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Cam's Cards > Gen Surg Rosh Review > Flashcards

Gen Surg Rosh Review Flashcards

1
Q

What is the first step in management of a small bowel obstruction?

A

NG tube decompression

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2
Q

What is the most common cause of SBO?

A

Adhesions

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3
Q

What is the BEST imaging for SBO?

A

CT with contrast

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4
Q

What is the initial imaging for SBO?

A

Abdominal XR

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5
Q

Name some common radiologic findings in SBO.

A

Dilated loops of bowel
Air fluid level on upright or decubitus films
String of pearls sign
Stack of coins sign

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6
Q

What type of cholecystectomy are dropped gallstones more common with?

A

Laproscopic cholecystectomy.

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7
Q

What type of bowel sounds do you expect in SBO?

A

High pitched early in SBO, hypoactive later in SBO.

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8
Q

Where are stones stuck in choledocolithiasis?

A

In the common bile duct.

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9
Q

How long does it take for biliary colic to resolve?

A

Within 6 hours of onset

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10
Q

Abdominal pain, fever, and jaundice is known as what triad? What diagnosis is it seen in?

A

Charcot triad, seen in ascending cholangitis.

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11
Q

What other two symptoms added to charcot triad makes reynolds pentad?

A

Confusion and hypotension

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12
Q

What is the term for gallstones in the galbladder?

A

Cholelithiasis

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13
Q

What is the initial imaging for suspected choledocholithiasis?

A

Transabdominal ultrasound

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14
Q

What is the treatment for choledocholithiasis?

A

ERCP

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15
Q

What is the number 1 cause of pancreatitis in the US?

A

Gallstone obstruction of the pancreatic duct

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16
Q

What is the most specific lab marker for pancreatitis?

A

Elevated lipase

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17
Q

What do you expect to see on US in cholelithiasis?

A

Acoustic shadowing

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18
Q

Which sign is characterized by a palpable gallbladder on physical examination from a dilated gallbladder?

A

Courvoisier sign.

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19
Q

What are the risk factors for cholelithiasis?

A

Female, 40-50 years old, pregnancy, obesity, rapid weight loss

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20
Q

How does pain from cholelithiasis change with eating?

A

Pain begins suddenly after eating a fatty or large meal.

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21
Q

What are gallstones most commonly made of?

A

Cholesterol

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22
Q

What is the most appropriate IV fluid for a preoperative patient who is NPO?

A

lactated ringer solution`

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23
Q

Is albumin considered a crystalloid or colloid?

A

Colloid.

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24
Q

A skin lesion described as an irregular, erythematous plaque with a hemorrhagic crust is most consistent with what diagnosis?

A

Squamous cell carcinoma.

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25
Q

A skin lesion described as a dome-shaped, waxy papule with central umbilication is most consistent with what diagnosis?

A

Molluscum contagiosum

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26
Q

A skin lesion described as a pearly, translucent lesion with rolled borders is most consistent with what diagnosis?

A

Basal cell carcinoma

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27
Q

What type of skin lesion can develop into squamous cell carcinoma?

A

Actinic keratosis

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28
Q

What two viruses are associated with squamous cell carcinoma?

A

Epstein-Barr virus and human papillomavirus.

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29
Q

Which physical exam finding is highly suggestive of mesenteric ischemia?

A

Abdominal pain that is out of proportion to the exam.

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30
Q

What section of the colon is most prone to colonic ischemia?

A

The splenic flexure and rectosigmoid junction.

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31
Q

Why is the splenic flexure more common to colonic ischemia?

A

It has limited collateral blood flow

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32
Q

What is the most common presentation of adrenal crisis due to autoimmune primary adrenal insufficiency?

A

Shock.

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33
Q

What are the two types of cells that make up the thyroid, and what are their functions?

A

Follicular cells, which secrete thyroid hormones T3 and T4, and parafollicular cells (also known as C cells), which secrete calcitonin.

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34
Q

What are the categories of results for radionuclide scanning of the thyroid?

A

Hot nodules, warm nodules, and cold nodules.

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35
Q

What is a normal finding of radionuclide scanning?

A

Warm nodules indicate normal thyroid activity.

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36
Q

Cold nodules on radionuclide scanning indicate what?

A

It is a nodule made up of low functional or nonfunctional thyroid tissue.

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37
Q

What type of thyroid nodules have the highest risk of malignancy?

A

Cold nodules

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38
Q

What test has the highest sensitivity and specificity for determining the diagnosis of a thyroid nodule?

A

US guided FNA

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39
Q

What do you expect on a radionuclide scan of a patient with graves disease?

A

Diffuse increased uptake in both thyroid lobes.

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40
Q

NAFLD increases risk for what type of cancer?

A

Hepatocellular carcinoma

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41
Q

True or false: death rates due to hepatocellular carcinoma in both men and women are increasing.

A

True.

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42
Q

Describe the typical patient that presents with a primary spontaneous pneumothorax.

A

Tall, thin man between 20-40 who smokes.

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43
Q

What is pleurodesis?

A

A procedure in which an irritant (talc being the most commonly used agent) is introduced into the pleural space to collapse it and prevent recurrence of pneumothorax.

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44
Q

When should vitamin K be administered to patients with acute cholangitis?

A

If the patient has hypoprothrombinemia as a result of liver damage secondary to cholangitis.

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45
Q

What is the most common pathogen causing bacterial infection in choledocholithiasis?

A

E. coli

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46
Q

What is the first line agent for primary prophylaxis of variceal hemorrhage in patients with cirrhosis?

A

Nonselective beta blockers such as propanolol

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47
Q

What are some causes of cirrhosis?

A

Alcoholic liver disease, nonalcoholic steatohepatitis, hepatitis B, hepatitis C, and schistosomiasis.

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48
Q

What is the most common cause of upper gastrointestinal bleeding?

A

Peptic ulcer.

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49
Q

What is the most common cause of lower GI bleeds?

A

Diverticular bleeding from diverticulosis

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50
Q

What postoperative prophylactic is used to prevent postoperative pulmonary complications?

A

Incentive spirometry

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51
Q

Most major surgeries are not preformed if platelet count is

A

50k

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52
Q

What is the first line treatment for patients with immune thrombocytopenia for non-emergent and elective surgeries?

A

Steroids and IVIg

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53
Q

True or false: thrombocytopenia can be a manifestation of acute hepatitis.

A

True.

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54
Q

What medication is indicated at potassium >6.5mmol/L?

A

calcium chloride (calcium gluconate)

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55
Q

What is the progression of EKG changes as K rises?

A

Peaked T waves
Dropped P waves
Widened QRS complexes
Sine waves

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56
Q

What medications can be given to quickly lower K levels?

A

IV insulin with dextrose, sodium bicarb, and albuterol

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57
Q

True or false: a hemolyzed specimen will result in an elevated serum potassium level.

A

True, potassium is primarily an intracellular ion.

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58
Q

What grading system is used to evaluate patients with prostate cancer?

A

Gleason grading system

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59
Q

High intake of dietary _______ increases risk for prostate cancer.

A

fat

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60
Q

PSA level >_____ is associated with advanced disease.

A

40ng/mL

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61
Q

What zone of the prostate does prostate cancer most commonly arises from?

A

The peripheral zone.

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62
Q

What is the best diagnostic tool for diagnosis of achalasia?

A

Esophageal manometry

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63
Q

What is the expected result of a barium swallow study in a patient with achalasia?

A

Bird-beak appearance

but barium swallow is not the best diagnostic because it is normal in 1/3 of people who have achalasia

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64
Q

What is an important cause of achalasia worldwide?

A

Chagas disease

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65
Q

What results on esophageal manometry confirms achalasia?

A

Incomplete relaxation of the lower esophageal sphincter

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66
Q

What treatment is appropriate to give a patient with well controlled asthma prior to surgery to reduce postop pulmonary complications?

A

A rapid acting beta agonist

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67
Q

What should the peak expiratory flow rate be for patients with asthma before elective surgery?

A

Greater than 80% of their predicted value.

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68
Q

What is the best treatment option for moderate to severely active ulcerative colitis?

A

Infliximab

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69
Q

What class of medications is infliximab in?

A

TNF-blocking agent

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70
Q

What is the appropriate skin margins for an excisional biopsy for superficial spreading melanoma?

A

2mm

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71
Q

What is the most common site for metastasis of melanoma?

A

Lymph nodes.

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72
Q

What is the major concern of anal fissure surgical repair?

A

Irreversible fecal incontinence

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73
Q

Name 5 surgeries with high intrinsic cardiac risk.

A 
Laparoscopic total abdominal colectomy with ileostomy
Breast reconstruction with free flap
Open cholecystectomy
Open ventral hernia repair
Whipple procedule, pylorus sparing
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74
Q

What is the Hamman sign?

A

The mediastinal crunching sound that correlates with diastole of the heart, indicating esophageal perforation.

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75
Q

What is the best test to diagnose a Zenker diverticulum?

A

Barium swallow.

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76
Q

What is the anatomic area of muscular weakness where the Zenker diverticulum is located?

A

Killian triangle.

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77
Q

What is the triad of symptoms in Wernicke encephalopthy?

A

Confusion, ataxia, and ophthalmoplegia.

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78
Q

What condition can unresolved Wernicke encephalopathy lead to?

A

Korsakoff psychosis

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79
Q

What are the symptoms of Korsakoff psychosis?

A

Anterograde and retrograde amnesia and confabulation

80
Q

What would you expect to see on brain MRI of a patient with Wernicke encephalopathy?

A

Signal abnormality within the mamillary bodies

81
Q

What is the treatment for Wernicke encephalopathy?

A

IV thiamine infusion

82
Q

What is the gold standard for diagnosis of renal artery stenosis?

A

Renal arteriography

83
Q

What is the preferred initial test in a work up for renal artery stenosis?

A

Ultrasound

84
Q

In renal artery stenosis, peak systolic velocity of the renal arteries should be >_____

A

200cm/second

85
Q

What is the surgical treatment for renal artery stenosis?

A

Endovascular stent placement

86
Q

What are the two causes of renovascular stenosis?

A

Atherosclerosis of renal arteries

Fibromuscular dysplasia

87
Q

What are some other common causes of secondary hypertension?

A

Primary kidney disease, primary aldosteronism, and sleep apnea syndrome.

88
Q

Limb ischemia from an acute arterial occlusion is associated with increased risk of limb loss if duration is >___

A

6 hours

89
Q

True or false: an acute arterial embolism in the brain presents as sudden, painless onset of neurologic deficits.

A

True.

90
Q

What complication of pancreatitis typically occurs more than 4 weeks after an episode of acute pancreatitis, can can present with abdominal pain, weight loss, early satiety, jaundice, or be asymptomatic?

A

Pancreatic pseudocyst

91
Q

What is the preferred imaging modality to diagnose a pancreatic pseudocyst?

A

MRI

92
Q

Describe the imaging findings of a pancreatic pseudocyst?

A

Well-circumscribed oval or round fluid collection, typically extrapancreatic, with homogenous fluid density, no solid components, and a well-defined wall that completely encapsulates the fluid.

93
Q

What is the treatment for symptomatic pancreatic pseudocysts?

A

Endoscopic drainage.

94
Q

What makes a pancreatic pseudocyst a pseudocyst rather than a cyst?

A

It is lined with granulation tissue rather than epithelial tissue

95
Q

What is a retention cyst?

A

Small dilated pancreatic duct side branches arising due to obstruction

96
Q

What is the most common cause of acute pancreatitis?

A

Gallstones.

97
Q

What is the best place to insert a central venous catheter?

A

Subclavian vein due to the lowest risk of infection.

98
Q

If the subclavian vein cannot be accessed for a central line, where is the second and third options for central line placement?

A

Second: Internal jugular vein (Double the risk of infection compared to subclavian)

Third: femoral vein (highest risk of infection)

99
Q

Which internal jugular vein follows a direct path to the superior vena cava?

A

The right internal jugular vein. The left internal jugular vein drains into the brachiocephalic vein.

100
Q

How does a patient typically describe the vision loss caused by amaurosis fugax from carotid artery stenosis?

A

A curtain being pulled and descending over their visual field causing vision loss.

101
Q

What is the goal standard for diagnosis of carotid artery stenosis?

A

Contrast angiography

102
Q

What is the preferred anticoagulant when cancer is a factor in VTE?

A

LMWH

103
Q

What anticoagulants require initial parenteral therapy?

A

Warfarin, dabigatran, and edoxaban

104
Q

What anticoagulant should be avoided in the setting of coronary artery disease?

A

Dabigitran

105
Q

What blood gas findings do you see in respiratory acidosis?

A

PaCO2 elevated >45mm Hg

pH < 7.35

106
Q

What changes to blood gasses do you see in chronic respiratory acidosis?

A

PaCO2 elevated > 45 but pH can be normal or near normal with an elevated serum bicarbonate.

107
Q

What is the most common cause of respiratory alkalosis?

A

Hysterical hyperventilation.

108
Q

What is seen on peripheral blood smear in DIC?

A

Increased fibrin degradation products and schistocytes.

109
Q

What is the most common cause of DIC?

A

Infection - often sepsis from gram-negative organisms

110
Q

What is the most common artery affected by PAD?

A

Distal superficial femoral artery

111
Q

Where would you suspect claudication in PAD of the distal superficial femoral artery?

A

Calf pain

112
Q

Where would you suspect claudication in PAD of the deep femoral artery?

A

Thigh and lower leg

113
Q

Where would you suspect claudication in PAD of the common iliac artery?

A

Buttocks and thigh

114
Q

Where would you suspect claudication in PAD of the popliteal artery?

A

behind knee and calf

115
Q

What medications can reduce elevated intracranial pressure?

A

Intravenous mannitol and hypertonic solution

116
Q

How long after a meal would pain be expected to occur for a duodenal ulcer?

A

3 hours

117
Q

What medications are part of quadruple therapy for Helicobacter pylori infection?

A

Bismuth subsalicylate, a proton pump inhibitor, metronidazole, and tetracycline.

118
Q

What is Zollinger-Ellison disease?

A

A gastrin-secreting cancer that results in acid hypersecretion in the stomach.

119
Q

What is the best initial test for a suspected pheochromocytoma?

A

24 hour urine collection for fractionated catecholamines

120
Q

What is the classic triad of symptoms for a pheochromocytoma?

A

Episodic headaches, sweating, and tachycardia

121
Q

Which familial syndromes increase the risk of pheochromocytoma?

A

Multiple endocrine neoplasia type 2, neurofibromatosis type 1, and von Hippel-Lindau.

122
Q

What is the Parkland formula used for?

A

Used to determine the fluid requirements in the first 24 hours for burn patients. Half of the required fluid is given in the first 8 hours, and the remaining fluid is given over the next 16 hours.

123
Q

What is the Parkland formula?

A

The Parkland formula (4 mL/kg x body weight in kg x percent of body surface area burned)

124
Q

Does choledocholithiasis cause conjugated hyperbilirubinemia or unconjugated hyperbilirubinemia?

A

Conjugated hyperbilirubinemia

125
Q

what are common differential diagnoses of upper GI bleed?

A
  1. Esophageal varices
  2. duodenal ulcers
  3. Gastric ulcers
  4. mallory weis tear
  5. Acute gastritis
126
Q

What is the initial tx for upper GI bleed?

A
  1. IVF
  2. NGT suctioning
  3. Water lavage
127
Q

What is the choice of imaging for upper GI bleed?

A

EGD

128
Q

What is the most common cause of upper GI bleed?

A

PUD

129
Q

What labs should be performed for upper GI bleed?

A
  1. Chem-7
  2. Type and Cross
  3. LFTs
130
Q

What test can help find the source for a massive GI bleed if endoscopy is clear?

A

selective mesenteric angiography

131
Q

Why is BUN elevated in upper GI bleed?

A

because of absorption of blood by the GI tract

132
Q

What artery is involved in bleeding from a duodenal ulcer

A

gastroduodenal artery

133
Q

What causes a duodenal ulcer?

A

increased secretion of gastrin

134
Q

what test should you do to evaluate for zollinger-ellison syndrome

A

Gastrin levels and secretin stimulation test

135
Q

what is the cause of gastric ulcers?

A

decreased cytoprotectin which causes a decrease in bicarbonate and mucus production

136
Q

What are some risk factors for gastric ulcers?

A

Smoking, alcohol, NSAIDs, male gender, advanced age,

137
Q

What is the most common location for a gastric ulcer?

A

70% are on the lesser curvature

138
Q

How do you diagnose a gastric ulcer?

A

EGD and should get a biopsy to rule out cancer

139
Q

What diagnostic would be indicated in a patient with a history of PUD who presents with acute onset of epigastric pain?

A

A CXR looking for free air under the diaphragm indicating a perforated peptic ulcer

140
Q

What other procedure must be performed along with a truncal vagotomy when treating a perforated peptic ulcer?

A

a Drainage procedure

pyloroplasty
antrectomy
gastrojejunostomy

141
Q

What is a truncal vagotomy?

A

resection of 1-2cm of each vagal trunk as it enters the abdomen on distal segment of the esophagus. this help decrease gastric acid secretion

142
Q

What are the causes of a mallory-weis tear

A

increased gastric pressure, often aggravated by a hiatal hernia

143
Q

gold standard imaging for diagnoses mallory weis tear?

A

EGD

144
Q

What is macklers triad and what diagnoses is it used for?

A
  1. emesis
  2. lower chest pain
  3. cervical emphysema (subQ air)

used for boerhaaves syndrome

145
Q

What is the most common location for boerhaaves syndrome

A

posterolateral aspect of the esophagus 3-5 cm above the GE junction

146
Q

what type of cancer develops in barretts esophagus?

A

adenocarcinoma

147
Q

What is barretts esophagus

A

columnar metaplasia from the normal squamous epithelium

148
Q

When is surgery indicated for GERD? what surgery?

A
  1. failure to respond to medications
  2. respiratory problems as a result of esophageal disfunction resulting in aspiration

Surgery would be LAP NISSEN

149
Q

What type of blood is associated gastric cancer?

A

Type A there is an A in gastric

150
Q

What are the symptoms for gastric cancer

A
  1. Weight loss
  2. Emesis
  3. Anorexia
  4. Pain/epigastric pain
  5. Obstruction
  6. Nausea

WEAPON

151
Q

What is a surveillance laboratory finding in gastric cancer

A

CEA which you can monitor

152
Q

What is the histology of gastric cancer?

A

adenocarcinoma

153
Q

What is the most common sign of an anastomotic leak after gastric bypass surgery?

A

Tachycardia

154
Q

what is a petersens hernia?

A

a hernia seen after gastric bypass, internal herniation of small bowel through the mesenteric defect from the roux-en-y Limb

155
Q

What condition commonly mimics a SBO

A

paralytic ileus (on AXR you will see gas distention including the colon)

156
Q

What are classic electrolyte abnormalities seen with proximal SBO?

A

hypovolemic, hypochloremic, hypokalemia, alkalosis

157
Q

What tumor classically causes SBO due to mesenteric fibrous?

A

carcinoid tumor

158
Q

What are the possible complications of meckels diverticulum?

A
  1. intestinal hemorrhage
  2. intestinal obstruction
  3. inflammation
159
Q

what heterotropic tissue is most often found with meckels diverticulum?

A

Gastric mucosa

160
Q

How do you treat a appendiceal abscess that is found preoperatively?

A

Percutaneous drainage then appendectomy 6 weeks later

161
Q

Carcinoid tumors arise from what cells?

A

Neuroendocrine cells

162
Q

What kind of sin changes does a carcinoid tumor cause?

A

Pellagra- this is due to it causing a niacin deficiency

163
Q

Where do carcinoid tumors typically occur

A
  1. Appendix
  2. ileum
  3. Rectum
164
Q

What chemical do carcinoid tumors secrete?

A

Seretonin and vasoactive peptides

165
Q

What will be elevated in someones urine if they have a carcinoid tumor?

A

5-HIAA (hydroxyindoleacetic acid)

166
Q

What is it called when you have communication from the GI tract to the skin?

A

Enterocutaneous fistula

167
Q

What is the Tx for enterocutaneous fistula?

A

NPO; TPN

168
Q

What are causes of enterocutaneous fistula?

A

Anastomotic leak, Crohns, diverticulitis,

169
Q

What type of fistula would you expect in someone with a history of diverticulosis and frequent UTIs?

A

Colovesical fistula

170
Q

What is the most common colonic fistula and most common cause of colonic fistulas?

A
  1. Colovesical fistula

2. Diverticulitis

171
Q

How do you Dx a colonic fistula?

A

Barium enema or cystoscopy

172
Q

What are the risk factors for colorectal carcinoma?

A

Diet- low in fiber high in fats
Genetics
IBD: ulcerative colitis > crohns

173
Q

What are the reccomendations for colorectal cancer screening in patients with a first degree relative with colon cancer before age 60?

A

Start at age 40 or 10 years before the age of the youngest first degree relative with colon cancer

then every 5 years after that

174
Q

What are the recommended screenings for colon cancer in patients with no family history of colon cancer?

A 
One of the following:
Colonoscopy at 50 then every 10 years 
Double contrast barium enema Q5years 
CT colonography Q5years 
Flex sigimoid Q5years
175
Q

What is the most malignant adenomatous polyps

A

Villous> tubovillous> Tubular

Villous think villain

176
Q

Polyps greater than what size have a high risk of malignancy?

A

> 2cm

177
Q

What are the most common causes of colonic obstruction in adult population?

A

colorectal cancer
Diverticular disease
colonic volvulus

178
Q

Where are most polyps founds?

A

Rectosigmoid

179
Q

What other tumor must be looked for in patients with FAP

A

duodenal tumors

180
Q

What is gardners syndrome

A

Neoplastic polys of the small bowel and colon, 100% of patients will have cancer by 40 if not found

181
Q

What are associated finding with Gardeners syndrome?

A
  1. Desmoid tumors- in abdominal wall or cavity
  2. Osteomas of skull
  3. sebaceous cysts

Can be remembered with SOD

182
Q

Most common site for diverticulosis?

A

Sigmoid colon

183
Q

Diagnostic approach in the patient with pain and signs of inflammation?

A

CT scan of abdomen and pelvis

184
Q

Tx for diverticulosis?

A

high fiber diet

185
Q

What is the best test for diverticulitis

A

CT scan

186
Q

what is initial therapy for diverticulitis?

A
  1. NPO
  2. IV fluids
  3. Broad spectrum antibiotics
187
Q

What is the Tx for diverticular abscess?

A

Percutaneous drainage

188
Q

What is the most common type of colonic volvulus?

A

Sigmoid volvulus

189
Q

What are signs of necrotic bowel in colonic volvulus?

A

Free air, pneumatosis

190
Q

Imaging for suspected colonic volvulus?

A

CT scan or sigmoidscopy

191
Q

Tx for sigmoid volvulus?

A

sigmoidscopic reduction

192
Q

How do you Dx a cecal volvulus?

A

AXR- seeing dilated ovoid colon with large air/fluid level in RLQ forming the classic coffee bean shape

193
Q

Tx for cecal volvulus

A

emergent surgery

194
Q

what is the most common carcinoma of the anus?

A

squamous cell

195
Q

What disease is commonly associated with anal fistula

A

Chrons

196
Q

what is the Tx If an anal fistula goes through the sphincter muscle?

A

seton placement

Cam's Cards (103 decks)

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