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Rotations > Gen Surg Essay Exam > Flashcards

Gen Surg Essay Exam Flashcards

1
Q

Ddx of breast mass? (9)

A
  1. Breast cyst
  2. Fibroadenoma
  3. Cystosarcoma phyllodes
  4. Fat necrosis
  5. Abscess
  6. Lactating adenoma
  7. Juvenile hypertrophy
  8. Gynecomastia
  9. Cancer
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2
Q

what are the two variations of Fibroadenoma?

A
  1. Giant fibroadenoma: >5cm, usually in pregnant or lactating women, usually shrink
  2. Juvenile fibroadenoma: adolescent females, around time of puberty
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3
Q

how does cystosarcoma phyllodes spread?

A

hematogenously NOT lymph nodes

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4
Q

what is cystosaracoma phyllodes? tx?

A
  • found in 30-40yr old WOMEN
  • look like fibroadenoma on US
  • painless mass
  • tx: local excision
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5
Q

what is juvenile hypertrophy? treatment?

A
  • bilateral hypertrophy

tx: subcutaneous mastectomy or reduction mammoplasty

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6
Q

what are the 3 peaks of gynecomastia?

A
  1. Neonatal: due to maternal estrogen in utero
  2. Puberty: reassurance
  3. 50-70 yrs: drugs, liver disease, gonadal failure
    * not a risk factor for breast ca*
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7
Q

Ddx of calcifications/abnormal mamogram? (6)

A
  1. Mass lesions
  2. Radial scar
  3. Ductal ectasia
  4. Sclerosing adenosis
  5. Lobular hyperplasia
  6. Cancer
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8
Q

Treatment of ALH/ADH?

A
  • excision to exclude DCIS

- dont need to have negative margins

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9
Q

what are the contraindications to breast preservation? (5)

A
  1. Inability to receive radiation (prior radiation, pregnancy, collagen vascular disease)
  2. High tumor to breast size ratio
  3. Multifocal disease
  4. Inability to achieve negative margins
  5. Fibrous tissue disorders
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10
Q

when is a SLNBx contraindicated?

A

if there are palpable lymph nodes in the axilla

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11
Q

when should you do radiation therapy after a mastectomy?

A

Tumor >5cm and more than 4 LN positive

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12
Q

what are prehepatic causes of jaundice? (4)

A

Hemolysis:

  1. Congenital
  2. Transfusion reaction
  3. Autoimmune
  4. Drug induced
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13
Q

What are intra-hepatic causes of jaundice? (5)

A
  1. Hepatitis
  2. Cirrhosis
  3. Hepatocellular diseases (gilberts, hemochromatosis, wilsons, G6PD def, crigler-najjar)
  4. Hepatic abscess (pyogenic, amebic)
  5. Hepatic cancer (primary or metastatic)
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14
Q

Posthepatic causes of jaundice? (5)

A
  1. Cholecystitis
  2. Choledocholithiasis
  3. Biliary stricture
  4. Pancreatic cancer
  5. Cholestasis (pregnancy, sepsis, CHF)
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15
Q

What are some key things to ask about in a pt w jaundice for history?

A
  1. itching
  2. dark urine
  3. light stools
  4. travel
  5. blood transfusions
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16
Q

What is charcots triad?

A
  1. RUQ pain
  2. Fever
  3. Jaundice
17
Q

what is reynolds pentad?

A
  1. RUQ pain
  2. Fever
  3. Jaundice
  4. Hypotension
  5. Altered mental status
18
Q

what lab tests should you order in jaundice pt?

A
  1. LFTs (AST, ALT, AP, total ind/direct bili, albumin, PT)
  2. CBC, peripheral blood smear
  3. Pregnancy test
  4. direct coombs test for autoimmune hemolysis
19
Q

what is the differential diagnosis of a neck mass? (7 categories)

A
  1. Thyroid: cyst, goiter, cancer
  2. Lymph Node: infected, reactive, lymphoma, metastatic cancer
  3. Salivary gland: submandibular or parotid tumor (benign or malignant)
  4. Soft tissue: abscess, lipoma, sebaceous cyst, primary soft tissue tumor
  5. Vascular (hemangioma, carotid body tumor, aneurysm)
  6. Nerve: neuroma
  7. Congenital remnants
20
Q

What are the congenital remnants that can present as a neck mass?

A
  1. Thyroglossal duct cyst
  2. Branchial cleft cyst
  3. Dermoid cyst
21
Q

things to ask about in history for someone w a neck mass?

A
  1. Recent URI
  2. Insect bites/exposure to animals
  3. family history (esp MEN syndrome)
  4. Radiation exposure
  5. Obstructive symptoms
22
Q

mass in the midline of the neck? (4 ddx)

A
  1. Thyroglossal duct cyst: moves w swallowing, in child
  2. Abscess
  3. Lipoma
  4. Sebaceous or dermoid cyst
23
Q

mass in the lateral neck?

A
  1. Inflammatory LN
  2. Metastatic cancer
  3. Salivary gland tumor
  4. Branchial cleft cysts: usually 20-30yo, small pit in skin anterior to SCM
  5. Carotid body aneurysm or tumor
24
Q

treatment of thyroglossal duct cysts?

A

excision w a segment of hyoid bone (sistrunk procedure)

25
Q

what level do you check in medullary ca of thyroid?

A

Calcitonin

26
Q

Differential diagnosis for dysphagia? (functional disorders) (3)

A
  1. Achalasia
  2. Chagas disease
  3. Esophageal spasm syndromes
27
Q

What are thee 4 esophageal spasm syndromes?

A
  1. Nutcracker esophagus
  2. Diffuse esophageal spasm
  3. Hypertensive lower esophageal sphincter
  4. Non-specific elongated motor disorders
28
Q

Mechanical disorders causing dysphagia?

A
  1. Benign or malignant
  2. Stricture
  3. GERD
  4. Hiatal hernia
  5. Diverticuli (zenkers, epiphrenic, traction)

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