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5 Written questions

5 Matching questions

  1. 65yM s/p gastrectomy presents with abdominal pain, N/V, palpitations. Physiology?
  2. 15yF with elevated serum Ca, low serum phosphate. Tx?
  3. 45yM s/p liver txt, hypoglycemia, coagulopathy, elevated ammonia, hyperkalemia, oliguria. MNGT?
  4. 41yM with severe pain in left hip joint. MNGT
  5. Signs of liver failure
  1. a FHH med, primary surgery (
    •The distinction is important, as patients with primary
    hyperparathyroidism benefit from surgery and those with FHH do not.)
  2. b 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. c 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.
  4. d relax hip, ext rotate, flex, (
    The joint space is most relaxed when the
    *hip is flexed and externally rotated.
    This tends to be the least painful position for patients with
    •septic arthritis.)
  5. e hyperosmolar, unconjugated bile salts, (vagotomy leads to dumping syndrome, hyperosmolar emptying into small intestine)

5 Multiple choice questions

  1. 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.)
  2. 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.)
  3. technetium pertechnetate, (
    • diagnosed using
    ***nuclear medicine scans technetium pertechnetate
  4. 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.)
  5. 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.)

5 True/False questions

  1. distinguish dehiscence vs. eviscerationdehisce fascia, evisce peritoneal contents, (
    Dehiscence refers to a separation of the fascial layer. Evisceration is when peritoneal contents extrude through the fascial separation.)

          

  2. 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.)

          

  3. 40yF with preop for elective gynecological surgery, demonstrates cholelithiasis on Xray, no evidence of RUQ pain nor inflammation. MNGTb9, 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.)

          

  4. 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. )

          

  5. Zollinger-Ellison syndrome triadulcer, gastrin, pancreas, (
    •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.)