Ksurgery 300-400

Front 1

Q300. association of BM with SBO

Back 1

A300. usually BM at very start of obstruction, followed by increasdd peristalsis and

Front 2

Q301. dx if there is stool on DRE of patient with SBO

Back 2

A301. ileus, NOT mechanical obstruction

Front 3

Q302. what is early post-op SBO

Back 3

A302. sx that occur <40d following surgery; results from narrowed lumen, exact cause not known

Front 4

Q303. w/u for post-op SBO

Back 4

A303. CT to rule out infection; exact cause not needed

Front 5

Q304. tx for post-op SBO

Back 5

A304. supportive care

Front 6

Q305. cause of chronic mesenteric ischemia

Back 6

A305. occlussion of 2/3 BV; Dz also seen in 3rd as well

Front 7

Q306. Dx of chronic mesenteric ischemia

Back 7

A306. if no ATH, use arteriograpyhy

Front 8

Q307. tx for chronic mesenteric ischemia

Back 8

A307. revasc with antegrade aortomesenteric bypass/perivisceral aortic endarterectomy; angioplasty; retrograde bypass from iliac artery

Front 9

Q308. when to operate on acute mesenteric ischemia

Back 9

A308. this is a surgical emergency!

Front 10

Q309. causes of acute mesenteric ischemia

Back 10

A309. embolism in SMA or celiac artery

Front 11

Q310. which part of the small intestines is spared in acute mesenteric ischemia? why?

Back 11

A310. prox jejunum b/c of collaterals

Front 12

Q311. tx for acute mesenteric ischemia

Back 12

A311. embolectomy; 2nd-look laparotomy should also be done if bowel doesn't appear viable

Front 13

Q312. when should a AAA be repaired

Back 13

A312. 5cm

Front 14

Q313. #1 cause of morbidity and mortality in AAA repair

Back 14

A313. cardiac complications

Front 15

Q314. how should AAA found on physical exam be confirmed

Back 15

A314. CT scan; don't use arteriography b/c it just shows the lumen of BV, can't dx aneurysm from this, although it will help to plan the operation

Front 16

Q315. what are the 2 types of AAA repairs; benefits of each

Back 16

A315. EVAR (endovascular aneurysm repair) - pts with copd, obesity, malig, etc get more protection from rupture with EVAR; open repair - stood the test of time, est as a tx

Front 17

Q316. disadvantages to EvAR

Back 17

A316. rquire imaging f/u every 3-6 mos; patient mortality of 2-3%

Front 18

Q317. presentation of AAA rupture

Back 18

A317. back pain; pulsaltile mass; hypotension

Front 19

Q318. management of acute pancreatitis

Back 19

A318. resuscitative measures/supp O2; monitor cardio-pulm status; CT abdomen

Front 20

Q319. complications of acute pancreatitis

Back 20

A319. hemorrhage; necrosis; fluid collection; infection; pleural effusion; -> pulm/renal probs

Front 21

Q320. process of infected pancreatic necrosis

Back 21

A320. 2/2 infx by bowel organisms; occurs w/i first few weeks of onset

Front 22

Q321. pancreatic abscess cause and tx

Back 22

A321. accumulation of pus and infectious debris; tx with surgical drainage

Front 23

Q322. tx of infectious pancreatic pseudocyst

Back 23

A322. percutaneous/operative drainage

Front 24

Q323. Ranson's criteria seen on admission

Back 24

A323. WBC >16,000; glucose >200; age > 55yo; AST >250; LDH >350

Front 25

Q324. Ranson's criteria following 48 hrs

Back 25

A324. HCt fall by 10%; Ca <8; BUN increase of 5; fluid requirement >6 L; base excess of >4; P02 <60

Front 26

Q325. value of Ranson's criteria

Back 26

A325. more criteria have more severe dz and increased risk of comlication and death

Front 27

Q326. what indicates severe acute pancreatitis

Back 27

A326. necrosis of pancreas; 50% have inx and increased microvasc permeability; -> increased volume los; decreased perfusion of kidneys, lungs, etc

Front 28

Q327. when should a contrast-enhanced CT of the pancreas be done?

Back 28

A327. if pancreatitis dx is in question; if no improvement in 3-5 days; severe pancreatitis based on ranson score (looking for necrosis)

Front 29

Q328. what, if seen on CT, wouldu indicate severe dz and increased risk of complications

Back 29

A328. 2+ extrapancreatic fluid collections or necrosis of >50% of pancreas

Front 30

Q329. management of necrotizing pancreatitis

Back 30

A329. 50% of time,; complicate by infection, so must adminster proph Antibiotics when necrosis is confirmed on CT

Front 31

Q330. how should gallstone pancreatitis be treated?

Back 31

A330. cholecystectomy after pancreatitis has resolved

Front 32

Q331. which Antibiotics penetrate pancreas

Back 32

A331. imipenem; cilistatin

Front 33

Q332. Tx for carotid artery dz

Back 33

A332. surgery should always be done on sx side 1st, if both are affected

Front 34

Q333. when should elective CEA be done

Back 34

A333. if 60% stenosis is seen, unless patient is high risk

Front 35

Q334. what is complication o fCEA or medical management of carotid artery dz

Back 35

A334. stroke can occur with either

Front 36

Q335. how is amt of stenosis determined in carotid artery dz

Back 36

A335. US; if that is unclear, do MR angiogram, carotid angiogram or CT reconstruction angiogram

Front 37

Q336. what are risk factors for CEA

Back 37

A336. prior radiation to the neck; coronary artery stent; recrrent coronary artery stenosis

Front 38

Q337. what is a short term tx for carotid artery dz

Back 38

A337. stent

Front 39

Q338. When should barium enema be used in dx diverticulitis

Back 39

A338. never- there is sig risk involved with intraeritoneal leakage of barium

Front 40

Q339. dx of diverticulitis

Back 40

A339. CT scan will show colonic wall thickening, mesenteric fat stranding; can see diverticulae

Front 41

Q340. complications of diverticulitis

Back 41

A340. perforation; abscess; bowel obstruction; fistula (#1 cause of fistulas in adults)

Front 42

Q341. tx of abscesses from diverticulitis

Back 42

A341. if small, Antibiotics; if big, CT-guided drainage + Antibiotics; if no imrpovement after 72 hrs, surgery

Front 43

Q342. if there is an increased risk of recurrence with diverticulitis, management?

Back 43

A342. elective surgical resection with primary anastamosis even if prior flare-up was treated conservatively

Front 44

Q343. how should uncomplicated diverticulitis be treated?

Back 44

A343. monitor hydration, give IV Antibiotics, bowel rest and observation

Front 45

Q344. how should complicated diverticulitis be treated?

Back 45

A344. surgical resection; colostommy; closure of the rectal stump; reanastomosis performed at a later date

Front 46

Q345. what is fascial dehiscence?

Back 46

A345. disruption of fascial closure within 3 days of operation, with or without operation

Front 47

Q346. complications of fascial dehiscence

Back 47

A346. enterocutaneous fistula; evisceration; incisional hernia

Front 48

Q347. risk factors for fascial dehiscence

Back 48

A347. failure of surgical technique, anesthetic relaxation; >70 yo; DM; infx; malnutrition; pulm dz

Front 49

Q348. tx of fascial dehiscence

Back 49

A348. wound care; elective repair of defect

Front 50

Q349. time frame that fascial dehiscence is most likely to occur?

Back 50

A349. up to 3 weeks following surgery, after that, fibrous scar formation has enough strengthh to prevent evisceration

Front 51

Q350. vitamins involved in wound healing

Back 51

A350. vitamin c, a, b6; (collagen cross linking)

Front 52

Q351. tx of ptx

Back 52

A351. tube thoracostomy/needle aspiration

Front 53

Q352. difference btwn primary and 2ndary spontaneous ptx

Back 53

A352. 1ary: from spont rupture of blebs; 2ndary: from bullous emphysematous dz, CF, CA, PCP, necrotizing infx, copd

Front 54

Q353. sx of tension ptx

Back 54

A353. dyspnea; jvd; decreased breath sounds; increased resondance; trachea shifts away from affected side

Front 55

Q354. tx perf of duo ulcers

Back 55

A354. if no h/o prior ulcers or + HP, omental patch closure and HP tx; if + h/o prior ulcers and - HP, highly selective vagotomy

Front 56

Q355. tx of perf gastric ulcer

Back 56

A355. + closure of perf or excise/resect ulcer w 1ary repair or Billroth I/II

Front 57

Q356. tx of obstructing gastric ulcer

Back 57

A356. antretomy and Whipple

Front 58

Q357. are H2 blockers or PPIs more effective in tx ulcers

Back 58

A357. PPIs

Front 59

Q358. string sign

Back 59

A358. seen in hypertrophic pyloric stenosis, showing narrowed pylorus

Front 60

Q359. stack of coins sign

Back 60

A359. intestinal obstruction

Front 61

Q360. tx for intussusception

Back 61

A360. radiographic reduction; if fails, open surgery

Front 62

Q361. incision through previous scar- good or bad?

Back 62

A361. good. promotes wound healing

Front 63

Q362. featuress of large bowel ischemia

Back 63

A362. minimal pain; see thumbprinting on barium enema; BVs are usually patent

Front 64

Q363. when should a colectomy be done on a patient with UC

Back 64

A363. 10-20 yrs with dz... (after 10 yrs, CA risk increases 4x)

Front 65

Q364. complication of typhoid fever

Back 65

A364. Peyer's patches bleed /perf in 2-3rd week following sx

Front 66

Q365. how to stop intractable bleeding

Back 66

A365. use laparoscopic towels to pack abdomen

Front 67

Q366. what is seen on EKG of patient with high Mg?; how can it be reversed

Back 67

A366. sim to increased K; CaCl2

Front 68

Q367. what is seen with low Na on EKG

Back 68

A367. nothing

Front 69

Q368. what is seen with low K on EKG

Back 69

A368. flattened T waves and U waves

Front 70

Q369. when is succussion splash seen in the abdomen

Back 70

A369. any sort of obstruction

Front 71

Q370. what are the most common causes of pyloric obstruction

Back 71

A370. duo ulcer; gastric CA

Front 72

Q371. how is mild Na deficiency tx?; severe Na defic?

Back 72

A371. fluid restriction; if CNS sx present, give hypertonic saline

Front 73

Q372. how is ARDS monitored

Back 73

A372. ABG

Front 74

Q373. surgery = physiological stress

Back 74

A373. surgery = physiological stress

Front 75

Q374. benefits of enteral feeding

Back 75

A374. preserves gut mucosal mass and nml gut flora

Front 76

Q375. benefits of parenteral feedings

Back 76

A375. good for rapid administration

Front 77

Q376. what happens if TPN is suddenly DCd?

Back 77

A376. rebound hypoglycemia,; give D10W when TPN is suddennly DCd

Front 78

Q377. what does surgery do to fluid levels

Back 78

A377. following surgery, increased cortisol levels --> increased sugar in serum --> increased urine output

Front 79

Q378. what TPN additive is good for liver encephalopathy

Back 79

A378. lactulose

Front 80

Q379. how is AAA dx?

Back 80

A379. U/S then CT scan to det true size

Front 81

Q380. A patient is diagnosed with invasive ductal adenocarcinoma. What is the most important factor in the staging of this patient’s cancer?

Back 81

A380. Lymph Node Involvement

Front 82

Q381. Which nerve, if damaged in an axillary dissection, will result in only a sensory deficit?

Back 82

A381. Intercostobrachial nerve

Front 83

Q382. What cancer drug can cause pulmonary fibrosis?

Back 83

A382. Bleomycin

Front 84

Q383. A 59-yo male presents with complaints of recurrent UTIs. On further questioning, it sounds as if the patient is also experiencing pneumaturia. What is the most likely underlying cause for this patient’s symptoms?

Back 84

A383. Diverticulitis; (Colorectal fistula is also a cause, but is very rare)

Front 85

Q384. What is considered the triangle of Calot in GB surgery?

Back 85

A384. Cystic Duct,; Common Hepatic Duct,; Cystic Artery

Front 86

Q385. A 73-yo female presents with nausea, vomiting, obstipation and abdominal distention. She is afibrile, with slight tachycardia and a distended abdomen without peritoneal signs. She has no History of surgery. What is the most likely cause of this patient’s bowel obstruction?

Back 86

A385. Gallstone Ileus; (may also present with pneumobilia)

Front 87

Q386. A critically ill hemodynamically unstable intubated patient on vasopressors with History of recent MI and long ICU course begins having fevers. Labs are: WBC 19,000, AST 100, ALT 45, ALK Phos 345, total bilirubin 3.0, direct bilirubin 2.8. Abdominal ultrasound shows no stones in the gallbladder. Dx?; What is next step in Tx given patient’s condition?

Back 87

A386. Dx: Acute Acalculous Cholecystitis; (due to biliary sludge secondary to inactivity of the biliary tree. It is seen in critically ill patients with prolonged periods of fasting or Parenteral nutrition, or in patients with multiple transfusions or trauma patients); Tx: Percutaneous Cholecystostomy; (until patient is stable enough to undergo a cholecystectomy)

Front 88

Q387. Type of Shock:; An 18-yo male restrained driver with tachycardia, hypotension, and a rigid abdomen

Back 88

A387. Hypovolemic shock

Front 89

Q388. Type of Shock:; An 80-yo nursing home resident, febrile, unresponsive, hypotensive, with gram-negative rods cultured in urine.

Back 89

A388. Distributive shock; (Sepsis or Anaphylaxis)

Front 90

Q389. Type of Shock:; A 16-yo male victim of a motor vehicle crash with hypotension, bradycardia and the inability to move or feel both lower extremities

Back 90

A389. Neurogenic shock; (seen in patients with spinal cord injuries; caused by a decrease in sympathetic output; CO, CVP, PCWP and SVR are all decreased)

Front 91

Q390. Type of Shock:; A 67-yo male in the medical ICU on 15L of oxygen by facemask, hypotension and crackles in the bases of both lungs

Back 91

A390. Cardiogenic shock; (seen in patients with acute MI and respiratory distress; CO is decreased and everything else is increased)

Front 92

Q391. What is Duke’s staging for Colon Cancer (A-D)?

Back 92

A391. A: limited to Mucosa; B1: into the Muscularis Propria; B2: through the Muscularis Propria; C1: into MP with positive LN; C2: through the MP with positive LN; D: Metastasis or Unresectable

Front 93

Q392. What is the proper medical Tx (post-colectomy) for Duke’s stage C Colon Cancer?; What common cancer Tx is not used in colon cancer?

Back 93

A392. 5-FU and Leucovorin (Levamisole); Radiation is not used in colon cancer; (only in rectal cancer)

Front 94

Q393. What is the Diagnostic Test for patients with Rectal Cancer?; What is the adjuvant Tx for T3-T4 Rectal Cancer? (2)

Back 94

A393. Diagnostic test: Endorectal Ultrasound; Tx: Pre-op Radiation Therapy and 5-FU

Front 95

Q394. A 52-yo female presents with 5-day history of increasing LLQ pain, N/V and fever. Two previous episodes of the pain were treated with Antibiotics. She is tachycardic, has LLQ pain and diffuse peritoneal signs. A CT shows air in the abdomen. Dx?; Next step?

Back 95

A394. Dx: Perforated Diverticulum; Next step: Emergency resection of the Sigmoid colon with diverting colostomy

Front 96

Q395. A 27-yo male presents with severe RLQ and testicular pain that began 5 hours ago. The pain is the worst he has ever experienced and is assoc with nausea. He is writhing in pain and cannot hold still as you talk to him. He is afebrile and has a WBC of 10,300. Diagnostic test?; Dx?

Back 96

A395. Diagnostic test: Urinalysis; (on every patient with RLQ pain); Dx: Kidney Stone

Front 97

Q396. An 80-yo female presents with vomiting 5 times that day which was thick and brown in appearance. She also complains of severe abdominal pain that began the previous night and has gotten worse and that she has had no BM or flatus throughout the day. She has no History of previous surgery and underwent a colonoscopy 1 month ago for chronic constipation, which elicited normal results. What is the most likely cause of this bowel obstruction?

Back 97

A396. Sigmoid Volvulus

Front 98

Q397. How is Total Body Water calculated in men and women?

Back 98

A397. Men: 60% of body weight; Women: 50% of body weight

Front 99

Q398. A patient’s recent blood glucose levels have been high at 500 mg/dL. This morning her sodium was 134 mmol/L. What is the corrected sodium level? (Eqn)

Back 99

A398. (Na + [glucose – 100] x 0.016) =; (134 + [500 – 100] x 0.016) = 140 mmol/dL

Front 100

Q399. How is plasma osmolality calculated? (Eqn); An osmolar gap is present if the measured and calculated osmolarity differ by how much?

Back 100

A399. (2 x Na) + (glucose/18) + (BUN/2.8); Differ by 15 mOsm/kg

Front 101

Q400. What causes a bluish discoloration of the periumbilical area?; What is another sign of this?

Back 101

A400. Fox’s sign: Retroperitoneal Hemorrhage; (ex: acute hemorrhagic pancreatitis); another sign: Ecchymosis or discoloration of flank; (Grey Turner’s sign)