5 Written Questions
5 Matching Questions
- Dukes Colon Cancer Staging
- HPI of Meckel's diverticulum?
- Elevated intracranial pressure, MNGT
- 76yM alcoholic with hematemesis. Endoscopy reveals duodenal ulcer. Sclerotherapy, tamponade, banding fails to control bleeding. MNGT
- On precordial auscultation, crackles are heard. DDx
- a 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
***Dukes' C lesions have accompanying regional lymph node
involvement. TNM staging is now probably the most widely used system
- b Asx, GI bleed, (
•Meckel's diverticuli are usually found incidentally, although they
can present with
***painless lower GI bleeding or
***confused with acute appendicitis. They are usually found within)
- c 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. )
- d TIPS, portal shunt, (
If endoscopic methods are ineffective, or the patient has numerous
•portal shunts can be considered.
*TIPS have increased in popularity as a method for portal
decompression. This can be performed in the acute setting. Surgical
shunts are also an option, but are primarily reserved for stable
patients with recurrent bleeding episodes and
* not performed in an acutely unstable patient.
*Mesocaval shunts connect the SMV to the IVC in a variety of manners.
*Splenorenal shunts are actually the most common type of shunt.
*Nonselective shunts that completely divert portal blood flow from
the liver can actually INCREASE hepatic encephalopathy. Most surgeons
prefer selective shunts, which preserve a component of hepatic blood
flow and thus function. Synthetic graft material can be safely used to
create the shunts. Postoperative mortality is directly related to the
patient's preprocedure medical condition and degree of hepatic
failure i.e., Child class.)
- e eso perf, (
"Hamman's crunch" is precordial crackles heard on auscultation
that correlate with heart sounds in the setting of mediastinal
emphysema and is
•suggestive of esophageal perforation.
*** When present along with subcutaneous emphysema of the chest and
neck, pneumomediastinum from an esophageal perforation is the most
likely diagnosis. The most common cause of esophageal perforation is
iatrogenic, but it may be spontaneous (Boerhaave's syndrome) or
secondary to a malignancy or stricture.)
5 Multiple Choice Questions
- 2ft ileocecal, (
***2 ft of the ileocecal valve. )
- ZES (
•The Zollinger-Ellison syndrome was described in 1955, in two patients with the
*gastric hypersecretion, and
*nonbeta islet cell tumors of the pancreas.)
- revasc, smoking cessation, pentoxifylline, cilostazol, (
determined in part by the
*severity of the symptoms.
•Patients with limb-threatening ischemia, indicated by
***tissue necrosis, and
should be considered for revascularization.
•On the other hand, patients with intermittent claudication, usually
described as an "ache" in the calf, should first be managed
conservatively. This includes institution of
***lifestyle modifications such as
***walking programs, and
•medical therapy with
- mammograms, tamoxifen, bl mastectomy, (Once
this diagnosis has been confirmed,
***management decisions can be made including
1. close observation with frequent screening mammograms,
2. chemoprevention with tamoxifen, or
3. prophylactic bilateral mastectomy.
A unilateral mastectomy is not an option as a diagnosis of
•atypical ductal hyperplasia increases the risk of breast cancer in
- 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,
5 True/False Questions
Colonoscopy. Polyp histology is villous adenoma. MNGT? → hemicolectomy (
• formal right hemicolectomy is indicated due to the high probability
of finding cancer in the specimen. A lesser operation, such as open or
laparoscopic polypectomy, would then require a second operative
procedure if cancer is present.)
65yM with esophageal cancer undergoes esophagectomy. In chest cavity, odorless milky fluid is found. MNGT? → 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.)
Anal abscess. MNGT?. Location? Which antibiotic? → mammogram
Spinal cord cut at C6 (quadriplegia). What is intact? → 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
•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.)
MCC of mesenteric ischemia → embolus, SMA, (
embolic event to the SMA)