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Step 2 flashcards > Surgery oral exam > Flashcards

Surgery oral exam Flashcards

1
Q

Management for apendicitis

A
  • Admit, IVF, abx, NPO
  • non-perf (<5 days): single dose unosyn pre-op, appy, no post-op abx
  • Perf: 5-7 days of zosyn
  • free perf: exlap, appy, wash and drain
  • small abscess: abx, interval appy (4-6 wks)
  • large abscess: percutaneous drainage, abx, interval appy
  • get cultures and sensitivities for this stuff!
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2
Q

CRC metastatic work-up

A
  • CXR
  • LFTs
  • CT abdomen/pelvis
  • Rectal ca: do a trans-anal ultrasound
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3
Q

CRC surgery

A

-preop: dose of cefoxitin, no post-op abx
-5cm margins (proximal and distal)
-hemi-colectomy –> tension free anastamosis
-12 Lymph nodes for adequate staging
-DVT ppx
(Stage 3/4: adjuvant FOLFOX)

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3
Q

Post-CRC surgery surveillance

A
  • CEA: q3 months x 1 yr, q 6months x 2 yrs

- colonoscopy: q6mo for 1st year, yearly for year 2, and every 3 years thereafter

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5
Q

Diverticulitis imaging

A

AXR

abdominal/pelvic CT

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6
Q

Diverticulitis management

A
  • IVF, NPO, foley, Abx (Unosyn) 7-10 days, NGT
  • surgery: perf, stricture, fistula
  • abscess 3cm –> CT-guided percutaneous drainage… no improvement after 3 days –> OR
  • Hartmann’s procedure: end colostomy, stapled rectal stump. reverse 2-3 mo. later
  • colonoscopy 6wk later to r/o CRC
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7
Q

Melanoma surveillance

A

FU w derm q 3 mo. x 1 yr, q 6mo x 5 yrs

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8
Q

Rx PVD

A
  • PACE + statin (PDE inhibitor, ASA, Cessation of smoking, Exercise)
  • Surgery: refractive claudication, rest pain, tissue necrosis, infxn
  • Open (bypass, endarterectomy) vs endovascular (angioplasty, stent)
  • bicarb and fluids w IV contrast
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9
Q

Rx acute limb ischemia

A
  • IV heparin
  • embolectomy (fogarty balloon)
  • Open bypass for embolectomy failure
  • stryke >30mmHg –> fasciotomy
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10
Q

Chronic mesenteric ischemia management

A
  • endarterectomy, bypass, angioplasty and stenting

- ASA

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11
Q

acute mesenteric ischemia management

A
  • CTA, EKG (pt in a fib?), IVF, abx*
  • small vessel: remove dead bowel, check doppler on remaining bowel, 2nd look 24 hr later
  • SMA emoblus: heparin, embolectomy
  • SMA thrombus: heparin, bypass, stenting
  • SMV thrombus: heparin
  • Papaverine for NOMI
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12
Q

Drugs implicated in acute mesenteric ischemia

A

digoxin, cocaine, diuretic, pressors

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13
Q

IBD management

A
  • Surgery: stricture/obstruction, fistula, perforation, abscess, refractory toxic megacolon, dysplasia
  • Toxic megacolon: steroids, abx, no improvement after 48 hrs –> OR
  • do appy in chrons
  • surgery: bowel resection, stricturoplasty
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14
Q

Gallbladder management

A
  • cholelithiasis: ccy if sxs
  • cholecystitis: IVF, abx, ccy w/in 72 hrs
  • choledocholithiasis: IVF, ERCP, ccy w/in 6 wks
  • Cholangitis: IVF, Zosyn 7-10 days. In shock: ERCP/PTC/open surgical decompression w t-tube. Stable: continue conservative management w ERCP in 24-48 hrs. - don’t improve w/in 24 hours? –> emergent ERCP
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15
Q

Carotid bruit imaging

A
  • duplex US: flow characteristics, not good for location

- Angiogram: can cause stroke, risk of contrast, ionizing radiation involved

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16
Q

Carotid bruit management

A
  • CEA for sxs >50% (study showed 70%), asxs >80% (study showed 60%)
  • Or angioplasty w stent: incr rate of stroke, decr rate of MI
  • ASA
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17
Q

CEA FU

A

-at 2 weeks, then every 6 months

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18
Q

SBO management

A
  • check for hernias!
  • NPO, NGT, IVF, Foley
  • Partial SBO/reducible hernia: conservative management. No improvement in 24-48 hrs –> OR
  • Complete SBO: Laparotomy and LOA, find transition poitn
  • Pre-op abx: cefoxitin
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19
Q

Pancreatitis imaging

A

CXR (ARDS), KUB, CT w contrast, US if thinking gallstones

-CT with IV and PO contrast for: severe pancreatitis, signs of sepsis, clinical deterioration

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20
Q

Pancreatitis management

A
  • NPO, IVF, foley, NGT
  • Enteral feeds > TPN after 7 days
  • Pain: Meperedine, Dilaudid
  • pancreatic necrosis: imipen
  • surgery for pseudocyst >6 wks
  • surgery for pancreatic abscess: abx + CT-guided drainage
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21
Q

Pancreatic necrosis management

A
  • suspect infxn? (7 days after onset of necrosis) –> CT guided FNA, blood cx, abx (Zosyn)
  • -> gram stan and culture
  • clinically unstable? –> surgical debridement
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22
Q

Anal fissure management

A

(fissure, hemorrhoids, anal cancer)

  • sitz baths, stool softener, fiber
  • flagyl great for anal infxn
23
Q

anal cancer work-up

A
  • Proctoscopic exam, colonoscopy, trans-anal US
  • abdm/pelvic CT, CXR, LFTs
  • chemo , radiation
24
Q

Upper GI bleed

A
  • PUD: PPI, erythromcyin/reglan, EGD: cautery, band, vasopressin
  • Gastritis
  • Mallory weiss
  • esophageal varices - IV vasopressin, octreotide, EGD banding or slcerotherapy, arteriography coil glue, blakemore. Do ppx abx for any cirrhotic hospitalized for bleeding (e.g. ceftriaxone).
  • cont…: surgery non-shunt - (esophageal transection w variceal ligation, devascularization of the GEJ) or shunting procedures/TIPS
  • gastric or esophageal cancer
  • erosive esophagitis
25
Q

Labs for an upper GI bleed

A
  • Chem 7, CBC, LFTs, PT/PTT, amylase, type and cross

- BUN/Cr >36 in UGIB +/- prerenal azotemia

26
Q

Upper GI bleed management

A
  • ABC (recheck vitals q 10 min)
  • IVF, foley, NPO, NGT (diagnostic)
  • Reverse coagulopathy if necessary
  • Triage to ICU etc
  • Put on heart monitor
  • IV PPI, IV erythromycin
  • EGD - coagulation/cautery and epi, ligation/banding for varices
  • -> arteriography coil, vasopressin, glue
27
Q

breast cancer metastatic work-up

A
  • LFTs
  • serum Ca2+/AlkPhos, bone scan
  • PET/CT
  • Brain MRI if s/s
28
Q

Brest lump work-up

A

30: Mammogram
- -> magnify imaging
- -> core biopsy + hormone status receptors testing
- also get an US, of axilla too
- unsuscpicious/non-simple cyst: get FNA –> get tissue if bloody, i.e. get excisional biopsy

29
Q

Admit orders

A
  • Admit to step down
  • IVF @ __
  • Foley
  • NPO
  • NGT if ileus/n/v
  • ?Telemetry
  • Daily labs: ___
  • Serial exams q3hrs and vitals per floor routine
  • Pain: PCA intermittent Dilaudid
  • DVT ppx: IV heparin, SCDs, Teds
  • ?CIWA
30
Q

Fever work-up

A

UA
CXR
Blood Cx
Inspection of wound

31
Q

Angiography

A

-therapeutic options: vasopressin, coiling, embolization, fibrin glue

32
Q

PUD GERD

A

Trial of PPI, then EGD w bx, then high res manometry w ph probe.

  • NIssen for refractory GERD
  • PUD:
  • bleeding: oversew
  • Perforation: patch
  • Obstruction: highly selective vagotomy, gastrojejunostomy
  • Non-healing/intractibility: highly selective vagotomy, antrectomy/distal gastrectomy
33
Q

CT bowel obstruction

A

PO contrast and IV contrast

34
Q

Do not give PO contrast:

A

Mesenteric ischemia

35
Q

CT for mesenteric ischemia

A

w contrast

  • see bowel thickening
  • pneumatosis intestinalis
  • bowel dilation
  • mesenteric stranding
36
Q

Mesenteric ischemia Rx

A
  • IVF, broad-spectrum abx
  • SMA embolus and thrombosis: IV heparin, embolectomy or bypass for large vessel
  • cannot do surgical revascularization in small vessels
  • SMV thrombosis: IV heparin
  • NOMI: correct the underlying problem
  • Papaverine
  • surgery for peritonitis = transmural ischemia
  • send home on ASA
37
Q

Labs for mesenteric ischemia

A
  • Chem 7
  • CBC
  • LFTs
  • amylase
  • lactic acid
  • LDH
  • FOB
  • CTA, or mesenteric angiography
38
Q

Management for ischemic colitis

A
  • broad-spectrum abx, IVF, NPO, serial abdominal exams

- surgery: infarction, refractory to rx, stricture, hemorrhage, fulminan colitis

39
Q

Melanoma late stages

A
  • Stage 3: IFN-alpha
  • Stage 4: High-dose IL-2, BRAF inhibitors, CTLA-4 inhibitors, (immunotherapy based on genetic mutations present) clinical trial
40
Q

Post wide-excision for FU of melanoma Stage 1/2

A

-Derm: q 3mo x 1 yr, q 6mo x 5 yr

looking for local recurrence

41
Q

Breast cancer - pre-op metastatic work-up

A
  • CXR
  • LFTs
  • alk phos, Ca2+
  • Brain MRI if s/s
42
Q

Breast ca. treatment

A
  • DCIS: Lumpectomy (2mm margins) + radiation
  • Radiation: anyone w BCT
  • Chemo: anyone who has +node, or ER+ >5mm
  • ask about fertility before chemo!
  • Chemo can be neo- or adjuvant
  • LCIS: lumpectomy, treat per final pathology
43
Q

Breast ca - lumpectomy for…

A
  • tumor <5 cm
  • no CI to radiation post-lumpectomy
  • somebody wanting BCT
44
Q

breast lumpectomy contraindications:

A
  • can’t get clear margins
  • diffuse suspcious microcalcifications
  • previous XRT to breast
45
Q

Breast SLN for…

A
  • DCIS: high-risk, mastectomy

- T1, T2, and T3 tumors

46
Q

Breast cancer radiation

A
  • most women having BCT for invasive cancer/DCIS
  • women >70 may not require XRT
  • Mastectomy negates need for radiation, except >4 LN, tumor invasion of chest wall, inflammatory breast ca.
47
Q

ER+ tumors

A
  • ->21 gene testing
  • low risk: may only need hromones (not chemo)
  • medium risk and up: may need chemo + hormones
48
Q

Breast cancer T1 / 2 / 3/ 4

A

T0: no evidence of primary tumor
Tis: DCIS/LCIS
T1: 5cm
T4: any size, extension to chest wall or skin

49
Q

Breast cancer: chemo

A
  • node +
  • ER + >5mm
  • Her2neu+ >1cm
  • Triple negative
  • Neoadjuvant for inflammatory breast ca.
50
Q

Acute complication of AAA repair

A

MI, hemorrhage, distant emboli, renal failure, colonic ischemia

51
Q

Late complication of AAA repair

A

AEF, graft infxn, graft thrombosis, anterior spinal syndrome

52
Q

complication of CEA

A

-MI*, stroke, hematoma, wound infxn, superior laryngeal n, hypoglossal n injury, death.
-Long term: restenosis
(Post-op FU at 2 wks and every 6 mo.)

53
Q

meds for pts w carotid stenosis

A

-ASA, statin, beta-blocker

Step 2 flashcards (7 decks)

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