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LMCC > Surgery > Flashcards

Surgery Flashcards

(101 cards)

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1
Q

Sclerotherapy

A

Varicose vein treatment
Inject superficial vein lumen with sclerosing substance (hypertonic saline, detergent solutions ie. sodium tetradecyl sulfate and corrosive agents ie. glycerin) which reacts with vascular endothelium and seals the vein leading to its permanent collapse

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2
Q

Up to ___ deg angulation is acceptable in fifth metacarpal fractures

A

40

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3
Q

Up to ___ deg angulation is acceptable in second metacarpal fractures

A

10

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4
Q

Up to ___ deg angulation is acceptable in third metacarpal fracutres

A

20

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5
Q

Boxer’s fracture

A

Acute angulation of neck of 5th metacarpal into palm

Ulnar gutter x 4-6wks

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6
Q

Major predictors of increased perioperative CV risk

A

Unstable coronary syndromes
Acute or recent MI with evidence of important ischemic risk by clinical symptoms or noninvasive study
Unstable or severe angina
Decompensated HF
Significant arrhythmias
High grade AV block
Symptomatic ventricular arrhythmias with underlying heart disease
Supraventricular arrhythmias with uncontrolled ventricular rate
Severe valvular disease

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7
Q

Treatment of tension pneumothorax

A

Needle thoracostomy at 2nd ICS mid clavicular line

then chest tube in 5th ICS anterior axillary line

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8
Q

Treatment of hemothorax

A

Tube thoracostomy

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9
Q

Most common neoplasm found in ventricular system of brain, esp in children

A

Ependymomas

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10
Q

2 most commonly injured knee structures

A

Medial collateral ligament

Anterior cruciate ligament

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11
Q

Open pneumothorax treatment

A

Air tight dressing sealed on 3 sides (allows air to escape during expiratory phase but seals itself during inspiratory)
Chest tube
Surgery

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12
Q

Incarcerated hernia

A

Can’t be reduced

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13
Q

Strangulated hernia

A

Vascular supply of bowel is compromised

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14
Q

Internal hernia

A

Sac protrudes through fascial defect within abdo cavity or diaphragm

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15
Q

Richter’s hernia

A

Only part of bowel wall is affected

Can lead to strangulation of that part –> gangrene –> perforation

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16
Q

Spigelian hernia

A

AKA lateral ventral hernia

Sac protrudes through defect in linea semilunaris

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17
Q

Littre’s hernia

A

Involves meckel’s diverticulum

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18
Q

Most common type of inguinal hernia

A

Indirect

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19
Q

Investigation of choice to dx Meckel’s diverticula in children

A

Technetium-99m pertechnetate scan
Radionuclide binds to plasma protein and accumulates in functional gastric mucosa –> focus of increased activity often mid abdo or in RLQ

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20
Q

Pyloric stenosis

A

2-8wks of age
1st born male
Non-bilious vomiting PPP
Palpable olive, visible gastric peristalsis
Volume depleted - hypoK, hypoCl, metabolic alkalosis

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21
Q

Intussusception

A

3mo to 3yrs of age
Adenovirus, rotavirus, mostly idiopathic
Some have lead points (meckel’s, polyp, tumour)
10% recurrence

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22
Q

Pneumotosis intenstinalis on AXR

A

Necrotizing enterocolitis

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23
Q

Bleeding meckel’s diverticulum is typically painless vs painful

A

Painless

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24
Q

Gastroschisis

A

Tissues exposed outside of abdo wall

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25
Omphalocele
Tissues covered outside of abdo wall
26
Risks a/w succinylcholine
Malignant hyperthermia | Hyperkalemia
27
Malignant hyperthermia
``` Genetic dz Auto dominant with reduced penetrance Mutations with ryanodine receptor Chromosome 19 Pts with diseases (central core disease, minicore myopathy, King-denborough syndrome) that affect chromo 19 are at high risk of developing MH if exposed to triggering agents ```
28
Postcholecystectomy syndrome
Persistent abdo pain, dyspepsia after chole Caused by changes in bile flow due to loss of reservoir function in gallbladder Can lead to: continuous increase of bile flow into upper GI tract leading to esophagitis and gastritis or related to lower GI tract where diarrhea and colicky lower abdo pain may result
29
Fothergill sign
Mass does not change in shape or cross midline with rectus sheath flexon, suggests rectus sheath hematoma
30
Epidural hematoma
Lenticular shaped bleed on NCCT Most often caused by severe trauma rupturing middle meningeal artery Admit, serial CTs if stable (<30mL, <15mm thick, minimal midline shift, GCS < 8, no focal deficit) Otherwise, urgent craniotomy to evacuate clot
31
Subdural hemorrhage
``` Crescent shaped bleed Rupture of vessels that bridge subarachnoid space Serial CTs if stable/improving Craniotomy if clinically symptomatic More likely to present subacute/chronic ```
32
Peptic stricture
Endstage of chronic reflux esophagitis Often a/w hiatal hernias Heartburn, dysphagia, odynophagia, food impaction, weight loss, chest pain Progressive with solids then liquids
33
Achalasia
Failure of peristalsis of esophagus and LES failure Rare Simultaneous difficulty in swallowing solids and liquids
34
Risk factors a/w colonic volvulus
``` Chronic constipation Advancing age (usually 70-80yo) Institutionalized pts with neuropsych d/o Use of psychotropic drugs High fiber diet ```
35
Most common cause of fever first 48h post-op
Atelectasis
36
Biliary atresia
Conjugated bilirubinemia Shrunken gallbladder on U/S Biopsy that reveals portal fibrosis and bile duct proliferation
37
Tx for biliary atresia
``` Kasai proecdure (most successful procedure is Roux-en-Y hepatoportojejunostomy done before 60d of age) Ursodeoxycholic acid may be useful to promote bile flow in patent extrahepatic biliary system (done AFTER kasai procedure) Liver transplant is definitive tx ```
38
Top 3 causes of SBO
From most common to least 1. Adhesions 2. Bulge (hernias) 3. Cancer
39
Triad of findings in AXR for SBO
1. Dilated small bowel (>3cm) 2. Air fluid levels on upright 3. Scare air in colon
40
Imaging sign of ischemic bowel
Pneumatosis intestinalis (free air in bowel wall)
41
Inguinal hernia anatomy
MDs don't LIe Medial to the inferior epigastric artery = Firect inguinal hernia Lateral to the inferior epigastric artery = Indirect inguinal hernia
42
Borders of Hesselbach's Triangle
Lateral: Inferior epigastric artery Inferior: Inguinal ligament Medial: Lateral margin of rectus sheath Direct inguinal hernias protrude through this triangle
43
Post-op complications from hernia repair
Recurrence Scrotal hematoma (painful swelling from compromised venous return of testes) Nerve entrapment - ilioinguinal N --> numbness of inner thigh or lateral scrotum; genital branch of genitofemoral N --> in spermatoc cord Stenosis of femoral vein --> acute leg selling Ischemic colitis
44
Hernia most likely to become strangulated
Femoral
45
Most common hernia in women secondary to pregnancy
Femoral
46
Crohn's disease surgery options
Resection and anatomosis | Stricutroplasty
47
UC surgery options
Proctocolectomy and ileal pouch-anal anatomosis | Proctocolectomy with permanent end ileostomy
48
Hartmann procedure
Proctosigmoidectomy - resection of rectosigmoid colon with closure of anorectal stump and formation of an end colostomy Anastomosis in ~3mo
49
Top causes of LBO in order
Cancer Diverticulitis Volvulus
50
Ogilvie's syndrome
Acute pseudo-obstruction Distention of colon without mechanical obstruction in distal colon Usually conservative mgmt only
51
Outpt treatment of LBO
Clear fluids | Ancef + Flagyl 7-10d
52
Most common non-neoplastic polyp
Hyperplastic
53
Malignant potential of polyps
Villous (sessile) > tubulovillous > tubular (pedunculated)
54
Familial adenomatous polyposis
Auto dominant colorectal adenomas --> virtually 100% lifetime risk of colon CA If no polyposis found: annual flex sig from puberty to age 50, then routine screening Tx: Sx indicated by 17-20yo, total proctocolecotmy with ileostomy or total colectomy with ielorectal anastomosis + chemo
55
Hereditary non-polyposis colorectal Cancer
AKA Lynch syndrome Auto dominant R>L
56
HNPCC I
Hereditary site-specific colon CA
57
HNPCC II
Cancer family syndrome - high rates of colon, endometrial, ovarian, hepatobiliary, small bowel CA
58
Amsterdam Criteria to dx hereditary non-polyposis colorectal CA
- 3 or more relatives with verified Lynch syndrome associated cancers and 1 must be 1st degree relative of other 2 - 2 or more generations involved - FAP excluded
59
Angiodysplasia most common location
Right colon of pts >60yo
60
Volvulus types in order of frequency
Sigmoid > cecum > transverse colon > splenic flexure
61
UC vs CD for more likely to cause toxic megacolon?
UC
62
1st degree hemorrhoids
Bleed but don't prolapse | Tx: high fibre, sitz baths, steroid cream, parmoxine (Anusol), rubber band ligation, sclerotherapy, photocoagulation
63
2nd degree hemorrhoids
Bleed, prolapse with straining, spontaneous reduction | Tx: Rubber band ligation, photocoagulation
64
3rd degree hemorrhoids
Bleed, prolapse, requires manual reduction | Tx: Same as 2nd degree, may require close hemorrhoidectomy
65
4th degree hemorrhoids
Bleed, permanently prolapse, can't be manually reduced | Tx: Closed hemorrhoidectomy
66
Tx for anal fissures
Stool softeners, increased fibre intake, sitz baths Topical nitro or CCB Lateral internal anal sphincterectomy (most effective) - NOT POSTERIOR (causes keyhole deformity) Botox
67
Most common neoplasm of anal canal
SCC of anal canal | ABOVE dentate line
68
Most common benign hepatic tumour
Cavernous hemangioma
69
Most common malignant hepatic tumour
Metastases (colorectal)
70
Definitive mgmt of acute cholangitis
ERCP and sphincterotomy
71
Most common gallbladder cancer
Adenocarcinoma
72
Cholangiocarcinoma
Malignancy of extra or intrahepatic bile ducts
73
whipple procedure
pancreaticoduodenectomy | Remove: CBD, gallbladder, duodenum, head of pancreas, sometimes distal portion of stomach
74
Most clearly established risk factor for pancreatic CA
smoking
75
Most common location for pancreatic CA
Head of pancreas
76
Most useful serum marker of pancreatic CA
CA 19-9
77
Most common type of pancreatic CA
Ductal adenocarcinoma
78
Two greatest risk factors for breast CA
1. Gender | 2. Age
79
Most common type of breast CA Found in men and women
Invasive ductal carcinoma
80
Triple test for breast CA Dx
1. Clinical breast exam 2. Imaging (U/S <30yo, mammography + U/S if >30yo) 3. Pathology (U/S or mammography guided core needle biopsy preferred over excisional)
81
Lobular carcinoma in situ vs ductal carcinoma in situ tx
DCIS needs lumpectomy with wide excision margins + radiation vs LCIS which does NOT need wide excision s
82
Paget's disease of breast
Ductal carcinoma that invades nipple with scaling and eczematoid lesion
83
Tamoxifen
SERM | regular gyne f/u if on it for breast CA tx b/c of increased risk of endometrial CA
84
Most common sites of metastasis for breast CA
Bone > lungs > pleura > liver > brain
85
Best predictor of primary adrenal carcinoma
Size > 6cm
86
Pheochromocytoma investigation
24h urine epinephrine, norepinephrine, metanephrine, normetanephrine, vanillylmandelic acid
87
Cushing's investigation
24h urine cortisol or 1mg O/N dexa suppression test
88
Treatment of adrenal gland tumours
Functional --> resect | Non-functional: >4cm --> resect, <4cm --> F/U imaging in 6-12mo, resect if >1cm enlargement
89
Vasoactive intestinal peptide secreting tumour
Commonly located in distal pancreas Most are malignant when diagnosed Severe watery diarrhea, dehydration, weakness, lyte imbalance Dx: serum VIP, CT, U/S Tx: Somatostatin analogues, surgical resection
90
Peds hydrocele
Most resolve spontaneously by 1 yr | Surgical repair if persist >2yr, painful, infection
91
Umbilical hernias
Repair if not spontaneously closed by age 5
92
Hirschprung's disease rectal biopsy
Gold standard for dx | Look for aganglionosis and neural hypertrophy
93
Cryptorchidism
Most spontaneously descend by 6mo Tx: hCG to stimulate T production (descent mediated by descendin which is created in response to testosterone) Orchidopexy if undescended by age 6mo-2yr No effect on malignant potential on testicle
94
Most common cause of bowel obstruction btwn 6-36mo
Intussusception
95
Peds inguinal hernias
ALL INDIRECT Incarceration more common in female Low birth weight and male sex increases risk Dx: PHYSICAL EXAM (U/S only if uncertain by P/e) Tx: manual reduction in ED and repair within few weeks if <1yr vs elective if >1yr If incarcerated --> emergency repair
96
Metastatic disease from testicular cancer most likely to spread to ____ lymph nodes
Retroperitoneal/para-aortic
97
Metastatic disease from lung cancer most likely to spread to ____ lymph nodes
Mediastinal
98
Metastatic disease from small/large bowel CA most likely to spread to _____ lymph nodes
Mesenteric
99
Acute cholangitis treatment
Endoscopic sphincterectomy
100
3 most common causes of acute dyspnea in postoperative period
``` Laryngospasm (stridor) Bronchospasm Aspiration PNA (crackles/rhonchi in RLL) ```
101
Malignant hyperthermia treatment
``` Discontinue volatile agents and succinylcholine, hyperventilate Dantrolene IV Bicarb Coll patients if core temp >39 Manage hyperkalemia ```

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