Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery Clerkship > Dr. Pestana's Notes--Skin, Opth, ENT, Neuro > Flashcards

Dr. Pestana's Notes--Skin, Opth, ENT, Neuro Flashcards

1
Q

Describe the characteristics of patient most likely to get skin cancer.

A

blonde, blue-eyed, fair-skinned people who live where the sun is fierce and who by virtue of occupation or hoppy are exposed to rays all day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Basal cell carcinoma accounts for ____ of skin cancers, Squamous cell accounts for ___ and melanoma accounts for ____. These often coexist.

A

50%; 25%; 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

_____ carcinoma may show up as a small, raised waxy lesion or as a nonhealing ulcer on the upper face.

A

Basal cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Basal cell rarely mets to LN. If waxy, lesions can be _____. If nonhealing ulcer, lesion must be _____.

A

removed in toto; full-thickness biopsied at edge of lesion (differentiate from squamous and melanoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The most dangerous basal cell ulcer is known as a _____ b/c it can kill by relentless local invasion. Removal requires ____ margins.

A

rodent ulcer; 1mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Typical location of rodent ulcer is in ____, which makes it cosmetically difficult, therefore surgeons use ____ surgery, which uses microscopic sections and tissue dx as excision is being done.

A

upper face; Mohs surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

_____ cancer is usually seen on the lower lip and territories below the horizontal live drawn across the mouth. This cancer CAN mets to _____.

A

Squamous cell; regional LNs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Excision of Squamous cell carcinoma requires _____ margins. _____ may need to be biopsied or dissected; radiation is another treatment option

A

0.5 to 2cm; Sentinel LNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name the ABCDEs of melanoma

A

asymmetric, irregular borders, different colors, diameter >0.5cm, evolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pathology of melanoma MUST include the presence of cancer and _____

A

depth of invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Melanoma: _____ have good prognosis. ____ have bad prognosis and can be lethal.

A

superficial invasions; deep invasions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Melanomas less than ___ deep require local excision only. Those between _____ require 2cm margins and attention to LNs. Those greater than ____ have a terrible prognosis despite therapy.

A

1mm; 1 to 4mm; 4mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MC locations of mets malignant melanoma

A

LNs, liver, lung, brain, bone, other “weird” places

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Metastatic malignant melanoma has no predictable timetable. _____ is the current preferred adjuvant systemic therapy.

A

Interferon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

____ is a vision impairment resulting from interference with the processing of images by the brain during the first 6 or 7 years of life. Most common presentation is a child with _____.

A

Amblyopia; strabismus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If strabismus not surgically corrected in a child with amblyopia, permanent ____ of the suppressed eye could occur. A ____ can also cause the same issue.

A

cortical blindness (even though technically the eye can see); congenital cataract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Strabismus is verified by showing that the reflection from a light comes from ______ in each eye.

A

different areas of the cornea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When strabismus not diagnosed right away, there can be exaggerated convergence caused by refraction difficulties. _____ instantly resolve the issue.

A

corrective glasses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A ____ in a baby is indicative of retinoblastoma and is an ophthalmologic emergency. It could also be a _____, but you must treat it right away to prevent amblyopia.

A

white pupil; congenital cataract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

___ is a common source of blindness and is silent in nature so it is rarely discovered by PCP unless eye exam is done.

A

Glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

_____ glaucoma shows up at very severe eye pain or frontal headache typically starting in the evening when the pupils have been dilated for several hours. Pt might say they are seeing ____ around lights.

A

Acute angle closure; halos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Acute angle closure glaucoma on physical exam shows a _____ pupil that [DOES/DOES NOT] react to light; the cornea has a _____ hue and the eye feels hard as a rock.

A

mid-dilated; does not; greenish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Emergency surgery for Acute angle closure glaucoma includes ______ to allow drainage of fluid trapped in the [ANTERIOR/POSTERIOR] chamber.

A

drilling a hole in the iris; anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

While waiting for sx for Acute angle closure glaucoma, give ______ and apply topical ____. Mannitol and pilocarpine may also be used.

A

carbonic anhydrase inhibitors (Diamox); beta blockers and alpha2-selective adrenergic agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

____, another ophthalmologic emergency, is when the eyelids are hot, tender, red and swollen and the patient is febrile. The key finding is a ___ pupil when the eyelids are pried open.

A

Orbital cellulitis; dilated and fixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Dx and tx Orbital cellulitis [emergency!]

A

CT scan and drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Chemical burns of eye require _______ immediately for about _____. ____ is tested to assure no harmful chemicals remain in the conjunctival sac.

A

irrigation (water or saline); 30 minutes; pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

[ACID/ALKALINE] burns of the eye are worse than [ACID/ALKALINE] burns of the eye

A

alkaline; acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

_____ is another emergency recognized by patients reporting “flashes of light” and “floaters”. The number of floaters tells you about the magnitude of the problem.

A

Retinal detachment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

In retinal detachment, the person with one or two floaters may only have ______ of the retina, whereas a “snowstorm” of floaters or a big dark cloud at the top of the visual field indicates _______.

A

vitreous tugging; big horseshoe piece of retina pulling away and at risk for ripping of rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Emergency tx Retinal detachement

A

laser “spot welding” to protect remaining retina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

_____ is seen when an elderly patient describes sudden vision loss from one eye. In _______ the damage is irreversible.

A

embolic occlusion of retinal artery; 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Intermittent tx for embolic occlusion of retinal artery

A

breathe into paper bag and have someone repeatedly press hard on eye and release [to vasodilate and shake clot into more distal location to prevent ischemia]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

_____ patients MUST have an ophthalmologic evaluation. ___ damage may have already occurred at this time.

A

Type 2 DM [type I have about 20yrs before developing eye problems]; retinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

_____ neck masses are usually seen in young people and typically have been present for years before they become symptomatic (get infected) and medical help is sought.

A

Congenital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

____ is a neck mass is 1-2cm and located on the midline at the level of the hyoid bone and seems to be connected to the tongue.

A

Thyroglossal duct cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Surgical removal of thyroglossal duct cyst includes 3 things. [Sometimes nml thyroid location identified via radionuclide scan before sx]

A

cyst, middle segment of hyoid, track that leads to base of tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

_____ are neck masses that occur along the anterior edge of the SCM anywhere from front of tragus to base of neck.

A

Branchial cleft cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

____ is a neck mass found at the base of the neck as a large, mushy, ill-defined mass that occupies the entire supraclavicular area.

A

Cystic hygroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Cystic hygromas usually extend into the ____ and therefore must be worked up with a _____ before surgical removal

A

mediastinum (deep into the chest); CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Most new enlarged neck LNs are benign. F/U should be ____ later and only if the LNs are still there, should a workup be done. A history of wks/months of enlarged LNs are indicative of a ____ or _____.

A

3 to 4 weeks; infection; neoplasm

42
Q

_____ is typically in young people with multiple enlarged LNs in neck and elsewhere; usually suffer low-grade fever and night sweats.

A

Lymphoma

43
Q

Dx and tx Lymphoma

A

FNA and node removal for pathology; chemotherapy

44
Q

Metastatic tumor to the supraclavicular nodes usually comes from below the clavicles, primarily ____ and ____ tumors. The node should be removed for pathology.

A

lung; intraabdominal

45
Q

______ of the head and neck is usually seen in old men who smoke and drink and have rotten teeth. Patients with ____ are also prime candidates.

A

Squamous cell carcinoma of mucosae; AIDS

46
Q

Squamous cell carcinoma of mucosae usually shows up first as a ______ in the neck, typically the jugular chain. Workup includes ____, looking for primary tumor/tumors first.

A

metastatic LN; triple endoscopy (aka panendoscopy)

47
Q

For Squamous cell carcinoma of mucosae, ____ of the primary(ies) establishes the diagnosis, and ____ demonstrates the extent. Sometimes ____ of the mets node is done.

A

biopsy; CT; FNA [NEVER open bx]

48
Q

For Squamous cell carcinoma of mucosae, treatment involves (4) things.

A

resection, radical neck dissection, +/- radiotherapy, +/- platinum-based chemo

49
Q

Name a few presentations of Squamous cell carcinoma of mucosae.

A

persistent hoarseness, persistent painless ulcer in floor of mouth, persistent unilateral earache

50
Q

____ should be suspected in an adult who has sensory hearing loss in one ear. ___ is best diagnostic modality.

A

Acoustic neuroma; MRI

51
Q

_____ produce GRADUAL unilateral face paralysis, affecting both the forehead and lower face. [Sudden-onset suggests ____.] _____ is the best diagnostic study.

A

Facial nerve tumors; Bells-palsy; Gadolinium-enhanced MRI

52
Q

____ tumors are visible and palpable in front of the ear or around the angle of the mandible. Most are _______, which are benign but have potential for malignancy. They [DO/DO NOT] produce pain or facial nerve paralysis

A

Parotid; pleomorphic adenomas; DO NOT

53
Q

___ is used to both diagnose and treat parotid tumors, preventing recurrences and sparing the facial nerve. ____ alone leads to recurrence and in malignancy, the ____ is sacrificed and a graft is done.

A

superficial parotidectomy (+/- FNA [open biopsy contraindicated]); Enucleation; facial nerve

54
Q

____ are the cause of unilateral ENT problems in toddlers. Earache, rhinorrhea or unilateral wheezing can be indicative. ____ is the appropriate tx.

A

Foreign bodies; endoscopy under anesthesia + extraction

55
Q

_____ is an abscess of the floor of the mouth, often the result of a bd tooth infection. The problem here is a threat to the _____ and therefore incision and drainage are done. (Occasionally intubation/tracheostomy may be needed.)

A

Ludwig angina; airway

56
Q

Tx Bell’s palsy

A

antivirals (prompt and early admin) and steroids

57
Q

Facial nerve injuries are _____ if paralyzed right away and ____ if later develop paralysis due to swelling.

A

permanent; reversible (spontaneously resolved)

58
Q

_____ is suspected when pt develops diplopia (from paralysis of extrinsic eye muscles) in patient suffering from frontal or ethmoid sinusitis. Emergency that requires these things…

A

Cavernous sinus thrombosis; IV abx, CT/MRI, draingage of affected sinuses

59
Q

Epistaxis in children is typically from ____; the bleeding comes from the _____, and phenylephrine spray and local pressure controls the problem.

A

nosepicking; anterior septum

60
Q

An 18yo with epistaxis suggests ____ (especially with septal perforation), treated via ______, or _____ (benign but eats away at nearby structures), treated with surgical resection.

A

cocaine abuse; posterior packing; juvenile nasopharyngeal angiofibroma

61
Q

Elderly HTN pts can have epistaxis that are copious and life-threatening. _____ and ____ are usually required. Sometimes surgical ligation of feeding vessels can be done.

A

Control of HTN; posterior packing

62
Q

Dizziness can be caused by either _____ or ____.

A

inner ear dz; cerebral dz

63
Q

When dizziness is caused by inner ear dz, the patient describes the room as _______. These 3 medications may help alleviate the problem.

A

“spinning around them”; meclizine, promethazine, diazepam

64
Q

When dizziness is caused by cerebral dz, the patient describes the room as _______. The pt may require _____ for further evaluation.

A

stable (patient himself is unsteady); neurologic workup

65
Q

_____ includes vertigo, tinnitus and hearing loss and is primarily treated with _____.

A

Ménière disease; diuretics

66
Q

Vascular problems have ____ onset, without headache when they are _____ and with headache when they are ____.

A

sudden; occlusive; hemorrhagic

67
Q

As ICP increases due to obstruction from tumor over months, severe headaches (worse in the _____), ____ and ____ can be seen.

A

AM; blurred vision; projectile vomiting

68
Q

TIAs are sudden, transitory losses of neuro function that come on [WITH/WITHOUT] headaches and resolve spontaneously, leaving no neurologic sequela. Sxs depend on area of brain affected.

A

without

69
Q

MCC TIAs is high-grade (>70%) stenosis at the _____ or ulcerated plaque at the _____.

A

internal carotid; carotid bifurcation

70
Q

TIAs are predictive of ____ and therefore elective ____ may prevent and minimize that possibility.

A

stroke; carotid endartectomy

71
Q

Workup of TIAs include noninvasive Duplex studies. Surgery is indicated if the lesions are found _____. Angioplasty and stent can be done if a _______ first.

A

in locations where neurological deficits occur; filter is deployed to prevent embolization

72
Q

Ischemic strokes that have been present for longer than _____ are not amenable to revascularization procedures, although ___ can be started (best w/in 90 min).

A

3 hours; tPA

73
Q

Assessment of ischemic stroke is done via _____ to confirm extent and rule out hemorrhage, and therapy is centered on _____.

A

CT scan; rehabilitation

74
Q

Ischemic strokes may be complicated by a _____ if blood supply to the brain is suddenly increased.

A

hemorrhagic infarct

75
Q

Hemorrhagic stroke is seen in pts w/ ____ who complain of severe headache of sudden onset and go on to develop neuro deficits. ___ is used to evaluate the location and extent and therapy is focused on ___ and ___.

A

HTN; CT scan; control of HTN; rehabilitation

76
Q

Subarachnoid bleeding from intracranial aneurysms may present with no _____ because ______, and the pt may be sent home prematurely. Luckier patients have _____ and ______.

A

neuro findings; no hematoma pressing on the brain; meningeal irritation and nuchal rigidity

77
Q

Patients with subarachnoid bleeding that were not diagnosed right away may come back to ED with a much worse ____ bleed.

A

sentinel

78
Q

Workup for subarachnoid hemorrhage is ____ followed by a _____ to locate a potential aneurysm. Sometimes a ___ is done to identify old blood in the spinal fluid. Tx includes ____ in surgery or ___, a radiological alternative.

A

CT; ateriogram; spinal tap; clipping; endovascular coiling

79
Q

Most intracranial tumors are mets. About half come from the _____; next most common are ____ and ____.

A

lungs; breast; melanoma

80
Q

About half of primary brain tumors in adults are _____; about 20% are ____.

A

gliomas; meningiomas

81
Q

The most malignant intracranial tumor is a ____. _____ are usually benign.

A

glioblastoma multiforme {glioma}; Meningiomas

82
Q

Most intracranial tumor treatment includes ___ and ____ but not ____ because it’s hard to breach the blood-brain barrier.

A

surgery; radiotherapy; chemotherapy

83
Q

Brain tumors can be located in a “silent” area of the brain and therefore don’t suggest a location. Only sxs of these tumors can be _____ and ______.

A

severe, progressively worsening headaches (worse in AM); increased ICP

84
Q

Clinical presentation of increased ICP

A

blurred vision, papilledema, projectile vomiting, Cushing reflex

85
Q

What is the Cushing reflex, seen in increased ICP?

A

bradycardia and HTN (pressing on baroreceptors in brain)

86
Q

Brain tumors can be seen on ____, but ___ gives better detail and is preferred. Increased ICP is treated with ____ while waiting for surgery to treat tumor.

A

CT; MRI; high-dose steroids (dexamethasone)

87
Q

Tumors at the ______ produce inappropriate behavior, optic nerve atrophy on side of tumor, papilledema on contralateral side of tumor and anosmia [Foster-Kennedy syndrome]

A

base of the frontal lobe

88
Q

____ occur in children who are short for their age; show bitemporal hemianopsia and a calcified lesion above the sella on CT scan.

A

Craniopharyngiomas

89
Q

_____ produce amenorrhea and galactorrhea in young women. Tx with ____. ____ is reserved for those who wish to become pregnant.

A

Prolactinomas; bronocriptine; transnasal, trans-sphenoidal surgical removal

90
Q

Prolactinoma: must rule out ____ by testing for hCG, rule out ____ by testing TSH, determine ____ levels and get an ____ of the sella.

A

pregnancy; hypothyroidism; prolactin; MRI

91
Q

Atypical symptoms of ____ include HTN, diabetes, sweaty hands, headache and history of wedding bands/hats that no longer fit. Workup includes ____ and ____.

A

acromegaly; somatomedin C levels; pituitary MRI

92
Q

Tx of Acromegaly includes ____ (preferred) or ____. Somatic changes are irreversible.

A

surgery (transnasal or trans-sphenoidal); radiotherapy

93
Q

_____ occurs when bleeding into a pituitary tumor causes subsequent destruction of the gland. Hx includes chronic pituitary tumor problems followed by an acute episode, starting with _____ and signs of increased compression due to _____.

A

Pituitary apoplexy; severe headache; hematoma of nearby structures

94
Q

Signs of pituitary apoplexy/damage includes ___ and ____. Tx immediately with _____ and eventually other hormones. Can diagnose with ____ or ____.

A

stupor; hypotension; steroid replacement; CT; MRI

95
Q

Tumors of the _____, aka _____, produce loss of upper gaze and physical finding known as “sunset eyes”

A

pineal gland; Parinaud syndrome

96
Q

Brain tumors in children are usually in the _____. _____ is the most common and arises in the _____, producing stumbling/truncal ataxia.

A

posterior fossa; Medulloblastoma; cerebellum

97
Q

The second MC child brain tumor is a _____. Affected children often assume the ______ position in order to open the flow of cerebrospinal fluid and relieve their headache.

A

Ependymoma; knee-chest

98
Q

Brain abscesses usually develop in ______. There is fever and an obvious source of infection nearby like ____ or _____. Can visualize on CT. Tx includes _____.

A

one to two weeks; otitis media; mastoiditis; surgical resection

99
Q

_____, aka ______, produces extremely severe, sharp shooting pain in face brought about by touching a specific area and lasting about 60 seconds. Pts normally ___ years old and have a ____ neurologic exam.

A

Trigeminal neuralgia; tic douloureux; 60; normal

100
Q

____ is done for patients with trigeminal neuralgia to rule out other causes. Tx includes ____ (med) or ___ (procedure). Some surgeons believe the process is caused by pounding from a nearby vessel, and suggest an operation.

A

MRI; carbamazepine; radiofrequency ablation

101
Q

_____, aka _____, develops several months after a crushing injury; there is a constant, burning, agonizing pain that doesn’t respond to usual analgesics.

A

Reflex sympathetic dystrophy; causalgia

102
Q

In reflex sympathetic dystrophy (causalgia), extremity is usually _____ and ____. Dx includes successful ____ and curative tx includes ____.

A

cold; moist; sympathetic block; surgical sympathectomy

Surgery Clerkship (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions