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Daily reviewers > Surgery Treatments > Flashcards

Surgery Treatments Flashcards

1
Q

Cancer of the tongue

A

Partial glossectomy +

supraomohyoid dissection (N0)
MRND (N+)
With mandibular involvement:
composite resection (Partial glossectomy + floor of the mouth and mandibulectomy)
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2
Q

Cancer of the base of the tongue

A

Early: Surgery + RT + BND
Advanced: Total resection with or without laryngectomy

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3
Q

Cancer of the alveolus of gingiva

A

Resection of the tumor plus

marginal mandibular resection or segmental mandibular resection plus

ipsilateral supraomohyoid dissection (N0)
MRND (N+)

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4
Q

Cancer of the larynx (Supraglottic / Glottic)

A

Early lesion: RT

Advanced: Surgery plus RT

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5
Q

Cancer of the larynx (Subglottic)

A

total laryngectomy plus neck dissection regardless of status

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6
Q

Benign epithelial and non epithelial salivary gland tumor like Pleomorphic adenoma

A

Surgical excision
Parotid: superficial parotidectomy with facial nerve presevation
Enucleation is not recommended

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7
Q

Mucoepidermoid Cancer of the parotid gland

A

Lateral lobe: Superficial parotidectomy with facial nerve preservation
Deep lobe: Total parotidectomy with facial nerve preservation
Nerve sacrifice: if encased by tumor and non functional preoperatively

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8
Q

Mucoepidermoid cancer of the submandibular gland

A

En bloc resection of the gland and submental and submandibular LN
MRND (N+)

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9
Q

Graves disease drugs given prior to surgery

A

Lugol’s solution: Decrease vascularity of thyroid thus decreased risk for thyroid storm
PTU, Methimazole

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10
Q

What is the Hartley-Dunhill or subtotal thyroidectomy procedure?

A

total lobectomy, isthmusectomy, and subtotal thyroidectomy on the other side.

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11
Q

Toxic adenoma

A

Unilateral lobectomy and isthmusectomy

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12
Q

Thyroid storm

A

beta blockers, oxygen supplementation, hemodynamic support, PTU, Lugol’s iodine, and ipodate
Corticosteroids
non-aspirin compounds

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13
Q

Acute suppurative thyroiditis (Preceeded by URTI in children)

A

Parenteral antibiotics

Drainage of abscess

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14
Q

Subacute thyroiditis (Painful type) - preceeded by URTI

A

Symptomatic
Short term thyroid hormone replacement
Thyroidectomy reserved for medical failure

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15
Q

Subacute thyroiditis (Painless type) - autoimmune in origin

A

Short term thyroid replacement

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16
Q

Chronic thyroiditis (Hashimoto’s / Lymphocytic thyroiditis)

A

Thyroid hormone replacement

Surgery only when CA is suspected

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17
Q

Reidel’s thyroiditis (Invasive fibrous thyroiditis)

A

Wedge excision of the thyroid isthmus
L-thyroxine
Steroids

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18
Q

Solitary Thyroid nodule investigation pathway

A
  1. TSH test (IF thyrotoxic -> Scan for either hot [Radioactive iodine or surgery] or cold)
  2. FNAB

Either:

a. Observe for cystic that regresses
b. Thyroid lobectomy for benign or high clinical suspicion
c. Total or partial thyroidectomy for malignant

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19
Q

Simple thyroid cysts when do you do unilateral lobectomy

A

> 3 attempts, >4 cm, complex cysts

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20
Q

Papillary carcinoma of the thyroid (Orphan Annie nuclei, Psammoma bodies)

A

TT / NTT

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21
Q

Follicular carcinoma (More common in iodine deficient areas)

A

Adenoma: lobectomy + Isthmusectomy

Older and > 4cm: TT/ NTT

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22
Q

Hurthle cell carcinoma (subtype of follicular carinoma)

A

Adenoma: Lobectomy + Isthmusectomy
Carcinoma: TT / NTT + Routine central neck node dissection

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23
Q

Medullary thyroid carcinoma (from the parafollicular cells located at the superolateral lobes of the thyroid gland)

A

Pheocromocytoma (Treat first)

TT + BCND

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24
Q

Thyroid Lymphoma

A

CHOP

Cyclophosphamide, doxorubicin, Vincristine, prednisone

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25
Q

Most common injury in thyroid surgery

A

Parathyroid injury

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26
Q

Most common location of ectopic parathyroids

A

Paraesophageal

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27
Q

Clinical manifestation of primary hyperparathyroidism

A 
Kidney stones
Painful bones
abdominal groans
Psychic moans
Fatigue overtones
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28
Q

Parathyroid

A

adenoma: Resection
Hyperplasia: 3 1/2 Parathyroidectomy or total parathyroidectomy + Autotransplantation
Carcinoma: en bloc resection + Ipsilateral thyroid lobe

29
Q

Preoperative localization test for parathyroid adenoma

A

Sestamibi

30
Q

Secondary or tertiary hyperparathyroidism

A

3 1/2 parathyroidectomy or total parathyroidectomy + autotransplantation

31
Q

Values of a defective LES

A

mean resting pressure <1 cm most common)

32
Q

GERD

A

12 week antacid or PPI

Antireflux procedure: Nissel fundoplication

33
Q

Diaphragmatic (Hiatal Hernia) Types

A
  1. sliding - upward disclocation of the cardia (Most common)
  2. rolling / paraesophageal - upward dislocation of the fundus
  3. mixed
  4. additional organ herniates
34
Q

Borchardt’s triad

A

Chest pain, retching with inability to vomit, and inability to pass an NGT

35
Q

Diaphragmatic hernia treatment (Type II)

A

Asymptomatic: Observation
Symptomatic: Elective reduction surgery with repair of diaphragmatic defect +/- fundoplication

36
Q

Zenker’s diverticula (Found in the Killian triangle situated behind the esophagus at the level of the cricopharyngeus muscle)

A

2cm: diverticulectomy or diverticulopexy

37
Q

Gold standard test for achalasia

A

Manometry

38
Q

Treatment for achalasia

A

Heller’s myotomy + Partial fundoplication

39
Q

Most common primary esophageal motility disorder

A

Nutcracker esophagus

40
Q

Phases of caustic injury

A

Acute necrotic phase (1-3 days)
Ulceration and granulation phase (3-5 days)
Cicatrization and scarring phase (3rd week)

41
Q

Esophageal carcinoma

A

Trans-thoracid esophagectomy, trans-hiatal esophagectomy

Ivor Lewis procedure

42
Q

Mallory weiss tear

A

Non-operative

43
Q

Gastric outlet obstruction which presents as nonbillous vomiting leading to profound hypokalemic, hypochloremic, metabolic alkalosis

A

NPO, NGT, IVF, Acid suppression

44
Q

Gastric Ulcer types

A
  1. Antral lesser curvature
  2. Antral plus duodenal
  3. Pre-pyloric
  4. High in lesser curvature
  5. NSAID
45
Q

Bleeding peptic Ulcer

A
  1. Oversew

2. V&D or A (D) or Distal Gastrectomy (G)

46
Q

Perforated peptic ulcer

A
  1. Patch Graham’s procedure (Both) + BX or wedge resection (G)
  2. HSV or V&D or A (D) or Distal Gastrectomy (G)
47
Q

Dumping syndrome - due to the destruction of the pyloric sphincter causing abrupt delivery of hyperosmolar load to the small intestines

A

Dietary: avoidance of liquids during meals & High fiber diet
Medical: Octreotide for early dumping, alpha glucosidase inhibitor for late

Surgical: Conversion to Roux-en-Y anastomosis

48
Q

Passaro’s triangle

A

Head of the pancreas
Junction of the hepatic and cystic duct
junction of the 2nd and 3rd portion of the duodenum

49
Q

Gastric adenocarcinoma

A

Endoscopic mucosal resection for tumors <2cm limited to the mucosa or submucosa

The rest: resection of all tumor (R0) with 5cm grossly negative margins with enbloc removal of adjacent LN and involved organs.

Standard operation: Radical subtotal gastrectomy

50
Q

Gold standard for the diagnostic evaluation of gastric adenocarcinoma

A

upper endoscopy and biopsy

51
Q

Low grade vs High grade Gastric MALT lymphoma

A

Low grade: H. pylori eradication

High grade: Chemo and or radical subtotal gastrectomy

52
Q

GIST tumor marker

A

c-KIT and CD34

53
Q

Gastrointestinal Stromal Tumor

A

Wedge resection with negative margins

for unresectable: Imatinib

54
Q

Appendicitis Stages

A
  1. Congestion
  2. Suppurative
  3. Gangrene
  4. Rupture
55
Q

GI carcinoid of the appendix that will warrant a right hemicolectomy

A

Between 1-2 cm located at the base (mesoappendiceal invasion)

> 2cm will also warrant a right hemicolectomy

56
Q

Adenocarcinoma of the appendix

A

Right hemicolectomy

57
Q

Sigmoid volvulus

A

Soft rectal tube for decompression

Resection with primary anastomosis (prepped bowel)

Resection of the sigmoid colon with construction of a colostomy Hartman’s pouch for emergent operation

58
Q

Acute diverticulitis

A

Uncomplicated: clear liquid diet and broad spectrum antibiotics
Generalized peritonitis: Urgent celiotomy
Diverticulitis with abscess: Drainage
Diverticulitis with fistula: Antibiotics, TPN, bowel rest, excision of diseased colon

59
Q

Rectal prolapse

A

Low anterior resection
retrorectal sacral fixation
retrorectal sacral rectopexy
Thiersch procedure

60
Q

Hemorrhoid

A

1st and 2nd: Medical management
3rd and 4th: Surgery
External hemorrhoid: Excision

61
Q

Acute variceal bleeding

A

Vasopressin
Octreotide
Early endoscopy and vericeal ligation

Refractory bleeding: Surgical shunt or TIPS

62
Q

Budd-Chiari syndrome

A

Systemic anticoagulation

63
Q

Pyogenic Liver abscess

A

Broad spectrum antibiotic

Percutaneous aspiration

64
Q

Liver hemangioma

A

Small: enucleation
Large: Resection

65
Q

Liver adenoma

A

Resection

66
Q

Hepatocellular & Cholangiocarcinoma

A

Resection

67
Q

Choledochal Cyst Triad (This is due to pancreatic secretions backing up the bile duct)

A

Right upper quadrant pain, jaundice, mass

68
Q 
Sclerosing cholangitis 
(Presents as weight loss, fatigue, intermittent jaundice, pruritus, abdominal pain)
A

Liver Transplantation

Daily reviewers (7 decks)

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