Surgery test prep #2

Question 1

triad of angina pectoris, syncope, CHF

Answer 1

aortic stenosis

Question 2

imaging shows:
Left ventricular hypertrophy
CXR= pulmonary congestion

Answer 2

aortic stenosis

Question 3

blowing high pitched diastolic murmur

Answer 3

arotic regurg

Question 4

harsh midsystolic murmur heard at left sternal border

Answer 4

aortic stenosis

Question 5

Achalasia.
what is it?
sx's?
dx?
tx?

Answer 5

inability LES muscle to relax, dysphagia due to 3 mechanisms.
1)non-peristolic contractions
2)incomplete relaxation of LES
3)increased resting tone of LES
sx’s= dysphagia, halitosis, regurge, chest pain
labs=CXR reveals dilated eophagus, barium swallow shows bird beak image
tx= antimuscarinic(Levsin, dicyclomine, botulinum) then endoscopic dialation, esophagomyotomy

Question 6

pt presents with reflux, epigastric pain, and can predispose to barretts esophagus

Answer 6

Hiatal hernia type 1 (sliding esophageal) where gastroesophageal jx and stomach protrude into thoracis cavity

Question 7

sliding esophageal type 1 hiatal hernia tx?

Answer 7

antacids first, then surgery

Question 8

sx’s heartburn, regurg, dysphagia with endoscopy showing pink mucosa in distal esophagus?
tx?

Answer 8

barretts.
tx=antacids, H2 blockers, no smoking,
Nissen fundoplication

Question 9

Leiomyoma
what is it?
how do you tx?

Answer 9

MC benign lesion of the esophagus with growth narrowing the lumen.
asymptomatic and found by accident on endoscopy
tx.biopsy….

Question 10

acute abdomen.
RUQ
RLQ
LLQ
LUQ
Diffuse

Answer 10

RUQ; perforated duodenal ulcer, cholecystitis, hepatitc abscess, appendicitis
RLQ:appen, cecal diverticulitis, Meckels diver
LLQ: sigmoid divertic, volvulus
LUQ: splenic rupture, splenic abscess
diffuse: bowel obs, leaking aneurysm, mesenteric ischemia

Question 11

Whats the difference between esophageal cancer and Barretts esophagus?

Answer 11

1. esophageal cancer is caused by drinking etoh and smoking, Barretts is caused by chronic GERD
2. esophageal caner is mostly upper esophagus or middle. Barretts is mostly lower esophageal.
3. esophageal cancer is MC in blacks. barretts is MC in whites

Question 12

MC sx for esophageal cancer and barretts?

tx?

Answer 12

dysphagia then wt loss

chemo then surgery

Question 13

what is a tear at the gastroesophageal junction called? Whats a tear at the esophagus is called?
how do you dx?
whats always present?

Answer 13

Mallory-Weiss syndrome
Boerhaaves syndrome
upper endoscopy
hematemesis

Question 14

pt complains of epigastric burning pain 24/7, diarrhea, wt loss + peptic ulcers

Answer 14

Zollinger-ellison syn=Gastrinoma=a pancreatic tumor that secrtes high gastrin

Question 15

zollinger-ellison syn TOC?

tx?

Answer 15

secretin test= give pt secretin and this normally inhibits gastrin secretion. In zollinger it increases gastrin
and get fasting gastrin level
tx=High dose proton pump inhibitors.

Question 16

ligament of treitz?
sx’s of proximal bleed?
Test?

Answer 16

the boundary between upper GI bleeds and lower GI bleeds
sx’s= hematemesis, coffee grounds, melena,
test= upper endoscopy

Question 17

Ddx upper GI bleed?

Answer 17

PUD peptic ulcer disease
reflux esophagitis
esophageal varices
gastric varices
mallory-weiss
aortoenteric fistula?

Question 18

palpable mass in abdominal area?

Answer 18

gastric carcinoma

Question 19

pt presents with acute abdo pain, with inability to vomit but is retching, epigastric distension. what test, what do you see?

Answer 19

Volvulus

abdominal series coffee bean sign.perform sigmoidscopy

Question 20

for primary liver cancer and metastatic liver cancer what test can you get for both?

Answer 20

elevated bilirubin, and alk phos

Question 21

Hemangioma size and sx’s?

Answer 21

if over 4cm with symptoms=lobectomy.

Question 22

the most useful procedure for variceal bleeding?

Answer 22

esophagogastroscopy

Question 23

pt presents with high fever, tachycardia, leukocytosis, peritoneal signs, toxic?
what test you want?

Answer 23

ruptured appendix

Ct or ULS but acute appendicytis is clinical dx

Question 24

most causes of acute pancreatitis are due to ?
sx’s
TOC?

Answer 24

etoh or gallstones
epigastric pain radiating to the back, decreased bowel sounds, low grade fver, tachycardia, hypotension, leukocytosis,
TEST=CT

Question 25

turners sign?
cullens sign?
TX?

Answer 25

flank ecchymoses
periumbilical ecchymoses
tx= NPO, IVF, analgesia,

Question 26

whats more sensitive
amylase
lipase

Answer 26

LIPASE, you have amylase in your saliva