastectomy or lumpectomy w/radiation) + chemo/hormonal

  1. lobular carcinoma infiltrative

*surgery (mastectomy or lumpectomy w/radiation) + chemo/hormonal

37
Q

What is the ddx for a lump in neck (thyroid)?

A

nodular goiter

thyroid cancer

thyroid adenoma

38
Q

How to work up thyroid mass?

A

TFTs

Fine needle aspiration cytology and US

39
Q

What syndromes are associated with medullary carcinoma?

A

MEN type 2A

MEN type 2B

40
Q

How to tx medullary thyroid cancer in MEN syndromes?

A

take out pheochromocytoma first, then take out thyroid cancer

41
Q

How to stage and tx thyroid cancer?

A

remove thyroid gland (total thyroidectomy)

then stage with radioactive iodine scan for any other thyroid tissue in the body

*if positive, do therapuetic iodide tx and then recheck scan in 6 wks

42
Q

What long term management do pts with thyroid cancer post resection need?

A

long term thyroid replacement (levothyroxine)

43
Q

How to work trouble swallowing food?

A

CBC, CMP, CXR, upper GI swallow w/ barium study

next step: upper endoscopy and biopsy

44
Q

What is the best test to look for local invasion of tumors of GI tract?

A

endoscopic US

45
Q

What is the most common type of esophageal cancer and how to manage?

A

adenocarcinoma from GERD

monitor with endoscopy

when Barrett’s goes to high grade dysplasia - resect

46
Q

How to tx carpal tunnel syndrome?

A

rest

orthotic splints

NSAIDs

steroid injections

*if need surgery (very rare) must get EMG adn nerve conduction study first to confirm dx

47
Q

How to work up a scaphoid fracture (of the wrist)?

A

Wrist x ray (but may be negative at first)

splint/cast

repeat x rays in 1-2 wks

*if not definitive, get MRI to dx

48
Q

How to dx pancreatic cancer?

A

CA 19-9 elevated

CT scan is gold standard to dx

49
Q

How to tx pancreatic cancer?

A

pancreaticoduodenectomy (Whipple)

*will not resect if tumor is not encased in blood vessels or has positive lymph nodes in liver or liver mets

50
Q

How to manage congenital diaphragmatic hernia?

A

place NG to decompress

ABCs - intubation

operative repair

51
Q
A

Step 3 (15 decks)

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