case files

Question 1

if you find malignant cells on FNA (breast) what is the next step

Answer 1

core needle biopsy to determine invasive vs in situ

Question 2

Tamoxifen cancer side effect

Answer 2

tamoxifen may cause uterine cancer

Question 3

Aromatase inhibitors are used for what cancers?

Answer 3

ER + breast cancer (post menopausal)

Inhibit peripheral conversion of androgens to estrogen

Question 4

Hoarseness and wheezing in GERD

Answer 4

atypical

may represent silent aspiration

Question 5

Barrett pathology

Answer 5

squamous —> columnar

Question 6

what is better therapy for GERD, PPI vs H2 block?

Answer 6

PPI is better

H2 develops resistance

Question 7

long standing gerd w/ s/s refractory to medical management need?

Answer 7

EGD

Question 8

whats better, ppi vs surgery for gerd?

Answer 8

TRICK! they are about equal

surgery is ok if pateitn doesnt want meds, cant afford them, just feels like it haha

Question 9

Best test as objective indicator of gERD

Answer 9

24 hour pH monitoring

Question 10

lung complication of esophogeal rupture

Answer 10

pleural effusion

Question 11

test for esophogeal rupture

Answer 11

water soluable contrast esophagram

Question 12

most common cause of esophogeal rupture

Answer 12

iatrgenic (egd)

Question 13

5α-reductase inhibitor ( conversion of
testosterone to DHT). Used for BPH and malepattern
baldness.

Answer 13

Finasteride

Question 14

α1-antagonist used to treat BPH by inhibiting smooth muscle contraction. Selective for α1A,D
receptors (found on prostate) vs vascular α1B receptors.

Answer 14

Tamsulosin

s/e may include dizziness

Question 15

Surgical rx of BPH

Answer 15

TURP

transurethral resection of prostate

Question 16

Tests for patients w/ BPH symtpoms

Answer 16

Creatinie- look for renal obstruction

PSA- ↑↑ would –> biopsy

UA

DRE

Question 17

First step in SBO management

Answer 17

NG tube decompress

Fluid resuscitate

foley

if necrosis, surgery after volume

Question 18

common bileduct dilation size in choledoco

Answer 18

> 5 mm

Question 19

Treatment of severe cholangitis

Answer 19

ERCP decompression

+ abx/ supportive

Question 20

Bleeding from a abbarent submucosal stomach artery

Answer 20

dieulafoy erosion

Question 21

ulcer size requiring surgery

Answer 21

> 3 cm

Question 22

Most common cause of pediatric upper GI bleed

Answer 22

extrahepatic portal venous obstruction–> esophageal varices

Question 23

do you do surgery for lower GI Bleeding

Answer 23

rarely

used only when bleed cannot be identified using all other methods

Question 24

Invasive lobular carcinoma in situ

Answer 24

15% of breast ca

orderly row of cells

not seen well on mamogram

usually bilateral, mult lesions

Question 25

Arises from ductal
atypia.

Often seen early as microcalcifications
on mammography.

Answer 25

Ductal carcinoma in situ

Early malignancy w/o basement membrane
penetration.

Question 26

GCS eye max

Answer 26

max 4

Question 27

GCS motor max

Answer 27

max 6

Question 28

GCS verbal max

Answer 28

5

Question 29

dilated pupil vs side of mass lesion

Answer 29

dilated side= mass lesion side

Question 30

watery diarrhea categories

Answer 30

osmotic- lactose
secretary- vibrio (↑ secretion)
functional

Question 31

Oral fluids for burns

Answer 31

less than 15% burn

Question 32

Parkland formula and time

Answer 32

4 ml * kg* % burn

1/2 in first 8

1/2 in second 16 hours

Question 33

what “degree” of burn is most painful

Answer 33

second

Question 34

what degree of burn is painless

Answer 34

3

rx: will need grafting

Question 35

Burn rx that cuases leukopenia

Answer 35

silver sulfadiazine

does not penetrate eschar- wont help infection

Question 36

Burn treatment that penetrates the full thickness

Answer 36

sulfamylon

painful, may cause metabolic alk