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ABSITE RAPID FACTS > True Learn > Flashcards

True Learn Flashcards

1
Q

Indications for Surgery

UC Elective

A

1) Failure of Medical Management
2) Complications/side effects of meds
3) dysplasia
4) Invasive Cancer
5) Extraintestinal manifestations
6) Growth retardation

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2
Q

Indications for Surgery

UC Emergent

A

1) Toxic Megacolon
2) Sepsis/fulminant colitis
3) Perforation
4) Hemorrhage

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3
Q

Indication for Drainage

Pancreatic Pseudocyst

A

1) Persistence >6 weeks
2) Enlarging size
3) infection
4) Symptomatic

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4
Q

Indication for Surgery

Distal Pancreatectomy

A

1) MCN
a) Symptomatic
b) Asymptomatic > 3 cm
c) Solid component
d) Enlarged Duct
2) Pancreatic Neuroendocrine tumors
3) Poorly differentiated solid mass
4) Adenocarcinoma of Pancreatic tail without mets
5) Symptomatic SCN
6) Chronic Pancreatitis or Pseudocyst of only tail
7) Grade III and some grade IV trauma

** Preservation of Spleen only in benign disease or trauma**

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5
Q

Indications for Surgery

Type B Aortic Dissection

A

1) impending/actual rupture
2) Sx related to dissection ( CHF, Angina, Aortic Regurgitation, Stroke, Pain)
3) Malperfusion
4) Aneurysm >6.5 cm OR expansion >1cm/year

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6
Q

RELATIVE Indications for Carotid Stenting

A

1) Severe cardiac risk
2) Previous LATERAL neck surgery/Radiation
3) Extremely proximal/distal plaques
4) Tortuous Vessel Anatomy
5) Contralateral nerve palsy

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7
Q 
Diagnosis 
B/l absence of iris 
Intellectual disability 
Hypospadia, cryptochordism OR Streak ovaries
Del short arm chromosome 11
A 
WAGR Syndrome
Wilms Tumor
Anidiridia 
Genitourinary Malformations
Retardation
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8
Q

Non-Hodgkin’s Lymphoma Staging

A 
I- confined to GI tract (single or multiple)
II (tumors below diaphragm) 
IIE- through serosa
II1- local LN involvement
II2- distant LN involvment
III- Supradiaphragmatic disease
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9
Q

Type I Endoleak

A

Failure of seal proximally (Ia) ir distally (Ib)
TREAT ALL
Balloon, stent proximally and distally

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10
Q

Type II Endoleak

A

Filling of sac by lumbar branches or IMA
TX if size increasing
(Embolization, sac puncture (thoracolumbar approach), lap/open ligation of feeding vessels

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11
Q

Type III Endoleak

A

failure of graft to seal with itself (component to component leaks)
TREAT ALL: replace components

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12
Q

Type IV Endoleak

A

Leak through porous graft (self-limited with reversal of AC)

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13
Q

Type V Endoleak

A

sac leaks fuck knows why

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14
Q

Evidence of fistula with 2 openings and single tract

A

Poss. Horseshoe fistula

Tx: Hanley’s Procedure (Post aspect incised, anterior aspect incised with secondary incision and penrose drain)

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15
Q

Diagnostic Criteria

Hepatorenal Syndrome

A

1) Cirrhosis and Ascites
2) Cr >1.5
3) No improvement in serum Cr despite 2 days diuretic abstinence and albumin 1g/kg
4) Absence of shock
5) No nephrotoxic drugs
6) Absence of parenchymal disease

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16
Q

Pathophysiologic Mechanism

Hepatorenal Syndrome

A

splanchnic vasodilation causes activation of RAAS and SNS and secretion of ADH resulting in renal hypoperfusion.

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17
Q

Treatment

Hepatorenal Syndrome

A

Liver Transplant

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18
Q

Complications

Laparoscopic Sleeve Gastrectomy

A

Bleeding
Stenosis
Staple Line Leakage

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19
Q

Complications
Laparoscopic Sleeve Gastrectomy
Gastric Stenosis
TREATMENT

A

Endoscopic Balloon Dilation

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20
Q

MCC
Anal fissure
Posterior Midline

A

Constipaton

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21
Q

Other Causes
Anal Fissure
Anterior Midline

A

Constipation in FEMALES

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22
Q

Other Causes
Anal Fissure
Location OTHER than Posterior Midline

A 
Crohn's Disese
TB
Syphillis
HIV/AIDS
Anal Cancer
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23
Q 
Cytologic Criteria (In ascitic fluid)
Spontaneous Bacterial Peritonitis
A

2 of the 3 in setting of Pt with appropriate hx and sx
Total protein > 1 g/dl
Glucose <50 mg/dl
LDH > upper limit or normal for serum

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24
Q

Diagnosis

Ascites + “Obstruction of lymphatic vessels at the base of the mesentery”

A

Chylous Ascites

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25
Q

Pathophysiology

Chylous Ascites

A

Obstruction of lymphatic vessels at the base of the mesentery or cisterna chylii

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26
Q

Ddx

Chylous Ascites

A

End Stage Pancreatic Cancer (compresses cysterna chylii)
Congenital lymphangiectasia
Thoracic duct obstrution
Lymph peritoneal fistula

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27
Q

Steroid MOST effective in active Crohn’s Disease

A

Budesonide

Prednisone used typically

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28
Q

Amount of Endogenous fluid produced by GI tract per day

A

7 liters

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29
Q

Amount of saliva produced per day

A

1500cc

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30
Q

Stomach fluid produced per day

A

1000-2000cc

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31
Q

Amount of bile produced per day

A

500cc

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32
Q

Pancreatic secretion produced per day

A

1500cc

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33
Q

Amount of fluid produced by small bowel per day

A

1500cc

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34
Q

MCC Death in 1st year post cardiac allograft

A

Allograft vasculopathy

signs of atherosclerosis without calcification

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35
Q 
Rutherford Classification + Treatment
Sensory Loss: None
Motor Loss: None 
Arterial Doppler: Audible
Venous Doppler: Audible
A

Class I: Limb viable, not immediately threatened
Heparin Drip
CDT possible

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36
Q 
Rutherford Classification + Treatment
Sensory Loss: None or Minimal (toes)
Motor Loss: None
Arterial Doppler: Often Inaudible
Venous Doppler: Audible
A

Class IIa: Marginally threatened, salvageable if treated promptly

Heparin Drip
CDT Possible

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37
Q 
Rutherford Classification + Treatment
Sensory Loss: More than toes, associated with rest pain
Motor Loss: Mild or moderate
Arterial Doppler: Usually Inaudible
Venous Doppler: Audible
A

Class IIb: Immediately threatened, salvageable with immediate revascularization.

Heparin Drip
Open Thrombectomy

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38
Q 
Rutherford Classification + Treatment
Sensory Loss: Profound, anesthetic
Motor Loss: Profound, paralysis, rigor
Arterial Doppler:  Inaudible
Venous Doppler: Inaudible
A

Class III: Limb irreversibly damaged, major tissue loss or permanent nerve damage inevitable

Heparin Drip
Open thrombectomy in early presentation
Amputation if late presentation

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39
Q

Access preference (KDOQI) for ESRD on HD

A

1) Autologous radiocephalic (forearm) AVF
2) Autologous brachiocephalic AVF
3) Transposed Brachiobasilic AVF
4) Upper arm Brachial-cephalic prosthetic graft

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40
Q

Characteristics of working fistulas

A

Rule of 6’s

1) Bloodflow adequate to support HD (>600ml/min)
2) Diameter greater than 6mm in a location accessible for cannulation and discernible margins for repeated cannulation
3) Depth approximately 6 mm

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41
Q

Relative indications for prosthetic graft vs fistula

A

1) small basillic vein b/l
2) hx of several central venous catheter infections
3) obesity

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42
Q

Electrolyte abnormalities

Tumor lysis syndrome

A

HYPOcalcemia (good question answer)

HYPER K, Phos, Uric Acid, Creatinine

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43
Q

AAST Pancreatic Trauma Grade

hematoma with minor contusion/laceration but without duct injury

A

Grade 1

advance one grade for multiple injuries up to grade III.

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44
Q

AAST Pancreatic Trauma Grade

major contusion/laceration but without duct injury

A

Grade 2

advance one grade for multiple injuries up to grade III.

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45
Q

AAST Pancreatic Trauma Grade

distal laceration or parenchymal injury with duct injury

A

Grade 3

advance one grade for multiple injuries up to grade III.

46
Q

AAST Pancreatic Trauma Grade
proximal (i.e. to the right of superior mesenteric vein) laceration or parenchymal injury with injury to bile duct / ampulla

A

Grade 4

47
Q

AAST Pancreatic Trauma Grade

massive disruption to pancreatic head

A

Grade 5

48
Q

Indications for Angiography in Blunt Pelvic Trauma

A

PELVIC FX AND…

1) Hemodynamic instability in a patient with little or no hemoperitoneum by FAST/DPL
2) Requires >4 U RBC in 24 hours
3) Requires >6 U RBC in 48 Hours
4) Large or expanding hematoma identified at celiotomy
5) CT evidence of large retroperitoneal hematoma with extravasation of contrast
6) need for detection and treatment of other injuries during angiography.

49
Q

Most appropriate 1st step in workup

Postmenopausal vaginal bleeding

A 
Endometrial biopsy 
(Transvaginal u/s does NOT rule out disease if negative)
50
Q

3 principles of safe PEG placement

A

Endoscopic gastric dilation
Endoscopic visual focal finger invagination
Transillumination

51
Q

RELATIVE Contraindications

PEG Placement

A

Failure of transillumination
Previous history of GERD
Previous abdominal surgery
Esophageal or oropharyngeal cancer (d/t seeding of PEG tract)

52
Q

ABSOLUTE Contraindications

PEG Placement

A

Coagulopathy
Completely obstructing esophageal cancer
Any contraindication to endoscopy

53
Q

Most common indication for hysterectomy (USA)

A

symptomatic uterine fibroid

54
Q

Indications

Hysterectomy

A 
Symptomatic uterine fibroid (MCC) 
Ovarian Ca
Cervical Ca
Endometrial Ca
Vaginal Bleeding
55
Q

Intraop Management of volume status

Pheochromocytoma

A

High Intravascular volume during and immediately after procedure (Pts have low volume at baseline d/t catecholamine excess).
Pts with CHF or elderly may need arterial line +/- PA catheter

56
Q

Intraop Management of HTN

Pheochromocytoma

A

Sodium nitroprusside drip

Magnesium IV

57
Q

Intraop Management of arrythmias

Pheochromocytoma

A

Short acting beta blockers (esmolol)

Lidocaine

58
Q

Landmark

Recurrent laryngeal nerve in neck surgery

A

tubercle of zuckerkandl lies immediately lateral to and covers the RLN.
(can also be medial)

59
Q

MCC

Liver abscess

A

ascending infection from portal vein

60
Q

Most common site of recurrence

Melanoma

A

Skin
Subcutaneous tissues
distant lymph nodes
Visceral sites

61
Q

Most common site of recurrence

Melanoma, Visceral

A 
lung
liver
brain
bone
GI tract
62
Q

Indication for collis gastroplasty in nissen fundoplication

A

if <2-3cm of esophagus is present intra abdominally

Lap stapler is fired parallel to lesser curvature at the level of the cardia to create neo-esophagus

63
Q

Key elements of Nissen fundoplication

A

Lap is standard of care
esophageal mobilization
division of short gastrics to create tension free wrap
mandatory crural repair

64
Q

Most important predictor of survival

Adrenal cancer

A

adequacy of resection
5 year survival with adequate resection is 50%
with inadequate resection median survival is less than one year

65
Q

CT findings suggestive of adrenal ca

A 
Size >6cm 
tumor heterogeneity
irregular margins
presence of hemorrhage
adjacent lymphadenopathy
liver mets
66
Q

Location of placement for end colostomy

A

through rectus, at summit of infraumbilical fan fold

67
Q

Location of mesh
Chevel’s Repair
Ventral hernia

A

Between anterior rectus sheath and subcutaneous layer

68
Q

Soap bubble sign

A

Meconium ileus, seen in RLQ.

69
Q

Ascites with “scalloping” of solid organs and calcifications of peritoneum

A

pseudomyxoma peritonei

70
Q

Management
Penetrating trauma MEDIAL to lateral canthus of eye
some loss of sensation

A

Irrigation, debridement, primary closure in multiple layers.
Nerve exploration/repair NOT indicated

71
Q

Management
Penetrating trauma LATERAL to lateral canthus of eye
some loss of sensation

A

Irrigation, debridement, primary closure in multiple layers.
NERVE EXPLORATION/REPAIR IS INDICATED

72
Q

Operative technique

Exposure of SMA for embolectomy

A

anterior approach, base of transverse mesocolon

73
Q

Operative technique

exposure of SMA for bypass

A

lateral approach with formal mobilization of duodenum or ligament of treitz

74
Q

Preferred site of SMA bypass

A

R common iliac
(second choices L common iliac, infrarenal aorta)
supraceliac aorta can be used if retrograde disease

75
Q

Methods of documenting parathyroid allograft function

A

normocalcemia
measuring AC vein PTH concentration
“transient parathyroidectomy” tourniquet on one arm, measure other arm.

76
Q

Most common presentation of gallbladder cancer if symptomatic

A

abdominal pain (biliary colic/cholecystitis presentation)

77
Q

Early complications

Gastric banding

A 
acute stomal obstruction
band infection
gastric perforation
hemorrhage
bronchopneumonia
delayed gastric emptying
PE
78
Q

Late complications

Gastric banding

A 
Band erosion
band slippage/prolapse
port or tubing malfunction
leakage at port site tubing or band
pouch or esophageal dilation 
esophagitis
79
Q

Malignant hyperthermia mutation

A

RYR1 (ryanodine receptor gene)

AD

80
Q

incidence of marginal ulcers

s/p gastric bypass

A

3-15%

81
Q

incidence of bowel obstruction

s/p gastric bypass

A

7%

82
Q

incidence of DVT/PE

s/p gastric bypass

A

0.33%

83
Q

Incidence of devastating anastomotic leak

s/p gastric bypass

A

0.3%

84
Q

Incidence of anastomotic stenosis

s/p gastric bypass

A

1-19%

85
Q

What the magnet does to pacemaker/ICD

A

turns off defibrillator

resets pacemaker to factory settings (demand mode at a fixed rate)

86
Q

most common site of recurrence

Colon cancer s/p surgical removal

A

liver
80% in first 2 years
90% in first 4 years

87
Q

Puestow procedure

A

Longitudinal pancreaticojejunostomy

88
Q

Frey procedure

A

Coming out of the pancreatic head and roux en y pancreaticojej

89
Q

Type I gastric ulcer

A

Angularis incisura of lesser curvature

Normal/low acid

90
Q

Type II gastric ulcer

A

Stomach and duodenal ulcers

Associated with acid (may be normal)

91
Q

Type III Gastric ulcer

A

Prepyloric

Normal or HIGH acid

92
Q

Type iv gastric ulcer

A

GE junction

Acid normal or low

93
Q

Ligaments divided in extended left hemi

A

Renocolic
Splenocolic
Pancreaticocolic
Gastrocolic

94
Q

Firm flesh colored plaques

Fingerlike projections of spindle cells

A

Fermatofibrosarcoma protuberans

95
Q

Trace mineral deficiencies
Pancytopenia
Neuropathy with ataxia

A

Copper

96
Q

Trace mineral deficiencies

Hyperglycemia confusion peripheral neuropathy

A

Chromium

97
Q

Trace mineral deficiencies

Pellagra with diarrhea dementia, dermatitis

A

Niacin B3

98
Q

Trace mineral deficiencies
Cardiomyopathy
Hypothyroidism
Neurological changes

A

Selenium

99
Q

Trace mineral deficiency
Poor wound healing
Wasting
Skin rash

A

Zinc

100
Q

Correct procedure

Carotid Trauma lateral tear

A

Lateral arteriorrhaphy with 6-0 polypropylene interupted

101
Q

Correct procedure

Carotid Trauma loss of wall or large defect

A

Patch angioplasty with saphenous vein thin walled ptfe or bovine pericardium

102
Q

Correct procedure

Carotid Trauma through and through

A

Segmental resection and end to end anastomosis or interposition graft with saphenous vein or ptfe

103
Q

Large abdominal bulge hernia sx WITHOUT fascial defect

A

Diastasis recti

104
Q

Contraindications

Saphenous vein stripping

A

Outflow obstruction of deep system where saphenous is the only outflow

I.e. occlusion of superficial femoral vein

105
Q

Largest risk factor

Post op cardiac complications

A

Uncompensated CHF

Not CAD

106
Q

Indications

ICP monitoring

A

Postrecussitative GCS 40
Any hx of hypotension
Abnormal motor posturing

107
Q

Indications for Surgery

Transanal resection of malignant Tumor

A 
<3 cm in size
<30% of the circumference of bowel
Within 8 cm of the anal verge 
T1 only
Mobile nonfixed Tumor
Well to moderately differentiated 
No lymphovascular or perineural invasion 
No LAD on imaging 
Margin clear > 3 mm
108
Q

Distal Gastrectomy

D1.5

A

extended lymphadenectomy (D1: 1, 3, 4sb, 4d, 5, 6, 7 PLUS 8a, 9)
Omentectomy
Preservation of spleen and pancreas

109
Q

Free water deficit

A

(Serum Na -140)/140 * tbw

Tbw = 0.6bw male 0.5bw female

110
Q

Indications for Surgery

BKA

A

Non salvageable lower extremity infection
Chronic non healing le wounds
Acute lower extremity infection
Trauma with vascular or neurological injury
Open tibia fx with post tibial n distruption
Warm ischemia > 6 hours

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