Surgery Flashcards by Abi Hager

Most common place to find inflammation of the GI tract with Crohn’s disease?

Terminal ileum

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Name 4 things you will see on lab work after vomiting

Hypokalemia, hypochloremia, metabolic alkalosis, aciduria

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Four Fs of cholecystitis

Female, Fat, Forty, Fertile

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Inspiratory arrest when palpating the RUQ is what famous sign

Murphy’s sign = cholecystitis

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Name two places of referred pain for acute cholecystitis

Right back/flank and right shoulder

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Main difference btw acute and chronic pancreatitis

No elevated lipase/amylase in chronic and will show calcifications on pancreas

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What antibiotic can cause biliary sludge?

Ceftriaxone

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Where are anal fissures most commonly found?

Posterior midline

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Pt presents with tearing rectal pain with bowel movements that last for hours after. Blood on tissue after BM. What is the dx and tx

Anal fissure. Conservative tx = sitz baths, high fiber diet, stool softeners. Next: nifediine ointment, nitro ointment, topical diltiazem, botox. Last resort: lateral internal sphincterotomy

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Sentinel pile refers to

Skin tag associated with anal fissure

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Abd pain, bilious vomiting, hyperactive (high pitch) bowel sounds, dilated loops of bowel on radiograph all point to what dx

Small bowel obstruction

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Treatment for small bowel obstruction

NPO, place NG tube, IV fluids

If strangulated or peritoneal signs = emergency surgery

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First 2 weeks post op, pt presents with abd pain, vomiting, current jelly (bloody mucous) stools, and a sausage like mass on exam. What is most likely the dx?

Intussusception

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What should you order for a pt with intussusception?

Labs, ultrasound: US will show target sign, place NG tube, and give IVF.

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Pt presents with obstipation, abdominal pain, vomiting 3 days post-op. Radiographs show dilated loops of bowel. What is dx and tx

Paralytic ileus

NPO, NG tube, IVF, stop opiates

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Pt feels full after eating small amounts of food with stomach pain and nausea. What is dx and tx

Gastroparesis. Treat with high fiber diet and Regalen/Metaclopramide (D2 antagonist)

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Pt presents with diarrhea after major surgery and abscess. MCC and diagnosis?

C-diff from broad spectrum abx such as penecillins, cephalosporins, or FQs

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Dx and Treatment for C-diff

Stool culture. Treat with flagyl or PO Vanc (remember this is the only use for oral vanc)

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MCC of large bowel obstruction in older adults

Carcinoma of the colon or diverticulitis

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MCC of SBO in adults

Adhesions from surgery

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4 cardinal signs for bowel strangulation

fever, leukocytosis, tachycardia, localized abd tenderness

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If hemorrhoids are painful, are they internal or external?

External

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If a patient has internal hemorrhoids, but notices pain when a “lump” protrudes out of her anus, what is causing the pain?

Prolapse

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Bright red painless bleeding per rectum in a young person is most commonly

Internal hemorrhoids

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Name the grades of internal hemorrhoids

I: no prolapse II: prolapses with defecation but reduces spontaneously III: prolapses with BMs but must be manually reduced IV: Irreducible and could be strangulated

Hemorrhoidectomy is reserved fro what grade of hemorrhoids

Stage IV

Treatment for mild to moderate IBD?

Sulfasalazine or 5-ASA

String sign of the terminal ileum on radiographs or cobblestoning and skin lesions on endoscopy should make you think of

Crohn's disease

The lead pipe or tubular appearance on radiographs

Ulcerative colitis

Bloody diarrhea and continuous inflammation should make you think of what IBD?

A pt with IBD that is taking sulfasalazine should be on what supplement?

Folate

What part of the colon is diverticulosis MC?

Sigmoid

Treatment for uncomplicated diverticulitis?

Cipro/Levo + Metronidazole

What type of imaging is CI in acute diverticulitis

Barium enema and colonoscopy

Two MC organisms involved in diverticulitis

E. Coli and B. Fragilis

Toxic megacolon is usually caused by

UC or C. Diff

Pt with UC presents with fever, tachycardia, abd pain, abd distention, and bloody diarrhea. Colon is dilated >6 cm. Dx is most likely

toxic megacolon

MCC for esophageal stricture

GERD

Shatzki ring is usually present with

hiatal hernia | shatzki ring can cause dysphagia with solids

Plummer-Vinson Syndrome is

Triad: dysphagia + esophageal webs + iron deficiency anemia

Elderly man with dysphagia, weight loss, and sig hx of smoking and alcohol use. What imaging modality should you use

Esophagoscopy

GERD is associated with what type of esophageal cancer

Adenocarcinoma

Smoking and drinking is associated with what esophageal cancer

SCC

Abd pain that improved with meals is most likely a

Duodenal ulcer

What is triple and quadruple therapy for H. Pylori?

Tetracycline + Metronidazole + PPI ( + Bismuth for quad)

Left-sided (distal) colorectal cancer lesions are associated with

Streptococcus bovis endocarditis

A nodule on the thyroid that does not take up any iodine is most likely

Cancer

Thyroid nodules that take up iodine are

Benign

Ascending aortic dissection is

a surgical EMERGENCY! Need open repair stat

How can you treat aortic dissection prior to sugery

Lower the BP: BBs, nitro, pain control

Patient presents with "ripping" or tearing chest pain that radiates to the back. What do you expect to see on x-ray?

Widened mediastinum

Severe iron deficiency anemia post gastric by-pass may present with symptoms like

Cheilosos, koilonychia, pallor, dry skin

Labs with iron deficiency anemia will show

Low iron and ferritin but high TIBC

Two main RF for gastric cancer

Smoking and H. Pylori

A man who smokes, lost 20lbs in 6months, and has intermittent abd pain most likely has

Gastric cancer, adenocarcinoma

Barretts esophagus leads to what type of cancer

Esophageal; adenocarcinoma

Smoking and drinking leads to what type of esophageal cancer

SCC

Usually, a patient with Crohn's will present with bloody or non-bloody diarrhea?

Non-bloody

What specific labs are we looking for with Crohn's

ASCA positive; p-ANCA negative (UC)

After assessing ABCDE a pt with 2nd or 3rd degree burns, what do you do?

Give 4L of LR over 8 hrs

Gram neg bacteria associated with wound burns

Pseudomonas aeruginosa

Transudate fluid for a pleural effusion is usually from

CHF

Exudate fluid in a pleural effusion is usually from

Lung inflammation

Some skin lesions must be excised with 1 or 2cm margins. When do you do each

If the biopsied lesion is <1mm thick = 1cm margin | If >1mm thick = 2cm margins

What size AAA needs operated on

5.5cm or greater

Who should get at least one abd US for AAA rupture prevention

Men 65-75 y/o with smoking history

MCC of inherited colorectal cancer

Lynch Syndrome; also increases risk for endometrial cancer

RLQ pain with neg rebound or guarding + bloody stools should make you think

colorectal cancer with lynch syndrome

When should an IVC filter be placed

Pt has evidence for VTE and cannot take anticoagulant (anticoagulation is CI in pts that are actively bleeding)

A hernia medial to the inferior epigastric is a

Direct inguinal hernia

A pt with a pituitary adenoma will likely show what visual deficits

Diminished temporal fields or hemianopsia

Pts with DVT and cancer should receive what

Low molecular weight heparin

Cortisol-secreting adrenal carcinoma is surgically removed. What should be given immediately after to prevent hypotension

IV hydrocortisone

Classic triad for pheochromocytoma

Headaches, sweating, tachycardia

What happens when a person has pheochromocytoma

Chronically high catecholamines

What drug should be given preop for pheochromocytoma

Phenoxybenzamine to control BP and HR

What type of skin lesion has telangiectasia within papule

BCC; Tx: MOHs surgery

Ulcerated lesions with raised edges

SCC

Alkalosis = what electrolyte imbalance

Hypokalemia (K+ is shifting INTO the cells through H+K_ pump)

Acidosis = what electrolyte imbalance

Hyperkalemia

When is wound debridement required fro healing?

Stage 3 and 4. Into the hypodermis (3) or bone/soft tissue (4) with fat or eschar present

MC type of testicular cancer

Seminomatous germ cell tumor

Low BP, abd pain, and hematochezia should suggest

Ischemic colitis

What two areas are known for ischemic colitis

Splenic flexure and rectosigmoid junction

2/3 of volvulus affects what part of the colon

Sigmoid (bent inner tube on x-ray)

Treatment for sigmoid volvulus

Flex sig and then sigmoidectomy electively

Cecal volvulus is normally found in a different population than sigmoid, what pop

Younger, 30s-50s. Look for coffee bean sign

What is the FIRST LINE drug for hyperkalemia with peaked T waves

10% Calcium gluconate to stabilize the membrane; THEN you can give albuterol or insulin or bicarb

What should be measured intraoperatively to confirm the parathyroid adenoma is causing the problem

PTH

In hyperparathyroidism the phosphorus levels will be

Low

Hemophilia A and B affect what part of the coag cascade

``` A = 8 B = 9 ```

What promotes drug factor VIII and VWF

Desmopressin; use in hemophilia 8 and VWF disease

Thickened colon and fat stranding should indicate

Diverticulitis. Start IV ABX

Free air on CXR calls for

Ex lap

What is the first thing you should order on a pt with syncope

ECG

What long term treatment should be administered after a Roux-en Y bypass

Micronutrient supplementation

"worst HA of my life" is mc caused by

a ruptured aneurysm

What do you expect to see on lumbar puncture in a SAH?

Xanthrochromia = degredation of Hb (bilirubin = yellowish)

Post-prandial abd pain, diarrhea, and weight loss on a pt with sig CVD and smoking hx is at major risk for

Mesenteric ischemia

A lentil or biconvex shape hematoma in the brain is indicative of

Epidural hematoma

Lunar shaped hematoma is indicative of

Subarachnoid hematoma

Most SENSITIVE test for cholecystitis

HIDA

First test for cholecystitis

RUQ US

Excisional hemorrhoidectomy is reserved for

Grade IV

MC thyroid cancer

Papillary

Most aggressive thyroid cancer

Anaplastic

A gastrin secreting tumor (gastrinoma) that leads to diarrhea and PUD should make you think

Zollinger-Ellison Syndrome

With a GI bleed, on BMP you might see

Elevated BUN/Cr

Pneumothorax affecting <15% of lung space =

Supplemental O2 only

What is Courviosier sign and what does it mean

Palpable gallbladder with jaundice = pancreatic cancer

MC non-infectious cause of post-op fever is

Medications

Painless hematuria in a pt with smoking hx should make you think

Bladder cancer

What would CBC show with megaloblastic anemia

Elevated MCV but low Hb and HCT. Usually B12 deficiency

Surgery Flashcards

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