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5 Written questions

5 Matching questions

  1. 65yM s/p gastrectomy presents with abdominal pain, N/V, palpitations. Physiology?
  2. Risk factors for dehiscence
  3. 73yM with rectal cancer, mobile, nonulcerated, 5 cm from anal verge, 4cm circumference, 3 cm in diameter, U/S shows T1 stage. MNGT?
  4. 21yM in MVA has laceration to aorta. Dx test
  5. modified radical mastectomy
  1. a all 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. )
  2. b 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.)
  3. c malnutrition, obesity, diabetes, uremia, malignancy, immunology, steroids, infection, coughing, NOT running stitch, (
    • Malnutrition,
    • obesity,
    •diabetes,
    •uremia,
    •malignancy,
    •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.)

    ••••••••[testicle]
  4. d hyperosmolar, unconjugated bile salts, (vagotomy leads to dumping syndrome, hyperosmolar emptying into small intestine)
  5. e transanal Excision, adjuvant chemo, (
    •Local treatment of rectal cancer
    ***is the treatment of choice in selected individuals with low-lying
    rectal cancers. The lesion must be
    -mobile,
    -nonulcerated,
    -within 10 cm of the anal verge,
    -less than 3 cm in diameter,
    -less than one-fourth the circumference of the rectal wall, and
    -stage T1 or T2 on endorectal ultrasound.

    Transanal excision is the most straightforward technique of local treatment. It entails full thickness excision of the lesion into the perirectal fat with adequate margins. For early lesions into the
    submucosa only (T1),
    ***no adjuvant therapy is required unless poor prognostic features are
    present on final pathology (poorly differentiated or lymphatic/
    vascular invasion).
    • If the lesion penetrates the muscular wall (T2),
    ***adjuvant radiation therapy with or without chemotherapy is
    indicated following surgical removal.

    •Overall, the disease free survival rate is 80%.)

5 Multiple choice questions

  1. decel, distal to left subclavian at 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.)
  2. Asx, GI bleed, (
    •Meckel's diverticuli are usually found incidentally, although they
    can present with
    ***painless lower GI bleeding or
    ***inflammation
    ***confused with acute appendicitis. They are usually found within)
  3. 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. )
  4. mammogram
  5. ulcer, gastrin, pancreas, (
    •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. 71yM with hematemesis, hematochezia, history of ETOH detox. DDx? How do you distinguish?eso varices, duod perf, tic, AAA, hypotension, pain, distention, liver disease, (
    1. posterior perforation of a duodenal ulcer that has eroded into the gastroduodenal artery causing bleeding per rectum, tachycardia, and hypotension.
    2. Diverticulosis is a common cause of bright red blood per rectum in elderly patients but is often
    painless.
    3. A ruptured AAA generally presents with hypotension and profound shock. A distended abdomen and pulsatile mass can be found on physical examination.
    4. Ruptured esophageal varices present with upper GI bleeding and hematemesis and are most often associated with patients who have chronic liver disease.)

          

  2. Tx for Meckel's diverticulum?resection

          

  3. Tx for peripheral arterial occlusive diseaseheparin, catheter embolectomy, no arteriogram, no duplex, (
    •Acute arterial occlusion is a surgical emergency. However, the most
    important intervention is
    *immediate heparinization.
    The infusion of heparin will help prevent extension of the clot.
    Furthermore, it will help to keep collateral vessels open. If the
    patient is stable enough to undergo operative intervention, a
    *catheter embolectomy would be the procedure of choice.
    Physical examination findings including vascular examination and level
    of temperature change and altered sensation can help identify the
    level of the occlusion prior to operative intervention.
    *Duplex ultrasound is NOT necessary to isolate the occlusion.
    *Arteriograms are more useful in the OR following the embolectomy.
    •Finally, if small vessel occlusion occurs,
    *catheter-directed thrombolytics can help restore distal perfusion.
    Once perfusion to the threatened limb has been restored, the workup to
    identify the thromboembolic source should be obtained.
    •Typical sources for emboli include
    *atrial thrombus,
    *valvular disease,
    *aortic aneurysms, or
    *iliac artery atherosclerotic disease.)

          

  4. 41yM with severe pain in left hip joint. MNGTheparin, catheter embolectomy, no arteriogram, no duplex, (
    •Acute arterial occlusion is a surgical emergency. However, the most
    important intervention is
    *immediate heparinization.
    The infusion of heparin will help prevent extension of the clot.
    Furthermore, it will help to keep collateral vessels open. If the
    patient is stable enough to undergo operative intervention, a
    *catheter embolectomy would be the procedure of choice.
    Physical examination findings including vascular examination and level
    of temperature change and altered sensation can help identify the
    level of the occlusion prior to operative intervention.
    *Duplex ultrasound is NOT necessary to isolate the occlusion.
    *Arteriograms are more useful in the OR following the embolectomy.
    •Finally, if small vessel occlusion occurs,
    *catheter-directed thrombolytics can help restore distal perfusion.
    Once perfusion to the threatened limb has been restored, the workup to
    identify the thromboembolic source should be obtained.
    •Typical sources for emboli include
    *atrial thrombus,
    *valvular disease,
    *aortic aneurysms, or
    *iliac artery atherosclerotic disease.)

          

  5. 18yM with thin habitus, presents with spontaneous pneumothorax. MNGTprimary 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.)

          

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