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5 Written questions

5 Matching questions

  1. 16yM with unilateral scrotal swelling. Is this tumor likely to increase, decrease, or no change to testosterone?
  2. 65yM s/p gastrectomy presents with abdominal pain, N/V, palpitations. MNGT
  3. 21yM in MVA has laceration to aorta. Dx test
  4. Dukes Colon Cancer Staging
  5. 16yM with unilateral scrotal swelling. Scrotal ultrasound demonstrates intraparenchymal mass. MNGT
  1. a CT, chest, abd, pelvis, serum hcg, afp, ldh, radical orchiectomy, (
    Upon the diagnosis of an intraparenchymal testicular mass, a
    • staging CT scan of the chest, abdomen, and pelvis should be obtained.
    • It is reasonable to evaluate the serum levels of beta-HCG and AFP as they may be elevated in 80-85% of patients with nonseminomatous
    germ cell tumors.
    • LDH, on the other hand, can be elevated in patients with seminomas and can be of prognostic significance.

    • Finally, if elevated, these serum markers can serve as a means to monitor the presence of residual disease and should be measured after resection of the tumor.

    Additionally, the mass should be
    • excised in order to establish a histologic diagnosis.
    • A radical orchiectomy should be performed from an inguinal approach.
    • Less invasive approaches such as biopsies or a scrotal approach to the tumor should be avoided as they can alter the lymphatic drainage and potentially adversely affect overall outcomes.)
  2. b Dukes, A bowel ball, B serosa or fat, C regional LN, D distant, (
    Dukes originally proposed a staging classification for colon cancer.
    ***Dukes' A lesions are confined to the bowel wall,
    ***Dukes' B lesions extend beyond the wall involving the serosa or
    fat, and
    ***Dukes' C lesions have accompanying regional lymph node
    involvement. TNM staging is now probably the most widely used system
    for staging.)
  3. c small, low carb, cholestyramine, no ppi, (
    These symptoms can be managed by
    *eating small, low carbohydrate meals throughout the day.
    •Postvagotomy diarrhea is related to the
    *rapid transit of unconjugated bile salts and is effectively
    *treated with cholestyramine.
    * [NOT] Proton pump inhibitors are not a useful therapy for alkaline reflux.)
  4. d CXR, widened mediastinum, CT, aortogram, (

    •Diagnosis is difficult, but is suggested by a
    *widened mediastinum on chest x-ray and
    *confirmed with a CT scan of the chest
    *or an aortogram.)
  5. e Leydig, androblastoma, incr testosterone, (
    The majority of testicular tumors occurring in young adults are malignant tumors. The tumors may originate from germinal or nongerminal cells. Approximately 95% of testicular tumors are germinal tumors. These include seminomas -the most common-, embryonal cell carcinomas, choriocarcinomas, and teratocarcinomas. On the other hand,
    • Leydig cell tumors and androblastomas originate from nongerminal cells and may
    • produce excess testosterone.

    Benign tumors such as fibroma can occur but are rare.)

5 Multiple choice questions

  1. needle core (
    The management of a breast lesion has become more complex as our
    knowledge regarding breast cancer development and treatment has
    continued to grow.
    •The gold standard for evaluation of a suspicious lesion on mammogram
    is a core needle biopsy.)
  2. liver failure, new txt, (
    •Signs of liver dysfunction include
    ***hypoglycemia as the liver is unable to perform gluconeogenesis,
    ***coagulopathy with elevated prothrombin times,
    ***elevated ammonia levels,
    ***acid-base changes unable to clear lactate via the Cori cycle,
    ***hyperkalemia, and
  3. bridging veins, (
    •Subdural hemorrhages typically have a
    *crescent shape and
    *extend across suture lines covering the entire surface of one hemisphere. These are usually the result of the
    *disruption of bridging veins.
    •Epidural hematomas on the other hand have a
    *biconvex lens appearance on CT scan. They typically develop after an
    *injury to the middle meningeal artery.)
  4. fluid, coags, blood, (
    The initial
    •management should include
    * fluid resuscitation and
    *replacement of blood and clotting factors as needed.)
  5. carcinoma (20% incidence of gallbladder carcinoma. Signs and symptoms of carcinoma of the gallbladder are generally indistinguishable from those associated with cholecystitis and
    cholelithiasis. They include abdominal discomfort, right upper
    quadrant pain, nausea, and vomiting. )

5 True/False questions

  1. Zollinger-Ellison syndrome triadthrough int inguinal ring, in spermatic cord, (
    A direct hernia comes through the medial inguinal canal floor and is
    found behind the spermatic cord. An indirect hernia passes though the
    internal inguinal ring, and thus can be found within the spermatic
    cord. The spermatic cord also contains the vas deferens, the
    testicular artery, lymphatics, and nerve fibers.)


  2. 18yoM with thin tall habitus has spontaneous pneumothorax repaired on left side. Where is recurence likely to occur?ipsilateral (50% recur)


  3. Tx for peripheral arterial occlusive diseaseheparin, catheter embolectomy, no arteriogram, no duplex, (
    •Acute arterial occlusion is a surgical emergency. However, the most
    important intervention is
    *immediate heparinization.
    The infusion of heparin will help prevent extension of the clot.
    Furthermore, it will help to keep collateral vessels open. If the
    patient is stable enough to undergo operative intervention, a
    *catheter embolectomy would be the procedure of choice.
    Physical examination findings including vascular examination and level
    of temperature change and altered sensation can help identify the
    level of the occlusion prior to operative intervention.
    *Duplex ultrasound is NOT necessary to isolate the occlusion.
    *Arteriograms are more useful in the OR following the embolectomy.
    •Finally, if small vessel occlusion occurs,
    *catheter-directed thrombolytics can help restore distal perfusion.
    Once perfusion to the threatened limb has been restored, the workup to
    identify the thromboembolic source should be obtained.
    •Typical sources for emboli include
    *atrial thrombus,
    *valvular disease,
    *aortic aneurysms, or
    *iliac artery atherosclerotic disease.)


  4. 45yM s/p liver txt POD #2, rising AST/ALT. MNGT?reassurance (

    All liver transplant patients have an initial rise in transaminases
    which should decrease over the first 48 hours. )


  5. Tx for thyroid whose bx is amyloidtotal thyroidectomy, no radioactive iodine, (
    total thyroidectomy is the treatment of choice.
    •Modified radical neck dissection is indicated in patients with
    ***palpable lymphadenopathy and in patients with
    ***tumors larger than 2 cm since 60% of these patients will have
    lymph node involvement
    Because medullary carcinoma originates from the thyroid C-cells, they
    ***do not respond to thyroxine
    ***or radioactive iodine therapy.)


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