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Surgery EOR| 522 Exam
Questions
What is the test of choice for DVT? - ✔ ✔ doppler ultrasound
What is the treatment for a colovesical fistula? - ✔ ✔ colectomy and primary bladder closure
Contraindications for surgery for lung cancer: STOP IT - ✔
✔ superior vena cava syndrome, supraclavicular node metastasis, scalene node metastasis, tracheal carina involvement, oat cell carcinoma, pulm fx tests shows FEV<1, myocardial infarction, tumor elsewhere
Contraindications of lumpectomy (instead....simple/total mastectomy, modified radical mastectomy, axillary dissection, sentinel lymph node biopsy, breast reconstruction)
- ✔ ✔ dermal lymphatic involvement, diffuse or multiple tumors, unwillingness or inability to undergo radiation treatment, expectation of a poor cosmetic outcome
D/D of lower extremity claudication? - ✔ ✔ neurogenic/nerve entrapment/discs, arthritis, coartation of
the aorta, popliteal artery syndrome, neuromas, anemia, diabetic neuropathy pain
Decreased CO2, hyperventilation, or increased pH is aka ___.
- ✔ ✔ respiratory alkalosis
Dialysis is needed when approximately _____or more of
kidney function is lost. - ✔ ✔ 90%
Dialysis vascular access: _________is the preferred access method. Creates a direct connection between an artery and vein. Located under skin usually in lower arm. Created 2-
months before it will be used. - ✔ ✔ AV (arteriovenous) fistula
Dialysis vascular access: _________is used when patients veins are not suitable for creating a fistula. Flexible rubber tube is used to create a path b/w artery and vein. Can be used 2 weeks after they are created. Possible narrowing of blood
vessels and infection. - ✔ ✔ Synthetic AV bridge graft
Dialysis vascular access: _________uses a thin, flexible tube that is placed into a large vein (neck usually) -- can be used
immediately. Highest infection risk and poorest function. - ✔
✔ Central venous catheter
Dx tests for pheochromocytoma - ✔ ✔ Urine screen for VME (vanillylmandelic acid), metanephrine, epinephrine, norephinephrine
CHEMOTHERAPY IS DONE! - ✔ ✔ estrogen receptor negative AND HER negative AND size less than 2cm
With pituitary tumors, the most common is a ____. The most common presentation is bitemporal hemianopsia (lateral visual fields blind). Medical tx = bromocriptine. Surgical tx =
transsphenoidal resection. - ✔ ✔ prolactinoma
What are the screening recommendations for colorectal
cancer? At what age should screening begin? - ✔ ✔ At age 50 or age 40 for increased-risk patients:
--yearly fecal occult blood test
--flexible sigmoidoscopy every 5 years
--colonoscopy every 10 years
--double contrast barium enema every 5 years
Where is the most common site of distal metastases? - ✔ ✔ liver
Which suture is smaller: a 5.0 or a 3.0? - ✔ ✔ a 5.
What is the test of choice for cholecystitis? - ✔ ✔ u/s -- then HIDA scan
What are two treatments for a pancreatic pseudocyst? - ✔
✔ pancreatic rest (NPO), surgical drainage
What condition mimics SBO? - ✔ ✔ paralytic ilius
What does CXR show with aortic dissection? - ✔ ✔
widened mediastinum
What does the PE show with a SBO? - ✔ ✔ distended tympanic abdomen, high pitches bowel sounds -- delayed findings are lethargic, dehydrated, tachycardia, decreased skin turgor, hypotension
What increased testing should be performed on a high risk
patient? - ✔ ✔ genetic blood testing, UC or Chron's > 10 years requires annual screening
What is a common cause of PUD? - ✔ ✔ H pylori
_________carcinoma is the MOST common cancer death in the US in men and women. It occurs more often in the ___lung
and more common in the ____lobe. - ✔ ✔ Bronchogenic; right; upper
A _________is an abnormal dilation of an artery. Involve all
layers of the arterial wall. - ✔ ✔ aneurysm
A ________is a collection of blood between the skull and dura. Usually in association with skull fracture as bone fragments lacerate meningeal arteries. What artery is most commonly
affected? - ✔ ✔ epidural hematoma; middle meningeal artery
resolves for a specific amount of time while standing. - ✔ ✔
Claudication
__________is the failure of the LES to relax during swallowing,
loss of esophageal peristalsis. - ✔ ✔ Achalasia
__________is the most common pulmonary complication after surgery -- affecting 25% of patients who have abdominal surgery. Most often due to closure of bronchioles -- but can also be due to obstruction (such as from blood clots or COPD
secretions). - ✔ ✔ Atelectasis
________ are incarcerated hernias that also have vascular
compromise. - ✔ ✔ Strangulated.
A ________is when air builds up in the pleural space and is unable to escape -- results in collapse of lung on affected side and pressure on mediastinum. With inhalation, the lung
collapses further. There is no place for the air to escape. - ✔
✔ pneumothorax
A ________is when the stomach herniates through the hiatus of diaphragm into the chest. Results from continued shortening of the esophagus as a result of repeated muscle contraction. -
✔ ✔ hiatal hernia
A _______is an obstruction of the perianal glands. Cryptoglandular in origin. Presents with perianal pain and swelling, spontaneous drainage of purulent material. What
are the cardinal signs? Treatment? - ✔ ✔ perianal abscess; pain, fever, redness, swelling, loss of function; I&D
A _______is necessary when an emergent airway is required...extensive orofacial trauma preventing laryngoscopy, upper airway obstruction , unsuccessful
endotracheal intubation - ✔ ✔ Cricothyroidotomy
_________is a palpable, NONTENDER gallbladder. Associated
with cancer on head of pancreas. - ✔ ✔ Courvoisier's gallbladder
_________is a SBO from a large gallstone that has eroded through the gallbladder and into the duodenum/small bowel.
Tx: removal of stone w possible cholecystectomy. - ✔ ✔
Gallstone illeus
_________is a vasospasm of the digital arteries with color changes of the digits. Usually initiated by cold or emotion. -
✔ ✔ Raynaud's phenomenon
______________is defined as presence of kidney damage (usually detected as urinary albumin >30mg/day) or decreased kidney fx (defined as estimated GFR <60 mL/min) for 3 or more
months, irrespective of cause. - ✔ ✔ Chronic kidney disease
_____________can be used for symptomatic large pelvic stones; nephroscope passes inside the renal collecting system through
unknown. More than 75% of men have this on autopsy. - ✔
✔ Prostate
_________is persistent HPTH after correction of secondary HPT results from autonomous PTH secretion not responsive
to normal negative feedback due to elevated Ca levels. - ✔
✔ Tertiary hyperparathyroidism
_________is stenosis of renal artery which results in decreased perfusion of the juxtaglomerular apparatus and subsequent activation of the renin-angiotensin-aldosterone system. S/S -
diastolic HTN, A-gram is diagnostic. - ✔ ✔ Renal artery stenosis
_________is the most common type of esophageal cancer at the
GE junction in the US. - ✔ ✔ Adenocarcinoma
_________occurs over 6-12 months in which the wound
contraction and tensile strength is achieved. - ✔ ✔ Tissue Remodeling
_________represent 1/2 of all small intestine malignancies. The most common site is the duodenum. What is the surgical
management? - ✔ ✔ Adenocarcinomas; wide resection of the involved bowel with wide margins --- adjuvant therapy poor response -- low survival rate due to delayed/advance disease at diagnosis
_________sign is a non tender but distended palpable
gallbladder, associated with jaundice. - ✔ ✔ Couvoisier's sign
UC almost always involves what areas and spreads where? -
✔ ✔ almost always involves the rectum and spreads proximally in a continuous route without skip areas -- anal involvement is uncommon
Ulcerative colitis only affects the ____. What is the hallmark
symptom? - ✔ ✔ colon; bloody diarrhea
Ureterscopic intervention or placing a ________can be used for
stones >10mm. - ✔ ✔ ureteral stent
Urinary frequency during the day wo nocturia is usually related to _______. Nocturia without frequency may occur in ____ patient in whom intravascular volume and urine output increase when supine. Also, renal concentrating ability decreases with age; therefore urine production in the geriatric
patient ________. - ✔ ✔ anxiety; CHF; increases at night
Use __&___to evaluate breast malignancy? - ✔ ✔
ultrasound and mammography
Use Ankle to Brachial index to access PVD. What is the
normal ABI. - ✔ ✔ ABI>1; Claudicator ABI<0.6; Rest Pain ABI<0.
________are when peritoneal sac and potentially peritoneal contents protrude through a weakness or defect in the muscle
or fascia of the abdominal wall. - ✔ ✔ Hernias
________burns are more serious because the body cannot buffer
, thus allowing them to burn for longer. - ✔ ✔ Alkali
________disease is a toxic multinodular goiter. - ✔ ✔
Plummer's disease
________hernias are typically small, less than 1cm defect in the abdominal wall due to incomplete umbilical closure. More
common in females. - ✔ ✔ Umbilical
________hernias cannot be reduced -- more likely associated with pain, n/v. Femoral hernias are most likely to be this way because space is limited by the inguinal ligament, lacunar
attachments, and Cooper's ligament. - ✔ ✔ Incarcerated
________hernias present with a bulge or lump at the site of a
previous surgical wound. - ✔ ✔ Incisional
________is acute pain and inspiratory arrest excited by
palpation of the RUQ during inspiration. - ✔ ✔ positive Murphy's sign
________is arteritis of the aorta and aortic branches resulting in
stenosis/occlusion/aneurysms. - ✔ ✔ Takayasu's arteritis
________is inborn error in liver bilirubin uptake and glucuronyl
transferase resulting in hyperbilirubinemia. - ✔ ✔
Gilbert's syndrome
________is intermittent claudication. S/S are absent pulses, bruits, muscular atrophy, decreased hair growth, thick
toenails, and tissue necrosis/ulcers/infection. - ✔ ✔ PVD
- peripheral vascular disease
________is multiple acquired diverticula through the colon.
What is the presentation? - ✔ ✔ Diverticulosis; LLQ pain, rectal bleeding, alternating constipation and diarrhea
________is reflux of gastric contents into lower esophagus
resulting from decreased fx of LES. - ✔ ✔ Esophageal reflux
________is second most common drug eruption after exanthematous drug eruptions. Characterized by short lived swelling of the skin, oropharynx, or genitalia. Transient leakage of plasma from small blood vessels into surrounding
connective tissue of the dermis resulting in wheals. - ✔ ✔
Urticaria
________is the inability to return the retracted foreskin over the glans. Condition leads to pain and edema treated by
circumcision. - ✔ ✔ Paraphimosis
Surgical: acute colonic obstruction with cecal diameter greater than 12cm
What is the treatment for SAH? - ✔ ✔ --Nimodipine CCB for vasospasm
--surgical metal clipping for aneurysm (alternative is balloon occlusion or coil embolization)
--AVM: pre op embolization -- for surgically inaccessible lesions, radiosurgery
What is the treatment for urinary retention? - ✔ ✔ foley
catheter
What is the tx for compartment syndrome? - ✔ ✔
fasciotomy
What is the tx of pneumothorax? - ✔ ✔ ABC's; oxygen, treat for shock, needle decompression of affected side, patient will need chest tube
What is Virchow's Triad (risk factors for thrombosis)? - ✔
✔ stasis, abnormal endothelium, hypercoagulability
What labs are often elevated with cholecystitis?
Choledocholithiasis? Cholangitis? Gallstone pancreatitis? - ✔
✔ cholecystitis: increased WBC and minor LFT abnormalities
Choledocholithiasis: increased bilirubin & alkaline phosphatase
Cholangitis: elevated serum bilirubin and transaminase levels, as well as leukocytosis
Gallstone pancreatitis: elevations in serum amylase and lipase
What medical management is used to treat nephrolithiasis? -
✔ ✔ NSAIDs or opiods for pain; alpha adrenergic blockers (tamsulosin) or CCBs (nifedipin) to dilate ureters
_______carcinoma from pre-existing benign adenoma is the most common malignancy after proctocolectomy in patients with familial polypoisis and require endoscopic surveillance. -
✔ ✔ Duodenal
_______cell carcinoma is the most common urologic
malignancy. Specifically what kind of cancer? - ✔ ✔ Renal; adenocarcinoma
_______hernias account for 96% of all groin hernias. Indirect
are more common and presents how? - ✔ ✔ Inguinal; protrusion into the scrotum
_______hernias present with a bulge lower in groin through the femoral ring and often into the thigh. Mass inferior to the
inguinal ligament. - ✔ ✔ Femoral
_______invades the inner ear and enteric tissues as well as the
lung. - ✔ ✔ Klebsiella
indigestion) that continues over time - ✔ ✔ Chronic cholecystitis
_______is bleeding into the bronchial tree. Causes are bronchitis, tumor mass, TB, bronchiectasis, pulmonary
catheters, trauma. - ✔ ✔ Hemoptysis
_______is hypertrophy of the smooth muscle of the pylorus, resulting in obstruction of outflow. Who is affected most
commonly? - ✔ ✔ Pyloric stenosis; 1st born males
_______is infection of one or more diverticula...typically from
____obstruction. - ✔ ✔ Diverticulitis; fecaltih
_______is intussusception of a full thickness portion of the rectum through the anal opening. Often occurs in thin,
asthenic women. 4-20cm of rectum. - ✔ ✔ Rectal prolapse (procidentia)
_______is malignancy of the extrahepatic or intrahepatic ducts -- primary bile duct cancer. Management is whipple
procedure. - ✔ ✔ Cholangiocarcinoma
_______is more than 2x/night of voiding. - ✔ ✔ Nocturia
_______is pain 1/3 of the distance between the umbilicis and
ASIS. - ✔ ✔ McBurney's point tenderness
_______is strong nonperistaltic contractions of the esophageal body; sphincter function usually normal. Sx are spontaneous
chest pain that radiates to the back, ears, neck, jaw, or arms.
An UGI series shows what? - ✔ ✔ Esophageal spasm; "corkscrew esophagus"
_______is the most common pathogen in wound infections and
around foreign bodies. - ✔ ✔ Staph aureus
_______is the most important anesthetic complication. Anesthesia causes an uncontrolled increase in skeletal muscle oxidative metabolism, which overwhelms the body's capacity to supply oxygen, remove CO2, and regulative body
temperature. - ✔ ✔ Malignant hyperthermia
_______is the reversing agent for benzodiazipines. - ✔ ✔
Flumazenil
_______is the reversing agent for opiods. - ✔ ✔ Naloxone
_______is usually caused by ineffective PTH (chronic renal failure, absent active vit D, ineffective active vit D,
pseudohypoparathyroidism), deficient PTH. - ✔ ✔ Hypocalcemia
_______of the gallbladder is complete obstruction of the cystic
duct by gallstone and filling of the gallbladder with fluid. - ✔
✔ Hydrops
_______pain is usually secondary to inflammation with secondary edema and distention of the prostatic capsule. Pain is poorly localized -- frequency associated with irritative sx
