Exam (elaborations)
ABSITE TRUELEARN QUESTIONS AND ANSWERS
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ABSITE TRUELEARN QUESTIONS AND ANSWERS
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ABSITE TRUELEARN QUESTIONS AND ANSWERSAortic Injury
- MC Location in Blunt Trauma
- MC Location in Penetrating Trauma
- Which is worse? - Answers-- MC Location in Blunt Trauma = Isthmus
- MC Location in Penetrating Trauma = Infra-renal aorta (+IVC)
- Which is worse?: suprarenal injuries, so generally blunt
MCCOD in Blunt Trauma - Answers-Brain Injury
EGD Findings a/w increase ulcer re-bleeding (3) - Answers-1. Active Bleeding / Oozing
2. Visible Vessel
3. Adherent Clot
DDx Inguinal Ulcer/Lesion (3) - Answers-1. Hidratenitis: affects apocrine (axilla/inguinal)
glands, represents chronic infection of gland
2. Granuloma Inguinale: only inguinal, think 3rd world
3. Lymphogranulosum Venerum: inguinal, think STI
Glomus Tumor
- Define
- Presentation Triad
- Two Key Signs
- Treatment - Answers-- Define: sub-ungal AV fistula
- Presentation Triad: pain, cold insensitivity, tenderness on palpation
- Two Key Signs
1. Love's = point tenderness
2. Hildreth's = relief with insufflation
- Treatment: surgery
Inguinal Hernia
- Recurrence with/without mesh
- Risk of incarceration each year - Answers-- Recurrence with/without mesh = 5 vs. 20%
- Risk of incarceration each year = 0.18%/year
Procidentia
- Etiology (2)
- Recognizing full vs. mucosal prolapse
- Definitive Test
- 3 Treatments + Description - Answers-- Etiology (2)
,1. Pudendal nerve injury
2. Laxity of anal sphincter
- Recognizing full vs. mucosal prolapse
1. Full = circular folds
2. Mucosal = linear folds
- Definitive Test = defecating proctogram
- 3 Treatments + Description
1. Transanal Excision = Altemier (incision 2cm above dentate line to open peritoneum,
then tack peritoneum at level to puborectalis)
2. Delorme (ideal of older patients): Mucosal excision + muscular plication
3. LAR with Sigmoid Pexy
Biliary Dyskinesia
- When to suspect?
- Describe method
- Treatment - Answers-- When to suspect?
Signs/symptoms of biliary colic with negative USG, CT, ERCP
- Describe method
Gallbladder gets filled with Tc99, infuse CCK. If EF <35% at 20min = diagnosis
- Treatment = lap chole
Injecting dye before WLE melanoma/breast:
- When to inject?
- Where to inject (layer of skin)?
- Why not inject after WLE? - Answers-- When to inject? hours before procedure
- Where to inject (layer of skin)? dermis, where lymphatics are
- Why not inject after WLE? b/c WLE disrupts the lymphatic pathways
Post-Hemorrhoidectomy Bleeding Etiologies/Mgmt
- Early (<24hrs)
- Late (>POD5) - Answers-- Early (<24hrs): likely to be surgical error, needs evaluation
- Late (>POD5): likely to be eschar from surgery falling off, no intervention
Esophageal CA Review
- Why so malignant (aka how do they spread?)
- Test to Diagnose?
- Test to determine resection?
- CI to Resection (3)
,- SCC vs. Adeno: prevalence, etiology, location/mets
- Tx
1. Chemo/XRT Options (2)
2. Surgeries (4) all of which require _____
3. Endoscopic Option for ____
4. Complications (2) + Treatment - Answers-- Why so malignant (aka how do they
spread?)
Through submucosal lymphatic channels
- Test to Diagnose? Esophagram
- Test to determine resection? CT Chest/Abd
- CI to Resection (3)
1. Invasion of nerves (hoarse RLN, Horners Brachial Plexus, or Phrenic Nerve)
2. Visceral Invasion (airway, vertebra, malignant effusion)
3. +Nodal Base (widely mets)
- SCC vs. Adeno: prevalence, etiology, location/mets
1. Adeno: MCC, lower esophagus associated with GERD/Achalasia, mets to liver
2. SCC: evenly divided, a/w smoking, ETOH, mets to lung
- Tx
1. Chemo/XRT Options (2): 5FU + Cisplatin
2. Surgeries (4) all of which require pyloromyotomy
- Transhiatal: cervical anastamosis, gastric complications
- Ivor Lewis: thoraco anastomosis, thoracic complications
- 3 Hole: 3 incisions neck, thorax, abdomen
- Colonic interposition: 3 anastamosis
3. Endoscopic Option for mucosal disease <2cm
4. Complications (2) + Treatment
- Stricture = dilation
- Fistula to airway = aspiration, palliatve stent
What hormone is NOT released during stress? - Answers-TSH
Pros/Cons of Burn Care
1. Silvadene
2. Silver Nitrate
3. Sulfamylon - Answers-1. Silvadene: good for cartilagenous areas (face/ears), causes
leukopenia
2. Silver Nitrate: good for large burns, but very concentrated and quenches cells leading
to hypoNa and hypoCl; also can cause methemoglobinemia
, 3. Sulfamylon: good for penetrating wounds, but painful and CA inhibitor so causes
metabolic acidosis
Lumbar Hernia
- Boundaries
- Primary vs. Secondary
- Causes
- When to repair? - Answers-- Boundaries: 12th rib, EOM, iliac crest
- Primary vs. Secondary
1. Primary: true hernia
2. Secondary: denervation injury
- Causes: surgical trauma (kidney operations)
- When to repair?: repair PRIMARY if large and symptomatic
Esophageal Leiomyoma
- MC ____ of the esophagus
- Location within esophageal wall (review layers)
- Location along esophagus
- Dx (2)
- Biopsy?
- When/how to treat? - Answers-- MC benign tumor of the esophagus
- Location within esophageal wall (review layers)
Occurs in muscularis b/c this is MESECNHYMAL tumor (mucosa --> submucosa -->
muscular propria...NO SEROSA)
- Location along esophagus: lower 2/3 where the SMOOTH MUSCLES are
- Dx (2): Esophagram --> CT to r/o CA
- Biopsy? NEVER; causes fibrotic tissue that makes treatment very hard
- When/how to treat? excision (ENUCLEATION) with right thoracotomy (if high
upper/mid esophagus) or left thoracotomy (if low esophagus or GEJ) for those that are
SYMPTOMATIC or >5cm
Pancreatic Divisum
- Gold standard diagnosis
- First line treatment
- If first line fails... - Answers-- Gold standard diagnosis: ERCP
- First line treatment: minor papillotomy with duct stenting
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