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5 Written questions

5 Matching questions

  1. 14yM nonfocal physical exam and VSS, HPI "concussion while skiing, and blacked out". head CT with crescent shape bright lesion. Etiology?
  2. 40yF with preop for elective gynecological surgery, demonstrates cholelithiasis on Xray, no evidence of RUQ pain nor inflammation. MNGT
  3. Tx for Meckel's diverticulum?
  4. 32yF preop for elective cholecystectomy shows calcified "porcelain" gallbladder. DDx?
  5. Most common location for extra adrenal pheochromocytoma
  1. a bridging veins, (
    •Subdural hemorrhages typically have a
    *crescent shape and
    *extend across suture lines covering the entire surface of one hemisphere. These are usually the result of the
    *disruption of bridging veins.
    •Epidural hematomas on the other hand have a
    *biconvex lens appearance on CT scan. They typically develop after an
    *injury to the middle meningeal artery.)
  2. b resection
  3. c reassurance unless risk, >2.5cm, sickle, diabetes, child, calcified wall, (
    The incidental finding is a gallstone within the gallbladder without evidence for inflammation.
    • For most patients with asymptomatic cholelithiasis, a cholecystectomy is not routinely performed.
    Only 20-30% of these patients will develop symptoms within 20 years.
    Moreover, only 1-2% per year will develop serious symptoms or complications from their gallstones.
    • However, certain patients are at greater risk for developing complications and should be considered for elective cholecystectomy.
    *This population includes patients with stones greater than 2.5 cm in size since they are at greater risk for obstruction.
    *Children with cholelithiasis have a high frequency of becoming symptomatic and also should be considered for early intervention.
    * In patients with sickle cell disease, acute cholecystitis can induce a sickle crisis, which can complicate surgery and as such should
    undergo elective cholecystectomy.
    • Finally, the finding of calcifications in the gallbladder wall, also known as a "porcelain gallbladder" is associated with increased risk of gallbladder carcinoma and an elective cholecystectomy should be considered.
    • Diabetes mellitus is associated with increased surgical risks with both emergent and elective cholecystectomy, and therefore diabetics should not be recommended for surgery for asymptomatic gallstones.)
  4. d paraaortic (along the embryologic path of the adrenal gland.)
  5. e 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. )

5 Multiple choice questions

  1. reverse Trandelenberg, head 30 degrees, ventricular catheter, mannitol, hyperventilation, (
    The management of
    •elevated intracranial pressure following traumatic injury has been
    extensively studied. Several interventions have been shown to be of
    benefit in the acute setting. The pressure can be relieved through
    mechanical means such as
    *elevating the head of the bed to 30 degrees or by
    *direct drainage of cerebrospinal fluid via a ventricular catheter.
    *Administration of a hyperosmotic solution such as mannitol can
    decrease intracranial pressure by reducing brain water, increasing
    plasma volume and reducing blood viscosity. )
  2. hypoglycemia, coag, elev ammonia, acidosis, hyperk, oliguria, (
    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.)
  3. vasopressin, octreotide, (
    The second step is to control the source of bleeding. Medical
    management may include
    *vasopressin or octreotide.)
  4. 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
    *elbow flexion.
    •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.)
  5. 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.

5 True/False questions

  1. 35yM with HPI epigastric pain alleviated with food, now CC acute abdomen. BP 90/60, pt is derilious and toxic appearing. MNGT?exlap (
    •However, if the patient did show signs of increasing toxicity and
    evidence for sepsis, such as hypotension or mental status changes, it
    would be reasonable to
    ***proceed with an exploratory laparotomy to make the diagnosis. Upper
    ENDOSCOPY is NOT indicated in the acute management of a perforated
    duodenal ulcer )

          

  2. Direct Herniathrough 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.)

          

  3. Significance of atypical ductal hyperplasiahypoglycemia, coag, elev ammonia, acidosis, hyperk, oliguria, (
    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.)

          

  4. Palpable breast lesion. MNGTmammogram

          

  5. 45yM smoker often experiences pain at night while lying in bed, and the pain improves with positioning of the affected extremity. Ddx? MNGT?peripheral arterial occlusive disease, arterial duplex of leg, aorta vs iliac, then angiogram, (
    The symptoms described by the patient are classic for rest pain.
    •Initial evaluation of this patient should be an
    ***arterial duplex study of the vessels of the affected leg. This
    noninvasive test can provide great detail on the extent of the disease
    and the location of hemodynamically significant obstruction.
    Furthermore, it will help determine if inflow obstruction is present
    in the aorta or iliac vessels.
    It is crucial in these patients to determine if the
    •arterial obstruction involves the aortoiliac vessels or is
    •confined to the lower extremity vasculature.

    After determining the location of the atherosclerotic lesion, you can
    •proceed with a traditional angiogram,
    ***CT angiogram, or even an
    ***MRI/MRA to evaluate the vessels in order to plan your intervention.)

          

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