Surgery Flashcards
Most common cause of esophageal perforation?
Iatrogenic
Most potent physiologic stimulus for pepsinogen release?
Food
The highest perforation rate after a caustic esophageal injury occurs during?
Ulceration and granulation phase
Surgical management of uncomplicated Barrett’s esophagus?
Anti-reflux procedure
The most effective surgical treatment for GERD?
Nissen fundoplication
Surgical treatment for ACHALASIA?
Heller’s myotomy +/- Partial fundoplication
Most common primary esophageal motility disorder?
Nutcraker/Supersqueezer esophagus
The only tumor virtually restricted to the Parotid gland?
Warthin’s tumor (Papillary cystadenoma lymphomatosum)
Where are foreign bodies in the head and neck most commonly found?
Ear
A deep neck infection may extend down to the mediastinum through?
Substernal space of Burns
Most common malignant tumor of the parotid gland?
Mucoepidermoid carcinoma
Most common malignant tumor of the minor salivary glands?
Adenoid cystic carcinoma
Most common brachial cleft anomaly?
2nd brachial cleft
Most common type of malignancy arising from a thyroglossal duct cyst?
Papillary carcinoma
Highest perforation rate after a caustic esophageal injury occurs during?
Ulceration and granulation phase
Surgical treatment of uncomplicated Barrett’s esophagus?
Anti-reflux procedure
Most effective surgical treatment for GERD?
Nissen fundoplication
Gold standard in the diagnosis of GERD?
24 hour pH monitoring
Most common organism responsible for acute otitis externa?
Pseudomonas aeruginosa
Most common primary tumor of the middle ear?
Glomus jugulare/ glomus tympanicum
Nasopharyngeal carcinoma is best treated by?
Chemo-radiotherapy (Cisplatin/5-FU)
Structures preserved in a modified radical neck dissection?
Sternocleidomastoid muscle
Internal jugular vein
Spinal accessory nerve
A “butterfly shaped” ulcer involving the hard palate?
Necrotizing sialometaplasia
Otologic meningitis is usually due to?
H. Influenza type B
Painless mass of the jaw associated with an impacted teeth?
Ameloblastoma (Adamantinoma)
Form of mucus retention cyst that involves th sublingual gland?
Ranula
Single most important predictor of survival in breast cancer?
Axillary lymph node metastasis
Breast cancer type confirmed by the presence of intracytoplasmic mucin?
Lobular CA
“Indian file configuration”
Paget’s disease may be confused with type of melanoma?
Superficial spreading melanoma
Most frequent site of metastasis for breast cancer?
Bone (vertebra)
Most important risk factor in the development of breast CA?
Gender
The level of axillary lymph nodes are based on this structure?
Pectoralis minor
Chronic inflammatory condition of the nipple areola complex that originates from areolar glands?
Hidradenitis suppurativa
Epidemic puerperal mastitis is most often transmitted via?
Suckling neonate
Kaposi’s sarcoma is treated primarily by?
Radiation
A rare but aggressive cutaneous malignancy arising from neuroendocrine cells?
Merkel cell carcinoma
Tumors arising from areas of previous radiation/lymphedema?
Angiosarcoma (Stewart-Treves Syndrome)
Mainstay of treatment for severe necrotizing soft tissue infections?
Wide debridement
Gold standard in the diagnosis of Pulmonary Embolism?
Pulmonary Angiogram
Most dreaded complication of placing a Swan Ganz catheter?
Pulmonary artery rupture
Most common cause of graft loss post kidney transplant?
Recipient death (Cardiovascular causes) - 1st
Allograft nephropathy - 2nd
A lethal and rapidly progressive soft tissue infection caused by microaerophilic streptococcus?
Meleney’s synergistic gangrene
Microsatellite instability is the hallmark of what hereditary cancer syndrome?
Lynch Syndrome (HNPCC)
Organism most elevated in primary liver cancer and germ cell tumors?
AFP
Most commonly mutated gene in human cancer?
P53
Earliest known genetic alteration in colorectal cancer?
APC gene
The sudden multiple appearance of seborrheic keratoses?
Lesser Trelat sign
Stressed induced hyperglycemia is primarily due to?
Peripheral resistance to insulin
Basic caloric requirement of a normal healthy adult?
25 kcal/kg per day
Reduced REE is characteristic of this phase of surgical metabolism?
Ebb phase
The primary source of energy during the stressed state?
Fat (50-80%)
Stressed induced hyperglycemia is primarily due to?
Peripheral resistance to insulin
Basal caloric requirement of a normal healthy adult?
25 kcal/kg per day
Mild stress - 25-30
Moderate stress - 30
Severe stress - 30-35
Burns - 35-40
A 60-year-old man with carcinoma of the esophagus is admitted with severe malnutrition. Nutritional support is to be initiated. What should be his daily caloric intake?
30 kcal/kg body weight/day
Reduced REE (resting energy expenditure) is characteristic of this phase of surgical metabolism?
EBB phase
The primary source of energy during the stressed state?
Fat (50-80%)
How many kilocalories does Liter of D5LR provides?
170kcal
Systemic proteolysis following injury is mediated primarily by?
Glucocorticoids
Development of dry, scaly dermatitis and alopecia while on prolonged par enteral treatment is most likely due to?
EFA deficiency
Differentiate VS Zinc deficiency
—–“Eczematoid rash”, diffuse/intertrigenous areas
A 42 y/o man with small-bowel fistula has been receiving TON within standard hypertonic glucose-amino acid solution for 3 weeks. The patient is noticed to have scaly, hyperpigmented lesions over the acral surfaces of elbows and knees, similar to enterohepatic acrodermatitis. What is the most likely cause of the condition?
Zinc deficiency
The most common fluid disorder in surgical patients?
Extracellular volume deficit
A 30 y/o man with a history of Crohn’s disease of the small bowel is admitted with enterocutaneous fistula. The daily output from the fistula is 2L. The approximate composition of the fluids in mEq/L is which of the following?
Na - 140
K - 5
Cl - 104
HCO3 - 30
In cases of persistnt hypocalcemia/hypokalemia, one should request for?
Serum magnesium levels
The most important treatment of metabolic acidosis?
Restore perfusion with volume resuscitation
Characteristic early acid base picture of sepsis?
Respiratory alkalosis
Following an infection, a 68 y/o woman developed gram-negative septicemia. Which statement is true for gram-negative bacterial septicemia?
Adverse changes can be accounted for lipid A release
IVF of choice for patients with closed head injuries?
Hypertonic saline
The earliest stage of hemostasis?
Vascular constriction
The average lifespan of platelets?
7-10 days
Inherited platelet disorder of adhesion?
Bernard-Soulier syndrome
A 75 y/o man is found to have prolonged bleeding from intravenous puncture sites. Platelet aggregation is inhibited by which of the following?
Aspirin
The most common abnormality of hemostasis in surgical patients?
Thrombocytopenia
Treatment of choice for patients with Von Willebrand’s disease?
Intermediate purity Factor 8/ DDAVP
A 24 y/o woman is scheduled for an elective cholecystectomy. The best method of identifying a potential bleeder is which of the following?
A complete history and physical examination
The most common indication for blood transfusion in surgical patients?
Volume replacement
After undergoing a transurethral resection of the prostate, a 65 y/o man experiences excessive bleeding attributed to fibrinolysis. It is appropriate to administer which of the following?
Aminocaproic acid
A 22 y/o man is brought into the emergency department in profound shock after a fall from the fourth floor of a building. After resuscitation, small bowel resection and hepatic segmentectomy are performed at laparotomy. He receives 15 U of packed RBCs, 4 U of fresh-frozen plasma, and 8 L of Ringer’s lactate. On closure, diffuse oozing of blood is noted. What is the most likely cause?
Platelet deficiency
Most important management of immediate transfusion reaction?
Stop the transfusion
A 64 y/o woman undergoing radical hysterectomy under general anesthesia is transfused with 2 U of packed RBCs. A hemolytic transfusion reaction during anesthesia will be characterized by which of the following?
Bleeding and hypotension
Shock that occurs in the setting of adequate intravascular volume?
Cardiogenic shock
A 30 y/o man is brought to the emergency department following a high-speed car accident. He was the driver, and the windshield of the car was broken. On examination, he is alert, awake, oriented, and in no respiratory distress. He is unable to move any of his four extremities; however, his extremities are warm and pink. His vital signs on admission are HR 54 bpm and BP 70/40 mmHg. What is the diagnosis?
Neurogenic shock
The preferred test in the diagnosis of cardiac tamponade?
Echocardiography
Persistently elevated base deficit in a trauma patient is usually due to?
Ongoing bleeding
First priority in the treatment of trauma?
Ensuring an adequate airway
A 32 y/o female falls from the tenth floor of her apartment building in an apparent suicide attempt. Upon presentation, the patient has obvious head and extremity injuries. Primary survey reveals that the patient is totally apneic. By which method is the immediate need for a definitive airway in this patient best provided?
Orotracheal intubation
The most common indication for intubation?
Altered mental status
Surgical airway of choice in patients with laryngeal fractures?
Tracheostomy
An 85 y/o ventilator-dependent male was endotracheally intubated 10 days ago. He remains unresponsive and is not a candidate for early extubation. The intensive care unit (ICU) attending elects to perform tracheostomy at the bedside. During the procedure, copious dark bold is encountered. This is most likely due to transection of which of the following:
Anterior jugular vein
Tracheostomy is performed uneventfully in a 79 year old ventilator-dependent encephalopathic male. After several spontaneous breaths, however, the patient stops breathing. The anaesthesiologist continues to assist the patient’s breathing for several minutes, after which the patient again breathes spontaneously. The most likely cause of apnea is:
Preoperative respiration was driven by hypoxia
Immediate management of patients with tension pneumothorax?
Needle thoracostomy (2nd ICS MCL)
Thoracostomy
4th or 5th ICS MAL
Tube thoracostomy is employed in each of the following conditions EXCEPT: A. Total right pneumonectomy B. Chylothorax C. Hemothorax from rib fracture D. Spontaneous pneumothorax E. After an Ivor-Lewis procedure
A. Total right pneumonectomy
A 70 y/o man is brought into the emergency department following his injury as a passenger in a car crash. He complains of right side chest pain. Physical examination reveals a respiratory rate of 42 breaths per minute and multiple broken ribs of a segment of the chest wall that moves paradoxically with respiration. What should the next step be?
Needle thoracostomy
Trauma patients with hypotension have lost approximately how much of blood volume?
30-40% (Class III shock)
The most reliable indicator for organ perfusion during resuscitation?
Urine output
The most common cause of cardiogenic shock/cardiac failure in trauma patients?
Tension pneumothorax
Prior to catheterization in stable patients at risk for urethral injury, one should perform?
Urethrogram
Gold standard in the diagnosis of presence of intra-abdominal injuries?
DPL
