5 Written questions
5 Matching questions
- 45yM s/p liver txt, hypoglycemia, coagulopathy, elevated ammonia, hyperkalemia, oliguria. MNGT?
- On precordial auscultation, crackles are heard. MNGT?
- Spinal cord cut at C6 (quadriplegia). What is intact?
- HPI of Meckel's diverticulum?
- Tx for Meckel's diverticulum?
- a resection
- 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 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.)
- d 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)
- e endoscopy, swallow study water sol, primary repair, (
***Diagnosis is often made after clinical suspicion by endoscopy or a
swallow study with water-soluble contrast. If diagnosed early within
24 hours, a primary repair is the first approach to treatment.
Closure is dependent on the amount of infected or necrotic tissue,
tension on the anastomosis, etiology of the perforation, and the
ability to adequately drain the contaminated areas. Late perforations
may be complicated in their management, requiring several procedures
or diversion to provide for adequate healing.)
5 Multiple choice questions
- 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.)
- 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. )
- b9, risk to b/l breasts, tamoxifen, (
•LCIS is a benign diagnosis and alone does not have a risk of
progression to an invasive cancer.
•However, a diagnosis of LCIS does increase the risk for development
of future breast cancer at a rate of about 1% per year. It is
important to remember that the
*risk is increased for both breasts. It has been shown that
*chemo-prevention with tamoxifen can decrease the incidence of breast
cancer by 49%.
It is also sufficient to follow this population closely with
*annual mammograms and
*semiannual clinical examinations.
*Prophylactic bilateral mastectomies are an option and result in a 90% decrease in the risk of subsequent breast cancer.
Since a diagnosis of LCIS increases the risk of cancer in both breasts, a mastectomy of the affected side is insufficient treatment.)
- 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.)
- 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 True/False questions
21yM in MVA has laceration to aorta. Dx test → 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.)
On precordial auscultation, crackles are heard. DDx → 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.)
15yF with elevated serum Ca, low serum phosphate. Tx? → 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.)
76yM alcoholic with hematemesis. Bleeding controlled with octreotide. MNGT → endoscopy, sclerotherapy, banding, balloon tamponade, (
Once the patient is stabilized,
*endoscopic evaluation of the bleeding is crucial. It can be both
diagnostic and therapeutic.
•Endoscopic techniques for controlling hemorrhage can include
76yM alcoholic with hematemesis. Fluids and clotting factors administered. VSS. MNGT → 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