GS Flashcards
1
Q
Ptn who had open surgery for hernia is now having hernia again, treatment
A
Laparoscopic surgery
2
Q
Case of cysts inside a cyst ( hydatid cyst ) treatment
A
Surgical removal
3
Q
Female with left leg swelling with intact pulse, how to diagnose
A
Doppler venous
4
Q
Abdominal wound by wood with fever and discharge, what to do next
A
CT abdomen
5
Q
1-After total thyroidectomy develops hypocalcemia despite calcium replacement more than once . What to check next?
A
Correct calcium and magnesium
6
Q
2 - Patient admitted for thyroid surgery because of progressive compression symptoms . Hemithyrodectomy done and biopsy showed 8mm papillary carcinoma , whats the next step
A
No meed for radiation
7
Q
After right hemithyroidectomy On biopsy found follicular lesion 8cm , next
A
Complete thyroidectomy
8
Q
Pt for thyroidectomy due to cancer and with mitral valve prolapse . Prophylaxis against infective endocarditits
A
No need
9
Q
Pt came after thyroid surgery with dysphagia and horseness of voice. Which nerve is injured
A
Recurrent laryngeal nerve
10
Q
7- A patient post thyroidectomy can not make high pitch sounds. Damage to which nerve is responsible
A
Superior laryngeal nerve
11
Q
Pt with thyroid nodule and hyperthyroidism lab , radioactive iodine shows the nodule hot, but all the remaining thyroid is cold. Initial Management: antihyperthyroid drugs in Hashimoto’s increases risk of
A
Primary thyroid lymphoma
12
Q
Normal follicular thyroid cells, how to manage?
A
Hemithyroidectomy
13
Q
Female , with lateral mass (lymph node) , thyroid was normal , biopsy showed normal follicular cells, what is the diagnosis
A
Metastasis
14
Q
25 years female with thyroid nodule TSH and T4 normal , FNA cytology done and according to Bethesda classification ((Stage IV )))what is the most accurate management?
A
Lobectomy
15
Q
Bethesda stage VI ?
A
Semi total thyroidectomy ( cancer )
16
Q
1-Pt with diffuse thyroid enlargement on exam there is 1 nodule in each lobe, labs showed hyperthyroidism what will you do?
42- 48 yo lady with diffuse goiter, high T4 low TSH, US show bilateral thyroid nodules , right 3x4 in size , left is 1x2 size what to do
A
Thyroid scan / total thyroidectomy
17
Q
Pt Postoperative blood transfusion develops fever and pain at site of infusion ?
A
Febril non hemolytic reaction
18
Q
Pt post op triple A repair become unstable even with fluid replacement and have negligible urine in cath decreased vascular resistance and increased cardiac out put.Type of shock ?
A
Septic shock
19
Q
female had a hip fracture now had DVT as I remember now she is on heparin but her platelet is low 58 so what will you do?
A
Stop heparin and start another anticoagulant
20
Q
Scar post surgery increasing in size?
A
Keloid
21
Q
during laparoscopy doctor just start the procedure pt become hypotensive 84/50 what’s the cause?
A
rapid inflation of the abdomen (Peritoneal stretching > vagal stimulation)
22
Q
-Most common complication post operative?
A
Atelectasis
23
Q
patient with abdominal mass after lifting heavy objects mass not change with cough. Dx?
A
Rectus sheet hematoma
24
Q
13yo obese boy found to have large hiatal hernia and grade 3 reflux asking about bariatric
A
Roux-en-Y Gastric Bypass
25
68-70 year old pt fall on the ground surgeon will do hip replacement surgery before surgery procedure what is the best prophylaxis thrombolytic drug for him
LMWH , enoxaparin .
| (IF patient with CKD -→UFH
26
Pt with pelvic fx and bleeding per rectum >> urethrogram > retroperitoneal urethra injury Mx?
Supa-pubic cystostomy
27
sure its cystostomy not cystectomy )
| 71-Membranous urethra injury management?
Retropubic catherter
28
- Old patient had percutaneous cholecystostomy, presented after 24hrs with upper GI bleeding what is the most important investigation?
angiography
29
pt complain of melena and epigastric pain diagnosed as peptic ulcer and received ppi but not improved endoscpy done showed multiple ulcers in the antrum what is the most accurate management
Antrectomy
30
84-Pt is with non-acth dependent cushing for rr adrenalectomy ..what is the postoperative management
Preoperative cortison
31
-Echinococcus syptomatic ((calcified)?
Surgery(cystopericystectomy
32
Case of liver cyst (echinoccosis) treatment ?
Albendazole
33
Classic amebic abscess scenario with clinical and imaging findings. Management?
Metronidazole
34
Old male with HTNand DMpresented with claudication examination reveals
right femoral intact pulse and diminished popliteal and distal pulse and left diminished
pulse intervention
CT angio
35
-50 years old patient, know case of DM, HTN presented with leg pain associated with hair loss , ABI more than 0.9, what is your diagnosis
Chronic limb ischemia ( ABI (ankle – brachial pressure index) more than 0.9 =cronic )
36
Diabetic patient with pseudo hyper epithelialization in situ?
Ulcer debridement
37
Dm pt with unilateral leg erythema Increases in dependant position, Cold, Femoral pulse is present, distal pulse can be palpated No tenderness, no swelling, no fever Otherwise unremarkable
Superficial thrombophlebitis
38
Patient with diabetes and hypertension smoking 40 c per day came to er complaining of leg pain on examination on lower limp the pulse was intact on femoral and pupletial artery’s and diminished on distal pulse first question was what is the best appropriate next step ?
Heparin
39
110-60 years old patient come with epigastric pain radiating to back . He’s smoker and long standing for DM and HTN . Abdominal examination show pulsatile subra umblical mass . What’s Dx
AAA
40
108-Pulse abdomen mass in middle abdomen what (next step to confirm) management ? A. angiography B. CTangio ✅✅ C. US
Key word: dx is abdominal aortic aneurysm intial US, confirmation and management CT angio
- 109-Pulsatile abdominal mass Abd X ray showed no air level What (((nexst step ))) investigation to order:
A. abd Us✅ B. CT angi
Done
41
-Surgery was done for diabetic septic foot ,no wound healing for 2month what is the cause
Poor blood supply
42
- 112-PT admitted due to MI after 2 days of discharge developed sever pain in his leg Dx?
1/ acute arterial thrombosis 2/ Acute Arterial Embolus ✅ 3/ DVT
Not sure
43
Female patient after cryotherapy for varicose 2years ago complainig of leg and foot pain what nerve is damaged
Saphenos nerve
44
Patient with unilateral left leg non-pitting edema, skin thickening and hyperpigmentation (dermal fibrosis) for 2 months. Management?
Compression bandages (combination of physical therapies; two-stage approach
45
presentation lymphedema, what is the important thing in hx to ask about?
Trauma
46
- 126-Bilateral great saphenous vein mange ?
sclerotherapy B. something endoscopic C. ablation ✅
| Key word:Any bilateral great saphenous = ablation Cosmetic =sclerotherapy
47
What is hard sign of vascular surgery?
Hard sign to detect vascular injury ?
Bruit // pulsatile bleeding
48
pt involved in RTA stable, but there is left leg swelling and paresthesia between toes xray showed fracture tibia pressure in posterior leg compartment is 35 mmHg
External fixation with multiple faciotomy
49
145-decrease in left testicular size post hernia repair ?
pampiniform plexus occlusion✅
50
Pain with absent cremasteric reflex, management
Surgical consult
51
recent abdominal surgery presented by fever&otheres. what is the most cause
Subphrenic abscess
52
female patient complains of urinary dribbling, dyspareunia, dysuria. What is the most likely diagnosis?
Ureter diverticulum
53
-Female (obese) with typical appendicitis: Right iliac pain and tenderness Nausea and vomiting. Loss of appetite. Leukocytosis What is the proper management
Adults = CT / pregnant or child = US
54
Post appendectomy female came with LR abdomen mild tenderness Ex Normal By CT there is 2*2 collection in Retrocecal
Antibiotics/ if more than 5 cm do percutaneous drainage
55
Pathophysiology of appendicitis in 58 male ?
Peripheral Vasoconstriction
56
Young unilateral testicular swelling since 1 day, on exploration viable but cord edematous
Appendicular torsion
57
161-Post-appendectomy, 0.5 cm carcinoid found on the tip of the appendix, mx?
Nothing = If carcinoid tumor less than 2cm > appendicectomy only More than 2cm or at base of appendix> right hemicolectomy
58
After appendectomy dr found a carcinoid mass more than 5 cm on the tale of appendix Next?
C.T scan abdomen and chest for staging
59
after initial conservative treatment of appendicular mass :
Laparoscopic appendectomy after 12 weeks ✅
60
80 y old man with bilateral hydronephrosis on Us images ?
BPH
61
Part of urethra affected by surgical (trauma) in males ?
Bulbar
62
By Cyctoscopy: Redness in the dome of bladder What is the most likely diagnosis:
Transitional bladder cancer
63
Old M c/o urinary sx, prostate median lobe hypertrophy, what is best for this pt?
Annual Prostate-specific antigen
64
Old pt came with difficulty urination and low back pain with high Prostate-specific antigen
dx?!
Prostatic cancer wirh spine metastasize
65
Urethral trauma with bleeding post MVC. Next step?
Suprapubic catherter ( retrograde urethrogram is essential for diagnosis of urethral injury, or urethral stricture )
66
sclerosing patient with history of rectal bleeding, anoscopy show swelling at 3,7 o'clock, sclerosing is planned what is the most appropriate to do sclerosing therapy
-Sclerotherapy use in management of
sclerosing = internal hemorrhoids
67
-Patient after hemorrhoids operation develop Suprapupic pain with inability to pass urine what
is cause?
Anasthesia effect
68
20s years old presented with pain during defecation minimum amount of blood, on examination the doctor seen a posterior midline fissure. He couldn’t do PR (rectal examination)exam as the patient was in severe pain Vitally stable What’s your next step?
EUA (Examine under anasthesia EUA
69
Old patient who has constipation on and off with streakin of blood in the stool with no fulness in the rectum ( no mention of pain )?
Old pt-fatigue sign of anaemia hb8 , stools with streak of blood -has hemorrhoids stage 2
Rectal cancer
70
Patient came with painless blood after defecation, whats the diagnosis?
Hemorrhoids
71
Hemorrhoids type 4, what is the management:
Hemeroidectomy
72
Patient with (perianal) painful (swelling)-vitals normal, (wbc normal)? Whats the diagnosis
Perianal hematoma
73
Anal fissure with sentinel pile not responsive to medical therapy. Next step
Lateral internal sphincterotomy is an operation performed on the internal anal sphincter muscle for the treatment of chronic anal fissure. The internal anal sphincter is one of two muscles that comprise the anal sphincter which controls the passage of fece
74
streaks of blood after defecating and pain?
Anal itching and pain post defecation and ask ddx?
31 year old male with constipation and during perianal exam there was sever pain and linear laceration at 6 and 12 oclock whats the dx
Anal fissure
75
pt with intermittent perianal pain and discharge, on P/E theres low-lying fistula with an opening
in posterior wall above anal verge. What to do
Fistulogram for investigation, fistulotomy for treatment
76
Perianal pain on examination no lesion, finger exam showed internal swelling with purulent
discharge on the anal canal , Dx?
Male adult with perianal swelling and discharge, then ruptured?
Internal abscess / fistula
77
pt presented with 3 months bleeding after stool, a perianal mass, and weight loss. Histology confirmed adenocarcinoma. CT finding shows no lymph node involvement and mass limited to 3cm from anal verge. What's treatment modality?
Case of perianal swelling , per rectal bleeding , investigated : it is 1 cm from anal verge biopsy: adenocarcinoma (rectal) Mx
Less than 6cm from anal verge > Abdominoperineal resection
| More than 6cm > Lower anterior resection.
78
First evaluate surgical wound by?
inspection Key word:
- If there’s signs of infection* (pulurent discharge, redness, tenderness) then wound exploration if superficial > clean, dressing and you may give abx
- If deep collection suspected >* order CT
- If small collection less than 4cm >* abx
If large 4cm and more* > percuteanous drainage + abx
- If signs of peritonitis > Laparotomy
79
10 cm laceration in anterior thigh what to do?
Compress the wound
80
Elderly pt sacral ulcer manag?
Daily dressing
81
Elderly pt underwent for a major surgery ..he need blood transfusion 15 PRBCs .. after that he start bleeding from wounds, nose, from NGT (stomach) .. what is the cause:
Thrombocytopenia ( there was no DIC in choices)
82
Girl with stab wound in the right anterior axillary line below the costal margin, stable?
A. Observation.
B. immediate surgical exploration. Perform FAST
If pt stable and chooses have CT go with it. If not choose A, if unstable Go with CT if not do Fast to pt.
83
Neck stab wund
Zone I, and III > C.T angio
• Zone II asymptomatic > C.T angio
• If symptomatic> surgical exploration
84
pt with forearm fracture and open wound 1cm , what’s TTT :
Debridment, irrigation, fixation
85
Pt post-operative and leak 20ml fluid from the wound:
Wound exploration
86
Post open appendectomy case with pain in wound site on examination u see pus oozing from
site of surgery what will u do next?
25 year old male Pt 8th day post surgery with wound site redness & tenderness with purulent
discharge.. most appropriate?
Exploration of wound then IV antibiotics
Open draingec
87
After herniotomy surgery for 5yrs boy came with fever and pus discharge and part of mesh seen ?
Draining of pus and remove mesh
88
X Ray showing both distal ulna and radius fracture with volar displacement On examination a 1 cm wound was seen at the volar aspect of the wrist Asks about initial management:
Irrigation of the wound and Closed reduction with cast below elbow
89
Trauma patient with a wound on his thigh subcutaneous fat is lost vasculature underneath is
exposed what provides the best management
person with car accident on left thigh show neurovessle fat and tissue out mange ?
Debridemnt with secondary closure✅
Key word: fat and vascular lost = secondary closure
If crash wound = primary
Debridment with slin grafting
90
Patient post surgery, there surgical wound redness, tenderness with no discharge, abdomen is
soft and lax .what to
Patient post surgery, there pus coming from surgical wound with tenderness and leukocytosis,
abdominal examination was done it was soft lax with no tenderness all over, what to do?
Antibiotics
91
Patient was hit with wood 5 days ago, now he comes with severe RLQ pain. On examination there is a small opening with pus discharge, put when tried to extend his thigh there was severe pain and you couldn't move it. What to do
Patient post resection and colostomy presents with spiking fever for 1 week. Chest is clear. Abdomen is clear. Wound is clear. Fever 38.2 Next step?
CT
| Spiking fever = peritonitis
92
Patient with right lower chest stab wound. Fast showed free abdominal fluid. What is your next
Exploratory laparotomy
93
An elderly with IHD day 2 post cholecystectomy presented with sudden chest pain SOB and vitally hypotension and tachycardia whats best ?
EEG
94
Elderly with weight loss (10kg) and anorexia in endoscopy there is large ulcer in stomach , biopsy was taken and the result is invasive adenocarcinoma . What is the next step:
CT ( Abdomen , chest, pelvis )
95
-Best diagnostic method for pulmonology embolism?
Spiral CT ( pulmonary angiography : best definitive diagnostic test )
96
Chronic thromboe-embolism confirme
QV ratio ✅ B. spiral CT C. D dimer
97
supraclavicular LN metastasize what you do for primary site :
Gastroduodenoscopy
98
How to diagnose Adhesion post operative?
| CT, but Initially > abdominal X-ray✅ (Air-fluid level, Bowel dilatation) Key word: initial x-ray
Wrong
99
Pt melena and fresh blood per rectum, upper and lower endoscopy negative, next investigation:
Endoscopic capsule
100
best diagnostic test for Coarctation of the aorta for neonate and adults?
Echo
101
A man who is a known case of diabetes presented with hemiparesis 15 hours after some procedure ? How to diagnose
CT angio
102
Pt with bronchogenic carcinoma, presented with progressive SOB, there’s elevated jvp, clear lung and quiet heart sounds. What will confirm your dx:
Echo ( This case of cardiac tamponed so diagnosis with echo = quit heart sound )
103
Pt presented with stabbed wound after wound exploration you found anterior abdominal fascia penetration, (his vitals were stable) what's your next step?
CT abdomen ( definitive diagnosis is by laparoscopy )
104
Best way to show cervical spine:
Lateral cervical X-ray
105
child episode of PR bleeding, fresh ; black stool (have both melena and hematochezia) ; NGT
showed greenish fluids ; colonoscopy was negative what is next to detect source of bleeding ?
TC 99 ( not sure )
106
Old with back pain radiated to back , CXR air under diaghram?
perforated peptic ulcer Key word: air under diaphragm
107
Pt in ICU with coffee ground vomit?
Strss gastritis
108
cerative on med presents with abd pain Invistigation show enlarged transver colon 15 cm or mm? Management
Steroids
109
morbidly obese male , how to decide best reduction surgery he will have ?
Endoscopy
110
Patient complained of abdominal pain 3 weeks after sleeve gastrectomy, what is the diagnostic test
CT
111
Patient after pacreatitis episode develops upper GI bleeding picture , scope was done, gastric fundus bleeding was found ,sclerotherapy done Duplex ultrasound showed: splenic vein
thrombosis with patent portal vein whats is your management
Splenectomy?
112
12 year old received a nonspecific blunt trauma on his abdomen and later presented with generalized abdominal pain. Imaging of the spleen showed a 7mm hematoma and 4 cm tear(grade 3). Your management:
Stage 1-2 = conservative ttt
Stage 3 = preserving surgery
Stage 4 = splenectomy
113
30 years old male after RTA had a splenectomy, what will be low after hours from the surgery
Insulin
114
Patient 3 days post splenectomy develop fever 38.5 what is the cause of bacteremia?
UTI
Key word: 0-2 day = atelectasis or pneumonia 3-5day= UTI
5-7=DVT
7 day = wound infection
8-15= drug fever or deep abscess
115
Alcoholic present with hematemesis. Imaging shows splenic vein thrombosis. Management?
Splenic vein thrombosis = spleenectomy
116
What type of mesh used in ventral wall hernia
Suply
117
40 years old man underwent open hernia relain and 2 weeks later presented with tenderness at the site of hernia repair and severe parasthesia/numbness/tingling around his thigh that went down his leg= management?
Inguinal intractable pain with hyperaesthesia with pain radiating to thigh 3 weeks post inguinal hernia with mesh, upon physical exam, no recurrence or surgical site infection, what's the mx:
Key word: this case of ilioinguinal nerve inj need to NSAID for long time maybe month if no response then nerve block and last resort is neurecromy can be do
118
Pt with Reducable hernia comes with intestinal obstruction manifestation and on exam was redness and on Xray : multiple air fluid level
multiple air fluid = strangulation
119
60 yo pt Post ventral hernia surgery with mesh 6yrs ago pt came with abdominal distention and on radiology cut off sign and target sign and soft tissue mass?
Late onset of crohns
120
-8 month infant with right inflamed red hemi scrotum, on examination there was red firm irreducible painful scrotal swelling which is extended to to left inguinal region. Left testis couldn't be palpated. What is the diagnosis
Incarcenated inguinal hernia
121
45-year-old female developed hernia located inferior and lateral to pubic tubercle. Type?
Femoral
122
Patient came after 5days of hernial repair complain of inguinal mass , there is no erythema , no tender and not associated with cough , what is most likely the cause :
Serosa
123
underwent hernia repair for right inguinal hernia, presented now complaining of that ipsilateral testicular size is decreased after hernia repair. Dx
pampiniform plexus compression
124
60 yrs old female with femoral hernia, asymptomatic, accidental finding mx?
- 319-Old man came to you with Inguinal reducible hernia, and he was advised to do hernia repair, and PE exam was normal he is asymptomatic what will you do?
Asymptotic = Observation
125
Case of hiatus herni' and ask about immediate management
Lifestyle modification
126
Pt do hernia repair "not sure about the type" then he present with mass in the inguinal hernia firm, regular, transpulsation "there was no Erythema or tender"and no fever
Pseudoaneurysm = A complication of laparoscopic inguinal hernia repair No erythema and no tenderness
127
-year-old weight lifter developed abdominal hernia that is irreducible, tender. Imaging shows air-fluid levels in small bowel and no free air in large bowel. Type?
incarcerated hernia is a part of the intestine becomes trapped in the sac of a hernia—the bulge of soft tissue that pushes through a weak spot in the abdominal wall. If part of the intestine is trapped, stool may not be able to pass through the intestine.
**strangulated hernia occurs when the blood supply to the herniated tissue has been cut off. Pt like Toxic hypotensive tachy ....etc.
128
18 year old healthy male was playing baseball and suddenly he felt abdominal pain. On examination he has para-umbilical mass. His vital signs Bp 100/76 RR 30 HR 100 O2 sat. 95% oxygen mask. What is your(( next)) step in management?
Abdominal US
129
Sclerotic lesion in distal femur:
Osteosarcoma
130
Patient w incidental finding of macroadenoma of pituitary during evaluation of
her headaches, physical and medical hx was unremarkable, what’s the best
next step?
A. - ant pituitary hormone scan ✅ B. - Referral to neurosurgery
131
-Mid-thigh lump with normal overlying skin and (+ve fluctuating) test. diagnosis
sebaceous cyst low- growing ,mobile , firm, painless nodule , dark colored may be seen on cyst , localized predominantly on the face, head, neck ,or genitals
Infection possible cause (painful, erythematous, mass exude pus )
132
Patient came the weight loss and abdominal distention, Ct found: Soft tissue mass retro- peritonal , and multiply hypo-dense or hyper (forget ) liver lesions
Old man came with vague abdominal pain with 20cm×20cm mass , finding in u/s multiple hypoechoic masses ( or nodule ? ) What is the diagnosis
Liposarcoma
133
-Old man has progressive dysphagia e mass in mid esophagus ,chest x-ray normal . What is the most likely cause?
Key word:SCC= mild and upper Adenocarcinoma = lower
134
what makes lymphadenopathy malignant more than infectious
Supraclavicular lymphadenopathy
135
Man with high grade dysplasia of the esophagus. How will you manage?
Refer to surgery
136
-Smoker with chronic dyspepsia, endoscopy biopsy is squamous cell with low grade dysplasia,
what is your management?
PPI and rescope every 6_12 month
137
Most common/important risk factor for esophageal cancer is:
A. Heavy smoking✅ B. Barrett's esophagus Key word : answer according to SSC or adenocarcinoma
138
Low grade dysplasia barrett's esophagus, what is the management:
Pantoprazole
139
Epigastric pain diarrhea and peptic ulcer with + secretin
Gastrinoma
140
klatskin tumor= is cholangiocarcinoma located at bifurcation of common hepatic duct, marker is
CA 19-9
141
Pt known case of lung cancer and had history of (epilepsy) and on medication, medication is
contraindicantion to this pt ?
Bupropion = epilepsy
142
pt with hypertenstion and by ct abdomen show hypoechoic on adrenal gland ? biopsy
نتاكد هل هو خبيث او لا
pt with hypertenstion and by ct abdomen show hypoechoic on adrenal gland ? biopsy
نتاكد هل هو خبيث او لا
if mass more than 6 cm do Adrenalectomy if less than 4 cm ? usully observantion
143
-adrenal tumor with high cortisol symptoms next management :
Surgery
144
Sarcoma notes
Sarcoma metastasis to…….
- 350-Sarcoma Biopsy most Diagnostic test:…….
Melanoma = ………
Sarcoma = …….
-Sarcoma "no incisional in choices ? Core needle biopsy
Lung / incisional biopsy
| Melanoma = excisional biopsy
145
Sarcom' of the thigh. Whats the best imaging for staging work up?
CT
146
Pt with mass 2 cm away from anal verge on proctoscopy appears as cauliflower
70 year old male Weight loss fatigue proctoscopy shows mass 2 cm from anal verge
cauliflower like friable mass ? Anal cancer because of wt loss
A. Anal cancer B.Chondalymia acuminta ✅ ( Key word: cauliflower
Chondalymia lata= syphilis
Chondalymia acuminate=cauliflower
147
Cancer in body of stomach with no metastasis and no lymph node ?
wide local local excision with clear margins
148
25 years male involved in RTA in ER he is fully continues and no abnormality in vital signs admitted for observation and a FAST scan done ,.what do you expect to find?
A. Pneumothorax
| B. major vessel bleeding in the thorax C. peritoneum free fluid✅
149
Pt came to ER after MVA with multiple trauma and hypotension, tachycardia, x ray shows cardiomegaly and sternal fracture , Dx ?
hemopericardium ✅
| Key word: cardiac teponante cause hemoprtcardium (hypotension , high JVP ,muffeled heart sound decrease)
150
Thoracocentesis: …..l.
Needle thoracotomy: …….
Between 8-10 ribs mid axillary line / 2nd rib space
151
Elderly smoker with progressive SOB, on CXR massive Rt pleural effusion what's your next step?
A. Thoracocentesis
152
-Case about pleural effusion on chest tube after a while there was blood in the water under seal (Hemorrhagic Pleural Effusions and Hemothorax), how to manage
Patient had fall 50 meter, absent lung sound on the right side, CXR was provided but not clear:
Chest tube (tube thoracostomy )
153
man presented with a gun shot wound in his chest that he received an hour ago, and you’ve done needle thoracentesis. 15 mins later 100 ml of blood is drained, what is the next most appropriate action
Thoracostomy
154
Patient who had had multiple traumas in MVA, they mention presence of free fluid in the
abdomen and spleen laceration + thoracic aortic rupture. Next
Thoracotomy
155
-RTA , presented with slow breath and decrease breath sound left lower lobe lung xray picture showed infiltrate in lower left lobe and he has lower limb fracture His blood pressure and HR was normal ,What is your management
Thoracostomy
156
Patient with pneumothorax tube thoracostomy inserted after 15 min water seal bottle is filled with blood PB: 90/60 HR: 100 Rr:22
Thoracotomy is indicated when total chest tube output exceeds 1500 mL within 24 hours
157
Patient who was hit in the chest while playing football, after it SOB, tracheal shift , hypotension and raised JVP , diagnosis :
Tension pneumothorax ✅
| - Key word: tension pneumothorax= SOB , raised JVP, hypotension tracheal shift
158
RTA , facial fractures , unconscious, what is opportunity in mx?
- Multi trauma pt, with many facial fractures, next step?
- man with facial bones fractures after RTA, in the ER what is the first thing to do?
Airway
159
386-man after accident and resuscitation in small hospital u need to transfer to another hospital after stabilization, it is 30 mins far. on xray u see fracture of 2-5 left ribs. no pneumothorax what will u do?
a. intubate✅
b. call the other hospital to inform the surgeon on call c. chest tube insertion
Not sure
160
Patient after RTA was conscious GCS 15 then suddenly collapsed u see a temporal fracture what caused his loss of consciousness?
Epidural hematoma
161
Young male with bilateral anterior without post lower limbs 2nd degree burn who weighs 70 kgs Asks about fluid replacement according to parkland formula:
A. 2.5L to be given in the first 8 hrs and 2.5 L in 16 hrs✅ B. 5L in first 6 and in 16 hrs
نستعمل =parkland form
4ml x TBSA (%) x body weight (kg)
ال lower limpالوحدة فيهم = ٩ الاثنين مع بعض = 18 نضربها بالوزن الي هو 70 نضربها بالرقم الثابت الي هو 4 تساوي 5040
نقسمها على اثنين عشان نعطي اول جزء في اول ٨ ساعات والجزء الثاني في ١٦ ساعة فتساوي 2500 يعني اثنين لتر في اول
162
pt with 20% back burn which indicate good response?
Urine output 0.9ml/kg /h
163
Burn case black soot over nostrils and mouth 40% carboxyhemoglobin. (Carbon monoxide toxicity):
Hyperbaric oxygen
164
multiple opening+ DM = ……
carbuncle
165
Open fracture came 4 days later to ER with signs of infection ( blue, necrosis) what's the most common organism
case about gas gangrene due to open leg fracture infected by
Clostridium
166
Patient with liver mass Ct first stage filling periphery late washout centrally :
Hemangioma
167
patient with post operetive 'abdominal destintion and small and large bowel obstruction and no fever 'nd a'bdomen not tender :
Hypo k ( it causes illus paralysis)
168
Child Diaphragmatic hernia first thing you do?
NGT
169
Weber in right and bilateral + rinne test?
Left sensorineural
Positive rinne = normal conductive hearingtest
Weber shift to right so it’s either right conductive or left sensorineural
170
Colon cancer common metastasis to?
Liver
171
Bradycardia (40 bpm) during laparoscopic procedure Is due to :
Rapid expansion of parietal peritoneum
172
60 years old patient come with sudden onset of upper abdominal pain after a few bouts of vomiting. Examination confirme sick patient with tenderness in epigastrium and supraclavicular subconscious emphysema . What’s Dx ?
boerhaav’s syndrome✅(is spontaneous perforation of the esophagus )
173
Pt with dysuria and cloudy urine with bubbling for 2 months, hx of recurrent left iliac fossa pain for the past 2 years ! Colonoscopy: no diverticulosis or polyp Cystoscopy: erythema on dome of the bladder. Most likely diagnosis:
Disease diverticular
174
Patient had a hyperextension trauma, complains of distal phalanx pain and tenderness in the volar aspect, he also feels tenderness in the palm, what's the dx
Rupture of flexor profondus
175
-50 male came with 4 time hematochezia , no weight loss , no abdominal pain dx:
Diverticulosis
176
patient on TPN will increased INR what to give?
Vit K
177
Patient with jerky carotid i
Hypertrophic cardio myopathy
178
patient came with melena and they did upper gi endoscopy and found 1cm bleeding duodenal ulcer and they ask about the duration of ppi ?
iv ppi for 72 hours then convert to oral✅
179
Patient post graham patch surgery, what is the most appropriate management?
Give IV PPI for 48hours
180
-6 yrs old, female presented with nausea and recurrent vomiting of every intake , pt became lethargy with decreased skin turgor and cry with tears. Investigation revealed Normal investigations apart from :High Na Low glucose What is the best next management ?
isotonic saline 20ml/kg
181
Young female c/o fatigue and jaundice high ALP and high bilirubin Us: no any finding MRCP : multiple stricture Next step to *confirm* Dx ?
Liver biopsy
182
Case of established diagnosis of biliary sludge of postoperative sleeve pt with jaundice and US report of biliary sludge. What is the management
Cholecystectomy
183
What is the Pathophysiology of bacterial peritonitis due to E. Coli ?
Bowel perforation
184
young male with ulcerative colitis , bloody diarrhea, abd pain and S/S of intestinal obstruction X-ray shows: megacolon What is appropriate management:
IV steroids
185
-65 male patient present with SOB and generalized fatiguability, On Ex: non tender mass in right iliac fossa, Hemoglobin: low What the most important step in Mx
Colonoscopy
186
Patient underwent esophageal dilation. After 12h patient had symptoms and they did gastrografin which showed leak. Temperature is 39. BP 100/50*?
A. Stent B. Esophagectomy C. Surgical drainage✅
Not sure
187
Sacral ulcer, skin necrosis and exposed subcutaneous fat manage?
Debridement with secondary closure graft
188
Case of cystic fibrosis with abd pain , bloating , pale stool Abd scraled or curve???
Chronic pancreatitis
189
Patient claudication long case, then after full treatment with thrombolysis, patient is risk for what while staying in hospital
PE because of DVT
190
Scenario Liver mass 3 cm next with splenomegaly ?
Triphasic CT
191
Epilepsy pt posterior dislocation, which joint?
Subacromial
192
Meigs syndrome ( ovarian tumor + ascites + pleural effusion ) How to confirm the Dx?
Tissue histopathology
193
Sigmoid volvulus case (s&s), ttt:
sigmoidoscopy detorsion if stable✅
194
Hepatitis B and lesion 6 cm what to do next?
Transcatheter arterial chemoembolization) ( if lesion is less than 5 d excision )
195
24 years old with history of appendectomy 5 years ago present with abdominal pain , distintion , vomitting for 3 days Ct scan show obstruction signs And peritonitis , Whats contraindicated in this patient ?
Nitroz oxide
196
What hormone is associated with Biliary colic?
cholecystokinin
197
- pt with history of crohn's after colon surgery developed severe diarrhea what you will give ?
Cholystamin
198
55 year old with constipation and distention, on examination there is , CXR pic with coffee bean appearance, where is the site of obstruction?
Sigmoid
199
Euvolemic hyponatremia fluid replacement
Water Restriction✅
hyponatremia ttt =fluid (euvolemia)
Isotonic saline= (hypovolemia)
Hypertonic saline= (sever symptomatic hyponatremia)
200
Post colectomy for colon cancer she is Diabetic, received dextrose and Insulin for 2 days, then she developed confusion and agitation. Lab : hypoNA hypoK, urine osmolality normal, serum 270. Most likely cause
Water overload
201
What pass through deep inguinal ring:
round ligament in female
| Spermtic cord in male
202
burn patient and resuscitation done, which of the following reflect a good resuscitation has been achieved
Urine output
203
ULQ lump increasing with time, size 15x15 cm, us show solid mass with multiple cystic spaces with posterior costic enhancement
= (PHYLLOID TUMOR) = simple mastectomy
204
radical mastectomy complaining of loss of sensation in inner side of right arm?
Inner-costo brachial nerve
205
Acute mastitis organism ?
Staph aures
206
Lactaional mastitis case treatment
= oxacillin with continu breast feeding
207
Birad 4 , next step
1. 2.3.=follow up
- 4.5 = core biopsy
- 6= surgery
208
invasive intraductal papilloma. The most appropriate management is?
Wide local excision
209
Color of discharge in intraductal papilloma ?
| duct ectasia, color of discharge?
Papilloma = red / Ectasia = green
210
32 yo I think female concerned about breast cancer, because her mother have it and her sister has ovarian cancer. What to do?
BRACA
211
4-5 cm phyllodes mx?
Benign breast phyllodes tumor ?
phylloid less than 10cm benign = wide locl excision
| - Above 10 cm simple mastectomy
212
hard, mobile, well-circumscribed painless left breast mass that has been increasing in size?
Phylloid
213
typical pancreatitis: epigastric pain, high amylase what is next step?
best initial = Us
- Confirm= ct
- Amylase = sensitive
- Lipase = specific
214
Scenario of abd pain post meal with a hx of pancreatitis month ago Fluid collection found what is it?
Pseudo.Cyst
| Keyword; complication of pancreatitis is pseudo. cyct
215
Pancreatitis 5 weeks ago. Now she has epigastric tenderness and cannot tolerate food with vomiting each time. By ultrasound you found large about 12X10 mass With thick wall and fluid inside. Labs: 346 amylase, Wbc 15k. What is the diagnosis
Walled of necrosis ( not sure )
216
Chronic pancreatitis what you will find?
hyperglycemia, hypocalcemia+increase lipolysis
217
40 years old woman with no pain but you noticed jaundice. She has high direct bilirubin and
high ALT what is your diagnosis?
Carcinoma in head of pancreas
218
case of acute pancreatities ?Iv fluids and analgesic Abx for necrosis
acut pancreatic start with Npo and then iv fluid then analgesic
219
30 y/o Cystic fibrosis with GI Symptoms what complication he might have?
Chronic pancreatitis
220
best method for pancreatic pseudocyst drain ?
Endoscopic
- pseudo cyct drain if not infective= endoscopic
- If infective(fever , leukocytosis ) =precetsnous drainge
221
Pancreatic pseudo cyst treatment
- less than 6 cm and 6 week > observation - more than 6 cm and 6 week > drainage
222
Gray turner sign = abdominal hemorrhage, ts sign of ?
Necrotizin pancreatitis
223
Patient has radial nerve injury , where level of injury ?
Patient had loss of sensation on the snuff box and dorsum of the medial hand, hehad wrist drop. At which level is the radial nerve injured?
spiral groove humerus
224
Typist c/o tingling and pis in left thumb, index and middle & problem in dorsiflexion and fingers extending which nerve affected ?
Radial
225
-Patient with pain when writing at keyboard, some test showed hypoperfusion to superficial palmar arch, what’s the artery affected
Ulnar artery
226
Thenar muscle atrophy ?
Median nerve
227
Pt had surgery then Lost sensation in ear pinna and upper neck what nerve is injured ?
Great auricular nerve
228
Male with left little finger and(( ring numbness)) or pain , raisstress test increases the symptoms, what’s dx:
thoracic plexus
- Keyword :little finger affected when raise his hand above and feeling numbness so thoracic plexus is block = thoracic outlet syndrome
229
Athlete with pain during standing PE: tenderness in medline planter surface?
Plantar fasciitis
230
An elderly with IHD day 2 post cholecystectomy presented with sudden chest pain SOB and vitally hypotension and tachycardia whats best ?
CT angio
231
Most common cause of biliary colic
Gallstones
232
pt with typical cholecystitis Mx?
immediate lap chole ( within 72 hours )
233
Abdominal pain and US show stones in gall bladder with(( normal wall ))what is the management ?
a) Lap chole b) Ursodeoxycholic ✅
Ursodeoxycholic Acid, is a naturally occurring bile acid and is used to dissolve gallstones that are rich in cholesterol. It is also used to improve the flow of bile in primary biliary cirrhosis.
- 579-Old man came with jaundice and dark urine , palpable gallbladder , lab shows direct
234
Old man came with painless jaundice and dark urine , palpable gallbladder , lab shows direct bilirubin?
klatskin tumor
235
Patient during complicated lap chole the surgeon accidentally transected the CBD (common bile duct( above the level of cystic duct, what’s your management?
Hepao-jejunustomy
236
Lowest risk for cholesterol gallstones ?
Nulliparity
237
With RUQ pain, US showed fluid around gallbladder, management:
US guided aspiration
238
- Recurrent RUQ pain aggregation with morphine, temperature 36.5
Biliary colic
239
Pt came to ER with ruq pain and jaundice, with fever i think, 2 h later patient improved, us showed multiple gallstones within normal walled gallbladder, management
Lab cholecystectomy
240
Patient with jaundice, abd pain and on US u see stones and dilated CBD vitals show fever only asking about diagnosis?
fever+ jaundice +abd pain=ascending cholangitis
241
Pt with DM and HTN and SCA , type of gallbladder stones will form?
Diabetic obese elderly female with sickle cell trait has Lithiasis what kind of stone she has?
Sickle cell disease = pigmented
SC trait= mixed
242
Patient with history of lap chole few weeks ago presenting with right upper abdominal pain , respiratory symptoms , US done and show pus collection at site of gallbladder 12*6 cm What is the most appropriate in management?
Percutaneous drainage
243
Patient post bariatric surgery complains of on and off fever for one week On examination chest,
abdomen and wound were normal How are you going tomanage
CT abdomen ( spiking fever = pus )
244
female pt present with right upper Q pain ,febrileLab test show: increased WBCs increase ALP increase Direct bilirubin US Show : fluid around gallbladder , multiple stone What the most appropriate management ?
Antibiotics
245
Elderly pt admitted to Icu with acute MI , and developed pneumonia on tazocin , he also have RUQ pain and tenderness. Management ?
us guided cholecystostomy drainage
246
ulcerative colitis pt with y shape something with very enlarged transverse colon and no haustrea what is Rx ?
pan colectomy with ileostomy
247
Obstrictive jaundice pic and cholangitis on IV abx ,US (dilated ducts, gallbladder has
stones) what else in the mx?
Cholengitis = ERCP
248
Post lap chole presented after few days with abd distension and ascites and abd pain what will u do
ERCP
249
laparoscopic cholecystectomy come with discharge from middle managemen
Explorations
250
Patient on 3rd day post cholecystectomy develops fever, has no abdominal pain.What is the likely cause of fever:
UTI
251
sign in radiology for duodenal ulcer
Clover leaf
