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5 Written questions

5 Matching questions

  1. Borders of modified radical mastectomy
  2. Elevated intracranial pressure, refractory to mannitol after 24hrs. MNGT?
  3. 30yM with gastric ulcer demonstrates a tumor in his pancreas, and elevated gastrin levels. DDx
  4. 32yF preop for elective cholecystectomy shows calcified "porcelain" gallbladder. DDx?
  5. 21yM in MVA has laceration to aorta. Most common location?
  1. a sternum, subclavius, inframammary, lat dorsi, (
    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 ZES (
    •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.)
  3. c 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.)
  4. d 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. e consider barbiturate coma, craniectomy, (
    Additionally, if the ICP
    is refractory to these interventions, it is reasonable to consider a
    *barbiturate coma or potentially a
    *decompressive craniectomy.
    *Hyperventilation is used only in the acute setting to keep PaCO 2
    around 35 mmHg, which functions to decrease intracranial pressure by
    decreasing intracranial blood volume through vasoconstriction.)

5 Multiple choice questions

  1. FHH med, primary surgery (
    •The distinction is important, as patients with primary
    hyperparathyroidism benefit from surgery and those with FHH do not.)
  2. reassurance (

    All liver transplant patients have an initial rise in transaminases
    which should decrease over the first 48 hours. )
  3. 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 )
  4. 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.)
  5. 2ft ileocecal, (

    ***2 ft of the ileocecal valve. )

5 True/False questions

  1. 76yM alcoholic with hematemesis. Undergoes portal shunt. What types used for stable patient for recurrent episodes?mesocaval, splenorenal, (
    *TIPS have increased in popularity as a method for portal
    decompression. This can be performed in the acute setting. Surgical
    shunts are also an option, but are primarily reserved for stable
    patients with recurrent bleeding episodes and
    * not performed in an acutely unstable patient.
    *Mesocaval shunts connect the SMV to the IVC in a variety of manners.
    *Splenorenal shunts are actually the most common type of shunt.
    *Nonselective shunts that completely divert portal blood flow from
    the liver can actually INCREASE hepatic encephalopathy. Most surgeons
    prefer selective shunts, which preserve a component of hepatic blood
    flow and thus function. Synthetic graft material can be safely used to
    create the shunts. Postoperative mortality is directly related to the
    patient's preprocedure medical condition and degree of hepatic
    failure i.e., Child class.)


  2. ADH on needle core. 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. )


  3. 15yF with elevated serum Ca, low serum phosphate. DDx. MNGT?FHH med, primary surgery (
    •The distinction is important, as patients with primary
    hyperparathyroidism benefit from surgery and those with FHH do not.)


  4. 21yF with breast lump. Core bx dx is LCIS. MNGTmammogram


  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
    Stage IV Distant metastatic disease present)