5/17/13

Question 1

Old guy, smoker, drinker, has a hard, painless, enlarged anterior cervical lymph node. What the most likely Dx?

Answer 1

SCC metastasis from respi or digestive tract

Question 2

What is the conservative tx of internal hemorrhoids?

Answer 2

sitz baths, stool softeners, and stool bulking agents

Question 3

What is the treatment for advanced hemorrhoids?

Answer 3

surgery

Question 4

What must be done before treatment for hemorrhoids is begun?

Answer 4

rule out malignancy

Question 5

How would you rule out malignancy in a pt that may have hemorrhoids?

Answer 5

rectal exam, anoscopy, and flexible sigmoidoscopy

Question 6

What is the strongest prognostic indicator in penile cancer?

Answer 6

presence/absence of nodal metastasis

Question 7

If palpable inguinal lymph nodes are found in a pt w/ penile cancer, what is done next?

Answer 7

Abx for 4-6 wks and reexamine (may be reactive, not metastatic)

Question 8

What predisposes to acute ascending cholangitis?

Answer 8

ongstanding gallstones

Question 9

What happens in acute ascending cholangitis?

Answer 9

partial obstruction of common bile duct allows ascending infection, pus

Question 10

What is the tx for acute ascending cholangitis?

Answer 10

immediate decompression of common bile duct (ERCP, percutaneous transhepatic cholangiography, or open)

Question 11

What is the best way to prevent DVT in a pt who has had a lower extremity operation and must be confined to bed rest?

Answer 11

LMWH

Question 12

What is the most common complication of a ventriculo-peritoneal shunt? What is the tx?

Answer 12

mechanical obstruction; replace shunt

Question 13

A pt has a pelvic fracture and is hemodynamically unstable. The bleeding is not in the thorax or abdomen. What should be done right away?

Answer 13

External fixation of the fracture

Question 14

A pt has a pelvic fracture but is hemodynamically stable.What should be done now?

Answer 14

check for injuries to:
rectum
vagina / urethra (retrograde urethrogram)
bladder (retrograde cystogram)

Question 15

A 19 y.o. male is in a motorcycle accident. He has a pelvic fracture. There is blood at the urtethral meatus, scrotal hematoma, and the sensation that he wants to urinate, but can’t. Rectal exam shows high-riding prostate. Location of injury? Next step?

Answer 15

posterior urethra; retrograde urethrogram

Question 16

A 22 yo female is involed in a car accident and incurs a pelvic fracture. She has blood in the urethral meatus. Location of injury? Next step?

Answer 16

bladder; retrograde cystogram

Question 17

Female w/ suspected bladder injury does a retrograde cystogram, but it is negative. What should be done now? Why?

Answer 17

drain contrast from bladder and take new x-ray; if injury at trigone, contrast has leaked retroperitoneally, which was obscured by full bladder.

Question 18

Trauma pt has broken ribs, but no pelvic fracture. Blood at urethral meatus. Where is the injury? What is the next step?

Answer 18

kidneys; CT