General Sugery Flashcards
(122 cards)
0
Q
Tx for GERD that cannot be controlled by medical means or presence of ulcers, stenosis
A
Laparoscopic Nissen fundoplication
1
Q
Dx of GERD
A
pH monitoring and correlation with symptoms
2
Q
Dysphagia of liquids but not solids
A
Achalasia
3
Q
Definitive dx of dysphagia
A
Manometry
4
Q
Tx of achalasia
A
Balloon dilatation by endoscopy
5
Q
Progressive dysphagia
Weight loss
Hx smoking drinking or GERD
A
Esophageal cancer
6
Q
Type of esophageal cancer in smokers and drinkers
A
Squamous cell
7
Q
Type of esophageal cancer in GERD
A
Adenocarcinoma
8
Q
Dx for esophageal cancer
A
Barium swallow, endoscopy and biopsy
9
Q
Tx of Mallory-Weiss tear
A
Endoscopy and photocoagulation
10
Q
Tx of Boerhaave syndrome (prolonged forceful vomiting leading to esophageal perforation)
A
Contrast swallow
Emergency surgical repair
11
Q
Wrenching epigastric pain
Fever, leukocytosis
Subcutaneous emphysema in neck
A
Perforation of esophagus
Most commonly by endoscopy
12
Q
Elderly
Anorexia, weight loss, epigastric discomfort, early satiety
A
Gastric cancer
13
Q
Dx and tx for gastric adenocarcinoma
A
Endoscopy and biopsy, CT
Surgery
14
Q
Tx of gastric lymphoma
A
Chemotherapy, radiotherapy
Surgery if perforation
15
Q
Tx of MALToma
A
Eradicate H. pylori
16
Q
Signs of small bowel obstruction
A
Progressive distention
No gas or feces
High pitched bowel sounds coinciding with colicky pain
17
Q
Tx of small bowel obstruction
A
NPO, NG suction, IV fluids
Surgery if strangulated or after several days without spontaneous resolution
18
Q
Tx for incarcerated hernia
A
If irreducible and strangulated, emergent surgery
If reducible then elective surgery
19
Q
Diarrhea, facial flushing, wheezing, right sided heart valve damage, prominent jugular venous pulse
A
Carcinoid syndrome
Result of liver mets
20
Q
Dx of carcinoid syndrome
A
24 hour urine collection for 5-hydroxyindoleacetic acid
21
Q
Elderly person with anemia and 4+ occult blood
A
Right sided colon cancer
22
Q
Dx and tx for cancer of right colon
A
Colonoscopy and biopsy
Right hemicolectomy
23
Q
Bloody bowel movements
Narrow caliber
A
Left sided colon cancer
24
Dx of cancer of left colon
Flexible proctosigmoidoscopy and biopsy
Full colonoscopy
CT for operability and extent
25
Initial tx of large rectal cancers
Chemotherapy, radiotherapy
26
Familial polyposis
Familial multiple inflammatory
Villous adenoma
Adenomatous polyp
Premalignant polyps
27
Juvenile polyp
Peutz-Jeghers
Isolated inflammatory polyp
Hyperplastic polyp
Benign polyps
28
Surgical indications for ulcerative colitis
```
Disease >20 yrs
Poor nutritional status
Multiple hospitalizations
Need for high dose steroids, immune suppressants
Toxic megacolon
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29
Surgical tx of ulcerative colitis
Removal of affected colon and all rectal mucosa
30
Abdominal pain, fever, leukocytosis
Epigastric tenderness, massively distended transverse colon
Gas within wall of colon
Toxic megacolon
31
Etiology of pseudomembranous colitis
Cephalosporins most commonly
Clindamycin
Any antibiotic
32
Tx of pseudomembranous colitis
Metronidazole
Or vancomycin
Emergency colectomy if unresponsive and WBC >50k
33
Difference between internal and external hemorrhoids
Internal bleed. Only painful if prolapsed. Tx with ligation
| External are painful. May need surgery
34
Blood streaked stool
Fear of pain causes avoidance of bowel movement and constipation
Young women
Anal fissure
35
Common location and tx of anal fissure
Posterior midline
Calcium channel blocker ointment
Botox
Lateral internal sphincterotomy
36
Unhealing fissure, fistula or ulcer in the anal area
Crohn's disease
37
Tx for Crohn's disease fistula
Drainage with setons
| Remicade
38
Perirectal pain, unable to sit or have bowel movement
| Inflammation lateral to anus
Ischiorectal abscess
| Tx is I&D
39
Hx ischiorectal abscess with drainage
| Fecal soiling
Fistula in ano
R/o draining tumor
40
Homosexual
Fungating mass grows out of anus
Inguinal nodes felt
Tx?
Squamous cell carcinoma of anus
Chemoradiation then surgery which is rarely required
41
Most common sites of GI bleeding
Upper GI between nose and ligament of Treitz
Look in nose and mouth, endoscopy indicated
42
Causes of lower GI bleeding
In elderly
| Angiodysplasia, polyps, diverticulosis, cancer, hemorrhoids
44
Dx of cause of vomiting blood or melena
Upper GI endoscopy
45
Where may red blood per rectum arise
| How do you dx where
Anywhere, upper or lower
| Pass NG tube, if you get normal bile without blood then assume lower. If blood or no bile, do endoscopy
46
Dx of location of active lower GI bleed
1. Anoscopy (r/o hemorrhoids)
2. Angiogram if bleeding >2 mL/min
Wait for hemostasis then colonoscopy if <0.5 mL/min
Tagged red-cell study 0.5-2 mL/min
Capsule endoscopy being used more frequently
47
Dx of location of blood per rectum w/o active bleeding
| Young and elderly
Young: upper GI endoscopy
Old: upper and lower GI endoscopy
48
Blood per rectum in peds pt
| Dx?
Meckel diverticulum
| Technetium scan
49
Tx for massive upper GI bleed/stress ulcer
Angiographic embolization
50
Sudden onset, constant, severe, generalized abdominal pain
| generalized signs of peritoneal irritation
Perforation
51
Dx of perforation
Most common cause?
Tx?
Free-air under diaphragm on upright X-ray
Perforated peptic ulcer most common
Emergency surgery required
52
Sudden onset, colicky pain with localization and radiation
| Pt moves constantly seeking position of comfort
Obstruction
i.e. ureter, cystic duct, etc
53
Gradual onset, starts ill-defined then localizes
typical radiation patterns
localized signs of peritoneal irritation
Inflammatory process
Fever, leukocytosis common (except pancreatitis)
54
Severe abdominal pain
| Blood in gut lumen
Ischemia
55
```
Child: ascites, nephrosis
Adult: ascites
Mild generalized acute abdomen
Possible fever, leukocytosis
Dx? Tx?
```
Primary peritonitis
Dx by ascitic culture
Tx with antibiotics
56
What needs to be ruled out before exploratory laparotomy on generalized acute abdomen (6)
MI, pneumonia, PE
| Primary peritonitis, pancreatitis, nephrolithiasis
57
Alcoholic
acute upper abdomen with constant pain radiating to back
nausea, vomiting, retching
Dx? Tx?
Acute pancreatitis
Dx by serum (1-2 d) or urinary (3-6 d) amylase, lipase
Tx by NPO, NG suction, IV fluids
58
LLQ abdominal pain
fever, leukocytosis, peritoneal irritation
Dx? Tx?
Acute diverticulitis
Dx by CT
NPO, IV fluids, antibiotics
Percutaneous drainage if abscess, surgical resection if 2 or more attacks
59
Elderly, signs of obstruction
distended colon
huge air filled loop in RUQ that tapers down to LLQ in the shape of a "parrot's beak"
Dx? Tx?
Sigmoid volvulus
Xray
Tx by rigid proctosigmoidoscopy and rectal tube
Recurrence warrants elective sigmoid resection
60
Acute abdomen predominantly in elderly
Associated A-fib or recent MI
Signs of acidosis, sepsis, blood in gut lumen
Mesenteric ischemia
If caught early, try arteriogram and embolectomy
61
Cirrhosis
Vague RUQ discomfort, weight loss
Tx?
Primary hepatocellular carcinoma
| Resection if possible
62
Blood marker for hepatocellular carcinoma
AFP
63
Most common liver tumor
Metastasis
64
Hepatic lesion caused by birth control pills
Hepatic adenoma
| May rupture and bleed requiring emergency surgery
65
Fever, leukocytosis, liver tenderness
hx acute ascending cholangitis
Dx? Tx?
Pyogenic liver abscess
Ultrasound or CT
Percutaneous drainage
66
Immigrant
fever, leukocytosis, liver tenderness
Tx?
Amebic abscess of liver
| Metronidazole or drainage
67
Unconjugated hyperbilirubinemia
| Normal conjugated
Hemolytic jaundice
68
Elevated conjugated and unconjugated bilirubin
Elevated liver enzymes
modestly elevated alk phos
Dx?
Hepatocellular jaundice
Most commonly hepatitis
dx by serology
69
Elevated conjugated and unconjugated bilirubin
modestly elevated liver enzymes
very high all phos level
Dx?
Obstructive jaundice
most commonly by gallstones
dx by ultrasound
70
Next steps after obstructive jaundice from stones is confirmed
ERCP
sphincterotomy to remove stone
cholecystectomy
71
Tumors that could cause obstructive jaundice (3)
adenocarcinoma of head of pancreas
adenocarcinoma of ampulla of Vater
cholangiocarcinoma of common bile duct
72
Workup of obstructive jaundice without stones
CT, percutaneous biopsy if tumor suspected
| if CT negative, ERCP and biopsy
73
Obstructive jaundice
anemia
positive blood in stools
dx?
Ampullary cancer
dx by endoscopy
(may not be seen on CT as they can obstruct while still being very small)
74
Colicky RUQ pain
self-limited up to 30 minutes
triggered by fatty foods, associated nausea, vomiting
no peritoneal irritation
Biliary colic
Elective cholecystectomy if stones confirmed
75
RUQ pain with signs of peritoneal irritation
fever, leukocytosis
Dx? Tx?
Acute cholecystitis
ultrasound or HIDA scan
NPO, NG suction, IV fluids, antibiotics
elective cholecystectomy
76
What is Tx for acute cholecystitis when patient is poor surgical candidate
Transhepatic cholecystostomy
77
High spiking fevers, very high leukocytosis
Very high alk phos
Tx?
Acute ascending cholangitis
IV antibiotics
Emergency decompression of common duct via ERCP
Eventual cholecystectomy
78
Causes of acute pancreatitis (2)
Alcohol, gallstones
79
What is pancreatic rest
Tx for pancreatitis which includes
| NPO, NG suction, IV fluids
80
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Epigastric midabdominal pain radiating to back
nausea, vomiting, retching
elevated amylase, lipase
elevated hematocrit
Tx?
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Acute edematous pancreatitis
| Tx is pancreatic rest
81
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Epigastric midabdominal pain radiating to back
nausea, vomiting, retching
elevated amylase, lipase
decreased hematocrit
Tx?
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Acute hemorrhagic pancreatitis
Tx is ICU admission, drainage of pancreatic abscesses, daily CT scans
Poor prognosis
82
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Elevated WBC count
Elevated blood glucose
Low serum calcium
Low, decreasing hematocrit
Increased BUN
Decreased PO2
```
Ranson's criteria for pancreatitis
83
Tx for necrotic pancreas
| How long do you wait
Necrosectomy
| Wait 4 weeks before debridement
84
Signs of suppurative pancreatitis
| When does it become evident
Persistent fever, leukocytosis
10 days after pancreatitis begins
Abscess on CT
85
Etiology of pancreatic pseudocyst
| Where does pancreatic juice collect?
5 weeks after acute pancreatitis or pancreatic trauma
| Juice collects in lesser sac
86
What are options for drainage of >6cm pseudocyst
Percutaneous
Surgically into GI tract
Endoscopically into the stomach
87
Symptoms of chronic pancreatitis
Calcified pancreas, steatorrhea, diabetes, constant epigastric pain
88
Tx of chronic pancreatitis
Insulin- diabetes
Pancreatic enzymes- steatorrhea
Pain- unresponsive to most therapies
ERCP and stenting if pancreatic duct is obstructed
89
Which hernias do not require surgery
Umbilical hernias in ages 2 to 5
| Sliding hiatal hernias (not true hernias)
90
Gold standard for breast cancer diagnosis
Mammographically or sonographically guided multiple core biopsies
Need tissue to diagnose breast ca
91
Young woman
mobile, firm, rubbery breast mass
Dx, Tx?
Fibroadenoma
FNA or sonogram
Removal optional
92
Rapidly growing breast tumor in very young adolescents
Giant juvenile fibroadenomas
93
Late 20's
Grow to be very large over years distorting breast
Dont invade or become fixed
Benign but can become malignant
Cystosarcoma phyllodes
Core or incisional biopsy is necessary
94
30's-40's
Bilateral breast tenderness related to menstrual cycle
Multiple lumps that come and go
Fibrocystic disease (mammary dysplasia)
95
If cystic mass is drained in suspected fibrocystic disease what is next step if
Clear fluid, cyst goes away
Cyst persists
Blood is aspirated
Goes away- nothing
Persists- biopsy
Blood- sent for cytology
96
20's-40's
Bloody nipple discharge
Dx? Tx?
Intraductal papilloma
Galactogram
Surgical resection
97
Tx for breast abscess
I&D, biopsy of abscess wall
| Cancer until proven otherwise
98
Approach to breast cancer during pregnancy
Same if non-pregnant except
no radiotherapy
no chemotherapy during first trimester
99
Tx of resectable breast cancer
lumpectomy, axillary sampling, plus radiation
or
modified radical mastectomy with axillary sampling
100
Tx after breast surgery with positive nodes
Chemotherapy
Hormonal therapy
(Premenopause- tamoxifen, post- anastrozole)
101
Headache, tender back pain
hx breast cancer
Dx?
Metastases
| MRI
102
Work-up for thyroid nodules
| If benign? If malignant?
FNA
benign- follow
malignant- thyroid lobectomy
103
Which thyroid cancer requires total thyroidectomy
| Why?
Follicular cancers
| So radioactive iodine can be used for mets
104
Thyroid nodule in hyperthyroidism
| What test? Tx?
Nuclear scan
if hot adenoma- surgical excision
if nothing found- radioactive iodine
105
Workup for suspected hyperparathyroidism
repeat Ca2+, look for low phos, r/o cancer with bone mets
check PTH
sestamibi scan may locate culprit gland
106
Tx for hyperparathyroidism
Surgical excision of culprit gland
107
Workup for Cushing's disease
Overnight low-dose dexamethasone suppression test
If no suppression- 24 hour urine cortisol
If elevated- high-dose dexamethasone suppression test
If suppressed- pituitary adenoma
If unsuppressed- adrenal adenoma
108
Extensive peptic ulcers
resistant to usual therapies
watery diarrhea
dx? tx?
```
Zollinger-Ellison (gastrinoma)
measure gastrin, secretin
CT scan to locate tumor
Surgical resection of tumor
Omeprazole for symptoms if mets present
```
109
Dx and Tx of insulinoma
Measure insulin, c-peptide (both high)
| CT to locate tumor and then resection
110
Hypersecretion of insulin in the newborn requiring 95% pancreatectomy
Nesidioblastosis
111
Severe migratory necrolytic dermatitis
mild diabetes
anemia, glossitis, stomatitis
Dx, Tx?
Glucagonoma
CT to locate and then resection
If mets- somatostatin and streptozocin
112
Hypertension
hypokalemia, not taking diuretics
modest hypernatremia, metabolic alkalosis
low renin
Primary hyperaldosteronism
113
How to differentiate adrenal hyperplasia versus adenoma in hyperaldosteronism
Hyperplasia- responds appropriately to postural changes (more aldosterone when upright)
Adenoma- inappropriate or lack of response
114
Tx of primary hyperaldosteronism
Hyperplasia- medical treatment
| Adenoma- CT and the resection
115
Dx of pheochromocytoma
24 hour urinary VMA, metanephrines, or free catecholamines
| CT scan for adrenals, radionuclide for extra-adrenal sites
116
Tx of pheochromocytoma
Resection after careful preparation with alpha and beta blockers
117
What is seen on CXR in coarctation of the aorta
Scalloping of the ribs
| Erosion of ribs from collateral intercostals
118
Dx and Tx of coarctation of the aorta
CT angiogram
| Surgical correction
119
Medication resistant hypertension
Faint bruit over flank
Dx, Tx?
Renovascular hypertension
Duplex scanning of renal vessels, CT angiogram
Balloon dilatation and stenting of renal arteries
120
Most common etiology of renovascular hypertension for men, women
Men- atherosclerotic disease
| Women- fibromuscular dysplasia
121
Medical Tx for portal vein hypertension
Octreotide (somatostatin analogue)
| Or vasopressin but contra in elderly and CAD
122
Common historical component in hepatic adenoma
Oral contraceptive use
