General Surgery

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flucas
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165794
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General Surgery
Updated:
2012-08-17 22:28:07
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medical mnemonics general surgery info
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general surgery info with medical mnemonics
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  1. What are the retroperitoneal structures?
    • Suprarenal (aka adrenal glands)
    • Aorta/IVC
    • Duodenum
    • Pancreas
    • Ureters
    • Colon (ascending and descending only)
    • Kidneys
    • Esophagus
    • Rectum
  2. What are the branches of the external carotid artery?
    "Some Aggressive Lovers Favor Odd Positions More Stimulating"

    • Superior thyroid
    • Ascending pharyngeal
    • Lingual
    • Facial
    • Occipital
    • Posterior Auricular
    • Maxillary
    • Superficial temporal
  3. What are the branches of the lumbar plexus?
    • "I Instantly Get Laid On Fridays"
    • "2 from 1, 2 from 2, 2 from 3"

    • Iliohypogastric (L1)
    • Ilioinguinal (L1)
    • Genitofemoral (L1, L2)
    • Lateral femoral cutaneous (L2, L3)
    • Obturator (L2, L3, L4)
    • Femoral (L2, L3, L4)
  4. What are the carotid sheath contents?
    "I See 10 cc's in the IV"

    • IC: internal cartotid
    • 10: vagus nerve
    • cc: common carotid
    • IV: internal jugular vein
  5. What are the branches of the axillary artery?
    "Screw The Lawyers Save A Patient"

    • Superior thoracic
    • Thoracoacromial
    • Lateral thoracic
    • Subscapular
    • Anterior circumflex humeral
    • Posterior circumflex humeral
  6. What are the dependent pouches of the abdomen where fluid, blood, and pus can collect?
    • hepatorenal pouch (supine)
    • rectouterine pouch (supine, semi-upright)
  7. What are the 10 most common cancers in adults?
    • 1. melanoma
    • 2. colorectal adenocarcinoma
    • 3. breast adenocarcinoma
    • 4. prostate adenocarcinoma
    • 5. lung adenocarcinoma
    • 6. pancreastic adenocarcinoma
    • 7. thyroid carcinoma
    • 8. leukemia
    • 9. endometrial carcinoma
    • 10. renal cell carcinoma
  8. What are the 10 most common cancers in children?
    • 1. leukemia
    • 2. CNS tumors
    • 3. neuroblastoma
    • 4. lymphoma
    • 5. retinoblastoma
    • 7. sarcomas
    • 8. bone tumors
    • 9. hepatoblastoma
    • 10. germ cell tumors
  9. What are the major indications for breast mass excision?
    • mass >3cm
    • mass growing in size (ultrasound)
    • suspicious cytology, atypia
    • patient request
  10. What are the important points in HPI of patient with nipple discharge?
    • unilateral or bilateral?
    • sungle duct or multiple ducts involved?
    • spontaneous or expressed?
    • bloody or not bloody?
    • appearance/color of discharge
  11. What is the differential dx of bilateral milky spontaneous nipple discharge?
    • direct nipple stimulation/irritation (e.g. new bra)
    • pregnancy
    • prolactinoma
    • recent lactation with ductectasia
    • drugs (e.g. dopamine antagonists; pysch meds)
    • hypothyroidism
  12. What are appropriate lab tests to work-up nipple dishcarge?
    rule out: hypothyroidism, prolactinoma, pregnancy

    • serum TSH levels
    • serum prolactin levels
    • urine HCG levels (if not premenopausal)
  13. What is an acceptable dose of heparin for DVT prophylaxis?
    5000 units BID or TID
  14. What is the differential diagnosis of a pt with a lung cavity with air-fluid levels?
    • tuberculosis
    • bronchiectasis
    • infected cyst or bulla
    • cavitating lung carcinoma
    • locaulated empyema
    • fungal infection
  15. What clinical conditions commonly lead to a (primary) lung abscess?
    • necrotizing pneumonia
    • aspiration (stroke, alcoholism, seizure, esophageal disease)
    • suppressed cough (stroke, ventilator)
    • immunocompromised state (HIV, malignancy, chemo)
  16. What is the chance that a new solitary lung nodule on CXR is malignant?
    • 20-40% chance
    • risk increases if smoker
  17. What are the general histological types of lung cancer?
    • Non-small cell lung carcinoma
    • neuroendocrine neoplasms
    • bronchial gland carcinomas
  18. What are the general and individual histological types of lung cancer?
    • non-small cell lung carcinoma:
    • squamous cell 
    • adenocarcinoma
    • broncheoalveolar carcinoma
    • large cell carcinoma

    • neuroendocrine neoplasms:
    • classic carcinoid
    • atypical carcinoid
    • SCLC

    • bronchial gland carcinomas:
    • adenoid cystic carcinoma
    • mucoepidermoid carcinoma
    • mucous gland adenoma
  19. What are the different kinds of renal stones based on composition?  
    • 80%: calcium (w/ oxalate or phosphate); radioopaque
    • 10%: magnesium ammonium phosphate; opaque in alk urine
    • 6-10%: uric acid; radiolucent (gout, post-chemo, myeloprolif.)
    • 1%: cysteine (aut. recessive)
  20. What are common causes of metabolic acidosis with a (high) anion gap?
    "MUDPILES"

    • Methanol
    • Uremia
    • Diabetic Ketoacidosis
    • P
    • Infection
    • Lactic Acidosis
    • Ethylene glycol, Ethanol (alcoholoic KA)
    • Rhabdomyolysis
    • Salicylates
  21. What are the common causes of normal anion gap metabolic acidosis?
    "HARD UP"

    • Hyperalimentation
    • Acetazolamide (and other carbonic anhydrase inhibitors)
    • Renal Tubular Acidosis
    • Diarrhea
    • Uroenteric Fistula
    • Pancreaticoduodenal fistula
  22. What are the pathophysiological differences between high anion gap metabolic acidosis and normal anion gap metabolic acidosis?
    • high anion gap = production of organic acids
    • normal anion gap = production of chloride and/or excretion of bicarbonate
  23. What are the normal antireflux mechanisms?
    • barrier: LES
    • clearance: esophageal clearance
    • passageway: adequately functioning gastric reservoir
  24. What are the operative indications for bowel obstruction?
    • any large bowel obstruction
    • incarcerated/strangulated hernia
    • peritonitis/acute abdomen
    • pneumoperitoneum
    • suspected strangulation
    • closed loop obstruction
    • complete obstruction
    • always operate on virgin abdomen
  25. When is it safe NOT to operate on a bowel obstruction?
    • SBO due to adhesions
    • no signs of strangulation
    • obstruction due to adynamic ileus
  26. What are the 4 cardinal signs of bowel strangulation?
    • fever
    • leukocytosis
    • acute abdominal pain --> peritonitis
    • tachycardia
  27. What are the most common causes of adynamic ileus?
    • generalized peritonitis (e.g. perforated organ)
    • acute pancreatitis
    • electrolyte abnormalities (e.g. hypokalemia)
    • postoperative ileus
    • infection (e.g. diverticulitis, appendicitis, PID, sepsis)
    • thoracic causes (e.g. pneumonia, fx ribs)
    • retroperitoneal disorders (e.g. ureter, spine)
    • drugs (e.g. opiates, CCB, psychotropics)
  28. What are the most common causes of large bowel obstruction?
    • colon cancer
    • diverticulitis
    • volvulus
    • hernia
  29. What are the 3 main contributors to postoperative wound dehiscence with laparotomy?
    • inadquate wound closure
    • increased intra-abdominal pressure
    • deficient wound healing
  30. What are the BI-RADS categories?
    • Breast Cancer nodules on Mammogram:
    • I: definitely benign, annual screening
    • II: probably benign, annual screening
    • III: probably benign but could be malignant, f/u <1yr, 2% risk
    • IV: suspicious for malignant, 23-34% risk
    • V: probably malignant, 95% risk
    • VI: definite malignancy already proven with biopsy
  31. What are the most common causes of postoperative fever?
    • "Wind, Water, Wound, Walk, Weird"
    • POD #1: pneumonia, atelectasis
    • POD #3: UTI (esp. with Foley)
    • POD #5: wound infection
    • POD #7: DVT
    • POD #9+: abscess, drug reaction, transfusion rxn
  32. What is the order of the "reconstructive ladder"?
    • direct wound closure (primary, secondary)
    • graft
    • local flap
    • distant flap
    • free flap
  33. What is the difference between a skin graft and a skin flap?
    • graft = receives new blood supply from host
    • flap = own vascular supply, more risk of rejection
  34. What can cause/keep open fistulas?
    • "FRIEND"
    • Foreign body
    • Radiation
    • Inflammation
    • Epithelialization
    • Neoplasms
    • Distal obstruction
  35. What separates a thyroid adenoma from a thyroid carcinoma?
    capsular and/or vascular invasion
  36. What are important prognostic factors in well-differentiated thyroid cancer?
    • "AMES"
    • Age (>45 yo)
    • Metastasis
    • Extrathyroidal invasion
    • Size (>4cm)
  37. What are the methods of surveillance for recurrent thyroid cancer?
    • Physical examination
    • Thyroglobulin levels
    • Radioactive iodine scan
    • Ultrasonography  
  38. What are the causes of hypercalcemia?
    • calcium supplements
    • hyperparathyroidism, +/- renal failure
    • hypo/hyperthyroidism
    • sarcoidosis/granulomatous disease
    • paraneoplastic syndrome
    • multiple myelosis
    • adrenal insufficiency
    • drugs (diuretics, thiazide, lithium)
    • milk alkali syndrome
    • immobilization
    • Vit. D toxicity
    • benign familial hypercalcemic hypocalciuria
    • Paget's disease
  39. What are the symptoms of hypercalcemia?
    • "Bones, Stones, Thrones, Groans, and Moans"
    • bones: fractures, osteoporosis
    • stones: renal stones, renal colic, pancreatitis
    • Thrones: polyuria, incontinence, constipation
    • Groans: lethargy, depression, confusion, coma
    • Moans: headache, myalgia, hyporeflexia
  40. What are the symptoms of hypocalcemia?
    • Neuro: circumoral parasthesia, depression, confusion, Chvostek's sign, Trousseau's sign, seizures
    • MSK: tetany, hyperreflexia, cramps, osteomalacia
    • CV: ECG changes, arrhythmia
  41. What are the causes of hypocalcemia?
    • hypoparathyroidism
    • Vit. D deficiency
    • pseudohypoparathyroidism
    • hypomagnesemia
    • malabsorption
    • pancreatitis
    • hypoalbuminemia
    • chelation of calcium
    • osteoblastic metastases
    • toxic shock syndrome
    • hyperphosphatemia
  42. What are the common causes of hypoparathyroidism?
    • postoperative
    • idiopathic
    • pseudohypoparathyroidism (familial)
    • hypomagnesemia
  43. What are the indications for AAA surgical repair?
    • >5.5. cm
    • thrombosis
    • mycotic
    • saccular
    • embolization
    • aortocaval fistula
    • aortoenteric fistula
    • increased growth rate
  44. What are the recommendations for AAA screening/surveillance?
    • screen: 
    • all men >65 yo or >55 yo with FHx
    • all women >65 yo with FHx or tobacco hx

    • surveillance:
    • >3.5 cm: U/S 3 yrs
    • 3.5-4.5 cm: U/S annually
    • 4.5-5.5 cm: U/S 6 mo
  45. What are the levels of the CEAP classification?
    • classification of venous insufficiency severity:
    • C0 = no evidence
    • C1 = superficial/reticular spider veins only
    • C2 = simple varicose veins only
    • C3 = ankle edema (not foot edema)
    • C4 = skin pigmentation in gaiter area (lipodermatosclerosis)
    • C5 = healed venous ulcer
    • C6 = open venous ulcer
  46. What are the basic MVA injury history questions?
    • seat belt used?
    • air bags deployed?
    • extraction and transport times?
  47. What are the general concerns of MVA trauma?
    • tension pneumothorax
    • myocardial contusion
    • injury to thoracic aorta
    • intraabdominal injury
    • ruptured diaphragm
  48. What are the absolute indications for surgery in a pt with blunt injury following MVA?
    • peritoneal signs
    • hemodynamic instability with +FAST or +DPL

    (relative indication: free fluid in abdomen on CT scan with no solid organ damage)
  49. What are positive signs on a DPL?
    • DPL = diagnostic peritoneal lavage
    • RBC >100,000/uL
    • WBC >500/uL
    • increased amylase (vs serum)
    • +bile, bacteria, food, stool
  50. How can you clinically estimate amount of blood loss preop?
    Class I: <15% of blood volume lost; vital signs are normal; slight anxiety.

    Class II: 15-30% of blood volume lost; pulse >100 per minute; blood pressure normal; decreased pulse pressure; tachypnea; output 20-30 ml/hour; moderate anxiety; capillary refill time increased

    Class III: 30-40% of blood volume lost; pulse >120; blood pressure decreased; respiratory rate 30-40/min; output 5-15 ml/hour; anxious and confused.

    Class IV: over 40% of blood volume lost; pulse >140; blood pressure very low; narrow pulse pressure; negligible urine output; confused, lethargic.

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