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MS3 > Surgery Rotation 1 > Flashcards

Surgery Rotation 1 Flashcards

1
Q

What is the problem and presentation of polycythemia vera

A

Mainly proliferation of RBCs

Presentation:
♣ Increased blood viscosity
• Plethora (flushed face)
• Transient blurred vision
• Headache
• Erythromelalgia (severe, burning pain and red-blue coloration in the extremities due to episodic blood clots in vessels of extremities)
♣ Thrombosis (e.g Budd Chiari)
♣ Bleeding
♣ Itching after bathing (aquagenic pruritis)
♣ Gouty arthritis due to increased RBC turnover
♣ Splenomegaly

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2
Q

Treatment of polycythemia vera

A

♣ Phlebotomy

♣ Hydroxyurea (if increased risk of thrombus)

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3
Q

What is essential thrombocythemia + presentation

A 
o	Mainly a proliferation of platelets
o	JAK2 kinase mutation 
o	Presentation:
♣	Increased bleeding – dysfunctional platelets 
♣	Thrombosis – too many platelets
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4
Q

What is myelofibrosis and findings

A

o Obliteration of bone marrow with fibrosis due to increased fibroblast activity
o JAK2 kinase mutation
o Findings:
♣ “Teardrop” RBCs – due to marrow fibrosis
♣ Splenomegaly – extra-medullary hematopoiesis

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5
Q

Is EPO high or low in polycythemia vera

A

o Increased red cell mass, without elevated EPO (unlike other causes of erythrocytsosis)

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6
Q

Cause and presentation of thrombotic thrombocytopenic purpura (TTP)

A

o Platelets used up in pathologic formation of microthrombi in small vessels
o Due to decreased ADAMTS13, enzyme that normally cleaves vWF for degradation
♣ No vWF degradation = abnormal platelet adhesion = microthrombi
o Findings (Pentad):
♣ Thrombocytopenia = platelets being used up
♣ Microangiopathic hemolytic anemia = RBCs sheared by microthrombi
♣ Renal insufficiency (thrombi involve vessels of the kidney)
♣ Neurological symptoms (confusion, HA, seizures, coma) – thrombi involve vessels of CNS
♣ Fever

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7
Q

Cause and presentation of hemolytic uremic syndrome

A

o Platelets used up in pathologic formation of microthrombi in small vessels
o Commonly caused by Shiga toxin-producing E. Coli O157:H7 (STEC)
♣ Accompanied with diarrhea
o Findings (triad):
♣ Microangiopathic hemolytic anemia
♣ Renal insufficiency (thrombi involve vessels of the kidney)
♣ Thrombocytopenia

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8
Q

What causes metabolic acidosis

A 
•	Anion gap  Adding acid to the blood
o	MUDPILES:
♣	M – Methanol
♣	U – Uremia (renal failure) 
♣	D – Diabetic ketoacidosis
♣	P –  Propylene glycol/Paraldehyde
♣	I – Isoniazid/Iron
♣	L – Lactic acidosis
♣	E – Ethylene glycol (antifreeze)
♣	S – Salicylates (aspirin)
•	Non-anion gap  Losing excessive HCO3-
o	Diarrhea, Renal tubular acidosis, Spironolactone, Acetazolamide
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9
Q

What causes metabolic alkalosis

A 
♣	Causes:
•	Losing H+  excessive vomiting, diuretics, hyperaldosteronism 
♣	Differential of metabolic alkalofis (pH > 7.45; HCO3- > 24)
•	Low urine chloride
♣	Will respond to saline
o	Vomiting/nasogastric aspiration
o	Prior diuretic use
•	High urine chloride
o	Hypovolemia/euvolemia
♣	Current diuretic use
•	Will responds to saline
♣	Bartter & Gitelman syndrome
•	Saline unresponsive
o	Hypervolemia
♣	Excessive mineralocorticoid activity
o	Saline unresponsive
•	Primary hyperaldosteronism
•	Cushing disease
•	Ectopic ACTH production
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10
Q

Fluid given for euvolemic hypernatremia

A

• Free water supplementation

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11
Q

Fluid given for hypovolemic hypernatrermia (both symptomatic and asymptomatic)

A

• Non-symptomatic
o 5% dextrose
• Symptomatic
o 0.9% saline (isotonic solution) until Euvolemic, then 5% dextrose (hypotonic solution)

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12
Q

Pathogenesis of DKA

A

♣ Lack of insulin means glucose cannot get into the cell for glycolysis to make ATP cell instead uses fatty acid beta oxidation which breaks down into ketone bodies
♣ Sodium levels will be low
• Hyponatremia due to sodium loss via diuresis

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13
Q

Will Na+ and K+ be high or low in DKA?

A

♣ Sodium levels will be low
• Hyponatremia due to sodium loss via diuresis (osmotic diuresis due to increased glucose)
♣ High serum potassium but low total body potassium
• Cells will exchange H+ for K+ causing high potassium
• Potassium in the blood will be excreted cause low total body potassium

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14
Q

IV fluids given to treat DKA

A

♣ 0.9% normal saline initially

♣ Add dextrose 5% when serum glucose <200 mg/dL

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15
Q

Replacement of one cell type by another

A

Metaplasia

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16
Q

Abnormal cells, lacking differentiation

A

Dysplasia

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17
Q

What is atelectasis

A

Collapse of lung

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18
Q

Ptosis, diplopia, weakness

A

Myasthenia gravis

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19
Q

Clinical presentation of Lambert-Eaton

A
  • Proximal muscle weakness that improves with use
  • Autonomic symptoms (dry mouth, impotence)
  • Eyes usually spared
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20
Q

Tumor associated with Lambert eaton

A

Small cell carcinoma of lung

21
Q

Clinical presentation of Parkinsons

A 
TRAPS + mask-like facies
T - Tremor (resting)
R - Rigidity (cogwheel)
A - Akinesia 
P - Postural instability
S - staggering gait
22
Q

What is akinesia

A

Impairment of voluntary movement

23
Q

Compare histology of Alzheimers, Frontotemporal dementia, Parkinsons dementia, Lewy Body dementia

A

Alzheimers - Extracellular beta-amyloid plaques; intracellular neurofibrillary tangles made of tau protein

Frontotemporal dementia - Pick bodies (round aggregates of tau protein)

Parkinsons - Lewy bodies (eosinophilic inclusions of alpha-synuclein) within neurons

Lewy Body dementia - Lewy bodies within the cortex (aggregates of a-synuclein)

24
Q

What is the striatum and where is it located

A

Striatum = caudate + putamen

Caudate located lateral to ventricles

Putamen located lateral to globus pallidus

(look up image)

25
Q

Components of Whipple procedure

A
  • Cholecystectomy
  • Truncal vagotomy
  • Antrectomy
  • Pancreaticoduodenectomy—removal of head of pancreas and duodenum
  • Choledochojejunostomy—anastomosis of common bile duct to jejunum
  • Pancreaticojejunostomy—anastomosis of distal pancreas remnant to jejunum
  • Gastrojejunostomy—anastomosis of stomach to jejunum
26
Q

What is seborrheic keratosis (gross and histology)

A

“Stuck on” coin-like plaque

HIstology = keratin pseudocysts

27
Q

What is actinic keratosis

A

Hyperkeratotic scaly plaque

Precursor lesion of SCC

Histology = ???

28
Q

What are the boundaries of the upper GI

A

Tip of nose to ligament of Treitz

29
Q

What is the ligament of Treitz

A

Suspensory ligament connecting the duodojejunal junction to the retroperitoneum (connective tissue surrounding the Celiac artery and SMA)

30
Q

Steps to find the source of blood per rectum

A

Could be from upper or lower GI:

1) NG tube to aspirate gastric contents to check for blood - if no blood, then you can exclude tip of nose to pylorus
2) Upper GI endoscopy to exclude duodenum - want to see green fluid (bile tinged)
3) Anoscopy to exclude hemorrhoids (cannot do colonoscopy during active bleeding b/c blood obscures the field)
4a) 1/2 options - angiogram for more severe bleeds
4b) 2/2 options - if less blood, wait until bleeding stops and do a colonoscopy

31
Q

Most common cause of blood per rectum in a child

A

Meckel diverticulum

32
Q

Differential dx of acute abd

A

Perforation
Obstruction
Inflammatory process
Ischemic process

33
Q

Most common cause of perforated abd

A

Perforated peptic ulcer

34
Q

Difference in gallbladder in obstruction caused by stones vs. malignancy

A

Stones = dilated ducts with nondilated gallbladder full of stones

Malignancy = large, thin-walled distended gallbladder

35
Q

Cancers that may cause gallbladder obstruction

A
  • Head of pancreas
  • Cholangiocarcinoma (of duct)
  • Ampulla of Vater
36
Q

What is the sphincter of Oddi

A

Muscular valve that controls the flow of digestive juices into the ampulla of Vater

37
Q

What are the 3 major openings of the diaphragm

A

♣ THINK: I ate ten eggs at twelve
• I ate = “I” for IVC and “ate” for T8
• Ten eggs = “Ten” for T10 and “eggs” for esophAGus and vAGus
• At twelve = “At” for AAT (Aorta, Azygous, Thoracic) and twelve for T12

38
Q

Histological difference between ductal and lobular carcinoma in the breast

A

Ductal (most common) = Small, glandular, duct-like cells

Lobular = Single file row of cells due to loss of e-cadherin

39
Q

What disease presents with stones, thrones, bones, groans, and psychiatric overtones

A

Hyperparathyroidism

40
Q

Presentation of glucagonoma

A

Necrolytic dermatitis, diabetes (hyperglycemia), DVT, weight loss, depression

41
Q

What substances are measured to assess for pheochromocytoma?

A

Vanillylmandelic acid (VMA), metanephrines, catecholamines

42
Q

Definition of “-tomy”

A

To cut

43
Q

Definition of “-ectomy”

A

To take out or resect

44
Q

Definition of “-ostomy”

A

To make a mouth/opening

Could be from a single organ to the outside (colostomy) or could be an anastomoses between two organs (gastrojejunostomy)

45
Q

Definition of “-plasty”

A

To change the shape of something

46
Q

Definition of “-pexy”

A

To fix in place

47
Q

Defintion of “-rrhaphy”

A

To saw together

48
Q

Describe the percentage of body surface area when dealing with burns in adults

A

Rule of 9s:

Head = one 9
Each upper extr = one 9
Trunk = four 9s; two in front and two in back
Each lower extr = two 9s; one in front and one in back

49
Q

Describe the percentage of body surface area when dealing with burns in kids

A

Rule of 9s:

Head = two 9s
Each upper extr = one 9
Trunk = four 9s; two in front and two in back
Both lower extr = total of three 9s; 1.5 each

MS3 (88 decks)

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