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MS3 > Surgery Rotation 13 > Flashcards

Surgery Rotation 13 Flashcards

1
Q

What are the 4 combinations in which sodium can enter the body

A

Bound to neg charge = NaCl or NaHCO3

Or in exchange for another positive = H+ or K+

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2
Q

What are the ways we can convince the kidney to fix metabolic alkalosis

A

Provide KCl (5-10 mEq/hr)

This way the kidney will either exchange Na for K or absorb Na with Cl

So that the kidney will not exchange Na with H (don’t want to lose more acid) or absorb Na with HCO3 (don’t want to absorb more base)

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3
Q

What is Meniere disease

A 
•	Increased pressure and volume of endolymph
•	Features:
o	Recurrent vertigo
o	Ear fullness/pain
o	Unilateral sensorineural hearing loss 
o	Tinnitus
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4
Q

Treatment of Prinzmetal / Vasospastic angina

A
  • Calcium channel blocker (preventive)

- Sublingual nitroglycerin (abortive)

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5
Q

Tx of relapsing remitting MS

A

interferon-beta

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6
Q

Treatment of A-fib in a patient with hemodynamic instability

A

Direct current cardioversion

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7
Q

What is the cause of S3 heart sound

A

Rapid flow of blood from atria to ventricles

Caused by volume overload (e.g. CHF, mitral/tricuspid regurg)

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8
Q

What is the cause of S4 heart sound

A

Atrium contracting against a stiff ventricle (e.g. hypertrophic cardiomyopathy, aortic stenosis, LV hypertrophy)

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9
Q

Causes of acute pancreatitis

A

I GET SMASHED

Idiopathic. Gallstones. Ethanol. Trauma. Steroids. Mumps. Autoimmune. Scorpion sting. Hypertriglyceridemia/hyoercalcemia. ERCP. Drugs.

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10
Q

Components of MEN1

A

Parathyroid hyperplasia, pituitary adenoma, pancreatic tumor

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11
Q

Components of MEN2a

A

Parathyroid hyperplasia, medullary thyroid cancer, pheochromocytoma

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12
Q

Components of MEN2b

A

Pheochromocytoma, medullary thyroid cancer, Marfanoid/Mucosal neuromas

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13
Q

How do you diagnose a sarcoma

A

(painless enlarging mass)

Dx with biopsy (NOT FNA)

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14
Q

Tx of soft tissue sarcoma

A

Wide, local excision or amputation + radiotherapy

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15
Q

Where do sarcomas usually spread to first?

A

Lungs (hematogenously)

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16
Q

Tx of sarcoma met to lungs

A

Can do wedge resection if it is the only met and primary tumor is under control

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17
Q

Progression to liposarcoma

A

99% do NOT come from lipoma

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18
Q

Presentation and tx of thyroglossal duct cyst

A

Midline mass that moves when tongue moves

Remove surgically

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19
Q

Test to assess for reflux

A

Esophageal pH testing

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20
Q

Test to assess for achakasia

A

Mannometry

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21
Q

Test for a pt with clinically obvious chronic gerd

A

Endoscopy and biopsy to look at damage

22
Q

Management of barrets esophagus

A

Nissen fundiplocation

Or intensive therapy of acid (eg PPI - omeprazole)

23
Q

Testing prior to Nissen

A

Make sure Gerd is the cause. Mannometry to make sure esopageal contraction is good. Gastric emptying test to check pyloric sphincter. Barium swalllow to locate GE junction

24
Q

Diagnose: liquids more difficult to swallow than solids

A

Achalasia

Vs. cancer where solids are harder

25
Q

Gastroschisis - presentation, associated disorders, complications

A

Gastroschisis = viscera not covered by sac

Defect lateral to midline

Not usually associated with other disorders

May be atretic or necrotic requiring removal; short gut syndrome

26
Q

Omphalocele - presentation, associated disorders

A

Covered by sac; midline

Associated with other disorders

27
Q

Diagnose: 4 wk old infant with non-bileous vomiting and “olive” mass

A

Pyloric stenosis

28
Q

Metabolic complications of pyloric stenosis

A

Hypochloremia; metabolic alkalosis

29
Q

Tx of pyloric stenosis

A

Surgery = myotomy

30
Q

Diagnose: 2 wk old infant with bileous vomiting. Pregnancy complicated by polyhydramnios

A 
Intestinal atresia (narrowing or absence of portion of intestine) 
Duodenal atresia = double bubble on XR

Or annular pancreas

31
Q

What disorder is associated with intestinal atresia

A

Down Syndrome

32
Q

Diagnose: 1 wk old baby with bileous vomiting, draws up his legs, has abd distenstion

A

Malrotation and volvulus

33
Q

Diagnose: 3 day old newborn that has not passed meconium

A

Meconium ileus (consider cystic fibrosis)

Hirschsprung disease (biopsy will show no ganglia)

34
Q

Diagnose: 5 day old former 33 weeker develops bloody diarrhea

A

Necrotizing enterocolitis

35
Q

Describe XR of necrotizing enterocolitis

A

Pneumocystis intestinalis (air in wall)

36
Q

Tx of necrotizing enterocolitis

A

NPO, TPN (if nec), abx, resection of necrotic bowel

37
Q

Diagnose: 2mo old baby has colicky abd pain and current jelly stool w/ sausage shaped mass in the RUQ

A

Intussusception

Barium enema is dx and tx

38
Q

Medical tx of BPH

A

Tamsulosin (a1-antagonist which relaxes smooth muscle) or finasteride (5a-reductase inhibitor)

39
Q

Surgical tx of BPH

A

TURP

40
Q

Tx of prostate cancer

A

Surgery, radiation, leuprolide or flutamide

41
Q

Best test to diagnose kidney stones

A

CT

42
Q

Tx of kidney stones

A

If stone <5mm, hydrate and let it pass. If >5mm, do shock wave lithotripsy. Surgical removal if >2cm.

43
Q

Diagnosis of testicular torsion

A

Do STAT doppler U/S -will show no flow (contrast w/ epididymitis)

44
Q

Tx of testicular torsion

A

Can surgically salvage if <6hrs. Do orchiopexy to BOTH testes.

45
Q

Location and presentation of osteosarcoma

A

Usually occurs in metaphysis – distal femur or proximal tibia (knee region)

Imaging reveals a mass with sunburst appearance and lifting of periosteum (Codman triangle)
-THINK: osteoSarComa (S = sunburst and C = Codman)

46
Q

Location and presentation of Ewing Sarcoma

A

Arises in the diaphysis of long bones

Lytic bone lesions

X-ray reveals “onion-skin” appearance – tumor grows within medullary center of bone, pushing outwards and causing periosteum (outer layer) to lay down new layers of bone
- THINK: eWING = Chicken WINGS and onion rings

47
Q

Why give epi with lidocaine

A

To prevent systemic absorption

48
Q

Next step in management of pt with suspected esophageal cancer

A

Barium swallow BEFORE endoscopy and biopsy so you know obstruction and don’t rupture esophagus

49
Q

Tx of Mallory Weiss tear

A

Endoscopy. Can maybe do photocoagulation

50
Q

Differentiate Mallory Weiss vs boerhaave

A

B will have horrible pain and appear very sick

M is just vomiting blood

51
Q

Management of suspected boerhaave

A

No endoscopy - can worsen tear

No barium - will spill out and worsen problem

Do gastrographing swallow first - water soluble and safer than barium. But gives poor quality pictures. May miss perforation

If gastrograph is negative then do barium to be sure

52
Q

Tx of confirmed esophageal rupture

A

Surgery

MS3 (88 decks)

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