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Level 2 CE > Surgery Recall > Flashcards

Surgery Recall Flashcards

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1
Q

rare cause of pancreatitis

A

scorpion sting (from island of trinidad)

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2
Q

ranson’s criteria

A 
On admission 
- WBC >16,000
- age >55y 
- glucose >200 
- AST >250 
- LDH >350 
W/in 48 hrs 
- Hct dec >10% 
- BUN inc >5 
- serum Ca <8 
- PaO2 <60 
- base deficit >4 
- fluid needs >6L 
<3 = 0-3% mortality
3-5 = 11-15% mortality 
>/=6 = 40% mortality
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3
Q

BISAP score

A 
B= BUN >25 
I = impaired mental status 
S = SIRS 
A = age >60
P = pleural effusion  
<2 = 0-0.5% mortality 
=2 = 2% mortality 
>3 = 5-20% mortality
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4
Q

ABCDEs of melanoma

A 
A = asymm 
B = border irregularities 
C = color variation 
D = diameter >0.6cm and dark color 
E = evolves
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5
Q

Ballance’s sign

A

constant dullness to percussion in left flank/LUQ and resonance to percussion in right flank seen with splenic rupture or hematoma

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6
Q

Battle’s sign

A

ecchymosis over the mastoid process in patients with basilar skull fractures

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7
Q

beck’s triad

A

JVD, HOTN, muffled heart sounds = caridac tamponade

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8
Q

bergman’s triad

A

fat emboli syndrome

  • mental status changes
  • petechiae (often in axilla/thorax)
  • dyspnea
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9
Q

blumer’s shelf

A

mets disease to the rectouterine (pouch of Douglas) or rectovesical pouch creating a shelf that is palpable on rectal exam

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10
Q

boas’s sign

A

right subscapular pain resulting from cholelithaisis

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11
Q

borchardt’s triad

A

seen with gastric volvulus

  • emesis then retching
  • epigastric distension
  • failure to pass NGT
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12
Q

carcinoid triad

A

Flushing, diarrhea, right sided heart failure

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13
Q

charcot’s triad

A

cholangitis

  • fever (chills)
  • jaundice
  • RUQ pain
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14
Q

chvostek sign

A

twitching of facial mm when tap facial nerve with HYPOcalcemia

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15
Q

courvaisier’s law

A

enlarged nontender gallbladder = obstrxn of CBD most cmnly with pancreatic cancer
- not gallstone bc GB scarred 2/2 to chronic cholelithiasis

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16
Q

cushing’s triad

A

inc ICP

  • HTN
  • bradycardia
  • irregular respirations
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17
Q

dance’s sign

A

empty RLQ in kids with ileocecal intusssusception

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18
Q

fothergill’s sign

A

mass in the abd wall = mass felt while there is tension on mm
intra-abdominal mass = no mass with tension

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19
Q

fox’s sign

A

ecchymosis of inguinal ligament seen with retroperitoneal bleeding

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20
Q

Goodsall’s rule

A

anal fistula in straight path anteriorly and a curved path posteriorly from midline

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21
Q

hamman’s sign/crunch

A

crunching sound on auscultation of heart resulting from emphysematous mediastinum
seen with boerhaave’s, pneumomediastinum

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22
Q

howship-romberg sign

A

pain along inner aspect of thigh - due to obturator hernia nerve compression

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23
Q

kehr’s sign

A

severe left shoulder pain in patients with splenic rupture - referred pain from diaphragmatic irritation

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24
Q

Kelly’s sign

A

visible peristalsis of the ureter in response to squeezing or retraction - used to ID the ureter furing surgery

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25
krukenberg tumor
mets tumor to ovary - usually from GI cancer
26
Laplace's law
wall tension = pressure x radius | - thus colon perforates preferentially at cecum bc of inc radius and resultant inc wall tension
27
rule of 2s in meckel's diverticulum
2% of pop have it 2% of those are sx occurs w/in 2 feet of ileocecal valve
28
rule of 10s in pheochromocytoma
``` 10% are bilateral 10% are malignant 10% in kids 10% are extra-adrenal 10% have multiple tumors ```
29
raccoon eyes
bilateral black eyes as a result of basilar skull fracture
30
reynold's pentad
- fever - jaundice - RUQ pain - AMS - shock/sepsis i.e Charcot's triad + AMS + shock/sepsis seen in pts with suppurative cholangitis
31
saint's triad
- cholelithiasis - hiatal hernia - diverticular disease
32
silk glove sign
indirect hernia sac in peds pts | sac feels like a finger of a silk glove when rolled under examining finger
33
sister mary joseph's sign
mets tumor to umbilical lymph node
34
trousseau's sign
carpal spasm after occlusion of blood to forearm with BP cuff in patients with HYPOcalcemia
35
valentino's sign
RLQ pain from perforated peptic ulcer due to succus/pus draining into RLQ
36
westermark's sign
dec pulm vascular markings on CXR in a patient with pulm embolus
37
whipple's triad
insulinoma - hypoglycemia (<50) - CNS and vasomotor sx (syncope, diaphoresis) - relief of sx with admin of glucose
38
afferent loop syndrome
obstruction of afferent loop of billroth II gastrojejunostomy
39
blind loop syndrome
bacterial overgrowth of intestine caused by stasis
40
compartment syndrome
compartmental HTN due to edema results in mm necrosis of LE bc fascial compartmetn do not stretch often seen in the calf patient may have a distal pulse
41
dumping syndrome
delivery of large amt of hyperosmolar chyme into small bowel usually after vagotomy and a gastric drainage procedure (pyloroplasty/gastrojejunostomy) results in autonomic instability, abd pain, diarrhea
42
gardner's syndrome
GI polyps and assc findings of SOD (sebaceous cysts, osteomas, desmoid tumors) polyps have high malignancy potential
43
leriche's syndrome
``` C = caludication of buttocks and thighs I = impotence A = atrophy of legs (seen w. iliac occlusive disease) ```
44
Mendelson's syndrome
chemical pneumonitis after aspiration of gastric contents
45
Mirizzi's syndrome
extrinsic obstruction of cmn hepatic bile duct from gallstone in GB or cystic duct
46
ogilvie's syndrome
massive nonobstructive colonic dilatation
47
peutz-jeghers syndrome
STK11 gene mut | benign GI polyps and buccal pigmentation
48
plummer vinson syndrome
``` esophageal web fe-def anemia dysphagia spoon-shaped nails atrophic oral and tongue mucosa typically occurs in elderly woman 10% dev SQCC ```
49
RED reaction syndrome
rapid vancomycin infusion | resulting in skin erythema
50
refeeding syndrome
hypokalemia hypomagnesemia hypophosphatemia - after refeeding a starved patient
51
short gut syndrome
malnutrition resulting from <200 cm of viable small bowel
52
another name for Sipple's syndrome
MEN II
53
tietze's syndrome
costochondritis of rib cartilage aseptic treat with NSAIDs
54
another name for Wermer's syndrome
MEN I
55
most cmn indication for surgery with Crohn's dz
SBO
56
most cmn type of melanoma
superficial spreading
57
most cmn type of breast cancer
infiltrating ductal carcinoma
58
most cmn site of breast cancer
upper outer quadrant
59
most cmn vessel involved with a bleeding duodenal ulcer
gastroduodenal artery
60
most cmn cause of CBD obstruction
choledocholithiasis
61
most cmn cause of cholangitis
bile duct obstruction resulting from choledocholithiasis
62
most cmn cause of pancreatitis
EtOH
63
most cmn bacteria in stool
bacteroides fragilis
64
most cmn cause of SBO in adults in US
postop peritoneal adhesions
65
most cmn (top 3) causes of SBO in US adults
postop adhesions hernia cancer
66
most cmn cause of SBO in children
hernias
67
most cmn cause of emergency abd surgery in the US
acute appendicitis
68
most cmn site of GI carcinoids
appendix
69
most cmn AXR finding with SBO
air fluid levels
70
most cmn electrolyte def causing ileus
hypokalemia
71
most cmn cause of transfusion hemolysis
clerical error
72
most cmn cause of blood transfusion resulting in death
clerical error - wrong blood types
73
most cmn site of distant mets of sarcoma
lungs - heme spread
74
most cmn cause of shock in a surgical patient
hypovolemia
75
most cmn position of anal fissure
posterior
76
most cmn cause of acute pancreatitis
gallstones
77
most cmn cause of chronic pancreatitis
EtOH
78
most cmn cause of large bowel obstruction
colon cancer
79
most cmn type of colonic volvulus
sigmoid volvulus
80
most cmn cause of fever <48 postop hrs
atelectasis
81
most cmn bacterial cause of UTI
e coli
82
most cmn CXR finding with traumatic thoracic aortic injury
widened mediastinum
83
most cmn abd organ injured in blunt abd trauma
liver - not the spleen as noted in recent studies
84
most cmn abd organ injured in penetrating abd trauma
small bowel
85
most cmn benign tumor of the liver
hemangioma
86
most cmn malignancy of the liver
mets
87
most cmn cause of pneumonia in the ICU
gram neg bacteria
88
most cmn cause of epidural hematoma
MMA injury
89
most cmn cause of lower GIB
upper GIB
90
most cmn type of hernia
inguinal hernia - Right > left
91
most cmn cause of esophageal perforation
iatrogenic instrumentation (eg EGD)
92
most cmn cancer in females
breast cancer
93
most cmn cancer in males
prostate cancer
94
most cmn cranial nerve injured in blunt trauma
CN I olfactory nerve
95
most cmn type of cancer causing death in males and females
lung cancer
96
most cmn cause of free peritoneal air
perforated PUD
97
most cmn symptom with gastric cancer
wt loss
98
most cmn site of colon cancer heme mets
liver
99
most cmn cause of death ages 1-4
trauma
100
% of US people who will dev appendicitis
7%
101
acceptable % of normal appendices removed with preop dxg of appendicitis
up to 20% | better to remove some normal appendices than to miss a case of acute appendicitis (which could rupture)
102
% of cases that can US dxg cholelithiasis
98%
103
% of cases where lower GIB stops spontaneously
90%
104
% of cases where upper GIB stops spontaneously
80%
105
drainage testicular veins
left --> left renal vein | right --> IVC
106
Gerota's fascia
fascia surrounding kidney
107
prominent collateral circulations seen in portal HTN
esopahgeal varices hemorrhoids (inf hemorrhoidal vein to internal iliac vein) patent umbilical vein (caput medusa) retroperitoneal vein via lumbar tributaries
108
parts of the GI tract are retroperitoneal
``` S - suprarenal/adrenal glands A - aorta D - duodenum (2-3rd) P - pancreas (except tail) U - ureters C - asc and desc colon K - kidneys E - esophagus R - rectum ```
109
gubernaculum
embryological structure that adheres testes to scrotal sac | used to help manipulate testes during indirect hernia repair
110
name of the LNs between pec minor and pec major mm
Rotter's LNs
111
position of left vagus nerve
anterior (bc esophagus rotates clockwise during dev)
112
morrison's pouch
hepatorenal recess | the most posterior cavity in peritoneal cavity
113
location of foregut
mouth --> ampulla of Vater
114
location of midgut
ampulla of vater --> distal 3rd of transverse colon
115
location of hindgut
distal 3rd of transverse colon --> anus
116
location of neurovascular bundle on rib
VAN under rib
117
order of the femoral vessels
NAVeL to your navel
118
hesselbach's triangle
inguinal ligament epigastric vessels lateral border of rectum sheath
119
nerve ON TOP of the spermatic cord
ilioinguinal nerve
120
Calot's triangle
cystic duct common hepatic duct cystic artery there's a lymph node in there
121
what separates right and left liver lobes
Cantle's line - from IVC to left of gallbladder fossa
122
gastrinoma triangle
this is where >90% of gastrinomas are found - jxn of 2nd and 3rd duodenum - cystic duct - pancreatic neck
123
artery responsible for anterior spinal syndrome
artery of Adamkeiwicz (oof of aorta)
124
space of Retzius
preperitoneal space anterior to bladder
125
white lines of Toldt
lateral peritoneal reflections of ascending and descending colon
126
strongest layer of the small bowel
submucosa
127
parts of GI tract without serosa
esophagus | middle and distal rectum
128
vein that overlies the pylorus
vein of Mayo
129
pouch of douglas
b/w rectum and bladder or uterus
130
thoracic duct empties into?
left subclavian vein or left IJV jxn
131
coronary vein
aka left gastric vein
132
hypogastric artery
aka internal iliac artery
133
left or right renal vein longer?
left
134
layers of abd wall
``` skin subcut fat Scarpa's fascia Camper's fascia external oblique internal oblique trasnversus abdominis transversalis fascia preperitoneal fat peritoneum ```
135
major structural diff b/w jejunum and ileum
``` jejunum = long vasa recta, large plica, thicker wall ileum = shorter vasa recta, small plicae, thinner wall ```
136
what is a preop colon surgery bowel prep?
bowel prep with colon cathartic,oral abx (neomycin and arythromycin base), IV abx before incision (controversial)
137
billroth I
anterectomy with gastroduodenostomy - ONE limb
138
billroth II
anterectomy with gastrojejunostomy - TWO limbs
139
roux-en-y limb
jejunostomy in y-shape | free end anastomosed to second hollow structure (like esophagojejunostomy)
140
brooke ileostomy
standard ileostomy that is folded on itself to protrude from the abdomen <2 cm to allow easy appliance placement and collection of succus

Level 2 CE (1 decks)

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