5 Written questions
5 Matching questions
- MCC of mesenteric ischemia
- Deceleration injury. Most common damage to aorta?
- 15yF with elevated serum Ca, low serum phosphate. DDx. MNGT?
- 45yM s/p liver txt, hypoglycemia, coagulopathy, elevated ammonia, hyperkalemia, oliguria. MNGT?
- Indirect Hernia
- a embolus, SMA, (
embolic event to the SMA)
- b 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,
- c through 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.)
- d 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.)
- e 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.)
5 Multiple choice questions
- us, intra malignant, extra b9, (
• Testicular cancer is the most common malignancy in men between the ages of 15 and 35.
* It typically presents as unilateral scrotal swelling. On examination, it is important to distinguish
* intraparenchymal masses usually malignant from
* extraparenchymal masses usually benign.
* This is easily done with scrotal ultra-sound.)
- vasopressin, octreotide, (
The second step is to control the source of bleeding. Medical
management may include
*vasopressin or octreotide.)
- eso varices, gastritis, duodenal ulcer, (
In patients with liver failure, the •source of an upper GI bleed is
*esophageal varices in 50%,
*gastritis in 30%, and
*duodenal ulcers in only about 10%.
Esophageal variceal bleeding is a potentially fatal complication of
- 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
- Mannitol, herniation, (
This patient has evidence of a severe head injury. The initial step
should be to protect his airway and prevent hypoxia, which could
adversely affect his head injury. Thus, the initial step should be
endotracheal intubation. Mannitol is indicated in patients with
evidence of herniation, such as those with pupillary dilatation.)
5 True/False questions
Palpable breast lesion. MNGT → 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. )
MCC location of Meckel's diverticulum? → 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)
40yF with preop for elective gynecological surgery, demonstrates cholelithiasis on Xray, no evidence of RUQ pain nor inflammation. MNGT → FHH med, primary surgery (
•The distinction is important, as patients with primary
hyperparathyroidism benefit from surgery and those with FHH do not.)
35yF s/p cholecystectomy for cholelithiasis, histology shows incidental gallbladder carcinoma. MNGT? → submucosa none, muscularis radical lymph, hepatic resection, (
The management of these patients is based on the depth of tumor penetration into the wall of the gallbladder. No further surgical intervention is required if the tumor invades superficially into the
mucosa and submucosa. These patients are placed on surveillance programs. However, if the lesion penetrates deeper into the muscularis or perimuscular connective tissue of the gallbladder wall, a radical second procedure is undertaken which includes radical lymphadenectomy
and partial hepatic resection.
If a malignancy is identified at the time of initial surgery, removal
of the regional lymph nodes, partial liver resection and, in some
cases, pancreaticoduodenectomy are indicated.)
Tx for Meckel's diverticulum? → vitelline, omphalomesenteric, antimesenteric, gastric mucosa, (
***remnant of the vitelline or omphalomesenteric duct and are found
***antimesenteric side of the ileum. They often
***contain ectopic gastric mucosa.
***Acid secretion from this leads to ileal ulceration and bleeding. )