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Surgery > Pestana: general surg > Flashcards

Pestana: general surg Flashcards

1
Q

diagnosing motility disorder of esophagus

A
  1. barium swallow

2. definitive: manometry

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2
Q

treatment for achalasia

A

balloon dilatation- endoscopy

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3
Q

achalsia has dysphagia worse for liquids or solids

A

liquids

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4
Q

achalsia on x ray

A

megaesophagus

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5
Q

diagnostic for boerhaave syndrome

A

contrast swallow (gastrografin first, barium if negative)

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6
Q

most common reason for esophageal perforation

A

instrumental perf

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7
Q

gastric adenocarcinoma presentation

A

elderly

anorexia, weight loss,
epigastric distress, early satiety

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8
Q

treatment of gastric adenocarcinoma vs gastric lymphoma

A

adeno: surgery
lymphoma: Chemo/RT (surgery if perf risk)

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9
Q

SBO presentation

A

colicky pain, vomiting, distension
no gas or feces

high pitched bowel sounds

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10
Q

treatment of SBO

A

NPO, NG suction, IV fluids

if doesn’t spontaneously resolve within 24 hrs (for complete) or few days (if partial)–> surgery

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11
Q

strangulated obstruction presentation

A

compromised blood supply–> fever, WBCs, peritoneal signs, sepsis

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12
Q

carcinoid syndrome in small intestine seen with mets to where?

A

liver

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13
Q

other symptoms of carcinoid syndrome

A

diarrhea, flushing, wheezing

right sided heart damage

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14
Q

diagnosing carcinoid syn

A

24 hr urinary 5-HIAA

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15
Q

cancer of left vs right colon presentations

A

right: iron def anemia
left: bloody bm’s

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16
Q

are polyps that are juvenille or peutz-jeghers premalignant?

A

no

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17
Q

most common antibiotic to cause c dif

A

cephalosporins

clinda was the first described

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18
Q

cause of anal fissure

A

tight sphincter

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19
Q

treatment for anal fissure

A 
CCBs
botox
nitroglycerin
forceful dilatation
stool softeners
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20
Q

75% of GI bleeding comes from where

A

upper GI tract

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21
Q

red blood per rectum indicates bleeding from…

A

anywhere in the GI tract!

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22
Q

diagnostic steps when patient is actively bleeding from rectum

A

pass NG tube and aspirate gastric contents

if bleeding–> upper GI bleed
if white–> do endoscopy to see if duodenum is a source
if green–>lower GI

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23
Q

lower GI bleeding workup

A
  1. anoscopy: r/o hemorrhoids
  2. if bleeding rate:
    > 2 ml/min: angiogram
    <0.5 mL/min: wait and do c-scope
    0.5
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24
Q

massive upper GI bleed in the stressed, multiple trauma, or complicated post-op patent is probably from…

A

stress ulcers

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25
Q

stress ulcers diagnosis confirmation and therapy

A

diagnostic: endoscopy
treatment: angiographic embolization

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26
Q

diagnosis to confirm acute abdominal pain by perf

A

x ray: free air under diaphragm

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27
Q

most common example of perforation to cause abdominal pain

A

peptic ulcer

28
Q

what is this: x-ray of air fluid levels in small bowel, disteneded colon, huge air-filled loop in RUQ rhat tapers down toward LLQ with shape of “parrot’s beak”

A

volvolus of sigmoid

29
Q

volvolus of sigmoid occurs in which population

A

elderly

30
Q

treating volvolus of sigmoid

A

proctosigmoidoscopic
rectal tuble left in

recurrent–> sigmoidectomy

31
Q

presentatiion of mesenteric ischemia

A

elderly

acute abdomen + afib/recent MI (clot breaks off into superior mesenteric artery)

32
Q

specific blood marker for primary hepatoma

A

alpha fetoprotein

33
Q

whats more common: mets to liver or primary liver cancer?

A

mets to liver (20:1)

34
Q

pyogenic liver abscess seen as complication of

A

biliary dz- acute asc. cholangitis

35
Q

amebic abscess of liver affects which population

A

mexican men

36
Q

diagnosis and treatmnet of pyogenic liver abscess vs. amebic abscess

A

pyogenic:
Diagnose: US
Treat: percutaneous drainage

amobeic:

diagnose: serology
treat: metronidazole

37
Q

hemolytic jaundice is unconjugated or conjugated bilirubin?

A

unconjugated

38
Q

labs of hepatocellular jaundice

A

very high AST/ALT
modest high Alk phosph
high unconjugated and conjugated bili

39
Q

courvoiser-terrier sign

A

seen in malignant obstructive jaundice

thin-walled distended gallbladder seen

40
Q

ERCP

A

invasive, need anesthesia

visualizes biliary and pancreatic ducts

also therapeutic: can do sphincterotomies, retrieve stones, drain pus, make stents, biopsy tumors, etc.

41
Q

MRCP

A

non-invasive, patient awake

only diagnostic of biliary and pancreatic

42
Q

which cancer: obstructive jaundice with anemia and positive blood in stools?

A

ampullary cancer

43
Q

presentation of biliary colic vs cholecystitis

A

colic: temporary (10-30 minutes), no periotoneal signs
cholecystitis: constant; fever, WBCs, peritoneal signs

44
Q

acute ascending cholangitis presentation

A

deadly! sonte reached common duct–> obstruction/inf.

104-105 degree fevers, sepsis

45
Q

treatment of acute ascending cholangitis

A

IV antibiotics and emergency decompression of common duct- ERCP or percutaneous transhepatic cholangiogram

eventually cholecystectomy

46
Q

treatment of acute edematous pancreatitis (gallstones, alcoholics)

A

few days of pancreatic rest- NPO, NG suction, IVF

47
Q

labs in acute hemorrhagic pancreatitis

A

starts as edematous (elevated amylase, lipase)

low hematocrit!

elevated: WBCs, glucose, BUN
Low calcium
metabolic acidosis, low arterial PO2

48
Q

how is acute hemorrhagic pancreatitis deadly?

A

leads to mutiple pancreatic abscesses

49
Q

which antibiotics for acute hemorrhagic pancreatitis abscesses

A

carbapanems
quinolones
metronidazole

50
Q

pancreatic psuedocyst sequelae of…

A

5 weeks after acute pancreatitis or pancreatic trauma

51
Q

treatment of pancreatic pseudocyst depending on size/time

A

under 6 cm/<6 weeks: observe

over 6 cm/>6 cm: drainage

52
Q

what are the two exceptions for hernias that dont need to be surgically repaired?

A

umbilical hernias in kids 2-5 (close by themselves)

esophageal sliding hiatal hernias

53
Q

medullary cancers of thyroid come from which cells

A

C cells - make calcitonin

54
Q

therapy for follicular neoplasm of thyroid

A

total thyoidectomy

55
Q

treatment for hyperthyroidism

A

radioactive iodine

56
Q

what should you check for if hyperparathyroidism found?

A

bone mets

57
Q

dexamethasone test results meaning and workup

A

suppression at low dose–> r/o cushing’s

no suppression–> 24 hr urine free cortisol measurement
–> if elevated: high dose dex test

suppression at high dose: pitutiary microadenoma

no suppression –> adrenal adenoma or paraneoplastic sy

58
Q

insulin and c peptide high or low in diabetics vs insulinomas?

A

diabetics: insulin high, low c-peptide
insulinomas: both high

59
Q

nesidioblastosis

A

hypersecretion of insulin in new born

pancreatectomy required

60
Q

glucagonoma symptoms

A

severe migratory necrolytic dermatitis
anemia
glossitis
stomatitis

61
Q

treatment of glucagonoma

A

resection is curative

somatostain and stretozocin will help with metastatic/inoperable

62
Q

primary hyperaldosteronism symtoms

A

hypokalemia
hypertensive- but renin low

hypernatremia, metabolic alkalosis

63
Q

hyperaldosteronism caused by hyperplasia vs adenoma

A

hyperplasia:
- responds to postural changes (more aldosterone when upright than lying down)
- treated medically

adenoma:

  • no postural response
  • surgical resection
64
Q

diagnosing coarctation of aorta

A

spiral CT diagnostic

CXR: scalloped ribs

65
Q

renovascular HTN seen in two groups

A

women with fibromuscular dysplasia

old men with arteriosclerotic occlusive dz

Surgery (22 decks)

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