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5 Written questions

5 Matching questions

  1. Complications of mastectomy
  2. 16yM with unilateral scrotal swelling. Is this tumor likely to increase, decrease, or no change to testosterone?
  3. HPI of Meckel's diverticulum?
  4. On precordial auscultation, crackles are heard. DDx
  5. 16yM with unilateral scrotal swelling. Scrotal ultrasound demonstrates intraparenchymal mass. MNGT
  1. a 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)
  2. b Leydig, androblastoma, incr testosterone, (
    The majority of testicular tumors occurring in young adults are malignant tumors. The tumors may originate from germinal or nongerminal cells. Approximately 95% of testicular tumors are germinal tumors. These include seminomas -the most common-, embryonal cell carcinomas, choriocarcinomas, and teratocarcinomas. On the other hand,
    • Leydig cell tumors and androblastomas originate from nongerminal cells and may
    • produce excess testosterone.

    Benign tumors such as fibroma can occur but are rare.)
  3. c CT, chest, abd, pelvis, serum hcg, afp, ldh, radical orchiectomy, (
    Upon the diagnosis of an intraparenchymal testicular mass, a
    • staging CT scan of the chest, abdomen, and pelvis should be obtained.
    • It is reasonable to evaluate the serum levels of beta-HCG and AFP as they may be elevated in 80-85% of patients with nonseminomatous
    germ cell tumors.
    • LDH, on the other hand, can be elevated in patients with seminomas and can be of prognostic significance.

    • Finally, if elevated, these serum markers can serve as a means to monitor the presence of residual disease and should be measured after resection of the tumor.

    Additionally, the mass should be
    • excised in order to establish a histologic diagnosis.
    • A radical orchiectomy should be performed from an inguinal approach.
    • Less invasive approaches such as biopsies or a scrotal approach to the tumor should be avoided as they can alter the lymphatic drainage and potentially adversely affect overall outcomes.)
  4. d 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.)
  5. e 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.)

5 Multiple choice questions

  1. 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.)
  2. through 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. 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.)
  4. 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.)
  5. on needle core, 20% DCIS (
    A diagnosis of atypical ductal hyperplasia cannot be established on
    core biopsy alone. Studies have demonstrated that nearly 20% of
    patients with this diagnosis on core biopsy go on to have evidence of
    ductal carcinoma in situ or invasive ductal carcinoma after excisional

5 True/False questions

  1. palpable breast lesion suspicious on mammogram. MNGTmammograms, tamoxifen, bl mastectomy, (Once
    this diagnosis has been confirmed,
    ***management decisions can be made including
    1. close observation with frequent screening mammograms,
    2. chemoprevention with tamoxifen, or
    3. prophylactic bilateral mastectomy.

    A unilateral mastectomy is not an option as a diagnosis of
    •atypical ductal hyperplasia increases the risk of breast cancer in
    both breasts.)


  2. Borders of modified radical mastectomysternum, 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. )


  3. 25yM with head injury during ski accident, with pupillary dilatation. Likely tx?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.)


  4. Developmental source for Meckel's diverticulum?2ft ileocecal, (

    ***2 ft of the ileocecal valve. )


  5. Direct Herniathrough 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.)