DOMINATE THE CLERKSHIP REVIEW PACKET. What are the electrolyte compositions of NS, LR, Plasmalyte A? Na Cl K HCO3 Ca Mg ph NS LR Plasmalyte A

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1 DOMINATE THE CLERKSHIP REVIEW PACKET POST OP CARE Fluids What percent of total body water does each compartment (extracellular, intracellular, interstitial, intravascular) make up? What are the electrolyte compositions of NS, LR, Plasmalyte A? Na Cl K HCO3 Ca Mg ph NS LR Plasmalyte A Calculate the amount of fluid required for a patient who is NPO Which patients should not receive K? Nutrition What is the order of return of bowel function? Calculate the caloric and protein needs for a patient. How is nutritional status evaluated? Medical complications What medical complications must always be considered in a crashing patient? How is hyperkalemia managed? Surgical complications What surgical complication should always be on the differential diagnosis? What surgical complication must always be suspected with any abdominal surgery? What are the common causes of postoperative fever? What work up should be done? How are wound infections managed? Describe common risk factors for poor wound healing. Physical exam What is the most important part of the physical exam? What are the three important physical exam findings you should assess on each pt? What other key aspects of the physical exam should you know?

2 ABDOMINAL PAIN What is the most important part of assessing a patient with abdominal pain? What should you do even before making a diagnosis? What are some techniques for creating a solid differential diagnosis? Define peritonitis. What are important causes of abdominal pain in the following locations? RUQ Epigastrium LUQ RLQ Lower abd LLQ What are important causes of abdominal pain that can occur anywhere in the abdomen? What diagnosis should you always suspect in anyone with abdominal pain? What are some diagnoses of exclusion? What additional exam should always be done on patients with abdominal pain? Describe the classic presentation of acute appendicitis? What is McBurney s point? Describe the Psoas / Obturator / Rovsings signs. What are the most common causes of small bowel obstruction? What are the most common causes of large bowel obstruction? What specific causes should you consider in patients with prior gastric bypass surgery? What specific causes should you consider in infants or kids? How is ectopic pregnancy diagnosed & treated?

3 Describe and differentiate the different biliary causes of abdominal pain. Cholelithiasis Biliary Colic Acute Cholecystitis Choledocholithiasis Cholangitis History Exam Labs Ultrasound Treatment What is the management of incidentally discovered gallstones? What is Charcot s triad? Reynold s pentad? What are the ultrasound findings suggesting acute cholecystitis? Next step if ultrasound is not diagnostic? Differential diagnosis for painless jaundice? Describe the management of diverticulitis. What is the most common type of inguinal hernia? GI BLEED List the causes of upper GI bleeding. Describe the steps in management of acute UGI bleeding. What other treatment is important in patients with PUD? List the causes of lower GI bleeding. Describe the steps in management of acute LGI bleeding.

4 TRAUMA What is the trimodal distribution of death from trauma? What are the causes of immediate death (seconds to minutes)? What are the causes of early death (minutes to hours)? What are the causes of late death (days to weeks)? What are the goals of prehospital care? Describe what is assessed in each step of the ABCs of the primary survey? How is GCS calculated? Intubate if GCS less than what? What should always be ruled out in patients with altered mental status? How can you estimate a patient s blood pressure? What imaging is performed in all patients immediately after primary survey? List the thoracic injuries that can be immediately lethal. What are the indications for surgery for PTX / HTX? Most worrisome aspect of flail chest? How are blunt aortic injuries managed? What is Beck s triad? Treatment for pericardial tamponade? What are the different zones of the abdomen? Best abdominal imaging study in hemodynamically unstable patient? Most common solid organ injured with blunt trauma? What treatment must patients receive after splenectomy? What is the most common cause of death from trauma? What is Cushing s triad? Which has a worse prognosis, epidural hematoma or subdural hematoma? What medical interventions can help minimize secondary brain injury?

5 What is the normal systolic BP in kids? Femoral neck fractures are at risk for what? Severely injured extremities are at risk for what? What are the signs/symptoms of this condition? What patient s need a retrograde urethrogram? What is the lethal triad? CRITICAL CARE What are the different ventilator control variables? What are the different modes of ventilation? What other parameters can be controlled? Criteria for diagnosis of ARDS? Goal TV in ARDS management? What is shock? Define the following: SIRS, sepsis, severe sepsis, septic shock, multiple organ failure. What are the different types of shock and the associated changes in cardiac output, CVP, and systemic vascular resistance? Type of Shock CO CVP SVR What is unique about cardiogenic shock? How are the daily caloric needs for a patient calculated? How is nutritional status assessed? How is osmolarity calculated? What are the best indicators of acute renal failure?

6 SURGICAL ONCOLOGY List the most common cancers and the leading causes of cancer death in the US. Breast What are the risk factors for breast cancer? What are the different types of tumors/cancers? What is BIRADS? What are the best imaging modalities for breast disease? Define the following terms: -Lumpectomy -Mastectomy -Breast conservation therapy (BCT) -Sentinel lymph node biopsy (SLNB) -Axillary lymph node dissection (ALND) What is the difference between total mastectomy, modified radical mastectomy (MRM), & radical mastectomy? Which patients should receive chemotherapy? What is meant by ER+, PR+, HER-2/neu+? How do they affect prognosis and treatment? What is tamoxifen and who should receive it? How about Herceptin? Which factors are the most important in predicting survival? To what sites does breast cancer metastasize? Colorectal What is the lifetime risk of colon cancer? What are the guidelines for colorectal cancer screening? What are the different types of adenomatous polyps & their risk of malignancy? Name the inherited syndromes that cause colon cancer. What tumor marker is often elevated in colorectal cancer? To what sites does colon cancer metastasize? How is anal cancer different than colorectal cancer in terms of treatment?

7 Skin What is the most common type of skin cancer? Describe the appearance of the major skin cancers. -BCC -SCC -Melanoma What are the most important prognostic factors in melanoma? Endocrine Describe the different types of thyroid cancer. What are the causes of primary hyperparathyroidism? What tumors are associated with multiple endocrine neoplasia syndrome (MEN) I? MEN 2A? MEN 2B? What is the most common cause of Cushing s syndrome? Cushing s disease? How is the location of the tumor determined? How are adrenal incidentalomas managed? How are pheochromocytomas diagnosed? Treated? What is the rule of 10s for pheochromocytoma? Misc How do patients with extremity sarcomas typically present? How are sacromas treated? Name the risk factors for esophageal cancers. What is the most common malignant lesion found in the liver? VASCULAR SURGERY Peripheral arterial disease Describe the arterial anatomy of the lower extremity. How do you calculate an ABI? What are the key values to know? What is unique about diabetic patients? What is the difference between a pulse and a Doppler signal? What is claudication? What is the characteristic history given by patients? What is the natural history of claudication? Amputation rate at 5 years? How should claudication be managed?

8 What are the signs & symptoms of extremity ischemia? Why do patients with chronic extremity ischemia do better than healthy patients when an acute arterial occlusion occurs? Determine the etiology of lower extremity wounds based on location. Aneurysms Popliteal artery aneurysms cause what complication? What should always be ruled out in patients with a popliteal artery aneurysm? What patients should be screened for AAA? What test is used for screening? What are the annual rupture rates of AAA based on size? When should AAA repair be offered? Cerebrovascular disease What are the specific signs & symptoms of a stroke? What are the indications for carotid endarterectomy? Venous disease Describe Virchow s triad. Describe the management of venous stasis wounds. BARIATRIC SURGERY Draw a roux-en-y gastric bypass. What are the indications for bariatric surgery? Name some comorbidities that are improved after surgery. How effective is bariatric surgery at achieving weight loss? What are the two different mechanisms by which bariatric surgery causes weight loss? What are potential post op complications? What is dumping syndrome? Why are these patients at increased risk for cholecystitis?

9 CARDIOTHORACIC SURGERY What life threatening conditions must always be on the differential diagnosis for chest pain? What are some of the serious complications associated with thoracic or abdominal aortic dissection? What are the indications for CABG? What is the most common mediastinal tumor? What is the most common congenital heart defect? What is the most common valve lesion? What are the two types of replacement valves? How do the anticoagulation requirements differ and why? What paraneoplastic syndromes are associated with lung cancer? To what sites does lung cancer metastasize? What cancers metastasize to the lungs? PEDIATRIC SURGERY What is the differential diagnosis for bilious emesis in a newborn? Describe the embryologic pathology of malrotation. What is midgut volvulus? What is a Ladd procedure? How does pyloric stenosis present and how is it managed? What chromosomal defect is associated with duodenal atresia? How does intussusception present? What is the etiology? How is it managed? What is the rule of 2 s for Meckel s diverticulum? How does this present? What is the #1 cause of an acute abdomen in kids? How is biliary atresia managed? What are the differences between omphalocele and gastroschisis? What patients are at increased risk of inguinal hernias? When should umbilical hernias be repaired?

10 What is the most common solid abdominal malignancy in kids? What is the most common type of TEF? How does it present? What is it associated with? TRANSPLANT SURGERY What are the general contraindications to transplantation? What are the two major concerns after a transplant? What are the different types of rejection? What are the approximate patient survival rates after different types of transplants? What are the most common causes of chronic renal failure? What is the most common cause of liver failure requiring transplant?