General Surgery Treatments

Question 1

Sliding Esophageal Hiatal Hernia

Answer 1

Nissen Fundoplication

Question 2

Paraesophageal Hiatal Hernia

Answer 2

Surgical, because of frequency and severity of potential complication

Question 3

Treatment for flail chest

Answer 3

Intubation

Question 4

Cardiac Tamponade

Answer 4

Pericardial Window - if blood returns, median sternotomy

Question 5

Massive Hemothorax indication for thoracotomy

Answer 5

Massive = >1500cc on initial placement of chest tube

Persistent = >200 cc of bleeding via chest tube x 4 hours

Question 6

what is a positive Diagnostic Peritoneal Lavage

Answer 6

> 10cc blood aspirated

Question 7

In a blunt trauma victim, celiotomy would require?

Answer 7

Peritoneal signsm free air on CXR/CT scan, unstable patient with positive FAST exam or positive DPL results

Question 8

Indications for surgical exploration in all penetrating neck wounds.

Answer 8

"Hard signs"
Shock,
exanguinating hemorrage
expanding hematoma
pulsatile hematoma
neurologic injury

Question 9

What is the 3 for 1 rule

Answer 9

3L of crystalloid for every 1L of blood loss

Question 10

Minimal urine output for an adult trauma patient

Answer 10

50ml/ hr

Question 11

How much blood can be lost into the thigh with a closed femur fracture

Answer 11

upto 1.5L of blood

Question 12

Surgical cricothyroidectomy is contraindicated to what population

Answer 12

<12 y.o.

Question 13

Rectal Penetrating injury tx

Answer 13

Diverting proximal colonstomy

Question 14

Tx for EXTRAperitoneal minor bladder rupture

Answer 14

Bladder catheter

Question 15

Extensive irreperable biliary, duodenal and pancreatic head injury

Answer 15

Trauma Whipple

Question 16

Treatment for minor pancreatic injury

Answer 16

Drainage

Question 17

What is the lethal triad

Answer 17

Acidosis
Coagulopathy
Hypothermia

Question 18

Myoglobinuria Tx

Answer 18

“HAM”
Hydration with IV
Alkalization of urine with IV bicarb
Mannitol diuresis

Question 19

Tx for 1st degree burn

Answer 19

keep clean, neosporin

Question 20

Tx for 2nd degree burn

Answer 20

Remove blisters, antibiotic tx

Silicone
Silver ion dressings

Question 21

Tx for 3rd degree burn

Answer 21

Early excision of exchar(within 1st week post burn) and ST SG

Question 22

Why is glucose-containing IVF contraindicated in burn patients in the first 24 hours

Answer 22

Serum glucose will be elevated on its own

Question 23

Why do severely burned patients require nasogastric decompression?

Answer 23

20% TBSA develop paralytic ileus–>vomiting–>aspiration–>pneumonia

Question 24

IV antibiotics contraindicated in fresh burns

Answer 24

Eschar is avascular. Topical is used

Question 25

Carbon monoxide inhalation overdose

Answer 25

100% O2

Question 26

Central line is changed in burn patients every

Answer 26

3-4 days

Question 27

Indications for surgical intervention in UGIB

Answer 27

Refractory or recurrent bleeding and site known, >3 u PRBCs or >6 u PRBC overall

Question 28

When is surgery indicated for duodenal ulcers?

Answer 28

``` "I HOP" Intractability Hemorrhage Obstruction Perforation ```

Question 29

Common surgical option for Truncal Vagotomy

Answer 29

Pyloroplasty

Question 30

Duodenal Perforation tx

Answer 30

Graham patch | Truncal vagotomy

Question 31

Mallory weis syndrome treatment

Answer 31

Room temperature water lavage

Question 32

Mallory Weis surgery indication

Answer 32

When medical/endoscopic treatment fails (>6PRBC)

Question 33

Esophageal Variceal Bleeding tx

Answer 33

Somatostatin and vasopressin

Question 34

What is Sengstaken Blakemore ballon

Answer 34

Tamponades with an esophageal balloon and a gastric balloon

Question 35

Treatment for Diverticulits

Answer 35

High fiber diet

Question 36

What type of surgery is usually performed for an acute case of diverticulitis with a complication (perforation, obstruction)

Answer 36

Hartmann's procedure

Question 37

Initial treatment for colonic volvulus

Answer 37

Non operative

Question 38

Treatment for Cecal Volvulus

Answer 38

Emergent surgery, right colectomy

Question 39

What are the major differences in the emergent management of cecal volvulus vs sigmoid

Answer 39

Cecal=surgical reduction | Sigmoid=endoscopic reduction of twist

Question 40

What is "closed" vs "open" hemorrhoidectomy

Answer 40

Closed (Ferguson_ closes the mucosa with sutures after removal of hemorrhoid tissue Open (Milligan-Morgan) leaves mucosa open

Question 41

What condition is contraindicated to hemorrhoidectomy?

Answer 41

Crohn's Disease

Question 42

Colonoscopic tx option for bleeding vascular ectasia or polyp

Answer 42

Laser, electrocoagulation, local epinephrine injection

Question 43

Medical Tx for IBD

Answer 43

Sulfazaline | Steroids

Question 44

Medications for CD but not UC

Answer 44

Methotrexate, antibiotics

Question 45

Perianal Crohn's disease

Answer 45

Metro | Cipro

Question 46

MC indication for surgery in CD

Answer 46

SBO

Question 47

Tx for Portal Hypertension

Answer 47

"TIPS" | Transjugular Intrahepatic Portosystemic Shunt

Question 48

What is Kocher's incision

Answer 48

Right subcostal incision for Biliary surgery

Question 49

What is the treatment of major CBD injury after a lap chole

Answer 49

Choledochojejunostomy

Question 50

Complications of Lap Chole

Answer 50

CBD injury, right hepatic duct/artery injury; cystic duct leak, biloma

Question 51

What is the waiting period before a pseudocyst should be drained?

Answer 51

It takes 6 weeks for psudocyst walls to "mature" to hold sutures.

Question 52

What is the treatment for inflammatory CA of the breast?

Answer 52

Chemotherapy first! Followed by RT, mastectomy or both.

Question 53

Treatment for DCIS <1cm

Answer 53

Remove with 1 cm margin and XRT

Question 54

Treatment for DCIS >1cm

Answer 54

Lumpectomy with 1 cm margins and radtiotion or TOTAL mastectomy (no axillary dissection)

Question 55

When must simple mastectomy be perfromed for DCIS

Answer 55

Diffuse breast involvment

Question 56

Adjuvant Rx for DCIS

Answer 56

Tamoxifen | Postlumpectomy

Question 57

Treatment for LCIS

Answer 57

Close follow up

Question 58

Role of chemo in Pyllodes tumor

Answer 58

if >5cm and stromal overgrowth

Question 59

Preoperative Medical treatment for Pheochromocytoma

Answer 59

Increase IV volume with a-blockade (phenoxybenzamine)

Question 60

Medical treatment for Insulinoma

Answer 60

Diazoxide, to supress insulin release

Question 61

Rx for Glucagonoma

Answer 61

Somatostatin, IV Amino acids and surgical resection

Question 62

Indication for surgery with multinodular goiiter

Answer 62

Cosmetic deformity compressive symptoms Cannot rule out cancer

Question 63

If medullary thyroid CA and pheochromocytoma are found, which one si operated first?

Answer 63

Pheochromocytoma