Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

high yield concepts > SURGERY USMLE > Flashcards

SURGERY USMLE Flashcards

1
Q

dysphagia that is worse for liquids

A

Achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cancer of the esophagus

A

SCCA- smokers

Adenocarcinoma - GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mallory Weiss tear

A

junction of stomach and esophagus
forceful vomiting
Bright red hematemesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Booerhave’s syndrome

A

prolonged vomiting

esophageal perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Gasric adenocarcinoma

A

Anorexia
Weight loss
Vague epigastric distress or early satiety
Occasional hematemesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment for gastric lymphoma

A

Chemotherapy
Surgery if perforation is feared
Low grade lymphomatoid transformation can e reversed by eradication of H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mechanical intestinal obstruction

A

typically caused by adhesions

colicky abdominal pain, protracted vomiting, progressive abdominal distension, and no passage of gas or feces.

Xrays: distented bowel loops of small bowels, with air fluid levels

TX: NPO, NG suction, IV fluids
Surgery if no improvement within 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Strangulated obstruction

A

compromised blood supply leading to bowel ischemia
starts as MBO then fever, leukocytosis, constant pain, signs of peritoneal irritation, full blowen peritonitis and sepsis

TX: surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Carcinoid syndrome

A

SB carcinoid tumor with livers mets

Diarrhea, flushing of face, wheezing, R heart valvular damage

DX: 24 hour urinary collection of 5- hydroxyindolacetic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Classic picture of acute appendicitis

A

begins with anorexia, followed by:
vague periumbilical pain -> localizing RLQ
Tenderness, guarding
Modest leukocytosis (10000-15000) with neutrophilia and immature forms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cancer of the Right colon

A

presents with anemia (hypochromic)
50-70
stool +4 FOBT

Colonoscopy and biopsies
TX: Right hemicolectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cancer of the Left colon

A

bloody bowel movements and obstruction
Flexible proctosigmoidoscopic exam (45-60 cm) and biopsies
Full colonoscopy to r/o synchronous second primary lesion proximally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Colonic polyps

A

may be premalignant (familial polyposis, familial multiple inflammatory polyps, villous adenoma and adenomatous polyp)

not Premalignant ( juvebile, PEutz Jeghers, isolated inflammatory, and hyperplastic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Chronic ulcerative colitis

A

managed medically

Surgery: >20 years (high incidence of malignant degeneration, ), severe interference of nutritional status, multiple hospitalizations, toxic megacolon.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pseudomembranous enterocolitis

A

overgrowth of Clostridium difficile
Clindamycin - first one to cause
Cephalosporin - most common cause

Profuse watery diarrhea, crampy abdominal pain, fever, leukocytosis.

TX: Metronidazole with vancomycin as alternative
>50 000 WBC and serum lactate >5 mg/dL requires emergency colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Anal fissure

A

young women
exquisite pain with defecation and blood streaks

TX; stool softeners, topiccal nitoglycerin, local injection of botulinum toxin, diltiazem ointment 2% TID topically for 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Crohn’s disease

A

often affects anal area
starts with a fissure, fistula or small ulceration
dx should be suspected when the area fails to heal and gets worse after surgical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ischiorectal abscess

A

febrile with exquisite perirectal pain that does not let him sit down or have bowel movements

Classic findings of abscess in the lateral to the anus
TX: IND

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Fistula -in-ano

A

Epithelial migration from the anal crypts and from the perineal skin form a permanentt tract.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Squamous cell carcinoma of the anus

A

more common in HIV and in patients with receptive sexual practices.

fungating mass, metatastic inguinal nodes

TX: Nigro chemoradiation protocoal followed by surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Steps of wound healing

A 
Coagulation
Inflammation
Colllagen synthesis
aniogenesis
Epithelization 
Contraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Phases of wound healing

A

Hemostasis and inflamamtion
Proliferation
maturation
remodelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Most common cause of post operative fever within th first 24 hours

A

Atelectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Acute abdomen

A

abrupt onset of abdominal pain usually accompanied by one or more peritoneal signs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

kehr’s sign

A

pain referred to the left shoulder due to irritation of the left hemidiaphragm.

often seen with splenic rupture and residual pneumoperitoneum after laparoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Pain relieved by vomiting

A

supportive of SBO, afferent loop syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Bilious vomiting

A

Proximal SBO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Mucoid diarrhea with blood (red currant jellys tool)

A

Intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Mcburney’s point

A

Appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Beck’s tamponade triad

A

Hypotension
JVD
Muffled heart sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Clinically apparent tamponaded

A

as little as 60-100mL of blood in the pericardial space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Pneumothorax

A

air in the pleural space

Chest pain
Dyspnea
Hyperresonant of affected side
Decreased breath sounds on affected sides

TX; tube thoracostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

tension pneumothorax

A

life threatening emergency caused by air entering the pleural space and unable to escape

Ipsilateral lung collapse and mediastinal shift (away from the injured lung), impairing venous return and thus decreased cardiac output, resulting to shock

TX: needle decompression followed by tube thoracostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Hemothorax

A

presence of blood in the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Indications for thoracostomy

A

1500 cc initial drainage from the chest tube
200 cc/hr for 4 hours continued drainage;
Thoracic great vessel injury
Esophageal injury
ptients who decompensate after stabilization

36
Q

Size of chest tube to use:

A

For adult large hemothorax: 36-40 French
For adult pneumothorax: 24 French or pigtail catheter
For children: four times the size of appropriate endotracheal tube size:

ET tube size = age+16/4

37
Q

seat belt sign

A

ecchymotic area found in the distribution of the lower anterior abdominal wall and can be associated with perforation of the bladder or bowel as well as a lumbar distraction fracture

38
Q

Cullen’s sign

A

Periumbilical ecchymosis (indicative of intraperitoneal hemorrhage

39
Q

Grey-Turner’s sign

A

flank ecchymoses (indicative of retroperitoneal hemorrhage)

40
Q

Acute pancreatitis

A

suspected in an alcoholic who develops an upper acute abdomen

rapid onset for an inflammatory process and the pain is constant, epigastric, radiating straight through the back, with nausea, vomiting, and retching

41
Q

Primary Hepatoma

A

vague right upper quadrant discomfort and weight loss.
AFP
Resection is done if technically possible

42
Q

Hepatic adenoma

A

arise as a complication of birth control pills

tendency to rupture and bleed massively

43
Q

Pyogenic liver abscess

A

complication of biliary tract disease, particularly acute ascending cholangitis.

Fever, leukocytosis and a tender liver

44
Q

Amebic abscess of the liver

A

Treated with metronidazole abd rarely require drainage

45
Q

Biliary colic

A

occurs when a stone temporarily occludes the cystic duct. Causes colicky pain in the right upper quadrant radiating to the right shouder and back.

46
Q

Charcot’s triad

A

fever, jaundice, RUQ pain

47
Q

Reynold’s Pentad

A

fever, jaundice, RUQ pain, altered mental status, evidence of sepsis (hypotension)

48
Q

Acute pancreatitis

A

may be edematous, hemorrhagic, or suppurative

49
Q

Acute edematous pancreatitis

A

occurs in the alcoholic or pt with gallastones
Epigastric and midabdominal pain radiating straight through the back, accomapanied by nausea, vomiting, and continued retching

Amylase and lipase is elevated and hematocrit are high due to hypovolemia

50
Q

Fibroadenoma

A

firm, rubbery mass that moves easily with palpation.

FNA or core biopsy

51
Q

Indirect Inguinal hernias

A 
Rule of 5's
5% lifetine incidence in males
5x more common than direct inguinal hernias
5-10x more common in males than females
Generally occur by 5th decade of life
52
Q

Inguinal Hernias

A

MDs Dont Lie

Medial to the inferior epigastric artery - DIRECT
Lateral to the IEA - INDIRECT

53
Q

Abdominal HErnia

A

Defect in the abdominal wall causing abnormal potrusion of intra-abdominal contents

RF:
activities which increase intra-abdominal pressure
Congenital abnormality (patent processus vaginalis)
Previous hernia repair
Loss of tissue strength and elasticity

54
Q

Hesselbach’s triangle

A

Lateral : inferior epigastric artery
Inferior: inguinal ligament
Medial: lateral margin of rectus sheath

55
Q

Inguinal Canal Walls

A

MALT x 2

2M roof = 2 muscles (internal oblique, trasversus abdominis)
2A Anterior wall - 2 aponeurosis (external and internal oblique)
2L Floor = 2 ligaments (inguinal and lacunar)
2T Posterior wall = Transversalis fascia, conjoint Tendon

56
Q

Classification of Hernia

A

Complete: Hernia sac and contents protrude
Incomplete: partial protrusion through the defect
Internal: sac herniating into or involving intra-abdominal wall
External: sac protrudes completely through the abdominal wall
Strangulated: vascular supply of protruded viscus is compromised
Incarcerated: Irreducible hernia, not necessarily strangulated
Sliding: part of wall of hernia sac formed by retroperitoneal structure (colon)

57
Q

Richter’s Hernia

A

only part of the bowel circumference *usually anti-mesenteric border) is incarcerated or strangulated

58
Q

femoral hernia

A

affects mostly females

Pregnancy - weakness of pelvic floor musculature
Increased intra-abdominal pressure

Into femoral canal, below the ingunial ligament but may override it
Medial to femoral vein within femoral canal

59
Q

Superdicial Inguinal Ring

A

Opening in external abdominal aponeuorosis; palpable superior and lateral to pubic tubercle

Medial border: medial crus of external abdominal aponeurosis

Lateral border: lateral crus of external oblique aponeurosis

Roof: intercrural fibers

60
Q

Deep inguinal Ring

A

Opening in transversalis fascia: palpable superior to mid-inguinal ligament

Medial: inferior epigastric vessels

Superior-LAteral border: Internal oblique and transversus abdominis muscle

Inferior border: inguinal ligament

61
Q

Mcburney’s sign

A

Tenderness 1/3 the distance from the ASIS to the umbilicus n the right side

62
Q

Crohn’s Major Patterns

A

Ileocecal 40% (RLQ pain, fever, weight loss)

Small intestine 30% (especially terminal ileum)

Colon 25% (diarrhea)

63
Q

Findings in Crohn’s disease

A

Cobblestoning on mucosal surface due to edema and linear ulcerations

Skip Lesions: normal mucosa in between

Creeping fat: mesentery infiltrated by fat

granulomas: 25-30%

64
Q

Findings in Ulerative colitis

A

(+) diarrhea with or without blood
colicky abdominal pain, urgency, tenesmus, and incontinence
Presence of extraintestinal manifestaions

Endocoscopically, there is loss of vascular markings, erythema, granularity of mucosa, petechiae, exudates, edema, erosions, and spontaneous bleeding

Biopsy: crypt abscesses, crypt blanching, shortening and disarray and crypt atrophy

Inflammation is continuous and usually involves the rectum

65
Q

Top 3 cause of LBO

A

cancer
diverticulitis
Volvulus

66
Q

Clinical Features of LBO

A

Open loop *incompetent ileocecal valce) - similar with SBO

Closed loop (80-90%) - competent ileocecal valve resulting in proximal and sital occlusions

67
Q

Functional LBO

A

Colonic Pseudo Obstruction (Ogilvie’s Syndrome)

Acute pseudo obstruction
Distention of the colon without mechanical obstruction in distal colon

68
Q

Diverticulum

A

abnormal sac like protrusion from the wall of a hollow organ

69
Q

Diverticulosis vs Divericulitis

A

Diverticulosis - presence of diverticuli within the colonic wall

Diverticulitis 0 inflammation of one or more diverticuli

70
Q

Hinchey Staging and treatment for Diverticulitis

A

1 - Phlegmon/small pericolic abscess (medical)
2 - Large abscess/fistula (Medical, abscess drainage resection)
3 - Purulent peritonitis (resection or hartmann procedure)
4 - Feculent peritonitis (hartmann procedure)

71
Q

Familial Adenomatous Polyposis

A

autosomal dominant inheritance, mutation in adenomatous polyposis coli (APC) gene on chromosome 5q21

72
Q

Gardner’s syndrome

A

FAP + Extra-intestinal lesions (sebaceous cysts, osteomas, desmoid tumors)

73
Q

Turcot syndrome

A

FAP + CNS tumors (childhood cerebellar medulloblastoma)

74
Q

LYNCH syndrome

A

Hereditary Non-polyposis colorectal cancer

autosomal dominant inheritance, mutation in a DNA mismatch repair gene (MSH2, MSH6, MLH1) resulting in microsatellite instability genomic instability and sbsequent mutations)

early age of Onset RIGHT>left

75
Q

Amsterdam criteria for Lynch syndrome

A

3 or more relatives verified and 1 must be 1st degree relative of the other 2

2 or more generations involved

1 case must be diagnosed before 50 years old

FAP is excluded

76
Q

Staging for Colorectal cancer

A

I - T1M2 N0M0
II - T3,4 N0M0
III- TxN + M0
IV - TxNxM1

77
Q

CRC (right coloon)

A

25%

Exophytic lesions with occult bleeding

weight loss, weakness, rarely obstruction

Iron deficiency anemia, RLQ mass

78
Q

CRC (left colon)

A

35%

Annular, invasive lesions

Constipation +/- overflow (alternating bowel patterns), abdominal pain, decreased stool caliber, rectal bleeding

BRBPR, LBO

79
Q

CRC (rectum)

A

30%

ulcerating

Obstruction, tenesmus, rectal bleeding

Palpable mass on DRE, BRBPR

80
Q

Primary tumor staging of CRC

A

T0 - no primary tumor
Tis - Carcinoma in situ
T1 - Invasion into submucosa
T2 - Invasion into musculariss propria
T3 - Invasion through muscularis propria and into serosa
T4 - Invasion into adjacent structures or Organs

81
Q

Regional LN staging CRC

A 
N0 = no
N1 = 1-3
N2 = 4 or more
82
Q

Toxic Megacolon

A

extension of inflammation into smooth musce layer causing paralysis
Damage to the myenteric plexus and electrolyte abnormalities are not consistently found

Etology:
IBD (UC> CD)
Infectious colitis

Dx Criteria:
Must have both colitis and systemic manifestations
Radiologic evidence of dilated colon
3 of : fever, HR>120, WBC>10.5, anemia
1 of : fluid and electrolyte disturbances, hypotension, or altered LOC

83
Q

Fistula

A

abnormal communication between 2 epithelized surfaces

84
Q

Park’s classification of Perianal fistulas

A

Transphicteric - Most common, Results form ischiorectal abscesses with extension of the tract through the external sphincter

Intersphicteric - Confinded to the intersphincteric space and internal sphincter, result from perianal abscesses

Suprasphincteric - Pass through the levator ani, over the top of the puboretalis, and into the intersphincteric space. Result from Supralevator abscesses

Extrasphincteric - bypass the anal canal and sphincter mechanism, passing through the ischiorectal fossa and levator ani muscle and open high in the rectu,

85
Q

Goodsall’s rule

A

The anal line divides it into anterior and posterior regions. If the abscess is in the posterior region, it usually drains in the midline and follows a curvilinear tract.

In the anterior region, the abscess will usually drain straight to the anus. It follows a radial tract of drainafe except if external canal is beyond 3cm of the line.

high yield concepts (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions