Pestana- General Surgery

lizruns33's version from 2016-01-21 00:12


Question Answer
Diagnosing GERD pH monitoring
Treatment for ulceration secondary to GERDLaparoscopic Nissen fundoplication
Solids swallowed easier than liquidsAlchalasia
Diagnosis for alchalasiaBarium swallow followed by manometry
Treatment of mallory-weiss tearPhotocoagulation
Diagnosis of Boerhaave syndromeContrast swallow- gastrografin first, then barium if negative
Gastric cancer more common in elderlyGastric adenocarcinoma
Presentation of carcinoid syndrome Diarrhea, flushing, wheezing, right sided heart valvular damage
First symptom of acute appendicitisAnorexia and vague periumbilical pain
Leukocyte count in acute appendicitis10,000-15,000
Treatment of cancer of right colon Right hemicolectomy
Workup for colon cancerColonoscopy, biopsy, CT scan to help stage
Malignant polypsFamilial polyposis, familial multiple inflammatory polyps, villous adenoma, adenomatous polyp
Benign colonic polypsJuvenile, Peutz-Jeghers, isolated inflammatory, HYPERPLASTIC
When is Chrons surgically treated?For strictures, fistulas, or bleeding
Why is surgery for UC avoided?Always requires removal of the rectal mucosa, raising need for a stoma or an ileoanal anastamosis
Indications for UC surgery?Disease more than 20 years, TOXIC MEGACOLON, severe nutritional depletion, multiple hospitilizations, need for high dose steroids
What antibiotics cause pseudomembranous enterocolitis?Clindamycin, cephalosporins
Diagnosis of pseudomembranous enterocolitis?Stool toxin
Treatment of internal hemorrhoids Rubber band ligation
Therapy for anal fissureStoll softeners, topical nitroglycerin, lateral spincterotomy, calcium channel blockers (diltiazam ointment)
Should surgery be done for Crohns of the anus?No
Ischiorectall abscessPerianal abscess
Treatment of perianal abscessI&D, rule out cancer
When does fistula-in-ano develop?After an ischiorectal abscess is drained
What is the tract between for fistula in ano?Between the anal crypts (where abscess originated) and perineal skim (where drainage was done)
Treatment for fistula-in-anoFistulotomy
Treatment for SCC of anus5 weeks of chemoradiation
Causes of GI bleeding from colonAngiodysplasia, polyps, diverticulosis, cancer
MelenaBlack, tarry stools
Diagnosis of hemorrhoidsAnoscopy (NOT colonoscopy- too much blood)
Workup for active bleeding from rectumAnoscopy. If negative (no hemorrhoids) do arteriogram if a lot of blood or tagged red-cell if not that much blood to find source of bleeding
Workup for recent history of blood from rectumUpper GI endoscopy for young, upper and lower for old
Cause of blood per rectum in a childMeckel diverticulum
Workup for meckel diverticulumTechnetium scan
Treatment for stress ulcers (upper GI bleed)Angiographic embolization, and keeping gastric pH above 4
Massive upper GI bleedStress ulcers
Causes of acute abdomenObstruction, perforation, ischemia, inflammation
Diagnosis of perforationFree air under the diaphragm
Peritonitis presentationAscites, some fever, SINGLE organism from culture
Treatment of peritonitisAntibiotic, not surgery
Other differentials for acute abdomen MI, pneumonia, PE, pancreatitis, kidney stones
Clinical presentation of acute pancreatitisSevere epigastric, constant pain radiating to the back. Nausea, vomiting
Diagnosis of acute pancreatitis Serum amylase
Diagnosis of ureteral stonesCT scan
"Parrot's beak" on colon XraySigmoid volvulus
Who do we see volvulus of sigmoid in?Old people
Treatment for volvulus of sigmoidProctosigmoidoscopy w/ old rigid instrument
What predisposes to mesenteric ischemia?Atrial fibrillation or recent MI
Primary hepatoma Hepatocellular carcinoma
Blood marker for liver cancerAlpha fetoprotein
What's more common... primary or metastatic cancer to liver?Mets (20:1)
Management of hepatic adenomaEmergency surgery
What causes pyogenic liver abscess?Ascending cholangitis
Treatment of pyogenic liver abscess?Percutaneous drainage
Types of jaundiceHemolytic, hepatocellular, obstructive
Bilirubin level for hemolytic jaundice 6-8
Courvoisier-Terrier sign Malignant obstruction: Large, thin-walled, distended gall bladder
Why in obstructive jaundice caused by stones (not tumor) is the gallbladder not dilated?Because of chronic inflammation it cannot dilate
3 kinds of obstructive jaundice tumorsHead of pancreas, ampulla of vater, common bile duct
Ampullary cancerObstructive jaundice PLUS bleeding into GI tract/anemia
Partial or complete obstruction in acute ascending cholangitis?Partial
Fever in ascending cholangitis104-105
Treatment of ascending cholangitisAntibiotic, decompression via ERCP, eventual elective cholecystectomy
Biliary pancreatitisStones in ampulla= both pancreatic and biliary ducts.
Treatment for biliary pancreatitis Conservative- stones will usually pass spontaneously
Types of acute pancreatitisEdematous, hemorrhagic, or suppurative
Type of pancreatitis in alcoholics or patients with gallstonesEdematous
Elevated hematocritEdematous pancreatitis
Lower hematocritHemorrhagic pancreatitis
Acute hemorrhagic pancreatitisRanson's criteria... low calcium even with calcium administration, BUN increases, eventual metabolic acidosis and low arterial PO2
Ranson's criteriaWBC >16,000 Glucose >200 Age >55 AST >250 LDH >350
Eventual complication of hemorrhagic pancreatitis Development of multiple pancreatic abscesses
When do pancreatic abscesses form?About 10 days after the onset of pancreatitis
Necrosectomy Taking out necrotic tissue
Why do pancreatic pseudocysts occur?As a late sequela of acute pancreatitis or of pancreatic trauma
What is the time frame for pancreatic pseudocyst?5 weeks after the original problem
When are pancreatic pseudocysts drained?Greater than 6cm or present for >6 weeks
Consequences of chronic pancreatitisSteatorrhea, diabetes, constant pain
When are umbilical hernias not operated on?For kids 2-5 years old
What other hernia is not repaired?Esophageal sliding hiatal hernia
3 big families of malignant tumorsEpithelial, adenocarcinomas, sarcomas
Where does breast cancer like to mets to?Bone and brain
What age is cystosarcoma phyllodes seen? Late 20s
Management of cystosarcoma phyllodesAlthough most are benign, MUST remove them. Potential to become malignant sarcomas
What age do we see mammary dysplasia?30-40
Mammary dysplasiaFibrocystic disease/cystic mastitis
Bilateral tenderness related to menstrual cycle Mammary dysplasia
Workup for mammary dysplasia Mammogram (can have lumps), aspiration of mass (if bloody send for cytology)
Workup for intraductal papilloma Galactogram and mammogram (mammogram will NOT show papilloma, just used to rule out more serious)
Who is breast abscess seen in?Lactating women
Fixed mass vs moveableFixed= more likely to be malignant
Treatment for breast cancer during pregnancyNo radiotherapy, no hormonal therapy, and no chemo during the 1st trimester
What breast surgery requires radiotherapy after?Lumpectomy, not mastectomy
When do you do sentinel node biopsy?When lymph nodes are not palpable
When do you do pre-op chemotherapy for breast cancer?Inflammatory cancer
Management of ductal carcinoma in situSTILL do surgery because of high incidence of recurrence. Lumpectomy followed by radiation
What is inoperability of breast based on?Local extent, not metastases
When is adjuvant therapy used for breast cancer?Virtually all cases. Chemotherapy and hormonal therapy if receptor positive
What hormonal therapy do premenopausal women use for breast cancer?Tamoxifen
What hormonal therapy do postmenopausal women use for breast cancer?Anastrozole
What tells us that systemic therapy is needed for breast cancer?Positive axillary nodes
Where does breast cancer like to mets to in the spine?Vertebral pedicles
Does thyroid cancer affect thyroid function?No
How can follicular cancer be determined benign or malignant?Lobectomy (often FNA does not diagnose it)
Is papillary cancer fast or slow growing? Slow
What is the management of follicular cancer?Total thyroidectomy
Management of medullary cancerRadical surgery, workup for MEN, type 2
Management of anaplastic cancerOften is is so fast spreading all you can do it a tracheostomy
Which thyroid cancer is reactive to radioactive iodineFollicular
Treatment of hyperthyroidismRadioactive iodine
Treatment of hyperparathyroidism Removal of gland- 90% of time it is a single adenoma. Can use sestamibi scan to help locate the gland before surgery
Diagnosis of CushingLow dose dexamethasone-> if no suppression, -> 24 hour ruin free cortisol -> if elevated, high dose suppression test
No suppression of high dose dexamethasone Adrenal adenoma or paraneoplastic syndrome
Zollinger Ellison Gastrinoma (found on CT of the pancreas)
Symptoms of Zollinger EllisonPeptic ulcer disease resistant to ALL therapy (even against H. pylori), watery diarrhea, high gastrin level
Management of Zollinger EllisonRemoval or tumor, omeprazole
High insulin, high C-peptideInsulinoma
Hyper secretion of insulin in the newborn, requiring 95% pancreatectomyNesidioblastosis
Migratory necrolytic dermatitisGlucagonoma
Anemia, glossitis, stomatitis Glucagonoma
Treatment for glucagonomaResection, stomatostatin for inoperable disease
What causes primary hyperaldosteronism?Adenoma or hyperplasia
Aldosterone high, renin lowPrimary hyperaldosteronism
How to differentiate between hyperplasia and adenoma for hyperaldosteronism? Appropriate response to postural changes (standing up increases aldosterone) is hyperplasia
Management of primary hyperaldosteronism Adrenal CT to localize problem, then surgical removal
Diagnosis of pheochromocytoma24 hour urinary VMA
Treatment of pheochromocytoma Find it on adrenal CT scan, surgical removal WITH pharmology: ALPHA BLOCKERS
Who is pheochromocytoma often seen in?Thin, hyperactive women
Scalloping of the ribs Coarctation of aorta
What causes scalloping of the ribs?Erosion from large collateral intercostals
Diagnosis of coarctation of aortaCT angio
Spiral CT with IV dye contrastCT angio
Who is renovascular hypertension seen in?Young women with fibromuscular dysplasia and old men with arteriosclerotic occlusive disease
Is renovascular hypertension responsive to usual antihypertensive medications?No
Workup of renovascular hypertensionDuplex scanning and CT angio
Therapy for renovascular hypertensionBalloon dilatation and stenting in young women
-tomyto cut
-ectomyto take out
-ostomyto make an opening
-plastyto change the shape of (ex. pyloroplasty)
-pexyto fix in place
-rrhaphyto saw together

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