Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery Clerkship Final > Emma Holiday Review > Flashcards

Emma Holiday Review Flashcards

1
Q

Airway

If trauma patient comes in unconscious?

A

Intubate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Airway

If GCS < 8?

A

Intubate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Airway

-If guy stung by a bee, developing stridor and tripod posturing?

A

Intubate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Airway

-If guy stabbed in the neck, GCS = 15, expanding mass inlateral neck?

A

Intubate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Airway

-If guy stabbed in the neck, crackly sounds with palpating anterior neck tissues?

A

Fiberoptic Broncoscope, intubate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Airway

-If huge facial trauma, blood obscures oral and nasal airway and GCS =7?

A

Cricothyroidotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Breathing

You intubated your patient…next best step?

A

Check for bilateral breath sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Breathing

You intubated your patient, listen with stethoscope…. decreased sounds on the left? Why? What do you do?

Next step?

A

Pull back, you have intubated the right mainstem broncus.

Pull back your ET tube.

Chest Xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Patient in traumatic accident with trauma to the chest.

hypertensive, chest hurts, dyspneic, new murmurs

A

Traumatic Aortic Injury - get to OR immediately!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Physical Exam for Pneumothorax… what might we hear?

A

Absent/decreased breathe sounds on side of pneumo

hyperresonance to percussion

JVD and trachea deviated away from the pneumothorax = Tension Pneumo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chest Xray abnormal….

Listen and hear decreased breathe sounds, dull to percussion

A

Hemothorax - Chest tube, let drain

Indication for OR: high output >1.5 liter in chest tube or >200 CC/hr over 1st 4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chest Xray… Rib fractures in a bad car accident after hitting the steering wheel.

“White out” lung

Tx?

A

Pulmonary Contusion

Tx: Pulmonary toilet, control pain from rib fractures, coughing, clearing secretions and taking deep breathes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Chest Trauma: pt has inward mvmt of the right ribcage upon inspiration.

Dx?

Tx?

A

Flail Chest, >3 consecutive rib fractures

O2 and pain control (not opiates - can decrease respiratory drive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Chest Trauma: pt has confusion, petechial rash in chest, axilla and neck and acute SOB.

Dx:

When to suspect it?

A

Fat embolism

after long bone fractures (esp femur)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Chest Trauma: pt dies suddenly after a 3rd year medical student removes a central line.

Dx?

When else to suspect it?

A

Air embolism

Lung trauma, ventilator use, during heart vessel surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cardiovascular

If hypotensive, tachycardiac?

A

Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cardiovascular

If flat neck veins and normal CVP - what type of shock?

A

Hypovolemic/Hemorrhagic Shock - most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cardiovascular

Next step if you have identified your patient is in Hypovolemic/Hemorrhagic Shock?

A

2 large bore peripheral IV - 2L NS or LR over 20 min followed by blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cardiovascular

If muffled <3 sounds, JVD, electrical alternans, pulsus paradoxus?

Confirmatory test?

Treatment?

A

Pericardial tamponade

FAST Scan

Needle decompression, pericardial window or median sternotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cardiovascular

If decreased Breathe Sounds on one side, tracheal deviation AWAY from collapsed lung?

Next best step?

A

Tension pneumothorax

needle decompression**, followed by a chest tube –> DON’T DO A CHEST XRAY!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

FACT: Head Trauma

GCS Max Scoring: 15
GCS Min Scoring: 3

Eyes: 4

Motor: 6

Verbal: 5

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Head Trauma:

Hematoma, edema, tumor can cause increased ICP

Symptoms?

Tx?

Surgical Intervention?

A

HA, projective vomiting, AMS

elevate head of the bed, give Mannitol to relieve pressure (water renal function), hyperventilate to pCO2 28-32

Ventriculostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Neck Trauma

Penetrating trauma - Gunshot wound or stab wound

Zone 3 - boundaries? imaging?

Zone 2 - boundaries? imaging?

Zone 1 - boundaries? imaging?

A

Zone 3: above angle of the mandible; aortography and triple endoscopy (trachea, esophagus)

Zone 2: angle of mandible to level of cricoid; 2D doppler +/- exploratory surgery

Zone 1: below level of cricoid; aortography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Abdominal Trauma

If Gunshot wound to the abdomen? (free air under a diaphragm)

A

DIRECTLY TO OR with Exploratory Laparotomy + Tetanus prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Abdominal Trauma

If stab wound & pt is unstable, with rebound tenderness & rigidity or with evisceration?

A

Ex-lap + tetanus prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Abdominal Trauma

-If stab wound but pt is stable?

A

FAST exam. (intraabdominal bleeding?)
DPL, if FAST is equivocal.
Ex-lap if either are positive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Abdominal Trauma

If blunt abdominal trauma pt with hypotension/tachycardia.

A

OR for ex-lap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Blunt Abdominal Trauma

if unstable?

if stable?

A

unstable: OR + Ex-Lap

stable: abdominal CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Blunt Abdominal Trauma

STABLE PT - what’s injured?

  • if lower rib fx + bleeding into abdomen
  • if lower rib fx + hematuria
  • if Kehr sign (referred pain in left shoulder bc of phrenic nerve) & viscera in thorax on CXR
  • if handlebar sign
  • if epigastric pain, best test?
  • if retroperitoneal fluid is found
A

-if lower rib fx + bleeding into abdomen: Spleen or Liver Laceration

-if lower rib fx + hematuria: Kidney laceration

-if Kehr sign (referred pain in left shoulder bc of phrenic nerve) & viscera in thorax on CXR: Diaphragm rupture

-if handlebar sign: Pancreatic rupture

  • *-if epigastric pain, best test?** Abdominal CT
  • *​-if retroperitoneal fluid is found:** Consider duodenal rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Pelvic Trauma

If hypotensive, tachycardic?

A

FAST and DPL to r/o bleeding in abdominal cavity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Fact: Pelvic Trauma

Can bleed out into pelvis –> stop bleeding by fixing pelvic fracture

Internal Fixation –> if stable

External Fixation –> If not

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Pelvic Trauma

If blood at the urethral meatus and a high riding prostate?

Next best test?

If normal urethrogram? what next test?

What are you looking for?

A

Consider pelvic fracture with urethral or bladder injury.

Retrograde urethrogram (NOT FOLEY!)

Retrograde cystogram to evaluate bladder –> check for extravasation of dye. Take 2 views to ID trigone injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Pelvic Trauma

During a retrogram cystogram to evaluate the bladder, check for extravasation of dye. Taking 2 views to ID trigone injury.

If extraperitoneal extravasation - what Tx?

If intraperitoneal extravasation - wht Tx?

A

Extraperitoneal: Bed rest + Foley (for comfort)

Intraperitoneal: Ex-lap and surgical repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

FACT: Ortho Trauma - Fractures that go to OR

  • Depressed skull fx
  • severely displaced or angulated fx
  • any open fx (sticking out bone needs cleaning)
  • femoral neck or intertrochanteric fx
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Ortho Trauma: Common Fractures

(1) Shoulder pain s/p seizure or electrical shock
(2) Arm outwardly rotated & numbness over deltoid
(3) Old lady falls on outstretched hand, distal radius displaced
(4) Young person falls on outstretched hand, anatomic snuff box tenderness
(5) “I swear I just punched a wall…”

A

(1) Posterior shoulder dislocation
(2) Anterior shoulder dislocation (axillary nerve damage)
(3) Colle’s fracture
(4) Scaphoid fracture - normal 1st Xray –> BEWARE!!

(5) Metacarpal neck fracture (4th or 5th digit) aka “Boxer’s Fracture”.
May need a K Wire.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Ortho Trauma

Clavicle most commonly broken where?

A

Between middle and distal 1/3.
Need a figure 8 device.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Fever on Post-Op Day (POD) #1:

Most common cause of low fever (<101 F) and non-productive cough?

Dx: ?

Tx: ?

A

Atelectasis

CXR - see bilateral lower lobe fluffy infiltrates

Mobilization and incentive spirometry

GET UP AND MOVE OR GET PNEUMONIA AND DIE!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Fever on Post-Op Day (POD) #1:

High Fever (up to 104 F), very ill-appearing

Pattern of spread?

Common Bugs?

Tx?

A

Necrotizing Fasciitis

in subQ along Scarpa’s Fascia

Group-A Beta-Hemolytic Strep (GABHS) or clostridium perfringens

IV PCN, go to OR and debride skin until it bleeds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Fever on Post-Op Day (POD) #1:

High fever (>104 F) with muscle rigidity

Caused by?

Genetic Defect?

Tx?

A

Malignant Hyperthermia

Succinylcoline or Halothane

Ryanodine Receptor gene defect

Dantrolene Na –> Blocks RyR1 receptor and decreases intracellular calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Fever on Post-Op Day (POD) #3-5:

Fever, productive cough, diaphoresis

CXR: shows consolidation

Treatment?

A

Pneumonia

Check sputum sample for culture

Cover with FQN (Moxi) to cover strep pneumo in the mean time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Fever on Post-Op Day (POD) #3-5:

Fever, dysuria, frequency, urgency, paritcularly in a patient with a foley

Next best test?

Tx?

A

UTI

UA and Culture

Abx, change out foley

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Fever POD #7 and beyond

Pain & Tenderness at IV Site?

Tx?

A

Central Line Infection

Do blood cx from the line.
Pull the line.
Abx to cover staph.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Fever POD #7 and beyond

Pain @ incision site, edema, induration but no drainage.

Tx?

A

Cellulitis

Do blood Cx.
Start Abx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Fever POD #7 and beyond

Pain @ incision site, induration WITH drainage.

Tx?

A

Simple Wound Infection

Open wound and repack.
No Abx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Fever POD #7 and beyond

Pain with salmon-colored fluid from incision.

Tx?

A

Dehiscence (violation of the fascia)

Surgical emergency!!
Go to OR, give IV Abx and do primary closure of the fascia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Fever POD #7 and beyond

Unexplained fever?

Dx?

Tx?

A

Abdominal Abscess

CT with oral, IV and rectal contrast to find the abscess.
Diagnostic Lap if needed.

Drain it! Percutaneously, IR-guided or surgically.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Fact: Fever > POD 7 and beyond…

Random causes of Fever

  • Thyrotoxicosis
  • Thrombophlebitis (after ObGyn procedures)
  • Adrenal Insufficiency
  • Lymphangitis
  • Sepsis
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Fact: Pressure Ulcers are caused by impaired blood flow –> Ischemia

Don’t Culture –> cause just get skin flora.
Check CBC and Blood Cultures.
Could be bactermia or osteomyelitis.
Tissue biopsy to r/o Marjolin’s Ulcer –> Squamous Cell Carcinoma
Best prevention is turning pt q2hrs.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Fact: Pressure Ulcers are caused by impaired blood flow –> Ischemia​

Stage 1: Skin intact but red. Blanches with pressure.

Stage 2: Blister or break in the dermis.

Stage 3: SubQ destruction into the muscle.

Stage 4: Involvement of joint or bone.

Tx for Stages 1-2: Mattress with cream on it. No big deal.

Tx for Stages 3-4: Surgery with flap reconstruction. Before surgery, albumen must be >3.5 and bacterial load must be <100K.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Thoracic - Pleural Effusions

see fluid >1 cm on CXR at the costovertebral line in lateral decub position.

What must you do?

A

Thoracentesis, see what kind of fluid you are dealing with.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Thoracic - Pleural Effusions (fluid > 1cm)

If transudative, likely systemic cause…CHF, nephrotic or cirrhotic

If transudative with low pleural glucose?

If transudative with high lymphocytes?

If transudative and bloody?

A

low pleural glucose - Rheumatoid Arthritis

high lymphocytes - TB

bloody - Malignant Cancer or PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Thoracic - Pleural Effusions (fluid > 1cm)

If exudative – likely ??

If complicated (+ gram or cx, pH <7.2, glucose low (Cause cancer cells or bugs eating it)) – Tx?

Light’s Criteria - transudative if….

A

exudative: parapneumonic, cancer, etc.

complicated: insert chest tube for drainage

If LDH < 200
LDH effusion/serum <0.6
Protein effusion/serum <0.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Spontaneous Pneumothorax can happen in emphysema pts or in young, healthy, tall, thin men.

Subpleural Bleb ruptures –> Lung collapses.

Symptoms/Signs: ??

Dx: ??

Tx: ??

Indications for surgery: ??
Do what: ??

A

S/S: sudden dyspnea (or asthma or COPD-emphysema)

Dx: CSR

Tx: Chest Tube placement

Indications for Surg: Ipsi or contralateral REcurrence, bilateral, incomplete lung expansion, occupations (pilot, scuba), live in remote areas

Surg: VATS, pleurodesis (bleo, iodine or talc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Lung Abscess usually 2/2 aspiration (drunk, elderly, enteral feeds) seen on CXR.

-most often in posterior _______ or _________ lower lobes

Tx: initially with Abx (not drainage)–> give ____ or ______

Indications for Surgical drainage: ??

A

upper or superior lower lobes

give IV PCN or Clindamycin

Indications: abx fail, abscess >6 cm, emphysema present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Work up of a Solitary Lung Nodule

1st Step: ??

A

Find an old CXR to compare!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Characteristics of a Solitary Benign Lung Nodule:

Popcorn calcification: ??

Concentric calcification: ??

Pt <40 yo, <3 cm, well-circumscribed: ??

Tx: ??

A

Popcorn calcification: Hamartoma (MOST COMMON)

Concentric calcification: old granuloma (old TB)

Pt <40 yo, <3 cm, well-circumscribed: close follow-up, not a big deal

Tx: CXR or CT scans q2mo to look for growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Characteristics of a Solitary Malignant Lung Nodule:

-If pt has risk factors (smoker, old), >3cm, if calcifications

Tx: ??

A
  • *Remove the nodule**
  • with broncoscopy if central
  • open lung biopsy if peripheral
58
Q

Diagnosis?

Pt presents with weight loss, cough, dyspnea, hemoptysis, repeated pneumonia (same side) or lung collapse.

A

Lung Cancer

59
Q

Lung Cancer - Pt presents with weight loss, cough, dyspnea, hemoptysis, repeated pneumonia or lung collapse.

Most common cancer in non-smokers?

Location and mets?

Characteristics of effusion?

A

Adenocarcinoma, can occur in scar tissue of old pneumonia

Peripheral cancer, mets to liver, bone and brain and adrenals

Exudative effusion with high hyaluronidase

60
Q

Lung Cancer - Pt presents with weight loss, cough, dyspnea, hemoptysis, repeated pneumonia or lung collapse.

Patient with kidney stones, constipation and malaise.
Low PTH + Central lung mass?

A

Squamous Cell Carcinoma

Paraneoplastic syndrome (it makes a parathyroid hormone) 2/2 secretion of PTH-rP = Low PO4 and High Ca++ (hypercalcemia)

61
Q

Lung Cancer - Pt presents with weight loss, cough, dyspnea, hemoptysis, repeated pneumonia or lung collapse.

Patient with shoulder pain, ptosis, constricted pupil and facial edema?

A

(Pancoast Tumor) Superior Sulcus Syndrome from small cell carcinoma.

a Central Cancer.

62
Q

Lung Cancer - Pt presents with weight loss, cough, dyspnea, hemoptysis, repeated pneumonia or lung collapse.

Patient with ptosis better after 1 minute of upward gaze?

A

Lambert Eaton Syndrome (paraneoplastic syndrome) from small cell carcinoma.

Antibodies to pre-synaptic Ca++ channel.

63
Q

Lung Cancer - Pt presents with weight loss, cough, dyspnea, hemoptysis, repeated pneumonia or lung collapse.

Old smoker presenting w/Na = 125, moist mucus membranes, no JVD?

A

SIADH (paraneoplastic syndrome) from small cell carcinoma.

Produces Euvolemic hyponatremia.

Tx: Fluid restriction +/- 3% saline in <112.

64
Q

Lung Cancer - Pt presents with weight loss, cough, dyspnea, hemoptysis, repeated pneumonia or lung collapse.

CXR showing peripheral cavitation and CT showing distant mets?

A

Large Cell Carcincoma

65
Q

4 Types of Lung Cancers?

Peripheral:
1.
2.

Central:
3.
4.

A
  • *Peripheral:**
    1. Adenocarcinoma
    2. Large Cell Carcinoma

Central:
3. Small Cell Carcinoma
​4. Squamous Cell Carcinoma

66
Q

What type of lung cancers can we operate on?

A

Non-Small Cell Cancers (Adenocarcinoma, Squamous Cell Carcinoma and Large Cell Carcinoma)

67
Q

ARDS (Acute Respiratory Distress Syndrome)

Pathophys: inflammation –> impaired gas exchange, inflammatory mediator release, hypoxemia

Etiology: gram neg sepsis, gastric aspiration, trauma, low perfusion, pancreatitis

Dx: ??
1.
2.
3.

Tx: ??

A
  • *Dx:**
    1. CXR - bilateral fluffy alveolar infiltrates (lung infiltrates and edema)
    2. PAO2/Fi02 < 200 (<300 means acute lung injury) = hypoxia
    3. PCWP (wedge pressure) < 18 (means pulmonary edema is non-cardio - lungs screwed up, not heart)

Tx: PEEP

68
Q

Murmur Buzzwords:

  • cresc/descrend Systolic Ejection Murmur
  • louder with squatting
  • softer with valsalva (decreases preload)
  • *-parvus et tardus**
A

Aortic Stenosis

69
Q

Murmur Buzzwords:

  • louder with valsalva (decreases preload) Systolic Ejection Murmur
  • softer with squatting or handgrip
  • little kid or tennager on pre-sports physical
A

Hypertrophic Obstructive Cardiomyopathy (HOCM)

70
Q

Murmur Buzzwords:

  • Late Systolic Ejection Murmur with CLICK
  • softer with squatting
  • louder with valsalva (decreases preload) and handgrip
A

Mitral Valve Prolapse (MVP)

71
Q

Murmur Buzzwords:

Holosystolic murmur radiates to axilla w/Left atrial enlargement

A

Mitral Regurgitation

72
Q

Murmur Buzzwords:

-Holosystolic murmur with late diastolic rumble in kids

A

Ventricular Septal Defect (VSD)

73
Q

Murmur Buzzwords:

-Continuous machine like murmur

A

PDA - Patent Ductus Arteriosus

74
Q

Murmur Buzzwords:

-Wide fixed and split S2

A

ASD - Atrial Septic Defect

75
Q

Murmur Buzzwords:

-rumbling diastolic murmur with an opening snap, left atrial enlargement and A-fib

A

Mitral Stenosis

76
Q

Murmur buzzwords:

Blowing diastolic murmur with widerned pulse pressure and eponym parade

A

Aortic Regurgitation

77
Q

Murmur Buzzwords: louder with inspiration - left or right-heart?

A

Right-sided heart issues

78
Q

Esophagus

Diagnosis: Pt with bad breathe and snacks in esophagus in the AM?

True or False diverticulum?

Tx: ?

A

Zenker’s Diverticulum

False Diverticulum - only contains mucosa

Tx: surgery

79
Q

Esophagus

Diagnosis: dysphagia to liquids & solids.

Barium Swallow: Bird’s Beak

Tx: ?

It’s associated with __________ and ___________ cancer.

A

Achalasia

Tx: CCB, nitrates, botox or heller myotomy

Chagas, esophageal cancer

80
Q

Esophagus

Diagnosis: Dysphagia worse with hot & cold liquids + chest pain that feels like MI with NO regurgitation.

Barium Swallow: spasming esophagus

Tx: ??

A

Diffuse esophageal spasms

Tx: CCB or nitrates

81
Q

Esophagus

Diagnosis: Epigastric pain worse after eating or when laying down. Silent aspirations: chronic dry cough, wheeze hoarseness.

Most sensitive test: ?

When do you do an endoscopy: ?

Tx before surgery: ?

Indications for surgery?

A

GERD

24 hour pH monitoring (manometry)

Endoscopy if “danger signs’ present

Tx with behavioral modifications and then antacids, H2 blockers, PPI’s

Surgery: bleeding, stricture, Barrett’s, incompentent LES, max dose PPI with still symptoms or doesn’t want meds.

82
Q

Esophagus

Diagnosis: If hematemesis (blood occurs after vomiting with subQ emphysema - transmural tear). Can see pleural effusion with increased Amylase.

Next Best test?

Tx?

A

Boerhaave’s Esophageal Rupture

CXR, gastrograffin esophagram, NO endoscopy

Surgical Repair, if full thickness

83
Q

Esophagus

Diagnosis: gross hematemesis, unprovoked in a cirrhotic patient with portal HTN.

Tx of choice?

A

Gastric Varices

Tx: Endoscopic sclerotherapy or banding

**DON’T Prophylactically band asymptomatic varices. Give BB**

84
Q

Esophagus

With Gastric varices, if in hypovolemic shock… what tx?

A

Resuscitation with ABCs, NG lavage, medical tx with Octreotide or SS.

Balloon tamponade ONLY if need to stabilize for transport.

85
Q

Esophagus

Diagnosis: Progressive dysphagia with weight loss?

Smokers/drinkers in middle 1/3 of esophagus?

Ppl with long standing GERD in the distal 1/3 of esophagus?

Best first test: ?

A

Esophageal Carcinoma

Squamous cell (middle 1/3)

Adenocarcinoma (distal 1/3)

Barium Swallow, then endoscopy with biopsy, then staging CT

86
Q

Stomach

Acid reflux pain after eating, when laying down (not GERD)

Type 1: GE jxn herniates into thorax. Worse for GERD. Tx -> symptoms.

Type 2: Abdominal pain, obstruction, strangulation. Tx -> surgery

A

Hiatal Hernia

Type 1: Sliding

Type 2: Paraesophageal

87
Q

Stomach

Mid-epigastric pain worse with eating. H pylori, NSAIDS, steroids.

Work up: ?

Surgery if: ?

A

Gastric Ulcers

Work up: double-contrast barium swallow - punched out lesion with regular margins. EGD with biopsy can tell H. Pylori, malignant, benign.

Surgery if: Lesion persists after 12 weeks of treatment.

88
Q

Stomach: Gastric Cancer

Most common, esp in Japan: ?

Krukenberg Tumor: ?

Virchow’s Node: ?

Lymphoma: ?

Blummer’s Shelf: ?

Sister Mary Joseph: ?

MALT-lymphoma: ?

A

Most common, esp in Japan: Adenocarcinoma

Krukenberg Tumor: Gastric Cancer –> Ovaries

Virchow’s Node: L Supraclavicular fossa

Lymphoma: HIV

Blummer’s Shelf: Mets felt on DRE

Sister Mary Joseph: Umbilical node

MALT-lymphoma: H. Pylori (only cancer that can be treated with antibiotics)

89
Q

Fact

Stomach: Randoms

Mentriers: protein losing enteropathy (foamy pee), enlarged rugae

Gastric Varices: splenic vein thrombosis

Dieulafoy’s: vessel erodes in to the stomach and can have hematemesis

A
90
Q

Duodenum

  • mid-epigastric pain better with eating
  • 95% associated with H. Pylori
  • Healthy pts <45 yo cna do trial of H2 Blockers or PPI
A

Duodenal Ulcers

91
Q

Duodenal Ulcers

What is the best test for diagnosis?

Tx?

A

Best Test: CLO test - endoscopy with biopsy b/c it can also exclude cancer

Blood, stool or breath test can be used for H. Pylori specifically

Tx: TRIPLE THERAPY –> PPI, clarithromycin & amoxicillin for 2 weeks. Breath or stool test can be done to test for cure.

92
Q

Duodenum

-Mid-epigastric pain/ulcers that don’t resolve with medical therapy?

A

ZE Syndrome

93
Q

Best Test for ZE Syndrome?

Tx?

What else to look for if diagnosed?

A

Best Test: Secretin Stimulator Test (find inappropriate high gastrin; gastrin should be suppressed)

Tx: Surgical Resection of pancreatic/duodenal tumor

Else to look for: Syndrome pancreatic tumor is associated with… Pituitary and Parathyroid problems.

94
Q

Duodenum

  • patient has bilious vomiting and post-prandial pain.
  • recently lsot 200 lbs on “Biggest Loser”

Pathophys of this condition: ?

Tx: ?

A

SMA Syndrome bc 3rd part of duodenum is compressed in area between aorta and SMA (Superior mesenteric artery)

Tx: restoring weight/nutrition; last resort: Roux-en-Y

95
Q

Exocrine Pancreas

-Mid-epigastric pain radiating through to the back

A

Acute Pancreatitis

96
Q

Pancreatitis

Most common causes: ?

How to Dx: ? Best Imaging: ?

Tx: ?

Bad Prognostic Factors - What criteria?

Complications: ?

A

Common Causes: Gallstones & ETOH

Dx: Increased amylase & Lipase
Best Imaging: CT

Bad Prognostic Factors: Ranson’s Criteria

Complications: Pseudocyst (no cells!), Pancreatic ascites, Hemorrhage, Respiratory Failure (ARDS), Abscess/Necrosis, Splenic Vein thrombosis, GI Obstruction

97
Q

Chronic Pancreatitis: Chronic mid-epigastric pain, DM, Malabsorption symptoms (Steatorrhea)

Can cause splenic vein thrombosis –> which leads to …. ?

A

Gastric varices

98
Q

Pancreatic Adenocarcinoma: Usually don’t have sxs until advanced.

If in head of pancreas –> may have palpable (large), non-tender GB with itching and jaundice called _____________ sign.

Migratory Thrombophlebitis called ___________ sign.

Dx with Endoscopic US and FNA Biopsy

Tx w/Whipple if: ___________________

A

Courvoisier’s Sign

Trousseau’s Sign

Tx with Whipple if: no mets outside abdomen, no extension into SMA or portal vein, no liver mets, no peritoneal mets.

99
Q

Endocrine Pancreas - Insulinoma

Whipple’s Triad: what is it?

Labs: ?

A
  • *Whipple’s Triad:**
    (1) sxs (sweat, tremors, hunger, seizures)
    (2) Blood glucose <45
    (3) sxs resolve with glucose admin
  • *Labs:**
  • Inc. Pro-Insulin
  • Inc. C-peptide
  • Inc. Insulin

*If faking, the C-peptide and Pro-insulin would be low.

100
Q

Endocrine Pancreas: Glucagonoma

Sxs: ?

Characteristic rash is called: ?

A

Sxs: hyperglycemia, diarrhea, weight-loss

Necrolytic migratory erythema

101
Q

Fact.

Endocrine Pancreas - Somatostatinoma

  • Commonly malignant
  • An extremely rare tumor that occurs in the pancreas or part of the small intestine
  • Sxs: Malabsorption, steatorrhea, ect from exocrine pancreas malfunction
A
102
Q

Endocrine Pancreas: VIPoma

Sxs: ? (looks similar to Carcinoid Syndrome)

Tx: ?

A

Watery diarrhea, Hypokalemia, dehydration, flushing

Tx: Octreotide

103
Q

Gallbladder

Diagnosis: RUQ Pain –> radiating to back/shoulder, N/V, fever, worse s/p fatty foods

Best 1st Test: ?

Tx: ?

A

Acute Cholecystitis

U/S

Cholecystectomy; Perc Cholecystomstomy, if unstable

104
Q

Gallbladder

Diagnosis: RUQ Pain, high bili and alk-phos

Dx: ?

Tx: ?

A

Choledocolithiasis

U/S shows common bile duct stone

Chole +/- ERCP to remove the stone

105
Q

Gallbladder

Diagnosis: RUQ Pain, fever, jaundice, dec BP, AMS

Tx: ?

A

Ascending Cholangitis

Tx: Fluids and broad-spectrum Abx and ERCP to remove stone

106
Q

Gallbladder: Choledochal Cysts

Type 1:?

Type 4:?

A

Type 1: Fusiform dilation of Common Bile Duct –> tx with excision

Type 4: Caroli’s Disease - cysts in intrahepatic ducts –> needs liver transplant

107
Q

Gallbladder: Cholangiocarcinoma - rare

Risk Factors: ?

A

Primary Sclerosing cholangitis (UC), liver flukes and thorothrast exposure.

Tx: surgery +/- radiation

108
Q

Liver: Hepatitis causes…

AST = 2x ALT –> ___________

ALT > AST (both high 1000s) –> ____________

ALT & AST high s/p hemorrhage, surg or sepsis –> ___________

A

Alcoholic heptatitis (reversible)

Viral hepatitis

Shock Liver

109
Q

Liver: Cirrhosis & Portal HTN

Tx: Somatostatin and Vasopressin vasoconstrict to decrease portal pressure
B Blockers also decrease portal pressure

*Don’t need to treat esophageal varices prophyactically, but band/burn them once they bleed.

TIPS procedure relieves portal HTN but…. what complication? tx?

A

worsens Hepatitic Encephalopathy bc promotes clearance of ammonia resulting in higher ammonia levels

Tx: Lactulose (poop out the ammonia)

110
Q

Liver: Hepatocellular Carcinoma

Risk Factors: ??

Tumor Marker: ??

Dx (Imaging): ?

Tx: can surgically remove solitary mass
use radiation or cryoablation for pallation of multiple masses

A

RF: Chronic Hep B Carrier, Hep C Carrier, Cirrhosis for any reason, aflatoxin or carbon tetrachloride

Tumor Marker: AFP (in 70%)

Dx: CT/MRI

111
Q

Liver:

  • *-women on OCP (estrogen helps it grow)**
  • palpable abdominal mass or spontaneous rupture –> Hemorrhagic shock
A

Hepatic Adenoma

Dx: U/S or MRI

Tx: Stop the OCPs.
Resect if large or pregnancy is desired.

112
Q

Liver

  • *-2nd Most Common benign liver tumor**
  • *-women** > men
  • less likely to rupture
  • no Tx needed
A

Focal Nodular Hyperplasia

113
Q

Liver: Bacterial Abscess

3 Most common bugs: ??

Tx: ??

A

3 Bugs: E. Coli, Bacteriodes, Enterococcus

tx: surgical drainage and IV abx

114
Q

Liver

RUQ pain, profuse sweatings and rigors, palbable liver?

Tx: ?

A

Entamoeba Histolytic

Tx: Metronidazole - DON’T drain it

115
Q

Liver

Pt from Mexico presents w/RUQ and large liver cysts found on U/S?

Mode of transmission?

Lab findings?

Tx?

A

Enchinococcus

Mode of transmission: Hydatic cyst paracyte from dog feces

Lab: Eosinophilia, +Casoni skin test (from IgE in skin from eosinophils)

Tx: Albendazole and surgery to remove ENTIRE cyst
Ruptured cyst –> Anaphylaxis, even death

116
Q

What 2 abscesses in the body are NOT treated by drainage?

1.

2.

A
  1. Lung Abscess
  2. Entamoeba histolytic Liver abscess
117
Q

Fact - Spleen: Post-Splenectomy check platelets

  • if Post-op thrombocytosis >1 mil –> give Aspirin to prevent clots
  • give Prophylactic PCN bc of spleen’s role in immune functions
  • 3 Vaccines to give: S. Pneumo, H. Flu and N. Meningitidis vaccines
A
118
Q

Fact - Spleen: ITP

  • consider in isolated thrombocytopenia (bleeding gums, petechiae, nosebleeds)
  • Decreased platelet count, increased megakaryocytes in bone marrow
  • NO splenomegaly

-Tx: 1st - Steroids
Relapse - splenectomy

A
119
Q

Fact - Spleen: Hereditary Spherocytosis

Sxs: hemolytic anemia (jaundice, increased indirect bilirubin, LDH, decr haptoglobin, elevated retic count) + spherocytes on smear + osmotic fragility test

-prone to gallstones

Tx: Splenectomy (accessory spleen too)

A
120
Q

Fact - Spleen: Traumatic Splenic Rupture

consider with Lower rib fractures and intra-abdominal hemorrhage

-Kehr’s Sign (Irritates L Diaphragm resulting in Left shoulder pain)

A
121
Q

Appendix

pain starts in peri-umbilical area –> sharp RLQ pain, N/V

When surgery: ?

If perforated/abscess: ?

A

Appendicitis

when: clinical picture is convincing, not imaging necessary but typically CT scan done

perf/abscess: drain, abx (to cover E. Coli & Bacteriodes) and do interval appendectomy

122
Q

1 Site for a Carcinoid Tumor: ??

A

Appendix

123
Q

1 site

Appendix: Carcinoid Tumor

  • Carcinoid Syndrome sxs: ??
  • When does it happen:??
  • What else to look out for: ??
  • If >2cm, @ base of appendix or with + nodes: ??

Otherwise: appendectomy is good enough

A

Sxs: Diarrhea, Wheezing, Flushing

When: mets to liver (1st pass metabolism)

What else: Diarrhea, Dementia, Dermatitis (NIACIN DEFICIENCY)
Note: Serotonin and Niacin both made from Tryptophan so if all of it is going to make Serotonin –> Niacin will be low.

If >2cm: Hemicolectomy

124
Q

Bowel Obstruction: Small Bowel Obstruction

  • Suspect in hernia, prior GI surgery (Adhesions), Cancer, Intussusception, IBD
  • Sxs: pain, constipation, obstipation, vomiting

-FIRST TEST: ??
CT can show point of obstruction.

-Tx: IVF, NG Tube

-When surgery: ??

A

First test: Upright CXR to look for free air

Do surgery if peritoneal signs, increased WBC, no improvement within 48 hours

125
Q

Fact:

Bowel Obstruction: Volvulus - either cecal or sigmoid

-Decompression from below if not strangulated. Otherwise, need surgical removal and colostomy.

A
126
Q

Bowel Obstruction: Post-Op Ileus (general stasis of bowel)

-consider if hypoKalemic (make sure to replete), opiates

What will you see on an flat/upright KUB?

-Do surgery for perforation.

Give what medicine?

A

Dilated loops of small bowel with air-fluid levels

Lactulose/erythromycin

127
Q

Bowel Obstruction: Ogilvie’s Syndrome

  • massive colonic distension
  • If >10cm, need _____________ (procedure) and ___________ (watch for bradycardia) or colonscopic decompression.
A

decompression with NG Tube and Neostigmine

128
Q
A
129
Q
A
130
Q
A
131
Q
A
132
Q
A
133
Q
A
134
Q
A
135
Q
A
136
Q
A
137
Q
A
138
Q
A
139
Q
A
140
Q
A
141
Q
A

Surgery Clerkship Final (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions