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Jeopardy Flashcards

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1
Q

Critical maneuver in the surgical treatment of Zenker’s diverticulum

A

Zenker’s diverticulum = esophageal diverticulum, sac-like outpouching thru a weakness in the muscle

Critical maneuver = cricomyectomy/cricopharyngeal myotomy = cutting of the cricopharyngeal muscle

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2
Q

Most common cause of lower GI bleed

A

Diverticular disease

2nd = AVM

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3
Q

Most common nerve injured during an inguinal hernia repair

A

Ilioinguinal nerve

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4
Q

62 yo M w/ hematuria, flank pain, and right renal mass

(a) Dx
(b) Tx

A

(a) renal cell carcinoma until proven otherwise

(b) remove kidney

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5
Q

Most cause of portal HTN in the US

A

Alcoholic cirrhosis

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6
Q

Makeup of NS

A

Normal saline has Na and Cl: 154 of both

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7
Q

Margins for a 3mm thick melanoma

A

2 cm

-all melanomes of 2 mm or more depth get 2cm margins

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8
Q

If pt w/ APC mutation of chromosome 5 gets colon removed at age 20, what further maintenance is required

A

APC mutation on chromosome 5 = FAP (familal adenomatous polyposis)

After prophylactic complete colectomy at 20, still need yearly EGD to screen for duodenal carcinoma

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9
Q

3 buckets of etiologies for mesenteric ischemia

A
  1. Arterial embolism/thrombosis- if have an emboli or clot that blocks the splanchnic blood supply
    - ex: cardiac embolism, atherosclerotic disease, thrombosed mesenteric aneurysm, aortic/mesenteric dissection
  2. Venous thrombosis- hypercoagulable state, malignancy, prior abdominal surgery
  3. Nonocclusive mesenteric ischemia- from splanchnic hypoperfusion and vasoconstriction (ex: hypovolemic shock)
    - most commonly affects watershed areas of the colon that have limited collateralization
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10
Q

Type of IBD w/ transmural involvement

A

Chron’s

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11
Q

Beck’s triad

(a) What does it indicate?
(b) Name the three parts

A

Beck’s triad = cardiac tamponade

(b) Distended neck veins, hypotension, muffled heart sounds

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12
Q

Tx for hydrogen fluoride burn

A

Calcium gluconate

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13
Q

2 genetic syndromes that carry organ removal early on in life for cancer prophylaxis

A

MEN2- prophylactic thyroid removal due to 100% risk of medullary thyroid cancer

FAP (APC mutation)- ppx colon removal at age 20

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14
Q

Immediate actions to prevent rhabdo

A

Tons of IV fluids

-alkalinize urine

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15
Q

First line in mgmt of anal fissures

A

Physical exam: if posterior and midline w/o perianal skin tags, can start first line tx of

  • constipation relief: fiber, stool softener
  • topical analgesia
  • topical nifedipine or topical nitroglycerin

If Not midline, presence of perianal skin tags- must work up for Chron’s

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16
Q

Peritoneal-lined abdominal wall defect

A

Omphalocele
-50% cardiac defects

While without peritoneal lined = gastrochiesis

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17
Q

Most common valvular abnormality secondary to an MI

A

Mitral valve prolapse

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18
Q

Vitamin that reverses effect of steroids on wound healing

A

Steroids hinder wound healing, thought that vitamin A reverses that effect

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19
Q

Which has a better prognosis: gastrochiesis or omphalocele?

A

Gastrochesis has better outcome b/c omphalocele (peritoneal lined) has almost 50% chance of concomitant cardiac defect

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20
Q

What is Eisgenmenger’s syndrome?

A

When a congenital left to right shunt causes pulmonary HTN and eventual reversal of the shunt into a cyanotic right to left shunt

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21
Q

Pulsatile right groin mass 4 hrs s/p cardiac cath

Dx

A

Pseudoaneurysm of femoral vein
-from blood collection when catheter removed too gradually from femoral vein

Tx = inject thrombin

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22
Q

Workup when suspecting mesenteric ischemia

A

Patient HDS? Yes- Abdominal CT, if suspicious for mesenteric ischemia do mesenteric arteriogram

If HDUS, resuscitate w/ IVF, empiric abx, get plain abdominal film to look for free air/signs of advanced ischemia

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23
Q

What UV ray is associated w/ melanoma

A

UV B

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24
Q

Treatment plan for rectal cancer 1cm above the dentate line

A

APR = abdominal peritoneal resection w/ neoadjuvant chemo

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25
Which anorectal entity can be treated w/ botox
Anal fissure- if fails conservative medical management (topical analgesia and nifedipine, relief of constipation), can turn to surgery or botulinum toxin -botulinum toxin over surgery in pts at high risk for incontinence (multiparous F and older pts)
26
First branch of the abdominal aorta
Phrenic artery
27
General goal of fluid resuscitation in burn victim used over Parkland formula
Usually give fluids until urine output is about 1-1.5cc per ml of fluid (LR) given
28
Shortcut for maintenance fluids
Just add 40 to wt if pt is over 20 kg Ex: maintenance fluids for 70 kg pt = 110 cc/hr
29
What is priaprism?
Erection lasting 8 or more hours
30
Where is the blood coming from if: Pringle maneuver being performed but the pt is still bleeding from the liver
Pringle maneuver = compression of the portal triad = compressing portal vein, hepatic artery, and CBD So if still bleeding blood is coming from the hepatic vein (only one not compressed)
31
Why does TPN have to be administered thru a central line?
B/c it's hyperosmolar- if put directly into small veins in the arm it would cause direct sclerosis -central line or PICC line
32
Most common type of breast cancer
Invasive ductal carcinoma
33
Cause of pneumaturia in pt w/ acute sigmoid diverticulitis
Vesical fistula = fistula btwn bladder and colon | -pneumaturia = air in the urine
34
Most common endocrine tumor of the pancreas
Insulinoma = most common If gastrinoma, suspect MEN1 (much less common)
35
What is the urachus?
Urachus = fibrous remnant of the allantois, connection btwn bladder and umbilicus
36
Pt w/ hematemesis morning after binge drinking
Mallory-Weiss tear 2/2 repetitive wretching during vomiting
37
Calf pain and associated ABIs, what happens under the following ABC (ankle brachial index) under .9 under .5 under .3
Under .9 = intermittent clauddication Under .5 = rest pain Under .3 = ulcers/skin break down
38
Features of MEN2B
1. Medullary thyroid cancer 2. Pheochromocytoma 3. Marfanoid habitus 4. Mucosal neuromas in 100%
39
Features of MEN1
3 P's: pancreatic, parathyroid, pituitary 1. Pancreatic tumor- gastinoma 2. Parathyroid gland hyperplasia 3. Pituitary tumor = prolactinoma
40
When to suspect hemobilia
Hemobilia = bleeding into biliary tree (GI bleed) b/c of fistula btwn artery and bile duct -suspect it when pt presents w/ jaundice, GI bleed w/ recent liver injury or instrumentation (ex: TIPs, biopsy, trauma)
41
Gene associated strongly w/ male breast cancer
BRCA2 BRCA2- 10% risk of breast cancer in male
42
Cardiac chamber most commonly injured by penetrating trauma
Right ventricle | -sits the most anteriorly
43
What artery is involved if a duodenal ulcer is bleeding?
Gastroduodenal artery | -from the common hepatic artery of the celiac trunk
44
72 yo F w/ loop of bowel medial to the femoral vein on CT Dx?
Femoral hernia Mneumonic for lateral to medial is NAVAL: nerve, artery, vein, ___ (space where hernia goes), lymphatics
45
Mgmt of 83 yo M w/ sigmoid volvulus
Immediately: flexible sigmoidoscopy to reduce it, then definitive surgery to prevent recurrence -sigmoidectomy (removal of sigmoid colon) a few days after once stabilized, or immediately if can't reduce w/ sigmoidoscopy
46
32 yo M in MVA HR 40, BP 80/38 What type of shock is he in?
Neurogenic shock - hypovolemic/septic would have tachycardia if BP was so low - low HR shows spinal cord injury
47
In Budd-Chiari, what part of the liver can continue to drain into the IVC
Budd-Chiari = hepatic vein thrombosis -caudate lobe is basically it's own separate lobe, it has it's own vein draining into the IVC, so it will maintain drainage in Budd-Chiari
48
Mediastinal tumor associated w/ myasthenia gravis
Thymoma
49
83 yo M w/ LBO and dilated U-shaped area of colon Dx?
Sigmoid volvulus | 'coffee-bean' shape on abdominal plain film
50
Most common form of anal cancer
Squamous cell
51
Most common site of lower extremity atherosclerotic occlusion
Superficial femoral artery
52
Hemorrhoids (a) Which causes pain (b) Which causes BRB per rectum
Hemorrhoids (a) Only external hemhorroids are painful (unless internal prolapse) b/c internal are above the dentate/pectinate line (b) Internal hemorrhoids bleed
53
Name for transient monocular blindness
Amaurosis fugax
54
Most common organ injured in blunt trauma
Spleen
55
Embryonic malformation causing midgut volvulus
Malrotation
56
Acute left shoulder pain upon passive elevation of legs Dx
= Kher's sign- sign of blood or air in peritoneal cavity | -classically a sign of splenic rupture
57
Which brachial plexus do the parathyroid glands come from
Inferior parathyroids come from the third brachial plexus Superior parathyroids come from the fourth brachial plexus
58
Vitamin needed for collagen cross linking
Vitamin C
59
Clinical significance of PCWP
Pulmonary capillary wedge pressure- measured by Swan Ganz catheter into pulmonary arteries, is used as an indirect measure of left atrial pressure - diagnostic for LV failure, MS, cause of acute pulmonary edema ex: acute pulmonary edema w/ normal PCWP = ARDS
60
Features of MEN2A
1. Medullary thyroid cancer (100%) - ppx remove thyroid at 6 mo 2. Pheochromocytoma 3. Parathyoid hyperplasia - 4 gland hyperplasia
61
Predominant type of collagen present 6 weeks after surgery
Type I collagen
62
75 yo F w/ symptomatic 79% ICA stenosis Next step?
Carotid endarterectomy | -for anything above 70% stenosis and below 99% (already fully occluded at 99%...)
63
Maintenance fluids for a 60 kg pt
60 kg pt- 100 cc/hr of maintenance fluids 4-2-1 rule, or shortcut of just adding 40 to wt
64
Cell type (a) First to the scene for wound healing (b) Most important for wound healing (c) Deposits collagein
Cell type (a) Platelets are first on the scene (b) Macrophages are the most important for wound synthesis (c) Fibroblasts deposit collagen
65
Name the 2 watershed areas of the colon
Splenic flexure and rectosigmoid junction -have minimal collateral blood supply => fastest to be affected by splanchnic hypoperfusion
66
Most common source of emboli to the lower extremity
The hearttttt
67
Treatment for squamous cell anal cancer
Nigro protocop = pre-operative use of chemotherapy and medical radiation for squamous cell carcinoma of the anus -tx NOT excision
68
2 weeks s/p liver trauma pt presents w/ jaundice and hematemesis Dx?
Hemobilia = bleeding into the biliary tree b/c of fistula btwn splanchnic vessel and a bile duct - consider after liver injury or instrumentation - artery anastamoses to bile duct => bleeding into the duodenum - jaundice 2/2 hemolysis
69
Tonicity of fluids for the first 24 hrs post-op
Isotonic
70
Liver tumor in 25 yo F w/ RUQ pain and intraabdominal hemorrhage
Hepatic adenoma -RF = OCP use
71
Where does the thoracic duct drain into?
Left subclavian vein
72
An isolated lower extremity crush injury puts what organ system at risk of failure?
Kidneys Nephrotoxicity from rhabdo: all blood gets crushed in the trapped limb => hemolysis => rhabdo -damage to kidneys from myoglobin
73
Pt presents w/ Charcot's triad (a) First line (b) Next step if don't improve w/ first line therapy
Charcot's triad = fever, RUQ pain, jaundice = presentation of cholangitis (a) Give abx and fluids, then if pt improves schedule elective choley (b) If pt doesn't improve w/ abx and fluids, assumption that stone is in CBD => do ERCP to remove stone in the common bile duct
74
What is the definitive tx for anal sphincters
Lateral sphincter removal (lateral internal sphincterectomy) -only once medical management has been failed and endoscopy has ruled out Chron's
75
G-cells (a) Location (b) Function
G-cells (a) antrum of the stomach (b) Secrete gastrin to stimulate secretion of HCl
76
What solution is used for fluid resuscitation in burn victims?
``` Use LR (not NS!!!!) -NS in super high volumes can cause hyperchloremic metabolic acidosis (b/c has 154 Cl) ```
77
52 yo M w/ epigastric pain and free air in the abdomen on plain film
Ruptured gastric ulcer
78
Most common bladder cancer
Transitional cell carcinoma- arising from transitional epithelium -most common cancer of the GU system, second most common cancer of the kidney
79
62 yo M p/w severe epigastric pain, diaphoresis, dyspnea, and rales Dx?
Acute MI
80
Percent of body surface burned if both arms are affected
18% | -each arm is 9% in an adult
81
32 yo F w/ cecal volvulus Treatment
Cecal volvulus = rotation/torsion of a mobile cecum and ascending colon, which can progress to ischemia, necrosis, perforation Tx for cecal volvulus = right hemicolectomy
82
Most common solid tumor in children (a) Under 2 yo (b) Over 2 yo
Solid tumors in children | a) Under 2 yo = neuroblastoma (b) Over 2 yo = nephroblastoma (Wilm's
83
Treatment for testicular torsion
Untwist and hope it reperfuses... If you go to the OR to untwist, do bilateral untorsion and fixation b/c other side is at high risk
84
Pancreatic tumor associated w/ necrotizing skin process
Glucagonoma - necrolytic migratory erythema strongly associated w/ glucagonoma - red patches commonly affecting limbs and skin around the mouth
85
Procedure for resolved gallstone pancreatitis
Lap choley | -40% cases of pancreatitis caused by gallstones, so once acute phase is calmed down, tx w/ lap choley
86
Keloid vs. hypertrophic scar (a) Biggest differentiator (b) Prognosis
Keloid = tissue extends beyond the border of the original wound, while they don't extend in hypertrophic scar Hypertrophic scars may spontaneously resolve, while keloids are unlikely to
87
64 yo M w/ postprandial abdominal pain w/ bloody diarrhea
Mesenteric ischemia- classically have pain out of proportion to physical exam

Surgery (10 decks)

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