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5 Written questions

5 Matching questions

  1. Most common location for extra adrenal pheochromocytoma
  2. ADH on excisional bx. MNGT
  3. 32yF preop for elective cholecystectomy shows calcified "porcelain" gallbladder. DDx?
  4. Colonoscopy. Most common finding on polyp biopsy.
  5. Thyroid biopsy with amyloid. DDx?
  1. a paraaortic (along the embryologic path of the adrenal gland.)
  2. b 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. c 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
    both breasts.)
  4. d ta, (
    •Villous adenoma is a premalignant condition. The incidence of
    carcinoma in a polyp depends on the histology type and size of the
    •Tubular adenomas are the most
    *common type of polyps 60-80%, but are the
    * least likely to harbor carcinoma less than 5% if smaller than 1 cm
    in diameter.
    •Villous adenomas are the least common type, but overall the
    *most likely to contain malignant foci 50% if greater than 2 cm in
  5. e medullary cancer (
    The needle biopsy revealing
    •amyloid makes the diagnosis of
    ***medullary thyroid cancer.)

5 Multiple choice questions

  1. 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.)
  2. all breast, LN, pec major, (

    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. )
  3. vasopressin, octreotide, (
    The second step is to control the source of bleeding. Medical
    management may include
    *vasopressin or octreotide.)
  4. 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. lig art ( •In deceleration injuries, laceration involving the aorta most frequently occurs just distal to the left subclavian artery at the level of the ligamentum arteriosum. This is where the aorta is fixed and thus more susceptible to shear forces. The tear may be complete or partial.)

5 True/False questions

  1. Tx for Meckel's diverticulum?vitelline, omphalomesenteric, antimesenteric, gastric mucosa, (
    ***remnant of the vitelline or omphalomesenteric duct and are found
    on the
    ***antimesenteric side of the ileum. They often
    ***contain ectopic gastric mucosa.
    ***Acid secretion from this leads to ileal ulceration and bleeding. )


  2. 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. )


  3. 35yM with HPI epigastric pain alleviated with food, now CC acute abdomen. CXR and KUB show no free air on upright films. 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.)


  4. 65yM s/p gastrectomy presents with abdominal pain, N/V, palpitations. Physiology?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.)


  5. 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.)


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