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Surgery > Osler, part 2 > Flashcards

Osler, part 2 Flashcards

1
Q

HPI of pancreatic CA

A

Gradual onset
Pain in lower back or epigastric, straight through to back
Fairly constant, worse at night
Dull, gnawing, visceral quality
Better when sitting up or leaning forward or fetal position +/- worse with eating/laying supine

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2
Q

Related sx of pancreatic CA

A 
Wt loss
Anorexia
Generalized malaise and weakness
New onset DM
Jaundice (early sign of pancreatic head due to bile duct obstruction)
Pruritis
Acholic stools
Dark urine
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3
Q

PE of pancreatic CA

A 
Courvoisier's sign: Palpable, nontender, distended GB associated with jaundice
\+/- hepatomegaly
\+/- RUQ mass
Cachexia
\+/- superficial thrombophlebitis
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4
Q

Signs of metastasis of pancreatic CA

A 
Abdominal mass
Ascites
L supraclavicular LAD (Virchow's node)
Periumbilical mass (Sister Mary Joseph's node)
Palpable rectal shelf
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5
Q

Grey Turner’s sign

A

Bruising of the flanks
Appears as blue discoloration
Sign of retroperitoneal hemorrhage

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6
Q

Workup for pancreatic CA

A

MRI
CT with IV contrast
ERCP: useful if obstructive jaundice, or sx without evidence of mass on CT
EUS (endoscopic u/s): clarification of small (<2 cm) lesions in neg/equivocal CT findings
CA 19-9: post-op monitoring
Tissue dx not necessary unless neoadjuvant therapy is planned

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7
Q

Purpose of Nissen fundoplication

A

Treats refractory GERD to prevent Barrett’s esophagus

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8
Q

Pre-op evaluation of Nissen fundoplication

A 
Most important test is upper endoscopy
Esophageal manometry
pH testing
UGI series
Esophagogram
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9
Q

HPI of GERD

A 
In chest/throat
Burning
Severity around 5
Comes and goes
Wheezing, CP, dysphagia
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10
Q

Sx of GERD- refractory

A 
Sore throat
Hoarseness
Trouble swallowing
Cough
Noncardiac CP
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11
Q

Indications for TURP or open simple prostatectomy

A

Acute urinary retention
Persistent or recurrent UTIs
Significant hemorrhage or recurrent hematuria
Bladder calculi secondary to bladder outlet obstruction
Significant sx from bladder outlet obstruction that are not responsive to medical or minimally invasive therapy
Renal insufficiency secondary to chronic bladder outlet obstruction

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12
Q

S/sx of prostate CA

A 
Urinary frequency
Urgency
Nocturia
Hesitancy
Hematuria- uncommon presentation
Hematospermia- uncommon presentation
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13
Q

Major RF for prostate CA

A

Smoking

1st degree relatives also a RF

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14
Q

Labs/diagnostics for prostate CA

A

PSA levels

Prostate bx guided by TRUS

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15
Q

RFs for prostate CA

A

AA > whites
Genetic- BRCA2 mutation
Smoking
Diet- high red meat diet

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16
Q

USPSTF guidelines for prostate CA

A

Decisions about screening should be make on an individual basis after consultation with a provider (C Recommendation)
Recommends against PSA-based screening past the age of 70 (D recommendation)

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17
Q

Labs and decision making process for thyroid nodules- initial

A

Check TSH and T3/4

Order u/s

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18
Q

Labs and decision making process for thyroid nodules- low TSH

A

Order iodine uptake
If no increase uptake, then order FNA
If increased, so no FNA
Indeterminant: get FNA

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19
Q

Labs and decision making process for thyroid nodules- high or nl TSH

A

Cystic nodules need no further testing
Spongiform > 2 cm
Hyperechoic >1.5 cm
Hypoechoic >1 cm need FHx of thyroid CA

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20
Q

What should be done for thyroid nodules if you did not do an FNA?

A

F/u in 6-12 mos

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21
Q

In anaplastic thyroid CA, what is the tx?

A

Needs palliative surgery only

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22
Q

What categories of FNA bx are considered to be surgical?

A

FN/SFN
SFM
MGT

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23
Q

Labs for toxic multinodular goiter

A

Low TSH
High T3/T4
Order U/s
TSAb

24
Q

When to do surgery for toxic multinodular goiter

A

If meds don’t work or if having ocular sx

25
Q

Sx of nonfunctioning goiter

A

Hoarseness
Dysphagia
Discomfort (esp when lying down)
SOB

26
Q

Indications for tonsillectomy- absolute

A

Enlarged obstruction, dysphagia, sleep d/o, cardiopulm complications
Peritonsillar abscess unresponsive to medical management/drainage
Tonsillitis + febrile seizures
Tonsils requiring bx to define tissue pathology

27
Q

Indications for tonsillectomy- relative

A

Persistent/foul taste or breath d/t chronic tonsillitis
Chronic/recurrent tonsillitis (seven in one year, five each in two years, or three each in three years) d/t strep, unresponsive to beta lactamase
Unilateral tonsillar hypertrophy, neoplasm

28
Q

Surgical workup for tonsillectomy

A 
Coagulation parameters
-FHx
--If neg- no coags needed
--If pos, coags needed
If malignancy- XR, CT, or MRI
Antibodies for streptolysin-O (ASLO)
Histology- only if CA suspected
29
Q

Presentation of MI

A

May present as nl MI that we’ve learned, may also be a “silent” presentation (ex. women, diabetics, elderly)
Retrosternal CP radiating to jaw, down left arm, SOB

30
Q

Labs/tests for potential CABG pt

A 
EKG- T wave inversion is 1st sign
Troponins
CBC
CMP
Lipid profile
CXR
31
Q

Cath lab results and CABG

A 
Do a CABG if:
50% stenosis found in LCA
-3-vessel dz
Proximal LAD stenosis
Failure of PCI
CABG is better for diabetic pts than stenting
32
Q

RFs of aortic stenosis

A

HTN
DM
Smoking
Hypercholesterolemia

33
Q

Presentation of aortic stenosis

A

Usually asx until the development of syncope, angina and dyspnea/CHG when aortic valve is <1.0 cm
Narrowed valve leads to hypertrophied left ventricle

34
Q

PE of aortic stenosis

A

Systolic ejection murmur that is harsh/rumbling crescendo-decrescendo
Murmur increases with squatting/leg raise, sitting and leaning forward. Decreases with valsalva/standing
Pulsus parvus et tardus: small, delayed carotid pulse
Narrowed pulse pressure
S4
Hand-grip maneuver- murmur will decrease

35
Q

Disease that can cause aortic regurgitation

A 
Rheumatic heart dz
Endocarditis
Bicuspid valve dz
Aortic root dz
Aortic dissection
RA
SLE
Myxomatous disease
36
Q

PE of aortic regurgitation

A

Diastolic decrescendo blowing murmur heard at LUSB
Murmur increases with squatting, sitting forward, and handgrip. Decreases with Valsalva, standing. May radiate to LSB.
Austin-Flint murmur: bounding pulses. Wide pulse pressure

37
Q

PE of chronic aortic regurgitation

A

Water hammer pulse

Swift upstroke and rapid fall of radial pulse accentuated with wrist elevation. May have S3 and rales

38
Q

Presentation of mitral stenosis

A

Can present as right-sided heart failure, pulmonary HTN with hemoptysis, and a-fib

39
Q

PE of mitral stenosis

A

Diastolic rumble at the apex
Opening snap, loud S1
Pulses usually reduced

40
Q

Tx of aortic stenosis

A

Aortic valve replacement

41
Q

Dx of aortic stenosis

A

Echo and cardiac cath

42
Q

Dx of aortic regurgitation

A

Echo and cath

43
Q

Tx of aortic regurgitation

A

Surgery is definitive and indicated in acute and symptomatic AR or symptomatic with EF <55%
Should have valve replacement

44
Q

Dx of mitral stenosis

A

CXR and echo
CXR: left atrial enlargement
Echo: LAE, thick calcified valve, “fish mouth” shaped orifice

45
Q

S/sx of mitral stenosis

A 
DOE
Orthopnea
PND
Palpitations
CP
Hemoptysis
Thromboembolism
All sx will increase with exercise and pregnancy
46
Q

PE of mitral stenosis

A

RVF (JVD, hepatomegaly)

47
Q

Diseases where mitral regurgitation will present- acute

A

Endocarditis
Papillary muscle rupture
Chordae tendinae rupture

48
Q

Diseases where mitral regurgitation will present- chronic

A

MVP
Rheumatic fever
Marfan syndrome
Cardiomyopathy

49
Q

S/sx of mitral regurg

A 
DOE
PND
Orthopnea
Palpitations
Pulmonary edema
50
Q

PE of mitral regurg

A

Holosystolic murmur at the apex, radiates to the back or clavicular area
AFib is common
Diminished S1, widening of S2, laterally displaced PMI, loud palpable P2

51
Q

Dx of mitral regurg

A

CXR and echo

Valve replacement must be performed if left ventricular function is too severely compromise

52
Q

Cause of infective endocarditis

A

Most common d/t IV drug use, previous congenital or acquired cardiac lesions, immunocompromise, IV catheters

53
Q

Presentation of infective endocarditis

A 
Fever
Weakness
Night sweats
Anorexia
Murmur
Splinter hemorrhages
Osler nodes
Janeway lesions
Roth spots
54
Q

Dx of infective endocarditis

A

BCx and echo revealing valvular vegetations

55
Q

When is surgery indicated for infective endocarditis?

A

Reserved for prosthetic valve endocarditis, failure of medical management, life-threatening emboli, severe valvular insufficiency, obstruction, and CHF

Surgery (30 decks)

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