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Boards and Wards Complete > Surgery Part 2 (156-201) > Flashcards

Surgery Part 2 (156-201) Flashcards

1
Q

Lateral deviation of head because of hypertrophy of unilateral SCM

A

Torticollis

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2
Q

Torticollis can be caused by congenital, neoplasms, infection, trauma, disease, of drug tox… but it’s especially caused by…

A

D2 blockers esp phenothiazines

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3
Q

Tx for torticollis

A

Muscle relaxants and/or surgical repair

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4
Q

Midline congenital cyst that EVELVATES on swallowing

A

thyroglossal duct cyst

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5
Q

Lateral congenital cysts that don’t present until adulthood when they get inflammed. Don’t elevate on swallowing

A

Branchial cleft cyst

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6
Q

Aspirate of cyst contains cholesterol crystals

A

Branchial cleft cyst

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7
Q

Neck mass that is caused by occluded lymphatics, usually present in the first 2 years of life. Lateral OR midline. Transluscent, benign mass painless and soft.

A

Cystic hygroma

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8
Q

What diseases are cystic hygromas associated with?

A

Fetal hydrops, Turner’s syndrom or Noonan’s syndrome

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9
Q

Lateral or midline solid mass composed of overgrowth of epithelium. No elevation with swallowing

A

Dermoid cyst

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10
Q

Palpable mass at the bifurcation of the common carotid artery originating from neural crest cells. Located in teh carotid body within the carotid sheath.

Tumor causes bradycardia, dizziness. Can move horizontally but not vertically

A

Paraganglioma (carotid body tumor)

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11
Q

Unilateral cervical lymphadenitis is usually bc what etiololgy?

A

Bacterial, usually Staph aureus

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12
Q

Scrofula is caused by what etiology?

A

Tuberculosis

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13
Q

Enlargement of the thyroid gland, usually secondary to decreased iodine intake or inflammation.

A

Goiter

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14
Q

What is the differential for RUQ abdominal pain? (7)

A
  • Biliary colic
  • Cholecystitis
  • Choledocholithiasis
  • Pneumonia
  • Fitz-Hugh-Curtis syndrome
  • Cholangitis
  • Hepatitis
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15
Q

Constant RUQ to epigastric pain. Ultrasound shows no gallbladder wall thickening or pericholecystic fluid

A

Biliary colic

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16
Q

fever RUQ pain, inspiratory arrest upon deep palpation of RUQ

Labs: moderate to severe leukocytosis, increased LFTs and increased bilirubing

A

Cholecystitis

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17
Q

What does the ultrasound of a pt with cholecystitis show?

A

gallstones (maybe), pericholecystic fluid, thickened gall bladder wall.

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18
Q

RUQ pain worse with fatty meals, jaundice. Ultrasound shows CBD dilation.
Labs: increased LFTs and bilirubin

A

Choledocolithiasis

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19
Q

pleuritic chest pain and fever. CXR shows infiltrate, and labs show leukocytosis

A

pneumonia

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20
Q

Syndrome of perihepatitis caused by ascending chlamydia or N. gonorrhea salpingitis

A

Fitz-Hugh Curtis syndrome

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21
Q

What does a pt’s gallbladder and biliary tree look like in pt with fitz hugh curtis syndrome?

A

Normal gallbladder and biliary tree

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22
Q

Pt shows Charcot’s triad and later develops into Raynold’s pentad… What are the sx and dx?

A

Charcot’s triad: fever, jaundice and RUQ pain
Reynold’s pentad: hypotension and mental status change

Dx: cholangitis

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23
Q 
What are the labs for cholangitis?
WBC?
blood culture? 
LFTs?
Bilirubin?
A

leukocytosis
culture shows enteric organisms
increased LFTs
increased bilirubin

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24
Q

What does the US for cholangitis look like?

A

biliary duct dilation from obstructing gallstones

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25
Q

How to dx cholangitis?

A

ERCP of percutaneous transhepatic cholangiography

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26
Q

RUQ pain, fever, jaundice, elevated LFTs bilirubin and leukocytosis. Whats the top 2 DDX? what’s next step to find out what pt has?

A

Cholangitis and Hepatitis

Do hepatitis virus serology

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27
Q

What is McBurney’s point

A

1/3 the distance from the ASIS to the umbilicus, if tender indicates appendicitis

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28
Q

Why must rectal exam be done on pt with suspected appendicitis?

A

r/o retroperitoneal appendicitis

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29
Q

What finding is seen on plain film or CT abd for appendicitis?

A

fecalith

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30
Q

What organism can mimic appendicitis? What would you do to differentiate it?

A

Yersenia enterocolitis

Do fecal culture

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31
Q

crampy lower abd pain, vaginal bleeding, adnexal mass, menstrual irregularity.
Labs show anemia and increased HCG.
Cudocentesis shows blood

A

ectopic pregnancy

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32
Q

Lower abd pai, purulent vaginal discharge, cervical motion tenderness, adnexal mass.
Wet mount shoes WBCs, culture could show Gonorrhea or chlamidya. What’s the two ddx?

A

Salpingitis or Tubo-ovarian abcess

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33
Q

What is the 1-10-100 rule?

A

In Meckel’s diverticulum, there 1-2% prevalence, 1-10cm in length. 50-100cm proximal to the ileocecal valve.

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34
Q

What is the rule of 2s?

A 
In Meckel's diverticulum, 
2% of population
2% are symptomatic usually before age of 2
Remnants are usually 2 inches
found 2 ft from ileocecal valve
2x as common in males
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35
Q

How does Meckel’s diverticulum present?

A

GI bleed, SBO and Meckel’s diverticulitis (like appy)

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36
Q

Female Acute onset sharp unilateral lower abd/pelvic pain. Pain related to position, nausea, fever present, tender adnexal mass.

A

Ovarian torsion

If intermittent, could be incomplete torsion

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37
Q

MC in infants 5-10 months. Infant crying and pulling legs up to abdomen. Stool looks dark and red (name?) and dx?

A

Currant jelly stool

Intussusception

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38
Q

How do you diagnose intusussception?

A

barium or contrast enema has diagnostic coiled spring appearance.

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39
Q

Why does intussception become more likely after adenovirus infection?

A

Adenovirus makes peyer’s patches thick, making an anchor of tissue which stays put while the rest of bowel telescopes.

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40
Q

What is the Ddx for LUQ pain?

A

Peptic ulcer
MI
Splenic rupture

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41
Q

Epigastric pain relieved by food or antacits

A

peptic ulcer

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42
Q

Sudden upper abdominal pain with shoulder pain and GI bleed

A

perforated ulcer

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43
Q

CP, SOB, diaphoriesis, nausea. Labs show elevated trops

A

MI

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44
Q

What is Kher’s sign

A

LUQ pain and referred left shoulder pain

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45
Q

Tachycardia, broken ribs, hx of trauma, hypotension Kher’s sign +.
Labs leukocytosis

A

Splenic rupture

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46
Q

What is the xray finding for splenic rupture?

A

medially displaced gastric bubble

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47
Q

How to dx splenic rupture?

A

CT scan

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48
Q

LLQ pain DDX?

A 
Diverticulitis
Sigmoid volvulus
Pyelonephritis
Ovarian torsion
Ectopic pregnancy
Salpingitis
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49
Q

LLQ pain, mass, fever and urinary urgency. Labs show leukocytosis. CT/US show thickened bowel wall

A

Diverticulitis

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50
Q

If you are concerned about diverticular abscecess, what should you NOT do

A

use contrast enema

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51
Q

Elderly chronically constipated patient, abdominal pain, distension and obstipation

A

Sigmoid volvulus

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52
Q

What is the classic Xray and contrast enema finding for sigmoid volvulus?

A

xray - inverted U

contrast enema bird’s beak

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53
Q

High fever, rigors, CVA tenderness

A

Pyelonephritis

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54
Q

severe epigstric pain radiating to the back, N/V, signs of hypovolemis bc of third spacing. Decreased bowel sounds.

A

Pancreatitis

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55
Q

What is Gray Turner’s sign?

A

Sign of pancreatitis - ecchymotic appearing skin findings on flank

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56
Q

What’s cullen’s sign?

A

Ecchymotic area periumbilically

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57
Q

What is the classic xray finding for pancreatitis?

A

Sentinel loop –> dilated small bowel or transverse colon adjacent to the pancreas

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58
Q

What findings might a CT scan show in pancreatitis?

A

phlegmon, pseudocyst, necrosis, abscess

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59
Q

If pancreatitis does not improve, what kind of sequele finding should you look for?

A

Pancreatitc pseudocyst bc it might cause fever or shock in infected or hemorrhagic causes.

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60
Q

Back or abd pain and shock, compression on duodenum or ureters can cause obstructive symptoms. palpable pusatile mass

A

AAA

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61
Q

Position dependant mildine abdominal pain, worse after eating, dysphagia, hoarse voice

A

GERD

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62
Q

How do you diagnose GERD?

A

barium swallow, manometric or pH testing esophagoscopy

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63
Q

What is the general management for all abdominal surgical problems?

A

NPO, NG tube, IV fluids, and cardiac monitoring

IV antibiotics as needed.

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64
Q

What condition do most (80%) of pts with reflux also have?

A

Hiatal hernia

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65
Q

What are the 4 types of hiatal hernias?

A

Type 1 - sliding (most common) - movement of the GE junction and stomach into the mediastinum
Type 2 - herniation of the stomach fundus through the diaphragm parallel to esophagus
Type 3 - Herniation of the stomach fundus AND the GE junction above the diaphragm
Type 4 Herniation of the abdominal organs

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66
Q

What is the treatment for a type II hiatal hernia?Why?

A

Surgery because increased risk of strangulation

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67
Q

What is the most common motility disorder?

A

Achalasia

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68
Q

What happens in achalasia?

A

loss of esophageal motility and failure of Lower esophageal sphincter to relax.

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69
Q

What are 2 causes of achalasia?

A

ganglionic degneration or Chagas disease

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70
Q

If pt has achalasia, what type of dysphagia do they have?

A

Dysphagia to both solids and liquids

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71
Q

Why does achalasia increase the risk of esophageal cancer?

A

Stasis promotes development of Barrett esophagus

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72
Q

What would barium swallow and manometry in achalasia pt show?

A

barium swallow - dilation of proximal esophagus

Manometry - increased LES pressure and failure of relaxation

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73
Q

What is the treatment of achalasia
1st line?
alternatives?

A

Endoscopic dilation of LES with balloon cures 80%

Alternative is myotomy with a modified fundoplication

Surgical tx or Botox of LES could also be considered.

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74
Q

What kind of diverticula are proximal?

A

Zenker’s diverticula

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75
Q

What is the treatment of Zenker’s diverticula?

A

Myotomy of cricopharyngeus muscle and removal of diverticulum

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76
Q

Where are zenker’s diverticula usually located?

A

between the thyropharyngeal and cricopharyngeus muscle fibers

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77
Q

What is the most common esophageal cancer?

A

Squamous cell cancer

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78
Q

When does squamous cell esophageal cancer most commonly present?

A

Men in 6th decade of life.

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79
Q

What are some risk factors for squamous cell esophageal cancer development?

A

Alcohol

Tobacco

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80
Q

What kind of cancer is MC seen in pts with reflux which has progressed into Barrett’s esophagus (10% of pts)?

A

Adenocarcinoma

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81
Q

What are some signs/sx for esophageal cancer development?

A

DYSPHAGIA, wt loss, hoarseness, tE fistula, recurrent aspiration

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82
Q

What would barium study demonstrate in esophageal cancer?

A

Apple-core lesion

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83
Q

How do you confirm diagnosis of esophageal cancer?

A

endoscopy, biopsy and CT abdomen and chest (performed to figure out extent of spread)

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84
Q

Tx of esophageal ca?

A

esophagectomy with gastric pull up, poor prognosis unless resected prior to spread)

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85
Q

What are the most common benign gastric tumors?

A

leiomyoma and polyps

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86
Q

After what age and gender do people start to get stomach ca?Blood group?

A

Men >50 yrs, linked to blood group A

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87
Q

What are some risk factors to gastric tumors?

A 
Nitrosamines
Excess salt intake
Low fiber diet
H. pylori infection 
Achorydia
chronic gastritis
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88
Q

What kind of cancer is stomach cancer usually? Location

A

Adenocarcinoma in the antrum, rarely fundus

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89
Q

What other cancer is associated with an H.pylori infection?

A

Lymphoma

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90
Q

What is the name of infiltrating diffuse adenocarcinoma that is the most deadliest gastric cancer?

A

Linitis Plastica

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91
Q

What is Virchow’s node?

A

large, rock hard supraclvicular notde

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92
Q

What is a krukenberg tumor?

A

Mucinous RED SIGNET CELLS

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93
Q

Where does this ca start and metastasize to?

A

Starts in Gi tract, ends up in ovaries

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94
Q

What is sister mary joseph’’s sign?

A

metastasis to the umbilicus so feel hard nodule there

95
Q

What is Blumer’s shelf?

A

Palpable nodule superiorly on a rectal exam caused by matastasis of GI cancer

96
Q

What is the treatment for metastatic GI cancers?

A

mostly palliative care, combo/chemo therapy when tolerated.

97
Q

What is the diagnostic physical exam landmarks/finding you need to detmerine if a hernia is a direct inguinal hernia?

A

Hasselbach’s triable (inferior epigastric artery, rectus shath, and inguinal ligament

98
Q

What is the most common inguinal hernia?

A

indirect type (2/3rds)

99
Q

Where do indirect inguinal hernias pass?

A

lateral to inferior epigastric artery into spermatic cord, covered by cremasteric muscle

100
Q

What is a hernia that protrudes below the inguinal ligament?

A

femoral hernia

101
Q

Concurrent direct and indirect hernia

A

Combined (pantaloon hernia)

102
Q

Part of hernia sac wall is formed by visceral organ

A

Sliding hernia

103
Q

Part of bowel is trapped in the hernia sac

A

Richter hernia

104
Q

Meckel’s diverticulum contained insider hernia

A

Littre hernia

105
Q

Able to replace herniated tissue to its usual anatomic location

A

Reducible

106
Q

Hernia that’s not reducible

A

Incarcerated hernia

107
Q

Incarcerated hernia with vascular compromis

A

Strangulates hernia

108
Q

Herniation through surgical inscision, commonly secondary to wound infection

A

Incisional

109
Q

What gender are femoral hernias most common in?

A

women

110
Q

What complication do visceral hernias have?

A

intestinal obstruction

111
Q

What is the most common benign tumor of the liver?

A

hemangioma

112
Q

What increases the risk of hepatic adenomas?

A

OCPs

113
Q

If an adenoma ruptures, whats the danger?

A

Severe intraperitoneal bleed

114
Q

What is the most common primary hepatic malignant tumor?

A

Hepatocellular carcinoma

115
Q

What’s a hepatoma?

A

Another name for malignant hepatocellular carcinoma

116
Q

Why is hepatocellular carcinoma most common in coutheast asia and sub saharan africa?

A

Bc vertical transmission of Hepatits A

117
Q

What other co-morbid diseases is hepatocellular ca associated with?

A

cirrhosis, HBV, HCV, alcoholism, hemochromatosis, Wilson’s disease

118
Q

What marker would be very high in hepatocellular ca?

A

Very high alpha feto protein (AFP)

119
Q

If chemo is decided upon in pt with hepatocellular ca, what drug is used?

A

Sorafenib

120
Q

What toxic exposures are hemangioscarcomas associated with?

A

polyvinyl chloride
thorostrat
Arsenic

121
Q

What is the demographic of the patient who gets gallstones

A

female, forty, fertile and fat

122
Q

In patients younger than 20 yrs with gallstones, what should they also undergo work up for?

A

congenital spherocytosis or hemoglobinopathy

123
Q

What is a gallbladder with calcified gallbladder walls?

A

porcelain gallbladder

124
Q

What are 2 risk factors in developing gallbladder ca?

A

Native American descent and porcelain gallbladder. These pts should undergo cholecystectomy.

125
Q

Why does biliary colic occur?

A

transient gallstone impaction in cystic or CBD (though most gallstones stay asymptomatic)

126
Q

Pt has sharp colicky pain worse with eating, especially fats

A

Pt has biliary colic

127
Q

How do you diagnose biliary colic?

A

ultrasound

128
Q

What if pt has biliary colic without stones? How to diagnose?

A

HIDA scan - less than 20% ejection fraction suggests acalculous cholecystitis

129
Q

Why does cholecystitis occur?

A

Secondary to infection of obstructed gallbladder

130
Q

What organisms are likely to cause cholecystitis

A

EEK! bugs - e.coli, enterobacter, enterococcus, klebsiella spp

131
Q

If pt has emphysematous cholecystitis, what do you expect the WBC count to be?

A

> 20,000

132
Q

How do you treat cholecystitis?

A

NPO, IV hydration and antibiotics to cover gram negatives

133
Q

What should be used as pain control for cholecystitis?

A

Demerol because morphine causes spasm of sphincter of oddi

134
Q

Why does choledocholithiasis occur?

A

Gall stone stuck in common bile duct

135
Q

What is the first line diagnosis for choledocholithiasis

A

Ultrasound, CBD >9 mm dm

136
Q

What is the normal diameter of the CBD?

A

3-4mm - it increases by 1mm per 10 years over the age of 50

137
Q

Passage of the stone into CBD can cause what complication?

A

pancreatitis if the ampulla of vater is obstructed.

138
Q

Pt comes in with charcot’s triad progressing to Reynold’s pentad, what should be done?

A

Charcots = jaundice, RUQ pain, jaundice, fever
Reynold’s altered mental status and hypotension

LIFE THREATENING EMERGENCY - ascending cholangitis

Tx: NPO, IV hydration, antibiotics to cover gram negative rods and anaerobes
ERCP/PTC to decompress biliary tree

139
Q

What organism is associated with gall bladder cancer?

A

Clonorchis sienensis (liver fluke) infestation

140
Q

What is Klatskin’s tumor?

A

When the tumor forms at the confluence of the hepatic ducts forming in the common duct

141
Q

What is courvoisier’s law?

A

Gallbladder enlargens when CBD is obstructed by pancreatic cancer, but not when CBD is obstructed by a stone.

142
Q

What is the treatment for gallbladder cancer?

A

palliative stenting of bile ducts, consider surgical resection only of palliation

143
Q

What is happening in pancreatitis?

A

pancreatitic enzymes autodigest pancreas causing hemorrhagic fat necrosis and calcium deposition which leads to pseudocyts

144
Q

Why do pancreatitis patient prefer prostration position?

A

The fetal position allows more room in the retroperitoneal space for the swollen pancreas

145
Q

What lab is 90% sensitive for pancreatitis?

A

Serum amylase

146
Q

When should you start a pancreatitis pt on TPN?

A

if they have been NPO >7-10 days

147
Q

How do you determine the prognosis of pacreatitis?

A

Ranson’s criteria. Look up p173

148
Q

What is the treatment of a pancreatic pseudocyst?

A

Percutaneous drainage or pracreaticogastrostomy or pancreaticojejunostomy

149
Q

How can you tell if a pancreatic pseudocyst is new or old?

A

new - contain blood, necrotic debris, leukocytes

Old - straw colored fluid

150
Q

What kind of cancer is most pancreatic ca

A

adenocarcinoma 90%

151
Q

Which demographic is pancreatic cancer mc in?

A

african americans, cigarette smokes, males.

152
Q

What is Trousseau’s syndrom?

A

classic sign of pancreatic cancer - migratory thrombophlebitis

153
Q

How to dx pancreatic ca?

A

CT scan

154
Q

What is the mc pancreatic islet cell tumor?

A

insulinoma (proliferation of B-cells)

155
Q

What is a glucagonoma?

A

proliferation of alpha cell –> produces sx of hyperglycemia, exfoliative dermatitis

156
Q

Somatostatinoma?

A

delta cell proliferation –> makes somatostatin, pts develop diabetes

157
Q

Secretes vasoactive intestinal peptide, causes prolonges watery diarrhea with severe electrolyte balances

A

VIPoma

158
Q

Clinically pt has elevated serum insulin, glucagon, and/or +gastrin secretin test. What does pt have?

A

Gastrinoma - Zollinger Ellison syndrome

159
Q

What genetic dz is zollinger ellison associated with?

A

MEN 1

160
Q

Where are gastrinomas often located?

A

in the gastrinoma triangle - confluence of the cystic and CBD superiorly, the second and third portions of the duodenum inferiorly and neck and body of the pancreas medially

161
Q

What would an abdominal series show in small bowel obstruction?

A

“stepladder” pattern of air fluid levels – distended loops of small bowel, air fluid levels

162
Q

Tx for SBO

A

IV fluids, NG tube decompression andfoley catheter.

163
Q

What is the most likely cause of postoperative SBOs?

A

adhesions - 80% resolve without surgery.

164
Q

What is the most common benign tumor of the small bowel?

A

Leiomyoma

165
Q

Where are the top 2 locations of carcinoid tumors?Sx?

A

appendix
small bowel
Sx include cutaneous flushing, diarrhea and respiratory distress.

166
Q

Where do most polyps arise?

A

sigmoid or rectum

167
Q

What is the most malignant polyp?

A

villous adenoma

168
Q

What is the smallest malignant potential polyp

A

tubular adenoma

169
Q

What is the most common cc for neoplastic complaints?

A

rectal bleeding

170
Q

If invasive adenoCA is found on colonoscopy, tx?

A

colectomy is not mandatory if gross and margins are clear.

171
Q

What gene is FAP associated with?

A

APC gene - abundant polyps thought the colon and rectum beginning at puberty

172
Q

Pt with poplyposis, desmoid tumors, osteomas of the mandible and skull, and sebaceous cysts

A

Gardener’s syndrome

173
Q

Pt with polyposis with medullablastoma or glioma

A

Turcot’s syndrome

174
Q

What is the most sensitive way to predict FAP

A

retinal pigment epithelium predicts FAP with 97% sensitivity

175
Q

Pt with autosomal dominant dz has nonneoplastic hamartomatous polyps in the stomach, small intestine, and colon, skin, mucous membranes and HYPERPIGMENTATION of the freckles on the lips
Tx?

A

Peutz-jegher’s syndrome

prophylactic colectomy

176
Q

Jeuvenile Polyposis syndrome syndrome - also has hamartomatous polyps Tx?

A

Polypectomy for pts who are symptomatic

177
Q

True diverticula are..

A

herniations involving the full bowel wall

178
Q

Where are true diverticula often found?

A

in cecum and ascending colon.

179
Q

What are false diverticula?

A

only mucosal herniations through muscular wall

180
Q

Where are false diverticula found?

A

> 90% found in sigmoid colon

181
Q

What causes diverticula?

A

increased intraluminal pressure promoted by a low fiber diet

182
Q

Is bleeding more consistent with diverticulosis or diverticulitis?

A

Dierticulosis

183
Q

What is the most common fistula associated with diverticular dz?

A

colovesicula (presents with recurrent UTIs and /or pneumaturia

184
Q

What must be done 4-6 weeks after resolution of symptoms of diverticulitis?

A

colonoscopy to exclude underlying neoplasm

185
Q

Bright red blood per rectum is indicative of what?

A

bleeding in the distal small bowel or colon.

186
Q

How to dx GI bleed?

A

Digital rectal exam and visualization with an anoscope/sigmoidoscope to locate site of bleed.

187
Q

How to tx lower GI bleed?

A

IV fluids and transfusions to maintain hemodyanimic stability. Surgery is rarely required, and should only be considered if bleeding persists (resolves in 90% of cases)

188
Q

What are the 3 MCC of large intestinal obstruction?

A

adenoCA, scarring secondary to diverticulitis, and volvulus.

189
Q

What should you NEVER do with suspected obstruction?

A

DO NOT GIVE BARIUM ORALLY W SUSPECTED OBSTRUCTION

190
Q

What is Ogilvie’s syndrome?

A

Pseudo - obstruction –> massive right sided colon dilatation with no evidence of obstruction

191
Q

What should you treat ogilvie’s syndrome with?

A

Colonoscopy and rectal tube for decompression

192
Q

What is the indication for Neostigmine in ogilvie’s syndrome?

A

For rapid bowel evacuation once a distal obstruction has been ruled out and pt has no hx of cardiac disease (why? bc neostigmine will cause bradycardia so pt needs to be monitored while it’s being administered)

193
Q

Rotation of the large intestine along its mesenteric axis

A

Volvulus

194
Q

What is the most common site of volvulus?

A

sigmoid and cecum in elderrly

195
Q

What is classic finding on xray of a volvulus?

A

dilated loops of bowel with loss of haustra with a kidney bean appearance

196
Q

What is the classic finding on barium enema of a volvulus?

A

bird’s beak or ace of spades picture with point of beak pointing to the site of bowel rotation

197
Q

What is the second leading cause of cancer deaths?

A

colon cancer

198
Q

When should CEA be obtained?

A

pre operative and post operative to colon ca resection

199
Q

Autosomal dominant predisposition to colorectal ca with right sided predominance (70% proximal to splenic flexure)

A

Lynch syndrome I

200
Q

All features of lynch syndrome I + extracolonic cancer esp in the endometrium, ovary, stomach and pancreas

A

Lynch syndrome II

201
Q

What are the screening guidelines for colonoscopy?

A

> 50 yrs without risk factors
Yearly stool occult blood tests
flexible sigmoidoscopy every 3-5 yrs or colonoscopy every 10 years or barium enema every 5-10 yrs

202
Q

What is the adjuvent tx for metastatic colon ca??

A

FOLFOX (p184)

203
Q

why are hemorrhoids caused?

A

varicosity in the lower rectum or anus caused by congestion in the veins of the hemorrhoidal plexus

204
Q

Which type of hemorrhoids are painful

A

internal hemorrhoid is generally not painful

external = pain

205
Q

What is a thrombosed external hemorrhoid?

A

Classically painful, but a true hemorrhoid, but a subcutaeneous external hemorrhoidal veins of the anal canal. Classified by degreed p185

206
Q

What is the definitive tx for hemorrhoids?

A

sclerotherapy, cryosurgery, rubber band ligation

207
Q

What are factors that predispose to maintaining fistula patency?

A 
Foreign body 
Radiation
Infection
Epithelialization
Neoplasm
Distal obstruction
208
Q

Pt with severely painful bowel movement associated with bright red bleeding

A

Classic presentation for anal fissure, 90% located in the posterior midline

209
Q

Tx for anal fissure?

A

stool softeners, dietary modifications, bulking agents, Botox type A or nitroglycerin ointment.

210
Q

What drug is used to presensitivze tumor cells before radiation is administered to tx rectal cancer?

A

5- flourouracil

211
Q

What are the 2 indications for bariatric surgery?

A

BMI >40
or BMI>35 with one or more related comorbid conditions

Pts must undergo 6 mo supervised medical weight loss program before consideration of surgery

212
Q

What is Roux en Y gastric bypass associated with postop complication?

A

Dumping syndrome

*dumping syndrome is not an issue with vertical sleeve gastrectomy

213
Q

What kind of deficiencies might a pt with gastric bypass have?

A

Hyperparathyroid bc hypocalcemia
Iron
B12
Zinc

214
Q

Cyclical or noncyclical breast pain not because of breast lumps

A

mastalgia

215
Q

Tx for mastalgia?

A

Danzol

216
Q

Thoracoepigastric vein phlebitis where there is skin retraction along the vein course

A

Mondor’s disease

217
Q

What kind of states is gynecomastia seen in?

A

hyperestrogen –> anything that inhibits liver breakdown of estrogen

218
Q

What are the risk factors of breast cancer?

A

Woman
age
young first menarche 50
FHx (BRCA 1 or 2)

Not by: increased caffine, sexual orientation, fibroadenoma

219
Q

Where does breast cancer most commonly occur?

A

Upper outer quadrant.

220
Q

MC breast issue in teens and young women (20’s) — histo shows myxoid stroma with curvilinear, slit ducts. Tx?

A

none required- fibroadenoma. will resorb within a few weeks. Re-eval in 1 month.

221
Q

Look at breast mass work up algorithm

A

p. 191

222
Q

MC breast tumor in 35-50 yrs, arise in terminal ductal lobar unit. Multiple bilateral small umpts tender during menstrual cycle

A

Fibrocystic disease

223
Q

Pt with serous, bloody nipple discharge

A

Intraductal papilloma (solitary papillomas dont increase cancer risk, but multiple do)

224
Q

Pt with irregularly shaped ductal calcifications on mammography. Dx? Tx?

A

ductal CA in situ Tx: excision of mass, ensure clean margins on excision add, post op radiation to reduce rate of recurrance

225
Q

Therapy with what SERM reduced the incidence of recurrence of invasive of DCIS by half

A

Tamoxifen therapy for 5 years.

226
Q

Histo shows mucinoius cells with saw tooth and cloverleaf configurations dx?

A

Lobular cardinoma in situ –> not precancerous but IS a marker for future IDC risk in both breasts.

227
Q

WHAT IS THE MOST IMPORTANT PROGNOSIS FACTOR OF IDC?

A

tumor size

228
Q

Pt with dermatitis and macular rash over the nipple/areola. Dx?

A

Paget’s breast disease - underlying ductal ca is almost always present

229
Q

What issue in young women interferes with a mammography’s sensitivity and specificity?

A

Dense breast tissue

230
Q

Pt iwth absent cremestaric reflex on affected side, acute onset testicular pain, edema and vomiting. Dx? Tx?

A

Testicular torsion, do dopplar ultrasound to assess artery flow
Tx: Emergent surgical decompression with excision of testicle if it infarcts

231
Q

unilateral testicular pain, dysuria. pccasional urethral discharge, fever, leukocytosis in severe cases , painful and swollen epididimys

A

Epididymitis

232
Q

What do labs show for epididymitis?
UA?
Urine Cx?
Swab?

A

UA - negative or pyuria
get culture
Swab for gonorrhoeae and chalmydia

233
Q

What is the blue dot sign?

A

uhmm..

Boards and Wards Complete (13 decks)

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