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Revision LMCC > High Yield: Surgery 2 > Flashcards

High Yield: Surgery 2 Flashcards

1
Q

Describe: Fistula of the GI tract (3)

A
  • can have enterocutaneous fistula
  • succus entericus (intestinal contents), color green
  • tx: replacing electrolytes, lactacted ringer fluids
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2
Q

What’s the workup of dysphagia? (3)

A
  • barium swallow
  • except if older with alarm sx (microcytic anemia that points to chronic bleeding, weight loss): with dysphagia, use endoscopie
  • if iron deficiency anemia + older patient: colosnocopy
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3
Q

Differentiate Mallory-Weiss and Boerhaave syndrome (3)

A
  • Mallory-Weiss:
    • Tear of the mucosa of the esophagus at the lower oesophagal sphincter, superficial, happens with people who vomit a lot
  • Boerhaave syndrome
    • super severe, complete transmural perforation of the esophagus, releases air in mediastinum, called pneumomediastinum (on chest x-ray widened mediastinum + crepitus)
    • #1 cause: endoscopy
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4
Q

Describe dx and tx: Mallory-Weiss (2)

A
  • dx: endoscopy
  • if actively bleeding, ablate it. if not bleeding, leave it alone
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5
Q

Describe dx and tx: Boerhaave syndrome (2)

A
  • dx: gastrografin swallow
  • tx: surgery
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6
Q

H.pylori can cause 2 types of cancers, name them

A
  • Gastric adenocarcinoma
  • Malt lymphoma
    • if you tx and eradiate malt lymphoma, the malt lymphoma will go away
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7
Q

Name the two most common causes of stomach ulcers

A
  • NSAID
  • H.Pyloric
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8
Q

Name two most common causes of bowel obstructions

A
  • Hernia
  • Adhesions secondary to surgery
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9
Q

Describe tx: Small bowel distension (4)

A

Bowl rest regimen

  • NG suction
  • NPO
  • IV fluids
  • If no improvement: surgery
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10
Q

Describe: Pseudomembranous colitis (5)

A
  • caused by C.Diff
  • caused by atb broad spect use.
  • fever
  • leucocytosis
  • diarrhea
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11
Q

Name most common atb broad spect that causes: Pseudomembranous colitis (2)

A
  • cephalosporin
  • clindamycin
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12
Q

Describe dx and tx: Pseudomembranous colitis (2)

A
  • dx: stool toxin A and B
  • tx: ORAL vancomycin
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13
Q

Ulcerative colitis is associated with what? (2)

A
  • Associated with toxic megacolon and primary sclerosing cholangitis
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14
Q

What’s first line tx of anal fissure? (3)

A
  • Topical nitroglyceren
  • Calcium channel blockers
  • Sitz Bath
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15
Q

Describe: Perforated bowel (4)

A
  • pneumoperitonium
  • board-like rigidity
  • suden onsent
  • not want to move
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16
Q

Describe: Acute mesentaric ischemia (3)

A
  • like an MI of the mesentaric acteries
  • pain out of proportion to physical exam (worst abdominal pain, but physical exam no tenderness, no peritonitis or rigidity)
  • RF atherosclerosis disease: HTA, smoking, DLP, DB
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17
Q

Describe dx: Acute mesentaric ischemia (1)

A

CT angiogram

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18
Q

Describe: Pyogenic liver abscess (3)

A
  • secondary to acute ascending cholangitis
  • dx: CT
  • tx: percutaneous drainage
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19
Q

Describe: Acute ascending cholangitis (4)

A

Charcot’s triad

  • jaundice
  • fever
  • right upper quadrant abdominal pain
  • Renald’s pentad: Charcot’s triad + AEC + hypotension
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20
Q

Describe: Entamoeba histolytica (4)

A
  • can cause Amebic liver abscess
  • Vignette of patient
    • from south America
    • RUQ pain
    • diarrhea
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21
Q

Describe tx: Entamoeba histolytica (1)

A

metronidazole

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22
Q

Describe: Echinococcus (4)

A
  • Associated with south america
  • Dogs
  • US: Abscess in liver with multiple little cysts
  • needs to be removed surgically
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23
Q

Name first step: Cholecystitis

A

RUQ ultrasound (2/3 criteria)

  1. Gallbladder wall thickening > 4mm
  2. pericholecystic fluid
  3. Gallstone
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24
Q

Describe tx: Cholecystitis

A

Cholecystectomy within 72h

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25
Q

If on RUQ of suspected cholecystitis, only less than 2/3 criteria are met? (2)

A
  • Dx unclear
  • Next step: HYDA scan
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26
Q

Describe labs and ultrasound: Choledolythiasis (3)

A
  • ⬆️ Alkaline Phosphatase (ALP)
  • ⬆️ Direct bilirubin
  • RUQ ultrasound: dilation of the common bile duct > 6 mm
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27
Q

How to tx: Choledolythiasis (1)

A

ERCP

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28
Q

Name complications: Choledolythiasis (2)

A
  • Ascending cholangitis (and a complication of Ascending cholangitis is pyogenic liver abscess)
  • jammed in sphincter of Oddi -> backflow of pancreatic juices -> gallstone pancreatitis
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29
Q

Describe sx : Pancreatitis (1)

A
  • Epigastric pain radiates to back
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30
Q

Describe labs: Pancreatitis (2)

A
  • ⬆️ amylase
  • ⬆️ lipase
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31
Q

Describe dx: Pancreatitis (1)

A

RUQ ultrasound (not CT)

  • to find source of pancreatitis, most common is gallstone and alcohol use -> cholecystectomy during hospital visit
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32
Q

Name common complication and what to do: Pancreatitis (2)

A
  • few weeks later, pancreatic pseudocyst
    • postprandial fullness
    • early satiety
    • abdominal distension
    • vague abdominal pain
    • CT of the abdomen will show pancreatic pseudocyst
  • leave this alone unless bigger than 6 cm (drain)
33
Q

Name greatest RF for breast cancer? And osteoporosis? Stroke?

A
  • Breast cancer, osteopororis: Age
  • Stroke: HTA
34
Q

How to dx pheochromocytoma (2)

A
  • Metanephrines
  • Follow up with CT scan of adrenal glands to look for mass
35
Q

Describe: Pheochromocytoma (4)

A
  • Due to hypercatecholaminia
  • Paroxysmal hypertension
  • Nerveness
  • Headache
36
Q

Name cases where you’d do a bowel rest regimen (4)

A
  • Panceatitis
  • Small bowel obstruction
  • Volvulus
  • Diverticulitis
37
Q

Describe the difference between direct hernia, indirect and femoral

A
  • direct:
    • “old man hernia”
    • acquired most of the time
    • least likely to incarcenate
    • medial to the inferior epigastric arteria
  • indirect:
    • usually congenital
    • due to patent processus vaginalis, intestines will herniate in inguinal ring, down to scrotum
    • lateral to the inferior epigastric arteria femoral:
  • femoral
    • usually females
    • (lateral to medial) nerve -> artery -> vein -> empty space -> lymphatics
    • occupy the empty, medial to the vein
    • most likely to incarcerate
38
Q

Describe: Ombilical hernia in kid (1)

A
  • Usually reassurance, it’ll go away before 5 yo
39
Q

Describe tx: Acalculus cholycistitis

A
  • ICU patients who have been on Total parenteral nutrition (TPN) for a long time or due to systemic ischemia
  • tx: cholecystostomy tube
40
Q

Describe: Congenital diaphragmatic hernias (3)

A
  • Bowel in the left lung usually
  • First thing to do: Intubate patient (for a few days to let lungs mature)
  • Surgery later
41
Q

Describe: Mid gut volvulus (3)

A
  • Double bubble sign with air distal to that
  • Distal air can also present with corkscrew sign
  • Imagerie: Upper GI study (barrium swallow with x-ray)
42
Q

Describe: Necrotizing enterocolitis (4)

A
  • Associated with premature kid that feeds too early
  • Hematochizea
  • pneumatosis intestinalis (air in bowel wall) -> surgical intervertion
  • otherwise, IV ATB + fluids
43
Q

Describe: Meconium ileus (2)

A
  • Fecal plug at the terminal ileum, due to cystic fibrosis where stool too dry and gets stuck -> proximal backflow with small bowel obstruction
  • Dilated loops of small bowel + ground glass appearance in lower abdomen
44
Q

Describe dx and tx: Meconium ileus (3)

A
  • dx and tx: gastrografin enema
45
Q

Describe: Interception (3)

A
  • causes ischemia of telescoped part
  • jelly stool
  • colicky pain (comes and go) vs volvulus (constant pain + no/ billius vo)
46
Q

Describe tx: Interception (1)

A

air enema

47
Q

Describe: Meckel’s diverticulum (3)

A
  • retained remnant of the embryonic vitelline duct
  • sx due to to ectopic gastric and pancreatic tissue in RLQ
  • Painless hematochizia
48
Q

Describe: Cryptorchidie (2)

A
  • Increased risk of malignancy and infertility
  • tx: orchidopexie by age 1 (reduces risk of infertility but not reduce risk of malignance)
49
Q

When to do aortic stenosis valve replacement? (3)

A

When they have sx

  • CHF
  • Angina
  • Syncopie
50
Q

When to do coronary artery bypass graft (CABG)? (2)

A
  • if there’s 3 vessel disease or
  • proximal left anterior descending artery has 70% stenosis
51
Q

If you do chest x-ray and there’s a new nodule, what’s the best next step? (2)

A
  • look for old xray to compare
  • if no old x-ray, chest CT of the chest and abdomen
52
Q

What do you have to measure before you do lung surgery? (2)

A
  • FEV1: amount of air you can force from your lungs in one second
  • after lung surgery, there has to be at least 800 ml of FEV1, otherwise you can’t do it
53
Q

Who’s at an increased risk of aspiration? (5)

A
  • On ventilator
  • Alcoholics
  • Epilepsia
  • Dementia
  • Stroke

leads to right lower lobe pneumonia or abscesses

54
Q

Describe tx: Aspiration pneumonia

A
  • usually colonized anaerobic bacteria -> Clindamacine
55
Q

Describe: Subclavian steal syndrome (4)

A
  • due to stenosis of the proximal subclavian artery
  • use one arm (ex: left) and do bicep curls, suddenly feel lightheaded + dizziness, only when using the affected arm
  • dx: duplex scanning
  • tx: bypass surgery
56
Q

Describe: Abdominal aortic aneuvrysm (4)

A
  • Repair it if > 5 cm
  • or growing > 1 cm /year
  • tx: percutaneous stent
  • screening : 65 y.o. who has smoked with abdominal ultrasound
57
Q

Describe dx and tx: Peripheral artery disease (3)

A
  • dx: ankle brachial index
    • 0.4 - 0.9: peripheral artery disease -> exercise
    • < 0.4: severe -> stent or bypass
  • medically: aspirin + statin
58
Q

Describe: Aortic dissection (5)

A
  • widened mediastinum on chest xray
  • tearing chest radiating to back
  • dx: CT angio or transesophageal echo or MRI echo (for renal disease)
  • type A dissection: proximal to left subclavian (ascending arch is involved) -> tx surgery
    • Anterior Pain, Ascending Arch
  • type B dissection: distal to left subclavian -> tx beta blocker
    • Back Pain
59
Q

Differentiate: Basal cell carcinoma vs Squamous cell carcinoma

A
  • Basal cell carcinoma: Pearly telangiectasias
  • Squamous cell carcinoma
60
Q

Describe importance of tx of strabismus (2)

A
  • if young child: needs to be correct amblyopia (permanent vision loss = loss of vision from under stimulation of the retina and visual cortex during the early years)
  • older: refractory difficulty, tx is glasses
61
Q

Describe: Acute angle glaucoma (4)

A
  • severe eye pain
  • halo around lights
  • pupil is dilated and fixed
  • eye rock hard
62
Q

Describe tx: Acute angle glaucoma (4)

A
  • laser beams that drills through iris for aqueous humour drainage
  • betablocker (minimise aqueous humour production)
  • pilocarpine (induce miosis, allow more myosis)
  • Carbonic Anhydrase Inhibitors (ex: acetazolamide)
63
Q

Describe: Orbital cellulitis (5)

A
  • Preseptal (Periorbital):
    • Anterior to the septum of the eyelid
    • no blurry vision or pain
  • Postseptal (Orbital)
    • blue vision + pain
    • emergency
    • Dx: Emergency CT scan if postseptal
64
Q

If Squamous cell carcinoma of the head and neck in old men who smokes, drinks and has rotten teeth, what do you do? (3)

A
  • Triple endoscopy looking for primary tumors (in pharynx, trachea, and oesophegas), CT to check for spread of sx
    • Persistent hoarsness -> laryngeal cancer
    • Persistent painless ulcer in floor of mouth -> Squamous cell carcinoma of mouth
    • Persistent unilateral earache -> Cancer in pharynx that is blocking the eustachian tube
65
Q

If the internal carotid artery is stenosed greater than 70% with sx, what’s the best next step?

A

Carotid endarterectomy

66
Q

With sx of stroke, what’s the next best step? (3)

A
  • Head CT WITHOUT contrast to r/o hemorrhage
  • If not hemorrhage, proceed with Thrombolytic therapy
  • If hemorrhage, blood pressure control with calcium channel blocker (ex: nifedipine)
67
Q

What’s tx of prolactionma? (2)

A
  • Carbergoline or bromocriptine (dopamine agonists, dopamine suppresses prolactin release)
68
Q

Describe dx of acromegaly or gigantism (1)

A
  • ⬆️ IGF-1 levels (what’s released by live after growth hormone stimulates it)
69
Q

Describe: Brain abscess (3)

A
  • Fever
  • Brain tumor sx: HA, projectile vomiting, nausea, eye pressure, etc
  • Usually caused by ENT infections near by (ex: bacterial sinusitis that progresses to the brain)
70
Q

Describe dx and tx: Brain abscess (2)

A
  • Dx: CT head WITH contrast
  • Tx: Resection or incision+Drainage
71
Q

If sx brain tumor (worsening headache, morning headache, projectile vomiting), name imgary

A

MRI brain

72
Q

Differentiate epididymitis (4) and testicular torsion (4)

A
  • epididymitis :
    • fever, pyuria, tender cord
    • main causes:
      • young: gono, clam
      • old: E.colo
  • testicular torsion :
    • no fever, no tender cord
    • no cremasteric reflex
73
Q

Describe tx: Epididymitis (2)

A
  • young: ceftriaxone + arithro
  • old: fluoroquinolone
74
Q

Describe dx and tx: Testicular torsion (2)

A
  • dx: doppler scrotum to check for blood flow
  • tx: surgical emergency -> BILATERAL orchiopexy bc increased risk of torsion of the other testical
75
Q

If someone has kidney stone and leads to fever, what’s next step?

A

Percutaneous nephrostomy tube (emergency), to allow fluid to drain out so it doesn’t worsens hydronephrosis

76
Q

If you have sx of Pneumaturia (“gas” in the urine), what’s most likely cause? (2)

A
  • Diverticulitis, bc can cause fistulas from bowel to bladder (enterovesical fistula), can cause air to be urinared, can also cause fecaluria
  • Crohn’s disease (also associated with fistula)
77
Q

Name types of transplant rejection (4)

A
  1. Hyperactuce rejection = minutes
    • due to performed antibodies = vascular thrombosis = type 2 hypersensitivity
  2. Acute rejection = days to months, organ function failuare
    • tx = steroid bolules
    • dx = biopsy
  3. Chronic rejection = years
    • organ function failure
    • tx: retransplant
  4. Graft versus host disease (GvHD) = multiple areas of body affected
    • CD8 T killer cells response against host
    • immune system from donated organ starts attacking the host
    • very systemic (elevated LFT, creat, rash, diarrhea, etc)
78
Q

Describe: Red blood cell transfusion reactions

A

Timing is key

  1. 30 s = IgA def, anaphylaxis
    • tx: IM epinephrine + fluids
  2. 30 mins = ABO incompatibility, flank pain, hypotension
    • Tx: IVF, discontinue transfusion
    • iatrogenic mistake
  3. 3 hours = febrile = cytokines in blood transfusion = prevent with leukoreduction
    • tx: self-limited
  4. 3 days = delayed hemolytic = jaundice
    • tx: self-limited

Revision LMCC (6 decks)

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