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5 Written questions

5 Matching questions

  1. MCC location of Meckel's diverticulum?
  2. 25yM with head injury during ski accident, with pupillary dilatation. Likely tx?
  3. 71yM with hematemesis, hematochezia, history of ETOH detox. DDx? How do you distinguish?
  4. 16yM with unilateral scrotal swelling. DDx. Initial MNGT
  5. 76yM alcoholic with hematemesis. MNGT
  1. a 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. b fluid, coags, blood, (
    The initial
    •management should include
    * fluid resuscitation and
    *replacement of blood and clotting factors as needed.)
  3. c 2ft ileocecal, (

    ***2 ft of the ileocecal valve. )
  4. d 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.)
  5. e 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 Multiple choice questions

  1. through inguinal canal, behind 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.)
  2. 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.)
  3. 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.)
  4. vasopressin, octreotide, (
    The second step is to control the source of bleeding. Medical
    management may include
    *vasopressin or octreotide.)
  5. 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

  1. 45yM s/p liver txt, hypoglycemia, coagulopathy, elevated ammonia, hyperkalemia, oliguria. MNGT?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,
    ***hyperkalemia, and
    ***oliguria.

          

  2. criteria for Glasgow Coma Scalewinged scapula, thoracodorsal nerve, lymphedema, (
    The surgeon must identify the thoracodorsal nerve and the long thoracic nerve, which inner-vate the latissimus dorsi muscle and the serratus anterior muscle, respectively. Damage to the long thoracic nerve results in a "winged scapula." After a complete dissection of level I, II, and III lymph nodes, the use of radiation therapy needs to be critically evaluated because of the long-term morbidity of lymphedema.)

          

  3. Deceleration injury. Most common damage to aorta?winged scapula, thoracodorsal nerve, lymphedema, (
    The surgeon must identify the thoracodorsal nerve and the long thoracic nerve, which inner-vate the latissimus dorsi muscle and the serratus anterior muscle, respectively. Damage to the long thoracic nerve results in a "winged scapula." After a complete dissection of level I, II, and III lymph nodes, the use of radiation therapy needs to be critically evaluated because of the long-term morbidity of lymphedema.)

          

  4. Colonoscopy. Polyp histology is villous adenoma. MNGT?hemicolectomy (
    • formal right hemicolectomy is indicated due to the high probability
    of finding cancer in the specimen. A lesser operation, such as open or
    laparoscopic polypectomy, would then require a second operative
    procedure if cancer is present.)

          

  5. Colon Cancer staging1 submucosa, 2 muscularis, 3 serosa, 4 contiguous, (
    Stage I T1 - invades submucosa
    T2 - invades muscularis propria
    Stage II T3 - invades through muscularis propria
    into subserosa
    T4 - invades into contiguous organs
    Stage III Any T with presence of positive lymph
    nodes
    Stage IV Distant metastatic disease present)

          

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