Surgery EOR (additional)

Lidocaine alone: max dose _____ mg/kg Lidocaine WITH epinephrine: max dose _____ mg/kg

•4.5

• 7

What is the typical abdominal exam finding in a child with intussusception? _____

Mid to upper right-sided sausage-shaped mass

Multiple endocrine neoplasia type 2 (MEN2), von Hippel-Lindau (VHL) syndrome, and neurofibromatosis type 1 (NF1) are associated with which adrenal tumor? _____

Pheochromocytoma

What physical exam findings are present in Courvoisier sign? _____

Enlarged, painless gallbladder on palpation and jaundice

A 22-year-old woman with a history of asthma, POD #1 in the hospital complains of constant chest tightness and shortness of breath. Vitals are within normal limits. Physical exam reveals bilateral expiratory wheezing. Bedside imaging is unremarkable. What is the best therapy for the most likely diagnosis? _____

Albuterol (b-agonist)

Perforation is a complication that occurs in 10% of patients with acute cholecystitis and is characterized by _____ bowel sounds

Hypoactive

The most common causes of post-operative fever may be remembered with the "5 W's":

POD 1-3: _____

POD 3-5: _____

POD 5+: _____

POD 7: _____

POD 8-15: _____

•Wind (atelectasis, pneumonia)

• Water (uti)

• Walking (dvt/pe)

• Wound infection (cellulitis, s.aureus) abscess

• Wonder drugs (drug fever)

A palpable nodule bulging into the umbilicus is called _____ sign. Usually indicates gastric or pancreatic malignancy

Sister mary joseph

The tremor that occurs with hyperthyroidism is typically a _____ frequency, _____ amplitude tremor that is present with action

•High

• Low

Treatment of non-purulent cellulitis = _____ Treatment (or empiric therapy) of purulent cellulitis = _____

•Cephalexin (keflex)

• Tmp-smx (bactrim)

Treatment of melanoma depends on the size of its thickness:

<1mm thickness: Wide excision with a _____cm margin of normal tissue

>1mm thickness:Wide excision with a _____cm margin of normal tissue

• 1

• 2

Which test is contraindicated in a patient who is suspected to have a subdural hematoma? _____

Lumbar puncture

What is the best initial cardiac test during preoperative evaluation? _____

Ekg

During the surgical excision of the parathyroid adenoma, what lab should be drawn intraoperatively to confirm the cause of the primary hyperparathyroidism has been removed? _____

Pth level

For small bowel obstruction:

Initial testing = _____

Confirmatory test = _____

•Abdominal x-ray

•Abdominal ct with contrast

What is the gold standard for diagnosing and staging of bladder cancer? _____

Cystoscopy with biopsy

Tamsulosin is a _____ that is used to relieve the obstruction in the case of BPH by relaxing smooth muscle in the bladder neck, prostatic capsule, and prostatic urethra.

Alpha-1-adrenergic antagonists

Of all smoking cessation aids, which has the highest cessation success rate? _____

Varenicline (chantix)

What is the most common complication of peptic ulcer disease? _____

Gi bleed

In a subarachnoid hemorrhage, patient can present with meningeal symptoms like stiff neck, and delirium. Perform _____ scan first then if negative perform a _____ to see _____ (a hemoglobin break down product), bilirubin in CSF as well as increased opening pressure.

• Ct without contrast

• Lp

• Xanthochromia

Initial biochemical testing for Pheochromocytoma is based upon the index of suspicion. If there is a low suspicion, _____ is test of choice; if there is a high suspicion, _____ is test of choice.

24-hour urinary fractionated catecholamines and metanephrines

• Plasma fractionated metanephrines

What is the most common cause of inherited unconjugated hyperbilirubinemia? _____

Gilbert syndrome

What test is important to establish the diagnosis of jaundice, and provide further information on etiology? _____

Fractionated bilirubin

What is the major differences in symptoms between a small bowel obstruction and an ileus? _____ abdominal pain + _____ in SBO but NOT ileus

•Colicky

• Emesis

Which grade of hemorrhoids requires manual reduction? _____

Grade iii

What are the most common side effects of dopamine agonists used to treat hyperprolactinemia? (2) _____

Nausea and postural hypotension

_____ are reddish lines sometimes seen in skin of the abdomen during pregnancy

Striae gravidarum

Normal chest x-ray in setting of hypoxia is highly suspicious for _____

Pulmonary embolism

Pleural effusion and atelectasis result in _____ breath sounds, _____ tactile fremitus, and _____ to percussion

Decreased • Decreased • Dullness

To diagnose orthostatic hypotension, measure patient's blood pressure while supine, then wait 5 minutes and measure while patient is standing, diagnosis is made if a fall of systolic BP >_____mmHg or diastolic BP >_____mmHg

20 • 10

Treatment for the following: Gonococcal: _____ Chlamydia: _____

•Ceftriaxone

• Doxycycline

Most common cause of: Primary hyperparathyroidism: _____ Secondary hyperparathyroidism: _____

•Parathyroid adenoma

•Ckd

Will primary or secondary (or both) adrenal insufficiency have decreased aldosterone? _____

Primary only

_____ most common causes of primary adrenal insufficiency _____ most common cause of secondary adrenal insufficiency

• Autoimmune/tb

• Exogenous steroid use

Which is more common primary, secondary, or tertiary adrenal insufficiency? _____

Secondary and tertiary (grouped together as central)

For Adrenal Gland layers and their secretion remember GFR = ACE G_____ = A_____ F_____ = C_____ R_____ = E_____

• Glomerulosa

• Aldosterone

• Fasciculata

• Cortisol

• Reticularis

• Estrogen

Does Budd-Chiari syndrome present with ascites? _____

Yes!

What syndrome is caused by the inactivation of pancreatic enzymes due to excess gastric acid. _____

Zollinger-ellison syndrome

Beta blockers are a mainstay treatment for isolated peripheral arterial disease.

_____ False!

What are the 2 most common pathological causes of arterial embolus formation? _____

A-fib + mitral stenosis

What is the gold standard imaging modality for an arterial embolism? _____

Angiography

_____ rupture presents with a triad of hypotension, a pulsatile abdominal mass, and flank pain

Abdominal aortic aneurysm

Abdominal aortic aneurysm rupture presents with a triad of _____, a pulsatile abdominal mass, and flank pain

Hypotension

Abdominal aortic aneurysm rupture presents with a triad of hypotension, a pulsatile abdominal mass, and _____ pain

Flank

Are tracheitis, bronchitis, or pneumonia absolute contraindications to elective surgery? _____

Yes

Is diabetic coma is an absolute contraindication to surgery? _____

Yes

Surgical site infections increases with degree of hyperglycemia → levels > _____mg/dL being sole predictor of surgical site infections.

140

Elevated preop blood glucose levels in DM patients lead to greater chance of surgical site infections. _____

True

What is the most common cause of hypercalcemia independent of PTH? _____

Malignancy (pth-rp secretion)

What is the most common cause of hypocalcemia if a patient has high PTH? _____

Ckd

What is the most common cause of hypocalcemia? _____

Hypoparathyroidism

Most common electrolyte mediated ileus in the surgical patient is _____

Hypokalemia

Is low molecular weight heparin contraindicated in renal disease? _____

Yes

What are the 2 main advantages of low molecular weight heparin such as Enoxaparin (Lovenox)? _____

No need to monitor ptt quickly reversible

Treatment of DVT? _____

Heparin--> warfarin

In terms of DVT:

First line initial image: _____

Gold Standard: _____

•Venous duplex us

• Venography

A _____ D-dimer can rule out DVT in a LOW risk patient

Negative

_____ which indicates presence of congestive heart failure = worst single finding predicting high cardiac risk post-operatively

Jvd

What Acid/Base disorders are associated with the following: Hyperventilation: _____

Vomiting: _____

Hypoventilation: _____

Diarrhea: _____

• Respiratory alkalosis

• Metabolic alkalosis

• Respiratory acidosis

• Metabolic acidosis

An _____ image of a patient with hypertrophic pyloric stenosis shows a thickened and lengthened pylorus

Ultrasound

An ultrasound image of a patient with hypertrophic pyloric stenosis shows a _____ and _____ pylorus

Thickened • Lengthened

Most common type of Pancreatic cancer? _____

Adenocarcinoma

Post-operative nausea and vomiting is an unpleasant complication affecting 30% of children and adults after anesthesia. _____

True!

Appropriate initial testing for the following symptoms: Hematochezia: _____ Melena: _____

Colonscopy • Egd

First sign of jaundice is usually _____

Scleral icterus

Complications of hernias include: _____, which is the inability to reduce the hernia, results in pain and enlargement. _____, which is also irreducible but is assoicated with ischemia and systemic toxicity

Incarceration • Strangulation

Which imaging modality is the gold standard for hepatic vein obstruction (Budd-Chiari Syndrome)? _____

Venography

What is the imaging modality of choice for screening hepatic vein obstruction (Budd-Chiari Syndrome)? _____

Abdominal ultrasound

What is the most common cause of cirrhosis in the United States? _____

Alcohol

Which other hepatitis requires co-infection with hepatitis B? _____

Hepatitis d

Gastritis and Peptic ulcer disease are both most commonly caused by _____ followed by _____

H. pylori • Nsaids

Can PPI's cause Vit B12 deficiency? _____

Yes

What is the most common cause of esophageal varicies in adults? _____

Cirrhosis

What is the imaging modality of choice for hematemesis? _____

Egd

In what position are GERD symptoms (heartburn, dysphagia, etc) worsened? _____

Supine

What is the diagnostic test of choice for gastric adenocarcinoma? _____

Upper endoscopy with biopsy

What kind of cancer presents with dyspepsia, weight loss, early satiety, abdominal pain/fullness, N/V, and iron deficiency anemia? _____

Gastric cancer

What is the most common type of gastric cancer? _____

Adenocarcinoma

Does achalasia present with an increased or decreased lower esophageal sphincter (LES) pressure? _____

Increased

Endoscopic screening recommended in pts w/ Barrett's esophagus w/o dysplasia every _____-_____ years

3 • 5

In terms of esophageal cancer, _____ is more common in the upper 1/3rd of the esophagus, and _____ is more common in lower 1/3rd.

Squamous cell • Adenocarcinoma

In terms of esophageal cancer, squamous cell is more common in the _____ of the esophagus, and adenocarcinoma is more common in _____.

Upper 1/3rd • Lower 1/3rd

Acute mesenteric ischemia results from arterial _____ from the heart, arterial _____ related to atherosclerosis

Embolism • Thrombosis

Acute mesenteric ischemia results from arterial embolism from the _____, arterial thrombosis related to _____

Heart • Atherosclerosis

How do you treat pseudomembranous colitis (AKA C-diff)?

Mild disease: _____

Severe disease: _____

• Metronidazole

• Po vancomycin

Diagnostic test of choice for Paralytic ileus? _____

Plain abdominal radiographs

_____ is decreased peristalsis WITHOUT structural obstruction that is caused by hypokalemia, chemo drugs such as Vincristine, and recent abdominal surgery.

Paralytic ileus

Paralytic ileus is decreased _____ WITHOUT structural _____ that is caused by hypokalemia, chemo drugs such as Vincristine, and recent abdominal surgery.

Peristalsis • Obstruction

What is the diagnostic test of choice for suspected colorectal cancer? _____

Colonoscopy with biopsy

_____ surgery uses a thin tube that is inserted into the abdomen through a small incision(s).The tube has a camera attached to it. The camera sends images to a video monitor

Laparoscopic

What is the diagnostic test of choice for Cholelithiasis? _____

Ruq ultrasound

Does cholelithiasis present with inflammation? _____

No

Initial diagnostic study for cholangitis is _____, however gold standard and definitive diagnostic is a Cholangiography via _____.

Ultrasound • Ercp

_____ classically presents with the Charcot triad of _____, fever, and RUQ pain

Ascending cholangitis • Jaundice

Ascending cholangitis classically presents with the Charcot triad of jaundice, _____, and _____

Fever • Ruq pain

Bowel obstructions present with crampy abdominal pain, abdominal distention, nausea and vomiting, and _____ which is defined as the absence of stool and flatus.

Obstipation

_____ presents with colicky abdominal pain, nausea, bilious vomiting, obstipation, abdominal distention, hyperactive bowel sounds (early) or hypoactive (late).

Small bowel obstruction

Small bowel obstruction presents with colicky abdominal pain, nausea, _____ vomiting, obstipation, abdominal distention, _____active bowel sounds (early) or _____active (late).

Bilious • Hyper • Hypo

Ileus presents with _____-active bowel sounds

Hypo

_____ is the most common indication for emergent surgery in pregnant women

Appendicitis