Surgery Case Files Flashcards
Mallory-weiss tear
Proximal gastric mucosal tear follow vigorous coughing, retching, or vomiting. Usually self limiting and amenable to endoscopic and or medical management.
Dieulafoy’s erosion
Bleeding from an abarrant submucosal arter located in the stomach. Endoscope is tx
What is the most effective long-term medical therapy following upper GI bleed?
PPI (or H2 blockers), H. pylori testing, NSAID discontinuation and replacement with a selective COX-2
Indications for surgery in upper GI hemorrhage:
Complicated peptic ulcer disease with massive, persistent, or recurrent upper GI hemorrhage or in associated with giant nonhealing ulcers (>3cm)
ER receptor positive breast cancer is best treated with this drug
Aromatase inhibitors
What is the advantage of a core needle biopsy over an FNA?
FNA only will show malignant cells and can not determine invasive v. in-situ. A core needle can, and is therefore needed before staging can take place.
Which breast cancer treatment is associated with uterine cancer?
Tamoxifen
What is the next step after a patient has failed PPI and has GERD with symtoms of reflux?
Endoscopy and 24hr pH monitoring.
extraesophageal complications of GERD?
laryngitis
reactive airway disease
recurrent PNA
pulmonary fibrosis
When do most esophageal perforations take place?
During endoscopic procedures
Why do most patients with esophageal rupture have a left pleural effusion?
Because most spontaneous ruptures occur in the distal thrid of the esophagus
Best intitial test to confirm an esophageal rupture?
Water soluble esophagogram
Primary surgical repair of the esophagus is preferred for lesions less than this old…
24hrs
Treatment offered for stage III melanoma
Interferon 2A
Only promising treatment for stave IV melanoma?
Interleukin 2
Which scoring system is best for melaoma?
Berslow system
Difference between biliary colic and acute cholecystitis?
Acute cholecystitis– elevated WBC count
Biliary colic– RUQ US with stones and pain but no white count
When should a provider suspect choledocolithiasis over cholelithiasis?
CBD stone should be sispected if there is a stone greater than 5mm diameter in the duct with elevated LFTs
Why should steroids not be used for a burn greater than 10%?
Infection risk
What is the interval for colonoscopy for someone with an abnormal scope? How about someone with a normal scope?
Surveillance every 3 if polyps identified
Repeat in 5 years if the polyp were not found to be abnormal
Preoperative evaluation of patients with colorectal cancer should include these studies…
CXR
CT ABD and Pelvis
What are the coloscopy recomendations for those with FAP? HNPCC? Strong FMHx?
FAP- Flex Sig every 1-2yrs starting at age 10-12
HNPCC- Screening starting at age 25
FMHx- Starting at age 40 or 10 years before the age of relative when diagnosed
What is the most common thyroid cancer?
Papillary thyroid carcinoma
MEN2 cancers
Medullary thyroid
pheochromocytoma
pituitary adenoma