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Surgery > Surgery EOR > Flashcards

Surgery EOR Flashcards

1
Q

Buzzword: Homan’s sign

A

DVT. Pain with forced dorsiflexion

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2
Q

Test of choice to dx suspected DVT

A

Venous Doppler US

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3
Q

Describe and associate Murphy’s sign

A

Patient’s breath “catches” during inspiration with palpation in the RUQ. Ass’d w/ cholecystitis.

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4
Q

Dx test for a pt with colicky RUQ pain

A

Suspect cholecystitis:
US is initial test
Gold std is HIDA

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5
Q

How can peptic esophageal strictures be prevented in pts with GERD?

A

PPIs

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6
Q

Dx test and tx for pt with progressive solid food dysphagia

A

Suspect esophageal stricture

  • Initial test is upper endoscopy
  • If a proximal (Zenker’s, laryngeal) lesion is suspected, start with a barium esophagram instead

Management: high dose PPIs and stricture dilation

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7
Q

Your 50-YO pt is complaining of feeling uncomfortably “full” after eating. How should this patient be managed?

A

This is functional dyspepsia.
Patients <60 YO should be treated depending on presence of alarm symptoms: weight loss, progressive dysphagia, pain with swallowing, persistent vomiting, GI bleeding, mass, melena, etc.

If alarm symptoms are present, proceed straight to endoscopy.

If no alarm symptoms are present, test for H pylori and consider PPI trial.

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8
Q

Your 65-YO pt is complaining of early satiety. How do you proceed?

A

Any pts >/=60YO with functional dyspepsia (with or without alarm symptoms) get an endoscopy.

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9
Q

Pt with extensive FHx of colon, endometrial cancers are suspect for:

A

Lynch syndrome (auto dom)

Susceptible to endometrial, ovarian, renal pelvis, ureter, stomach, small bowel, bile duct, and sebaceous neoplasms.

**ASA reduces incidence of cx in Lynch syndrome!

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10
Q

Preoperative prophylaxis for a pt with acute appendicitis without perforation?

A

1 dose cefotetan 2g IV 60 minutes prior to first incision

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11
Q

Your pt has intermittent claudication and ABI is performed. What value is considered diagnostic of PAD, and what is the first-line tx?

A

ABI =0.9 = PAD

Start patient on ASA, discuss RF modification (smoking cessation, exercise, managing HTN, hyperlipidemia, and DM).

Cilostazol may be used (phosphodiesterase inhibitor)

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12
Q

What is the tx for PAD in a pt who has pain at rest?

A

Revascularization (endovascular or surgical)

Indicated with pain at rest, ulcerations 2/2 poor perfusion, concern for limb loss, or symptoms refractory to medical tx.

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13
Q

What is the MC type of thyroid cx?

A

Papillary

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14
Q

Buzzword: psammoma bodies

A

Thyroid cx (papillary is MC)

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15
Q

How is thyroid cx dx?

A

PE: solitary hard nodule (lab will show non-fxn)
Initial test: US
*Dx: FNA

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16
Q

What type of thyroid cx is ass’d with MEN II?

A

Medullary (calcitonin can be used as a tumor marker)

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17
Q

What is the most aggressive form of thyroid cx?

A

Anaplastic, however, this is the least common

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18
Q

How is a confirmed unilateral adrenal tumor surgically treated?

A

Resection via open transabdominal surgery – important for greater visualization, resection of adjacent structures if necessary.

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19
Q

How is a bilateral adrenalectomy performed?

A

Posterior retroperitoneoscopic surgery

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20
Q

How does pseudo-obstruction or ileus differ in presentation from an SBO?

A

Usually ileus/pseudo-obstruction does not have colicky pain, may not have n/v

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21
Q

When does colon cx screening for avg risk pts begin?

A

Age 45

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22
Q

Discuss timing of different modalities of colon cx screening for avg risk pt

A

All begin at 45 - 75

Colonoscopy: every 10 if negative
FOBT: Annual if negative
Sigmoidoscopy: 3-5 years if negative

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23
Q

All patients presenting with acute abdomen should have what lab drawn?

A

Lipase - pancreatitis can vary in severity of presentation

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24
Q

What are the MC causes of acute pancreatitis?

A

Gallstones > EtOH

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25
Q

What is the pathognomonic PE finding for pancreatic cancer?

A

Courvoisier sign: palpable, nontender gallblader

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26
Q

What is the MC kind of pancreatic cx?

A

Ductal adenocarcinoma

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27
Q

What are three major modifiable RFs for pancreatic cx?

A
  • Cigarette smoking
  • Sedentary lifestyle
  • High BMI
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28
Q

What is the preferred imaging and monitoring for pancreatic cx?

A

Dx imaging: abdominal CT

Monitoring: CA 19-9

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29
Q

What antibiotics are used after surgical drainage of a pilonidal cyst?

A

None unless there are complications of superimposed cellulitis

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30
Q

Describe MET documentation

A

1: Can take care of self (ADLs)

3-4: Can walk up flight of stairs, or level groud 3-4 mph

4-10: Can do heavy work around the house, climb two flights of stairs

> 10: Can participate in sports, etc

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31
Q

Your pt has hx of urinary retention. Before his Foley is removed, what med might you consider administering and why?

A

An alpha-1-adrenergic blocker like tamsulosin to relax the smooth muscle of the bladder neck and prostatic capsule. This helps relieves obstruction/prevents early recurrence of retention.

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32
Q

What are the 3 MC causes of GI bleeds?

A 
Upper GI bleeds are MC than lower.
MC causes of upper GI bleeds are ulcers and esophageal varices. 
- H pylori
- NSAID use
- Esophageal varices/portal HTN
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33
Q

What structure defines the transition from upper to lower GI?

A

The ligament of Treitz.

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34
Q

What HPI info might make you suspect a gastric ulcer vs a duodenal ulcer?

A

Gastric ulcers are worse with food (pain immediately after meals, early satiety, may have weight loss).

Duodenal ulcers are relieved with food; pain begins 1-2 hours postprandial, may wake patient from sleep. MC.

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35
Q

How are upper GI bleeds dx?

A

Endoscopy

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36
Q

What drugs are most likely to cause an IgE-mediated allergic reaction?

A

Cephalosporins and PCNs

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37
Q

What drugs often cause non-IgE-mediated allergic reactions?

A

Narcotics
Muscle relaxants
Vancomycin
Contrast

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38
Q

How is von Willebrand disease treated?

A

Desmopressin

(If this fails, consider plasma-derived VWF concentrate or recombinant VWF).

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39
Q

What physiologic process is interrupted in von Willebrand disease?

A

VWF is important in primary hemostasis: bridges platelets and subendothelial structures, contributing to fibrin clot formation. It carries Factor VIII.

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40
Q

Describe the pathologic histological change that can take place in chronically untreated dyspepsia

A

In Barrett Esophagus the squamous epithelium becomes metaplastic columnar epithelium

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41
Q

How often should a pt with Barrett Esophagus w/o dysplasia get scoped?

A

Every 3-5 years.

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42
Q

Tx of uncomplicated, symptomatic Crohn’s dz?

A

Immunosuppressants.

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43
Q

How do surgical interventions vary for patients with Crohn’s disease vs ulcerative colitis?

A

In UC, surgical resection can be curative bc affected area is contiguous.

In Crohn’s, surgical resection is only indicated for complications such as stricture/obstruction, abscess, perforation, hemorrhage, or toxic colitis. Recurrence of disease is likely to occur.

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44
Q

What are some extraintestinal manifestations of Crohn Disease?

A 
Pyoderma gangrenosum
Erythema nodosum
Ankylosing spondylitis
Arthritis
Uveitis
Liver disease
Nephrolithiasis
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45
Q

What medication is administered immediately after resection of an adenocortical carcinoma to prevent hypotension?

A

Hydrocortisone - the risk of adrenal insufficiency or adrenal crisis is increased in this patient.

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46
Q

What is the Parkland formula?

A

Determines fluid resus quantities in 2nd/3rd degree burn pts:

4mL * %BSA * Kg (weight)
Give half of this over the first 8 hours
Give the second half of this over the next 16 hours

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47
Q

What is target urine output after fluid resus in a burn patient?

A

0.5mL per kg per hour

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48
Q

What bacteria need to be covered in burn wound infections?

A

Pseudomonas

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49
Q

What is the tx for carotid artery stenosis?

A

For patients with life expectancy 5+ years, an accessible plaque, stenosis of 70%+, M&M risk <6%, and no previous endarterectomy: Carotid endartectomy.

For other patients: either stenting or medical management (antiplatelet and statin therapy).

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50
Q

How is carotid artery stenosis diagnosed?

A

Angiography is gold std

US is often initial imaging performed

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51
Q

A 65-YO obese man with HTN presents to the clinic complaining of worsening SOB with physical exertion for the past two weeks. PE reveals bibasilar lung crackles, normal heart sounds, and 1+ pitting edema in both ankles. Which of the following is the best next step?

A

Echo to identify HF

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52
Q

Differentiate the types of hiatal hernias

A

Type 1: Sliding, the stomach herniates with the esophagus at least 2 cm
Types 2-4: Paraesophageal, the gastroesophageal junction is displaced with the fundus of the stomach herniated through the phrenoesophageal membrane.

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53
Q

How are hiatal hernias managed?

A

Sliding: conservative, manage GERD symptoms

Paraesophageal: conservative unless symptoms cannot be controlled, then surgery

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54
Q

Your patient just underwent laparoscopic surgery for an SBO and now has a metabolic disturbance. What is it most likely, and why?

A

During laparoscopic surgery, a lot of third-spacing occurs = volume contraction. This fluid is high in Na and low in bicarb, leading to an alkalosis. Additionally, NG decompression likely occurred p/op, and loss of HCl causes HCO3- to be released into the serum (adding to the alkalosis). This patient is likely in metabolic alkalosis.

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55
Q

What is the most likely metabolic disturbance after massive blood loss?

A

Metabolic acidosis

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56
Q

What is the most common metabolic disturbance ass’d with post-op respiratory depression?

A

Respiratory acidosis

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57
Q

What is the medical treatment for hyperthyroidism?

A

Methimazole or PTU if pregnant

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58
Q

What is the MC cause of hyperthyroidism?

A

Graves disease: autoimmune condition in which TRAbs activate thyrotropin receptors, stimulating thyroid hormone synthesis

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59
Q

What is the ideal modality for dx SBO?

A

Abdominal CT with contrast

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60
Q

What measure of dilation is necessary to dx an SBO on CT?

A

2.5+ cm

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61
Q

What is the MC cause of SBO?

A

Adhesions

Then hernias, then malignancy

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62
Q

What is the non-operative tx of SBO?

A

NG decompression
NPO
IVF

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63
Q

What is the MC cause of large bowel obstruction?

A

Malignancy (adults)

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64
Q

If a CT is non-diagnostic, what could you order to help dx patient presenting with “the worst headache of my life”?

A

LP: a subarachnoid hemorrhage will cause hemoglobin degradation products to be present in the CSF (xanthochromia).

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65
Q

Your patient presents with a severe headache and positive meningeal signs. After confirming your suspected diagnosis, what medication should be administered to prevent a common complication?

A

Nimodipine (CCB) should be given to decrease vasospasm

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66
Q

How is pheochromocytoma diagnosed?

A

In high-risk patients: plasma fractionated metanephrines

In lower-risk patients: 24-hour urine fractionated metanephrines and catecholamines

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67
Q

You want to r/o a dx of pheochromocytoma in your patient. What drug class could interfere with the necessary diagnostic test?

A

Tricyclic antidepressants can interfere with 24-hours urine fractionated metanephrine/catecholamine tests, which are used for patients with lower risk of pheochromocytomas

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68
Q

Your patient presents with Charcot’s triad. What is it, and what is the best management of the ass’d dx?

A

Charcot’s Triad: RUQ pain, jaundice, fever

Sus for cholangitis

ERCP is the tx (plus broad spectrum antibiotics: IV zosyn or metro + cephalosporin/levoflox)

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69
Q

Name 5 instances in which non-surgical management is warranted in pts with bowel obstruction?

A
  • Early post op
  • IBD patients
  • Gallstone ileus
  • Infectious small bowel disease
  • Colonic diverticular disease
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70
Q

How is testicular cancer dx’d and monitored?

A

Initial: US
Confirm: CT
Monitor: b-hCG, LDH, or AFP if non-seminoma

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71
Q

What is the MC type of testicular cx?

A

Germ cell

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72
Q

Without imaging, what kind of head injury are you sus of if the patient passed out, then had a lucid interval, and then experienced progressive neuro deterioration?

A

Epidural hematoma

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73
Q

CT shows a lens-shaped collection of blood in the cranium. What is the affected vessel?

A

Middle meningeal artery is torn in an epidural hematoma

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74
Q

What electrolyte imbalance is ass’d with respiratory alkalosis and why?

A

Hypokalemia: in alkalotic states, K+ leaves extracellular space in exchange for H+.

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75
Q

Pt presents with decreased breath sounds, dull percussion, decreased tactile fremitus, and CXR shows blunting of the costophrenic angle. How is this condition managed?

A

Thoracentesis (pleural effusion)

76
Q

You want to know the etiology of your patient’s pleural effusion- you order pleural and serum labs of what two values?

A

Lactate dehydrogenase and protein

77
Q

What is the gold std eval for patients with sus PUD?

A

Histologic tissue evaluation

78
Q

When is surgery considered appropriate for patients with PUD?

A

Ulcers >3cm
Or pts with complications: bleeding, perf, obstruction
Or pts refractory to medical therapy

79
Q

Pt presents with amenorrhea, headaches, and loss of temporal vision. What is the treatment for the most likely dx?

A

Dopamine agonists such as cabergoline or bromocriptine.

If unsuccessful, transphenoidal resection of pituitary should be considered.

80
Q

Buzzword: string sing

A

Seen on UGI series, pyloric stenosis

81
Q

Buzzword: target sign

A

Seen on US, pyloric stenosis

82
Q

What measurements, seen on US, are definitive for pyloric stenosis?

A

Thickened pylorus >4mm

Elongated pylorus >14mm

83
Q

What electrolyte and metabolic disturbances are likely present with pyloric stenosis?

A

Metabolic alkalosis
Hypokalemia
Hypochloremia

84
Q

MC type of gallstone?

A

Cholesterol

85
Q

MC type of kidney stone?

A

Ca oxalate

86
Q

Pts with recurrent upper UTIs are more likely to form what kind of stones?

A

Struvite

87
Q

What is the MC site for kidney stones to lodge?

A

Ureterovesical junction

88
Q

Describe size parameters to consider when deciding on treatment for nephrolithiasis

A

<5 mm stones are likely to pass spontaneously

> 8 mm are unlikely to pass, consider lithotripsy

89
Q

How is nephrolithiasis diagnosed?

A

Helical CT

90
Q

Labs on your patient show an electrolyte imbalance and EKG shows peaked T waves. What is the electrolyte imbalance, and what do you do?

A

Hyperkalemia

Administer Ca gluconate to stabilize the cardiac membrane before correcting K+.

Insulin, albuterol, and sodium bicarb are used to cause redistribution of K+.

Furosemide is used to eliminate excess K+.

91
Q

What is the initial imaging of choice when pneumothorax is suspected?

A

CXR

92
Q

Painless hematuria in a smoker?

A

Bladder cx

93
Q

Differentiate dx of cholecystitis vs cholelithiasis

A

Cholecystitis: HIDA scan is gold std

Cholelithiasis: US

94
Q

Differentiate some common causes of unconjugated vs conjugated hyperbilirubinemia.

A

Unconjugated:
HF, liver disease, intravascular hemolysis, Wilson disease, Gilbert syndrome

Conjugated:
Biliary obstruction (choledocolithiasis, acute/chronic pancreatitis, cholangiocarcinoma), viral hepatitis, cholangitis
95
Q

MC cause of inherited unconjugated hyperbilirubinemia?

A

Gilbert syndrome

96
Q

Compare the management of a Type A vs Type B aortic dissection

A

Type A includes the Ascending aorta and is a surgical emergency.

Type B ONLY includes descending aorta and may be managed medically + imaging surveillence:

  • Reduce BP to lowest tolerable level
  • Reduce HR <60
  • IV propranolol, labetalol, or esmolol
  • Nitroprusside after HR is controlled
  • Pain control
97
Q

What is the MC site of diverticula formation?

A

Sigmoid colon

98
Q

What is the MC cause of lower GI bleeding?

A

Diverticulosis

99
Q

What type of hernia has only a portion of the intestinal wall involved?

A

Richter hernia (just the antimesenteric wall of the intestine)

100
Q

What is the MOA of cilostazol, and what condition does it treat?

A

Cilostazol is a phosphodiesterase inhibitor that treats claudication

101
Q

What medications are common causes of orthostatic hypotension?

A

a-adrenergic blockers (doxazosin)
Antihypertensives
Nitrates
Antidepressants

102
Q

What is the first-line tx for acute ischemic stroke?

A

In eligible patients, fibrinolytic therapy with alteplase

103
Q

Buzzword: widened mediastinum on CXR

A

Aortic dissection

104
Q

What is the murmur ass’d with aortic dissection?

A

A decrescendo diastolic murmur at the right sternal border - aortic regurg

105
Q

What are erosions or ulcers occurring in the sac of a hiatal hernia called?

A

Cameron lesions

106
Q

What is the gold std test to dx acute angle closure glaucoma?

A

Gonioscopy showing intraocular pressure >22mmHg

107
Q

What is the management of choledocolithiasis?

A

ERCP stone retrieval (+ cholecystectomy)

108
Q

How is diverticulitis diagnosed?

A

Abdominal CT with contrast

  • Pericolonic fat stranding
  • Localized bowel wall thickening >4mm
  • Colonic diverticula
109
Q

Describe the tremor ass’d with hyperthyroidism

A

High frequency

Low amplitude

110
Q

What is the best initial imaging for a patient presenting with hemoptysis?

A

CXR

111
Q

What is one indicator of unresectability of gastric cx?

A

Disease encasement of the hepatic artery

112
Q

An LP should NOT be performed in a patient who has what kind of head injury? Why?

A

Subdural hematoma - risk of brain herniation

113
Q

CT shows a crescent-shaped hematoma- what vessel is involved?

A

Bridging veins/emissary eins

114
Q

A pt w/hx of partial gastrectomy presents with neurological deficits. What nutritional deficiency may be responsible?

A

B12 (lack of intrinsic factor = no absorption in terminal ileum)

115
Q

Where does most colonic bleeding occur?

A

R side of colon

116
Q

What imagining is used to dx pancreatic cx?

A

CT with contrast

117
Q

How is an arterial embolism diagnosed?

A

CTA of the pelvis with runoff.

118
Q

What is the MC limb artery to be affected by acute arterial occlusion?

A

Superficial femoral artery

119
Q

Buzzword: bilateral hilar adenopathy with noncaseating granulomas

A

Sarcoidosis

120
Q

Buzword: lupus pernio

A

Chronic, violaceous, raised plaques and nodules found on cheeks, nose, around eyes in sarcoidosis

121
Q

What are some appropriate therapies for cellulitis?

A

Bactrim
Clindamycin (C diff risk)
Doxycycline or minocycline

Should cover MRSA

122
Q

What antibiotics should be used in the conservative tx of cholecystitis?

A

Metro + 3rd gen cephalosporin, cover E coli

123
Q

What painkiller should be avoided in patients with cholecystitis?

A

Morphine - can cause Sphincter of Oddi spasm. Use meperidine instead.

124
Q

What antibiotic should be used for necrotizing pancreatitis?

A

Imipenem

125
Q

MC positioning of an anal fissure?

A

Posterior midline

126
Q

Prophylactic antibiotic for non-ruptured appendicitis in a patient with a PCN or cephalosporin allergy?

A

Clinda + cipro/levo/gent

127
Q

Buzzword: air fluid levels in stair step/ladder patterns seen on XR

A

Bowel obstruction

128
Q

Best imaging to dx bowel obstruction?

A

CT with contrast

129
Q

MC metabolic disturbance s/p SBO?

A

Metabolic alkalosis (hypochloremic, hypokalemic metabolic alkalosis)

130
Q

MC portion of the bowel to be involved in volvulus?

A

Sigmoid, cecum

131
Q

Elevated ALP, GGT, ALT, AST, bilirubin, IgM and +P-ANCA - dx?

A

Primary sclerosing cholangitis - dx via ERCP (gold std)

132
Q

Antibiotics used to treat ascending cholangitis?

A

PCN + aminoglycoside (gentamicin, tobramycin)

133
Q

Triple therapy for H pylori

A

C(L) AP:
Clarithromycin
Amoxicillin (or metronidazole)
PPI

134
Q

Quad therapy for H pylori

A 
T(reat) M(y) B(elly) P(ain):
Tetracycline
Metronidazole
Bismuth
PPI
135
Q

MC esophageal cx worldwide?

A

Squamous cell, ass’d w/tobacco and EtOH

136
Q

MC esophageal cx in US?

A

Adenocarcinoma (usually younger pt, ass’d w/ Barrett’s)

137
Q

Dx study for esophageal strictures?

A

Barium esophagram

138
Q

Buzzword: Schatzki ring

A

Mucosal constriction in the lower esophagus at the squamocolumnar jxn, ass’d with hiatal hernias

139
Q

MC gastric cx?

A

Adenocarcinoma

140
Q

What are some indicators of unresectability of gastric cx?

A

Vascular involvement of the aorta
Involvement of hepatic artery
Involvement of proximal splenic artery
Distant mets

141
Q

What is the gold std dx study for GERD?

A

24 hour ambulatory pH monitoring- not usually done.

Endoscopy or manometry is usually used.

142
Q

Surgical procedure for refractory GERD?

A

Nissen fundoplication

143
Q

What is a TIPS procedure and what are some complications?

A

Placing a stent in the liver to shunt blood away from the portal vein into the hepatic vein - bypassing cirrhotic liver parenchyma.

Complications include encephalopathy bc blood is not being filtered adequately

144
Q

What is a tumor marker for hepatic carcinoma?

A

AFP

145
Q

What are the boundaries of Hesselbach’s Triangle?

A

Lateral border of rectus abdominis muscle
Epigastric vessels
Inguinal ligament

146
Q

Qualifications for liver transplant in hepatic carcinoma

A

Tumors small and few:
Single <5 cm OR
<3 tumors all <3 cm and only in liver

147
Q

Buzzword: Stovepipe sign

A

Seen on barium study, indicative of ulcerative colitis (loss of haustral markings in large intestine)

148
Q

Buzzword: String sign

A

Seen on barium study, flow through narrowed/inflamed bowel seen in Crohn’s disease

149
Q

P-ANCA

A

Ulcerative Colitis

150
Q

ASCA

A

Crohn’s disease

151
Q

Dx imaging for Crohn’s?

A

Upper GI series with small bowel follow through in acute disease
Colonoscopy for guiding treatment

152
Q

Dx imaging for Ulcerative Colitis?

A

Flex sig

Colonoscopies are CIx!!! Also avoid barium enema

153
Q

Tx for UC?

A 
5-aminosalicylates:
- Oral mesalamine, best for maintenance
- Topical mesalamine
- Sulfasaline, give with folic acid
Steroids for acute flares
154
Q

Ratio of LFT values in EtOH hepatitis

A

AST>ALT 2:1

155
Q

What blood test results would support the assumption that hemolysis was causing jaundice in a patient?

A

Decreased haptoglobin and Hct

Increased LDH, reticulocytes, and fragmented RBCs on peripheral smear

156
Q

Pt with Afib with abdominal pain out of proportion to exam findings

A

Consider mesenteric infarction. Pt may be on OCPs rather than A-fib in scenario.
Emergent surgical intervention.

157
Q

Tumor marker in small bowel carcinoma

A

CEA

158
Q

What AG value signifies AG metabolic acidosis, and what are the causes?

A 
16+
MUDPILES:
**Methanol
**Uremia
**DKA
Paraldehyde
**Infection
Lactic acidosis
Ethylene glycol
Salicylates
159
Q

Common causes of non-anion gap metabolic acidosis?

A

Diarrhea
Pancreatic or biliary drainage
Renal tubular acidosis

160
Q

Earliest sign of compartment syndrome?

A

Loss of two-point discrimination

161
Q

Normal compartment pressure? Diagnostic pressure for compartment syndrome?

A

Normal: 0-8 mmHg

Compartment syndrome: >30mmHg

162
Q

Tx for DVT?

A

IV heparin then bridge to warfarin

163
Q

MC cause of arterial embolus from heart?

A

AFib

164
Q

Gold std dx for arterial embolism?

A

Angiography

165
Q

Surgical tx of arterial embolism?

A

Preop: anticoagulation with IV heparin, angiogram

Embolectomy via cutdown or fogarty balloon if embolectomy fails

166
Q

Tx of unstable angina

A
  • Admission, continuous cardiac monitoring, IV access, O2
  • Morphine and nitro
  • ASA +/- clopidogrel
  • LWMH for at least 2 days (enoxaparin/lovenox)
  • BBlockers
  • ACEi and statin if high LDL
  • Stress test, consider revascularization if no response to medical therapy
167
Q

Inverted U waves and angina in a smoker, not associated with exertion; dx and tx?

A

Prinzmetal angina, dx with angiography

CCB and nitro
AVOID BB, aspirin, and triptans

168
Q

Tx of PAD

A

Cilostazol, aspirin, clopidogrel/plavix

BB CIx in isolated PAD!

Surgical: fem-pop graft bypass, angioplasty, endarterectomy, or surgical patch angioplasty

169
Q

Buzzword: water bottle sign

A

Seen on CXR, suggestive of pleural effusion

170
Q

What are indications for CABG in patients with left main coronary artery stenosis?

A

50%+ stenosis

171
Q

What are some indications for CABG based on number of vessels involved?

A

3 vessel dz in asymptomatic - mild angina
1-2 vessel dz + large area of viable myocardium in high risk area
2-3 vessel dz in DM patients

172
Q

What are indications for CABG in a patient with LAD stenosis?

A

70%+ stenosis of LAD and proximal circumflex
70%+ LAD stenosis plus:
- EF <50% or
- Symptoms of ischemia

173
Q

What is the pre-op tx of a functional adrenal carcinoma (such as a pheochromocytoma or a cortisol-producing adenoma)?

A

Phenoxybanzamine or phentolamine 7-14 days: a-blocker to reduce HTN and to preempt the increase in catecholamines that will occur from handling the adrenal glands during surgery. Pts are advised to increase salt intake during this time

Followed by BB 2-3 days preoperatively.

174
Q

Tx for adrenal crisis

A

Hydrocortisone and IV NS

During illness, double hydrocortisone maintenance dose
During crisis, 5-10x increase

175
Q

A thyroid nodule is found on US. What are some attributes that would justify proceeding to FNA?

A
  • Cold nodule (on uptake scan)
  • Taller than wide
  • Microcalcifications
  • Hypoechogenicity
  • Solid
  • Irregular margins
176
Q

Tx for cellulitis

A

PO for mild cellulitis: cephalexin or dicloxacillin

Severe: Empiric TMP/SMX or clinda, consider IV vanc if concern for MRSA

Cat bite: Augmentin (amox/clav) or doxy

Puncture wound: cover pseudomonas with cipro

177
Q

Compare anterior, central, or complete cord transections

A

Anterior: loss of pain/temp below level; preserved joint position and vibration sense

Central: Loss of pain/temp at level of lesion, other senses preserved

Complete: No sensation below level of injury, urinary retention/bladder distention if above pelvis

178
Q

Describe findings in a Brown Sequard syndrome patient

A

This is hemisection of the cord:

  • Loss of join position and vibration sense on ipsilateral side
  • Loss of temp and pain on contralateral side
179
Q

Potential causes of “the worst headache of my life”

A

Subarachnoid hemorrhage causes:

  • Ruptured cerebral arterial aneurysm or AVM –> bleeding into CSF in subarachoid space
  • Ruptured berry aneurysm, usually nontraumatic (RF: smoking, HTN, EtOH, hypercholesterolemia)
180
Q

Someone in CKD might have what kind of metabolic disturbance?

A

AG metabolic acidosis

181
Q

What is the ideal vessel to use for an AV fistula?

A

Cephalic vein: >5mm large and close to the skin for 20cm+

182
Q

Common causes of microcytic anemia

A

TICS:

  • Thalassemia
  • Iron deficiency***
  • Chronic dz
  • Sideroblastic anemias
183
Q

Common causes of normocytic anemia

A

ABCD:

  • Acute blood loss
  • Bone marrow failure
  • Chronic disease
  • Destruction (hemolytic anemias)
184
Q

Common causes of macrocytic anemia

A

FATRBC:

  • Fetus
  • Alcohol**
  • Thyroid (hypothyroidism)
  • Reticulocytosis
  • B12/folate deficiency**
  • Cirrhosis
185
Q

Compare small and non-small cell lung cx

A

Small: highly aggressive, almost exclusively in smokers, not surgically treatable (chemo only). Ass’d with hyponatremia and hypercalcemia.

Non-small:

  • Adenocarcinoma MC, likely non-smoker on exam
  • Squamous cell: likely smoker w/hemoptysis on exam
  • Large cell: rapidly doubles

Surgery (1 decks)

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