Surgery Flashcards
1
Q
What is the most common thyroid cancer?
A
papillary
2
Q
What is the most common risk factor for bladder cancer?
A
smoking
3
Q
What is split S1 and S2 heart beats a side effect?
A
atrial septal defect
4
Q
What is a hypocalcemia a sign of?
A
hyperparathyroid
5
Q
What are the symptoms of hypocalcemia?
A
trousseau’s and chovostek’s – hyperreflexia
-prolonged QT
6
Q
What weight loss surgery has malabsorption and restrictive qualities?
A
gastric bypass (roux en y) -sleeve and band are only restrictive
7
Q
What are the signs and symptoms of B12?
A
AMS, neuro symptoms, increased MMA and homocysteine
8
Q
What are the signs and symptoms of pheochromocytoma?
A
intermittent HA, hypertensive crisis, young pt
9
Q
What is the tx of pheochromocytoma?
A
removal
10
Q
What is the initial study when a patent has bad breath and food is getting stuck?
A
barium swallow
11
Q
What is a trousseau’s sign a sign of?
A
hypocalcemia
12
Q
What is a concern when doing a thyroidectomy?
A
hoarse voice - don’t cut the recurrent laryngeal nerve
13
Q
What is the treatment of ulcerative colitis?
A
proctocolectomy
14
Q
Dysphagia with solid foods and liquids, what is the dx?
A
achalasia or cancer
-can be dysphagia with food first then eventually liquid
15
Q
Elderly man with foul undigested food, EGD shows webs, what is the dx?
A
Schatzki Ring
16
Q
Palpitations, headache, excessive sweating, how do you dx?
A
urine metanephrines
17
Q
What is the pancreatic cancer marker?
A
Ca 19-9
18
Q
Other than a lactate dehydrogenase and beta-HCG what other test do you order with testicular cancer?
A
alpha-fetoprotein
19
Q
How do you diagnose a thyroid mass?
A
fine needle aspiration or radioactive iodine
20
Q
What is a nonhealing peptic ulcer disease a symptom of?
A
Zollinger-Ellison syndrome
21
Q
How do you treat a 1 cm stone?
A
lithotripsy
22
Q
Periumbilical pain - RLQ pain is a sign of?
A
appendictis
23
Q
Blue discoloration of umbilicus is what?
A
Cullens
24
Q
What is severe diarrhea after eating and surgery a sign of?
A
dumping syndrome
25
What is the dx when you have an alcoholic with vomiting blood?
Mallory Weiss Tear
26
What is the tx of necrotizing fasciitis?
surgery STAT
27
What is the description of grade 4 internal hemorrhoid?
prolapsed and cannot be reduced
28
Numbness and paresthesia is a sign of?
hypocalcemia
29
What do we try to prevent when a patient has GERD?
Barrett's
30
Which obesity surgery has malabsorption?
bilopancreatic
31
Why does adjustable gastric bypass have a complication others don't?
other procedures do not require anastomosis - which can lead to leakage
32
What is a complication of lap band?
slips
33
A patient presents with flank pain and hematuria, how do you dx?
non contrast CT
34
How do you dx pyloric stenosis, a child with mass and non bilious vomiting?
Ultrasound (upper GI series)
35
What is the treatment for gastroparesis?
metoclopramide
36
Post op, crackles, and cough, what do you order?
CXR
37
What do you bridge coumadin with to treat a pre-op DVT?
lovenox
38
What is the dx when you have severe bleeding from wound and prolonged everything?
DIC
39
What is the dx when you have severe bleeding and deficiency in factor IX?
hemophilia B
40
What is a characteristics of Ransons pancreatitis criteria?
LDH > 370
41
What is a diagnostic feature of celiac disease?
blunt mucosa
42
What does the TIPS procedure has a risk of causing?
hepatic encephalopathy
43
What do you watch a AAA with?
ultrasound
44
Which type of colitis bleed?
ulcerative
45
Patient with diverticulitis, then it sounds like it perforated later, what is the tx?
surgery right away
46
What hernia is in the inguinal ring?
inguinal hernia
47
Hyperparathyroidectomy causes what complication?
hypocalcemia
48
What is a symptom of hyperparathyroidism?
Vitamin D deficiency
49
How do you diagnose H plyori?
biopsy
50
What do you check in order to check a patient's vitamin k?
PT
51
What is cholecystitis?
cystic duct inflammation
52
What does hemodialysis use?
AV fistula
53
What is the dx when there is a stone in the common bile duct?
choledocolithiasis
54
What procedure is a man most like to have?
whipple (87%)
55
Dry erosive nipple that is not healing with steroids, how do you dx?
biopsy - this is paget's
56
What is the dx when you have a wound not healing with yellow drainage?
seroma
57
What dx test do you want to do when a patient presents with cool leg and low pulses?
ABI
58
What is the next step when a patient presents with cool leg an no pulses?
revascularization
59
What is the tx for a enlarged sigmoid volvulus?
sigmoidoscopy and decompression
60
What is a symptom of varicose vein?
lipodermatosclerosis
61
How do you treat H pylori?
treat with (CAP) – clarithromycin + amoxicillin +/- metronidazole + PPI (i.e. Omeprazole)
62
What is the dx when a patient has right facial droop and arm weakness?
left middle cerebral artery
63
What is a symptoms of subclavian steal syndrome?
blood pressure discrepancy
64
What are examples of transudative effusions?
congestive heart failure, pulmonary effusion, cirrhosis, ascites, nephrotic syndrome
65
What surgery is needed with ascending colon cancer?
right hemicolectomy
66
What should a holosystolic murmur make you think of?
mitral regurgitation
67
What vaccine is contraindicated after a kidney transplant?
nasal influenza
68
What is the treatment of MRSA cellulitis?
doxycycline or vancomycin
69
What is the dx when you have mass on in the hyoid bone?
thyroglossal
70
What is the cause of a women with RA that has PUD?
NSAIDs
71
Patient has temporal pain and high ESR, what is the dx?
giant cell arteritis
72
How would non cancerous in the esophagus look?
smooth and well defined
73
What is the sign for a DVT?
homans
74
What is a symptom of perforate PUD?
melena
75
What will a patient with mesenteric ischemia have in their past medical history?
Afib
76
What is the dx when a hernia is in the inner thigh?
femoral
77
What is the presentation of an anal fissure?
tearing rectal pain and bleeding which occurs with or shortly after defecation, bright red blood on toilet paper
78
What is the tx of an anal fissure?
sitz bath
79
What is the most common cause of an upper GI bleed?
peptic ulcer disease
80
What are the side effects of lidocaine?
central - seizure
| cardiac - arrhythmia
81
What is the treatment of refractory heart failure?
combined vasodilator therapy
82
What do you bridge warfarin with?
heparin
83
What is found on PE with a obturator hernia?
lump in the medial thigh
84
What is the pathognomonic physical exam finding with acute mesenteric ischemia?
pain out of proportion
85
What is a symptom of chronic mesenteric ischemia?
fear of eating
86
What is multiple endocrine neoplasia, type II associated with?
medullary thyroid cancer
87
How do you workup a thyroid nodule?
ultrasound then FNA
88
When do you refer an AAA to a vascular surgeon?
> 5 mm in 6 months or exceeds 4 cm
89
What do you give post-carotid endarterectomy?
nifedipine
90
What is the treatment for a chronic fissure?
botulinum toxin and nifedipine cream
91
What is the treatment for claudication?
pentoxifylline and cliostazol
92
What would Crohn's show on barium enema?
extension into the mucosa, submucosa and muscularis (cobble stoning)
93
What is the treatment for Chron's that is refractory to steroids?
surgery
94
What are the signs and symptoms of autonomic dysreflexia?
sweating, flushing, and hypertension
95
Guy came in and you couldn't feel one of his testes, what is the dx?
hydrocele
96
Why do you perform surgery on someone with chronic pancreatitis?
intractable pain
97
What kind of hernia is under the inguinal ligament?
femoral
98
Suspicion for rupture esophagus post endoscopy, what initial test will detect it?
chest x-ray
99
What is the treatment of hemorrhoids that do not hurt but bleed with defecation?
dietary modifications
100
Hemorrhoids below what hurt?
dentate line
101
What pre-op test do you want to check for someone with 10 years of DM and on dialysis?
electrolytes
102
Post-op patient is having EKG changes (inferior ST elevation and later ST depression, also is having a fever, what is the cause?
pericarditis
103
Tingling and pain down the left arm radiating to the left hand associated with the left side of the face swelling, what else will you see?
miosis
104
What are the symptoms of horner syndrome along with pancoast syndrome?
miosis, anhidrosis, ptosis, exophalthmos + brachial plexus affected symptoms that give the tingling
105
Guy is post-gastric bypass surgery, what is he most at risk for now?
B12 deficiency
106
Guy was over 50, had signs of anemia, and changes in stool, what do you suspect?
colorectal cancer
107
What is the dx when an inguinal hernia can not be reduced?
incarcerated
108
What are the characteristics of AAA?
- 6 months check when between 2.5 - 5.0 cm
- usually grows around .22 cm a year
- 5 cm is when you refer it for surgery
109
When do you use milrinone (primacor)?
cardiogenic shock
110
What is the dx of IBD with rectal bleeding?
ulcerative colitis
111
Testicle pain that is relieved with elevation
epididymitis
112
Is a person with UC or Chron's more likely to form a fistula?
crohns
113
Elective anorexia postprandial pain, what is the dx?
(chronic) mesenteric ischemia
114
Afib causes, what stroke?
cardiogenic
115
High CO2 and acidotic, what is the dx?
respiratory acidosis
116
Prolonged QT and post thyroidectomy, what is the dx?
hypocalcemia
117
What is hand flapping a sign of?
encephalitis
118
What is the tx of furuncle?
I and D
119
What is the citalozol used to treat?
claudication
120
What is the tx when you have pain at rest?
revascularization angiogram
121
How do you dx atelectasis?
chest x-ray
122
How do you confirm a lung nodule in a smoker?
open biopsy
123
What is not a risk factor for bladder cancer?
female
124
What can develop on post op day 5?
pulmonary embolism
125
What do you order when a patient has broncho excretions on post op day 2?
chest x-ray
126
Unilateral vision loss and headache, what is the dx?
central ocular artery occlusion
127
What is the tx of intussusception?
barium enema is dx and tx
128
How do you dx a Zenker's?
barium swallow
129
What is a complication of a TIPS procedure?
hepatic encephalopathy
130
How do you dx a SBO?
air-fluid levels
131
What do you add is a PPI is not working?
H2 blocker
132
A patient presents with palpitations, hypertension, and sweating, what is the dx?
pheochromocytoma
133
What do you give to a patient preoperative for pheochromocytoma?
alpha blockers and beta blocks (in that order)
134
What is inferior to an inguinal hernia?
femoral
135
What is the tx for a pregnant woman with hemorrhoids?
laxatives
136
What levels do you check before a renal transplant?
CBC, electrolytes, LFTs
137
Diarrhea, flushing (carcinoid syndrome), how do you dx?
5 HIAA and metanephrines
138
Patient treated for PNA spikes, fever, and diarrhea, what is the tx?
metronidazole - they have c. diff
139
What is the tx for pancreatitis gallstones?
ERCP
140
What are the lab findings for a patient on warfarin?
elevated PT and INR
141
How do you dx Zollinger Ellison Syndrome?
increased gastrin level > 1000
142
What is the dx when the scrotum illuminates?
hydrocele
143
What is a risk factor for testicular cancer?
cryptorchism
144
How do you dx H pylor?
biopsy of esophagus and duodenum
145
What is the initial treatment for a bleeding esophageal varices?
hemolytic stability
146
ST elevation then anterior ST depression
MI
147
What is the best way to stage hepatocellular carcinoma?
Ultrasound then CT
148
What are the signs and symptoms of toxic mega colon?
dilation > 6 cm + septic sx
149
What vitamin helps with wound healing?
Vitamin A
150
What do you give to a patient who has hives and their throat is closing?
epinephrine IV
151
Pain on defecation, what is the dx?
anal fissure
152
What is a lab finding of malnutrition?
serum prealbumin < 10 mg/dL
153
What are the characteristics of a epidural hematoma?
Transient loss of consciousness from injury, then lucid period followed by increasing drowsiness, headache, and unilateral (contralateral) weakness.
154
What are the signs and symptoms of hyperthyroidism (Thyrotoxicosis)?
Nervousness, weight loss with increased appetite, heat intolerance, increased sweating, muscular weakness and fatigue, increased bowel frequency, polyuria, menstrual irregularities, infertility
155
What are the signs and symptoms of Graves disease?
non-tender and heat intolerance
156
When do you treat chronic pancreatitis?
intractable pain
157
How do you treat chronic pancreatitis?
pancreatic enzymes
158
How do you evaluate head trauma?
CT without contrast
159
Waxy pale burn from hot oil, what degree?
third degree
160
What is the tx for tinea capitis?
oral griseofulvin
161
60 yo woman w/ controlled HTN and DM comes in w/ recurrent DVTs. On Warfarin and HCTZ. She isn’t symptomatic however. INR was 2.5 (or 2.9). What should you do to treat her?
IVC filter
162
Pt w/ claudication in butt, hips and impotence. Where is the arterial insufficiency most likely located?
Aortoiliac
163
Pt s/p resection from gastric carcinoma. Now having paresthesias and decreased vibratory sense. What is the Dx?
Pernicious anemia- B12 deficiency
164
Pt who got elective endoscopy after GERD dx. Wakes up w/ pain and Hypotension. What other PE sign would be seen?
SubQ emphysema
165
Paraplegic pt who is beginning to get decubitus ulcer. What should you do?
Alleviate pressure points - turn patient every 2 hrs, you can get an ulcer within 30 mins.
166
You see the apple core lesion on the barium. What do you dx this pt with and how do you treat?
Colon Cancer and Surgery
167
Pt who is on mesalamine and keeps getting increasing sx of moderate Crohn’s. What would you start her on to help with her sxs?
Prednisone
168
Pt on warfarin and the INR was 9. What should you tx them w/ if there’s no active bleeding?
PO Vit K
169
Diet recommendation for someone on heparin?
Watch potassium
170
Diet recommendation for someone on coumadin?
Avoid green leafy foods.
171
What is the Trousseau’s sign. Also where is trousseau’s sign seen?
Hypocalemia
- Usually you get hypocalcemia after thyroid removal, because you can devascularized the parathyroid.
and seen in the hand
172
Pt comes in w/ symptomatic hypercalcemia. What symptoms would you likely see?
Bone (get eroded), moans (constipation), stones, groans (fatigue).
173
What medical history would indicate the need for parathyroidectomy?
Hip fracture from osteopenia
174
Tx for testicular CA?
Orchiectomy
175
Tx for thyrotoxicosis?
IV PTU
176
Sxs of thyroid storm?
diarrhea, hypertension, weight loss, tachycardia, tremors
177
Muscle protruding through mucosa in proximal esophagus, what would you dx?
Zenkers Diverticulum
178
How would you treat Zenkers?
Diverticulectomy and Myotomy
179
Lady had progressive left ear pain, then facial droop, inability to raise eyebrow.
Bells palsy
180
Sign of UC?
Bloody diarrhea, continuous, no fistula.
181
Treatment of UC?
Proctocolectomy
182
Patient has paresthesias and muscle weakness/spasms after total thyroidectomy. Why?
Hypoparathyroidism --> hypocalcemia
183
Patient has PUD that has not gone away with treatment over the year. Definitive Dx for diagnosis Zollinger Ellison?
Measure gastrin levels or secretin stimulation
184
Gastrinoma can be located where?
pancreas or duodenum
185
Woman with hematuria what would reduce her risk of bladder ca?
Smoking Cessation
186
Consequence of feeding syndrome with anorexia?
Hypophosphatemia
187
What cells do you see in asplenic pt?
Howell-jolly bodies
188
What is the mechanism behind Addisons?
autoimmune adrenal insufficiency
189
Test for Addison’s?
ACTH stimulation test
190
Where is ACTH made?
Anterior pituitary, it stimulates adrenal gland to secrete cortisol, aldosterone, etc.
191
Person gets N/V, fatigue after pituitary tumor removal. Test you should run?
24 hour urinary cortisol
192
Woman w/ fluctuant, erythematous mass in axilla. Afebrile. First treatment for this?
I&D
193
Pt w/ oliguria, increased BUN/Cr and low urine Na. Likely dx?
AKI - hypovolemia
194
Pt with all the signs of a DVT. What would you likely see on PE?
Pain upon dorsiflexion of foot
| Homan’s sign
195
Pt was urinating 5.5L of fluid in 6 hrs. What was their metabolic state?
Hypokalemic alkalosis
196
Pt had respiratory acidosis. What lab finding would you see?
pH - low < 7.35
PaCO2 - high >45
HCO3 - high >26
197
Pt w/ PMH of PUD. Comes in w/ wt loss, projectile vomiting after she eats. Likely PE sign you would see
peritoneal signs - rebound tenderness
198
Pt with ABI of 0.68 what is treatment?
Lifestyle modifications
199
Pt post operative day 5, CXR shows lobar infiltrates what do you dx and how do you treat?
Pneumonia and Vanco, Zosyn
200
SE of thyroidectomy?
Hypothyroidism
201
Labs describing biliary disease with a positive autoimmune factor?
Primary biliary cirrhosis, sclerosing cholangitis (cause this is with UC)
202
Moderate risk for colon cancer?
First degree relative
203
What surgery to do for crohns?
Ileocolectomy
204
Hydrocele presentation?
- Owl or Pumpkin sign
- Transilluminate
- Swollen testicule
- Painless
205
Best test for staging of RCC?
CT scan
206
Half life for heparin?
1.5 hrs
207
which blood thinner is intrinsic and which is extrinsic?
```
Heparin = intrinsic
Warfarin = extrinsic
```
208
What level of PTT indicates heparin is a therapeutic level?
60-90
209
What INR levels is normal in a patient on warfarin compared to a pt with prosthetic heart valves?
2-3 and 2.5-3.5
210
What lab findings would you see in a pt with Von Willebrand?
PTT increases and PT is normal
211
DIC increases PT and PTT, what usually causes this?
Pregnancy, trauma, malignancy
212
Diagnostic test for description of perforated ulcer?
XR (look for airy in the diaphragm)
213
Asks which of the following has relieving factor of sitting leaning forward
Pancreatitis and pericarditis
214
Origin of anal fissure that is located below the dentate line?
Posterior midline
215
What valvular abnormality will cause left atrial and ventricular hypertrophy?
Mitral Regurg, AFib, and S4
216
What test to do for a stable patient with pulsatile abdominal mass?
Ultrasound
217
Person had AAA fixed and 12L of fluids in but now has progressive oliguria and only 0.9 urine output, what do you want to do?
Give Norepi
218
Severe HTN after carotid endarterectomy what do you want to give?
Nifedipine
219
Afib and hypertension a picture of the CT of head what type of stroke?
Hemorrhagic
220
Person had car accident, has hemorrhagic shock, what is causing their metabolic state?
lactic acidosis- d/t lack of perfusion and switch to anaerobic metabolism and make lactate
221
Person in a car crash on warfarin now is hemorrhaging, what is the reversal agent?
FFP
222
Person has right upper lobe small cell lung cancer that has spread to local lymph nodes, what is the primary treatment?
Chemotherapy
223
Who would benefit most from renal artery angioplasty?
55 year old with HTN resistant to meds
224
Waxy burn, sign of what degree burn?
3rd degree
225
Ph was 7.48, CO2 44, HCO3 28, what metabolic state are they in?
Partially compensated metabolic alkalosis
226
Ph 7.2 with high CO2 and low O2, what metabolic state are they in?
Resp acidosis
227
Person had surgery 5 days ago, vital were stable (HR:96), EKG shows sinus tach with inferior ST elevations and lateral ST depressions?
Myocardial Infarction
228
Person had a previous enlarged thyroid that was 1.6 then was aspirated and shrunk to 1.3 now its back at 2.9 what do you do?
Surgical exploration and resection
229
Person has tachycardia, diaphoretic and tremor?
Subacute thyroiditis (painful thyroid mass)
230
Person has hyperparathyroid and high ionized calcium what test do you want to order?
Parathyroid nuclear scan
231
Why is it important to have good dental care?
Aspiration pneumonia
232
Pt had surgery now has fever and increased respiratory sputum what test?
CXR to observe for pneumonia
233
What will you see on chest xray of atelectasis?
Distal lobar collapses
234
What will you see on chest xray of pneumonia?
Consolidation
235
Fundal gastritis anemia indicates what?
Pernicious anemia
236
Pregnant female with prolapsing hemorrhoids with straining not painful but has blood, what is the tx?
Metamucil
237
Patient with internal and external hemorrhoids not painful had blood, what is the tx?
Rubber band ligation
238
Crohn's pathology?
Crypt inflammation and abscesses, which progress to tiny focal aphthoid ulcers.
These mucosal lesions may develop into deep longitudinal and transverse ulcers with intervening mucosal edema, creating a characteristic cobblestoned appearance to the bowel
239
Air in the biliary tree indicates?
Gallstone ileus
240
Girl is bleeding through her gums and has Increased aPTT and bleeding time, normal PT
Von willibrand
241
Stones in the hepatopancreatic duct what should you do?
ERCP
242
Person has ascites and palmar erythema what liver disease do they have?
Cirrhosis
243
What vitamin is associated with bleeding?
Vitamin K
244
Treatment for someone with von willebrand's?
Desmopressin - cells express von willebrand's factor and platelets stick to it
245
Rectal abscess tx?
I&D
246
Ileocecal stranding sign of what?
Crohns
247
Person has intestinal inflammation for 5 years what is he at risk for?
Malignancy
248
Treatment of an intra-abdominal abscess post appendectomy?
Drain then Rocephin + flagyl
249
When to give abx for surgery?
Within 1 hr of incision
250
Diverticulitis what procedure do you do?
Hartmanns (emergent procedure)
251
Pt has flushing sweating dyspnea (carcinoid syndrome) what can you measure in their urine?
5-HIAA
252
Most common area for a volvulus?
Sigmoid
253
Scaly lesion on leg KOH + what do you give?
Topical antifungals
254
Man comes in what a boggy testicle can’t palpate it, ultrasound shows non communicating with peritoneum, what do you want to do?
Hydrocelectomy
255
Patient has an acute onset of headache, n/v, photophobia and neck pain?
Migraine
256
Patient was hit by a bat had lucid interval, what do you suspect?
Epidural hematoma
257
S/Sxs of diabetes insipidus?
mc neurogenic after brain surgery or trauma, lots of urination, sodium goes up in serum
258
S/Sxs of SIADH?
paraneoplastic syndrome, to much adh, serum sodium goes down and low urine
output
259
Tx for symptomatic hyperkalemia?
Calcium Glucagon (to stabilize cardiac myocytes)
260
Treatment of Autonomic Dysreflexia?
CCB - nifedipine or nitrates
261
What to order pre-operatively for a patient with Chronic Renal Disease?
Electrolytes
262
Reaction to sulfa drugs (they describe the appearance of the rash)?
Erythema multiforme - target like apperance
263
Preop testing reveals elevated BUN/CR and a decreased FENA <1%, likely due to?
Prerenal Azotemia
264
Nec Fasciitis tx?
Surgical debridement
265
Man has “cauliflower” looking protrusions from his rectum Tx?
Podophyllin (condylox)
266
What is most worrisome if someone with constant upper abdominal pain?
Odynophagia
267
How do you treat an anal fissure that is non-infected?
Sitz baths
268
Numbness over the fourth and fifth fingers, what nerve?
Ulnar
269
Baby with a burn, erythematous and blisters what degree?
2nd degree
270
Pt with going for varicose vein surgery what do you see on skin?
Lipodermatosclerosis
271
Spooning of the nails is a sign of what?
Iron Deficiency Anemia
272
57 y/o post op day 1, with acute CP, SOB, sweating, EKG shows 3mm ST in V3 to 5, what else would you see?
Increase venous dilation
273
Pt with skin wound, what vitamin do you give?
Vitamin E
274
Management of fistula in crohn's?
Seton placement and drainage, fistulotomy, fistulectomy
275
S/Sx of addisons disease?
progressive anemia, low blood pressure, great weakness, and bronze discoloration of the skin.
- It is caused by inadequate secretion of hormones by the adrenal cortex.
276
TIA symptoms, pt is safe to discharge who do you tell the pt to follow up with?
Neurology
277
Adrenal insufficiency what vitamins are increased and decreased?
Increased K and decreased Na
278
Muffled heart sounds, management
Pericardiocentesis
279
15 min post central venous cath, develops acute dyspnea, decreased oxygen saturation, what likely occurred?
Pneumothorax
280
Decreased FEV1, decreased FVC, increased TLC indicates?
COPD
281
RUQ. jaundice, (+) murphys, mild leukocytosis, increased LFTs, indicates?
Choly
282
Dilated paraumbilical veins and painful purple anal mass, indicates?
Cirrhosis
283
HTN, hypokalemia, elevated serum cortisol/ACTH levels indicates?
Cushings
284
Post prandial abd pain worse after 48 hours, periumbilical pain, N/V, mildly distended abd, hypoactive bowel sounds?
SBO or Mesenteric Ischemia
285
Significant weight loss, severe epigastric abd pain and back pain with jaundice would make you think what?
Pancreatic cancer
286
Adrenal mass, labs hypokalemia, HTN, confirm dx with what labs?
Serum cortisol and ACTH
287
LLQ pain, diverticulitis, tender of DRE, what diagnostic test do you do next?
CT scan
288
What medication is given following a carotid endarterectomy?
CCB
289
72 w/ EoTH abuse with nystagmus and ataxia and AMS what vitamin is responsible for this?
Vitamin B1 (Thiamine)
290
No taste anterior tongue, face droop, can’t wrinkled head, what is the dx?
Bells
291
A2 + P2 separation 2nd beat sound w/ inspiration is likely due to?
ASD
292
Explain atelectasis physiology
Inadequate alveolar expansion (e.g., poor ventilation of lungs during surgery, inability to fully inspire secondary to pain), high levels of inspired oxygen
293
Male w/ DM pre-op and want to eval bleeding time, what lab test should be ordered?
LFTs/ Cr serum / TSH
294
Jaundice + weight loss + boring pain to back + GB palpable would make you think?
Pancreatic tumor
295
What type of cells are seen in Hodgkin's Lymphoma?
Reed Sternberg cells
296
What is the factor for Von Willebrand's disease?
8
297
How do you first diagnose a thyroid nodule?
ultrasound
298
How do you treat biliary colic?
refer to surgery
299
What do you tell a person that had H. pylori that went away?
tell them that they are fine
300
What is heard with an atrial septal defect?
split S1 and S2
301
What is it called when epididymitis is relieve with elevation?
Prehn's sign
302
What is Cullen's sign a sign of?
acute pancreattis
303
What electrolyte abnormality can occur with Cullen's sign?
hypophosphatemia
304
What is the tx for Crohn's when the treatment is refractory?
surgery
305
Peaked T waves on EKG are a sign of what?
hyperkalemia
306
What is a risk factor for bladder cancer?
smoking
307
Periumbilical pain radiating to RLQ, alk phos and billi high, what test do you do?
CT
308
Complication of refeeding in anorexia?
hypokalemia
309
The picture of stroke, person with afib and HTN, what kind of stroke?
ischemic
310
Can't move half the face or scrunch foredhead?
Bell's palsy
311
Someone with H pylori, what do you tell them to stop?
smoking
312
Stocking glove paresthesia, what vitamin deficiency to do they have?
thiamine - B12 was not an option
313
Anal fistula is associated with what disease?
Crohns
314
Patient lives in Costa Rico, what is the organism affecting the patient?
mycoplasma tuberculae
315
How do you diagnose mycoplasma tuberculae
sputum culture
316
Patient is on warfarin and their INR is 9, what do you want to give?
FFP
317
Teenager comes in with head injury and had a lucid interval, what is the dx?
epidural hematoma
318
What scan do you want to do for a brain bleed?
CT non contrast
319
Patient comes in with a family history of AAA, what do you want to do for surveillance?
US
320
How do you assess nutrition in a pre op patient?
albumin
321
Patient had flank and umbilical hematoma, what is the dx?
pancreatitis
322
Patient had pruritic raised lesions after taking a medication, what is the dx?
allergic reaction to medication
323
A healthy man comes in for pre op testing and states he runs 2 miles and swims, what is the appropriate pre op test for him?
observe
324
How do you treat a non infected anal fistula?
surgery
325
What do you treat an anal abscess?
I and D
326
Enlarged painless mass in the scrotum, what is the dx?
testicular cancer
327
What is CEA a marker for?
colon cancer
328
What is the cause of Addison's?
autoimmune
329
Patient had surgery and now presents with hypothyroid, what do you do?
give levothyroxine
330
What induces remission in chron's?
prednisone
331
Patient with crohn's is not improving what do you do?
corticosteroids
332
What is the definitive treatment for a sigmoid volvulus?
surgery
333
Cellulitis, how do you treat?
IV vanco
334
What are the findings with cholecystitis?
pain with US probe when you go over the RUQ
335
What is the treatment for internal and external hemorrhoids at the same time?
band ligation
336
Describe a grade 3 decubitus ulcer
full skin thickness but not through fascia
337
Wound healing that is open, involves granulation and epithelial tissue, what stage of healing?
secondary intention
338
Everything is increased (PT and PTT), what is the dx?
Von Willebrand's
339
Patient with peripheral vascular disease will present with what?
hemosiderin spots
340
What is therapeutic and diagnostic for an upper GI bleed?
endoscopy
341
What hernia also presents with GERD?
hiatal hernia
342
Post op day #2-3 with fever, what is the dx?
pneumonia
343
What do you give before surgery?
beta blocker
344
What do you not give before surgery?
metformin
345
Patient is contraindicated for colonoscopy ad has to check for cancer, what do you do?
double contract barium swallow (apple core lesions)
346
What are the sx and how do you dx pyloric stenosis?
```
sx = non bilious projectile vomiting
dx = ultrasound
```
347
Man is newly diagnosed with UC, when should he get his first colonscopy?
8 year post diagnosis
348
When should a healthy person get their 1st colonoscopy?
50 years old
349
Smoker has 1 cm mass in lung on CXR, what is the next step?
CT
350
Tall thin man with scapular pain and different BPs in each arm, what is this?
aortic dissection
351
Guy with PAD has bilateral calf pain and ABI with 0.8 (normal around 1.0), what is the next stp?
monitored exercise
352
Patient has epigastric postprandial pain 2-3 hours, what is the dx?
chronic mesenteric ischemia
| -use a CTA to diagnose
353
Drug to give after carotid endarterectomy?
CCB
354
What vaccine do you to give post splenectomy?
pneumococcal
355
Post op day 5 with fever, cough, tachycardia, rales on auscultation, what is the dx?
pneumonia
356
Post gastrectomy patient has tachycardia, diaphoresis, anxiety, diarrhea after eating sugary foods, what is the dx?
early dumping syndrome
357
Chronic alcoholic patient has new onset epigastric pain, palpable mass, normal vitals, what is the dx?
pancreatic psudocyst
358
Patient with exercise induced asthma what is recommended?
post op incentive spirometer
359
Old man presenting with constipation, obstipation, what is the initial study?
colonoscopy or barium enema
360
Patient has halitosis, regurgitation of food, what is the dx test?
barium swallow
361
Pt had portocaval shunting and now has neuro sx, what happened?
hepatic encephalopathy
362
Person with fistulas and aphthous ulcers, what is the dx?
Crohn's
363
Dude with history of hemorrhagic stroke and now has a PE, how do you treat?
IVC filter
364
Woman with thickened skin, dimpling of hair follicles, skin changes, what is the dx?
inflammatory carcinoma
365
30 year woman with urinary retention, increase frequency and urgency, noted detrusor muscle dysfunction, what is the dx?
MS
