SURGERY EOR ONLINE PRACTICE EXAM AND STUDY GUIDE 2024 | ACTUAL EXAM QUESTIONS AND ANSWERS, Exams of General Surgery

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SURGERY EOR ONLINE PRACTICE EXAM AND

STUDY GUIDE 2024 | ACTUAL EXAM

QUESTIONS AND CORRECT ANSWERS |

LATEST VERSION | ALREADY GRADED A+

Which type of suture is good for maximizing wound eversion? -----CORRECT ANSWER---------------vertical mattress Are Nylon, Prolene, Stainless Steel, and Silk sutures absorbable or non-absorbable? --- --CORRECT ANSWER---------------non-absorbable Are vicryl, monocryl, PDS (polydioxanone), chromic, and gut sutures absorbable or non- absorbable? -----CORRECT ANSWER---------------absorbable Which suture is smaller: a 5.0 or a 3.0? -----CORRECT ANSWER---------------a 5. How long does it take a wound to heal in the skin and mucosa? -----CORRECT ANSWER--------------- 5 - 7 days How long does it take a wound to heal in subcutaneous and peritoneum tissues? ----- CORRECT ANSWER--------------- 7 - 14 days How long does it take a wound to heal affecting the fascia? -----CORRECT ANSWER---- ----------- 14 - 28 days What are some local and systemic factors that affect wound healing? -----CORRECT ANSWER---------------Local: wound cleanliness, controlled bleeding, radiation, infection Systemic: nutrition, uncontrolled DM, medications, chronic illness, smoking, hypoxia

What are the three stages of wound healing? -----CORRECT ANSWER--------------- inflammatory, epithelialization & neovascularization, tissue remodeling The ________stage of wound healing occurs in the first few days. The initial injury leads to the recruitment of inflammatory cells into the wound, once a clot forms in response to disrupted blood vessels. Complex interaction between local tissue mediators and cells that migrate to the wound. -----CORRECT ANSWER---------------inflammatory The _______stage of wound healing results from the increase in cellular activity. Granulation tissue forms and depends on specific growth factors for further organization to occur in the completion of the healing process. Weeks to months. -----CORRECT ANSWER---------------Epithelialization and neovascularization _________occurs over 6-12 months in which the wound contraction and tensile strength is achieved. -----CORRECT ANSWER---------------Tissue Remodeling CDC Surgical Wound Classification: _________are uninfected operative wounds in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered. Operative incisional wounds, primarily closed or closed drainage. -----CORRECT ANSWER---------------Clean wounds CDC Surgical Wound Classification: _________are operative wounds in which the respiratory, alimentary, genital, or urinary tract is entered under controlled conditions and wo unusual contamination. Biliary tract, appendix, vagina, oropharynx are in this category. -----CORRECT ANSWER--------------- Clean-contaminated CDC Surgical Wound Classification:

_________are open, fresh, accidental wounds, operations w major breaks in sterile technique or gross spillage from the GI tract, and incisions in which acute, nonpurulent inflammation is encountered. -----CORRECT ANSWER---------------Contaminated CDC Surgical Wound Classification: _________ are old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation. -----CORRECT ANSWER---------------Dirty or infected IV Fluid -- What fluid should you NOT use with a brain injury because of worsening brain edema? -----CORRECT ANSWER---------------no sugar!!!!!!!!!! What is the 421 rule for adult fluid replacement? -----CORRECT ANSWER--------------- 4mL/kg for first 10kg/hr 2ml/kg for second 10kg/hr 1ml/kg for each additional kg/hr Patients with GI loss or 3rd space losses may require a ______amount of saline to maintain volume balance. -----CORRECT ANSWER---------------higher Normal replacement of fluids in surgical patients is _____mEg/kg of sodium and ______mEg/kg of potassium per day. -----CORRECT ANSWER---------------1mEg/kg of sodium; 0.5mEg/kg of potassium RANDOM FLASH CARDS NOW -----CORRECT ANSWER---------------RANDOM FLASH CARDS NOW Potassium rule of thumb: 10meq of potassium is expected to raise a patient's potassium level by ____. -----CORRECT ANSWER---------------0.1 points

When surgeons talk about classic "breast cancer", what form are they specifically talking about? -----CORRECT ANSWER---------------invasive ductal carcinoma Why is DCIS noninvasive? -----CORRECT ANSWER---------------because it does not penetrate the basement membrane With breast cancer, what is the one specific case when chemotherapy is not necessary? IN ALL OTHER CASES, CHEMOTHERAPY IS DONE! -----CORRECT ANSWER--------- ------estrogen receptor negative AND HER negative AND size less than 2cm What are the three most common breast malignancies? -----CORRECT ANSWER-------- -------DCIS - ductal carcinoma in situ, invasive ductal carcinoma,invasive lobular carcinoma Goldman Criteria

1. Age >70 - 5 points
2. MI wi 6 months - 10 points
3. S3 gallop, JBP>12cm - 11 points
4. Valvular Stenosis - 3 points
5. Rhythm not sinus - 7 points
6. PVC's >5/min at any time - 7 points
7. PO2<60, PCO3>50, K<3, HCO3<20, BUN>50, Cr>3, Chronic liver dz, debilitation - 3 points
8. Intraperitoneal, intrathoracic, aortic surgery - 3 points
9. Emergency Surgery - 3 points -----CORRECT ANSWER---------------Class I - 0 - 5 points - 1% risk Class II - 6 - 12 points - 7% risk Class III - 13 - 25 points - 14% risk Class IV - >25 points - 78% risk What is the gastrinoma triangle? This is where 90% of gastrimomas or non B cell pancreatic tumor are found. -----CORRECT ANSWER---------------junction of cystic duct & common bile duct, 2nd and 3rd portions of the duodenum, the junction of the neck and body of the pancreas

Invasive procedures are usually not performed when _______are <50,000 and _____>1.5. -----CORRECT ANSWER---------------Platelets, INR Gastric cancer is associated with ______ingestion. -----CORRECT ANSWER--------------

• betel-nut Most gastric cancer is found in what region of the stomach? -----CORRECT ANSWER--- ------------antral prepyloric region Stages of _________: Stage I - submucosa Stage II - muscularis propia Stage III - serosa Stage IV - adjacent structures -----CORRECT ANSWER---------------gastric cancer _______syndrome occurs in patients with severe peptic ulceration and evidence of a gastrinoma -----CORRECT ANSWER---------------Zollinger-Ellison Syndrome Gastrinomas are a _______disease despite the malignant nature of most tumors. ----- CORRECT ANSWER---------------curable Ranson Criteria for assessing the severity of acute pancreatitis. GA LAW ----- CORRECT ANSWER---------------glucose > 200mg/dl Age > 5 5 Lactate Dehydrogenase > 350u/L Aspartate Aminotransferase > 250u/L WBC>16, With the Ranson Criteria, what criteria means a worsening prognosis in the 1st 48 hours of pancreatitis? CHOBBS -----CORRECT ANSWER---------------Hematocrite drop >10%

BUN rise >5mg/L PO2<60mmHg Ca<8mg/dL Base Deficit>4meq/L Estimated fluid sequestration>6L When accessing cardiac disease prior to surgery, what is the most important thing to access? -----CORRECT ANSWER---------------aortic stenosis -- crescendo diastolic rumble at apex Guidelines for the use of antibiotics include administration within _______ of surgery and redosing after 4 hours. What is the abx of choice? -----CORRECT ANSWER---------- -----1 hour Abx of choice: cefazolin for all except colorectal then cefazolin/metronidazole Pre-op -- Metabolic disease/syndrome -- what are the 5 criteria? -----CORRECT ANSWER---------------3/5 to diagnose: 1 - diabetes 2 - central obesity 3 - HTN 4 - high serum triglycerrides 5 - low HDL levels ______should be monitored before surgery bc it is a stimulant and vasoconstrictor -- can lead to severe tachycardia -----CORRECT ANSWER---------------Cocaine Pre-Op -- What are the indications for EKG and CXR? -----CORRECT ANSWER---------- -----EKG - men >40, women>50, known CAD, DM, or HTN CXR - age >50, known cardiac or pulmonary disease What are the 5 classic "W's" of post operative fever? -----CORRECT ANSWER------------ ---W - wind (atelectasis) W - water (UTI) W - wound (wound infection)

W - walking (DVT/thrombophlebitis) W - wonder drugs (drug fever) If the post op fever occurs within the first 24 hours of surgery, what is the most likely cause? -----CORRECT ANSWER---------------wind/atelectasis If the post op fever occurs within days 3-5 post op, what is the most likely cause? ----- CORRECT ANSWER---------------water/UTI, catheter related phlebitis, pneumonia If the post op fever occurs within days 5-10 post op, what is the most likely cause? ----- CORRECT ANSWER---------------wound infection, pneumonia, abscess, infected hematoma, C diff colitis, anastomotic leak, DVT, peritoneal abscess, drug fever, PE, parotitis _______is the most common pathogen in wound infections and around foreign bodies. - ----CORRECT ANSWER---------------Staph aureus _______invades the inner ear and enteric tissues as well as the lung. -----CORRECT ANSWER---------------Klebsiella ______organisms are often found together with anaerobes. -----CORRECT ANSWER--- ------------Enteric organisms ie. enterobacteriaceae and enterococci Among the anaerobes, ___&___are often present in surgical infections and _____species are major pathogens in ischemic tissue. -----CORRECT ANSWER---------- -----Bacteroides & Peptostreptococci; Clostridium ___&___are usually nonpathogenic surface contaminants but may be opportunistic.

Some fungi and yeast cause abscesses in sinus tracts. -----CORRECT ANSWER--------- ------Pseudomonas & Serratia History of recent surgery, trauma, cancer, prolonged immobilization, or oral contraceptive use increases the risk of ____. -----CORRECT ANSWER---------------DVT - deep vein thrombosis What is Homan's sign? -----CORRECT ANSWER---------------pain on passive dorsiflexion of ankle What is the test of choice for DVT? -----CORRECT ANSWER---------------doppler ultrasound How is the D-dimer text useful? -----CORRECT ANSWER---------------It is good at ruling a DVT out (if the text is negative) but not rule it in Tx of DVT --

1. Initiate use of ____or____to what dose?
2. Overlap with the use of ____to what therapeutic range?
3. Why overlap therapies? -----CORRECT ANSWER---------------DVT
4. Initiate Heparin to PTT of 0.3-0.7 U/mL or LMWH wo monitoring.
5. Overlap with warfarin to INR between 2-3.
6. Overlap therapies to decrease changes of hypercoagulable state. The most common cause of SIRS (systemic inflammatory response syndrome) is sepsis. What are the criteria for dx of SIRS? -----CORRECT ANSWER---------------At least 2 of the following:
7. temp >38C or <36C
8. tachy >
9. tachypnea > 20 breaths/minute
10. PCO2 <32mmHg
11. WBC > 12,000/uL or <4000/uL

After sepsis, what are the next two most common causes of SIRS? -----CORRECT ANSWER---------------pancreatitis and drugs What is the difference between hypovolemia and dehydration? -----CORRECT ANSWER---------------hypovolemia is loss of both water and sodium while dehydration is loss of intracellular water or deficit with hypernatremia -- dehydration occurs when patient can not adjust water intake for water loss What are the clinical signs of dehydration and hypovolemia? -----CORRECT ANSWER-- -------------tachycardia, hypotension, pale skin, increased capillary refill time, dizziness, faintness, nausea, thirst, decreased urine output -- in hypovolemia, urine will demonstrate low sodium concentration What are 2 common conditions with dehydration? -----CORRECT ANSWER--------------- diabetes insipidus (lack of ADH or unable to respond to ADH), fever with increased water loss Hyponatremia Causes _______ = cirrhosis, CHF, nephrotic syndrome, massive edema _______=states of severe pain or nausea, trauma, brain damage, SIADH _______=prolonged vomiting, decreased oral intake, severe diarrhea, diuretic use Misc causes = factitious hyponatremia, hypothyroidism, adrenal insufficiency, malnourished states, primary polydipsia -----CORRECT ANSWER--------------- Hypervolemic, Euvolemic, Hypovolemic What are the two most common treatments for hyponatremia? Other less common treatment? -----CORRECT ANSWER---------------salt tabs and fluid restriction; vasopressin receptor antagonist in SIADH, CHF, and cirrhosis Hypernatremia is almost always due to _______. Therefore, what is the treatment? ----- CORRECT ANSWER---------------dehydration; rehydrate!

What s/s can result in a hyperkalemic patient? -----CORRECT ANSWER--------------- cardiac arrhythmias (tall peaked T waves) and weakness If the potassium level is above 6meq/L or the patient has EKG changes, what treatments can lower K temporarily? -----CORRECT ANSWER---------------calcium gluconate, sodium bicarbonate, insulin and glucose, kayexalate (takes longer to be effective) ______&______ is extremely effective in decreasing potassium. -----CORRECT ANSWER---------------Dialysis and furosemide Hypokalemia is usually due to ________, hypomagnesemia, alkalosis, high aldosterone levels. How is it treated? -----CORRECT ANSWER---------------potassium loss; replacement must be slow!!! Mild loss: oral KCl supplements or K containing foods Severe loss: IV supplementation - rate 10mEg/hr Causes of ________are VITAMIN D METABOLIC DISORDERS, abnormal PTH function, primary hyperparathyroidism, Lithium, malignancy, disorders related to high bone turnover rates (hyperthyroidism, prolonged immobilization, thiazide use, vit A intoxication, Pagets dz of bone, multiple myeloma), renal failure -----CORRECT ANSWER---------------hypercalcemia How should hypercalcemia be treated? -----CORRECT ANSWER---------------fluid and diuretics, bisphosphonates, and calcitonin _______is usually caused by ineffective PTH (chronic renal failure, absent active vit D, ineffective active vit D, pseudohypoparathyroidism), deficient PTH. -----CORRECT ANSWER---------------Hypocalcemia

How should hypocalcemia be treated? -----CORRECT ANSWER---------------intravenous calcium gluconate, Tums Increased CO2, hypoventilation, or decreased pH is aka ___. -----CORRECT ANSWER- --------------respiratory acidosis Decreased CO2, hyperventilation, or increased pH is aka ___. -----CORRECT ANSWER---------------respiratory alkalosis Increased H+ or HCO3 loss, DKA, lactic acidosis is aka ___. -----CORRECT ANSWER-- -------------metabolic acidosis Loss of H+ is aka ________. -----CORRECT ANSWER---------------metabolic alkalosis The d/d of post op ___________can be MI, atelectasis, pneumonia, pleurisy, esophageal reflux, PE, musculoskeletal pain, subphrenic abscess, aortic dissection, pneumo/chyle/hemothorax, or gastritis. -----CORRECT ANSWER---------------chest pain Who classically gets silent MI's? -----CORRECT ANSWER---------------diabetics How should syncope be initially evaluated? -----CORRECT ANSWER---------------It is important to distinguish syncope from cardiac arrest from other nonsyncopal conditions causing LOC Syncope d/d: Prodrome or aura usually associated with ____. -----CORRECT ANSWER---------------seizures (as is loss of continence)

Cardiac syncope's onset is usually ____without a prodrome. Monitor vitals regularly, EKG, orthostatic challenge, neuro exam etc. -----CORRECT ANSWER--------------- sudden In a surgery patient with dyspnea on exertion, what should be ruled out? -----CORRECT ANSWER---------------PE or pneumothorax What are some chronic dyspnea on exertion causes? -----CORRECT ANSWER----------- ----asthma, COPD, interstitial lung disease, myocardial dysfunction, obesity What are some acute dyspnea on exertion causes? -----CORRECT ANSWER------------- --angioedema, anaphylaxis, foreign objects, airway trauma, pulmonary infection, pleural effusion, peritonitis/ruptured viscous, bowel obstruction __________is pain, cramping, or both of the lower extremity (usually calf muscle) after walking a specific distance; then resolves for a specific amount of time while standing. -- ---CORRECT ANSWER---------------Claudication What is claudication associated with? -----CORRECT ANSWER---------------peripheral vascular occlusion D/D of lower extremity claudication? -----CORRECT ANSWER--------------- neurogenic/nerve entrapment/discs, arthritis, coartation of the aorta, popliteal artery syndrome, neuromas, anemia, diabetic neuropathy pain A _________is an abnormal dilation of an artery. Involve all layers of the arterial wall. --- --CORRECT ANSWER---------------aneurysm At what size is surgical repair of aneurysm recommended? -----CORRECT ANSWER---- -----------5.5 cm

95% of aneurysms are associated with ___________. -----CORRECT ANSWER---------- -----atheroschlerosis -- other causes are trauma, infection, syphilis, & Marfan's syndrome What is the classic triad of s/s related to ruptured AAA? -----CORRECT ANSWER-------- -------abdominal pain, pulsatile abdominal mass, hypotension Where does the aorta bifurcate? -----CORRECT ANSWER---------------At the level of umbilicus Because the ________is often sacrificed during AAA repair, colonic ischemia can occur. -----CORRECT ANSWER---------------IMA - inferior mesenteric artery _______is a separation of the walls of the aorta from an intimal tear and disease of the tunica media; a false lumen is formed and a "reentry" tear may occur, resulting in a "double barrel" aorta. -----CORRECT ANSWER---------------Aortic dissection Explain the DeBakey classifications (Type 1,2, & 3) of aortic dissections. -----CORRECT ANSWER---------------DeBakey Type 1 - ascending & descending aorta DeBakey Type 2 - ascending aorta DeBakey Type 3 - descending aorta Explain the Stanford classifications of aortic dissections. -----CORRECT ANSWER------- --------Type A -- ascending +/- descending aorta Type B - descending aorta What is the most common cause of aortic dissection. -----CORRECT ANSWER------------ ---HTN!

What are the s/s of aortic dissection. -----CORRECT ANSWER---------------abrupt tearing pain/sensation What are 3 other sequelae of aorta dissection? -----CORRECT ANSWER--------------- cardiac tamponade, aortic insufficiency, aortic arterial branch occlusion/shearing What is Beck's triad of cardiac tamponade? -----CORRECT ANSWER--------------- muffled heart sounds, JVD, hypotension What does CXR show with aortic dissection? -----CORRECT ANSWER--------------- widened mediastinum What is the gold standard but time consuming test of choice with aortic dissection/aneurysm? -----CORRECT ANSWER---------------aortagraphy Which type of aortic dissection should be treated with surgical repair? -----CORRECT ANSWER---------------Involvement of ascending aorta -- Type A or Type I Type III or B aortic dissections can be treated with what meds? -----CORRECT ANSWER---------------blood pressure meds _______is a diffuse disease process in arteries; artheromas containing cholesterol and lipid form within the intima and inner media, often accompanied by ulcerations and smooth muscle hyperplasia. Risk factors: HTN, smoking, DM, FH, hypercholesterolemia, high LDL, obesity, & sedentary lifestyle. -----CORRECT ANSWER---------------Atherosclerosis

Common sites of arterial plaque formation? -----CORRECT ANSWER---------------branch points (carotid bifurcation) or tethered sites (superficial femoral artery in Hunter's canal of leg) What is a major principle of safe vascular surgery? -----CORRECT ANSWER--------------- get proximal and distal control of vessel so that if you put tension on the vessel loop it will occlude the vessel What is Virchow's Triad (risk factors for thrombosis)? -----CORRECT ANSWER------------ ---stasis, abnormal endothelium, hypercoagulability What are the 6 classic s/s of acute arterial occlusion? -----CORRECT ANSWER----------- ----pain, paralysis, pallor, paresthesia, poikilothermia, pulselessness What is the immediate pre-op management of acute arterial occlusion? -----CORRECT ANSWER---------------anticoagulation with IV heparin -- angiogram 85% of emboli originate from where? -----CORRECT ANSWER---------------Heart -- a fib What is the most common site of arterial occlusion by embolus? -----CORRECT ANSWER---------------SFA -- superficial femoral artery What is the surgical treatment for acute arterial occlusion? -----CORRECT ANSWER----- ----------surgical embolectomy Post op management of possible _________ie. tissue swelling from reperfusion can increase intracompartmental pressure, resulting in decreased capillary flow, ischemia, and myonecrosis. -----CORRECT ANSWER---------------compartment syndrome

What are the classic s/s of compartment syndrome? -----CORRECT ANSWER------------- --pain, paralysis, parethesias, pallor What is the tx for compartment syndrome? -----CORRECT ANSWER--------------- fasciotomy ________is intermittent claudication. S/S are absent pulses, bruits, muscular atrophy, decreased hair growth, thick toenails, and tissue necrosis/ulcers/infection. ----- CORRECT ANSWER---------------PVD - peripheral vascular disease ______is the gold standard for diagnosis of PVD. -----CORRECT ANSWER--------------- arteriogram Use Ankle to Brachial index to access PVD. What is the normal ABI. -----CORRECT ANSWER---------------ABI>1; Claudicator ABI<0.6; Rest Pain ABI<0. What are the indications for treatment of PVD? STIR -----CORRECT ANSWER------------ ---S - severe claudication that is refractory to conservative tx T - tissue necrosis I - infection R - rest pain What is the major post op concern after PVD operation? -----CORRECT ANSWER------- --------cardiac status -- MI is the most common cause of post op death The three treatment options for _______are surgical graft bypass, angioplasty, endarterectomy. -----CORRECT ANSWER---------------PAD

Arterial/venous ulcer disease is best treated with revascularization. An expensive alternative is ______ which stimulates angiogenesis. When revascularization is not possible, ______ is performed. -----CORRECT ANSWER---------------hyperbaric oxygen; amputation __________most often occur in saphenous veins and are caused by incompetent valves from damage or venous dilation, AV fistula, congenital venous malformations. ----

• CORRECT ANSWER---------------Varicose veins What are some treatment options for varicose veins? -----CORRECT ANSWER------------ ---compression stockings, leg elevation, venous ablation, sclerotherapy, great saphenous vein stripping ___________is obstruction of left subclavian artery. S/S: upper extremity claudication and upper extremity blood pressure discrepancy. Tx: surgical bypass or endovascular stent -----CORRECT ANSWER---------------Subclavian steal syndrome _________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. -----CORRECT ANSWER---------------Renal artery stenosis _________is a vasospasm of the digital arteries with color changes of the digits. Usually initiated by cold or emotion. -----CORRECT ANSWER---------------Raynaud's phenomenon ________is arteritis of the aorta and aortic branches resulting in stenosis/occlusion/aneurysms. -----CORRECT ANSWER---------------Takayasu's arteritis _________aka thromboangiitis obliterans; occlusion of vessels of hands and feet. Seen in young MEN WHO SMOKE. -----CORRECT ANSWER---------------Buerger's disease

Anemia is evaluated by measuring ________. -----CORRECT ANSWER--------------- MCV - mean corpuscular volume MCV >100 is aka ____. MCV 80-100 is aka ___. MCV <80 is aka ___. -----CORRECT ANSWER---------------MCV >100 is macrocytic. MCV 80-100 is normocytic. MCV <80 is microcytic. What are the most common causes of macrocytic, normocytic, and microcytic anema? - ----CORRECT ANSWER---------------Macrocytic -- B12 def, folate def, EtOH, HIV drugs Normocytic -- anemia of chronic disease Microcytic -- GI loss, menstruation The normal Hemoglobin for an adult male and female is: The normal Hematocrit for an adult male and female is: -----CORRECT ANSWER--------- ------Hemoglobin - male=13.5-17. female=12- 16 Hematocrit - male & female=~40% The d/d for ________is gastric cancer, gastroenteritis, influenza, pneumonia, infectious disease illness. -----CORRECT ANSWER---------------anorexia The d/d for ________is gastric cancer, bowel obstruction, increased intracranial pressure, pregnancy, migraine, IBS, malignancy, appendicitis, cholecystitis, cholelithiasis, PUD, UTI... -----CORRECT ANSWER---------------nausea/vomiting The d/d for ____is jaundice of newborn, hyperbilirubinemia, cholelithiasis, small bowel adenocarcinoma, pancreatic carcinoma, pancreatic pseudocyst. -----CORRECT ANSWER---------------jaundice

The d/d for _____is upper GI bleed, esophageal or gastric varices, gastritis, malignancy etc. -----CORRECT ANSWER---------------hematemesis The d/d for ________infectious pathology, colorectal carcinoma, bowel obstruction, diverticular disease, volvulus, dietary. -----CORRECT ANSWER---------------diarrhea, constipation, opstipation The d/d for ________is diverticulosis, diverticulitis, colon polyps, colorectal carcinoma, UC, Chron's, cancer, hemorrhoids. -----CORRECT ANSWER---------------melena, hematochezia The d/d of ________is hiatal hernia, GERD, PUD, Barrett's, cholecystitis. ----- CORRECT ANSWER---------------heartburn, dyspepsia What are some causative agents of esophageal strictures? -----CORRECT ANSWER---- -----------GERD, iatrogenic, long term NG tubes, caustic agents {lye, over cleaners, drain cleaners, batteries} Treat shallow esophageal ulcers with _______, and use ____for moderate or deep ulcers. Upper GI at 10-14 days. -----CORRECT ANSWER---------------corticosteroids, antibiotics If an esophageal stricture develops, treat with what? What about in severe cases? ----- CORRECT ANSWER---------------dilation with Maloney dilator or balloon catheter. In severe cases, esophagectomy with colon interposition or gastric pull up After esophageal stricture, because of risk of esophageal squamous cancer, what should be done to screen more regularly (every other year)? -----CORRECT ANSWER-- -------------endoscopies

_________is the most common type of esophageal cancer at the GE junction in the US. -----CORRECT ANSWER---------------Adenocarcinoma ________is the most common type of esophageal cancer worldwide. -----CORRECT ANSWER---------------squamous cell carcinoma What are the 5 factors related to esophageal cancer? -----CORRECT ANSWER----------- ----tobacco, alcohol, GE reflux, barrett's esophagus, radiation Esophageal cancer is most common in what sex, age, ethnicity? -----CORRECT ANSWER---------------60s, male, black Treatment of _______with esophagectomy with gastric pull up or colon interposition. ----

• CORRECT ANSWER---------------esophageal cancer ________is reflux of gastric contents into lower esophagus resulting from decreased fx of LES. -----CORRECT ANSWER---------------Esophageal reflux Some causes of _______are decrease LES tone, decreased esophageal motility, hiatal hernia, gastric outlet obstruction, and NG tube. -----CORRECT ANSWER--------------- esophageal reflux Complications of esophageal reflux requiring surgery: -----CORRECT ANSWER----------- ----failure of medical therapy, esophageal strictures, progressive pulmonary insufficiency secondary to documented nocturnal aspiration, barrett's esophagus Barrett's esophagus is replacement of lower esophageal squamous epithelium with columnar epithelium secondary to reflux. This is a ________malformation. ----- CORRECT ANSWER---------------pre-malignant

________is the most common esophageal diverticulum. -----CORRECT ANSWER-------- -------Zenker's diverticulum What are the s/s of Zenker's diverticulum? Dx is made via ____. -----CORRECT ANSWER---------------dysphagia, neck mass, halitosis, food regurgitation, heart burn; barium swallow What are the two treatment options for Zenker's diverticulum? -----CORRECT ANSWER---------------diverticulectomy; cricopharyngeus myotomy if >2cm __________is the failure of the LES to relax during swallowing, loss of esophageal peristalsis. -----CORRECT ANSWER---------------Achalasia What is the most common s/s of achalasia? What is the worst? -----CORRECT ANSWER---------------Solid & liquid dysphagia; liquids are worse What is the diagnostic study of choice for achalasia? -----CORRECT ANSWER------------ ---manometry -- it shows failure of LES to relax during swallowing and increased pressure at LES What is the surgical treatment of achalasia? -----CORRECT ANSWER---------------LES balloon dilation, tx of reflux, partial fundoplication, myotomy of the lower esophagus and LES _______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? -----CORRECT ANSWER--------------- Esophageal spasm; "corkscrew esophagus"

_______is aka hypertensive peristalsis. Very strong peristalstic waves that cause radiating chest pain to the back, ears, neck, jaw, or arms. -----CORRECT ANSWER------ ---------Nutcracker esophagus 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. -----CORRECT ANSWER---------------hiatal hernia Hiatal hernia repair involves cutting ______&______ circumferentially around the esophagus as far into the chest as possible to free esophagus and all it to be pulled back into the abdomen. Suture wall of hernia closed. -----CORRECT ANSWER------------ ---lymphatics and vessels Peptic ulcer disease can be from gastric or duodenal ulcers. What is an easy way to distinguish the two? -----CORRECT ANSWER---------------duodenal ulcer pain is usually relieved with food intake What is a common cause of PUD? -----CORRECT ANSWER---------------H pylori How is H pylori treated? M.O.C. or A.O.C -----CORRECT ANSWER---------------2 week antibiotic regimen MOC = metronidazole, omeprazole, clarithromycin AOC = ampicillin, omeprazole, clarithromybin ________sign is RLQ/peritonitis as a result of succus collecting from a perforated peptic ulcer -----CORRECT ANSWER---------------Valentino's sign What are some risk factors for gastric cancer? -----CORRECT ANSWER---------------poor environment (smoked meats, high nitrates, low fruits & veggies), male, blood type A, previous partial gastrectomy, H pylori, pernicious anemia

What are the symptoms of gastric cancer? WEAPON -----CORRECT ANSWER----------- ----Weight loss, Emesis, Anorexia, Pain/epigastric discomfort, Obstruction, Nausea Gastric Metastases: ____is metastatic gastric cancer to nodes in the left supraclavicular fossa ____is periumbilical lymph node gastric cancer metastases; presents as umbilical mass ____gastric cancer (or other adenocarcinoma) that has metastasized to ovary ----- CORRECT ANSWER---------------Virchow's node; Sister mary josephs sign, Krukenbergs tumor The treatment of gastric cancer is with what? -----CORRECT ANSWER--------------- surgical resection with wide margins and lymph node dissection ~~ 5 year survival rate 25 - 50% ~~ _______is hypertrophy of the smooth muscle of the pylorus, resulting in obstruction of outflow. Who is affected most commonly? -----CORRECT ANSWER---------------Pyloric stenosis; 1st born males What is the s/s of pyloric stenosis? What shaped abdominal mass is seen in 85%? ----- CORRECT ANSWER---------------progressive projectile vomiting (non bilious); olive in epigastric region -- also hypokalemic hypochloremic metabolic alkalosis If the u/s is nondiagnostic of pyloric stenosis, then barium swallow shows what? ----- CORRECT ANSWER---------------"string sign" or "double railroad track sign" What is the initial treatment of pyloric stenosis? Surgical treatment? -----CORRECT ANSWER---------------hydration and correction of alkalosis; Fredet-Ramstedt pyloromyotomy (division of circular muscle fibers without entering the lumen/mucosa)

_______is biliary colic (temporary pain w no fever), n/v, dyspepsia (intolerance to fatty foods, flatulence, belching, indigestion) that continues over time -----CORRECT ANSWER---------------Chronic cholecystitis _____is constant RUQ abdominal pain > 6 hours, fever (101), n/v, referred right subscapular pain, referred epigastric discomfort. -----CORRECT ANSWER--------------- Acute cholecystitis ________is acute pain and inspiratory arrest excited by palpation of the RUQ during inspiration. -----CORRECT ANSWER---------------positive Murphy's sign What are some complications of cholecystitis? -----CORRECT ANSWER--------------- abscess, perforation, choledocholithiasis, cholecystenteric fistula formation, gallstone illeus What is the test of choice for cholecystitis? -----CORRECT ANSWER---------------u/s -- then HIDA scan What labs are often elevated with cholecystitis? Choledocholithiasis? Cholangitis? Gallstone pancreatitis? -----CORRECT ANSWER---------------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 Gallstones (cholelithiasis) increase with age and in what specific population? ----- CORRECT ANSWER---------------Fat, Female, Forty, Fertile Biliary colic that lasts longer than 6 hours is often ____. -----CORRECT ANSWER-------- -------cholelithiasis

15% of stones pass through the cystic duct and enter the common bile duct. Patient presents with RUQ abdominal pain, jaundice, light colored stools, and tea colored urine. This is aka ____. -----CORRECT ANSWER---------------choledocholithiasis In choledocholithiasis, what study can be used to extract the stones? -----CORRECT ANSWER---------------ERCP - endoscopic retrograde choloangeopancreatography _________is infection of the biliary tract. -----CORRECT ANSWER--------------- Cholangitis What is Charcot's triad? -----CORRECT ANSWER---------------fever with chills, RUQ abdominal pain, jaundice What is Reynold's Pentad? -----CORRECT ANSWER---------------Charcot's triad, hypotension, altered mental status What are some common causes of cholangitis? -----CORRECT ANSWER--------------- choledocholithiasis, stricture, neoplasm (usually ampullary carcinoma), extrinsic compression (pancreatic pseudocyst/pancreatitis), instrumentation of the bile ducts, biliary stent What are the most common causative organisms of cholangitis? -----CORRECT ANSWER---------------gram negative - E Coli, Klebsiella, Pseudomonas, Enterobacter, Proteus, Serratia. Enterococci are the most common gram positive bacteria Anaerobes are less common The treatment of ________is with stone extraction and/or decompression, laparotomy with T tube placement, NPO, IVF, broad spectrum abx. -----CORRECT ANSWER--------- ------cholangitis