The Superlatives of Surgery Flashcards
Most Commons, Pre-malignant lesions Exceptions, ONLY ones, Etc...
1
Q
Only IV NSAID
A
Ketorolac
2
Q
Most abundant source of energy (fast <5 days)
A
Lipids
3
Q
Flatus or passage of stool are not prerequisites for enteral feeding EXCEPT IN…
A
Gastroparesis
4
Q
Most common trace mineral deficiency
A
Zinc
5
Q
TBW of males versus females
A
Male: 60%
Female: 50%
6
Q
Most common fluid disorder in surgical patients
A
Extracellular volume deficit
7
Q
Most common cause of Extracellular volume deficit
A
Loss of GI fluids
8
Q
Most common abnormality of hemostasis
A
Thrombocytopenia
9
Q
Most common complication of warfarin therapy
A
Bleeding into the abdominal cavity
10
Q
Most common cause of abdominal pain in patients undergoing anticoagulation
A
Intramural bowel hematoma
11
Q
Most common indication for blood transfusion
A
Replacement of volume
12
Q
TRALI ALWAYS occurs before…
A
6 hours post transfusion
13
Q
Most common indication for intubation
A
Altered mental status
14
Q
Most common type of burn admissions
A
Flame burns
15
Q
Keratinocyte transit time
A
40-56 days
16
Q
Most common site of extravasation (Adult)
A
Dorsum of the hand
17
Q
Most common cause of extravasation (Infant)
A
high concentration dextrose, bicarb, Ca, TPN
18
Q
More sensitive to pressure?
Muscle or Skin?
A
Muscle! Hence necrosis tends to extend deeper than is superficially apparent
19
Q
Most protective factor from UV-related damage
A
Melanin
20
Q
Most common form of radiation exposure
A
UV radiation
21
Q
Pathognomonic for actinomycosis
A
Sulfur granules within purulent specimen
22
Q
Most common location for a dermoid cyst
A
Eyebrow
23
Q
Most common cutaneous cyst
A
Epidermal cyst
2nd: Trichilemmal cyst
24
Q
Most common cutaneous lesion of infancy
A
Hemangioma
90% involute
25
Most common subcutaneous neoplasm
Lipoma
26
More common location of granular cell tumors
Tongue
27
Most common type of skin cancer
BCC
28
Most frequent from of BCC
Nodulocystic / Nodulo ulcerative - RODENT ulcer
Morpheaform - more aggressive
29
Syndromic malignancies assoc with BCC
Gorlin's syndrome (Basal cell nevus)
| Nevus sebaceus of Jadassohn
30
Syndromic malignancies assoc with SCC
Epidermolysis verruciformis
Xeroderma pigmentosum
Epidermolysis bullosa
SLE
31
Premalignant lesion: Malignant melanoma
Dysplastic nevi
32
Most common type of malignant melanoma
Superficial spreading (anywhere EXCEPT hands and feet)
33
Least common type of malignant melanoma
Acral lentiginous (palms, soles, and ungal areas)
Most common: great toe, thumb
More common in dark skinned people
34
Types of of malignant melanoma with the best and worst prognosis
Best: Lentigo maligna
Worst: Acral lentiginous
35
Most important prognostic factor
Breslow thickness
36
Skin malignancy with worst prognosis
Merkel Cell Carcinoma
| IHC stain: neuron specific enolase
37
Most common sites of necrotizing soft tissue infection
Ext. genitalia, perineum, abd. wall
38
Most common site of breast cancer
Upper outer quadrant
39
Most common site of axillary LN mets
Lateral (level 1)
Levels reference point: Pectoralis minor!
40
At what size is gynecomastia considered in men?
>/= 2cm
41
Mammography by age
Baseline: 35
Annual: start at 40
42
Chemopreventive med for Breast CA with a more favorable adverse event profile
Raloxifene
43
Most important prognostic factor of disease free survival in breast CA
Axillary LN status
44
More common in situ breast CA in premenopausal women
LCIS
| also more common bilateral
45
True anatomic precursor of Breast CA
DCIS
46
Pathognomic for Paget's Disease of the Nipple
Large, pale, vacuolated cells
Always r/o malignant melanoma
47
Most frequent complication of MRM
Seromas beneath the skin flaps
48
Most tumors of the oral cavity are of this type
SCCA
49
Most common location of SCCA of the oral cavity
Lower lip
50
Head and Neck CA with best prognosis
Cancer of the lip
51
Lymph drainage of tongue cancer
Post 3rd: Deep Cervical LN
Medial ant: inf. deep cervical
Lateral ant: submandibular
Apex: submental
52
Most common nasopharyngeal malignancy in the pediatric age group
Lymphoma
53
Most common LN mets from oropharyngeal cancer
Subdigastric area (Level II)
54
Most common site of recurrent respiratory papillomatosis
Larynx
HPV 6&11
55
Most common site of laryngeal granulomas
Posterior larynx, arytenoid fossa
56
Most common cause of vocal cord paralysis
iatrogenic (s/p thyroid, carotid, thoracic sx)
L RLN more commonly affected EXCEPT if an anterior cervical approach is done
57
Area where parapharyngeal tumors usually arise
Anterior to styloid process
40-50% parotid in origin
58
Most common salivary gland affected
Parotid
59
Most common tumors of the parotid
Benign: pleomorphic adenoma
Malignant: mucoepidermoid
2nd most common malig: Adenoid cystic
60
Risk of malignancy depending on type of salivary gland
Minor Salivary Gland > Submandibular, Sublingual > Parotid
61
Most frequently injured nerve in parotidectomy
Greater auricular nerve - Frey syndrome
62
Frequently injured nerves in submandibular gland removal
Lingual and hypoglossal
63
Weight of thyroid gland
20g
64
RLN innervates all intrinsic laryngeal muscles except
Cricothyroid (ELN)
65
Most important lab for monitoring recurrence of thyroid cancer
Thyroglobulin
66
Higher risk for malignancy?
| Hot or cold thyroid nodules?
Cold
67
Most common cause of hyperthyroidsim
Graves Disease
68
Most common GI symptom of hyperthy
Diarrhea
69
Given pre-operatively to reduce vascularity of the thyroid
SSKI
70
Common causes of Acute thyroiditis
streptococcus and anaerobes
71
Most common presentation of Hashimoto's thyroiditis
Minimal or moderately enlarged firm granular gland
72
Most important test in evaluation of thyroid masses
FNAB
73
Most common site of mets for papillary thyroid CA
lungs
bone
liver
brain
74
Most important prognostic factor for papillary thyroid CA
Age
75
Most common site of mets for follicular thyroid CA
Lung
| Bone
76
Pre-malignant lesion of medullary thyroid CA
C Cell hyperplasia
77
Tumor markers for medullary thyroid CA
Most sensitive: calcitonin
| Better prognostic: CEA
78
Worst prognosis for medullary thyroid CA when...
Patient has MEN 2B
79
Characteristic finding in anaplastic CA
Giant and multinucleated cells
80
Most common thyroid lymphoma
Non-Hodgkins B cell type
81
1st diagnostic test in patients with suspected esophageal disease
Barium swallow
82
Essential pre-op eval before anti-reflux surg
Manometry
83
GOld standard diagnostic for GERD
24 hour ambulatory pH monitoring
84
Most specific symptom of foregut disease
Dysphagia
85
Most important consideration affecting competence of GEJ
Sphincter length (<1cm)
86
Most important factor in predicting failure of medical tx
Structurally defective LES
Review the principles of surg therapy of reflux (p. 53)
87
Borchardt's triad
Pain
nausea w/o ability to vomit
inability to pass NGT
88
Classic triad of achalasia
Dysphagia
Regurgitation
Weight loss
89
Most common area for Zenker's diverticulum
Killian's area
90
Most common primary motility disorder of the esophagus
Nutcracker esophagus
91
Most common cause of esophageal perforation
Endoscopy
92
Best prognosis for esophageal perforation achieved when
primary closure is done within 24 hours
93
Phase of caustic injury when esophagus is WEAKEST
II: Ulceration and granulation phase
94
Most common symptom of Esophageal SCCA
Dysphagia
95
Most radical surgical treatment of esophageal cancer
Ivor Lewis procedure
96
Gold standard for H. pylori diagnosis
Histologic exam of antral mucosa with special stains
97
Blood types and PUD
Type O: duodenal
| A: gastric
98
Most common location of gastric ulcer
Lesser curvature
99
Most common location for esophageal perforation
Left lateral wall, above GEJ
100
Most common cause of ulcer-related death
Bleeding
101
High risk lesions for ulcers
Posterior duodenal: near gastroduodenal art
| Less curvature: near left gastric art
102
Confirmatory test for gastrinoma
Secretin secretion test
First tests: Fasting gastrin and BAO
103
Pre-op imaging of choice prior to gastrinoma resection
Ocreotide scan
104
Most common gastric CA
AdenoCA 95%
Lymphoma 4%
GIST 1%
105
Most common pre-cancerous lesion of gastric adenoCA
atrophic gastritis
106
Most important prognostic factor in gastric adenoCA
LN involvement and depth of invasion
107
Most common site of GI lymphoma
Stomach
108
Most common gastric polyp
Hyperplastic / regenerative
109
Strongest layer of the SI
Tela submucosa
110
Most specific diagnostic for SBO
Abdominal series:
Dilated small bowel loops (>3cm)
Air fluid levels seen
Paucity of air in the colon
111
Indication for sx in partial SBO
No improvement of sx in 48 hours
112
Normal pattern of return to GI motility
SI: 24 hours
gastric: 48 hours
Colon: 3-5 days
113
Pathognomonic of Crohns
Fat wrapping around the serosal surface of the bowel (transmural infarct)
114
Most common cause of enterocutaneous fistulas
Iatrogenic
| Low output: 500
115
Most useful initial test in intestinal fistula
CT scan
| Fistulogram better in determining origin of fistula
116
Most common location of SI adenoCA
Duodenum
| If w/ Crohns: terminal ileum
117
Most common presentation of SI neoplasm
Partial SBO
118
Most accurate diagnostic for chronic radiation enteritis
Enteroclysis
119
Most prevalent congenital anomaly of the GI tract
Meckel's diverticulum
120
Most common cause of Acute mesenteric ischemia
Embolus
Most common source? Heart
Most common location? SMA
121
Golden period for intestinal ischemia
3-6 hours
| 3rd hour: start of cell sloughing
122
Diagnostic of choice for intussusception
CT scan: Target sign
123
MC etiology of short bowel syndrome
Acute mesenteric ischemia, malignancy, Crohns
Pedia: int. atresia, volvulus, NEC
124
Most common period in pregnancy when appendicitis occurs
2nd trim
| Also, appendicitis is the most common surgical emergency in preg
125
CT scan use in Colon disease
Extraluminal disease
