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5 Written questions

5 Matching questions

  1. 14yM nonfocal physical exam and VSS, HPI "concussion while skiing, and blacked out". head CT with crescent shape bright lesion. Etiology?
  2. Significance of atypical ductal hyperplasia
  3. 18yM with thin habitus, presents with spontaneous pneumothorax. MNGT
  4. Spinal cord cut at C6 (quadriplegia). What is intact?
  5. criteria for Glasgow Coma Scale
  1. a chest tube, pain, o2, serial CXR, thoracotomy, bleb resection, (
    Spontaneous pneumothorax is usually found in young males. A tall, thin habitus is common. Eighty-five percent of patients are found to have
    pulmonary blebs on the affected side.
    •The correct management is
    *placement of a chest tube,
    *pain control,
    *oxygen supplementation, and
    *serial chest x-rays to monitor resolution.
    *Thoracotomy is required if the pneumothorax does not resolve with a
    chest tube or if there is a persistent air leak.
    *Bleb resection and
    *pleurodesis is usually performed at the time of operation to prevent
    future bleb rupture and to promote adhesion of the lung to the chest
    wall.
    *Thoracotomy is also offered to patients after a recurrence to prevent
    future episodes.
    •Fifty percent of patients will have a recurrence on the ipsilateral side after a spontaneous pneumothorax.)
  2. b eye, motor, verbal, 8 coma, (

    •The Glasgow Coma Scale is
    ***used to quantify a neurologic examination in patients with a head
    injury.
    It is based on three elements:
    ***eye opening,
    ***motor response, and
    ***verbal response.
    The total score ranges from 3 worst to 15 best with a
    ***score of 8 or lower indicating a coma.


    GLASGOW COMA SCALE
    Score
    Eye opening
    Spontaneous 4
    To speech 3
    To pain 2
    None 1

    Motor response
    Obeys commands 6
    Localizes pain 5
    Withdraws to pain 4
    Abnormal flexion decorticate 3
    Extension decerebrate 2
    None flaccid 1

    Verbal response
    Oriented 5
    Confused conversation 4
    Inappropriate words 3
    Incomprehensible sounds 2
    None 1)
  3. c on needle core, 20% DCIS (
    A diagnosis of atypical ductal hyperplasia cannot be established on
    core biopsy alone. Studies have demonstrated that nearly 20% of
    patients with this diagnosis on core biopsy go on to have evidence of
    ductal carcinoma in situ or invasive ductal carcinoma after excisional
    biopsy.)
  4. d 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.)
  5. e 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.)

5 Multiple choice questions

  1. 2ft ileocecal, (

    ***2 ft of the ileocecal valve. )
  2. 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. )
  3. vasopressin, octreotide, (
    The second step is to control the source of bleeding. Medical
    management may include
    *vasopressin or octreotide.)
  4. technetium pertechnetate, (
    • diagnosed using
    ***nuclear medicine scans technetium pertechnetate
  5. ZES (
    •The Zollinger-Ellison syndrome was described in 1955, in two patients with the
    triad of
    *gastroduodenal ulcerations,
    *gastric hypersecretion, and
    *nonbeta islet cell tumors of the pancreas.)

5 True/False questions

  1. 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.)

          

  2. 21yF with breast lump. Core bx dx is LCIS. MNGTrelax 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.)

          

  3. 76yM alcoholic with hematemesis. Endoscopy reveals duodenal ulcer. Sclerotherapy, tamponade, banding fails to control bleeding. MNGTTIPS, portal shunt, (
    If endoscopic methods are ineffective, or the patient has numerous
    recurrences,
    •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.)

          

  4. 76yM alcoholic with hematemesis. Undergoes portal shunt. What types used for stable patient for recurrent episodes?mesocaval, splenorenal, (
    *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.)

          

  5. 35yM with HPI epigastric pain alleviated with food, now CC acute abdomen. BP 90/60, pt is derilious and toxic appearing. MNGT?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.)

          

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