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USMLE2 Surgery 5
GenSurg
| Question | Answer |
|---|---|
| colon polyps - in which are malignant conversion more likely? | 1. familial polyposis, 2. villous adenoma, 3. adenomatous polyp |
| colon polyps - which are benign? | 1. juvenile polyposis, 2. Peutz Jeghers, 3. inflammatory, 4. hyperplastic |
| pneumatosis intestinalis | a sign on x-ray which is highly suggestive for necrotizing enterocolitis. It refers to gas cysts in the bowel wall. |
| Tx for gastric adenoCA. Tx for Gastric lymphoma? | surgery for Gastric adeno. Tx for lymphoma includes eradication of H pylori, chemo, and radiation. |
| Sx of CA for R colon. Sx for CA of L colon. How to tx each? What if rectum is involved? | R colon: anemia in elderly, 4+ occult blood in stool. Tx with R hemicolectomy. L colon: bloody BMs where blood coats outside of the stool, constipation, stool with narrow caliber. L colectomy. If rectum involved, should so pre-op chemo and radiation. |
| Surgical indications for UC | 1. >20 years --> high rate of malignant degeneration, 2. interfere with nutritional status, 3. multiple hospitalizations, 4. need high dose steroids or immunosuppressants, 5. toxic megacolon. Tx with removal of affected colon - always inc rectal mucosa. |
| When does pseudomembranous colitis require emergency surgery | if WBC > 50K and serum lactate >5 --> emergency colectomy |
| nonhealing perianal fistula - what should you consider? | Crohn's disease |
| child passes large bloody bowel movement. What is it and how to dx and tx? | Meckel diverticulum. Dx w radioactively labeled technetium scan. Tx w resection of diverticulum if not complicated. If complicated, resect diverticulum PLUS area of bowel involved. Do not remove if it's just an incidental finding in another surgery. |
| elevated alpha-feto-protein in old man with cirrhosis and wt loss | primary hepatoma |
| elevated CEA in 50 yo man with nodular liver and h/o colon CA | liver mets from some other primary CA |
| xray in 80 yo pt showing distended bowel and large gas shadow that tapers into the shape of a parrot's beak. What is it and how to tx? | volvulus. Proctosignoidoscopy to relieve the obstruction and leave a rectal tube in. Possible surgery to prevent recurrance. |
| pt with afib develops abdominal tenderness with acidosis and distended bowel | consider mesenteric ischemia |
| 24 yo woman on OCP's since age 14 bleeding into her abdomen | hepatic adenoma --> rupture |
| regular liver abscess vs. liver abscess in someone who came from Mexico - what is the difference in management | nl liver abscess should be percutaneously drained. Liver abscess from Mexico is from amoeba and so should tx with Metronidazole (dx with serology, not aspiration of the pus). |
| very high alkaline phosphatase and jaundice | consider obstructive jaundice (maybe gallstones) |
| thin-walled distended gallbladder vs. thick-walled nonpliable gallbladder | thin-walled (courvoisier terrier sign) - obstructive jaundice that has been chronic and growing - should consider CA; thick-walled usu due to gallstones |
| Tx for cholangioCA (CA in the common bile duct) | curative surgery with Whipple (pancreatoduodenectomy) |
| acute ascending cholangitis. How to tx? | gallstone in CBD --> obstruction --> infection. If very high WBCs and very very high alk phos --> indicates possible sepsis. Tx with IV abx and emergency decompression of CBD by ERCP or PTC. |
| biliary pancreatitis | stone in the ampulla of Vater --> obstructs both pancreatic and biliary ducts |
| acute pancreatitis - edematous. How to tx? | after heavy meal or bout of EtOH. Key is elevated Hct. Tx with NPO, NG suction, IVF |
| acute pancreatitis - hemorrhagic. How to tx? What must you anticipate? | Lower Hct, Ca remains low despite repletion, Bun increased, metabolic acidosis, low PO2. Need to admit to ICU and do daily CT's to anticipate pancreatic abscesses to drain them. |
| Ranson criteria for pancreatitis: at admission | "GA LAW": Glucose >200, AST >250, LDH >350, Age >55 y.o., WBC >16000 |
| Ranson criteria for pancreatitis: initial 48 hours | "C & HOBBS" (Calvin and Hobbes): Calcium < 8, Hct drop > 10%, Oxygen < 60 mm, BUN > 5, Base deficit > 4, Sequestration of fluid > 6L |
| Treatment of pancreatic pseudocyst | <6 cm or less than 6 weeks --> observe for spontaneous resolution. >6cm or >6 weeks --> more likely to rupture or bleed --> drain cyst (to outside, to GI tract, or to stomach) |
| female pt in late teens/early 20s with firm, rubbery breast mass that moves easily with palpation. What is it, how to dx, and what is the tx? | fibroadenoma. Dx with US or FNA. Tx with optional resection. |
| 13 yo girl with giant juvenile fibroadenoma showing rapid growth. How to tx? | resection to avoid deformity and distortion to the breast |
| female pt in late 20s with slowly growing breast mass that moves easily with palpation. What is it, how to dx, and what is the tx? | Consider cystosarcoma phyllodes - most are benign, but they have potential to become outright malignant sarcomas. Dx with bx (not FNA) and resection is mandatory |
| Pt with BL breast tenderness that is related to menstrual cycle, with multiple lumps that come and go. What is it, how to dx, and what is the tx? | Mammary dysplasia - cysts. If there is no dominant mass, only need mammo. If there is a persistent mass, aspiration --> bx if not cured --> cytology if bloody fluid. |
| Woman in 20's to 40's with bloody nipple discharge. What is it, how to dx, and what is the tx? | Intraductal papilloma. Do mammo which will be neg. Can then do galactogram --> resection. |
| Lactating woman with breast abscess. How to dx and tx? | bx (r/o CA) and I&D. |
| How is breast CA dx and tx differently in pregnancy? | Dx and Tx the same as if there were no pregnancy except no radiation at all, and no chemo in first trimester. |
| Tx of resectable breast CA | [if tumor is small in large breast and away from nipple and areola - lumpectomy + axillary sampling + post-op radiation] OR modified radical |
| what is the most common form of BrCA? | Infiltrating ductal CA |
| what type of BrCA has the worst prognosis? | Inflammatory |
| What BrCA has the highest incidence of affecting both breasts? | lobular |
| How to tx ductal CA in situ? | total simple mastectomy if multicentric lesions throughout the breast (will not metastasize but will recur if not mastectomy); lumpectomy + radiation if lesion is confined to 1/4 of the breast |
| What causes a breast CA to be non-operable? | extent of local invasion |
| Where does BrCA metastasize to? | Brain and bone (vertebrae) |
Created by:
christinapham
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