Surgery Oral Exam

Front 1

What is Valentino's appy?

Back 1

Rupture of peptic ulcer that flows down the colic gutters

Front 2

Name ten things on on the DDX for RLQ pain:

Back 2

Appendicitis, diverticulitis, TOA, Hepatitis, mesenteric lymphadenitis, gastroenteritis, kidney stone, diverticulitis of cecum, PID, ectopic, UTI, IBD, Pancreatitis and PNA

Front 3

Describe the clinical appearance of SBO

Back 3

Patient is distended, air fluid levels seen on KUB, feculent vomit, typanic abd, dehydrated. Metabolic alkalosis with hypo K and hypo CL.

Front 4

If there is crohn's in the cecum why should you not take out the appendix?

Back 4

Because it may cause a fistula

Front 5

Name the 7 causes of a fistula:

Back 5

You bump fists with your FRIENDS: Foreign body, Radiation, Infection, Epitheliazation, Neoplasm, Distal obstruction, Stones

Front 6

How do you manage a Crohn's SBO?

Back 6

First with medical management: NPO, bowel rest, TPN and observation. If not improved in 3 weeks, may need to resect affected colon with anastamosis.

Front 7

How do you manage peri-anal disease with Crohn's?

Back 7

Drain the peri-rectal abscess and place a seton (hollow plastic tube) in the fistula and give metronidazole

Front 8

How do you treat mesenteric lymphadenitis?

Back 8

IVF

Front 9

How do you treat supperative thrombophlebitis?

Back 9

Remove the focus on infection (catheter, section of vein), IV antibiotics, consider surgical intervention.

Front 10

28 year old presents with abdominal pain, elevated WBC and large tubular structure in the retroperitoneum after vaginal delivery:

Back 10

Suppurative Thrombophlebitis: treat with exploratory celiotomy- find the ovarian vein and excise it

Front 11

Why should you do an EKG with increased calcium levels?

Back 11

Can cause short QT intervals with prolonged PR

Front 12

What is the medical treatment for hypercalcemia?

Back 12

NS to dilute, diuresis with lasix. Then begin calcitonin, Mithramycin and bisohosphonates.

Front 13

Name eleven common causes of hypercalcemia:

Back 13

CHIMPANZEES... or Hyperparathyroidism, Sarcoidosis, Vitamin A or D intoxication, Iatrogenic (thiazides), Milk alkali syndrome, metastatic cancer, Paget's disease, Addison's disease, neoplasm

Front 14

Name four ways to test for renal artery stenosis:

Back 14

Duplex the renal arteries, radioisotope renogram (arteriogram), hypertensive IVP

Front 15

What test would you do for Cushings?

Back 15

AM/PM cortisol levels and then a low dose/high dose dexamethasone to confirm (pituitary will have suppression with high dose)

Front 16

Name five causes of uncontrollable HTN:

Back 16

1. Cushing's syndrome
2. Renal artery stenosis
3. Conn's syndrome
4. Coactation of the aorta
5. Pheochromocytoma

Front 17

What tests for mets should be done with a diagnosis of melanoma?

Back 17

LFTs and CXR

Front 18

If there is a melanoma of the face, what should be removed?

Back 18

The melanotic lesion with adequate margins. Do a superficial parotidectomy and modified radical neck dissection. Avoid the marginal mandibular branch of the facial nerve.

Front 19

Change in mental status is due to ________ until proven otherwise:

Back 19

Hypoxia

Front 20

What are the two commmon causes of wound infection:

Back 20

Group D strep and clostridium

Front 21

An SpO2 of 70, 80, and 90 correspond to a PaO2 of what?

Back 21

40, 50, and 60. At a PaO2 of 60 the hemoglobin curve drops precipitously

Front 22

What size tube do you intubate with? Why? Where should it be placed?

Back 22

Size 8 tube becasue its the smallest a scope will fit down, tip of the tube should be 2cm above the carina, which is about the level of the clavicles.

Front 23

What is intermittent manditory ventillation?

Back 23

Has a predetermined rate but patients can breathe over the vent.

Front 24

What should initial vent settings be?

Back 24

10-15cc/kg, 10 breaths a min, FiO2 100% and weaned down to <60. PEEP of 5.
Change according to blood gas analysis

Front 25

What are the benefits and draw-backs of PEEP?

Back 25

Its good because it keeps pressure in the lungs that keeps alveoli open but is bad because it can cause a PTX, it decreases venous return and cardiac output and can cause hypotension.

Front 26

If a patient is allergic to heparin but has a PE, what do you do?

Back 26

Place a greenfield or bird's nest filter in the IVC below the renal arteries.

Front 27

What is Homan's sign?

Back 27

A sign of DVT: pain in the calf with dorsiflexsion of the foot while the knee is at 90 degrees

Front 28

Signs of DVT:

Back 28

One large leg, Doppler legs, spiral contrast CT of chest

Front 29

What causes duodeal atresia?

Back 29

Vascular insult during development that causes failure of recannalization

Front 30

Why does a child with pyloric stenosis have aciduria?

Back 30

Due to intractable vomiting, kidneys save Na+ at the expense of H+. They don't exchange it for K+ because K+ is low and they're trying to save that too.

Front 31

What tests should be done for pyloric stenosis?

Back 31

U/S or upper GI with barium.
Gastrograffin is water soluble in the peritoneal cavity but causes pneumonitis. Barium is bad in the peritoneal cavity

Front 32

What causes an inguinal hernia in children?

Back 32

Patency of the proccussus vaginalis

Front 33

What pre-op medications are given to a patient undergoing CEA?

Back 33

Prophylactic antibiotics (foreign body), heparin, and dopamine to keep BP up. Give an alpha blocker pre-operatively and have nitro drip ready for HTN crisis.

Front 34

Why does a patient have a HTN crisis with CEA?

Back 34

Carotid body is clamped, body thinks you're hypotensive, releases signal to increase catecholes and blood pressure. Should inhibit carotid body with lidocaine.

Front 35

Why is a bowel prep important in repair of a AAA?

Back 35

Because you ligate the IMA which provides blood to watershed areas of the colon (splenic flexure). If there is ischemia of the bowel, patient gets ischemic colitis 2-3 days post-op. Translocation of bacteria will infect the graft.

Front 36

What preparation is important for a AAA repair:

Back 36

Get EKG and stress test, do pre-op antibiotics (foreign body) and bowel prep.

Front 37

What is Dieulafoy's ulcer?

Back 37

large tortuous ateriole in the stomach that erodes and bleeds and can cause gastric hemorrhage.

Front 38

What are options for AAA repair?

Back 38

1. Open repair with direct transabdominal approach
2. Retroperitoneal approach
3. Endograft repair

Front 39

What is the major drawback of endovascular repair of AAA?

Back 39

Endoleak: occurs in 20% of patients. Need compliant patient for good followup.

Front 40

What is an aortoenteric fistula? What causes it?

Back 40

Fistula between the aorta and duodenum caused by slow growing graft infection with S. epidermidis.

Front 41

How do you approach fixing an aortoenteric fistula?

Back 41

Endoscopy in the OR, CT to look for gas bubbles or fluid, take out the infected graft, irrigate with betadine and perfirm exta-anatomic bypass (axillobifem)

Front 42

What is MEN1?

Back 42

Tumos associated with menin gene defect: Pituitary, parathyroid and pancreas

Front 43

What is Men 2a?

Back 43

Tumors associated with the Thyroid, parathyroid, and adrenals

Front 44

Men2b:

Back 44

Tumors associated with submucosa, medullary thyroid, and adrenal

Front 45

Why do a trach if patient is on vent for > 2 weeks?

Back 45

To prevent tracheoinnominate fistula (bracheocephalic artery)

Front 46

What should urine OP be in a burn patient?

Back 46

30cc/hr

Front 47

Why is myoglobin not good for kidneys? How do you fix this?

Back 47

It clogs the renal tubules. Flush with isotonic fluids and alkinalize the urine.

Front 48

Name 6 things to put on burns:

Back 48

1. Sulfamylon
2. Silvadene
3. Silver Nitrate
4. Bacitracin
4. Betadine
6. Acetic Acid

Front 49

What are the drawbacks of sulfamylon?

Back 49

painful- irritates nerve endings
Causes metabolic acidosis because its a CA inhibitor

Front 50

What are the drawbacks of silvadene?

Back 50

Transient neutropenia

Front 51

What are the drawbacks of silver nitrate?

Back 51

Metabolic alkalosis due to hypo K and hypo Na, turns everything black

Front 52

Name 6 ways to stop bleeding esophageal varices:

Back 52

1. sclerotherapy : using sodium morrhuate
2. Balloon tamponade
3. rubber band ligation
4. vasopressin
5. Somatostatin
6. Portocaval shunt

Front 53

What causes hepatic encephalpathy? How do we test for it?

Back 53

Its caused by bacteria normally detoxified in the liver
Test for it by measuring arterial ammonia

Front 54

What are Child's criteria?

Back 54

Predicts operative mortality in patient's with cirrhosis. Measures ascites, bili, albumin, and encephalopathy
A: no symptoms and no increased risk
B: well controlled ascites, moderate lab values, 15% increase
C: Ascites, encephalopathy, bad nurtrition, 40% mortality

Front 55

What is TIPS?

Back 55

transjugular intrahepatic portosystemic shunt: stent placed intrahepatically between the hepatic vein and branch of the portal vein. Is a temporary bridge to transplant

Front 56

If a mass is detected at the head of the pancreas on CT, how do you biopsy it?

Back 56

Transduodenal biopsy so that leakage goes into the stomach

Front 57

Where is the head of the pancreas?

Back 57

Above the portal vein

Front 58

Whipple procedure removes what?

Back 58

distal 1/2 of the stomach (antrum), head of the pancreas, duodenum, gallbladder, cystic duct, common bile duct, proximal jejunum and regional lymph nodes.

Front 59

Whipple is also a good procedure for what other carcinoma?

Back 59

Cholangiocarcinoma (5 year survival is 40%)

Front 60

If pancreatic cancer is unresectable in a patient with symptoms, what can be done?

Back 60

Relieve biliary obstruction with a stend placed with ERCP.
Stents are frequently infected and need replacement q3 months.

Front 61

Surgical solution to chronic pancreatitis?

Back 61

Roux en Y choledochojejunostomy: bypass from the CBD to the jejunum. This prevents alkaline gastritis.

Front 62

How do you medically treat alkaline gastritis

Back 62

Cholestyramine to decrease bile acid pool or Calcium to chelate bile acids

Front 63

What tests should be done to clincally stage colon cancer?

Back 63

CXR and LFTs and pre-op CEA level

Front 64

What preparation should be done for a bowel resection for colon cancer?

Back 64

Check labs, do bowel prep, give antibiotics (neomycin and erythromycin)

Front 65

What post-op test should be done 6 weeks s/p colon cancer resection?

Back 65

CEA

Front 66

Richter's hernia

Back 66

incarcerated or strangulated hernia involving one side of the bowel

Front 67

Littre's hernia

Back 67

hernia involving Meckel's diverticulum

Front 68

Spigelian hernia

Back 68

hernia through the linea semilunaris (spontaneous lateral ventral hernia)

Front 69

Pantaloon hernia:

Back 69

hernia sac is both direct and indirect and straddles the inferior epigastric vessels

Front 70

Grynfeltt's hernia

Back 70

hernia through superior lumbar triangle

Front 71

Petit's hernia

Back 71

hernia through inferior lumbar triangle

Front 72

Bochdalek's hernia

Back 72

hernia thorugh posterior diaphragm - usually left

Front 73

Morgagni;s hernia

Back 73

anterior parasternal diaphragmatic hernia

Front 74

Cooper's ligament

Back 74

pectineal line of pelvis

Front 75

Poupart's ligament

Back 75

attaches from the ASIS to the pubic tubercle

Front 76

Nissen

Back 76

wraps fundus 360 around LES

Front 77

Belsey Mark IV:

Back 77

270 degree wrap around the LES

Front 78

Toupe

Back 78

180 degree wrap around les

Front 79

hill repair

Back 79

posterior gastropexy: uses the arcuate ligament to re-establish the intra-abdominal position of the distal esophagus

Front 80

Collis-Nissen

Back 80

cut the stomach to lengthen the esophagus

Front 81

Heller Myotomy

Back 81

Used for achasia

Front 82

Bassini

Back 82

repair for inguinal hernia, sutures pouparts ligament to the transversus abdominus aponeurosis/conjoint tendon

Front 83

McVay

Back 83

Cooper's ligament sutured to transversus abdominis aponeurosis

Front 84

Wound infection in the first 24 hours is caused by

Back 84

Group D strep and Clostridium

Front 85

How do you kill clostridium

Back 85

PCN

Front 86

Treatment for acute hyperkalemia

Back 86

IV calcium is cardioprotective, sodium bicarbonate, glucose and insulin, albuterol, kayexalate, dialysis

Front 87

Name 6 complications after surgery

Back 87

1. Death
2. hemorrhage
3. loss of function
4. pain
5. scarring
6. Infection

Front 88

The biggest risk of giving packed RBCs is _________

Back 88

bleeding- dilutional effect on platelets