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670 Cards in this Set
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Controversial standard w/u for kid < 12 c 1st UTI
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VCUG (voiding cystourethrogram)
Some professional wait for 2nd |
50% have urinary anomaly
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Dx procedure to determine presence of bladder CA
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cystoscopy c Bx
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Most common presenting complaint of bladder CA
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painless hematuria
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Most common type of bladder CA
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transitional cell carcinoma
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First line Dx test for children c suspected osteomyelitis
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Bone scan
MRI = more sensitive; replacing it? |
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Conn's syndrome?
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Primary hyperaldosteronism
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Inc Na, Dec K
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How to treat Conn's syndrome?
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Cut out tumor
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Elements of MELD score
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INR, Bili, Cr,
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Hand injury c exposed vessels - do you clamp?
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No, b/c nerves follow the vessels
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6 hr rule for penetrating trauma
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If CXR neg at 6 hr, probably okay
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LES with reference to diaphragm
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Below the diaphram
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If LES above diaphragm
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hiatal hernia
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Sx of hiatal hernia? Why?
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GERD - crura help to prevent reflux
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Best prophylaxis for esophageal variceal bleeding who have not yet had bleed - med (2), surg (1)
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Med: Beta-blocker, nitrates
Surg: endoscopic band ligation |
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In US, esophageal CA more common in which race? What is the increased risk?
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African American: White 2-3:1
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Role of radiation in DCIS
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Used after lump excised (breast conservation therapy)
Limited retrospective show may not req adjuvant if low-grade |
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Medical therapy of choice for h. pylori
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Triple therapy: 2 abx + antacid
Flagyl, amox/tet, ranitidine |
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How give abx in triple therapy?
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Sequential better than both abx together
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Tx of choice for DVT in pt c c/in for anticoag (recent intracranial bleed)
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Place IVC filter
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How effective is IVC
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Good in short term, bad in long term
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Typical w/u for pt c suspected carpal tunnel (3)
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1. H&P
2. Xray to r/o Fx 3. EMG |
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Pt c carpal tunnel, suspect: 5
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DM, hypothyroid, pregnancy, acromegaly, RA
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Standard 2 drug regimen for intra-abdominal regimen
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Flagyl - cover anaerobes
Aminoglycoside - cover GNR Other combo: PCN/beta-lactamse inh |
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Art blood supply to esophagus: 3
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Sup -> thyroid arteries
Mid -> intercostal Inf -> L gastric artery |
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If acute panc not improve in 3-5 d, should order? Why?
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CT scan c contrast to r/o necrosis
Lights up extravasation |
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Most common cause of post op fever
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Atelectasis?
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5 W of post op fever
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Wind - atelectasis, PNA
Water - UTI Wound - inf Walking - DVT Wonder Rx |
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type of CA most likely having a paraneoplastic syndrome of growth hormone
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SCC of lung
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of lung CA, most likely to have elevated level of CEA
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Bronchoadenocarcinoma
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Tx of choice for acute hypercalcemia
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Volume expansion -> load then diuresis
Bisphosphonate if paraneoplastic |
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Non-surg measure to dec ICP in expanding mass lesion in head
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Hypervent -> blows off CO2 -> vasoconstriction
Mannitol ??Hypertonic saline?? |
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best predictor that splenectomy would cure ITP
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partial response to steroids
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Indications for prophylactic abx in burn victims
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Don't give it!! Abx can't penetrate dead tissue
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Most common cause of blood pleural effusion (3)
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Malig
Trauma TB inf |
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Approx cure rate after resection of gastrinoma
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~100% survival @ 10 yrs
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If present c gastrinoma, what other tumors should you look for? Syndrome?
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MEN 1
Parathyroid, pituitary |
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What causes the highest number of deaths from CA in US?
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Lung CA
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Presence of gallstones in CBD
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Choledocholithiasis
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Type of skin CA in areas of previous burn injuries
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SCC
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Role of ext mech stabilization in flail chest
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No role
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What is a flail chest
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Paradoxical movement of chest wall during breathing from rib Fx
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Tx of flail chest
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Analgesic to prevent hypovent
Intubate -> + pressure vent |
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Top 2 manifestations of chronic panc
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Endo: DM
Exo: steatorrhea |
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~ cumulative lifetime risk of developing Sx in asymptomatic cholelithiasis
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15-20%
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Watershed areas of bowel
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Splenic flexture
Recto-sigmoid jxn |
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Courvoisier's sign
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Palpable nontender GB c jaudice
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Courvoisier's sign is a sign for?
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Any tumor that compresses CBD
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rationale for removing GB during Whipple
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Ampulla of vater is affected -> remove to prevent cholelithiasis/cholestasis
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What's a Whipple?
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Pancreatico-duodenectomy
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Aortic dissection v. aneurysm
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Dissection -> only intima
Aneurysm -> all walls imtima, media, adventitia |
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Tx for acute hyperkalemia 5
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Myocardial stabilization -> 10% Ca gluconate
Glc c insulin -> drive into cells Kayexalate -> Na polystyrene sulfate Diuretics to waste Dialysis |
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Very sick pt, use this for acute cholecystitis
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Cholecystostomy -> tube placed into GB perc to decompress & drain
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Cushing's ulcers are?
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Central neuro insult causing single deep ulcer
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Iatrogenic destruction of nerve leading to winged scapula? Which muscle? Which surgery?
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Cutting long thoracic
Innervates serratus anterior Axillary node dissection |
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Other nerves damaged in breast surgery? Which muscle?
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Thoracodorsal -> lattismus dorsi
Costobranchial sensory nerves |
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Most common cause of spontaneous PTX?
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Spont rupture of sub-pleural bleb
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Which pop prone to spont PTX?
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Young, tall athletic male
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Top sites of mets for melanoma?
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Lung, brain, bone, GIT
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type of CA that can produce Lambert-Eaton syndrome
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SCLC
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What is Lambert-Eaton syndrome?
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Myasthenia gravis like syndrome where auto-Ab to calcium channels
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Hard indications for CABG 4
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Stenosis of L main coronary -> divides into LAD and circumflex
3 vessel dz 2 vessel dz if LAD involved Angina refractory |
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Sx of perioral numbness and paresthesias & + Chvostek Sx?
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Hypocalcemia
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Chvostek Sx is?
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Tetany of jaw when tap facial nerve
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Trousseau's sign
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Induction of tetany of arm c blood-pressure cuff
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Procedure to eval for regional mets of melanoma
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Sentinel LN Bx
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Blood supply for body and tail of pancreas
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Direct branches from splenic and L gastroepiploic arteries
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Natural Hx of bleeding in diverticulosis
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Bleeding usu stop spont
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Tests to w/u diverticulosis
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CBC
Colonscopy to r/o colon CA |
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Most common serum markers for panc CA
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CA 19-9
CA 50 |
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ABCDE of trauma
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Airway, Breathing, Circulation, Disability, Exposures
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Tx of choice for non-necrotic frostbitten skin
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Place in water just above body temp
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Dx suggested by calcified retroperitoneal mass in child c FTT, HTN
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Neuroblastoma
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Genetic test for neuroblastoma prog
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look for amplification of n-myc
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Class triad of acute embolic ischemia to intestine
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Severe pain out of proportion to physical exam
Evacuation of bowels -> bloody diarrhea H/o CV dz |
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Adjuvant chemo after surgery for CRC
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Pt c regional mets
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Duke's staging for regional mets of CRC
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Stage C
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Type of hernia follows path of spermatic cord
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Indirect inguinal hernia
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Most common type of inguinal hernia
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Indirect inguinal hernia
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ABCDE of melanoma
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Asymmetry, border irregular, color change, diameter, evolution
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Any change to nevus is consider this until proven OTW
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melanoma
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Poisoning causing high pulse Ox
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CO, CN
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Tumor suppression gene affected in FAP? Chr
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APC gene on chr 5
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FAP pt get colon CA by what age?
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40
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Surgical approach to thymoma for definitive Dx
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Median sternotomy
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Thymoma assoc with 2 dz
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Myasthenia gravis,
Hashimoto's |
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Masses found in ant mediastinum 4
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Thymoma
Teratoma Terrible lymphoma Thyroid CA |
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Sq papillomatosis of upper airway assoc c which inf? Subtypes?
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HPV 6, 11 -> the ones that cause simple warts
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Characteristics of nipple d/c that make malig more likely
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Bloody, spontaneous, u/l
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most common cause bloody nipple discharge
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benign intraductal papilloma
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B/l discharge of nipples 2
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think prolactinoma or antipsychotic
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~ 1 yr recurrence rate of duodenal ulcer
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70%
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Where do duodenal ulcers recur
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Recur adj to previous healed ulcer
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Acute panc accompanied by which Ca level
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Hypocalcemia (saponification)
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Pt can get acute panc from which Ca level
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Hypercalcemia
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Ped pt c abd mass -> imaging studies 3
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1. KUB
2. U/S 3. CT |
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Charcot's traid, Reynold's pentad refer to which condition
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Ascending cholangitis
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Sx of Reynold's pentad
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RUQ pain, fever, jaundice, hypotension, MS change
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Why do ascending cholangitis pt get jaundice?
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Obstructive -> inc direct (conj) bili
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Define trimodal death distribution of trauma
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1st pk: immediate death
2nd pk: 1-3 hrs 3rd pk: wks-months 2/2 complications |
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Indications for prophylatic mastectomy 5
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Strong FHx of breast CA in 1st degree relative
Known BRCA mutation Screening is difficult Cosmetic LCIS |
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Dx of LCIS
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Usu incident on Bx
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Dx test of choice in suspected PE c no clinical Sx of DVT
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?V/Q scan -> spiral CT
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Tx of choice for acute testicular torsion
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Immediate surgery
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Acute testicular torsion age of presentation
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Teenager
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How does testicular torsion usu present
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acute testicular pain, sometimes vomitting b/c pain
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How does the testis hang c torsion
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May be horizontal
Bell-clapper deformity (can spin easily) |
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Dx w/u for obstructive jaundice
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Bili fractionated
U/S ERCP or CT |
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Tests for localizing lower GI bleed 4
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Sigmoidoscopy, C-scope
Mesenteric angiogram T-99 RBC scan |
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Should hemodynamically unstable pt be scoped?
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NO! -> get angiogram
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W/u of DVT, PE blood marker
(sensitive, non-specific) |
D-dimer
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Battle Sx is?
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ecchymoses over mastoid
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Presence of battle Sx or raccoon eyes suggest?
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Fracture of base of post skull
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Best next step for suspected tension PTX
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Needle thoracostomy; chest tube
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Indirect inguinal hernia occurs when what fails to obliterate?
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Processus vaginalis
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Tx of choice for SBP
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IV abx
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Dizziness, syncope, confusion in carotid stenosis?
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Nope
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RF for melanoma 6
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Fair skin, sun expo, h/o sun burns, numerous nevi, dysplastic nevi, FHx/personal Hx
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Multicentric b/l dz suggets which breast carcinoma?
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Lobular
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Parkland formula for fluid resus in burn victims
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24 total = 4 mL x kg x % surface area burned
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most common Sx of ectopic ureter in female
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Incontinence, esp if drain distal to external urethral sphincter
(men always proximal) |
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Presence of multiple liver cysts on CT suggest
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Echinococcus (sheep liver fluke)
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Do you sample echinococcal cyst?
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Nope, because can see peritoneum
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Tissue removed in modified radical mastectomy 2
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All breast tissue off nipple, aerolar
All axillary nodes |
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Classic radical mastectomy remove
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Pect major
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Tx of choice for ulcerative colitis c high-grade dysplasia on Bx
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Colectomy
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Approach to surg Tx of CRC involving anal canal and sphincter
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Huge abd perineal resection -> life-long colostomy
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Emphysematous cholecystitis caused by? Assoc c?
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C. perfringens
DM |
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Triad of dysphagia, Fe def anemia, upper eso webs suggest
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Plummer-Vinson syndrome
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Plummer Vinson assoc c inc risk of
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Esophageal CA
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Does smoking inc risk of PUD
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Yup
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Traumatic rupture of aorta occur c which type injury? What structure is injured and how?
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Head-on blunt trauma to chest
Traction to ligamentous arteriosus during rapid accel-decel injury |
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XR finding of traumatic rupture of aorta
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Mediastinal widening
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Proper chemo adjuvant of thyroid CA post-op
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RAI -> obliterates remaining thyroid tissue
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Why give levothyroxine after thyroid surg 2
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Pt now hypothyroid
Suppresses TSH |
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Why bring down undescended inguinal testicle 3
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Lower risk of CA
Future testicular exam easier Improve fertility |
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Most common solid renal mass in newborn
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congenital mesoblastic nephroma
(Wilm's at age 2) |
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range of ABI for claudication (not resting pain)
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0.5-0.9
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Crossmatching recipient serum to donor lymphocyte prevent which type of rejection?
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Hyperacute
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Only Tx for hyperacute rejection
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Prevention
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Microprocedure for sclerosing basal cell CA, some cases SCC, locally recurrent skin CA
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Mose? micrographic procedure
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thoracic duct relative to esophagus
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post to esophagus
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rupture of thoracic duct causes
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chylomicron leak into pleural space
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Dx suggested by 8 y/o boy with painful limb that hurts in ant thigh
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Legg-Calve-Perthes
Avascular necrosis of capital femoral epiphysis |
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Acute or chronic panc presents at younger age
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Chronic
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FAST procedure aimed to pick up? 2
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Pericardial effusion
Free intraperitoneal fluid |
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FAST is better at finding which?
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Pericardial effusion
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Dx procedure of choice if FAST neg but suspect fluid in abdomen
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DPL - diagnostic peritoneal lavage
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prior to surg, acute cholecystitis should receive
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IVF resus
Broad-spec abx: flagyl, aminoglycoside amp/beta-lact inh |
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most common grafted artery in CABG
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LIMA: L internal mammary artery
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3 elements of Monroe-Kelly doctrine for head injuries
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Skull = vault of fixed volume; inc one-> dec other 2
Blood, parenchyma, CSF |
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only abs indication for surgery in acute pancreatitis
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Infective necrosis of pancreas
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Site of gastric CA mets in Krukenberg tumor
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Ovary
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Blood supply for fundus of stomach
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Splenic artery -> short gastric arteries
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10 yr survival rate for DCIS
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~100%
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greatest metabolic risk for shunting procedure for portal HTN
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worsening hepatic encephalopathy -> don't let toxins metabolize
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most common cause of lower GI bleed
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upper GI bleed
if actually lower, diverticulosis |
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intervention @ bedside if upper GI distension
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NG tube for gastric decompression
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most important RF for morbidity and mortality in pt c esophageal perf
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time from perf to Dx/Tx
perform primary closure in 24 hrs |
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first test to use in urological w/u
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IVP
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most common cause chronic pancreatitis in US
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EtOH
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most common adrenal tumor of children
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neuroblastoma
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causes of painless hematochezia 3
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r/o CA,
Diverticulosis Angiodysplasm (AVM) |
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Pediatric trauma pt not able to access IV; what use for fluid infusion
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IO - intraosseus
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top 2 lung CA assoc c smoking
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SCC, SCLC
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where do SCC and SCLC arise in lung?
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Central
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test to confirm gastrinoma
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Secretin test:
IV bolus of secretin induce huge rise in gastrin |
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surg in Tx of TB
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curative in multi-drug resistant TB but reserved for cavitary
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Conditions that predispose pt to bile duct CA 3
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Pre-existing cholangitis
PSC -> IBD assoc: UC Chronic liver fluke inf -> clinorrchus |
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Indication for escharotomy on circumferential limb burns
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Whenever Sx of neurovasc compromise -> worry about compartment syndrome
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Radical orchiectomy inv incision in this region
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Inguinal region -> extract testis by traction on spermatic cord
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Most common testicular CA in young men (3rd decade)
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Seminoma
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Lab values helpful to Dx seminoma
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None
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Fluid around GB, wall thickening and distension suggest
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cholecysitis
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Test of choice for acute cholecystitis
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U/S of RUQ; spec & sens
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If can't r/o cholecystitis by U/S then get
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HIDA
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Use of meds that incr risk of benign heaptic adenoma by 40
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OCP
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Prog indicator for melanoma
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Tumor thickness
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Other prog indicators for melanoma
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# Mitoses
Histo evidence of ulceration |
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Bx needed for melanoma
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Full thickness
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~% lung CA for subtypes
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Adenocarcinoma 1/3
SCC 1/3 SCLC 1/4 Large cell/anaplastic 10% |
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Incisional hernia repair by which type of closure?
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Grafting of synthetic prosthetic material
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Dx/Tx for solid testicular mass in adult men
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Orchiectomy
Assume malig; don't Bx |
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Course of axn in adult incidentally found to have Meckel's during another surgery
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Leave it alone unless symptomatic -> higher M&M if alter
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best way to eval suspicious breast mass
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Image-guided Bx: ~95% sens
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Hypothesis why pt with shock develop stress gastritis
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hypotension -> ischemia to gastric mucosa
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Common breast tissue d/o c mid-cycle pain and lumpy bumpy feel on exam
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Fibrocystic change
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Histo of fibrocystic change
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blue dome cyst
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Change of insulin levels in significant injury
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Increase b/c an acute phase reactant but so much infl that pt also hyperglycemic
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Bld marker used to monitor recurrence of colon CA
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CEA
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Type 1 gastric ulcer always located in
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Inf aspect of lesser curvature
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most common type of gastric ulcer
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type 1
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Bird's beak Sx in COLON in lower GIT c barium follow-through
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Volvulus
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Tx of volvulus
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Surgery!!
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Palliative technique for advance esophageal CA
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Can't be cured -> esophagectomy c radiation/chemo
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What esophageal CA so locally aggressive
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Lacks true serosa so can easily penetrate all layers
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Dx test of choice for penetrating abd wound
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Exp lap
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Dx test of choice for penetrating chest wound
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Don't need to explore if hemodynamically stable c good CXR/CT
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Top risk for mortality in severe burn injuries 3
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Extent of burn > 40%
Concurrent inhalation injury Age > 60 |
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mortality of burn injury if all 3 risk factors
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90%
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Benefits of adding epi to local anesthestics (lido, bupivocaine) 2
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Dec absorption into systemic
Prolonged duration of local anesthesia |
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Most important risk factor for melanoma
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Personal Hx
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surgery indication if sclerotherapy/balloon tamponade fail to ctrl esophageal variceal bleeding
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Shutn blood away -> TIPS
Embolize arteries veins feeding esophagus |
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Most common cause short bowl syndrome in children
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NEC
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Sx short bowel syndrome 4
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Malabsorption, steatorrhea, dec fat-soluable vitamins, wt loss
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Other causes short bowel syndrome 5
|
Extensive bowel surgery
Chron's disease Huge tumors Trauma to intestine Infarct |
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Rationale for avoiding splenectomy in mild spleen injury
|
High risk of sepsis c encapsulated organisms
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Lumpectomy = as effective as modified radical mastectomy if give
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Subsequent radition therapy
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top 3 causes of CA deaths in US
|
Lung
Breast/Prostate Colon |
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Pulm complications of chronic GERD
|
Asthma
Chronic cough Recurrent aspiration PNA Hoarseness |
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Inh anesthestic that causes trapped air in body to incr in volume
|
NO
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Natural Hx of umbilical hernia in newborn
|
Usu spont resolve by 2
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When do surgery for umbilical hernia in newborn
|
Ctn to grow
Remain past age 2 Becomes incarcerated |
|
|
|
LCIS best diagnosed by
|
Bx
Rarely assoc c palpable breast lumps or mammography |
|
|
|
Ampulla of Vater drains into what part of duodenum
|
2nd part of duodenum
|
|
|
|
Mortality rate for appy c perf appendix
|
~5%
|
|
|
|
5 yr survival rate for Whipple for resectable panc CA
|
10%
|
|
|
|
Overall survival rate of panc CA
|
<5%
|
|
|
|
1st steps to take in pt c solid breast mass 3
|
Dx mammogram +/- US
May need Bx |
|
|
|
Most common cause u/l sensoineural hearing loss
|
Vestibular schwannoma
|
|
|
|
Most common cause u/l conductive hearing loss
|
Cerumen impaction
|
|
|
|
Adaptive structure changes after part of small bowel remove 3
|
Remaining bowel: lengthening, incr density/villi; incr bowel diameter
|
|
|
|
Syndromes of apical lung tumor and why 3
|
Horner's syndrome: invasion on sympathetic
Pancoast: horner's + brachial plexus Sup vena cava: edema in face, upper ext |
|
|
|
Chemo therapy indicated for colon CA in these cases
|
Duke's class C (Stage 3 or 4)
|
|
|
|
Dx of traumatic brain injury, massive UOP, hypernatremia
|
Neurogenic DI
|
|
|
|
+ Tinnel's Sx suggest
|
Carpal tunnel
|
|
|
|
What is Tinnel's Sx
|
Percuss median nerve -> reproduces pain in hand in median distribution
|
|
|
|
best Tx for primary hepatocellular CA
|
Wedge resection
|
|
|
|
how long survival extended by resection of hepatocellular CA
|
3 yrs
|
|
|
|
Is mets to liver indication for surgery?
|
No, but can be done for solitary nodule
|
|
|
|
Define borders of Hasselbach's triangle 3
|
Lateral: inf epigastric artery
Inf: Inguinal ligament Med: Rectus abdominus |
|
|
|
Endocrine disturbance assoc c carpal tunnel 2
|
Hypothyroidism, acromegaly
|
|
|
|
Pre-op meds for pheochromocytoma
|
alpha blocker -> phentolamine
|
|
|
|
Dx suggested by thyroid aspirate c well-defined cluster of cells and psammoma bodies
|
Papillary CA of thyroid
|
|
|
|
Most common thyroid CA
|
Papillary 80%
|
|
|
|
Patho finding in arterial walls c AAA
|
atherosclerosis
|
|
|
|
Serum albumin half life
|
3 weeks
|
|
|
|
Serum transferrin half life
|
1 wk
|
|
|
|
Serum prealbumin half life
|
3 days
|
|
|
|
Long term marker of overall nutrition
|
Albumin
|
|
|
|
2 most common adverse events leading to death in pt undergoing carotid endartectomy
|
CVA, acute MI
|
|
|
|
indication for surgery in ulcerative colitis 4
|
Toxic megacolon
Large bowel obstruction Active bleeding CA |
|
|
|
Colectomy curative for ulcerative colitis?
|
Yes
|
|
|
|
Extraintestinal Sx resolve c colectomy? Exception?
|
Yes
PSC |
|
|
|
ACS routine screening for colon CA by 4
|
Colonoscopy at 50 q 10
Flexible sigmoidoscopy q 5 at 50 Digital rectal c guaiac Fecal occult |
|
|
|
Ligament of Treitz is sig because
|
Where retroperitoneal duodenum to intra-abdominal jejunum
|
|
|
|
Dx test for suspected injury to lower urinary tract before putting in foley
|
Retrograde cystogram
|
|
|
|
type 5 gastric ulcer best treated by? What Rx can be used to replace PG?
|
D/c NSAID use
Misoprostol |
|
|
|
Most common cause of death in burn pt
|
Sepsis
|
|
|
|
Superior dome of stomach
|
Fundus
|
|
|
|
Second degree burn is
|
Do not damage underlying nervous; mostly affect epidermis
Blistering |
|
|
|
Axn for burn victim c ultraphonia, hoarsenss, stridor
|
Imm endotracheal intubation
|
|
|
|
Surg Tx for stress incontinence
|
Strengthen pelvic floor
|
|
|
|
Activities that bring out stress incontinence 3
|
Laughing, coughing, lifting heavy objects
|
|
|
|
Blood supply for lesser curvature of stomach? Origin
|
L & R gastric arteries
L gastric off celiac R gastric off common hepatic |
|
|
|
CA thyroid nodule more likely to be hot/cold
|
Cold (don't take up RAI)
|
|
|
|
Bones, stones, groans (abd), moans (psych)
|
Hyperparathyroidism
|
|
|
|
Empyema is
|
Inf pleural effusion
|
|
|
|
Is empyema acidic/alkalotic
|
Acidic
|
|
|
|
Is empyema transudative/exudative
|
Transudative
|
|
|
|
Empyema is high/low in LDH
|
High
|
|
|
|
Presence of gallstones in gallbladder
|
Cholelithiasis
|
|
|
|
Presence of gallstones in common bile duct
|
Choledocholithiasis
|
|
|
|
Types of CA that have paraneoplastic syndrome of insulin-like proteins 3
|
Hepatocellular CA
Mesothelioma Sarcoma |
|
|
|
When use thrombolysis to Tx acute embolic intestinal ischemia
|
Never! surgical dz
Remove infarcted bowel |
|
|
|
Most common causes conductive hearing loss 5
|
Cerumen in ext acoustic meatus
TM perf Ossicular dysarticulation Otosclerosis Mid ear effusion |
|
|
|
Hemoglobinuria/myoglobinuria Tx to urine
|
Alkalinize the urine
|
|
|
|
If don't alkalinize urine, what does myoglobinuria lead to
|
Acute tubular necrosis
|
|
|
|
How alkalinize urine
|
Give pt bicarb
|
|
|
|
Fem art atherosclerosis present c claudication where
|
Distal leg (esp calf)
|
|
|
|
If claudication in hip flexors/buttocks, occlusion is where
|
Aorto-iliac occlusion
|
|
|
|
Dx test for w/u refractory GERD 4
|
Endoscopy
Monometry 24 hr pH monitoring Barium follow thru |
|
|
|
Gold standard Dx test for GERD
|
24 hr pH monitoring
|
|
|
|
Sensitive & spec of MRI to detect breast CA
|
90% sens
45% spec |
|
|
|
Classic timing of abd pain in chronic mesenteric ischemia
|
few hours postprandial
|
|
|
|
Chronic mesenteric ischemia thrombotic/embolic
|
Thrombotic
|
|
|
|
Acute mesenteric ischemia thrombotic/embolic
|
Embolic
|
|
|
|
Most common cause death in renal transplant pt
|
CA
Immunosuppression puts at risk for CA |
|
|
|
Most common site of mets for soft tissue sarcoma
|
mets to lung
|
|
|
|
Course of R & L laryngeal nerves
|
L: off CN X -> loops around ascending aorta ant -> tracheoesophageal groove
R: loops around R subclavian -> ascend R tracheoesophageal groove |
|
|
|
Why do ppl c lung CA get hoarse
|
L pharyngeal nerve compress by tumor
|
|
|
|
Other RF for SCC of skin besides sunlight 5
|
Burn scars, radiation scars, HPV, smoking, immunocompromised
|
|
|
|
Spont retroperitoneal hemorrhage uncommon adverse fx of which meds
|
Anticoag (esp warfarin)
|
|
|
|
Major bleeds from having high INR 3
|
Retroperitoneal hemorrhage
Intracranial Intra-articular |
|
|
|
Tx of choice for burn eschar
|
Escharotomy immediately b/c inf, infl, propagate sepsis-like state
|
|
|
|
To eval if breast mass solid or fluid filled in young pt
|
U/S
|
|
|
|
Gastrinoma triangle
|
Jxn of neck & body of panc
Jxn of cystic and common bile duct Jxn of 2nd/3rd parts of duodenum |
|
|
|
If breast mass is fluid-filled
|
Aspirate -> send for pathology
|
|
|
|
Most common site of colonic diverticula
|
Sigmoid
|
|
|
|
Which age group most likely to have colonic diverticula
|
Elderly
|
|
|
|
Most common presentation diverticulosis
|
painless rectal bleeding
|
|
|
|
Microscopically, where do diverticula tend to aris
|
Where arterial blood supply penetrate bowel wall
|
|
|
|
Rationale for fasciotomy for impaired vasc injury
|
Reperfusion injury: ROS -> severe edema -> compartment syndrome
|
|
|
|
Genetic syndromes assoc c incr risk sarcoma 4
|
Li-Fremmani: p53 mutation
Familial retinoblastoma Neurofibromatosis Familial polyposis |
|
|
|
Fascial layer encompassing kidney
|
Gerota's fascia
|
|
|
|
Adjuvant Tx of resectable panc CA is
|
Radiation
Gemcytomine |
|
|
|
Feeding in acute pancreatitis
|
NPO -> bowel rest
|
|
|
|
Role of cholecystectomy in preg
|
NONE
|
|
|
|
Are preg women more prone to biliary colic
|
Yes but usu resolve spont
|
|
|
|
Biggest risk of cholecystectomy in preg woman
|
Surgical abortion
|
|
|
|
Testicular CA spread to which LN first
|
Para-aortic nodes
|
|
|
|
Most common age of presentation osteosarcoma, Ewing sarcoma?
More common M or F? |
Adolescence; M > F
|
|
|
|
Selective vagotomy target branches going into which part of stomach
|
Fundus
|
|
|
|
Indications for selective vagotomy 2
|
Refrac ulcers
Whipple |
|
|
|
Cells located in fundus that secrete acid
|
Parietal cells
|
|
|
|
Splenectomy has been used to stage which CA (no longer done)
|
Hodgkin's lymphoma
|
|
|
|
Most important measures to take in acute pancreatitis 2
|
Fluid resus
Bowel rest |
|
|
|
Define causalgia
|
Condition following trauma where tissue becomes denervated and then hypersensitivity to pain after reinnervation
|
|
|
|
Type of lung CA: centrally located, related to cigs, produces PTHrP
|
SCC
|
|
|
|
best noninvasive test for h. pylori
|
stool Ag test; sens & spec
|
|
|
|
Incidental adrenal mass > what size must be excised
|
4 cm
|
|
|
|
Blood group assoc c greatest risk gastric CA
|
Type A
|
|
|
|
Majority of blood supply to thyroid from which larger arteries
|
External carotid
|
|
|
|
Risk factors for poor surg wound healing 8
|
Poor nutrition
Smoker Wound inf Steroids Immunocompromised DM PAD Poor surg technique |
|
|
|
Splenic vein thrombosis assoc c infl of
|
Pancreas
|
|
|
|
Main reason mammo used for w/u concerning breast mass
|
can look for calcification but really used to look for other microlesions
|
|
|
|
Med used for immunosuppression in transplant c tox: nephro, metabolic syndrome, HTN
Calcineuron-inh Dec synthesis IL-2 |
Cyclosporine
|
|
|
|
Best diet modification to prevent diverticulosis/diverticulitis
|
High fiber
|
|
|
|
Rovsing Sx?
|
Referred pain in RLQ c deep palpation of LLQ
|
|
|
|
Lab marker specific for hepatocellular CA
|
alpha feto protein
|
|
|
|
what other CA secrete a-FP
|
yolk sac tumor
|
|
|
|
Tx of choice for acalculus cholecystitis if not surg candidate
|
Perc cholecystostomy
|
|
|
|
Pain after cholecystectomy like biliary colic
|
post-cholecystectomy syndrome
|
|
|
|
Kehr's sign?
|
Referred pain to post shoulder in presence of diaphragmatic injury
|
|
|
|
Kehr's sign seen in 3
|
Splenic injury
Peridiaphragmatic abscess Renal calculi |
|
|
|
Top 2 RF for panc CA
|
Smoking
Advanced age |
|
|
|
which is more specific for panc injury - amylase v lipase
|
Lipase
|
|
|
|
Splenectomy cures how many pt c ITP
|
80%
|
|
|
|
W/u for gastric ulcer
|
Endoscophy c Bx
H. pylori Ag test |
|
|
|
Top for sites for distant mets of lung CA 4
|
Liver, adrenal, bones, brain
|
|
|
|
isolated lung mass more likely mets or primary
|
mets
|
|
|
|
XR findings of tension PTX 3
|
pocket of air
mediastinal shift away dec vasc markings |
|
|
|
Area most likely tender in diverticulitis
|
LLQ
|
|
|
|
Classic description of panc duct on ERCP in chronic pancreatitis 2
|
Chain of lakes, beads on a string
|
|
|
|
Also looks like
|
PSC
|
|
|
|
Causes of hypercalcemia 7
|
hyper-PTH
Malig Mulitple myeloma Paget's dz of bone Sarcoidosis Milk-alkali syndrome Addison's dz |
|
|
|
Lack of filling in GB on cholesyntigraphy suggest
|
Cystic duct occlusion
|
|
|
|
Blood supply for head of pancreas
|
Sup & inf pancreaticoduodenal arteries (ant & post)
|
|
|
|
Portion of stomach extending from angle of stomach to pylorus
|
Antrum
|
|
|
|
Antrum is primary location of what type of cells
|
Gastrin-secreting G cells
|
|
|
|
Rare, feared complication of urologic procedures (post-prostatectomy syndrome)
|
Glycine-induced hyponatremia
|
|
|
|
% of lung CA c paraneoplastic syndrome
|
10-20%
|
|
|
|
cutaneous T cell lymphoma has trophism for epidermis
May be mistaken for skin CA |
Mycosis fungoides
|
|
|
|
most common site of cutaneous melanoma in women
|
lower ext
|
|
|
|
most common site of cutaneous melanoma in men 2
|
Back, trunk
|
|
|
|
role of surg in SCLC
|
no role b/c it is found to be mets on diagnosis
|
|
|
|
pancoast tumor is usu which type of lung CA
|
SCC or bronchoadenocarcinoma
|
|
|
|
Dobutamine acts at which R
|
pure beta 1 agonist
|
|
|
|
cardio fx of dobutamine
|
inc iontropy
|
|
|
|
combine use of these is 80% spec, sens for lung CA
|
Chest CT, PET
|
|
|
|
Dx of young child c u/l foul-smelling otorrhea
|
foreign object in ext acoustic meatus
|
|
|
|
avoid what to prevent midcycle pain in fibrocystic women
|
caffeine
|
|
|
|
revascularization/angioplasty for PAD only indicated if 2
|
rest pain
ABI < 0.5 |
|
|
|
most common cause esophageal perf
|
iatrogenic
|
|
|
|
most feared complications of esophageal perf 2
|
sepsis
shock |
|
|
|
elevated lab values in choledocholithiasis
|
direct bili, ALP
|
|
|
|
pharm Tx for acute hemorrhage of esophageal varies 2
|
vasopression
ocreotide |
|
|
|
% gastric ulcers that are malig
|
10%
|
|
|
|
Most common cause of hypotension in pt c traumatic brain injury
|
Hypovolemia
|
|
|
|
Rare cause of hypotension in TBI pt
|
Neurogenic shock
|
|
|
|
What is neurogenic shock
|
When TBI causes decreased sympathetic tone
|
|
|
|
Improvement of myocardial fxn after CABG because
|
reperfusion in hibernating myocardium
|
|
|
|
what is hibernating myocardium
|
Viable myocardium that was previously underperfused that went into hibernating state (lower metabolism)
|
|
|
|
Mechanism of malabsorption in Zollinger-Elllison syndrome
|
Inc stomach acid production -> inc duodenal acid conc -> less active pancreatic enzymes
|
|
|
|
Melanoma c proclivity for palms, soles, nail beds, mucosal surfaces
|
Acral lentiginous melanoma
|
|
|
|
Race more prone to acral lentinginous melanoma
|
African Americans
|
|
|
|
3 main branches of celiac artery
|
Splenic artery, common hepatic artery, L gastric artery
|
|
|
|
Why are mammograms not used to screen breast CA in younger women
|
<30 have high incidence fibrocystic change and breast density -> low risk of breast CA
Affects specificity |
|
|
|
Name familial CA syndromes that increase risk for any type of thyroid cancer
|
MEN 2, 3 -> medullary
Gardner's (FAP) |
|
|
|
Finding considered + murphy's Sx
|
Cessation of inspiration during deep palpation of RUQ
|
|
|
|
Murphy's Sx signifies
|
acute cholecystitis
|
|
|
|
Image test to r/in acute cholecystitis
|
RUQ U/S
|
|
|
|
Traumatic injury to heart can be r/o c what test?
|
12 lead EKG
|
|
|
|
Most common primary site of CA when pt have liver mets?
|
Colon CA
|
|
|
|
Lifetime risk of SBO in pt c laparotomy?
|
15%
|
|
|
|
Most important risk factor for SBO?
|
Previous laparotomy
|
|
|
|
Dx of soft tissue tumor always begin c what procedure?
|
Core needle Bx
|
|
|
|
What don't excise soft tissue tumor?
|
Because complicates surgery when need to cut whole thing out: ruins margins
|
|
|
|
Most common bact cause of nosocomial bacteremia?
|
Coag neg staphylococcus
|
|
|
|
Most common contaminant of blood cultures?
|
Coag neg staphylococcus
|
|
|
|
Besides HBV, HCV, and EtOH, other risk factors for hepatocellular CA? 4
|
Vinyl chloride
Aphylotoxins (aspergillus) Hematomachrosis OCP? |
|
|
|
Most common site of gastric ulcers?
|
Lesser curvature of stomach in antral, pre-pyloric region
|
|
|
|
Most common bact cause of nosocomial bacteremia?
|
Coag neg staphylococcus
|
|
|
|
Most common contaminant of blood cultures?
|
Coag neg staphylococcus
|
|
|
|
Besides HBV, HCV, and EtOH, other risk factors for hepatocellular CA? 4
|
Vinyl chloride
Aphylotoxins (aspergillus) Hematomachrosis OCP? |
|
|
|
Most common site of gastric ulcers?
|
Lesser curvature of stomach in antral, pre-pyloric region
|
|
|
|
To protect from acute kidney injury, electrocuted pt should get which Tx? 3
|
Massive hydration, diuresis, urine alkalinization
= Tx for myoglobinuria |
|
|
|
Best at home 1st aid measure for burns <10% total body surface area
|
Copious irrigation c lukewarm tap water
|
|
|
|
Semi-invasive therapy for achalasia before surgical correction? 2
|
Balloon dilation
Selective myotomy of LES |
|
|
|
#1 cause of portal HTN in whole world
|
Schistosomiasis
|
|
|
|
Type of scan used to ID parathyroid adenomas
|
Sestimibe scan
|
|
|
|
Most common cause of bloody nipple discharge
|
Intraductal papilloma
|
|
|
|
Other causes of blood nipple discharge 3
|
Carcinoma, duct ectasia, infection
|
|
|
|
Dx test of choice for parotid mass
|
Don't aspirate, Bx, excise unless ENT b/c can injure facial nerve
|
|
|
|
Lab test for pheochromocytoma besides urinary VMA
|
Free metanephrine levels in blood
|
|
|
|
H. pylori = rf for which types of stomach CA? 2
|
Gastric adenoma
MALToma |
|
|
|
Dukes class A lesion for CRC?
|
Tumor confined to bowel wall
|
|
|
|
Dukes class C lesion for CRC?
|
Mets to regional LN
|
|
|
|
Dukes class B lesion for CRC?
|
Tumor invasion thru bowel wall but not thru regional nodes
|
|
|
|
3rd degree burn = full thickness burn is
|
Charring and blackening of epidermis, dermis, and dermal appendages BUT not to underlying tissues
|
|
|
|
How to distinguish primary HCC from mets to liver by abdominal CT?
|
Abdominal CT to r/o other sites
|
|
|
|
Most common cause of periop mortality in pt undergoing any form of vasc surg
|
Acute MI
|
|
|
|
Intraop med that reduces risk of periop MI in medium/high-risk pt
|
Beta-blockers
|
|
|
|
Tx of choice in asymptomatic cholelithiasis 3
|
None unless:
Hemolytic anemias -> splenectomy Obese -> bariatric surgery |
|
|
|
Most effective Tx for c. diff inf
|
Vancomycin PO
|
|
|
|
Other Tx options for c. diff
|
Metronidazole
|
|
|
|
DDx of adrenal mass 5
|
Incidentaloma (non-fxning adenoma)
Pheochromocytoma Aldosteronoma Cortisol-producing tumor Lung CA mets |
|
|
|
3 most common benign liver tumors
|
Hemangioma -> why don't bx
Focal nodular hyperplasia Adenoma |
|
|
|
Which benign liver tumor assoc c OCP?
|
Adenoma
|
|
|
|
Prolonged immobilization has what effect on serum Ca
|
Increases
|
|
|
|
Why does immobilization cause hypercalcemia
|
Increase bone resorption
|
|
|
|
Boerhaaves v. Mallory Weiss tear
|
Boerhaaves = complete perf of esophagus -> complications: sepsis, pneumomediastinum, mortality
Mallory-Weiss = noncomplete transmural tear at gastro-eso jxn |
|
|
|
Dx test of choice for scrotal hematoma
|
U/S
|
|
|
|
Superficial basal cell carcinoma should be Tx c local excision or?
|
5-FU
|
|
|
|
In pt c metab alkalosis due to vomitting, LR or NS is better?
|
NS b/c pt just need volume and Cl
|
|
|
|
pH of NSS
|
4.5
|
|
|
|
hepatic cirrhosis and hematomachrosis present c what type of portal HTN
|
Sinusoidal
|
|
|
|
Specialized and specific scan for pheochromocytoma
|
MIBG
|
|
|
|
Most common but nonspecific presenting Sx of lung CA
|
New onset cough
|
|
|
|
Highest risk groups for refeeding syndrome
|
Alcholic, Anorexic/eating d/o
|
|
|
|
Refeeding syndrome is
|
Rapid renourishment -> severe electrolyte disturbances (hypokalemia, hypomagnesemia)
|
|
|
|
Dx test to order in suspected intraabdominal inf
|
Abd CT c contrast
|
|
|
|
Top 3 causes of SBO
|
Adhesions, CA, hernia
|
|
|
|
Top 2 causes of immediate death in blunt trauma
|
Neuro injury
Cardiac injury |
|
|
|
Recurrence rate of spont PTX after single episdoe
|
30%
|
|
|
|
Recommended lab test on infant c hypospadius or cryptoorchidism
|
Karyotype
|
|
|
|
Most common mets to bone? 2
|
Breast, prostate
|
|
|
|
Gold standard test for traumatic rupture of aorta? Other? 2
|
Aortagram
Other: CT, TEE |
|
|
|
Lowest mortality surg procedure for Tx mitral valve stenosis
|
Comissurotomy (dec risk of death 3x)
|
|
|
|
Syndrome: severe shoulder pain, wasting of muscles in arm & hand, horner's, edema of upper ext
|
Pancoast
|
|
|
|
ERCP stands for
|
Endoscopic retrograde cholangiopancreatography
|
|
|
|
Tx of choice for severe finger tips (if no bone/nail involved)
|
Clean it; no need for primary closure
|
|
|
|
Rational for Bx non-healing gastric ulcer
|
R/o gastric carcinoma
|
|
|
|
Type of blood used if cross/match unavailable
|
2 U O-neg
|
|
|
|
Universal plasma donor
|
AB neg
|
|
|
|
Top 2 surg approaches to bariatric surgery
|
Lap band
Roux-en-Y |
|
|
|
Dx test of choice for suspected intestinal ischemia
|
Arteriography
|
|
|
|
Dx test of choice for unstable GI bleed
|
Arteriography
|
|
|
|
Recommended length of time to delay surgery when pt suffer MI
|
6 months
|
|
|
|
Test 98% sens, spec for gallstones
|
U/S
|
|
|
|
Most common part of GIT involved in Crohn's dz
|
Ileum
|
|
|
|
Define tenesmus
|
Painful passing of stool
|
|
|
|
Difference in outcome of CABG and perc transluminal coronary angioplasty 4
|
No difference in overall mortality, MI incidence
Lower periop risk in PTCA Greater recurrence of angina & need for intervention PTCA |
|
|
|
Most common cause of short bowel syndrome in adults 2
|
Crohn's = #1
Other common: mesenteric infarction |
|
|
|
Define incarcerated hernia
|
Non-reducible but not yet strangulated (dying)
|
|
|
|
Typical location of gastric carcinoma
|
Antrum (area prox to pylorus)
|
|
|
|
Esophageal varices form when blood stasis in portal vein backs up into which vein?
|
L gastric
|
|
|
|
Inexpensive Dx test 75% sensitive for SBO
|
AXR: 4 way series - flat & upright abd film + PA/lateral chest films
|
|
|
|
AXR finding in SBO:
|
Air-fluid levels, paucity of gas in colon & rectum, air in small bowel
|
|
|
|
Histo reason for invasion of esophageal CA
|
Esophagus lacks true serosa
|
|
|
|
3 realms of Glascow coma scale
|
eye opening, best motor response, best verbal response
|
|
|
|
Obturator Sx for appendicitis
|
Pain c internal rotation of femur (flex thigh & knee to 90o)
|
|
|
|
In both liver and lung, CA growth most likely to be
|
mets
|
|
|
|
Umbilical mets (Sis Mary Joseph nodule) most likely reflect which CA?
|
Gastric, ovarian CA
|
|
|
|
Most accurate Dx tool to eval pt c chronic pancreatitis
|
ERCP
|
|
|
|
Tx of choice for small aortic dissection limited to descending aorta
|
Anti-HTN
|
|
|
|
Type of skin CA characterized by pearly dome appearance, central ulceration, telangectasia
|
Nodular, ulcerative basal cell carcinoma
|
|
|
|
All pt c abd GSW req what w/u
|
Immediate lap if unstable
Stable: imaging |
|
|
|
Vinyl chloride predispose to which class of tumor
|
Angiosarcoma
|
|
|
|
Recommend f/u for pt c adenomatous, non-CA polyp on colonoscopy
|
Surveillance: colonoscopy q 3 yrs
|
|
|
|
Surgical f/u for pt c breast CA who has + SLNBx
|
Level 1 & 2 regional node dissection
|
|
|
|
Why do splenectomy on pt c myeloproliferative d/o?
|
For Sx relief (doesn't change course or mgmt of dz)
|
|
|
|
Pattern of bowel movement in pt c intestinal obstruction
|
BM at onset then constipation
|
|
|
|
Why give prophylatic cholecystectomy in pt c single episode gallstone-induced pancreatitis
|
Up to 40% recurrence in 1st 6 wk
|
|
|
|
Majority of chief cells in stomach found in
|
Proximal (body)
|
|
|
|
What do chief cells do?
|
Secrete pepsinogen
|
|
|
|
Outside of US, 2 types of parasites most likely to cause liver abscess
|
Entameoba histolytica, Echinococcus
|
|
|
|
Classic presentation of entameoba inf
|
H/o dysenteric diarrhea and single isolated cyst on liver
|
|
|
|
Classic presentation of echinococcus inf
|
H/o multiple liver cysts, can be in lung also
|
|
|
|
To tell which parasite is in liver abscess, what Dx?
|
Don't stick needle -> anaphylaxis
|
|
|
|
Approximate false neg rate for screening mammogram
|
10-20%
|
|
|
|
Polypectomy of colonic polyp = curative if adenomatous tissue not beyond what layer of colon
|
Submucosa -> then adenoma in situ & unlikely to recur
|
|
|
|
After ABCs, what measures to take with rib Fx? Why?
|
Analgesia -> poor pain ctrl leads to poor resp effort
|
|
|
|
C/in to balloon valvuloplasty?
|
If presence of valvular vegetation/calcification or fusion of chordae
|
|
|
|
Balloon valvuloplasty is used for which kind valve defect?
|
Stenosis
|
|
|
|
Pt failed medical management of GERD when which class cannot provide relief?
|
PPI (omeprazole)
|
|
|
|
Mechanism by which atelectasis causes post op fever
|
It doesn't!!!!
|
|
|
|
Duct that drains pancreas into common bile duct 2
|
Wirsung's duct (pancreatic duct)
Santorini's = minor contributory |
|
|
|
Carotid artery endarterectomy is indicated for stenosis at what level if asymptomatic?
|
70%
|
|
|
|
Endarterectomy indicated if pt has Sx of TIA and stenosis at which level?
|
50%
|
|
|
|
How do you determine the level stenosis in the carotids?
|
Doppler
|
|
|
|
What do you look at during doppler to determine the level of stenosis in carotids?
|
Velocity
|
|
|
|
Most common presenting Sx of Meckel's diverticulum
|
Painless rectal bleeding
|
|
|
|
By which post op week will surgical wound get to 75% strength
|
8 weeks
|
|
|
|
At what point will surgical wound receive 100% strength?
|
Never!
|
|
|
|
Breslow scale: primary melanoma of what depth considered local (>90% cure rate)
|
0.76 mm
|
|
|
|
Components of clotting cascade present in parietal participate? 5
|
Factor 8, vWF, fibrinogen, fibrin-stabilizing factor, and fibronectin
|
|
|
|
Early sepsis characterized by what acid-base disturbances? As evolves what does it turn into?
|
Resp alkalosis (hypermetabolic) -> metabolic acidosis (related to incr lactate)
|
|
|
|
Suspected eso perf, what most sensitive to Dx?
|
Barium GI series
|
|
|
|
What safer test should be performed before barium GI series in suspected eso perf?
|
Water-soluble contrast series
|
|
|
|
Why shouldn't you use barium if eso perforated?
|
Can exacerbate medistinitis?
|
|
|
|
Premalig skin lesion caused by chronic UV expo? (Rough, scaly, poorly-demarcated plaque)
|
Actinic keratosis (SCC precursor)
|
|
|
|
Longitudinal pancreaticojejunostomy used for
|
Chronic pancreatitis
|
|
|
|
Dx test for women with serosanguinous nipple d/c (no mass)
|
Ductogram (contrast injected into ductal system)
|
|
|
|
% women >60 c gallstones
|
50%
|
|
|
|
Which is better for metabolic acidosis - LR or NSS?
|
LR because NSS doesn't contain bases and will dilute bicarb
|
|
|
|
Other than aFP, what can be used for hepatocellular carcinoma?
|
Ferritin (high)
|
|
|
|
Ranson criteria used for
|
Pancreatitis
|
|
|
|
Metrics of Ranson criteria:
At admission: 5 At 48 hrs: 6 |
At admission: age, WBC, hyperglycemia, elevated LDH, elevated AST
48 hrs: rapid rise BUN, hypocalcemia, low pO2, high base def, high fluid sequestration, rapid drop in HCT |
|
|
|
Dx suggested by new onset DM, elevated direct bili, wt loss
|
Pancreatic adenocarcinoma
|
|
|
|
Electrolyte whose deficiency resembles Sx of hypocalcemia?
|
Mg
|
|
|
|
At what PRL level is Dx of prolactinoma
|
>300 mcg/L
|
|
|
|
If PRL elevated by <300, what should you consider?
|
Compressive stalk syndrome, antipsychotics
|
|
|
|
Almost critically ill pt require higher intake of protein except pt with dz of which organ system
|
Liver
|
|
|
|
Psoas sign of appendicitis is
|
Pain with extension at thigh
|
|
|
|
Penetrating neck injuries must violate which muscle plane?
|
Platysma
|
|
|
|
Formula for cerebral perfusion pressure
|
MBP - ICP
|
|
|
|
Dx suggested by air-fluid levels and coiling NGT in L chest
|
Atraumatic diaphragmatic hernia
|
|
|
|
Dx triad for breast masses:
|
Phys exam, mammo, Bx
|
|
|
|
Define isograft:
|
Donor and recipient are identical twins
|
|
|
|
Anatomic markers defining R & L liver lobes
|
Gallbladder fossa and IVC
|
|
|
|
Hamburger Sx is? seen in?
|
Pt has no appetite; appendicitis
|
|
|
|
Chandelier Sx seen in?
|
PID
|
|
|
|
Changes in color of stool & urine in choledocholithiasis?
|
Stool becomes clay color (bili dec); urine becomes brown (bili inc)
|
|
|
|
Procedure in pt c suspected tension PTX
|
Needle thoracostomy
|
|
|
|
Dx suggested by progressive paralysis of muscles innervated by CN VII c cheek mass
|
Parotid malig
|
|
|
|
Most common form of parotid malig
|
Mucoepidermal carcinoma
|
|
|
|
Top 2 causes of death during first 24 hr after trauma
|
CNS injury, hemorrhagic shock
|
|
|
|
First mammogram at what age?
|
35-39 ACS, 40 USPTF
|
|
|
|
Rectal shelf (Bloomer's shelf) on rectal exam represents? 2
|
GU CA or gastric CA c peritoneal spread
|
|
|
|
Surgical correction of acid dependent peptic ulcer
|
Selective vagatomy
|
|
|
|
Fourth part of duodenum ascends/terminates at what landmark?
|
Ligament of Treitz
|
|
|
|
Primary advantage of LAR of CRC
|
Spares anal canal and sphincter
|
|
|
|
Indications for surgery for PUD 3
|
Refractory to PPIs, large ulcers > 3 cm, non-healing ulcer
|
|
|
|
Top 2 Sx of cardiac contusion
|
Cardiogenic shock, arrhythmia
|
|
|
|
Best Tx for PE c no specific c/in to anticoag/thrombolytic
|
TPA
|
|
|
|
Neuron-specific enolase marker for which type of CA?
|
SCLC
|
|
|
|
Common PNA causing microbes that can cause 2o PTX or empyema 6
|
Staph aureus, TB, pseudomonas, klebsiella, PCP, pertussis
|
|
|
|
Tx of persistent empyema
|
surgery
|
|
|
|
Painless, well-circumscribed, firm, rubbery breast mass in F < 25 y/o suggests
|
Fibroadenoma
|
|
|
|
2 common med interventions for Graves
|
RAI, PTU
|
|
|
|
2 segments of colon that are intraperitoneal
|
Transverse and sigmoid
|
|
|
|
Dx test most reliable for determining true Cushing syndrome
|
24 urine cortisol, late night salivary cortisol
|
|
|
|
Best pt in menstrual cycle for self breast exam
|
1 week after LMP
|
|
|
|
Classic surgical Tx for BPH
|
TURP - transurethral resection of prostate
|
|
|
|
Classic medical Tx of BPH & M/A? 2
|
Finasteride - inh 5HT reductase
Prazasin - alpha-1 inh |
|
|
|
Melanoma c greatest potential for vertical growth
|
Nodular
|
|
|
|
L pleural effusion & pneumomediastinum found in what eso patho?
|
Distal eso perf
|
|
|
|
2 veins contributing to portal vein
|
SMV and splenic vein
|
|
|
|
Clinical breast exam picks up mass > what size ~ 100% time
|
2 cm
|
|
|
|
Other causes of incr amylase besides pancreatitis
|
Inflammatory conditions of bowel/GIT
|
|
|
|
Define hematochezia
|
bright red blood per rectum
|
|
|
|
Most common benign parotid tumor
|
Pleomorphic adenoma
|
|
|
|
Tx for pleomorphic adenoma of parotid
|
Excision
|
|
|
|
Indication for parathyroidectomy in HPTH
|
Sx of hypercalcemia c Ca > 1mg/dL above normal
Low bone density by DEXA scan <50 y/o Any Sx of renal insufficiency |
|
|
|
Hard indications for thyroidectomy in hyperthyroidism 3
|
Preg women/children (no RAI)
Suspected CA Mass fx |
|
|
|
Tx of choice for children c acute epiglottis
|
Nasotracheal intubation (tracheostomy if necessary)
|
|
|
|
Appearance of child c acute epiglottis 3
|
Hunched forward, significant stridor, drooling
|
|
|
|
Underlying event to r/o in pediatric TBI
|
Child abuse
|
|
|
|
1st 2 test to order in pt c thyroid nodule
|
TSH, FNA
|
|
|
|
Surgery on which 2 organs cause short bowel syndrome
|
ileum, jejunum
|
|
|
|
Gastroduodenal artery arises from which artery
|
Common hepatic artery
|
|
|
|
What condition cause cause big gastroduodenal artery bleed?
|
Duodenal ulcer (erodes post wall)
|
|
|
|
Carcinoid tumor of airway arise in which location
|
Main bronchi
|
|
|
|
Airway carcinoid tumors are usu benign or malig?
|
Benign (10% malig)
|
|
|
|
2 types of thoracic CA c chronic asbestos expo
|
Pleural mesothelioma, Bronchogenic carcinoma
|
|
|
|
Dx test that may be req in asymptomatic penetrating neck trauma 3
|
Arteriography, esophagoscopy, bronchoscopy
|
|
|
|
Indication for surgical resection in recurrent diverticulitis
|
Failure of med mgmt
|
|
|
|
Recommended f/u Tx for breast conservation therapy
|
Radiation
|
|
|
|
Dx suggested by dilated common bile duct on RUQ U/S, elevated LFT, normal amylase
|
Choledocholithiasis
|
|
|
|
Test of choice to distinguish testicular torsion from epidydimitis
|
U/S
|
|
|
|
Tx of choice for cauliflower ear
|
I&D of hematoma c application of pressure bandage
|
|
|
|
Dx of LCIS usu
|
incidental on Bx
|
|
|
|
Apocrine metaplasia, squamous metaplasia or glandular hyperplasia is most worrisome on breast Bx
|
Hyperplasia -> incr risk of breast CA by 2
|
|
|
|
AAA > what size should be repaired surgically (unless high risk)
|
5.5 cm (25% will rupture in 5 yrs)
|
|
|
|
Common presenting Sx of pancreatic adenocarcinoma 4
|
Obstructive jaundice, RUQ pain, new onset DM, wt loss
|
|
|
|
ID common risk factors for eso CA 6
|
Cigs, EtOH, chronic GERD, chronic hot liquid, expo to nitrosomines, malnutrition (low fiber)
|
|
|
|
Dx to perform in pt c palpable thyroid nodule, low TSH, and Sx of hyperthyrodism
|
FNA, Iodine scintogram
|
|
|
|
Dx test that can r/o or r/in cervical spine injury in trauma
|
Xrays: AP, lateral, peg
|
|
|
|
Lab for neuroendocrine tumors
|
Chromogranin A
|
|
|
|
Anisocoria is
|
Unequal pupil size
|
|
|
|
Most common sites of carinoid tumors
|
Appendix > small intestine
|
|
|
|
Carcinoid syndrome most seen in tumors located where?
|
Small intestine
|
|
|
|
Carinoid syndrome is 3
|
R valvular defects, diarrhea, flushing
|
|
|
|
Most important predictive factor in esophageal varices becoming hemorrhagic
|
Size of varices
|
|
|
|
The beta blocker used for eso varices
|
Natolol
|
|
|
|
Transient monocular blindness and Hollenhorst plaques on exam
|
Carotid artery dz
|
|
|
|
Most common postop morbidity in vasc surgery
|
Wound complications: lymphedema, poor healing, infection
|
|
|
|
Surgery generally indicated for which types of lung CA?
|
NSCLC stage 1 or 2
|
|
|
|
Primary Tx of SCLC
|
Chemo
|
|
|
|
Malig breast masses are usu firm/soft, irregular/well-circumscribed, fixed/mobile, solitary/multiple
|
Firm, irregular border, fixed, solitary
|
|
|
|
Tx of choice for low stage soft tissue sarcoma
|
Wide local excision c margins of 2 cm
|
|
|
|
Liver mass should not be Bx as part of initial mgmt because 2
|
Can be a hemangioma or echinococcal cyst
|
|
|
|
Besides clindamycin use, which abx predispose to c. diff inf
|
Cephalosporins, quinolones
|
|
|
|
Parodoxical aciduria is
|
Pt alkalotic but acidic urine because distal resorption of Na
|
|
|
|
Common causes of alkalosis in surgery pt
|
Hypervent, NG suction, citrate from transfusion
|
|
|
|
Tamoxifen only prophylatic if
2 |
High risk of breast CA but low risk of side fx
|
|
|
|
Most common subtype of melanoma
|
Superficial, horizontal spreading variety
|
|
|
|
Procedure that is the main stay med mgmt of chronic GERD
|
Nissin procedure (fundoplication)
|
|
|
|
Studies to eval for mets in pt c newly Dx lung CA
|
Head CT, LFT, abd CT, bone scan
|
|
|
|
Pt c thymoma have what autoimmune dz 50% time
|
Myasthenia gravis
|
|
|
|
How many pt c myasthenia gravis have thymoma
|
10%
|
|
|
|
What other autoimmune dz assoc c thymoma
|
Hashimoto's thyroiditis
|
|
|
|
Dx suggested by abd pain, bloody stools, abdominal bruits, thumbprinting of colon
|
Mesenteric vasc dz
|
|
|
|
What is thumbprinting of colon on AXR signify
|
Edema in bowel wall
|
|
|
|
GI organs that derive blood supply from SMA
|
Duodenum, jejunum, ileum, colon up to splenic flexure
|
|
|
|
Rational for surgical resection of liver when find benign hepatic adenoma in women c OCP 2
|
Could hemorrhage, could transfrom
|
|
|
|
Carotid endarterectomy v. angioplasty 3
|
Higher risk of intraop/postop stroke
Equal mortality/non-fatal MI risk |
|
|
|
Sens and spec of FNA for thyroid nodules
|
95% sens, 100% spec
|
|
|
|
Lung changes seen in acute pancreatitis
|
Mild pulm edema to fulminant ARDS
|
|
|
|
Risk of developing breast CA in pt c + FHx and atypical hyperplasia of Bx
|
10x baseline
|
|
|
|
5 Ps of acute vasc compromise
|
Pallor, parasthesia, pain, pulseless, poikilothermia
|
|
|
|
Acute/chronic mitral valve stenosis more likely to present c pulm edema
|
Acute
|
|
|
|
CA that may present c paraneoplastic PTHrP
|
SCC of lung, other SCC, renal cell CA
|
|
|
|
Bird's peak sign in lower eso suggest
|
Achalasia
|
|
|
|
Traction on which structure signify traumatic rupture of aorta
|
Ligametnum arteriosum
|
|
|
|
Tx of choice for schistosomiasis
|
Praziquantel
|
|
|
|
Sx of Katayama fever 4
|
Swimmer's itch, fever, myalgia, bloody diarrhea
|
|
|
|
General measures to take in any moderate-serious hand wound lac 6
|
Culture, copious irrigation, Xray series, IV abx, tetanus booster (IG if high-risk)
|
|
|
|
Older adult c painless rectal bleeding suggest
|
Diverticulosis
|
|
|
|
2nd most common cause painless rectal bleed in elderly
|
Hemorrhoids, angiodysplasia
|
|
|
|
Tx of choice for gas gangrene
|
Immediate debridment, IV PCN
|
|
|
|
CT is better for eval solid or hollow viscus organs
|
Solid
|
|
|
|
Direct hernia caused by weakening of which fascial layer
|
transversalis
|
|
|
|
Endocrine dz of 10s
|
Pheochromocytoma
|
|
|
|
Rule of 10s: 5
|
10% malig, kids, extra-adrenal, b/l, MEN assoc
|
|
|
|
Distinguish Graves dz from TMN (Plummer's)
|
Graves: diffusely enlarged, activating autoAb (type 2 HSR
Plumers: nodular, one hot nodule, usu endemic goiter |
|
|
|
microbes implicated in acute cholecystitis 5
|
E. coli, Klebsiella, pseudomonas, enterococci, bacteroides
|
|
|
|
Abx Tx for acute cholecystitis according to infectious disease society of America 2
|
2nd gen ceph or quin/flagyl
|
|
|
|
3 most frightening complications of acute/chronic sinusitis
|
Brain abscess, cavernous sinus thrombosis, orbital cellulitis
|
|
|
|
Blood value to check in suspected smoke inhalation
|
CO levels
|
|
|
|
Modification of what risk factor will slow progression of aortic aneurysm 2
|
Smoking, BP
|
|
|
|
Tx of choice for empyema
|
IV abx c perc drainage
|
|
|
|
W/u for suspect abdominal hemorrhage in blunt abd trauma 4
|
phys exam, FAST, DPL, exp lap if unstable
|
|
|
|
Underlying skin of open Fx should not be primarily closed for which reason
|
Primary closure increases risk of osteomyelitis
|
|
|
|
Dx test of choice for suspected eso perf
|
Gastrografin esophagram
|
|
|
|
Eponym for fibrosis after muscle necrosis in compartment syndrome
|
Volkmann's ischemic contracture
|
|
|
|
imaging test of choice for pancreatis Dx 2
|
CT abd if alcoholic; if not maybe RUQ U/S to r/o gallstone
|
|
|
|
Slipped capital femoral epiphysis present in which groups?
|
Obese pubertal boys
|
|
|
|
Presentation of SCFE? 4
|
Knee/hip pain, limping, ext rotation, post displaced
|
|
|
|
Dx test of choice for spinal stenosis
|
MRI
|
|
|
|
Typical presentation for spinal stenosis
|
Elderly c back pain worsened by standing up straight (extension)
|
|
|
|
Test of choice to eval traumatic urethral injury
|
Retrograde urethrogram
|
|
|
|
Tx of choice of PE in unstable pt
|
Embolectomy
|
|
|
|
Indications for prophylactic colectomy in UC
|
Chronic UC c dysplasia on Bx
|
|
|
|
Dx test of choice c suspected osteomyelitis 2
|
MRI
Nuc scan if have ortho hardware to check for infl around it |
|
|
|
Tx of choice for fulminant hepatic failure
|
liver transplant
|
|
|
|
Common causes fulminant hepatic failure
|
Severe Hep A, acetaminophen OD
|
|
|
|
Tx of choice for 2o preventation of PE/DVT in CA pt
|
Low MW hep (superior to warfarin, same mortality/bleeding risk)
|
|
|
|
Nutritional def implicated in poor wound healing 3
|
Vit C, Zn, Protein
|
|
|
|
Advantages of using Demerol after surg
|
Less likely to cause Sphincter of Oddi spasm
Less likely to cause constipation |
|
|
|
Disadvantages of Demerol
|
Highly habit-forming
|
|
|
|
Disadvantages of using demerol
|
Highly habit forming
Tends to depression cardioresp sys more than other opiod |
|
|
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Pt who should undergo 12 lead EKG as part of w/u 2
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M > 40, F > 50 c intermediate-high risk: angina, previous MI, compensated CHF, DM, CKD, valve dz
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Preop stress test for noncardiac cases 3
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High risk pt: known CAD, CHF, CVA
<4 MET (<1 flight of stairs) |
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Measure of functional status
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MET
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Most common preventable cause of death in hospitalized pt
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Venous thromboembolism
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Most common underlying path of compartment syndrome in post-vasc surg pt
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Reperfusion injury
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Tx of choice for mucomycosis 2
|
Surgical debridement
Amphotericin B |
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Intubation method of choice c cervical spine Fx 2
|
Awake fiberoptic intubation
Awake blind nasal intubation |
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Branchial cyst/thyroglossal duct cyst is more common and found midline
|
Thyroglossal
|
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|
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Tx of choice for thyroglossal/branchial cyst
|
Surgical excision
|
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Midshaft Fx will compromise which structure
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Radial nerve
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Clinical Sx of radial nerve injury
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Wrist drop
|
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Best DVT prophylaxis in surg pt
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Walking (preop and postop)
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Only genus of microbes that cause serious wound inf postop in 24 hrs
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Clostridium (esp perfinges)
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Typical presentation of occult postop intra-abdominal abscess
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Unrelenting fever +/- abd pain occuring 1-2 wk postop
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W/u for postop intra-abdominal abscess
|
CT of abd
|
|
|
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4 general classifications for surgical wounds to predict postop inf risk
|
Clean
Clean-contaminated: violation of plane into GI/GU/Resp tract Contaminated Dirty |
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Pt may reduce risk of wound inf by cessation of
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smoking
|
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|
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Phys exam finding in diagnosis of acute testicular torsion
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Absent cremasteric reflex
|
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Blue dot Sx (palpable blue nodule on upper pole)
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Sx of appendix testes
|
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Abd pain in young F is what until proven OTW
|
Preg!
|
|
|
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Role of compression stockings in surgical pt
|
Slightly reduce risk of DVT
|
|
|
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Which branch of CN VII most like injured in parotid surgery
|
Marginal mandibular
|
|
|
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Type of Bx on suspected melanoma
|
Full thickness Bx
|
|
|
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Dx test of choice for Zenker's diverticulum
|
Ba flouroscopy
Upper endoscopy |
|
|
|
Term for gallbladder c many linear calcifications on wall
Assoc c chronic cholecystitis and GB CA |
Porcelein GB
|
|
|
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Indications draining pancreatic pseudocyst 3
|
If symptomatic, continues to grow, or becomes inf
|
|
|
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Rare but classic complication of AAA repair presenting c conus medullaris syndrome
|
Ant spinal cord ischemia
|
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|
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Type of Fx when falling on extended wrist (esp little ladies)
Affects distal radius |
Colles Fx
|
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