General Surgery

Front 1

crushing pain with swallowing, harder to swallow liquids than solids, uncoordinated contraction- work up?

Back 1

1. barium swallow
def dx. manometry
(motility problems)
Tx- repeated dilations or surgical myotomy for achalasia

Front 2

esophageal cancer:
h/o smoking and etoh

Back 2

scc
(high incidence in blacks)

Front 3

esophageal cancer:
h/o chronic GERD

Back 3

adenocarcinoma

Front 4

esophageal cancer workup

Back 4

barium swallow
endoscopy and bx
CT to see if operable

Front 5

prolonged, forceful vomiting with bright red blood
-w/u?

Back 5

endoscopy
photocoag with laser

Front 6

prolonged, forceful vomiting with sudden onset epigastric and low stern pain, fever, leukocytosis
-w/U?

Back 6

contrast swallow (gastrografin first, barium if negative)
-ER surgical repair

Front 7

long standing GERD sx
w/u?

Back 7

endoscopy and bx

Front 8

surgical procedure for GERD

Back 8

if dysplasia--> resection
all others --> laproscopic Nissen fundoplication

Front 9

what type of stomach ca is more common in the elderly?
sx?

Back 9

gastric adenocarcinoma
- anorexia, wt. loss, epigastric distress or early satiety.

Front 10

which stomach ca can be reversed if you get rid of H.pylori

Back 10

lymphoma (maltoma)

Front 11

colicky abd pain,
protracted vomiting, progressive abd distention, no gas or BM
--w/u?
--tx?

Back 11

x-ray :: distended loops of small bowel with air fluid levels
tx: NPO, NG suction, IVF

Front 12

small bowel ob with fever, leukocytosis, constant pain...

Back 12

strangulated ob- compromised blood supply
tx= ER surgery

Front 13

small bowel ob sx + irreducible hernia that used to be reducible.

Back 13

incarcerated hernia
**

Front 14

diarrhea, flushing, wheezing, Rheart damage (JVD)

Back 14

carcinoid syndrome: seen in pts with small bowel carcinoid tumor with liver mets

Front 15

w/u for carcinoid syndrome

Back 15

24hr urine collection, look for 5-hydroxyindolacetic acid.
**

Front 16

1. anorexia
2. periublical pain
3. sharp, severe constant pain that localizes to RLQ
4. fever, leukocytois

Back 16

appendicitis
-ER apendectomy

Front 17

sx: anemia
often inelederly
stools with 4+ blood
w/u?
tx?

Back 17

mostly likely ca of right colon
dx: colonoscopy and bx
tx: right hemicolectomy and transfusions

Front 18

sx: bloody BM, constipation
w/u?
tx?

Back 18

mostly likely ca of left colon

flexible proctosigmoidoscopic exam and bx
if large ca--> preop chemo rad

Front 19

when is surgery an option for ulcerative colitis?

Back 19

severe, >20 yrs, medical management not helpful. surgery removes all of affected colon, rectal mucosa too.

Front 20

profuse water diarrhea, crampy abd pain, fever, leukocytosis after abx

Back 20

--> Pseduomembranous colitis from C. diff
dx: C. diff toxin assay
tx: d/c abx, metronidazole or Vanc

Front 21

sx: usually young F w/ pain on defecation + blood streaks on stool, start to avoid BM = constipation

Back 21

anal fissure
tx: relax sphincter by giving stool softners, topical nitroglycerin, local Botulin toxin, forceful dilatation, lateral internal sphincterotomy.

Front 22

tx of ischiorectal abscess
-caution if diabetic?
-other complications?

Back 22

I&D
- diabetic may get necrotizing infection
-fistula in ano

Front 23

fecal soiling and perineal discomfort after I&D of rectal abscess

Back 23

fistual in ano
-epithelial migration form anal crypts to skin= cordlike tracts, d/c

Front 24

SSC of anus:
mass out of anus and mets to inguianl nodes
pop?
dx? and tx?

Back 24

HIV +, homosexuals
dx: bx
tx: nigro chemoradiation protocol

Front 25

tests for GI bleeding:
vomit blood

Back 25

upper gi endoscopy
-look at naso and oropharynx first

Front 26

tests for GI bleeding:
melena

Back 26

upper gi endoscopy

Front 27

tests for GI bleeding:
red blood from rectum

Back 27

pass NG tube and aspirate gi contents

Front 28

results for NG tube aspiration:
-no blood, fluid is white (no bile)

Back 28

- nose to pylorus clear, but duodenum may be source
--> UGIE

Front 29

results for NG tube aspiration:
no blood and fluid is gren (blood tinged)

Back 29

exclude entire upper gi

Front 30

upper gi landmarks

Back 30

tip of nose to ligament of treitz

Front 31

h/o recent rectal bleeding but not actively bleeding now
w/u?

Back 31

UGIE if young
if old do UGIE and LGIE

Front 32

bloody rectum in a kid
w/u?

Back 32

meckel's so do technetium scan looking for ectopic gastric mucosia

Front 33

Sx:sudden onset, constant generalized abd pain.
Pe: tenderness, gaurding, rebound, -bs
W/U?

Back 33

perforation
dx: abd x-ray: free air under diaphragm

Front 34

sudden colicky abd pain, constant movement

Back 34

abd obsruction

Front 35

severe abd pain + blood in gut lumen

Back 35

ischemic process

Front 36

ascites + mild generalized acute abd pain
w/u?

Back 36

primary peritonitis:
- cx of ascitic fluid
- tx is abx not surgery

Front 37

DDx for generalized acute abdomen

Back 37

-primary peritonitis --> exploratory laparotomy
-MI --> ecg
- LL PNA -->cxr
-PE
- pancreatitis --> amylase
-urinary stones --> abd xray

Front 38

sx: rapid onset of epigastric pain radiating to back, n/v/ retching.
pe: ttp in upper quads

w/u? and tx?

Back 38

dx: serum or urinary amylase or lipase
ct if not clear
tx NPO NG suction IVF

Front 39

-colicky flank pain radiating to inner thigh and scrotum/labia
-inc urinary urgency and freq
w/U?

Back 39

plain x ray may show stones

Front 40

acute onset LLQ pain, fever, leukocytosis
w/u? tx?

Back 40

ct to confirm acute diverticulitis
NPO, IVF, abs
surgery if 2 or more attacs

Front 41

severe abd distention in elderly

Back 41

volvulus of sigmoid
dx with xray= air-fluid levels, parrots beak
tx: proctosifmoidoscopic exam
if recurrent resection

Front 42

serum marker for hepatocellular carcinoma
a/w- cirrhosis, and hepc

Back 42

alph fetoprotein

CEA marks metastic tumors from the colon

Front 43

tx of mets to liver

Back 43

resection if on one lobe or radioablation

Front 44

liver tumor a/w OCP's
dx?
tx?

Back 44

heaptic adenoma
dx with CT
tx er surg

Front 45

tender liver, fever, high wbc's
h/o acute ascending cholangitis

Back 45

-pyogenic liver abscess

dx: sonogram or CT
tx: percutaneous draiange

Front 46

jaundice
+ elevated unconjugated bili

Back 46

hemolytic jaundice

Front 47

jaundice
+ high direct and indirect bili,
high high liver transaminases, high alk phos

Back 47

hepatocellualr jaundice
- hepatitis

Front 48

jaundice
+ high direct and indirect bili,
high liver transaminases, very high alk phos

Back 48

obstructive jaundice
dx- sonogram

Front 49

pres: obsese, fertile, 40F withhigh alk phos, dilated ducts on sonogram and nondilated gB full of stones
tx?

Back 49

ERCP, sphincterotomy and choleystectomy

Front 50

location of tumors causing jaundice:
-adenocarcinoma
-cholangiocarcinoma

Back 50

-head of panc or ampulla of Vater
-CBD

Front 51

steps of w/u in biliary tumors

Back 51

1. u/s (dilated inrahepatic ducts, distended thin-walled gb)
2. ct
3. percutaneous bx
4. ERCP
5. brushings of cbd for cytology
tx- whipple's (pancreatoduodenectomy)

Front 52

which has better prognosis, ampullary cancer or CBD cancer or pancreatic cancer

Back 52

ampullary and CBD
pancreatic is worst

Front 53

location of biliary colic?
sx?, dx? tx?

Back 53

cystic duct (gallstones)
sx: colicky pain in RUQ, radiating to the R shoulder, 10-30 min
worse with fatty food, n/v
dx; U/s
tx: cholecystectomy

Front 54

location of cholecystitis?
dx?
tx?

Back 54

cystic duct
dx:u/s: gallstones, thick waled gb, pericholecystic fluid
tx: NPO, NG suction, IVF, abx

Front 55

if pts do not respond to initial tx of cholecystitis, what next?

Back 55

er cholecystectomy (common in diabetics),
er percutaneous transhepatic cholecystostomy if very sick

Front 56

location of cholangitis?
dx?
tx?

Back 56

CBD
dx: high bilis, high alk phos, really high wbc's
tx: ax, er decompression of CBD by ERCP (PTC also)

Front 57

location of biliary pancreatitis?
dx?
tx?

Back 57

ampulla, temporarily obstructing both panc and biliary ducts
dx: sonogram
tx conservative (NPO, ng tube, ivf) later elective cholecystectomy

Front 58

epigastric pain
+ high WBC, high glucose, low Ca2+, Hct drops, BUN incr, and metab acidosis

Back 58

acute hemorrhagic pancreatitis
-do serial CT's, may need to drain

Front 59

pancreatic pseudocyst (5wks post pancreatitis or trauma)
dx?

Back 59

dx w/ CT or U/s
tx: drain

Front 60

young F, teens, twenties
-firm rubbery breast mass, moves easily w/ palpation
dx?

Back 60

dx fibroadenoma w/ u/s or FNA

Front 61

tx of giant juvenile fibroadenomas

Back 61

removal

Front 62

cystosarcoma phyloodes

Back 62

removal

Front 63

fibrocystic disease

Back 63

usually w/ menses
aspirate: if clear: no big deal, come and go
if bloody, send to cytology, if mass persists or recurs after aspiration then bx

Front 64

bloody nipple d/c

Back 64

intraductal papilloma
-mammogram or galactogram

Front 65

most common breast ca

Back 65

invasive ductal carcinoma
-worst and most invasive

Front 66

tx for ductal ca in situ

Back 66

-simple mastectomy for multicentric lesions
-lumpectomy + radiation if lesion just in one quarter of breast

Front 67

female who recently recovered from breast ca now has persistent HA and back pain

Back 67

likely mets (brain or bone)
CT brain, bone scan and xray
-give steroids and radiation

Front 68

which type of breast ca is often bilateral

Back 68

lobular

Front 69

which type of breast ca has the best prognosis?
worst?

Back 69

medullary
inflammatory worst

Front 70

orange peel skin of breast, painful

Back 70

inflammatory breast ca
-do mammogram and mult core bx

Front 71

eczematous patches on nipple, pigment changes.
mucin filled cell in epidermis

Back 71

paget's dz

Front 72

bloody or serous nipple d/c

Back 72

intraductal papilloma
-do a mammogram

Front 73

leaf like projections of large bulky breast mass
(cyst)

Back 73

phyllodes tumor

Front 74

thyroid nodule:
if cancerous, would pt have hypo or hyperthyroid?

Back 74

usually hypothyroid

Front 75

w/u for cushing's

Back 75

low dose dexamethasone suppression test:
-if sup at low doseage= neg
-if high cortisol, try high dose
-sup at high does =pit microadenoma
-no supp= adrenal adenoma

Front 76

PUD sx hypersecretion of acid
a/w MEN
dx?
tx?

Back 76

dx: gastrin and glucagon levels, CT of pancrease
tx. removal and PPI

Front 77

migratory necrolytic dermatitis, diabetes, anemia, glossitis, stomatitis.
dx?

Back 77

labs- glucagon levels
ct- glucagonoma
tx with tumor resection, somatostatin and streptozocin if metastatic and inoperable.

Front 78

HTN + hypokalemia

Back 78

primary hyperaldoseronism
-renin low
-check response ot postural changes
tx- aldatone
CT or MRI
surgery

Front 79

HTN + HA, perspiration, palpitations, pallor
dx:?
tx?

Back 79

pheochromocytoma (chromaffin cell of adrenal medulla tumor tahat secretes NE and E and DA)
dx: 24h urine= VMA or metanephrine
CT scal of adrenals
tx: surgery with alpha blockers: phenoxybenzamine)

Front 80

heart abnormality a/w HTN

Back 80

coarctation of aorta

Front 81

HTN + fibromuscular dysplasia in young women

Back 81

renovascular HTN
dx with doppler of ranl vessels and ateriogram
tx: balloon dilatation and stenting

Front 82

pt has severe constatn retrosternal pain after UGIE, has ferver and sweats and subq emphysema at base of nec
dx, tx?

Back 82

gastrografin swallow
then er surgical repair

Front 83

which types of colonic polyps are benign?

Back 83

juvenile, peutz-jeghers, inflam, hyperplastic

Front 84

the more villous the poly, the more______

Back 84

malginant
-villous adenoma
-tubular
-tubulovillous

Front 85

polyps and their potential for malignant conversion

Back 85

familial adenomatous polyposis
-gardner, turcot
-villous adneoma
HNPCC/lynch
-adneomatous polyp

Front 86

h/o ulcerative colitis, now very sick with abd pain

Back 86

likely toxic megacolon, ER surg

Front 87

which type of hemorrhoids bleed but do not hurt?

Back 87

internal
-external really hurt but not blood
tx- need to rule out malignancy
so do proctosidmoidoscopy examination (rectal, anoscopy)

Front 88

excruiating abd pain, then 40 min later, cannot move, abd is rigid, xray shows free air under diaphragm

Back 88

-perforated duodenal ulcer
tx= er exploratory lapartomy

Front 89

liver abscess that results in bloody diarrhea, very common in MX
tx?

Back 89

entamoeba histolytica
tx- metronidizole, send serology but it takes forever, no cx

Front 90

dx test for alcoholic w/ constant chronic epigastric pain that radiates to the back, w/ dm, statorrhea, and calicifation in the upper abd on xray

Back 90

ERCP-- likely chronic pancreatitis
-stop etoh
-replace panc enysmes

Front 91

tx for breast ca in post menopausal pt that has +receptors

Back 91

anastrozole instead of chemo

Front 92

thyroid nodule w/u?

Back 92

tsh
us
fna
-if fna malignant or unk
--> thyroidectomy

Front 93

hypercalcemia, hypophosphatemia
w/u?

Back 93

pth
sestamibi scan
(likely pit adenoma)