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5 Written questions

5 Matching questions

  1. 41yM with severe pain in left hip joint. MNGT
  2. 73yM with rectal cancer, mobile, nonulcerated, 5 cm from anal verge, 4cm circumference, 3 cm in diameter, U/S shows T1 stage. MNGT?
  3. MCC of mesenteric ischemia
  4. HPI of Meckel's diverticulum?
  5. 14yM nonfocal physical exam and VSS, HPI "concussion while skiing, and blacked out". MNGT
  1. a relax hip, ext rotate, flex, (
    The joint space is most relaxed when the
    *hip is flexed and externally rotated.
    This tends to be the least painful position for patients with
    •septic arthritis.)
  2. b Asx, GI bleed, (
    •Meckel's diverticuli are usually found incidentally, although they
    can present with
    ***painless lower GI bleeding or
    ***inflammation
    ***confused with acute appendicitis. They are usually found within)
  3. c head CT, subdural crescent across suture, epidural biconvex, (

    Severe head injuries are a frequent problem encountered in the field of trauma.
    *CT scans are the primary diagnostic modality used to evaluate patients with suspected head injuries. Elevated intracranial pressure is a frequent result of severe brain injury either from brain swelling or mass effect from expanding hematomas.
    •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. d transanal Excision, adjuvant chemo, (
    •Local treatment of rectal cancer
    ***is the treatment of choice in selected individuals with low-lying
    rectal cancers. The lesion must be
    -mobile,
    -nonulcerated,
    -within 10 cm of the anal verge,
    -less than 3 cm in diameter,
    -less than one-fourth the circumference of the rectal wall, and
    -stage T1 or T2 on endorectal ultrasound.

    Transanal excision is the most straightforward technique of local treatment. It entails full thickness excision of the lesion into the perirectal fat with adequate margins. For early lesions into the
    submucosa only (T1),
    ***no adjuvant therapy is required unless poor prognostic features are
    present on final pathology (poorly differentiated or lymphatic/
    vascular invasion).
    • If the lesion penetrates the muscular wall (T2),
    ***adjuvant radiation therapy with or without chemotherapy is
    indicated following surgical removal.

    •Overall, the disease free survival rate is 80%.)
  5. e embolus, SMA, (
    embolic event to the SMA)

5 Multiple choice questions

  1. FHH med, primary surgery (
    •The distinction is important, as patients with primary
    hyperparathyroidism benefit from surgery and those with FHH do not.)
  2. lift arm above head, shoulder flex, elbow flex, wrist extension, no elbow extension, (

    This patient should be able to perform any activity that requires
    innervation from C6 or above.
    •The biceps and deltoid are innervated by C5,
    *so he should be able to lift his arms above his head,
    *have shoulder flexion, and
    *elbow flexion.
    •C6 innervates the extensor carpi radialis, so
    *wrist extension should be preserved.
    •The triceps rely on C7, so he would
    *not be able to perform elbow extension.)
  3. technetium pertechnetate, (
    • diagnosed using
    ***nuclear medicine scans technetium pertechnetate
  4. hypercarbic, acidotic, decr venous return, incr afterload, elev diaphragm, limit 20mmhg, (
    Increasing abdominal pressures for
    •laparoscopic procedures has several systemic effects. By increasing
    the carbon dioxide,
    *patients become hypercarbic and acidotic.
    *There is decreased venous return and
    *increased after-load.
    *The peritoneum is distended and the
    *diaphragm elevated.
    In patients with normal cardiac function,
    *cardiac output is not affected
    until the abdominal pressures reach about 20 mmHg.)
  5. through inguinal canal, behind 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.)

5 True/False questions

  1. Tx for Meckel's diverticulum?technetium pertechnetate, (
    • diagnosed using
    ***nuclear medicine scans technetium pertechnetate

          

  2. 30yM with tumor in pancreas. If it is a gastrinoma, how do you localize it?indium, intraop us, (
    •These tumors are associated with MEN I.
    These tumors occur predominantly in the pancreas, duodenum, antrum,
    and peripancreatic lymph nodes, but can also occur at distant sites
    like the ovary. Isolated tumors are found in 50%, and multiple tumors
    in 50%, but there is a higher incidence of multiple tumors in MEN I.
    *Tumors are malignant in 50%, with
    *metastases to the regional lymph nodes and the
    *liver.
    Once the diagnosis has been established, tumor localization can be
    achieved with
    •indium-labeled octreotide scan,
    •CT with fine cuts through the pancreas,
    •ultrasound,
    •MRI, or
    •selective angiography.
    None of these tests are highly sensitive, and often the tumors are not
    localized until the time of exploration and intraoperative-directed
    ultrasonography.)

          

  3. Borders of modified radical mastectomysternum, subclavius, inframammary, lat dorsi, (
    The anatomic limits of the modified radical mastectomy include the sternum medially, the subclavius muscle superiorly, the inframammary fold inferiorly, and the latissimus dorsi muscle laterally. )

          

  4. Colon Cancer stagingDukes, 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.)

          

  5. Indirect Herniathrough inguinal canal, behind 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.)

          

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