True Learn Flashcards
(110 cards)
1
Q
Indications for Surgery
UC Elective
A
1) Failure of Medical Management
2) Complications/side effects of meds
3) dysplasia
4) Invasive Cancer
5) Extraintestinal manifestations
6) Growth retardation
2
Q
Indications for Surgery
UC Emergent
A
1) Toxic Megacolon
2) Sepsis/fulminant colitis
3) Perforation
4) Hemorrhage
3
Q
Indication for Drainage
Pancreatic Pseudocyst
A
1) Persistence >6 weeks
2) Enlarging size
3) infection
4) Symptomatic
4
Q
Indication for Surgery
Distal Pancreatectomy
A
1) MCN
a) Symptomatic
b) Asymptomatic > 3 cm
c) Solid component
d) Enlarged Duct
2) Pancreatic Neuroendocrine tumors
3) Poorly differentiated solid mass
4) Adenocarcinoma of Pancreatic tail without mets
5) Symptomatic SCN
6) Chronic Pancreatitis or Pseudocyst of only tail
7) Grade III and some grade IV trauma
** Preservation of Spleen only in benign disease or trauma**
5
Q
Indications for Surgery
Type B Aortic Dissection
A
1) impending/actual rupture
2) Sx related to dissection ( CHF, Angina, Aortic Regurgitation, Stroke, Pain)
3) Malperfusion
4) Aneurysm >6.5 cm OR expansion >1cm/year
6
Q
RELATIVE Indications for Carotid Stenting
A
1) Severe cardiac risk
2) Previous LATERAL neck surgery/Radiation
3) Extremely proximal/distal plaques
4) Tortuous Vessel Anatomy
5) Contralateral nerve palsy
7
Q
Diagnosis B/l absence of iris Intellectual disability Hypospadia, cryptochordism OR Streak ovaries Del short arm chromosome 11
A
WAGR Syndrome Wilms Tumor Anidiridia Genitourinary Malformations Retardation
8
Q
Non-Hodgkin’s Lymphoma Staging
A
I- confined to GI tract (single or multiple) II (tumors below diaphragm) IIE- through serosa II1- local LN involvement II2- distant LN involvment III- Supradiaphragmatic disease
9
Q
Type I Endoleak
A
Failure of seal proximally (Ia) ir distally (Ib)
TREAT ALL
Balloon, stent proximally and distally
10
Q
Type II Endoleak
A
Filling of sac by lumbar branches or IMA
TX if size increasing
(Embolization, sac puncture (thoracolumbar approach), lap/open ligation of feeding vessels
11
Q
Type III Endoleak
A
failure of graft to seal with itself (component to component leaks)
TREAT ALL: replace components
12
Q
Type IV Endoleak
A
Leak through porous graft (self-limited with reversal of AC)
13
Q
Type V Endoleak
A
sac leaks fuck knows why
14
Q
Evidence of fistula with 2 openings and single tract
A
Poss. Horseshoe fistula
Tx: Hanley’s Procedure (Post aspect incised, anterior aspect incised with secondary incision and penrose drain)
15
Q
Diagnostic Criteria
Hepatorenal Syndrome
A
1) Cirrhosis and Ascites
2) Cr >1.5
3) No improvement in serum Cr despite 2 days diuretic abstinence and albumin 1g/kg
4) Absence of shock
5) No nephrotoxic drugs
6) Absence of parenchymal disease
16
Q
Pathophysiologic Mechanism
Hepatorenal Syndrome
A
splanchnic vasodilation causes activation of RAAS and SNS and secretion of ADH resulting in renal hypoperfusion.
17
Q
Treatment
Hepatorenal Syndrome
A
Liver Transplant
18
Q
Complications
Laparoscopic Sleeve Gastrectomy
A
Bleeding
Stenosis
Staple Line Leakage
19
Q
Complications
Laparoscopic Sleeve Gastrectomy
Gastric Stenosis
TREATMENT
A
Endoscopic Balloon Dilation
20
Q
MCC
Anal fissure
Posterior Midline
A
Constipaton
21
Q
Other Causes
Anal Fissure
Anterior Midline
A
Constipation in FEMALES
22
Q
Other Causes
Anal Fissure
Location OTHER than Posterior Midline
A
Crohn's Disese TB Syphillis HIV/AIDS Anal Cancer
23
Q
Cytologic Criteria (In ascitic fluid) Spontaneous Bacterial Peritonitis
A
2 of the 3 in setting of Pt with appropriate hx and sx
Total protein > 1 g/dl
Glucose <50 mg/dl
LDH > upper limit or normal for serum
24
Q
Diagnosis
Ascites + “Obstruction of lymphatic vessels at the base of the mesentery”
A
Chylous Ascites
25
Pathophysiology
| Chylous Ascites
Obstruction of lymphatic vessels at the base of the mesentery or cisterna chylii
26
Ddx
| Chylous Ascites
End Stage Pancreatic Cancer (compresses cysterna chylii)
Congenital lymphangiectasia
Thoracic duct obstrution
Lymph peritoneal fistula
27
Steroid MOST effective in active Crohn's Disease
Budesonide
| Prednisone used typically
28
Amount of Endogenous fluid produced by GI tract per day
7 liters
29
Amount of saliva produced per day
1500cc
30
Stomach fluid produced per day
1000-2000cc
31
Amount of bile produced per day
500cc
32
Pancreatic secretion produced per day
1500cc
33
Amount of fluid produced by small bowel per day
1500cc
34
MCC Death in 1st year post cardiac allograft
Allograft vasculopathy
| signs of atherosclerosis without calcification
35
```
Rutherford Classification + Treatment
Sensory Loss: None
Motor Loss: None
Arterial Doppler: Audible
Venous Doppler: Audible
```
Class I: Limb viable, not immediately threatened
Heparin Drip
CDT possible
36
```
Rutherford Classification + Treatment
Sensory Loss: None or Minimal (toes)
Motor Loss: None
Arterial Doppler: Often Inaudible
Venous Doppler: Audible
```
Class IIa: Marginally threatened, salvageable if treated promptly
Heparin Drip
CDT Possible
37
```
Rutherford Classification + Treatment
Sensory Loss: More than toes, associated with rest pain
Motor Loss: Mild or moderate
Arterial Doppler: Usually Inaudible
Venous Doppler: Audible
```
Class IIb: Immediately threatened, salvageable with immediate revascularization.
Heparin Drip
Open Thrombectomy
38
```
Rutherford Classification + Treatment
Sensory Loss: Profound, anesthetic
Motor Loss: Profound, paralysis, rigor
Arterial Doppler: Inaudible
Venous Doppler: Inaudible
```
Class III: Limb irreversibly damaged, major tissue loss or permanent nerve damage inevitable
Heparin Drip
Open thrombectomy in early presentation
Amputation if late presentation
39
Access preference (KDOQI) for ESRD on HD
1) Autologous radiocephalic (forearm) AVF
2) Autologous brachiocephalic AVF
3) Transposed Brachiobasilic AVF
4) Upper arm Brachial-cephalic prosthetic graft
40
Characteristics of working fistulas
Rule of 6's
1) Bloodflow adequate to support HD (>600ml/min)
2) Diameter greater than 6mm in a location accessible for cannulation and discernible margins for repeated cannulation
3) Depth approximately 6 mm
41
Relative indications for prosthetic graft vs fistula
1) small basillic vein b/l
2) hx of several central venous catheter infections
3) obesity
42
Electrolyte abnormalities
| Tumor lysis syndrome
HYPOcalcemia (good question answer)
| HYPER K, Phos, Uric Acid, Creatinine
43
AAST Pancreatic Trauma Grade
| hematoma with minor contusion/laceration but without duct injury
Grade 1
| advance one grade for multiple injuries up to grade III.
44
AAST Pancreatic Trauma Grade
| major contusion/laceration but without duct injury
Grade 2
| advance one grade for multiple injuries up to grade III.
45
AAST Pancreatic Trauma Grade
| distal laceration or parenchymal injury with duct injury
Grade 3
| advance one grade for multiple injuries up to grade III.
46
AAST Pancreatic Trauma Grade
proximal (i.e. to the right of superior mesenteric vein) laceration or parenchymal injury with injury to bile duct / ampulla
Grade 4
47
AAST Pancreatic Trauma Grade
| massive disruption to pancreatic head
Grade 5
48
Indications for Angiography in Blunt Pelvic Trauma
PELVIC FX AND...
1) Hemodynamic instability in a patient with little or no hemoperitoneum by FAST/DPL
2) Requires >4 U RBC in 24 hours
3) Requires >6 U RBC in 48 Hours
4) Large or expanding hematoma identified at celiotomy
5) CT evidence of large retroperitoneal hematoma with extravasation of contrast
6) need for detection and treatment of other injuries during angiography.
49
Most appropriate 1st step in workup
| Postmenopausal vaginal bleeding
```
Endometrial biopsy
(Transvaginal u/s does NOT rule out disease if negative)
```
50
3 principles of safe PEG placement
Endoscopic gastric dilation
Endoscopic visual focal finger invagination
Transillumination
51
RELATIVE Contraindications
| PEG Placement
Failure of transillumination
Previous history of GERD
Previous abdominal surgery
Esophageal or oropharyngeal cancer (d/t seeding of PEG tract)
52
ABSOLUTE Contraindications
| PEG Placement
Coagulopathy
Completely obstructing esophageal cancer
Any contraindication to endoscopy
53
Most common indication for hysterectomy (USA)
symptomatic uterine fibroid
54
Indications
| Hysterectomy
```
Symptomatic uterine fibroid (MCC)
Ovarian Ca
Cervical Ca
Endometrial Ca
Vaginal Bleeding
```
55
Intraop Management of volume status
| Pheochromocytoma
High Intravascular volume during and immediately after procedure (Pts have low volume at baseline d/t catecholamine excess).
Pts with CHF or elderly may need arterial line +/- PA catheter
56
Intraop Management of HTN
| Pheochromocytoma
Sodium nitroprusside drip
| Magnesium IV
57
Intraop Management of arrythmias
| Pheochromocytoma
Short acting beta blockers (esmolol)
| Lidocaine
58
Landmark
| Recurrent laryngeal nerve in neck surgery
tubercle of zuckerkandl lies immediately lateral to and covers the RLN.
(can also be medial)
59
MCC
| Liver abscess
ascending infection from portal vein
60
Most common site of recurrence
| Melanoma
Skin
Subcutaneous tissues
distant lymph nodes
Visceral sites
61
Most common site of recurrence
| Melanoma, Visceral
```
lung
liver
brain
bone
GI tract
```
62
Indication for collis gastroplasty in nissen fundoplication
if <2-3cm of esophagus is present intra abdominally
Lap stapler is fired parallel to lesser curvature at the level of the cardia to create neo-esophagus
63
Key elements of Nissen fundoplication
Lap is standard of care
esophageal mobilization
division of short gastrics to create tension free wrap
mandatory crural repair
64
Most important predictor of survival
| Adrenal cancer
adequacy of resection
5 year survival with adequate resection is 50%
with inadequate resection median survival is less than one year
65
CT findings suggestive of adrenal ca
```
Size >6cm
tumor heterogeneity
irregular margins
presence of hemorrhage
adjacent lymphadenopathy
liver mets
```
66
Location of placement for end colostomy
through rectus, at summit of infraumbilical fan fold
67
Location of mesh
Chevel's Repair
Ventral hernia
Between anterior rectus sheath and subcutaneous layer
68
Soap bubble sign
Meconium ileus, seen in RLQ.
69
Ascites with "scalloping" of solid organs and calcifications of peritoneum
pseudomyxoma peritonei
70
Management
Penetrating trauma MEDIAL to lateral canthus of eye
some loss of sensation
Irrigation, debridement, primary closure in multiple layers.
Nerve exploration/repair NOT indicated
71
Management
Penetrating trauma LATERAL to lateral canthus of eye
some loss of sensation
Irrigation, debridement, primary closure in multiple layers.
NERVE EXPLORATION/REPAIR IS INDICATED
72
Operative technique
| Exposure of SMA for embolectomy
anterior approach, base of transverse mesocolon
73
Operative technique
| exposure of SMA for bypass
lateral approach with formal mobilization of duodenum or ligament of treitz
74
Preferred site of SMA bypass
R common iliac
(second choices L common iliac, infrarenal aorta)
supraceliac aorta can be used if retrograde disease
75
Methods of documenting parathyroid allograft function
normocalcemia
measuring AC vein PTH concentration
"transient parathyroidectomy" tourniquet on one arm, measure other arm.
76
Most common presentation of gallbladder cancer if symptomatic
abdominal pain (biliary colic/cholecystitis presentation)
77
Early complications
| Gastric banding
```
acute stomal obstruction
band infection
gastric perforation
hemorrhage
bronchopneumonia
delayed gastric emptying
PE
```
78
Late complications
| Gastric banding
```
Band erosion
band slippage/prolapse
port or tubing malfunction
leakage at port site tubing or band
pouch or esophageal dilation
esophagitis
```
79
Malignant hyperthermia mutation
RYR1 (ryanodine receptor gene)
| AD
80
incidence of marginal ulcers
| s/p gastric bypass
3-15%
81
incidence of bowel obstruction
| s/p gastric bypass
7%
82
incidence of DVT/PE
| s/p gastric bypass
0.33%
83
Incidence of devastating anastomotic leak
| s/p gastric bypass
0.3%
84
Incidence of anastomotic stenosis
| s/p gastric bypass
1-19%
85
What the magnet does to pacemaker/ICD
turns off defibrillator
| resets pacemaker to factory settings (demand mode at a fixed rate)
86
most common site of recurrence
| Colon cancer s/p surgical removal
liver
80% in first 2 years
90% in first 4 years
87
Puestow procedure
Longitudinal pancreaticojejunostomy
88
Frey procedure
Coming out of the pancreatic head and roux en y pancreaticojej
89
Type I gastric ulcer
Angularis incisura of lesser curvature
| Normal/low acid
90
Type II gastric ulcer
Stomach and duodenal ulcers
| Associated with acid (may be normal)
91
Type III Gastric ulcer
Prepyloric
| Normal or HIGH acid
92
Type iv gastric ulcer
GE junction
| Acid normal or low
93
Ligaments divided in extended left hemi
Renocolic
Splenocolic
Pancreaticocolic
Gastrocolic
94
Firm flesh colored plaques
| Fingerlike projections of spindle cells
Fermatofibrosarcoma protuberans
95
Trace mineral deficiencies
Pancytopenia
Neuropathy with ataxia
Copper
96
Trace mineral deficiencies
| Hyperglycemia confusion peripheral neuropathy
Chromium
97
Trace mineral deficiencies
| Pellagra with diarrhea dementia, dermatitis
Niacin B3
98
Trace mineral deficiencies
Cardiomyopathy
Hypothyroidism
Neurological changes
Selenium
99
Trace mineral deficiency
Poor wound healing
Wasting
Skin rash
Zinc
100
Correct procedure
| Carotid Trauma lateral tear
Lateral arteriorrhaphy with 6-0 polypropylene interupted
101
Correct procedure
| Carotid Trauma loss of wall or large defect
Patch angioplasty with saphenous vein thin walled ptfe or bovine pericardium
102
Correct procedure
| Carotid Trauma through and through
Segmental resection and end to end anastomosis or interposition graft with saphenous vein or ptfe
103
Large abdominal bulge hernia sx WITHOUT fascial defect
Diastasis recti
104
Contraindications
| Saphenous vein stripping
Outflow obstruction of deep system where saphenous is the only outflow
I.e. occlusion of superficial femoral vein
105
Largest risk factor
| Post op cardiac complications
Uncompensated CHF
| Not CAD
106
Indications
| ICP monitoring
Postrecussitative GCS 40
Any hx of hypotension
Abnormal motor posturing
107
Indications for Surgery
| Transanal resection of malignant Tumor
```
<3 cm in size
<30% of the circumference of bowel
Within 8 cm of the anal verge
T1 only
Mobile nonfixed Tumor
Well to moderately differentiated
No lymphovascular or perineural invasion
No LAD on imaging
Margin clear > 3 mm
```
108
Distal Gastrectomy
| D1.5
extended lymphadenectomy (D1: 1, 3, 4sb, 4d, 5, 6, 7 PLUS 8a, 9)
Omentectomy
Preservation of spleen and pancreas
109
Free water deficit
(Serum Na -140)/140 * tbw
Tbw = 0.6*bw male 0.5*bw female
110
Indications for Surgery
| BKA
Non salvageable lower extremity infection
Chronic non healing le wounds
Acute lower extremity infection
Trauma with vascular or neurological injury
Open tibia fx with post tibial n distruption
Warm ischemia > 6 hours
