Surgery-GI

Question 1

Abd pain after trauma- X-ray, gas-filled loops of both small and large intestines and gastric dilation

Answer 1

Paralytic (dynamic) ileus

Question 2

Migratory pain, N/V, fever, leukocytosis, McBurney point tenderness, and Rovsing sign. NSIM?

Answer 2

<p>Immediate appendectomy; no imaging needed for classic presentation</p>

Question 3

Evidence of pancreatitis ( Midepigastric pain, N/V, elevated Amylase &amp; Lipase) with ALT >150; gallstones on US, diagnosis? NSIM?

Answer 3

<p>Gallstone pancreatitis; Laparoscopic Cholecystectomy

| </p>

Question 4

<p>The most common cause of SBO</p>

Answer 4

<p>Adhesions</p>

Question 5

<p>N/V, abd bloating, high-pitched hyperactive bowel sounds, dilated loops of bowel on x-ray</p>

Answer 5

<p>complete SBO</p>

Question 6

<p>Easily satiety, Nausea, non bilious vomiting, wt loss, hx of acid ingestion</p>

Answer 6

<p>Gastric outlet obstruction- pyloric stricture </p>

Question 7

<p>acute-onset severe abd pain, fever, tachycardia, sign of peritonitis (guarding, rigidity, reduced bowel sound, rebound tenderness) is? NSIM?</p>

Answer 7

<p>Perforated viscus, upright x-ray of chest &amp;amp; abd</p>

Question 8

Recurrent episodes of mild jaundice precipitated by stressors (eg. infection, fasting, vigorous exercise, surgery)

Answer 8

Gilbert syndrome

Question 9

cholestatsis and gallbladder ischemia leading to secondary infection by enteric organisms and resultant edema and necrosis of the gallbladder is? Tx?

Answer 9

Acalculous cholecystitis; Abx, percutaneous cholecystostomy, followed by cholecystectomy after pt is stable

Question 10

Left-sided and pain with radiation to the shoulder, fever, and vomiting

Answer 10

spleen infarct

Question 11

Hypotension, free intraperitoneal fluid, RUQ pain and bruising, and R shoulder pain

Answer 11

Hepatic laceration

Question 12

treatment for anal fissures

Answer 12

fiber, fluid intake, stool softeners, sitz baths, and topical anesthetics and vasodilators (Nifedipine, nitroglycerin, lidocaine)

Question 13

what is the differential diagnosis of an inguinal hernia

Answer 13

Lymphadenopathy, psoas abscess, ectopic testis, hydrocele of the cord, saphenous varix, lipoma, varicocele, testicular torsion, femoral artery aneurysm, abscess

Question 14

Gallstone that has passed through a biliary-enteric fistula is called? caused by?TX?

Answer 14

Gallstone ileum results from small bowel obstruction, Surgical removal of stone and cholecystectomy

Question 15

The 3 peritoneal signs

Answer 15

• rebound tenderness
• involuntary guarding
• Abdominal rigidity

Question 16

RLQ pain with extension of right thigh is called? Dx?

Answer 16

Psoas sign, abscess adjacent to posts or retrocecal appendix

Question 17

RLQ pain with internal rotation of R thigh called? Dx?

Answer 17

Obturator sign, pelvic appendix or abscess

Question 18

RLQ pain with LLQ palpation and retropulsion of colonic contents is called? Dx?

Answer 18

Rovsing’s sign, acute appendicitis

Question 19

Right pelvic pain during rectal examination, especially with pressure on right rectal wall

Answer 19

Rectal tenderness, pelvic appendix or abscess

Question 20

The most likely cause of abd pain, tachycardia, left chest wall and shoulder pain in blunt abd trauma is? NSIM?

Answer 20

Splenic injury; FAST examination

Question 21

Fever, RUQ pain, N/V, crepitus in abd wall adjacent to gallbladder, air-fluid levels in gallbladder. Dx? Tx?

Answer 21

Empheysematous cholecystitis; emergent cholecystectomy with broad-spectrum antibiotics with clostridium coverage (Amp-Sulbactam)

Question 22

25M, obese, with sedentary lifestyle, fluctuant mass cephalad to the anus (near the tip of the coccyx) in the intergluteal region with mucoid, purulent or bloody drainage, painful. Dx?

Answer 22

Pilonidal disease

Question 23

Colicky abd pain, vomiting, no flatus or stool, hyperactive to absent bowel sounds, distended and tympanitic abd. DX? NSIM?

Answer 23

SBO; bowel rest, NG suction, IVF and complicated needs urgent surgical exploration

Question 24

67M, N/V increasing abd pain over 3hrs. Post MI, DM 2, PUD, HTN & hypercholesterolemia. Dx?

Answer 24

Acute mesenteric ischemia

Question 25

Tx for complicated diverticulitis with abscess formation is

Answer 25

CT-guided percutaneous drainage. If fails surgical drainage

Question 26

Tx for Gallstones without symptoms

Answer 26

None

Question 27

Tx for Gallstones with typical biliary colic symptoms

Answer 27

• elective lap cholecystectomy

- Possible urosodeoxycholic acid in poor surgical candidates

Question 28

Tx for complicated gallstone disease (Acute cholecystitis, choledocholithiasis, gallstone pancreatitis)

Answer 28

-Cholecystectomy with in 72hrs

Question 29

Fluid shift from the interavscular space to the small intestine, leading to hypotension, stimulation of autonomic relaxes and release of intestinal vasoactive polypeptides after gastrectomy surgery is

Answer 29

dumping syndrome:

Question 30

Nausea, diarrhea, abd cramps, palpitation, diaphoresis, light-headless for about 20mins after eating

Answer 30

dumping syndrome:

Question 31

It occurs commonly in pediatric patients and following blunt abd trauma , with epigastric pain and vomiting after 24hr. Dx?, NSIM?

Answer 31

Duodenal hematomas; gastric decompression and parenteral nutrition

Question 32

Organs that can be affected from PAT on LUQ

Answer 32

-Spleen, Splenic flexure of the colon, left hemidiaphragm

Question 33

How do you establish an airway in an apnea patient with a cervical spine injury

Answer 33

Orotracheal intubation with rapid-sequence intubation

Question 34

Due to risk for carbon dioxide retention, you will not perform this type of intubation on patients with head injury who might require hyperventilation to prevent or treat intracranial hypertension except in children <12 because it is anatomically easier

Answer 34

Needle Criothyroidotomy

Question 35

Diaphragm can rise as high as what dermatome level on the Right and Left ?

Answer 35

R 4th thoracid dermatome

L 5th thoracic dermatome (level of nipple)

Question 36

A penetrating wound below the 4th intercostal space (level of nipples) is considered to involve the __ and requires ___ in unstable patient

Answer 36

Abdomen

exploratory laparotomy