Emergency_Surgery Test #4

Front 1

What are 4 risks of UTI?

Back 1

young children
immunocompromised
elderly men (BPH)
recently sexually active

Front 2

What are key S/S of UTI (pertinent positives)? (3)

Back 2

dysuria
urinary frequency
suprapubic discomfort

Front 3

What labs point towards a UTI?

Back 3

pos leukocyte esterase
RBC (ex. 2/hpf)
WBC (ex. 3/hpf)

Front 4

What is the most common pathogen of UTI?

Back 4

E. coli (80%)
proteus
Klebsiella
enterobacter
pseudomonas

Front 5

What is the general Tx plan for UTI?

Back 5

Ciprofloxacin x 3days

Front 6

What would you prescribe a pt w/ UTI if cannot afford a flouroquinolone? (3)

Back 6

Bactrim
Amoxicillin
Cephalexin

Front 7

Your patient w/ UTI has already been treated with Bactrim and returns complaining of similar symptoms. What do you treat with?

Back 7

Flouroquinolone x 7-10days

Front 8

Your UTI patient has a positive bHCG, what do you treat her with?

Back 8

Amoxicillin-Clavulanate (Augmentin)
Nitrofurantoin

Front 9

What can you use to treat UTI patients complaints of dysuria? What do you need to inform them of with this medication?

Back 9

Pyridium x 2-3days
urine may turn orange

Front 10

When is a urine culture needed for a UTI?

Back 10

if Tx not working or admitting pt

Front 11

When should you follow-up with UTI patient?

Back 11

2 weeks

Front 12

What are the first 2 conditions you need to think about with elderly and altered mental status?

Back 12

UTI
pneumonia

Front 13

What are key S/S of pyelonephritis (pertinent positives)? (6)

Back 13

fever
dysuria
urinary frequency
suprapubic discomfort
chills?
positive CVA tenderness

Front 14

What are the key labs for pyelonephritis? (5)

Back 14

pos nitrites
pos leukocyte esterase
RBC (ex 2/hpf)
WBC (ex 3/hpf)
WBC casts

Front 15

How is sepsis r/o for pyelonephritis?

Back 15

CBC (look @ WBC & bandemia)

Front 16

Does FQ PO or IV have better bioavailability?

Back 16

same :)

Front 17

How is an uncomplicated pyelonephritis pt treated?

Back 17

Cipro or Levaquin PO x 10days

Front 18

What are the Tx options for complicated pyelonephritis pts? (3)

Back 18

IV FQ
ampicillin + gentamicin IV
IV Rocephin

Front 19

Should urine cultures be sent for pyelonephritis pts?

Back 19

if complicated-yes

Front 20

What are key pertinent postitive S/S of nephrolithiasis? (9)

Back 20

excruciating flank pain
gross hematuria
N/V
suprapubic discomfort
radiates to back/groin
acute onset
tachycardia?
unable to sit still
pos CVA tenderness

Front 21

What are the key labs for nephrolithiasis? (2)

Back 21

blood & RBC (ex. 10/hpf) on UA

Front 22

What are 4 additional tests that may be done for nephrolithiasis?

Back 22

non-contrasted spiral CT
KUB (flat, upright)
chem-7 (check renal function)
WBC (r/o sepsis)

Front 23

What is included in the Tx plan for nephrolithiasis?

Back 23

analgesic (Toradol, Demerol, Delotid)
Phenagryn
adequate hydration (normal, not increased)
straining urine

Front 24

How are 4 reasons to admit a nephrolithiasis pt?

Back 24

intractable pain
intractable emesis
coexisting pyelonephritis
renal dysfunction

Front 25

What size kidney stone will generally pass on its own?

Back 25

<5mm

Front 26

Which type of renal failure has a sudden and severe drop in BP (shock) or interruption of blood flow to the kidneys from severe injury or illness?

Back 26

prerenal

Front 27

Which type of renal failure is caused from direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply?

Back 27

intrarenal

Front 28

Which type of renal failure is from a sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury?

Back 28

postrenal

Front 29

What type of imaging test is done to r/o hydronephrosis?

Back 29

renal ultrasound

Front 30

What is the Tx plan for a pt w/ hydronephrosis from BPH?

Back 30

drainage (possibly Kuday catheter)
BPH Tx
IV hydration

Front 31

What types of tests need to be done to determine the type/cause of renal failure?

Back 31

electrolytes (plasma & urine)
UA
FENa
renal US

Front 32

What do the diagnostic tests show for prerenal ARF?

Back 32

BUN/Cr > 20:1
FENa < 1%
sp gravity > 1.020
hyaline casts in urine

Front 33

What do the diagnostic tests show for intrarenal ARF?

Back 33

BUN/Cr 10:1-20:1
FENa > 1
sp gravity 1.010-1.020
US may help

Front 34

What do the diagnostic tests show for postrenal ARF?

Back 34

US shows hydronephrosis
serum/urine tests have similar results to intrarenal cause

Front 35

What type of diagnostic test is used for testicular torsion pts?

Back 35

DOPPLER US (duplex)

Front 36

What are pertinent positive S/S of testicular torsion?

Back 36

scrotal pain
acute
gets worse w/ time
does not change w/ position
N/V?
elevated, enlarged, tender testicle
horizontal "sideline" testicle
generally male <20yo

Front 37

How is testicular torsion treated?

Back 37

urology consult
manual detorsion
ice packs

Front 38

What is phren's sign?

Back 38

when you elevate testicle/scrotum pt's pain decreases

Front 39

What helps to differentiate epididymitis from testicular torsion? (4)

Back 39

epididymitis is more gradual, no associated vomiting, worsens with standing, positive phren's sign

Front 40

What is the common causative organism of epididymitis in pts <40yo? >40yo?

Back 40

<40yo Gonorrhea/Chlamydia

>40 UTI organisms (E. coli, proteus, Klebsiella)

Front 41

What is it called if epididymitis coinfects the testes? What is the "uncommon" causative organism?

Back 41

epididymitoorchitis
mumps

Front 42

What are key pertinent positive S/S of Fournier's gangrene?

Back 42

diabetic
itching
discomfort of inner thighs/scrotum/labia
edema of scrotum/labia
global erythema
US reveals gas in affected area
eventually smelly
travels along fascia

Front 43

What are 6 essentials of diagnosis for acute bacterial prostatitis?

Back 43

fever
low back pain
dysuria
urgency
prostatic tenderness
prostate enlarged

Front 44

What is the most common urologic diagnosis in men over 50yo and as many as 50% of men are affected in their lifetime?

Back 44

prostatitis

Front 45

How is prostatitis treated? (5)

Back 45

FQ (outpatient)
IV ampicillin+gentamicin (enterococcal inpatient)
analgesic
hot sitz bath
alpha1 blocker

Front 46

What is a persistent, involuntary, painful erection, unrelated to sexual stimulation and unrelieved by ejaculation?

Back 46

priapism

Front 47

What are some of the causes of priapism? (7)

Back 47

leukemia
metastatic carcinoma
sickling hemoglobinopathy
EtOH
marijuana
cociane
ecstasy (MDMA)

Front 48

What is phimosis and what is a risk factor for it?

Back 48

inability to retract foreskin

chronic balanoposthitis due to a bacterial or fungal infection

Front 49

What is paraphimosis and what may it cause if not treated?

Back 49

retracted, constricted foreskin proximal to glans)

may cause necrosis to the glans/urethra

Front 50

What is the "old thinking" for the inciting agent of PUD?

Back 50

"no acid no ulcer"

Front 51

Is PUD more common in men or women? What % of poplulation?

Back 51

men 3x more women
2%

Front 52

What is the most common type of gastric ulcer?

Back 52

type I gastric ulcer

Front 53

Which peptic ulcer has 2 gastic ulcers and 1 duodenal ulcer, elevated acid, and generally found in blood group O?

Back 53

type II gastric ulcer

Front 54

Which ulcer is not associated w/ high acid output, is generally in the lesser curve of the stomach (near incisure), and is generally found in blood group A?

Back 54

type I gastric ulcer

Front 55

Which type of peptic ulcer is near the GE junction, not an acid secretor, and is related to mucosal defense problems?

Back 55

Type IV Csendes (very uncommon)

Front 56

What are type V ulcers related to?

Back 56

gastritis
NSAIDs (surgical Tx generally not necessary)

Front 57

Are gastric or duodenal ulcers more common?

Back 57

duodenal

Front 58

Which types of peptic ulcers are acid secretors?

Back 58

type II and III gastric ulcers

Front 59

What type of elective procedure may be performed on type I gastric ulcers?

Back 59

distal gastrectomy Billroth I, no vagotomy

Front 60

What type of elective procedures may be performed on type II/III gastric ulcers?

Back 60

vagotomy & antrectomy

Front 61

What type of elective procedures may be performed on type IV gastric ulcers?

Back 61

gastrectomy w/ Roux-en-Y
lesser resection (antrectomy) w/ biopsy of ulcer

Front 62

What happens with a selective vagotomy?

Back 62

vagus clipped but liver/biliary segment preserved

Front 63

Which vagotomies also receive a pyloroplasty?

Back 63

truncal
selective

Front 64

Which vagotomy does not need a pyloroplasty?

Back 64

Highly selective, supra-selective, parietal cell, proximal gastric vagotomy

Front 65

What happens with Billroth I anastamoses?

Back 65

antrectomy then stomach attached to duodenum

Front 66

What happens with Billroth II anastamoses?

Back 66

antrectomy then stomach attached to jejunum

Front 67

Is Billroth I or II more phsyiolocial?

Back 67

Billroth I

Front 68

Explain the Roux-en-Y procedure?

Back 68

-stomach removed
-jejunum conneted to esophagus
-stomach end of duodenum disconnected and sewn up
-far end of duodenum reconnected to small bowel
-allows the bile duct & pancreatic duct to continue to drain into duodenum

Front 69

What are 3 emergent peptic ulcer indications for surgery?

Back 69

bleeding
perforation
obstruction

Front 70

How is an emergent duodenal ulcer treated?

Back 70

Oversew (closure w/ gram/omental patch/flap) +/- Truncal vagotomy and pyloroplasty

Front 71

How is an emergent type I gastric ulcer treated?

Back 71

antrectomy

Front 72

How is an emergent type II/III gastric ulcer treated? (4)

Back 72

biopsy, excision of ulcer, truncal vagotomy and drainage

Front 73

How is an emergent type IV gastric ulcer treated? (3)

Back 73

oversew
possible vagotomy?
drainage?

Front 74

How is an emergent type V gastric ulcer that will not stop bleeding treated?

Back 74

total gastrectomy

Front 75

When would a truncal vagotomy with antrectomy and Billroth I for duodenal ulcer obstruction be done? (2)

Back 75

Acid reduction operation
Antrectomy for gastric outlet obstruction

Front 76

What is gastric carcinoma generally related to? What is the most common type of gastric carcinoma?

Back 76

H. pylori

adenocarcinoma (90%)

Front 77

Where is virchow's node that may be seen with gastric CA?

Back 77

left supraclavicular node

Front 78

What is a blumer shelf node that may be seen w/ gastric CA?

Back 78

mets from tumor dropped down to pelvis; feel in rectum

Front 79

What is the surgical Tx options for gastric CA?

Back 79

Wide resection w/ adequate margins
total gastrectomy
-Mesenteric nodes

Front 80

What is linitis plastica?

Back 80

poor prognosis/deadly gastric cancer (desmoplastic spreading)

Front 81

What is the overall 5 year survival of gastric CA? Survival for early gastric CA?

Back 81

12%

90%

Front 82

What are 6 possible gastric surgery post-op complications?

Back 82

Recurrent ulcers
*Dumping syndromes
Postvagotomy diarrhea
Bile reflux gastritis
Anemia and metabolic issues
Post gastrectomy “stump” carcinoma

Front 83

What is "dumping syndrome"?

Back 83

occurs especially w/ Billroth II anastamoses; bile still coming down into duodenal stump; get diarrhea after large carbohydrate meal

Front 84

What may be the causes of a recurrent ulcer after gastric surgery? (4)

Back 84

-retained vagus nerve
-incomplete antrectomy distally (inc gastrin but secretin test will suppress)
-hyperparathyroidism (men)
-gastrinoma (will not suppress gastrin with secretin test)

Front 85

What % of pts have dumping syndrome after gastric resection and vagotomy?

Back 85

25%

Front 86

What are the early dumping syndrome symptoms w/in 15-30mins after meal? What is it caused by? What should be avoided?

Back 86

-GI and cardiovascular symptoms
-N/V, cramps, diarrhea, light headedness, diaphoresis
-Caused by GI peptide hormoness
-avoid hyperosmolar carbs on empty stomach

Front 87

What happens with late dumping of dumping syndrome?

Back 87

rare
-Vasomotor-weakness, sweating, dizziness, flushing, confusion
-Several hours after eating increased glucagon followed by exaggerated insulin response

Front 88

Why is diarrhea not like "dumping" after post partial gastrectomy?

Back 88

b/c diarrhea is not related to eating

Front 89

What are 2 reasons for why diarrhea may occur after post partial gastrectomy?

Back 89

bile salt mediated
loss of autonomic control & intestinal motility

Front 90

What may bile acids (bile reflux gastritis) lead to?

Back 90

mucosal injury and gastritis

Front 91

How is bile reflux gastritis treated?

Back 91

prokinetic agents
PPI
sometimes needs surgery

Front 92

What are 3 metabolic post partial gastrecomy complications?

Back 92

Osteopenia
Anemia
Steatorrhea

Front 93

When does stump carcinoma occur post partial gastrectomy?

Back 93

Occurs if it does at all many years after gastric surgery, possibly secondary to achlorhydria, and bile reflux

Front 94

Is obesity now generally a medical or surgical disease?

Back 94

has become a surgical dz

Front 95

What are the Tx options for rectal tumors?

Back 95

Endoscopic
Operating proctoscope
Trans anal excision
Simple (Kraske, Delorme, TEM)
Trans Abdominal approach

Front 96

What is included in the Hx for rectal cancer? (6)

Back 96

Change in bowel habits
Tenesmus
Bleeding
Rectal or Pelvic Pain
Abdominal distension cramps
Weight Loss

Front 97

What may be extra-rectally on PE for rectal CA? (3)

Back 97

Abdominal, pelvic masses
Hepatomegaly
Abnormal Lymph nodes

Front 98

How far does a rigid sigmoid scope go? Flexible?

Back 98

25cm
60cm

Front 99

What are 3 types of imaging techniques that can be used to help stage rectal CA? (3)

Back 99

US
CT
MRI

Front 100

What does stage Tis of rectal CA?

Back 100

carcinoma in situ (pre-cancerous polyp)

Front 101

What does stage T1 of rectal CA involve?

Back 101

invasion of submucosa

Front 102

What does stage T2 of rectal CA involve?

Back 102

invasion of muscularis propria

Front 103

What does stage T3 of rectal CA involve?

Back 103

invasion through muscularis propria into subserosa or perirectal fat

Front 104

What tests may be used in the work-up for distant metastatic rectal CA? (9)

Back 104

CXR
Abdominal CT
Abdominal US
Chest CT
Brain CT
Bone Scan
MRI of Abdomen
PET scan
CEA

Front 105

What does stage T4 of rectal CA involve?

Back 105

perforation or involves other organs directly

Front 106

What does stage N1 of rectal CA involve?

Back 106

1-3 lymph node mets

Front 107

What does stage N2 of rectal CA involve?

Back 107

4 or greater lymph nodes

Front 108

What does stage N3 of rectal CA involve?

Back 108

lymph nodes along named vessel

Front 109

How is stage II and greater of rectal CA and stage III and greater of colon CA treated?

Back 109

more than surgery
radiation
chemo

Front 110

How are small, less than 3 cm mobile, non ulcerating rectal tumors treated? ("good T1 pt")

Back 110

local excision
-may consider radiation for equivocal path margins

Front 111

How are T2 patients by US or larger T1’s or T1’s with poor histology for rectal CA treated?

Back 111

LAR/APR (coloanal pouch?)
TME (maintain radial margins)

Front 112

How are T3 or N1 rectal pts treated?

Back 112

neoadjuvant Tx w/ surgery to follow
-Approx 8 weeks post end of xrt
LAR/APR
ostomy

Front 113

What is the most important tool for colon cancer?

Back 113

screening

Front 114

What are risk factors for colon CA? (3)

Back 114

genetics
-breast CA increases risk of colon CA but colon CA does not increase risk of breast CA
low fiber diet
inactivity

Front 115

What are the 2 genetic pathways that may occur with colon CA?

Back 115

1-CIN (chromosomal instability)
2-MIN (microsatellite instability)

Front 116

What % of cancer genetics is sporadic mutation?

Back 116

85% (gene problem, but doesn't mean it is inherited)

Front 117

What is the Amsterdam criteria for colon cancer? (3)

Back 117

3+ cases of colorectal CA
2+ generation
1 person <50yo

Front 118

What is the Bethesda criteria for colon CA?

Back 118

Amsterdam criteria
individual w/ 2 NHPCC cancers
individual w/ CRC & other NHPCC or early adenoma
endometrial CA <45
R sided CRC age <45 w/ poor diff
signet ring <45
adenoma <40

Front 119

What newer agents may be used besides 5-FU/Leucovorin? (5)

Back 119

Xeloda-Capecitabine
Avastin
Irinotecan
Erbitux
Oxaliplatin-eloxatin

Front 120

What are the Tx options for obstructed colon tumor (esp L side)?

Back 120

-Colectomy w/ ileorectal anastamosis
-Hartman’s procedure
-Resection w/ primary anastamosis w/ proximal diversion
-Resection w/ on-table lavage & primary anastamosis
-Temporary stoma w/ stabilization & treatment
-Endoscopic stent placement

Front 121

What are 4 Tx options for FAP?

Back 121

-Total colectomy with ileorectal anastamosis
-Restorative proctocolectomy with IPAA
-Total proctocolectomy with end ileostomy
-Total proctocolectomy with -Kock pouch

Front 122

After FAP surgery what needs to be followed for polyps?

Back 122

pouch and duodenum

Front 123

What is a normal part of the aging colon process with Western diets and has problems including pain and inflammation, strictures, bleeding and perforation?

Back 123

diverticular dz

Front 124

What are the S/S of diverticulitis? (4)

Back 124

LLQ pain
fever
tenderness
change in bowels

Front 125

What is the most common diagnostic test for diverticulitis?

Back 125

CT

Front 126

How is diverticulitis generally treated?

Back 126

outpatient
antibiotic w/ anerobe coverage

Front 127

What is I for the Hinchey grading scale of diverticulitis? Tx?

Back 127

Pericolic abscess confined to the mesentery
-Conservative tx

Front 128

What is II for the Hinchey grading scale of diverticulitis? Tx?

Back 128

Pelvic abscess from perforation
-Percutaneous drain with subsequent one stage resection

Front 129

What is III for the Hinchey grading scale of diverticulitis? Tx?

Back 129

Peritonitis from abscess rupture
-surgery

Front 130

What is IV for the Hinchey grading scale of diverticulitis? Tx?

Back 130

Fecal peritonitis
-Urgent Surgery

Front 131

What are 5 indications for surgery of diverticultis?

Back 131

-Complicated diverticulits 1st attack
-Uncomplicated diverticulitis multiple attacks
-Unable to improve medically
-Inability to exclude cancer
-Bowel obstruction

Front 132

What is the surgical Tx for diverticulitis?

Back 132

emergency-Hartman's

elective-laparoscopic resection (must eliminate distal sigmoid to avoid recurrence)

Front 133

What is the 3rd most common cause for colon obstruction in Western populations and the number one cause in the rest of the world?

Back 133

volvulus

Front 134

What are 2 types of volvulus?

Back 134

sigmoid
cecal

Front 135

What is sigmoid volvulus associated with? Who is it commonly seen in? (5)

Back 135

redundant sigmoid colon w/ narrow base of attachment
-elderly
-constipated
-institutionalized
-Hirschprung
-Chagas

Front 136

Who is cecal volvulus seen in? What is it often precipitated by?

Back 136

younger pts
-pregnancy
-recent surgery
-distal obstruction

Front 137

What are the S/S of volvulus? (3)

Back 137

abdominal pain
N/V
constipation

Front 138

What imaging is used for volvulus?

Back 138

xray (plain & w/ barium)
-bird's beak

Front 139

With sigmoid volvulus, if there are not signs of peritonitis or acute ischemia, then what is attempted for Tx?

Back 139

endoscopic detorsion

Front 140

What is the Tx for cecal volvulus?

Back 140

ileo-cecal resection

Front 141

What is the genetic incidence of IBD?

Back 141

40%

Front 142

What are the S/S of ulcerative coliits? (8)

Back 142

rectal bleeding
diarrhea
frequent BMs
mucus
pus
bimodal age distribution
rectum & spreads proximally
no small bowel involvement

Front 143

What type of test is used initially for suspected ulcerative colitis?

Back 143

sigmoidoscopy

Front 144

What 2 extra-intestinal symptoms do not go away after exacerbations of ulcerative colitis?

Back 144

ankylosing spondylitis
sclerosing cholangitis

Front 145

What are extra-intestinal manifestations of ulcerative colitis? (13)

Back 145

erythema nodusum
erythema multiforme
pyoderma gandrenosum
pustular dermatitis
apthous stomatitis
uveitis
arthalgias
arthritis
ankylosing spondylitis
cirrhosis
sclerosing cholangitis
anemia
malnutrition growth retardation

Front 146

What is the Tx for mild ulcerative colitis? (4)

Back 146

avoid milk products
sulfasalazine
topical mesalamine
topical steroids

Front 147

How is severe ulcerative colitis treated?

Back 147

NG tube for colonic distension
IV fluids
IV steroids
antibiotic
cyclosporine?

Front 148

What are 3 acute needs for surgery with ulcerative colitis?

Back 148

Rectal bleeding
Toxic Megacolon
Perforation

Front 149

What are 3 chronic needs for surgery with ulcerative colitis?

Back 149

Failure of medical therapy
CA risk
dysplasia associated lesion or mass

Front 150

Is ulcerative colitis curative?

Back 150

yes w/ surgery, but ~1%/year increase in cancer

Front 151

What type of emergency surgery is done for ulcerative colitis?

Back 151

total colectomy w/ stoma

Front 152

What are 4 elective ulcerative colitis/FAP surgeries?

Back 152

-Subtotal colectomy with ileo rectal anastamosis
-Total abdominoproctocolectomy with ileostomy
-Total abdominal proctocolectomy with kock pouch
-Ileopouch anal anastamosis

Front 153

What has skip lesions, involves the small bowel, is transmural, and often has anorectal lesions?

Back 153

Crohn's dz

Front 154

If pt is <40yo, with no significant risk factors or worrisome signs, then what is the imaging method of choice for rectal bleeding?

Back 154

flexible sigmoidoscopy

Front 155

If pt is >40yo or has significant risk factors, then what is the imaging method of choice for rectal bleeding?

Back 155

colonoscopy

Front 156

Where are internal hemorrhoids located and what type are they?

Back 156

proximal to dentate line

columnar epithelium (mucosa)

Front 157

Where are external hemorrhoids located and what type are they?

Back 157

distal to dentate line

squamous epithelium (skin)

Front 158

What are 5 causes of hemorrhoids?

Back 158

Elevated intra-abdominal pressure
Pregnancy
Constipation
Weight lifting
Chronic straining

Front 159

What are 2 functions of hemorrhoids?

Back 159

aid in continence (plug)
protect anus/sphincter from defecation trauma

Front 160

What are 6 possible symptoms of internal hemorrhoids?

Back 160

Bleeding
Protrusion
Seepage/soilage
Staining
Pruritus
Rarely painful

Front 161

What is the grading system for internal hemorrhoids?

Back 161

I- nonprolapsing
II- spontaneously reduce
III - reduce manually
IV- irreducible

Front 162

What conservative measures may be taken to help with hemorrhoids?

Back 162

High fiber diet
Plenty of fluids
Fiber supplements
Stool lubricants/softeners

Front 163

What are the Tx options for grade I internal hemorrhoids? (4)

Back 163

- Diet
- Topical Ointment
- RBL
- Coagulation

Front 164

What are the Tx options for grade II internal hemorrhoids? (2)

Back 164

office therapy
surgery

Front 165

What are the Tx options for grade III internal hemorrhoids? (2)

Back 165

surgery
rubber band ligation

Front 166

How are grade IV internal hemorrhoids treated?

Back 166

surgical hemorroidectomy

Front 167

What are the surgical options for internal hemorrhoids? (3)

Back 167

excision
ligation
stapled anopexy-PPH

Front 168

What are the possible complications of a hemorrhoidectomy? (7)

Back 168

Hemorrhage
Infection
Urinary retention
Fecal impaction
Anal stricture
Sphincter injury/incontinence
Wet anus/ectropion

Front 169

What is the "rapid and bloodless" hemorrhoidectomy technique?

Back 169

Ligasure (radiofrequency)

Front 170

What are the possible symptoms of external hemorrhoids? (6)

Back 170

Protrusion/lump
Pain if thrombosed
Seepage/soilage
Staining
Pruritus
Bleeding only if ruptured

Front 171

What are the Tx options for external hemorrhoids?

Back 171

sitz baths
stool softeners
pain meds
excision
thrombectomy

Front 172

What is generally the position for anal fissures in females? Males?

Back 172

Females 90% posterior

Males 99% posterior

Front 173

What are 7 conditions that may cause atypical locations of anal fissures?

Back 173

Crohn’s disease
Malignancy
Tuberculosis
Syphilis
CMV
HIV
Trauma

Front 174

What are 4 possible causes of anal fissures?

Back 174

large hard stool (trauma)
diarrhea
Hypertonic/hyperspastic internal sphincter
Diminished blood flow/Ischemia

Front 175

What are 5 possible symptoms of anal fissures?

Back 175

Pain
Spasm
Bleeding
Seepage/soilage
Difficult evacuation

Front 176

What are 6 possible S/S of chronic anal fissures?

Back 176

Sentinel skin tag
Hypertrophic papilla
Exposed IAS
Hyperspastic IAS
Anal stenosis
Fistula

Front 177

What are the Tx options for anal fissures? (9)

Back 177

Sitz baths
Stool softeners
Pain meds
Topical nitroglycerin
Botox injection
Lateral internal sphincterotomy
Anoplasty
Fissurectomy
Anal Stretch

Front 178

What are 5 lumps/bumps that may be found in the anal region?

Back 178

Cyst
Papilla
Hemorrhoid
Condyloma
Cancer

Front 179

What are the possible causes of anorectal suppuration? (10)

Back 179

*Cryptoglandular
Carcinoma
Crohn’s disease
Foreign body
Trauma
Surgery
Radiation
Tuberculosis
Actinomycosis
LGV

Front 180

What are the possible symptoms of an anorectal abscess? (6)

Back 180

Pain
Swelling
Drainage
Bleeding
Constipation
Urinary difficulties

Front 181

How is an anorectal abscess treated?

Back 181

drainage

Front 182

What are the Tx options for an anorectal fistula? (7)

Back 182

Fistulotomy
Fistulectomy
Staged fistulotomy
Mucosal advancement flap
Anoplasty
Fibrin glue
plug for complicated cases

Front 183

When are antibiotics used for anorecal suppuration?

Back 183

Sepsis
Cellulitis
Immunosuppression (HIV, DM)
Prostheses (Valvular, Joint, Intravascular)

Front 184

What are 7 possible causes of rectal prolapse?

Back 184

Rectal intussusception
Deep cul de sac
Loss of rectal fixation
Redundant sigmoid
Levator ani diastasis
Patulous anal sphincter
Pudendal neuropathy

Front 185

What are 7 possible symptoms of rectal prolapse?

Back 185

Incontinence
Constipation
Protrusion
Bleeding
Discharge
Sensation of incomplete emptying
Rectal pressure/tenesmus

Front 186

What are the Tx options for rectal prolapse? (7)

Back 186

Rectal fixation
Sigmoid resection
Proctectomy
Combination of rectal fixation and sigmoid resection
Full thickness resection
Mucosal resection with muscular reefing
Anal encirclement

Front 187

What are 4 risk factors for anorectal condyloma acuminata?

Back 187

Homosexual males
Anoreceptive intercourse
Immunosuppression
HIV

Front 188

What are 6 possible symptoms of anorectal condyloma acuminata?

Back 188

Visible/palpable warts
Pruritus
Seepage/soilage
Bleeding
Wetness
Discomfort

Front 189

What is the recurrence rate of anorectal condyloma acuminata?

Back 189

8-40%

Front 190

What are the types of anal neoplasms that can occur at the anal margin? (4)

Back 190

Squamous cell carcinoma
Basal cell carcinoma
Paget’s disease
Bowen’s disease

Front 191

What are the types of anal neoplasms that can occur in the anal canal? (4)

Back 191

Epidermoid carcinoma
Adenocarcinoma
Malignant melanoma
Sarcoma

Front 192

What are 4 types of epidermoid carcinomas that may occur in the anal canal?

Back 192

Squamous cell carcinoma
Transitional cell carcinoma
Cloacogenic carcinoma
Basaloid carcinoma

Front 193

What are 5 symptoms of anorectal neoplasms?

Back 193

Bleeding
Pain
Presence of a mass
Pruritus
Discharge

Front 194

What are the Tx options for anal neoplasms? (5)

Back 194

Wide local excision
Abdominal perineal resection
Radiotherapy
Combination chemo-radiation
APR if excision not feasible

Front 195

What carries the worst prognosis with anal CA?

Back 195

Greater than 5 cm or other organ invasion

Front 196

What is the Nigro protocol used for?

Back 196

Epidermoid lesion of the anal canal (not rectum)
OR
anal margin lesions that are bulky, involve the sphincter, extend proximally

Front 197

What is the Nigro protocol for anal CA?

Back 197

Chemo: 5fu-mitomycin c
XRT
close follow up with bx’s
APR for treatment failure

Front 198

What is the 3rd most common site of melanoma?

Back 198

anus

Front 199

How may anal melanoma be treated?

Back 199

APR (however, may not improve outcome over lesser procedure)

poor prognosis :(

Front 200

What is anal adenocarcinoma from? What may be used as Tx?

Back 200

extension of Rectal cancer extending inferiorly
OR
can arise de-novo from anal crypt glands or in chronic fistula

APR

Front 201

What may cause itching on your "bottom"? :) (5)

Back 201

Pruritus ani
Malignancy
Yeast
Pinworm
Subtle incontinence

Front 202

What are the possible causeus of pruritus ani? (lots-18)

Back 202

Seepage/Soilage
Poor hygiene
Excessive cleansing
Obesity
Tight fitting clothes
Anorectal pathology
Diarrheal states
Pelvic radiotherapy
Dermatologic conditions
Perianal infections
Systemic diseases
Medications
Idiopathic
Caffeine
Citrus
Tomatoes
Spices
Beer

Front 203

What are the Tx options for pruritus ani? (6)

Back 203

Alterations in hygiene
Dietary manipulation
Bulking regimen(Psyllium)
Treat underlying causes
Avoid scratching
Surgical correction of specific anorectal disorders

Front 204

What is hidradenitis suppurativa?

Back 204

acute or chronic infection of the apocrine sweat glands that results in abscess and sinus tract formation

Front 205

What are the possible locations for hidradenitis suppurativa? (8)

Back 205

neck
axilla
inframmary folds
groin
genitals
perianal region
scalp
periumbilical region

Front 206

What are 5 risk factors for hidradenitis suppurativa?

Back 206

Obesity
Heavy perspirers
Mechanical irritation
Local trauma
African American

Front 207

What are the Tx options for hidradenitis suppurativa? (5)

Back 207

Good hygiene
Antibiotics
Incision/drainage of abscesses
Wide excision
Unroofing of tracts

Front 208

What are possible causes of pilonidal dz? (6)

Back 208

-Remnants of medullary canal
-Developemental dermal inclusions
-Vestigal sex glands
-Reaction to imbedded hair
-Infection w/in occluded hair follicle
-Presence of hair perpetuates the process

Front 209

What are 3 predisposing factors of pilonidal dz?

Back 209

Hirsutism
Chronic trauma
Deep intergluteal fold

Front 210

What are the Tx options for pilonidal dz?

Back 210

Pit excision
Cystotomy
Wide local excision
Lateral excision
Flaps
Cleft closure

Front 211

What are the 4 electricity parts of electrosurgery?

Back 211

current
circuit
impedance/resistance (pt)
voltage

Front 212

Where does energy travel with bipolar electrosurgery?

Back 212

b/t confines of electrodes (lower frequency)

Front 213

Which part of electrosurgery is mainly used?

Back 213

coag=blue (85% of time)

Front 214

Where is the Bovi pad typically placed?

Back 214

on thigh due to muscle mass

Front 215

What type of sensation is now being used with electrosurgery?

Back 215

sensing tissue sensation

Front 216

What does it mean by saying that electrosurgery is technique driven? (if cut fast what happens vs slow?)

Back 216

if cut fast dissection, if cut slower hemostasis

Front 217

Do smaller electrodes have higher or lower settings?

Back 217

lower

Front 218

Should the Bovi pad be close to the surgical size or farther away?

Back 218

closest to surgical site so won't get delay

Front 219

What are 6 locations that electrosurgery pads should be avoided?

Back 219

bony prominence
hairy area
scar tissue
prostheses
over tatoo
jewelry

Front 220

Where do most "fires" happen from electrosurgery?

Back 220

during head/neck procedures due to nasal cannula

Front 221

Where should you put the cut & coag pen when not in use? :)better get this one right

Back 221

in the non-conductive HOLSTER

Front 222

Should red rubber catheters be used with electrosurgery?

Back 222

no-only manufacturer approved insulated tips

Front 223

What should not be used to manange cords around pts with electrosurgery?

Back 223

metal

Front 224

Does charge move from negative to postive electrode or from positive to negative electrode?

Back 224

positive (cathode) to negative (anode)

Front 225

What are the 4 parts of the electrosurgical circuit?

Back 225

generator
active electrode
patient
return electrode

Front 226

What is the current that powers the electrosurgical generator?

Back 226

60 Hz

Front 227

What setting with electrosurgery can be used to decrease bleeding with cutting?

Back 227

blend=yellow (50% on & 50% off)

Front 228

Is the voltage for cutting or coagulation with electrosurgery higher?

Back 228

coagulation

Front 229

What are 4 types of electrosurgery?

Back 229

cutting
coagulation
dessication
fulguration (tip not placed on skin but just above)

Front 230

What are 4 variables that influence the tissue effect with electrosurgery?

Back 230

size of electrode
placement of electrode
type of tissue
eschar/scab

Front 231

How is electrosurgery used in gynecology?

Back 231

cervical resections and biopsies

Front 232

What is included in ortho H/PE?

Back 232

history!!!
observation
neuro below injury site
palpation (contralateral side, then location w/ most pain last)
stress/ligamentous test
apprehension test
ROM
strength test
functional test

Front 233

What should be included when talking to doc about ortho pt? (3)

Back 233

neuro status
open or closed
deformity (angulation, displacement, rotation)

Front 234

What is gustilo classification I for ortho?

Back 234

low energy
<1cm

Front 235

What is gustilo classification II for ortho?

Back 235

moderate soft tissue damage
>1cm

Front 236

What is gustilo classification IIIA for ortho?

Back 236

high energy
>10cm
extensive soft tissue damage
periosteum still covering bone

Front 237

What is gustilo classification IIIB for ortho?

Back 237

high energy
>10cm
extensive soft tissue damage
periosteal stripping

Front 238

What is gustilo classification IIIC for ortho?

Back 238

high energy
>10cm
extensive soft tissue damage
neurovascular compromise (artieral injury)

Front 239

What is the last bone in the body to finish growing?

Back 239

clavicle

Front 240

Explain the Salter-Harris classification for ortho fracture?

Back 240

1- physis
2- physis & metaphysis
3- physis & epiphysis
4- physis, metaphysis, epiphysis
5- crush injury to physis

Front 241

____ ___ sequala increases with the grade of the fracture.

Back 241

growth plate

Front 242

What are the 3 common fracture patterns seen in pediatrics?

Back 242

*greenstick (one side of cortex broken)
torus/buckle
bend

Front 243

How are greenstick fractures generally treated?

Back 243

break other side of cortex and cast

Front 244

What are 2 ways that comminuted fractures may happen?

Back 244

trauma
gunshot

>3

Front 245

How may a segmental fracture happen?

Back 245

gunshot

Front 246

How may a transverse fracture happen?

Back 246

football injury

Front 247

What are 2 fractures that occur for rotational forces, such as skiers when they twist with landing?

Back 247

oblique
spiral

Front 248

What segment of the bone does deformity deal with?

Back 248

distal segment

Front 249

What are the 3 types of ortho deformity?

Back 249

RAD
rotation (overlapping)
angulation (bent)
displacement

Front 250

What are 8 types of fractures?

Back 250

greenstick
torus/buckle
bend
comminuted
segmental
transverse
oblique
spiral

Front 251

Does radicular pain require an active or passive test?

Back 251

passive

Front 252

What are 2 fractures that occur for rotational forces, such as skiers when they twist with landing?

Back 252

oblique
spiral

Front 253

What segment of the bone does deformity deal with?

Back 253

distal segment

Front 254

What are the 3 types of ortho deformity?

Back 254

RAD
rotation (overlapping)
angulation (bent)
displacement

Front 255

What are 8 types of fractures?

Back 255

greenstick
torus/buckle
bend
comminuted
segmental
transverse
oblique
spiral

Front 256

Does radicular pain require an active or passive test?

Back 256

passive

Front 257

What are 5 chronic knee conditions?

Back 257

degenerative meniscus
OA
chondromalacia
malalignment
itis (prepatellar, patella/ITB)

Front 258

What are 3 things included in the effusion exam of the knee?

Back 258

anatomic countour/gutters/pouches
milking
ballottement

Front 259

What is antalgic gait?

Back 259

limping

Front 260

What equals a PCL injury?

Back 260

positive anterior drawer sign & negative Lachmans

Front 261

What are 4 tests included in the meniscal exam?

Back 261

joint line point tenderness
McMurray
Apley
Bounce Home

Front 262

What are 6 tests included in the ligament exam of the knee?

Back 262

valgus/MCL
varus/LCL
Lachman
anterior drawer
posterior drawer
apprehension

Front 263

What are the plain films done for the knee?

Back 263

acute (AP/notch/lateral & sunrise)

chronic (AP standing, 40yo)

Front 264

When is a MRI done for the acute knee? (5)

Back 264

acute
-ACL/PCL
-meniscus
-patellofemoral
-nondisplacement

Front 265

When is a MRI done for the chronic knee? (3)

Back 265

degenerative meniscus
OA
PF malalignment

Front 266

What do you think about with cloudy joint effusion of the knee? (3)

Back 266

gout
infection
inflammation

Front 267

What do you think about with serosanguinous joint effusion of the chronic knee?

Back 267

degenerative meniscus

Front 268

Does ITB inflammation have a specific location?

Back 268

yes

Front 269

What are 3 S/S of chondromalacia patella?

Back 269

anterior knee pain
flexion/crepitus
+provocative tests

Front 270

What is a straight leg raise good for?

Back 270

tendon rupture

Front 271

What are 5 conditions that may cause an acute ankle?

Back 271

inversion
fifth metatarsal (MCC)
achilles
eversion
proximal fibula

Front 272

What are 4 conditions that may cause a chronic ankle?

Back 272

osteochondral lesion
peroneal subluxation
posterior tibial insufficiency
chonic instability

Front 273

What is the presentation of acute ankle of inversion? (3)

Back 273

altered gait
lateral edema
'crunch'

Front 274

What ligament is commonly torn with an inversion injury of the ankle? What type of test may be used?

Back 274

anterior talofibular ligament

anterior draw sign test

Front 275

What does a Jones fracture involve?

Back 275

base of 5th metatarsal

Front 276

What test should be done for a torn achilles?

Back 276

Thompson

Front 277

What does the talar tilt test assess?

Back 277

calcaneofibular ligament or deltoid ligament

Front 278

Do NSAIDs increase or decrease fluid retention?

Back 278

generally increases

Front 279

What does a grade 1 ankle inversion injury involve?

Back 279

atfl partial tear
stable pe

Front 280

What does a grade 2 ankle inversion injury involve?

Back 280

complete tear of atfl
partial tear of lcfl
positive anterior draw test
negative talar tilt test

Front 281

What does a grade 3 ankle inversion injury involve?

Back 281

complete tear of atfl/lcfl
positive anterior draw test
positive talar tilt test

Front 282

What x-ray imaging is done for an acute ankle?

Back 282

ankle-AP/lateral/Mortise
foot-AP/lateral/oblique
leg-AP/lateral

Front 283

What is a Mortise x-ray of the ankle?

Back 283

AP w/ foot internally rotated 10-15 degrees; space should be 2-3mm all the way around and symmetrical

Front 284

When is a stressed x-ray performed in ortho?

Back 284

chronic condition

Front 285

What action are the peroneal tendons responsible for?

Back 285

dorsiflexion
eversion

Front 286

What is the "the sprain that just doesn't want to heal"?

Back 286

osteochondral lesion (OLT)

Front 287

What spinal nerves are involved with the rotator cuff?

Back 287

C4-C6

Front 288

What are 5 acute shoulder conditions?

Back 288

clavicle fx
AC separation
glenohumeral dislocation
rotator cuff
long head of biceps

Front 289

What are 4 acute shoulder conditions?

Back 289

rotator cuff (>50yo)
instability (18-30yo)
AC joint
Superior labrial anterior-posterior tear

Front 290

How is a rotator cuff tested? (3)

Back 290

supra - abduction
infra/teres minor - ex. rot
suscap - belly press/int. rot

Front 291

If there is impaired passive ROM in the shoulder then what may you be thinking?

Back 291

adhesive capsulitis

Front 292

What are 5 tests done for shoulder instability?

Back 292

apprehension
location-relocation
load-n-shift/glide test
jerk
sulcus

Front 293

What are 3 x-ray views that may be done for the shoulder?

Back 293

AP
axillary
outlet

Front 294

How much space is there with a chronic rotator cuff tear?

Back 294

<8mm

Front 295

What lesion makes recurrence rates for shoulder dislocation high?

Back 295

Bankhart lesion

Front 296

What type of test is used for SLAP?

Back 296

O'Brain

Front 297

Generally, what is the first action to "go" with rotator cuff tears?

Back 297

internal rotation

Front 298

Who is the recurrence rate of anterior shoulder dislocation high in?

Back 298

b/t ages 15-30

full thickness tears after age 50

Front 299

What do you think of with "young and overhead" shoulder inury?

Back 299

instability

Front 300

What do you think of with "older and overhead" shoulder injury?

Back 300

rotator cuff

Front 301

What is a reason to use MRI with contrast for the shoulder?

Back 301

labral & slap pathology

Front 302

What are 6 conditions that may cause ortho groin pain?

Back 302

hip OA
hip RA
hip Fx
avascular necrosis
SCFE
legg-perthes

Front 303

What are 4 risk factors for AVN of hip?

Back 303

>50
alcohol
steroids
sickle cell

Front 304

What are 3 conditions that may cause lateral hip pain?

Back 304

greater trochanteric bursa
meralgia paresthetica
referred pain spine

Front 305

What nerve roots are involved in cauda equina syndrome?

Back 305

L4, L5, S1

Front 306

What Hx/PE is done for herniated nucleus pulposus?

Back 306

radicular pain
L4, S1 reflexes
straight leg raise sitting
great toe strength
ankle/knee strength

Front 307

Does flexion of the spine increase or decrease arthritic pressure?

Back 307

decreases

Front 308

Does extension of the spine increase or decrease disc pressure?

Back 308

decrease

Front 309

What is included with spinal stenosis?

Back 309

older
bilateral thigh pain
activity related
negative SLR
reflexes intact

Front 310

What is the hallmark of cauda equina?

Back 310

loss of bladder/bowel function

Front 311

Which joint does jersey finger involve?

Back 311

DIP

Front 312

What has a stener lesion, weakness in pinch, and forced abduction with ortho?

Back 312

gamekeeper's thumb

Front 313

What fracture may occur if you fall on your extended wrist?

Back 313

navicular fracture

Front 314

Does medial elbow pain have valgus or varus stress?

Back 314

valgus

Front 315

What part of the bone is the "weak link"?

Back 315

physis

Front 316

Where are 5 apophyes?

Back 316

proximal humerus
medial elbow
asis
tibial tubercle
calcaneus