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Surgery > Osler > Flashcards

Osler Flashcards

1
Q

Reasons for colectomy

A

Appendiceal cancer
Colonic carcinoid
Colonic gastrointestinal stomal tumors (GIST)
Metastatic tumor

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2
Q

RF for colon cancer

A 
AA
Ashkenazi Jews
Obesity
Physical inactivity
High red meat diet
Diet high in fat and low in fiber
Smoking
Heavy alcohol use
DM
Increased age
Personal hx of colorectal CA or polyps
IBD
FHx
Having an inherited syndrome
Radiation therapy from other CAs
FAP: mutation in APC gene
HNPCC: mutation in MLH1 or MSH2 gene
Peutz-Jehgers: STK11 gene (hyperpigmentation around hands and lips, hamartomas)
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3
Q

Colon cancer PE findings

A

R-sided: occult blood loss, anemia
L-sided: obstruction and macrobleeding
Rectal: bleeding, obstruction, alternating diarrhea and constipation

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4
Q

Preop colon cancer eval

A

Colonoscopy
Maybe CT
CEA blood test
If rectal: adjuvant 5FU

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5
Q

Volvulus s/sx

A 
Acute/chronic abd pain
Distention
Vomiting
Obstipation
Diminished appetite
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6
Q

Workup for volvulus

A

X-ray: bent inner tube sign

CT best test

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7
Q

Initial treatment of sigmoid volvulus

A

IV resuscitation by detorsion of sigmoid via rigid proctoscopy

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8
Q

Followup tx of sigmoid volvulus

A

After endoscopic detorsion, pt should undergo resection of the sigmoid colon

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9
Q

When should an elective colectomy be considered for diverticulitis?

A

After an episode of complicated diverticulitis and/or recurrent uncomplicated diverticulitis

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10
Q

Sx of diverticulitis

A 
Change in BM
Anorexia
Nausea
Fever/chills
Urinary urgency
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11
Q

Labs for diverticulitis

A

Will see leukocytosis

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12
Q

Imaging for diverticulitis

A

CT scan abdomen
Barium enema
Don’t do colonoscopy while inflamed

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13
Q

What STI is a risk factor for colon cancer?

A

Anal HPV

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14
Q

Colonoscopy screening for high-risk pts

A 
HNCPP
FAP
Gardners
UC and Chron's
Screen in teens
IBD: Annually after 10 yrs of dx
-Consider prophylactic colectomy for high risk pt
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15
Q

Colonoscopy screening recommendation for intermediate risk

A

Personal hx or strong family hx

Colonscopy at 40 and then q3-5 yrs

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16
Q

Colonscopy screening recommendation for mild risk

A

Age, diet, physical activity, obesity, smoking, no family hx

Beginning at age 50 have colonscopy q 10 yrs, or yearly fecal occult blood test or flexible sigmoidoscopy q5 yrs

17
Q

Sx of appendicitis

A

Abdominal pain- classically begins diffusely in the umbilical region then localized to the RLQ
Anorexia
N/V following abdominal pain

18
Q

Signs of appendicitis

A

Maximal tenderness over McBurney point- 2/3 between umbilicus and ASIS
-Rebound tenderness, guarding, decreased bowel sounds, +/- fever
Rovsing’s sign: Deep palpation in LLQ causes rebound referred pain in RLQ
Psoas: RLQ pain which right hip is flexed
Obturator: pain in RLQ when flexed right thigh is internally rotated when pt is supine

19
Q

Labs/rads of appendicitis

A

Leukocytosis on CBC
CT scan w/o contrast
U/S

20
Q

GI sx of hemorrhoids

A

Nausea
Vomiting
Abdominal pain
Irregular/discolored/bloody stools

21
Q

Labs for hemorrhoids

A

Hemoccult
CBC (signs of infection or anemia d/t bleeding)
Coags to check for coagulopathy

22
Q

Imaging for hemorrhoids

A

Colonscopy
Anoscopy (anal speculum- mandatory for viewing internal hemorrhoids)
Flexible sigmoidoscopy (to evaluate for proximal dz such as rectal prolapse)
Enteroscopy

23
Q

Indications for hemorrhoid surgery

A

Conservative or nonsurgical tx fails
Presence of concomitant anorectal conditions
Pt preference
Grade III or IV hemorrhoids with severe sx

24
Q

Hx of groin hernia

A

Pt presents with pain and swelling in groin
Pain may radiate into scrotum
May be intermittent or continuous
May get worse after extended periods of standing and improve with rest
Ask for sx of bowel obstruction (n/v, abd distention, abd pain, constipation)

25
Q

PE of groin hernia

A

Examine supine and standing and with and without Valsalva
Women should be considered for surgical exploration and repair even if PE is negative
Complete PE includes full abdominal exam

26
Q

Imaging for hernia

A

Ultrasound or CT may only be helpful for atypical presentations
U/s for exclusion of testicular changes

27
Q

Labs for hernia

A

No labs are diagnostic of hernia

Possible leukocytosis and elevated lactate with intestinal ischemmia

28
Q

When to consider surgery for hernias

A

The hernia is painful and adversely affects the ADLs (Note a hernia may be painful for a few weeks after its development, but often becomes symptomless thereafter)
The hernia is large (5-10 cm)
It is a femoral hernia (all)

29
Q

RFs for breast cancer

A 
Prior radiation
Birth control
IUD
FHx of breast CA
Early menarche
Late menopause
Nullipara before age 30
Inactivity
Overweight or obese after menopause
Dense breast tissue
30
Q

When should genetic testing for breast CA be done?

A

Those who have family members with breast, ovarian, tubal, or peritoneal cancer

31
Q

PE of breast cancer

A

LAD
Breast: lumps, tenderness, erythema, skin changes, axillary LN, nipple retraction, palpable mass
MS: UE edema

32
Q

Labs/diagnostics for breast CA

A 
Breast u/s
Diagnostic mammography
Tissue bx with core needle sample, hormone receptor status
Sentinel LN bx
MRI breasts with IV contrast
CBC
CMP
UA
Urine pregnancy
33
Q

Reasons to get a hysterectomy

A

Complicated endometriosis
Adenomyosis
Endometrial carcinoma
Cervical malignancies

34
Q

When to be suspicious for endometriosis

A

Pelvic pain
Infertility
Dysmenorrhea
But may be asx

35
Q

Labs/diagnostics for cervical CA

A

Cone bx of cervix to determine cervical involvement
PET to check for mets to lung, liver, and bone
CT to stage
CXR

36
Q

Labs/diagnostics for reproductive CAs

A

Trans vaginal u/s
CA-125
B-hCG

37
Q

Lab studies related to hysterectomy

A 
CBC
Pap
Endometrial sampling
U/s
Blood type and cross
38
Q

Imaging related to hysterectomy

A 
ECG
CT
MRI
Cystoscopy
Barium enema
IVP
Blood chemistry
Tumor markers
39
Q

Indications for cholecystectomy

A 
Acute cholecystitis
Biliary colic
Gallbladder CA
Gallstone pancreatitis
Choledocholithiasis

Surgery (30 decks)

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