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Flashcards in ROSH Surgery boost Deck (85):
1

what is the MCC cause of hyperthyroidism?

Graves’ disease

2

what are the risk factors for Grave's disease?

stress

high iodine intake

drugs (lithium, interferon alpha, alemtuzumab)

3

what are the sign and symtpoms of graves?

weight loss, heat intolerance, tremor, palpitations, anxiety, increased frequency of bowel movements, and shortness of breath.

4

Exam findings for graves?

diffuse goiter

stare and lid lag

pretibial myxedema

 ophthalmopathy (exopthalmos, impairment of eye-muscle function)

5

what are the lab findings for Graves?

low TSH

 greater elevation in serum triiodothyronine (T3) than in serum thyroxine (T4).

6

how else will you diagnose Graves aside from HPI and labs?

1) Thyrotropin receptor antibodies--> (+) = confirm diagnosis of graves

2) if (=) --> RAIU which will show normal or high RAIU

 

7

how do you treat graves?

1) symptom control with a beta blocker

2) significant symptoms and risk for complications of hyperthyroidism --> methimazole or PTU (esp for pregnancy)

3) alternative to drugs: radioiodine ablation or thyroidectomy

 

 

8

if a patient underwent thyroidectomy and is now having symptoms of cold intolerance with elevated TSH, what do you think is happening?

Patients who have a total thyroidectomy should receive thyroid replacement hormone prior to discharge and should be monitored for signs and symptoms of hypothyroidism

9

patient presents with severe hypothyroidism leading to decreased mental status and hypothermia. what is your diagnosis?

Myxedema coma

10

[BLANK] is a complication after total thyroidectomy, due to the removal of one or more parathyroid glands during surgery

hypocalcemia--> Symptoms would include muscle twitching, carpopedal spasm, and perioral paresthesias. Prophylaxis is often given to patients with calcium and calcitriol.

11

What type of tumor is  pheochromocytoma?

neuroendocrine catecholamine-secreting tumor found in the adrenal gland

12

Pheochromocytoma is typically assocaited with?

MEN2

von Hippel-Lindau (VHL) 

 

 

13

TRIAD for Pheochromocytoma?

palpitations or tachycardia

 episodic headaches

 diaphoresis

14

patient w/ hypertension, positive family history, and adrenal mass found incidentally is suspicious for what?

Pheochromocytoma

15

what is diagnostic test for patients considered low risk for Pheochromocytoma?

 24-hour urine fractionated metanephrines andcatecholamines

 

*if positive then do CT or MRI to locate tumor

16

what is diagnostic test for patients considered high risk for Pheochromocytoma?

Plasma fractionated metanephrines 

17

how do you manage Pheochromocytoma ?

surgical resection of the pheochromocytoma 

preop: α-adrenergic blockade (phenoxybenzamine) and β-adrenergic blockade using a β-blocker such as propranolol to maintain cardiovascular and hemodynamic stability during surgery.

 

 

18

[Blank] a type of surgical site infection, is defined as an inflammatory condition of the skin and underlying subcutaneous tissue due to bacterial entry through a breach in the skin barrier.

Cellulitis

19

what are the risk factors for surgical site infections (cellulitis)?

smoking

older age

obesity

 malnutrition

diabetes

immunosuppressive therapy

20

when are surgical site infections (cellulitis) typically occur?

after abdominal surgery

21

how would you diagnose cellulitis? 

localized erythema

warmth and pain in incision site

purulent wound drainage

swelling

fever and leukocytosis

Diagnosis is clinical

22

how would you treat surgical site infection?

if cellulitis ONLY --> antibitoics

if cellulitis and abscess--> abx and I&D

23

[BLANK] is a collection of pus within the dermis or subcutaneous space, which manifests as a painful, fluctuant, erythematous nodule, with or without surrounding cellulitis

abscess

24

[BLANK] is a collection of blood, which usually results from failure of primary hemostasis. It usually appears a few days after surgery and manifests as swelling, pain, or bloody drainage from the wound

hematoma

25

[blank] is a collection of serum under the skin or in the subcutaneous space. It can also cause the incision to separate, predisposes the wound to infection, and manifests as swelling, pain, and thin, clear or blood-tinged drainage. 

Seroma 

26

[blank] is a copious, dishwater-like drainage with dusky and fiable subcutaneous tissue, pale and devitalized fascia

Necrotizing fasciitis

27

What is another name for necrotizing fasciitis of the perineum?

Fournier’s gangrene.

28

What medication is given in patients with subarachnoid hemorrhage to prevent vasospasm and subsequent mortality?

 Nimodipine (calcium channel blocker)

29

Patient will be complaining of abrupt onset of "worst headache of their life," or "thunder-clap" headache typically after physical exertion. diagnosis?

Subarachnoid Hemorrhage

 

Patients can also experience LOC, N/V, and meningeal signs.

30

how do you diagnose Subarachnoid Hemorrhage?

Diagnosis is made by non-contrast CT scan. Blood will appear white in color on the CT

If CT negative, and suspicion high, lumbar puncture

31

MCC for Subarachnoid Hemorrhage?

ruptured aneurysm

32

how do you treat Subarachnoid Hemorrhage?

supportive and nimodipine (decreases vasospasm)

33

after doing an LP on patient with suspicious subarachnoid hemorrhage, what do you see in the CSF?

Hemoglobin degradation products (xanthochromia)

34

Where are small bowel carcinoid tumors most commonly found?

ileum

35

what are the risk factors for small bowel carcinoma?

hereditary:  FAP, lynch, peutz-jeghers, IBD

diet in salt cured-food: alcohol, refined suger, red meat, smoked food

 

36

Colorectal Cancer Screening (AAFP)???

Routine?

 

Routine: Fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at 50 until 75

 

 

1 relative with colon cancer: colonoscopy at 40 or 10 years earlier than the age at which relative diagnosed

Familial adenomatous polyposis: sigmoidoscopy at age 12, then every 1-2 years

37

Colorectal Cancer Screening (AAFP)???

1 relative with colon cancer:?

1 relative with colon cancer: colonoscopy at 40 or 10 years earlier than the age at which relative diagnosed

Familial adenomatous polyposis: sigmoidoscopy at age 12, then every 1-2 years

Routine: Fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at 50 until 75

38

Colorectal Cancer Screening (AAFP)

with someone who as FAP:?

Familial adenomatous polyposis: sigmoidoscopy at age 12, then every 1-2 years​

 

Routine: Fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at 50 until 75

1 relative with colon cancer: colonoscopy at 40 or 10 years earlier than the age at which relative diagnosed

39

what is parkland formula?

to dertemine fluid resuscitation

 

*a target for adequate resuscitation after the initial treatment is a urine output of 0.5 mL per kilogram of weight per hour for adults 

40

what are the pulmonary risk factors for patients about to have surgery?

patients with COPD and increasing respiratory symptoms

decreasing exercise tolerance/ unexplained dyspnea

new lung auscultation findings 

 

** LOOK AT CHART

41

what is the treatment for peripheral artery disease (PAD)?

anti-platelet agents: aspirin or clopidogrel

42

What medication can you give to reduce intermittent claudication and improve exercise tolerance in patients with PAD?

Cilostazol

 

phosphodiesterase inhibitor

43

what is the first-line therapy for a typical anal fissure?

Fiber

Other treatment: sitz bath,  nifedipine or nitroglycerin 

44

clinical presentation of patient with anal fissures?

rectal pain and bleeding which occurs with or shortly after defecation

45

where are primary/typical fissures usually located?

posterior midline

46

Location and causes of secondary/atypical anal fissures?

Crohns, malignancy, pathological diseases

 

LOCATION: LATERAL to the anus

47

What are the steps if a patient comes in with UGI? 

*in order*

 

  1. Obtaining intravenous (IV) access
  2. nasogastric tube: assess amt of emesis and bleeding
  3. antiemetic
  4. upper endoscopy

48

How do you confirm the diagnosis of Mallory-weiss syndrome?

esophagoduodenoscopy (EGD)

49

What is  administered immediately at the time of catheterization to prevent the recurrence of early acute urinary retention due to benign prostatic hyperplasia (BPH)?

Alpha-1-adrenergic antagonists-->  relieve the obstruction in the case of BPH by relaxing smooth muscle in the bladder neck, prostatic capsule, and prostatic urethra

 

tamsulosin, alfuzosin

50

why are 5-α-reductase inhibitors drugs not useful to give to patients experiencing recurrence of early acute urinary retention due to benign prostatic hyperplasia (BPH)?

are helpful in the prevention of long term risk of acute urinary retention, but must be used for a year to be beneficial so they are not used to prevent early recurrence of retention

51

What treatment for acute urinary retention can cause transient hypotension, hematuria, and postobstructive diuresis?

 Decompression by catheterization.

52

When is esophagogastroduodenoscopy in a patient with dyspepsia done? 

patients < 60 years of age present with clinically significant weight loss, rapidly progressive alarm features, overt gastrointestinal bleeding, or if more than one alarm feature is present.

 

EGD should be performed on all patients ≥ 60 years of age with new dyspepsia.

53

Which imaging has the highest sensitivity for confirming SBO?

Abdominal CT with contrast

54

What is frequently the initial imaging modality to detect small bowel obstruction?

Abdominal X-ray but has lower sensitivity and specificity compared to CT

55

what is is a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction?

Transient ischemic attack (TIA)

56

Transient ischemic attack (TIA) are commonly associated with?

with a tightly stenotic atherosclerotic lesion at the internal carotid artery origin or in the intracranial portion of the internal carotid artery which causes impairment of collateral flow from the circle of Willis to the middle or anterior cerebral artery.

57

how do you treat TIA?

CEA: 70-90% symptomatic stenosis

carotid artery stenting (CAS): who cant undergo CEA or major surgery

Medical management: 50% stenosis

58

What medication is given prior to surgery for patients undergoing CEA?

aspirin

 

and is continued for at least three months after CEA is done.

59

 physical exam findings in pleural effusions?

↓ breath sounds

 dull percussion +

↓ tactile fremitus

60

plueral effusion CXR will show?

blunting of the costophrenic angle

61

how do different between transudative and esudative effusions?

light criteria

 

LOOK AT CHART

62

causes for parathyroidism?

 

parathyroid adenoma > gland hyperplasia, cancer

63

resenting signs and symptoms hyperparathyroidism?

 

 “bones, stones, abdominal groans, and psychic moans"

 

referring to arthralgias, kidney stones, anemia, weight loss, nausea, vomiting, constipation, depression, disorientation, and psychosis

64

labs for hyperparathyoidism?

65

how do you diagnose paraesophageal hiatal hernia?

initial: endoscopy

most sensitive: Barium swallow

66

how does sliding hiatal hernia differ from Paraesophageal hiatus hernia in terms of symptoms?

Paraesophageal hiatus hernia: epigastric or postprandial fullness, nausea, and vomiting

 

Sliding hiatus hernia: asso w/ GERD sxs--> (heartburn, regurgitation, and dysphagia)

67

SUBDURAL HEMATOMA

Patient will be ____ or _____

With a history of a _____ or ______

 

Patient will be elderly or alcoholic

With a history of a fall or traumatic head injury

 

68

SUBDURAL HEMATOMA

Complaining of _____, _____, ______, ______

headache, mental status changes, seizures, or focal deficits​

69

WHAT does a non contrast CT scan of a patient with subdural hematoma look like?

crescent-shaped hematoma

70

how to do you treat subdural hematoma?

craniotomy, burr hole trephination, or decompressive craniectomy.

71

subdural hematoma is MCC by?

 rupture of the bridging veins

72

Heart failure is diagnosed clinically. What criteria would you use?

Framingham

73

what are the major criteria in the  framingham diagnostic criteria?

 

7 things

acute pulmonary edema

cardiomegaly

hepatojugular reflex

JVD

paroxysmal nocturnal dyspnea or orthopnea

rales

third heart sound (S3) gallop

74

what is the framingham minor criteria?

 

6 things

ankle edema

SOB on exertion

hepatomegaly

nocturnal cough

pleural effusion

tachycardia >120bpm

75

what are the indicators of unresectability of gastric cancer

vascular involvement of the aorta

hepatic artery

proximal splenic artery

Distant metastases

76

Tremor in hyperthyroidism patients occurs during when?

rest?

activity?

The tremor that occurs with hyperthyroidism is typically a high frequency, low amplitude tremor that is present with action. 

77

how do you treat tremor + hyperthyroidism?

BB-->  propranolol

78

what type of tremor typically occurs at rest  and dampens with activity?

Parkinson’s disease

79

what type of tremor occurs exclusively with standing position?

 orthostatic tremor

This tremor involves the legs and trunk.

80

what do you administered perioperatively to prevent hypotension secondary to adrenal insufficiency in a patient undergoing unilateral or bilateral adrenalectomy?

Intravenous hydrocortisone

81

57 y.o. M smoker comes in with painless jaundice, (+) courvoiser sign, epigastric pain, unintentional weight loss, and depression.

diagnosis?

what is the initial modality oF imaging?

Pancreatic cancer

 Transabdominal ultrasound is preferred in patients who present with jaundice or in those patients suspected of having pancreatic cancer. 

82

a pancreatic mass is found on US, what should you do next?

obtain CT contrast of the abdomen to diagnose and stage pancreatic cancer. 

83

Which approach is preferred in cases of a bilateral adrenalectomy?

Posterior retroperitoneoscopic.

84

Which approach is preferred in unilateral adrenal tumor resection for suspected adrenocortical carcinoma?

open transabdominal approach especially with suscipcion of malignancy because greater visualization of the surrounding structures

85

what confirms diagnosis for diverticulitis?

Abdominal CT with contrast

 

*colonoscopy shouldnt be done during acute diverticulitis because it can cause perforation. colonoscopy must be done WHEN all symptoms resolve