SURGERY EOR COMPREHENSIVE EXAM
STUDY GUIDE WITH COMPLETE
SOLUTIONS
●● how to prevent post op a-fib
Answer: a beta blocker!!!
●● patient has mesenteric ischemia, history of pain after eating, poorly
localized or diffuse pain out of proportion to physical exam with weight
loss and possibly bloody stool - what caused this
Answer: likely A fib, bc MC source is embolus
●● cellulitis treatment if they have a sulfa allergy so cannot use bactrim,
and need to save linezolid and vanc for most severe cases
Answer: doxycycline or clindamycin
●● hyperparathyroidism
Answer: stones bones and abdominal groans
primary = excessive PTH from the gland and is associated with MENI
and II - will have fatigue, depression, memory impairment, sleep
disturbances, elevated calcium
secondary is due to renal failure or vit. D deficiency - will have
hypocalcemia
,●● tx of choice for liver cancer
Answer: resection of solitary lesions
transplant for unresectable lesions without mets.
resection of mets from colon cancer
mc type is hepatocellular carcinoma
●● sigmoid volvulus
Answer: pt has abdominal distention, cramps abdominal pain,
obstipation, prior occurrence
usually have chronic constipation too
may see a coffee bean sign on Xray
may be an older patient that is bed-ridden (especially if they have
dementia or neuropsychiatric impairment)
tx is endoscopic detorsion!!!
if they have cecal volvulus then tx is emergent resection
●● SBO tx
Answer: if incomplete mechanical obstruction, do NPO, IV ABX for 24
hours
if complete do NG decompression or resection if bowel is strangulated
,●● bowel wall thickening
Answer: what you see on CT for diverticular abscess
●● on PE of pt with an anal fissure, what else may you see?
Answer: skin tag or sphincter muscle
●● incarcerated hernia
Answer: painful bulge in stomach that will not reduce
pt. has nausea, vomiting,
may have an obstruction
●● strangulated hernia
Answer: the hernia will be incarcerated and the patient will appear toxic
there will be ischemia bowl and severe pain, tenderness, redness of the
area with fever
●● wound dehiscence
Answer: separation of the layers of a surgical wound; may be partial, or
superficial only, or complete, with disruption of all layers
●● seroma
Answer: accumulation of serum beneath the surgical incision
, ●● best way to access a pt. receiving dialysis
Answer: AV fistula - take a piece of vein from arm or leg and sew to an
artery and allow it to become larger and thicker
peritoneal dialysis can be used too
●● subclavian steal syndrome
Answer: pathophys: arm fatigue and vertebrobasilar insufficiency due to
obstruction of the subclavian artery - moving that left arm will increase
blood flow demand which is met by retrograde flow from the vertebral
artery thereby stealing from the vertebrobasilar arteries
hx: upper extremity claudication and muscle cramping in the arm due to
ischemia, dizzy, vertigo, syncopal attacks, dysarthria, nystagmus,
diplopia, blindness (due to vertebrobasialar insufficiency)
PE: difference in upper extremity pulses and brachial systolic BP
tx: surgical bypass, stent
●● amaurosis fugax
Answer: painless transient monocular vision loss
curtain falls down
STUDY GUIDE WITH COMPLETE
SOLUTIONS
●● how to prevent post op a-fib
Answer: a beta blocker!!!
●● patient has mesenteric ischemia, history of pain after eating, poorly
localized or diffuse pain out of proportion to physical exam with weight
loss and possibly bloody stool - what caused this
Answer: likely A fib, bc MC source is embolus
●● cellulitis treatment if they have a sulfa allergy so cannot use bactrim,
and need to save linezolid and vanc for most severe cases
Answer: doxycycline or clindamycin
●● hyperparathyroidism
Answer: stones bones and abdominal groans
primary = excessive PTH from the gland and is associated with MENI
and II - will have fatigue, depression, memory impairment, sleep
disturbances, elevated calcium
secondary is due to renal failure or vit. D deficiency - will have
hypocalcemia
,●● tx of choice for liver cancer
Answer: resection of solitary lesions
transplant for unresectable lesions without mets.
resection of mets from colon cancer
mc type is hepatocellular carcinoma
●● sigmoid volvulus
Answer: pt has abdominal distention, cramps abdominal pain,
obstipation, prior occurrence
usually have chronic constipation too
may see a coffee bean sign on Xray
may be an older patient that is bed-ridden (especially if they have
dementia or neuropsychiatric impairment)
tx is endoscopic detorsion!!!
if they have cecal volvulus then tx is emergent resection
●● SBO tx
Answer: if incomplete mechanical obstruction, do NPO, IV ABX for 24
hours
if complete do NG decompression or resection if bowel is strangulated
,●● bowel wall thickening
Answer: what you see on CT for diverticular abscess
●● on PE of pt with an anal fissure, what else may you see?
Answer: skin tag or sphincter muscle
●● incarcerated hernia
Answer: painful bulge in stomach that will not reduce
pt. has nausea, vomiting,
may have an obstruction
●● strangulated hernia
Answer: the hernia will be incarcerated and the patient will appear toxic
there will be ischemia bowl and severe pain, tenderness, redness of the
area with fever
●● wound dehiscence
Answer: separation of the layers of a surgical wound; may be partial, or
superficial only, or complete, with disruption of all layers
●● seroma
Answer: accumulation of serum beneath the surgical incision
, ●● best way to access a pt. receiving dialysis
Answer: AV fistula - take a piece of vein from arm or leg and sew to an
artery and allow it to become larger and thicker
peritoneal dialysis can be used too
●● subclavian steal syndrome
Answer: pathophys: arm fatigue and vertebrobasilar insufficiency due to
obstruction of the subclavian artery - moving that left arm will increase
blood flow demand which is met by retrograde flow from the vertebral
artery thereby stealing from the vertebrobasilar arteries
hx: upper extremity claudication and muscle cramping in the arm due to
ischemia, dizzy, vertigo, syncopal attacks, dysarthria, nystagmus,
diplopia, blindness (due to vertebrobasialar insufficiency)
PE: difference in upper extremity pulses and brachial systolic BP
tx: surgical bypass, stent
●● amaurosis fugax
Answer: painless transient monocular vision loss
curtain falls down
