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clinical rotations > General Surgery > Flashcards

General Surgery Flashcards

1
Q

What is the most common type of colorectal cancer?

A

Adenocarcinoma

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2
Q

What is a lab finding that may suggest colorectal cancer?

A

Iron deficiency anemia

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3
Q

What tumor marker is used in determining the prognosis of patients with colorectal cancer?

A

Carcinoembryonic antigen

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4
Q

Left-sided colonic ischemia may follow what procedure?

A

Abdominal aortic aneurysm repair

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5
Q

What is the treatment for ischemic colitis?

A

Most cases resolve with supportive care

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6
Q

What symptoms make up Charcot’s triad?

A

Abdominal pain (RUQ)
Jaundice
Fever

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7
Q

Charcot’s triad is commonly seen in what problem?

A

Acute cholangitis

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8
Q

What symptoms are added to Charcot’s triad to become Reynolds pentad?

A

Hypotension
Confusion
(Severe cholangitis)

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9
Q

What is the management for acute cholangitis?

A

Broad-spectrum abx (zoysn)
Biliary drainage (ERCP)

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10
Q

What size abdominal aortic aneurysm should have repeat imaging every year versus every 6 months?

A

Annual: 4 - 4.9cm
Every 6 months: 5 - 5.4cm

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11
Q

What size abdominal aortic aneurysm would be considered for surgery?

A

> 5.5cm

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12
Q

What does the USPSTF recommend for screening for AAA?

A

One-time ultrasound in men 65-75 who have ever smoked

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13
Q

What symptom is more commonly associated with a right-sided origin of colorectal cancer?

A

Melena

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14
Q

What procedure is both diagnostic and therapeutic for choledocholithiasis (gallstones in the common bile duct)?

A

ERCP

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15
Q

What is is used to prevent gallstone formation in patients with rapid weight loss?

A

Ursodeoxycholic acid

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16
Q

What is the treatment for cholelithiasis (gallstones)?

A

Observation (if asymptomatic)
Cholecystectomy

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17
Q

Where do internal hemorrhoids arise from?

A

Above the dentate line from the superior hemorrhoidal cushion

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18
Q

Where do external hemorrhoids arise from?

A

Below the dentate line and the internal hemorrhoidal plexus

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19
Q

What dermatologic manifestations are seen in Crohn’s and ulcerative colitis?

A

Crohn’s: erythema nodosum
UC: pyoderma gangrenosum

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20
Q

What is the treatment for ulcerative colitis?

A

Mild-moderate: mesalamine, topical or oral steroids, 5-ASA
Severe: IV steroids +/- topical steroids initially, then anti-TNF or anti-integrin
Colectomy for refractory cases (curative)

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21
Q

What are the 2 most common reasons for preoperative dialysis?

A

Volume overload
Hyperkalemia > 6.5

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22
Q

What is the classic triad of symptoms in pheochromocytoma?

A

Episodic headaches
Sweating
Tachycardia

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23
Q

What are the 4 subtypes of breast cancer?

A

Luminal A
Luminal B
HER2 positive
Triple negative (basal)

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24
Q

Of the 4 subtypes of breast cancer, which has the worst prognosis?

A

Triple negative

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25
Q

What is the most common lesion of the breast?

A

Fibrocystic changes

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26
Q

What are the signs/symptoms of fibrocystic breast changes?

A

Intermittent breast pain and tenderness that peak before each menstruation

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27
Q

What are the signs/symptoms of a posterior cerebral artery ischemic stroke?

A

LOC
Nausea or vomiting
CN dysfunction
Ataxia
Visual agnosia (homonymous hemianopia)

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28
Q

What is the gold standard for diagnosing cholecystitis?

A

Cholescintigraphy (HIDA scan)
*ultrasound is typically done first, but is not the gold standard

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29
Q

What is the ratio of pleural and serum protein in a transudative vs exudative cause of a pleural effusion?

A

Transudate: <0.5
Exudate: >0.5

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30
Q

If you have a ratio of pleural protein to serum protein that is < 0.5, what is most likely the cause of the effusion?

A

Heart failure

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31
Q

If you have a ratio of pleural protein to serum protein that is > 0.5, what is the most likely cause of the effusion?

A

Malignancy or bacterial/viral pneumonia

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32
Q

When performing an excisional biopsy of melanoma, what margin of unaffected skin should also be included in the biopsy?

A

2mm

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33
Q

What are the risk factors for esophageal adenocarcinoma?

A

Male
Chronic GERD (Barrett’s)
Tobacco/alcohol use
HPV infection

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34
Q

What serum marker is most useful in monitoring pancreatic cancer?

A

CA 19-9

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35
Q

What medication is used as primary prophylaxis for the prevention of variceal hemorrhage?

A

Non-selective beta blockers (propranolol)

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36
Q

What are the categories of a thyroid scintigraphy?

A

Warm: normal thyroid
Cold: low or non-functional thyroid tissue
Hot: take up more of the radioactive isotope and autonomously function

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37
Q

What protein measurement best assesses short-term nutritional status?

A

Prealbumin

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38
Q

What is the preferred form of vascular access in patients requiring long-term hemodialysis?

A

Upper extremity arteriovenous fistulas (AVFs)

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39
Q

How is a diagnosis of Hodgkin lymphoma made?

A

Lymph node biopsy showing Reed-Sternberg cells (owl’s eyes)

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40
Q

What diabetic medication should be held 24 hrs prior to surgery?

A

Metformin

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41
Q

What ankle-brachial index (ABI) indicates > 50% stenosis in a patient with PAD?

A

< 0.9

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42
Q

What are the signs/symptoms of Wernicke syndrome?

A

Encephalopathy (disoriented)
Ocular motor dysfunction (nystagmus)
Ataxia

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43
Q

What is the treatment for Wernicke’s syndrome?

A

Aggressive thiamine (B1) repletion
Replace thiamine BEFORE glucose

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44
Q

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

A

Lactated ringer

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45
Q

What is the difference between central and nephrogenic diabetes insipidus?

A

Central: decreased secretion of antidiuretic hormone (ADH)
Nephro: decreased sensitivity to ADH in the kidneys, leading to decreased urine concentration

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46
Q

What hormones are produced in the anterior pituitary gland?

A

FSH
LH
Adrenocorticotropic hormone
TSH
Prolactin
Growth hormone

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47
Q

What is recommended for patients undergoing colorectal surgery as prophylaxis for DVT or PE?

A

Intermittent pneumatic compression (SCDs) and low-molecular-weight heparin

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48
Q

What is the most common benign cause of large bowel obstruction?

A

Volvulus

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49
Q

What is the most common location of a large bowel obstruction?

A

Sigmoid colon

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50
Q

Why is surgery reserved as a last option treatment for anal fissures?

A

Because of the risk of irreversible fecal incontinence

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51
Q

What is Virchow’s triad?

A

A triad of risk factors for DVT: hypercoagulability, endothelial injury, and venous stasis

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52
Q

What is the recommended initial treatment for sigmoid volvulus without signs of perforation or bowel ischemia?

A

Sigmoidoscopy

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53
Q

Which type of aortic dissection is a surgical emergency?

A

Stanford A which involves the ascending aorta

54
Q

What is the most common childhood malignancy of the abdomen?

A

Wilms tumor

55
Q

What is the initial imaging test of choice if a Wilms tumor is suspected?

A

Ultrasound

56
Q

Should you perform a skin biopsy in a patient you suspect has cellulitis?

A

Only if the patient is immunocompromised or if an unusual organism is suspected

57
Q

What is the best test for H. pylori if a patient is undergoing endoscopy, has no active bleeding, and has not had any recent PPI or antibiotic treatment?

A

Biopsy urease test

58
Q

What is the best test for H. pylori if the patient has active bleeding or recent PPI or antibiotic use?

A

Stool antigen test or breath urease test

59
Q

What is the most appropriate treatment in a patient who presents with a breast mass where the overlying skin shows no signs of pressure necrosis or ischemia?

A

Needle aspiration

60
Q

How does a chronic subdural hematoma will appear on a noncontrast CT scan?

A

As a concave, crescent-shaped hypodensity

61
Q

How does an acute subdural hematoma will appear on a noncontrast CT scan?

A

As a concave, crescent-shaped hyperdensity

62
Q

What gland is responsible for the production of catecholamines?

A

Adrenal medulla

63
Q

What is an indication for surgical treatment of primary hyperparathyroidism in an asymptomatic individual?

A

Kidney stones

64
Q

Patients with a history of previous surgery, such as an open cholecystectomy, are more at risk for developing what?

A

Incisional hernia

65
Q

Individuals with a known family history of familial adenomatous polyposis should begin screening with either colonoscopy or flexible sigmoidoscopy at what age?

A

10

66
Q

What is needed to confirm the diagnosis of achalasia?

A

Esophageal manometry

67
Q

What thyroid cancer is the most common type of thyroid cancer overall and is associated with head/neck radiation exposure?

A

Papillary

68
Q

What thyroid cancer is associated with multiple endocrine neoplasia type 2 (medullary thyroid cancer, hyperparathyroidism, and pheochromocytoma)?

A

Medullary

69
Q

What is the most common cause of bloody, unilateral nipple discharge?

A

Intraductal papilloma

70
Q

When managing an unruptured AAA, what is indicated if the aneurysm is > 5.5 cm or if the patient is symptomatic?

A

Endovascular stent-graft placement

71
Q

What reading(s) on peripheral smear are consistent with the diagnosis of DIC?

A

Increased fibrin degradation products and schistocytes

72
Q

Kidney stones are most commonly composed of what?

A

Calcium oxalate

73
Q

What is the first test of choice to evaluate patients (especially pregnant women and children) when presenting with a fever following an abdominal surgery?

A

Abdominal ultrasound

74
Q

Where do perianal abscesses typically arise from?

A

The anal crypt gland

75
Q

What is a Hamman crunch sign?

A

Mediastinal crackling with each heartbeat seen/heard on physical exam in a patient with Boerhaave Syndrome

76
Q

What types of patients with diverticulitis should be treated inpatient?

A

Perforation
Abscess
Obstruction
Fistula
Sepsis
Immunosuppression
High fever
Leukocytosis
Diffuse peritonitis
> 70 years old
Severe comorbidities

77
Q

What is the Chvostek sign?

A

Contraction of the ipsilateral face muscles elicited by tapping the facial nerve just anterior to the ear
Seen in pts with hypocalcemia

78
Q

What initial lab should be drawn in patients with suspected hypothyroidism?

A

TSH

79
Q

Where are femoral hernias found?

A

Protruding through femoral ring inferior to inguinal ligament

79
Q

What is a “bird beak” sign of the sigmoid colon?

A

Gradual narrowing/tapering of the sigmoid colon up to the level of obstruction during contrast or barium insertion to the rectum or on CT scan

79
Q

In patients with PUD, what locations of the ulcers are relieved and aggravated by ingesting food?

A

Duodenal: pain alleviated by ingesting food
Gastric: aggravated by ingesting food

80
Q

What is a description of a lesion that would be associated with squamous cell carcinoma?

A

Irregular, erythematous plaque with a hemorrhagic crust on a sun-exposed area

81
Q

What lesions are described as extremely painful with a deep, “punched out” appearance?

A

Arterial ulcers

82
Q

What is the gold standard for determining whether a peripheral lung lesion is malignant or infectious?

A

open lung biopsy (surgical excision biopsy)

83
Q

What is the preferred technique used to biopsy most breast lesions that are suspicious for malignancy?

A

Core-needle biopsy

84
Q

What is considered the first-line diagnostic study for PE?

A

CT pulmonary angiography (CTPA)

85
Q

What compartment pressure is consistent with compartment syndrome and would like require an immediate fasciotomy?

A

> 30mmHg

86
Q

Which type of adenomatous polyps has the greatest risk of malignancy?

A

Villous

87
Q

Which laboratory value is the most specific for pancreatitis?

A

Lipase

88
Q

What is a common presentation for patients with chronic mesenteric ischemia?

A

Postprandial abd pain
Fear of eating
Weight loss

89
Q

What type of bile duct stone is most likely to be found in the primary form of choledocholithiasis?

A

Pigmented

90
Q

Patients who are symptomatic and have what % of occlusion should receive a CEA?

A

70-99%

91
Q

If a patient is hemodynamically unstable and you suspect an aortic dissection, what is the preferred initial imaging to get?

A

TEE

92
Q

A patient with PAD that experiences pain (intermittent claudication) in the thigh and buttock region likely has an occlusion of what artery?

A

Common iliac artery

93
Q

What is the Howship-Romberg sign?

A

Most specific physical exam finding associated with obturator hernia
Positive when pain extends down the medial aspect of the thigh with movement of the knee

94
Q

What is a rare type of hernia and is most common in older women between the ages of 70 and 90 years?

A

Obturator hernia

95
Q

What is the tumor marker most often used to detect and monitor pancreatic carcinoma?

A

CA 19-9

96
Q

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

A

Gleason

97
Q

An apple core sign in the ascending colon and is indicative of what?

A

Colorectal carcinoma

98
Q

What is the treatment of pulmonary embolism (PE) in hemodynamically stable patients who have failed or cannot tolerate anticoagulation?

A

Inferior vena cava filter

99
Q

How does diverticulosis present?

A

Painless hematochezia

100
Q

What are the signs/symptoms of idiopathic intracranial hypertension (pseudotumor cerebri)?

A

Female
Obese
Diffuse headache
Visual blurring
Peripheral vision loss
Bilateral papilledema
Elevated opening pressure on LP

101
Q

What is the treatment for idiopathic intracranial hypertension (pseudotumor cerebri)?

A

Acetazolamide
Serial LPs
Weight loss

102
Q

What is the gold standard for diagnosing diverticulitis?

A

CT scan w/contrast

103
Q

What is a pancreatic pseudocyst?

A

An encapsulated, mature fluid collection occurring outside the pancreas that have a well-defined wall with minimal or no necrosis

104
Q

What are the signs/symptoms of hypoparathyroidism?

A

Recent thyroid surgery
Extremity and perioral paresthesias, tetany, and lethargy
Labs will show low PTH, low calcium, high phosphorus

105
Q

What are the five parameters of the Ranson criteria that are assessed at initial presentation of acute pancreatitis?

A

Age > 55
WBC > 16
Glucose > 200
LDH > 350
AST > 250

106
Q

If you suspect a patient has a subarachnoid hemorrhage, but they have a negative CT scan, what is the next test you order and what would it show if it were positive for an SAH?

A

Lumbar puncture
Grossly bloody fluid in all four tubes or xanthochromia (CSF) indicates SAH

107
Q

What is a calcium channel blocker that should be given to every patient with an aneurysmal subarachnoid hemorrhage within 4 days of symptom onset and continued for 21 days?

A

Nimodipine

108
Q

What occurs in a patient with a type 1 sliding hiatal hernia?

A

The proximal stomach (known as the gastric cardia), herniates proximally through the diaphragm in the direction of the esophagus

109
Q

What occurs in a patient with a type 2 paraesophageal hernia?

A

The superior-lateral aspect of the stomach (known as the gastric fundus) herniates through a defect in the phrenoesophageal membrane adjacent to the esophagus. This herniation does not displace the phrenoesophageal membrane, and the GE junction remains level with the diaphragm

110
Q

What are some dietary risk factors for gastric carcinoma?

A

High-salt diet
Diet rich in nitroso compounds (found in tobacco smoke, processed meats, and fried foods)
Diet low in folate

111
Q

What is pernicious anemia?

A

Condition caused by a lack of intrinsic factor (IF), resulting in vitamin B12 (cobalamin) deficiency and megaloblastic anemia

112
Q

What is the classic triad of symptoms for pernicious anemia?

A

Weakness
Sore tongue
Paresthesias

113
Q

What is the most common site for ulcerative colitis?

A

Rectum (it is always involved in UC)

114
Q

The presence of hematuria with red cell casts associated with hemoptysis suggests what 2 diagnoses?

A

Vasculitis or Goodpasture syndrome

115
Q

What is seen on plain film and CT in a patient with a cecal volvulus?

A

Plain film: coffee bean
CT: whirl sign

116
Q

What is the most common location of an anal fissure?

A

Posterior midline

117
Q

What is the minimal platelet count for a thrombocytopenic patient who is undergoing a major surgical procedure?

A

50,000

118
Q

What is recommended for complicated diverticulitis with pericolonic abscess > 4 cm?

A

Percutaneous drainage

119
Q

What is the most common skin cancer?

A

Basal cell carcinoma

120
Q

Where should IVC filters be inserted?

A

At the inflow of the renal vein

121
Q

What tumor marker is associated with hepatic carcinoma?

A

Elevated alpha-fetoprotein (AFP)

122
Q

What will present classically with painless gross hematuria?

A

Bladder cancer

123
Q

What is the most common type of bladder cancer?

A

Transitional (urothelial) cell carcinoma

124
Q

What is the treatment for patients with esophageal variceal hemorrhage who fail initial endoscopic management?

A

Balloon tamponade

125
Q

What is the most common type and location of pancreatic cancer?

A

Adenocarcinoma in the head of the pancreas

126
Q

How long after a meal would you expect a patient with a duodenal ulcer to experience epigastric pain?

A

2-5 hours

127
Q

What condition might show a corkscrew esophagus on barium swallow imaging?

A

Esophageal spasm

128
Q

What is the most common cause of hematochezia in patients > 60 yo?

A

Diverticulosis

129
Q

Which type of head bleed present after head trauma with a brief period of unconsciousness followed by a lucid interval?

A

Epidural hematoma

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