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Surgery Flashcards

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1
Q

Amyand’s hernia

A

Inguinal hernia with appendix

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2
Q

Littre’s hernia

A

Meckel’s diverticulum hernia

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3
Q

Maydl’s hernia

A

2 small bowel loops in one sac

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4
Q

Morgangni hernia

A

abd contents in thorax

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5
Q

Pantaloon hernia

A

direct + indirect hernia

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6
Q

Richter’s hernia

A

sidewall of bowel

increased strangulation

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7
Q

Spigelian hernia

A

lat ventral wall hernia

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8
Q

Levels of axillary LNs

A

1- lat to pec minor
2- deep to pec minor
3- medial to pec minor

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9
Q

Systemic therapy for breast cancer

A

trastuzumab if HER2 +

docetaxel, adriamycin and cyclophosphamide

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10
Q

Presentation of Boerhave syndrome

A

L sided pleural effusion
subq emphysema
c/p and leukocytosis

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11
Q

Dx of Boerhave syndrome

A

water soluble contrast esophagogram

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12
Q

Staging for Melanoma

A

Clark method by level of invasion into dermal layers

Breslow method dept of invasion (better)

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13
Q

Causes of obstructions in adults (5)

A 
adhesions
hernia
Crohns
gallstone ileus
tumor
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14
Q

Causes of carpal tunnel (5)

A 
DM
hyperthyroid
acromegaly
pregnancy
myxedema
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15
Q

Tx for carpal tunnel

A

splint
NSAIDs
steroid injections q4 mo

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16
Q

Indication for cholecystectomy with acalculous gallbladder

A

<35% emptying of gallbladder

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17
Q

US findings with choledocholithiasis

A

common bile duct > 5mm

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18
Q

Dieulafoy erosions

A

bleeding from aberrant submucosal arteries in stomach

can cause significant bleeding

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19
Q

Upper GI bleeding causes

A 
Variceal veins (most common)
duodenal/gastric ulcers
Mallyr Weiss
neoplasm
AV malformation
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20
Q

Causes of acute lower GI bleeds

A 
Diverticulosis
angiogysplasia
neoplasm
hemorrhoids
IBD
ischemic bowel
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21
Q

Dx of lower GI bleed

A

colonoscopy if stable
mesenteric angiography
labeled RBC scan

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22
Q

Asscs with GI angiodysplasia

A

over 50 yrs
cardiac disease hx
aortic stenosis

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23
Q

Lobular carcinoma of breast risk

A

not seen well on mammography

resembles fibrocystic changes

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24
Q

Mgt of head trauma

A

Intubation
fluid/blood resuscitation
hyperventilation and mannitol for ICP decrease

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25
Lucid interval assc
Epidural hematoma
26
Mgt of burns
airway/intubation IV fluid resuscitation 4mL/kg/%burn in 24 hrs, half within 8hrs
27
PVD classification
1. ABI 0.8-1.0 2. ABI 0.41-0.8 (claudication) 3. ABI 0.2-0.4 (rest pain) 4-6. ABI < 0.2 with ulceration/gangrene
28
Stab wound mgt
primary assessment upright CXR FAST exam dx laparoscopy for diaphragm injury
29
Dx methods for stab wounds
local wound exploration diagnostic peritoneal lavage CT with contrast dx laparoscopy
30
Use of FAST exam
pericardial blood | abd injury
31
CT vs US in dx
CT better for abd pathology | US better for pelvic pathology
32
CRC chemo regimen
FOLFOX4 is name | 5FU, leucorovin, oxaliplatin
33
Presentation of soft tissue sarcoma
lg nontender mass in extremity
34
DDx of acute abd (8)
``` AAA mesenteric ischemia GI perforation bowel obstruction volvulus ectopic pregnancy MI splenic rupture ```
35
Medullary thyroid carcinoma assc
MEN2
36
Types of thyroid malignancies
Follicular-iodine uptake, Hurthle cells Papillary-common, Psammoma bodies, Orphan Annie eyes Medullary-calcitonin, MEN2, CEA marker
37
MEN2A neoplasms
``` Medullary thyroid parathyroid Pheochromocytoma Lichen planus amyloidosis Hirschsprungs ```
38
MEN2B neoplasms
``` Medullary thyroid pheochromocytoma Mucosal neuromas ganglioneuromatosis of GI Marfan habitus ```
39
Dx of thyroid nodule
Fine needle aspiration
40
Risks for spontaneous pneumothorax
subpleural blebs COPD TB/malignancy
41
Phases of wound healing
Inflammatory- secretion of growth factors (0-3 days) Proliferative- collagen/fibrin deposition (3-28 days) Remodeling- capillary regression (3wks to 1yr)
42
Nutrition important in wound healing
Vit C increases collagen Vit A increases epithelialization B6 increases cross linking
43
Abx for intraabdominal infections
standard=aminoglycoside +metronidazole/clindamycin | single agent options=ceftriazone, ampicillin-sulbactam, piperacillin-tazobactam, imipenem-cilastin
44
Fever within 24hrs post op
atelectasis
45
Causes of short bowel syndrome
Crohns mesenteric infarction necrotizing entercolitis (infants) volvulus
46
Assc with hepatic adenoma
OCPs | hemorrhage
47
Focal nodular hyperplasia
central scar pattern on CT women of reproductive years benign
48
Hemangioma of liver
most common benign liver tumor | do not bx due to hemorrhage
49
AFP tumor marker
HCC
50
CA 50 tumor marker
pancreatic
51
Neuron-specific enolase tumor marker
SCLC
52
CA 15-3 tumor marker
Breast cancer
53
Ferritin tumor marker
HCC
54
Tx for hepatic adenoma
excision due to hemorrhage risk
55
Indications for colon resection with diverticulitis
>4 recurrent episodes
56
Most common area for AAA
infrarenal
57
Risk reduction for AAA
beta blocker statin therapy smoking cessation
58
Surgical tx indication for AAA
>5.5cm diameter in women | >5.0cm diameter in men
59
Dx of AAA
US or CT
60
Tx for shock
fluids 1st vasopressors (NE, DA, epi) correct underlying problem
61
Definition of aneurysm
> 2x normal vessel diameter
62
Definition of ectasia
< 2x normal vessel diameter
63
Contents of triangle of Calot
Lund's node/Mascagni's node | cystic artery
64
Ann Arbor Staging
for lymphoma | 4 stages
65
Sloan Kettering LN classification
for LN of the head/neck | 6 stages
66
Dx of pancreatitis
CT scan
67
Tx for necrotizing pancreatitis
imipenem-cilastatin
68
Most common cause of unilateral bloody discharge of breast
intraductal papilloma | ductal ectasia is #2
69
DDx for nipple discharge (7)
``` pregnancy abscess galactorrhea fibrocystic changes intraductal papilloma diffuse papillomatosis (increased cancer risk) carcinoma ```
70
Tx for TIA due to carotid stenosis
tx side of TIA irregardless of stenosis %
71
Paraneoplastic syndromes with SCLC
``` Lambert-Eaton ACTH/Cushings Hypercalcemia SIADH paraneoplastic cerebellar degeneration ```
72
Courvoisier Sign
from biliary obstruction due to malignancy painless jaundice palpable gallbladder nontender
73
DDx for hypercalcemia (7)
``` hyperparathyroid malignancy (mets or PTHrP) milk alkali syndrome thiazides Pagets Familial hypocalciuric hypercalcemia granulomatous diseases ```
74
Tx for hyperparathyroid
parathyroidectomy
75
Sx of chronic mesenteric ischemia
postprandial pain | wt loss
76
Revised Cardiac Risk Index
``` risk statification for peri-op carid morbidity 1) ischemia heart disease 2) CHF 3) Cerebral vascular disease 4) High risk surgery 5) Insulin dependent DM 6) Cr >2mg/dL If RCRI >2, use beta blocker ```
77
Types of gastric ulcers
I) Lesser curvature, (70% of ulcers) 2) Assc with duodenal ulcer 3) Prepyloric region 4) High on lesser curvature 5) NSAIDs caused
78
FAST exam
``` ultrasound four views (subxiphoid, R&LUQ, pelvic) for ID of intraperitoneal fluid or pericardial fluid ```
79
Assc with myasthenis gravis
thymoma
80
Dx of MG
Edrophonium Tensilon test
81
Acute exacerbation tx of MG
plasmapheresis
82
Mediastinal tumors and location
ant-thymoma middle-lymphoma post-neurogenic tumors
83
Risk for testicular cancer
cryptorchidism
84
DDx for anal pain
anal fissure (post midline) hemorrhoids fistula-in-ano perirectal abscess
85
DDx for adrenal mass
``` adrenal adenoma pheochromocytoma mets ganglioneuroma carcinoma ```
86
Indications for adrenal tumor surgery
>4cm <4cm but enlarging solitary adrenal met
87
Dx of pheochromocytoma
24hr urine VMA/metanephrines plasma free metanephrines confirm with iodine-131 metaiodobenzylguanidine scan (MIBG)
88
Femoral hernia boundaries
Inguinal ligament superiorly Femoral vein laterally Piriformis/pubic ramus medially
89
Spigelian hernia
lateral to rectus sheath | along lower post rectus sheath
90
Obturator hernia
Mass on medial thigh
91
Necrotizing soft tissue infections
beta-hemolytic strep commonly no skin abnormalities edema and pain beyond erythema
92
Fournier gangrene
scrotal gangrene/perineum and groin | anaerobic strep and gram negative bugs
93
Wilm's tumor
peak age 1-5 years abd or flank mass hematuria
94
Abd mass with calcifications on XR in children
cystic meconium ileus | neuroblastoma
95
#1 renal mass in neonate
hydronephrosis
96
#1 renal mass in children >1yr
neuroblastoma
97
Complications of gastric bypass surgery
B12/iron/folate deficiency osteoporosis anemia
98
Dx of ITP
hypercellular megakaryocyte in marrow peripheral Plt destruction assc with IgG antiplatelet by spleen
99
Indications for splenectomy
``` congenital hemolytic anemias (thalassemia/spherocytosis) Myeloproliferative disorders ITP Hodgkins Lymphoma Splenic injury ```
100
Complications with splenectomy
abscesses postsplenectomy sepsis (in children <4yrs) encapsulated bug infections (need pneumovax)
101
Cauda equina syndrome
compression of sacral nerve bundle bladder/bowel dysfxn saddle paresthesias pain/weakness in legs
102
Mgt of herniated disc
``` bed rest heat/ice NSAIDs muscle relaxants PT ```
103
DDx for neonatal jaundice
``` hepatitis TORCH infections A1AT deficiency CF choledochal cyst/biliary atresia ```
104
Neonatal jaundice workup if over 2 weeks
abd US HIDA scan Percutaneous liver bx
105
Unconjugated hyperbilirubinemia in neonates
hemolytic disease Crigler-Najjar Gilberts Physiologic (resolved by 1 week)
106
Conjugated hyperbilirubinemia in neonates
biliary atresia insipissated bile syndrome TORCH infection/sepsis
107
Complications of biliary atresia surgery
Will develop portal HTN eventually
108
CKD stages
``` 1- >90 GFR 2- 60 to 90 GFR 3- 30 to 60 GFR 4- 15 to 30 GFR 5- <15 GFR ```
109
Common causes of CKD
DM #1 HTN glomerulonephritis
110
Transplant rejection meds
``` corticosteroids cyclosporin tacrolimus sirolimus mycophenolate mofetil/AZA ```
111
Infections post-transplant
CMV (especially) Pneumocystis carinii toxoplasmosis aspergillosis
112
Maligancies post-transplant
``` Lymphomas #1 SCC and cervical (HPV) Kaposi sarcoma NHL HCC ```
113
Empiric therapy for diabetic foot ulcer
Amoxicillin-clavulanic acid ciprofloxacin vancomycin long term IV 4-6 weeks
114
Charcot neuroarthropathy
destruction of well perfused and insensate foot extensive bone/joint remodeling similar presentation as diabetic foot ulcer
115
Wagner ulcer classification
``` 1-superficial 2-involves ligament, tendon or fascia 3- abscess or osteomyelitis 4-gangrene of distal foot 5-extensive gangrene ```
116
Lucid interval assc
epidural hematoma
117
Sx of chronic subdural hematoma
change mental status worsening over 1-4 weeks | due to trauma
118
Basilar skull fracture presentation
raccoon eyes fluid dripping from nose/ears ecchymosis behind ears
119
Mgt of hypovolemic shock from gunshot
Lg bore IV lines exploratory lap to control bleeding IV fluids after lap
120
Mgt of tension pneumothorax
chest tube placement prior to CXR | Lg bore IV
121
Vessels causing excess blood with hemothorax
intercostal arteries | tx with thoracotomy for ligation
122
Mgt of flail chest
fluid restriction/diuretics respiratory support r/o other causes
123
Presentation of diaphragmatic rupture
no breath sound on L side
124
Presentation of Aortic rupture
widened mediastinum | dx with arteriogram
125
Dx of intra-abd bleeding
periotneal lavage sonogram CT if stable
126
Mgt of bladder/urethral blood in trauma
retrograde urethrogram
127
Sx of fractured tunica albuginea
lg penile shaft hematoma | surgical emergency
128
Mgt of electrical burns
IV fluids and diuretics for myoglobinuria | surgical debridement
129
Complications of circumferential burns
circulatory compression/compromise | escharotomy needed
130
Mgt of 2nd degree burns
silvadene (silver sulphadiazine)
131
Fluids for burn pts
4cc/kg/% burned (up to 50%) 1/2 in first 8 hrs rest in remaining 16 hrs urinary output goal 1cc/kg/hr
132
Lg breast mass with slow growth
cystosarcoma phyllodes | bx and resection for mgt
133
Leukocoria in kids
retinoblastoma | cataracts
134
Mgt of acute glaucoma
mannitol pilocarpine acetazolamide
135
Mgt of Barrett's esophagus
Nissen fundoplication
136
Mgt of Boerhave Syndrome
gastrographin swallow to confirm | emergency surgery
137
Mgt of small bowel obstruction
NG tube and suction IV fluids observation
138
Dx of carcinoid syndrome
5-hydroxy-indoleacetic acid
139
Mgt of melena in unstable/hypotensive pt
NG tube, if no blood then emergency angiogram
140
Bloody stool in children
``` #1 Meckel's diverticulum dx with technetium scan ```
141
Acute abd and free air under diaphragm
most likely duodenal perforation | tx with exploratory lap
142
Dx of ureteral colic
KUB xray of abd | sonogram or IV pyelogram
143
Acute abd with elderly Afib pts
mesenteric artery occlusion | blood in stool and acidosis seen
144
Mgt of CRC mets to liver
one lobe-resection | both lobes-chemo
145
Amebic abscess mgt
tx with metronidazole serology titers DO NOT drain assc with Mexico
146
Mgt of hemorrhagic pancreatitis
serial CT for abscesses drainage of abscesses support
147
Thyroid mass with normal histology
no such thing metastatic follicular carcinoma thyroid scan to look for primary
148
Mgt of Cushing's
AM and PM cortisols dexamethasone suppression test MRI removal of adenoma
149
Mgt of gastrinoma
serum gastrin CT of pancreas removal of tumor
150
Sx of glucagonoma
stomatitis DM migratory necrolytic dermatitis
151
Borchardt's triad
epigastric pain retching w/o vomiting inability to pass NG tube for gastric volvulus
152
ASA classification
``` American Society of Anesthesiologists 1) Healthy 2) Mild systemic disease 3) Severe systemic disease 4) Extreme systemic disease 5) Emergency that is 1 or 2 6) Emergency that is 3 or 4 For surgery risk ```
153
Revised cardia risk index interpretation
0= 0.4% cardiac death, MI during surgery 1= 0.9% 2=6.6% 3>or = 11%
154
HTN unresponsive to meds
fibromuscular dysplasia | tx with balloon dilitation
155
DDx for bilary emesis in newborn
duodenal atresia annular pancreas malrotation
156
Cause of intestinal atresia in neonates
vascular accident in utero
157
Mgt of meconium ileus
gastrografin enema | surgery if enema ineffective
158
Mgt of intussusception
barium enema | lap if enema ineffective
159
Midline neck mass mgt
Likely thyroglossal duct | Sistrunk operation
160
Lateral neck mass mgt
Likely branchial cleft cyst | surgical removal
161
Fluid filled mass at base of neck
likely cystic hygroma | CT of neck and surgical removal
162
Mgt of enlarged LN
reschedule in 3 weeks and reassess if resolved-infection if persistent-workup and bx
163
Mgt of metastatic SCC of head/neck
triple endoscopy | FNA
164
Ludwig's angina
abscess of floor of the mouth | tracheostomy and drainage
165
CN VII palsy after trauma
if immediate-temporal bone transection | if gradual-edema from trauma (no tx)
166
Indications for aortic valve replacement
gradient over 50mmHg CHF from AS angina/syncope
167
Murmur echoing to axilla
mitral regurg
168
Lung surgery qualifications
need FEV1 at least over 800
169
Subclavian steal syndrome presentation
claudication of nondominant arm post brain neuro sx mgt with angiography and surgery
170
Mgt of aortic dissection
beta blockers and IV nitrates for BP control surgery for ascending AD ICU medical mgt for descending
171
Sx of brain tumors
progressive neuro sx emesis from increased ICP morning HA's tx=mannitol/hyperventilation/steroids/surgery
172
Bitemporal hemianopsia in children
Craniopharyngioma with calcifications | dx with MRI
173
Foster Kennedy syndrome
from frontal lobe tumors optic atrophy/papilledema central scotoma anosmia
174
Mgt of spinal cord syndromes
high dose corticosteroids
175
Sx of disc herniation
Positive straight leg raise muscle spasm pain down leg
176
Causalgia
reflex sympathetic dystrophy follows crush injury cold/cyanotic/moist extremity tx with surgical sympathectomy
177
Mgt of congenital hip dysplasia
abduction splinting
178
Leggs-Perthes disease
avascular necrosis of capital femoral epiphysis lat and AP XR for dx tx with casting and crunches
179
Slipped capital femoral epiphysis
ortho surgery needed | groin pain/limp
180
Post shoulder dislocation
easily missed on XR | axillary and scapular lat XR view needed
181
Risk with post hip dislocation
avascular necrosis of femoral head
182
Mgt of femur fractures
femoral neck-metal prosthesis (due to blood supply) | intertrochanteric-pinned together
183
Mgt of stress fractures
not seen on XR for 2 weeks | return in 2 weeks and repeat XR and cast
184
Mgt of priapism
alpha agonist injection into corpora
185
Low implantation of ureter
seen in females ureter empties into vagina IVP and surgery for mgt
186
Mgt of painless, gross hematuria
IV pyelopgram first cystoscopy possible CT afterwards
187
Mgt of prostate mass
trans-rectal needle bx | surgical resection
188
Mgt of prostate mets
LH agonist flutamide orchiectomy
189
Mgt of prostate cancer over 75yrs
if asymptomatic, no tx
190
Mgt of testicular mass
radical orchiectomy (rarely benign) LN dissection Platinum based chemo AFP and beta-hCG for monitoring

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