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5 Written Questions

5 Matching Questions

  1. ADH on needle core. MNGT?
  2. 15yF with elevated serum Ca, low serum phosphate. DDx. MNGT?
  3. 16yM with unilateral scrotal swelling. Is this tumor likely to increase, decrease, or no change to testosterone?
  4. Tx for Meckel's diverticulum?
  5. 35yM with HPI epigastric pain alleviated with food, now CC acute abdomen. CXR and KUB show no free air on upright films. MNGT?
  1. a primary vs FHH, PTH, 24hr urine, (
    •FHH, or familial benign hypercalcemia, is a rare condition
    characterized by asymptomatic or mildly symptomatic hypercalcemia. It
    is inherited as an
    *autosomal dominant trait and the
    *parathyroid glands are usually normal in size.
    The basis for the development of FHH appears to be mutations in the
    calcium-sensing receptor gene which regulates the parathyroid gland
    set point and modulates the extracellular calcium concentration. The
    condition may be mistaken for primary hyperparathyroidism because, in
    both conditions, the
    *serum calcium and
    *parathyroid hormone levels are elevated with a
    *concomitant low serum phosphate.
    •The distinction is made by obtaining a
    *24-hour urine calcium excretion level.
    *In patients with FHH, the urine calcium level is low,
    *whereas in primary hyperparathyroidism the level is high.)
  2. b excisional bx (
    As such, if a core biopsy demonstrates evidence for
    •atypical ductal hyperplasia, the standard of care is to
    ***proceed with an excisional biopsy to establish the diagnosis. )
  3. c CT abd, pelvis, (

    •If the plain films did not demonstrate free air and the patient
    remained hemodynamically stable, a
    ***CT scan of the abdomen and pelvis may be indicated to try to make
    the diagnosis.)
  4. d resection
  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. chest tube, NPO, TPN, 7dys, ligation, (
    •Aspiration of an odorless, milky fluid from the chest cavity is
    diagnostic, although increased lymphocyte counts and triglyceride
    levels in the fluid help confirm the diagnosis.
    •Normal chyle flow is around 2 L a day. Therefore, a chylous leak can
    result in nutritional depletion as well as decreased systemic
    lymphocytes to fight infection.

    •The first therapy is
    ***placement of a chest tube to drain the chyle and to allow for
    approximation of the lung against the mediastinum.
    ***Stopping oral intake and starting
    ***total parental nutrition is usually tried
    ***for 7-10 days to see if there is spontaneous resolution of the

    •If conservative measures fail,
    ***ligation of the thoracic duct can be performed.)
  2. mesenteric ischemia (
    Severe abdominal pain is the hallmark presentation of
    • acute mesenteric ischemia.)
  3. malnutrition, obesity, diabetes, uremia, malignancy, immunology, steroids, infection, coughing, NOT running stitch, (
    • Malnutrition,
    • obesity,
    •immunologic abnormalities,
    • steroid use,
    •infection, and
    •coughing, which increases intraabdominal pressures are all factors that
    increase the risk of wound dehiscence.

    Technical factors are also very important in preventing the
    dehiscence, but there is no proof that interrupted sutures are better
    than a running stitch for fascial closure.)

  4. consider barbiturate coma, craniectomy, (
    Additionally, if the ICP
    is refractory to these interventions, it is reasonable to consider a
    *barbiturate coma or potentially a
    *decompressive craniectomy.
    *Hyperventilation is used only in the acute setting to keep PaCO 2
    around 35 mmHg, which functions to decrease intracranial pressure by
    decreasing intracranial blood volume through vasoconstriction.)
  5. reverse Trandelenberg, head 30 degrees, ventricular catheter, mannitol, hyperventilation, (
    The management of
    •elevated intracranial pressure following traumatic injury has been
    extensively studied. Several interventions have been shown to be of
    benefit in the acute setting. The pressure can be relieved through
    mechanical means such as
    *elevating the head of the bed to 30 degrees or by
    *direct drainage of cerebrospinal fluid via a ventricular catheter.
    *Administration of a hyperosmotic solution such as mannitol can
    decrease intracranial pressure by reducing brain water, increasing
    plasma volume and reducing blood viscosity. )

5 True/False Questions

  1. Acute arterial occlusion, MNGT?mammogram


  2. Signs of liver failurethrough 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.)


  3. Complications of mastectomyall breast, LN, preserve pec major, same survival, (
    The Halsted radical mastectomy involves removal of all breast tissue, lymphadenectomy, and removal of the pectoralis major. The modified radical mastectomy preserves the pectoralis major muscle thus decreasing the morbidity of the surgery with the same survival. The modified radical mastectomy does include a lymph node dissection. 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. Dukes Colon Cancer Staging1 submucosa, 2 muscularis, 3 serosa, 4 contiguous, (
    Stage I T1 - invades submucosa
    T2 - invades muscularis propria
    Stage II T3 - invades through muscularis propria
    into subserosa
    T4 - invades into contiguous organs
    Stage III Any T with presence of positive lymph
    Stage IV Distant metastatic disease present)


  5. On precordial auscultation, crackles are heard. DDxendoscopy, swallow study water sol, primary repair, (
    ***Diagnosis is often made after clinical suspicion by endoscopy or a
    swallow study with water-soluble contrast. If diagnosed early within
    24 hours, a primary repair is the first approach to treatment.
    Closure is dependent on the amount of infected or necrotic tissue,
    tension on the anastomosis, etiology of the perforation, and the
    ability to adequately drain the contaminated areas. Late perforations
    may be complicated in their management, requiring several procedures
    or diversion to provide for adequate healing.)


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