Surgery E2 random questions pt 1

what is a major determinant of capillary oncotic (suck) pressure?

albumin

what is used to insufflate the abdomen for laparoscopic procedures?**

CO2 through ports/trocars → 4L volume**

what are the clinical features of third-spacing?

- dec urine output despite hydration

- dec BP

- dec CV pressure

- inc. HR and body weight

- edema

what solutions are preferred for tx of third-spacing?

replace intravascular volume→ NS or LR (crystalloids preferred)

which IVF solution causes fluid to stay in intravascular space and doesn't move around?

isotonic

who is NS indicated for?

- pts at risk for fluid overload →CHF, HTN

- hemorrhage, severe vomiting/diarrhea, GI suctioning losses, wound drainage

which IVF solution causes osmotic movement of water OUT of cells and INTO intravascular space?

hypertonic → 3% NaCl

which IVF solution causes osmotic movement of water OUT of intravascular space and INTO intracellular space?

hypotonic →0.45% NaCl

who is hypertonic saline indicated for?

severe hyponatremia and cerebral edema

DONT use in HF, RF, or cellular dehydration

who is hypotonic saline indicated for?

- intracellular dehydration

- hypernatremia

- DKA

what is the minimum UOP for an adult on maintenance IV fluids?

30 mL/hr or 0.5-1 ml/kg/hr over 24 hrs

trauma pt = 50 ml/hr

post op hypotension or tachycardia is ______________ until proven otherwise

hemorrhage

what term describes UOP <400 ml/day or <20 cc/hr?

oliguria →represents impending ARF and earliest sign of inadequate organ perfusion

FENa <1% indicates ____________ azotemia**

prerenal → HF, cirrhosis, intravascaular depletion

FENa >1% indicates _____________ azotemia**

intrinsic → ATN, glomerulonephritis

FENa >4% indicates ____________ azotemia**

postrenal →obstruction

which arteries supply 60% of breast blood?

anterior perforating intercostal arteries*** →arise from internal mammary artery or internal thoracic artery

where does majority of lymphatic drainage occur?

through the axilla (75%) and internal mammary nodes

what is the rationale for sentinel node biopsy during rx of early breast cancer?***

- lowest node draining the cancer is biopsied

- if negative → axillary node dissection avoided

- usually an axillary node!

what are the 4 nerves to be aware of during axillary dissection?

long thoracic

thoracodorsal

medial pectoral

lateral pectoral

which pathology of cancer is involved in 90% of invasive breast cancers?

infiltrating ductal carcinoma (IDC) ***

which type of breast cancer tends to grow in a single file nature, making it difficult to detect?

infiltrating lobular carcinoma

what are the treatments for the different stages of hypoxia?

mild = nasal cannula

moderate = face mask, non-rebreather, HFNC

severe = mech vent

severe resp distress = intubation

after how many days on a mechanical ventilator is trach indicated?

> 10 days

which ligaments anchor breast tissue to the pectoralis muscle?

ligaments of cooper

Cooper's troopers!!

what is the MC screening modality for breast cancer?

mammogram

which imaging study is used for local staging for DCIS and lobular cancer?

MRI →BIRADS score

1 = negative

2 = benign

3 = low sus

4 = sus

5 = super sus

6 = confirmed cancer

how is breast cancer diagnosed? how is it staged?

FNA bx

TNM staging

which hormonal therapies are used for ER+ breast cancer?

tamoxifen → use for 5 yrs

aromatase inhibitors → post-menopausal women

which breast surgery involves removal of the lesion only?

lumpectomy

central lump → periareolar incision

peripheral lump → curvilinear incision

who is nipple-sparing mastectomy possible in?

pts with cancer >2 cm away from nipple

what is the difference between a total mastectomy, radical mastectomy, and modified radical mastectomy?

total = removal of affected breast only

radical = removal of affected breast, ALL lymph axillary drainage, pectoral muscle

modified radical = removal of affected breast and PART of the axillary lymph drainage, preserves underlying muscles

damage to which nerve during breast surgery can cause winged scapula?

long thoracic nerve

what is known as swelling d/t obstructed lymph flow?

lymphedema → thick rough skin, pigment changes (usually dark), fibrosis

what is a DIEP flap?

removes tissue from lower abdomen with perforators and blood vessels

no muscle removed, but cut into to retrieve deep perforators!

what is a SIEA flap?

similar to DIEP but removes superficial perforators (doesn't cut into muscle)

what is a TRAM flap?

Transverse Rectus Abdominis Muscle (TRAM) is rotated on its pedicle or transferred as a free flap to reconstruct the breast mound

what is a painless, unilateral, firm rubbery breast mass with irregular borders?

fibroadenoma

what is the genetic cause of phyllodes tumors?

li-fraumeni syndrome

what is a unilateral, firm, enlarging painless breast mass?

Phyllodes tumor → high recurrence rate and/or metastatic potential

may stretch skin and show superficial veins

what is the mainstay of treatment for phyllodes tumors?

surgery →wide local excision with >1cm margins

large tumors may require mastectomy!

what is the MC congenital defect of male genitalia?

cryptorchidism → confirm with US and tx with orchiopexy

what is the tx for testicular torsion?

bilateral orchiopexy to scrotum

what imaging study diagnoses torsion?***

stat scrotal US + doppler

what is the gold standard for dx of urethral injury?

retrograde urethrogram

how would you treat a urethral injury?

cystoscopy with urethral repair

how long should a post-op foley be left in after urethral repair?

1-3 months

what are the s/sx of urethral injury?

blood at meatus

dysuria/retention

palpable bladder

usually follows trauma!

what are the surgical indications for BPH?

- PVR >100 ml

- retention

- gross hematuria

- recurrent UTIs

what is the MC prostate cancer?

adenocarcinomas → stimulated by testosterone

what are the surgical complications of prostatectomy?

- hematuria

- painful/difficulty urinating

- incontinence

- infection

- retrograde ejaculation

how is prostate cancer diagnosed?***

DRE and PSA is abnormal → get a biopsy (gold standard) to confirm

what are the prostate cancer gleason scores?

- gleason 6 = low grade

- gleason 7 (3+4) = intermediate with some poorly formed glands

- gleason 7 (4+3) = mostly poorly formed glands

- gleason 8 = only poorly formed glands, high risk dz

- gleason 9 or 10 = rly bad

which type of hysterectomy leaves the cervix?

partial

what is removed in a radical hysterectomy?

uterus

cervix

upper part of vag

which hysterectomy surgical approach involves resecting the uterus into small pieces?

laparoscopic

which hysterectomy surgical approach involves laparoscopic incisions to separate the uterus and pulling it out through the vagina?

robot-assisted vaginal

which hysterectomy surgical approach is done through the vaginal introitus and dissection starts around the cervix?

transvaginal

which hysterectomy surgical approach is an open procedure through a transverse or midline vertical incision in the lower abdomen?

abdominal

review organ prolapses!

what procedure is used to repair pelvic organ prolapse?

sacrocolpopexy → synthetic mesh attaches pelvic organs to pelvic bones

what is the gold standard for CAD diagnosis?

cardiac catheter

what is the surgical management for ASCVD?

PCI and CABG

what is the diff between AAA and aortic dissection presentation?***

AAA = nontender, pulsatile abd mass

AD = sudden severe tearing chest pain, pulsatile abd mass

at what size does AAA require surgery?**

>5.5 cm

enlarging >0.5 cm in 6 months

enlarging 1 cm in 12 months

symptomatic

what is Leriche syndrome?

claudication of thigh and butt + impotence with decreased femoral pulse

where is the MC location of a DVT?

left iliac→ dx with duplex US

what is the tx for acute ischemic stroke?

IV tPA within 4.5 hrs

what should you do to prevent hypertensive crisis when performing an adrenalectomy for pheochromocytomas?

treat with alpha blockade THEN beta blockade

what is the management for DVTs?

- intermittent sequential compression devices (SCDs)

- early ambulation

- pharm → LMWH, faxtor Xa inhibitors, unfractionated hep

how would you manage chronic venous insufficiency?

- leg elevation, regular exercise, elastic compression stockings

- surgery (not 1st line) → valvuloplasty, sclerotherapy, endovenous thermal ablation

what is the tx for peripheral artery disease?

- manage CV risk factors → stop smoking, control HLD/HTN/DM, weight loss

- exercise rehab

- foot care

- pharm → asa, clopidogrel

what is the ABI score?***

1-1.4 is normal

< 0.9 abnormal

0.5 is severe

what conditions are RF for PAD?***

- Inc. LDL

- HTN

- smoking

- DM

what meds are used for tx of intermittent claudication?

pentoxifylline

cilosatzol

which type of CABG procedure stops the heart to allow for a "bloodless field"?

on-pump → requires systemic anticoag, and systemic hypothermia

which type of CABG is known as beating heart surgery?

off-pump → sternotomy approach