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MS3 > Surgery Rotation 14 > Flashcards

Surgery Rotation 14 Flashcards

1
Q

Management of SBO causes by adhesions from surgery 5 years ago

A

NG suction, bowel rest, willing to wait about 24hr in complete obstruction, Willis to wait 3-5 day’s in incomplete obstruction

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2
Q

Main concern while waiting out SBO

A

Strangulation - fever, leukocytosis, pain etc

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3
Q

Management of strangulated obstruction

A

Emergency surgery

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4
Q

Management of acute appendicitis

A

Emergency surgery

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5
Q

Tests to diagnose atypical appendicitis

A

US or CT

US is user dependent
CT os more reliable

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6
Q

Treatment of peripheral artery disease

A
  1. Walking program

2. Aspirin

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7
Q

Is it possible to have elevated WBC in urinalysis in appendicitis?

A

Yes - if the inflammation of appendicitis is great enough, it can spread to the ureter and bladder leading to an abnormal urinalysis

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8
Q

What does an IV pyelography show you?

A

Will show blood flow to kidney, ureters, and bladder

Provides detailed info about anatomy of calyces and the size and shape kidney

Useful in detecting kidney stones

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9
Q

What is culdocentesis and when is it used

A

Culdocentesis is a procedure performed in women in which peritoneal fluid is aspirated from the posterior pelvic cul-de-sac (pouch of Douglas) through the posterior vaginal fornix

Historically, it was used to evaluate women for hematoperitoneum secondary to ruptured ectopic pregnancy or ruptured ovarian cyst, or for a pelvic infection

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10
Q

Next step in management of patient with clinically obvious intussusception

A

Nonoperative reduction using hydrostatic or pneumatic pressure via enema

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11
Q

Hormones secreted by renal cell carcinoma

A
  • Erythropoietin → polycythemia
  • ACTH → Cushing
  • PTH-related peptide → Hypercalcemia
  • Prolactin → hypogonadism, decreased libido, galactorrhea
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12
Q

Describe presentation of Crohn disease

A
  • RLQ pain (ileum is most common location)
  • Non-bloody diarrhea
  • Strictures (string sign appearance)
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13
Q

Describe presentation of Ulcerative colitis

A
  • LLQ pain (rectum)
  • Bloody diarrhea
  • Loss of haustra (lead pipe appearance)
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14
Q

Imaging used to diagnose acute cholecystitis

A

US

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15
Q

What are causes on non-visualization of the gallbladder on US

A
  • Non-distention due to inadequate fasting
  • Surgically removed
  • Congenitally absent
  • Ectopic location
  • Filled with stones
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16
Q

Diagnostic test for suspected appendicitis if not clinically obvious

A

CT

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17
Q

Best first test for suspected acute cholangitis

A

US

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18
Q

Best imaging test for suspected pancreatitis or pancreatic malignancy

A

CT

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19
Q

Treatment of appendiceal abscess

A

Patients can have high complication rate from immediate surgery due to the mass of inflamed and infected debris and adhesions

If stable, these patients should be managed with IV abx, bowel rest, and possible percutaneous drainage of abscess

Can return in 6-8 weeks for elective appendectomy

20
Q

Structures at risk for damage in a supracondylar fracture?

A

Brachial artery and median nerve

21
Q

Scary complication of scaphoid fracture

A

Osteonecrosis due to disrupted blood flow

22
Q

Next step in management of suspected renal contusion

A

CT scan

23
Q

Only imaging test commonly used in a penile fracture

A

Retrograde urethrogram for suspected urethral injury

Regardless, penile fracture is a urological emergency

24
Q

Will mechanical bowel obstruction have hyper or hypoactive bowel sounds

A

Hyperactive (e.g. gallstone ileus)

25
Q

Will acute bowel ischemia have hyper or hypoactive bowel sounds

A

Hypoactive

26
Q

Tx of small pneumothorax

A

Observation and oxygen

27
Q

How do you diagnose C. diff

A
  1. Stool culture
  2. Proctosigmoidoscopic exam
  3. Identification of toxin in stool (probably best option)
28
Q

Tx of C. diff

A
  • Stop offending abx
  • Do not give anti-diarrheals (it will keep toxin in body)
  • Metronidazole (or oral Vancomyin)
29
Q

Tx of internal hemorrhoids

A

Rubber band ligation or laser

Remember that internal hemorrhoids have no nerve innervation

30
Q

Tx of external hemorrhoids

A

Formal operation with anesthesia because ligation will be too painful

31
Q

Tx of anal fissures

A

If pain control doesn’t work, want to loosen anal sphincter (surgical sphincterectomy, botox injections)

32
Q

What is a fistula-en-ano

A

Occurs in someone who previously had an ischiorectal abscess drained

33
Q

Describe metastasis of anal adenocarcinoma vs anal squamous cell carcinoma

A

Adeno = mets only to abd lymph nodes

SCC = abd lymph nodes + groin lymph nodes

34
Q

Management of squamous cell carcinoma of the anus

A

Chemotherapy + radiation to shrink tumor, followed by surgery if necessary

35
Q

Which thyroid cancer spreads hematogenously (vs. others which spread via lymph)

A

Follicular

36
Q

What is melanosis coli

A

Dark brown discoloration of the colon with pale patches of lymph follicles

Caused by laxative use

37
Q

Describe primary biliary cirrhosis

A

-Autoimmune destruction of intra-hepatic bile ducts
o Associated with other autoimmune conditions
-Presentation:
o Cholestasis – due to destruction of bile ducts
o Jaundince, hepatomegaly, steatorhhea, portal HTN
o Hyperlipidemia (with xanthelasma)
o Metaboalic bone disease

38
Q

Antibody associated with primary biliary cirrhosis

A

anti-mitochondrial antibody (AMA)

39
Q

Most common cause of cirrhosis

A

viral hepatitis (C > B)

40
Q

Tx of acalculous cholecystitis

A
  • Enteric antibiotic coverage
  • Cholecystostomy for initial drainage
  • Cholecystectomy once clinically stable
41
Q

Neoplasms associated with Lynch syndrome

A

Aka Hereditary Nonpolyposis Colorectal cancer (HNPCC)

Colorectal cancer
Endometrial cancer
Ovarian cancer

42
Q

Initial treatment of esophageal variceal bleeding

A

Volume resuscitation, IV octreotide, Abx

43
Q

Tx of esophageal varices that stop bleeding after fluid and octreotide

A

Beta blocker (prophylaxis) with endoscopic band ligation in 1-2 weeks

44
Q

Tx of esophageal varices that continue to bleed after fluid and octreotide

A

Balloon tamponade (temporary)

Then TIPS or shunt surgery

45
Q

How do you diagnose meckels diverticulum

A

Radioactive technichium Study to identify gastric mucosa in the bowel

46
Q

Tx of stress ulcers

A

Radiographic ligation of vessels supplying the ulcers

MS3 (88 decks)

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