Surgery EOR

what is the most common type of liver cancer?
hepatocellular carcinoma
tx for hemochromatosis (excessive iron loading)
deferoxamine chelation

HBsAg
acute/chronic infection
HBeAg
VERY INFECTIOUS
acute/chronic infection
infectivity
wild type viral infection
anti-HBc
marker of exposure
persists indefinitely
anti-HBe
low infectivity
Anti-HBs
marker of immunity
VACCINATION
what can cause false + for hemoccult?
grapefruit, red meat, turnips
radishes, horseradish, cauliflower
VITAMIN C, NSAIDS, ASA
“gold standard” to diagnose chronic pancreatitis
ERCP
study of choice for gallbladder studies
U/S
study of choice for diverticulosis
barium enema
MCC LGI bleed
diverticulosis
(MC in sigmoid colon)
most common cause acute pancreatitis
biliary disease (gallstones)
alcohol
most common type of pancreatic cancer
ductal adenocarcinoma
(MC location = head)
what is courvoiser’s sign?
palpable, nontender gallbladder.
indicates obstruction of distal CBD due to mass.
TOC for pancreatic cancer
whipple (pancreatoduodenecotom)
MCC colon cancer
adenocarcinoma
MCC esophageal cancer
SCC
what drug can be used to treat acute mesenteric ischemia?
papavarine (vasodilator)
what is the study of choice for zollinger ellison syndrome?
secretin stimulating test
+ if secretin does NOT inhibit gastrin secretion
Tx: PPI, sx, chemo
T/F: cholangitis is an emergency
true. infection of biliary tract due to obstruction –> leads to biliary stasis and bacterial overgrowth.
MCC cholangitis
choledocolithiasis.
post ERCP.
what is charcot’s triad?
RUQ pain
jaundice
fever
reynold’s pentad?
charcot’s triad
septic shock
altered mental status
MCC gallbladder carcinoma
adenocarcinoma
MCC cirrhosis
alcoholic hepatitis (2nd MCC is Hep B & C)
omgea loop sign and coffee bean sign are characteristic of

volvulus

(SOC = SIGMOIDOSCOPY b/c you can diagnose and TREAT at the same time!)

what kind of volvulus needs emergency surgery?
cecal volvulus
what is diagnostic and therapeutic for intusseption?
barium enema
(“currant jelly sools” & “sausage like mass”)
MCC UGI bleed
PUD
MCC PUD
H pylori
NSAID
what causes a UGI bleed that is a mucosal tear at or just below GE junction due to forceful vomiting?
mallory weiss tear
tx for mallory weiss tear
resolves spontaneously
what is boerhaave’s syndrome?

Hallmarks: transmural tear causing esophageal perforation due to vomiting and retching that presents w/ UGI bleed

TOC: EMERGENT surgical treatment

hallmarks of esophageal varices

massive GI bleed, hematemesis, liver disease, cirrhosis

TOC: hemodynamic stabilization, *endoscopic hemastasis*

ex: drinking around holidays

MCC LGIB
dierticulsis
always suspect with occult blood loss & change in bowel patterns?
colon neoplasm
tx for peritonsillar abscess
I&D
clindamycin
MC breast cancer
IDC
what is an adrenal medulla catecholamine secreting tumor?
pehochromocytoma
suspect pehochromocytoma in who?
pt with HTN uncontrolled by meds
S&S: HA, diaphoresis, palpitations, severe HTN
dx pehochromocytoma?
24 hour urine for catecholamines
TOC for pheo?
surgery, alpha block THEN beta block prior to surgery
tx for prolocatinoma?
bromocriptine
TOC for adrenal crisis?
pt on steroids who stops taking them.
Tx: high dose prednisone and high dose fluids
appearance of pituitary adenoma after bilateral adrenalectomy for cushings?
Nelson’s Syndrome
what is idiopathic adrenocortical insufficiency?
addison disease
decrease in cortisol & aldosterone
TOC: hydrocortisone sodium succinate/phosphate
*steroid replacement for life*
tx hypothyroidism
synthroid (levothyroxine)
MCC hyperthryoidism
gave’s disease
MC testicular cancer
(MC neoplasm in males 20 to 35 yo)
nearly all testicular cancers are of GERM CELL origin.
almost half are seminomas
MC prostate cancer
MC cancer of men in US
MC kind = adenocarcinomascored with Gleason Staging Sx

thrombocytopenia is platelets less than
50,000
what does the prothrombin time (PT) evaluate?
extrinsic and common pathway
monitors coumadin therapy
Factors V, VII, X
PTT (partial thromboplastin time) evaluates:
evaluates intrinsic pathway and common pathway
normal is 30 – 40 seconds
monitors Heparin therapy
people who have never been immunized for tetanus (or immunization status is unknown) should receive:
immunoglobulin
Td should be given to who?
patients > 7 years of age
give TDaP if they have never had vaccine before
Patients < 7 yo get what tetanus shot?
DTaP
what is the MCC of ARDS?

sepsis

*Hallmarks*: profound dyspnea, labored breathing, diffuse infiltrates sparing the costophrenic angles

most common congenital heart defect
VSD
loud, harsh holosystolic murmur @ LLSB
what is the renal ca triad?
hematuria
flank pain
mass
most common hernia
indirect inguinal hernia
an indirect hernia passes lateral to what?
inferior epigastric vessels
antibiotic tx for diverticulitis
flagyl
what is barrett’s esophagus?
change from squamous epithelium of the esophagus to columnar metaplasia from chronic irritation from reflux.
risk? adenocarcinoma
MCC bowel obstruction?
adhesions
Cancer
for tetanus prophylaxis, if pt has “dirty contaminated” wound, their last tetanus shot should be w/i how long?
last 5 years.
if not, give another today.
receive next vaccine per schedule.
chromic catgut is absorbable/nonabsorbable?
absorbable
nylon sutures absorbable/nonabsorbable?
nonabsorbable
prolene (polypropylene) suture absorbable/nonabsorbable?
nonabsorbable
ethibond sutures absorbable/nonabsorbable?
nonabsorbable
PDS sutures absorbable/nonabsorbable?
absorbable
Monocryl absorbable/nonabsorbable?
absorbable
what causes gas gangrene?
clostridium perfringes or GAS.
develops SUDDENLY.
trauma @ surgical site. painful, swelling, dark skin.
Tx: debride (if really bad might need amputation, PCN, clinda)
most common post op cardiac event?
atrial fibrillation
what is the MCC post injury death to trauma patient?
hemorrhage leading to hypovolemic shock
parkland formula for burns

% BSA x weight (kg) x 4

give 1/2 fluids in first 8 hours.
remaining 1/2 in last 16 hours.

what is the MCC hiatal hernia?
sliding (type I)
movement of GE junction and stomach into the mediastinum
Tx: antacids per GERD
what is the MC motility disorder?

achalasia

loss of esophageal motility & failure of LES relaxation
S&S: dysphagia, weight loss
increase risk of esophageal cancer

how do you dx achalasia?
barium swallow.
Tx: dilation of proximal esophagus with endoscpoe cures 80%
“dark red currant jelly stool”
intusseception
Esophageal Diverticula/Zenker’s
proximal diverticula.
involves ONLY the mucosa between thryopharyngeal & cricopharyngeal mm
S&S: dysphagia, regurg solid fodo, choking, bad breath
Dx: clinical, barium swallow
Tx: myotomy, removal diverticulum
MCC esophageal cancer?
SCC
(alcohol x tobacco use)
MC location of carcinoid tumors
appendix
MC benign tumor of small bowel
Leiomyoma
massive LGI hemorrhage is usually caused by:
diverticular disease
chronic rectal bleed usually caused by
hemorrhoids, fissure, CA, polyps
MC cause and site of lg intestine obstruction
Ca
sigmoid colon
what is the most common breast tumor in teens and young women?
*fibroadenoma*
grows rapidly. no Ca risk. no tx required. f/u in 1 mo.
smooth borders on mammogram – same density as nl breast tissue.
MC breast tumor in pts 35 – 50 yo
fibrocystic breast disease
rarely post-menopausal
pt will c/o multiple small bumps and lumps that are tender during the menstrual cycle.
mammogram: no calcifications, cystic on U/S
what is the MCC of barrett’s esophagus?
GERD
T/F: mallory weiss tear is generally self limiting
true
usually on gastric side of GE junction.
80% stop spontaneously.
MCC esophagitis
GERD.
what is pill esophagitis?
caused by injury (local or topical).
may be caused by fosamax (alendronate), KCl, abx, NSAIDs, quinidine
what is most common – UGIB or LGIB?

UGIB (location proximal to ligament of treitz) accounts for 80% of ALL significant GI bleeding

endoscopy establishes dx 90% of the time.

which pt is more likely to have hypovolemia – pt with UGIB or LGIB?
UGIB more likely to have hypovolemia
MCC LGIB
diverticulosis
from RIGHT colon
MC presentation of LGIB
hematochezia
crohn’s is most common where
terminal ileum
T/F: rectum is often spared in crohn’s

true.

UC – rectum is often involved.

T/F: ulcerative colitis is transmural.
false. UC is NOT transmural (Crohn’s is) but is diffuse *mucosal inflammation* that often involves the rectum.
what is the MC operation performed by surgeons?

hernia repair

MC hernia is right indirect inguinal hernia

the indirect inguinal hernia follows what in males?
spermatic cord through inguinal canal
(VAS is also in inguinal canal)
(round ligament is in inguinal canal of females)
what is the MC site of bleeding for a duodenal ulcer?
gastroduodenal artery
S&S perforated peptic ulcer
fever
tachycardia
abd tenderness
rigidity/rebound
bleeding
obstruction
anorexia
N/V
what is the MCC pneumoperitoneum?
perforated gastric ulcer
(air within abdominal cavity)
what is the new TOC for splenic hemorrhage?
spleenorrhaphy (repair) rather than splenectomy due to the spleen’s important role.
what vaccines are required for those who are post-splenectomy?
pneumovax
H. flu
N. meningitis
what serum marker is specific for pancreatitis
serum *lipase* (note: increased levels do not correlate with increased severity of sxs)
what is the most common kind of pancreatic cancer?
ductal adenocarcinoma (most commonly @ head of pancreas)
mets to liver early
S&S pancreatic cancer
obstructive jaundice, weight loss, deep abd pain, pruritis, courvosier’s sign (jaundice & palpable nontender GB that indicates obstruction of CBD from tumor)
cullen’s sign is:
blue around umbilicus from peritoneal hemorrhage
MCC small bowel obstruction in western nations
adhesions
(MCC worldwide = hernias)
what is an idiopathic pseudo obstruction called?

ogilive’s syndrome

enormous dilation of right side of colon w/o obstruction

tx: bowel rest, IVF, rectal decompression tube via colonoscopy

what is the most frequently performed vascular operation in the US?

carotid endarterectomy

note: no surgery for carotids that are 100% occluded

when is carotid endarterectomy recommended?
patients with symptomatic stenosis & > 70% occlusion
what is the MCC cerebral ischemic event related to carotid stenosis?

embolization

acute MI and perioperative stroke are 2 MC severe complications following carotid CEA.

T/F: S&S carotid stenosis are dizziness, syncope, confusion.

false. almost NEVER.

usually experience TIA sxs like shade coming over eye, weakness of arm, hand or foot on one side.

what is the leading cause of disability for adults in the US?
stroke.
what kind of aneurysm has increased rupture risk?

saccular (berry) aneurysms

fuisform (uniform on both sides) have less risk

one unit PRBCs increases Hgb by ___ and Hct by ____
Hgb by 1 g/dL
Hct by 3%
what is the MC CNS malignancy?
mets from lung, breast, melanom
what are classic S&S ruptured AAA?
abd pain
pulsatile mass
hypotensionrecommend surg for > 5.5 cm in males (and some sources recommend > 5 cm in females)

what is the most common peripheral aneurysm?
popliteal artery
rupture is rare.
tx if the pt has sxs or if it is > 2 cm.
what is the MOST definitive test for AAA?
aortogram.
reveals size and extent.
S&S aortic dissection
tearing/ripping chest pain in hypertensive pts that radiates to back
what is Leriche Syndrome?
occlusive disease of iliacs and distal aortic.
aortoiliac disease.
hip claudication, gluteal mms affected, impotence.
what is the MC solid renal tumor?

Renal Cell Carcinoma

S&S: pain, weight loss, flank mass, HTN
classic triad: flank pain, hematura, palpable mass

peripheral arterial disease. ABI level in pts w/o disease:
> 1.0 (greater than one due to higher absolute pressure in the ankle)
peripheral artery disease. ABI in pt with REST PAIN.
usually ABI < 0.4 have rest pain and severe occlusive disease.
peripheral artery disease. claudication ABI.
< 0.7
venous ulcer location
medial ankle and calf.
PAINLESS, large, shallow, contain bleeding granulation tissue.
cool pale swollen leg with impalpable pulses.
arterial ulcer S&S
dorsum of foot, lower lateral ankle.
PAINFUL. absent pulses, pallor, may have “blue toes”
patient presents with sudden severe cramping and LLQ pain with + diarrhea, + hematochezia, + bowel sounds, tenderness to palpation and sxs out of proportion to the signs. Dx?
mesenteric ischemia/ischemic colitis.
*chronic*: usually supportive
*acute*: afib, following surgery
Tx: Laparotomy is the GOLD STANDARD.
what is the most prevalent GI complication following Cardiovascular surgery?

acute mesenteric ischemia / ischemic colitis

S&S: rapid onset pain that is OUT OF PROPORTION TO EXAM

when do you remove sutures from face/neck?
3 – 5 days (replace with steristrips)
when do yo remove sutures from scalp?
7 – 10 days
when do you remove sutures from trunk?
7 – 10 days
when do you remove sutures from extremities?
10 – 14 days
when do you remove sutures from joints?
14 days
what are the stages of wound healing?
injury
hemostasis
inflammation
proliferation
remodeling
closure (eventually)
what is the MC kind bladder cancer?

transitional cell carcinoma.

smoking is major risk factor.

classic S&S: painless hematuria

what is the MC genitourinary cancer?
prostate cancer
most common solid tumor of young adult males:
testicular cancer
S&S insulinoma
pancreas tumor that makes too much insulin.
irritability, diaphoresis, weakness, palpitations, tremulousnesstx: surgery

what nerves are at risk during thyroidecomy?

*recurrent laryngeal nerve* – causes hoarseness if unilateral and airway obstruction if bilaterally damaged.

*superior laryngeal nerve* – if damaged, pt will have deep and quite voice.

what is the most active form of thyroid hormone?
T3
(T4 –> liver –> T3)
what is the diagnostic TOC for dx thyroid nodule?
FNA
MCC thyroid enlargement
multinodular goiter
MC thyroid cancer

papillary carcinoma.

risk is radiation exposure.

primary closure
wound edges are opposed and closed by either sutures, clips, tapes, dermal adhesives.
secondary intention
DIRTY or contaminated wounds. dressing is placed in cavity to absorb fluids and prevents wound from sealing over.
closes by re-epithelialization and wound contraction.
wound is contaminated.might close appendectomy site like this if an abscess has formed.

tertiary closure. (delayed primary closure).
combination of primary + secondary closure.
contaminated wound may be initially tx with debridement or abx for several days.
close after several days.
most common bacteria in pilonidial abscess

staph

S&S: pain, tenderness, swelling, redness.
may first present as an enlarged hair folicle in otherwise normal skin.

what is the most common post op pulmonary complication?
atelectasis
what is the most common cause of wound dehiscence?

technical problem in wound closure — excess tension, ischemia, wrong knot tying, increased abd pressure.

MC after age 60.
5 – 8 post operative day

“serosanguinous discharge” common

what is wound evisceration?
would dehiscence –> wound evisceration.
serious condition when organs begin to push outside the open incision.
consider wound infection during which Post op days?

5 – 10 P.O.D.

(note: clostridium and strep may be within 24h)

MCC post op fever in first 24 hrs?
atelectasis
MCC death from pulmonary complications post op
pneumonia
MC gram negative.
what is the most commonly used absorbable suture?
vicryl
what is the MC needle size used for skin?
3/8
what is spontaneous esophageal rupture after forceful vomiting?
Boerhaave’s Syndrome.
what confirms dx of Boerhaave’s Syndrome?
gastrografin swallow
what is the most common BENIGN tumor of the liver?

hemangioma

rupture is rare.
bx is dangerous due to hemorrhage risk.

most common primary hepatic malignancy
hepatocellular carcinoma.
(note: *hepatoma* INCORRECTLY implies a benign tumor).labs show increase in AFP.

what are the FOUR F’s associated with cholelithiasis?
female
forty
fat
fertile
T/F: CT scan is the study of choice for cholecystitis.
FALSE.
Dx with U/S. Confirm with HIDA scan or nucleotide study.
list colon polyps from smallest to greatest risk of malignancy:

tubular adenoma –> tubulovillous adenoma –> Villous Adenoma

90% polyps are hyperplastic and benign

MC complaint is intermittent rectal bleeding

what is the most common cause of bloody nipple discharge?
intraductal papillomas
90% of invasive breast cancers are
infiltrating ductal carcinomas (IDC)
What breast surgery removes all tissues and lymph nodes, axillary contents are undisturbed?
total (simple) mastectomy
what breast surgery removes entire breast, axillary nodes, NO MUSCLES removed.
Modified Radical Mastectomy
what is the most extensive type of mastectomy?
radical mastectomy.
entire breast, and all lymph nodes are removed.
what is the gold standard to diagnose malignant hyperthermia?
IVCT (in vitro contracture test)
occurs with contracture of mm fibers to halothane or caffeine
What is the tx for malignant hyperthermia?
IV dantrolene
what is the strongest layer of the artery that allows for endarterectomy?
adventita
what is the only antimicrobial that works for tetanus?
flagyl
what is the MC sx chronic pancreatitis?

midepigastric pain.

weight loss may be seen in association with malabsorption secondary to exocrine insufficiency.

MCC hyperparathyoridism
adenoma.
what is Gilbert Syndrome?
the most common inherited cause of unconjugated hyperbilirubinemia
autosomal recessive condition
*intermittent jaundice in the absence of hemolysis or underlying liver disease*
most common location for mekel’s diverticulum:
Terminal Ileum
(most commonly encountered diverticulum of the small intestine)
tx of sigmoid volvulus
rigid proctosigmoidoscopy with decompression & untwisting of the volvulus
(rotation of the large intestine on its mesenteric axis; twisting can promote ischemic bowel, gangrene, perforation).
MC location of volvulus
sigmoid colon is #1
followed by cecum (MUST ALWAYS TX CECAL VOLVULUS SURGICALLY!)
MCC colon cancer
adenocarcinoma.
MC organ of metastasis is the liver.
S&S anal fissure
severely painful bowel movement associated with bright red bleeding
90% of fissures are located posterior midline
MC anal cancer

SCC

risks: fistulas, abscess, infection, crohn’s disease

in western societies, diverticula most often occur where?
sigmoid colon (greatest intraluminal pressure).
(right sided in asian populations).BLEEDING!

radiologic exam of choice for dx of diverticulitis
CT scan
when should someone with recurrent diverticulitis have surgery?
after fourth bout of diverticulitis.
what is the MCC of GI tract fistulas?
diverticulitis
what is the MC benign esophageal neoplasm?
leiomyoma
palpable olive mass, billous projectile vomiting
pyloric stenosis
gold standard to diagnose pulmonary embolism
pulmonary angiogram
giving large volumes of NS in burn patients initially may result in:
hyperchloremic metabolic acidosis
what kind of pneumonia would you expect in a post op pt in the ICU?
pseudomonas
how would you confirm the dx of hyperparathyroidism?
elevated serum parathyroid hormone (PTH) level
absence of familial pattern of hypercalcemiatx for primary hyperparathyroidism = surgery

pneumothorax treatment
chest tube placement
“burning epigastric pain” that improves with eating
PUD.
tx: amoxicillin, clarithromycin, omeprazole
tx gastric ulcer for 8 to 12 weeks and then eval for healing.
surgical indications for PUD
GI hemorrhage
perforation
intractable pain (considered intractable if persists for more than 3 mos despite tx)
obstruction
which ulcers should undergo bx?
gastric ulcers.
risk of carcinoma.
S&S pneumothorax
chest wall crepitation, diminished breath sounds. hypotension
hypotension in a poly trauma pt should be presumed to result from:
hemorrhage.
most common mediastinal tumor

thyoma.

considered borderline malignant b/c of potential spread and local invasion

tx: surgical resection via median sternotomy.

20 yo man notes nontender heavy sensation in scrotal area x 2 mos. no hx trauma. 2 cm non transilluminating, non tender mass is noted in right testicle. Most likely dx?
testicular cancer.
tx: surgery (radical orchiectomy) with possible chemotherap.
most common presentation of testicular cancer

“painless scrotal mass”

BCG and AFP may be elevated

what increases the risk of a germ cell tumor (testicular cancer)?
crytorchidism (undescended testicles)
grades of internal hemorrhoids (above the denate line)
grade 1: prominent hemorrhoids on inspection or anoscopy
grade 2: prolapse, reduce spontaneously
grade 3: manual reduction required
grade 4: not reducible
Goodsall Rule
used to find internal opening of a fistula.
most common location of anal fissures
most commonly found in the posterior midline position. chronic? associated with skin tag.
non operative tx for anal fissure

sitz baths, bulking agents, stool softener, nitroglycerin ointment (as vasodilator for improving blood flow)

chronic? injection of botulinum toxin or operative tx to reduce resting sphincter tone (lateral internal sphincterotomy)

what is the diagnostic workup for suspected anal fissure?
examination under anesthesia
anoscopy
proctoscopy
a nonhealing anal fissure or fissure located in an area other than posterior anus should alert to possible dx of:
crohn’s.
malignancy.
tx for thrombosed external hemorrhoid that doesn’t respond to medical therapy
excisional thrombectomy.
NOT I&D.
most common solid extracranial malignancy in childhood (and most common malignancy in children under age 1)
Neuroblastoma
clinically severe obesity is BMI > ____
40
what drug (in the absence of septicemia) may assist in fistula closure in a pt with crohn’s dz?
infliximab
repeated resection of the GI tract in pts with crohn’s may lead to:
clinical short bowel syndrome.
requires permanent TPN therapy.
what role does surgery have in crohn’s disease?
relieves symptoms refractory to medical therapy (pain, obstructive sxs, weight loss).
improve quality of life in those with severe med side effects.
what is “pancolitis”?
ulcerative colitis that involves the rectum & entire colon.
risk of colorectal cancer.
T/F: surgical therapy in UC relieves the sxs related to diseased colon and rectum.
true.
what are the main indications for surgical therapy in UC?
fulminant colitis.
toxic megacolon.
dysplasia, cancer.
intractable disease.
what is the most common operation performed for fulminant colitis?
abdominal colectomy with end ileostomy.
S&S of Charcot neuroarthropathy
soft tissue swelling
soft tissue erythema
increased local skin temperature
neuropathic ulcers tend to occur where?
pressure & weight bearing areas of foot.
vasculogenic ulcers on the tips of digits.
surgical treatment for GERD
Nissen Fundoplication.
360* wrap of the stomach around the GE junction.
creates valve effect.
development of acute onset chest pain after an episode of vomiting

boerhaave syndrome.

also S&S: should pain, dyspnea, mid epigastric pain

iatrogenic esophageal rupture is caused by:
endoscopy
how is dx of prostate cancer made?
transrectal bx of the prostate
carpal tunnel syndrome results in compression in which nerve?

median

tx: night time splint & NSAIDs

pts will c/o increases sxs @ night.

what other medical conditions are associated with carpal tunnel syndrome?
*hypothyroidism*.
diabetes mellitus.
hyperthyroidism.
pregnancy.
acromegaly.
S&S carpal tunnel
pain to the radial three fingers, especially at night.
general tx for cholecystitis
hospitalization.
IV antibiotics.
lap chole prior to hospital d/c.
what is the most common cause of upper GI bleed in pt with cirrhosis and portal HTN?
variceal bleeding
what is the most commonly applied diagnostic study for identification of traumatic rupture of the aorta?
CT angiogram
T/F: appendicitis may present as “intermittent” pain.
false.
probably viral gastroenteritis.
what nonspecific S&S may be associated with colon cancer?
postprandial bloating.
distention.
constipation.
most common cause of spontaneous pneumothroax?
rupture of subpleural bleb.
best management = insertion of chest tube or needle aspiration to allow lung reexpansion.
clinical hallmarks of pulmonary embolism
acute-onset hypoxia
anxiety
tachypnea
hypocarbia
no significant CXR findings
most common cause of short bowel syndrome in adults:
Crohn’s Disease
Mesenteric Infarction
what are the most common metastatic tumors found in the liver?
from colorectal carcinoma
most common cause of cardiogenic shock is:
MI
most common site of ectopic pregnancy
fallopian tube.
lack of submucosal layer allows for easy wall access and implantation of fertilized ovum.
drug of choice for acute hypertensive encephalopathy

labetolol

(warning: clonidine may cause rebound HTN)

MC intracranial tumors
acoustic neuroma (8 cranial nerve schwannoma).
cause CENTRAL vertigo.
what is the MCC pleural effusion?
CHF (transudate)
what is the MCC exudative pleural effusion?
bacterial pneumonia.
cancer.
surgical indications for peripheral artery disease?
“STIR”
severe claudication.
tissue necrosis.
infection.
rest pain.
gold standard to dx peripheral arterial disease
ANGIOGRAM
glasgow coma scale
“EVM – 4 5 6”
EYE OPENING
4 – spontaneous
3 – opens to verbal command
2 – opens to pain
1 – noneVERBAL
5 – oriented
4 – confused
3 – inappropriate
2 – incomprehensible
1 – none

MOTOR
6 – obeys commands
5 – movement to pain
4 – withdrawl from pain
3 – flexion
2 – extension
1 – none

score 3 to 8 = coma

are duodenal or gastric ulcers more common?
duodenal ulcers
is someone more likely to have bloody diarrhea with UC or Crohn’s?
UC
what is the most common hospital acquired infection?
UTI
MCC = e coli
most common metastasis site for breast cancer:
bones
fluid of choice in burn patients:
LR
MCC esophageal perforation
iatrogenic (EGD)
what reverses narcotics?
Naloxone (Narcan)
platelet count should be at least _____ before surg
50,000
what reverses coumadin (warfarin)?
vitamin K
what reverses heparin?
protamine
peaked T waves on EKG
hyperkalemia
U waves on EKG
hypokalemia
Short QT interval
hypercalcemia
Long QT interval (think: slow)
hypocalcemia
maximum dose of lidocaine
4 mg/kg
silk sutures are absorbable/nonabsorbable
non
nurolon sutures are absorbable/nonabsorbable
non
what is the treatment for a stable patient with pulmonary embolism?
anticoagulation (heparin followed by long term [3 – 6 mos] coumadin).
OR
greenfield filter.
treatment for UNSABLE patient with pulmonary embolism:
thrombolytic therapy.
possible operation.
possible catheter suction embolectomy.
causes of ileus:
laparotomy.
hypokalemia.
narcotics.
intraperitoneal infection.
order of recovery of bowel fxn after surg:
FIRST – small intestine
SECOND – stomach
THIRD – colon
what is suppurative hidradenitis?
infection/abscess of APOCRINE sweat glands.
MCC staph aureus.
tumor marker associated with colon cancer
CEA
hernia strangulation risks (from surgical recall p. 215)
higher with INDIRECT inguinal hernias than DIRECT inguinal hernias.
HIGHEST risk of strangulation with FEMORAL HERNIAS.
CO2 gas embolus triad:
1. hypotension
2. decreased end tidal CO2
3. “mill wheel” murmur
T/F: duodenal ulcer pain is decreased with food.

true.

food increases gastric ulcer pain.

pellagra is a deficiency of:
niacin (B3)
“3-D”
Dermatitis.
Diarrhea.
Dementia.

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