Lange Flashcards
Hidraenitis supperativa
infection of apocrine glands and surrounding subcutaneous tissue and fascia involing axilla, groin, perineum, and perianal region. Usu with staph or strep.
can treat with local hygeine and tetracycline.
Aromatase inhibitors or tamixofen/raloxifene -which one is better in post-menopausal women in preventing breast cancer recurrence
aromatase inhibitors
fine or coarse calcifications on mammogram -which has more likelihood of benign pathology?
coarse calcifications
If you suspect pagets disease of breast due to eczematous changes, what to biopsy?
nipple biopsy will show large vacuolated cells
In breast cancer, radiation therapy is required whenever breast conserving surgery is undertaken. When do you give hormones and/or chemo?
hormones if ER+/PR+
chemo if tumor is > 1 cm
How to treat someone who’s pregnant with breast cancer
chemo can be given after 1st trimester
radiation therapy is not allowed
so breast conserving surgery is not appropriate if radiation is not allowed
Bone is the most common metastasis from breast cancer. usu lytic or blastic?
lytic
can be treated with bisphosphonates
Breast cancer with linear “indian file” arrangement of tumor cells and a tendency to grow circumferentially around ducts and lobules.
Infiltrating lobular carcinoma
WHich vessel is at risk when doing a tracheostomy?
anterior jugular vein
dysphagia and aspiration can result from disruption of which nerve
internal branch of superior laryngeal nerve leading to sensory loss of larynx
Most common cause of primary mediastinal tumor is
neurogenic tumor usu arising from an intercostal nerve or sympathetic ganglion
How does spinal anesthesia work
induces venous vasodilation b/c of sympathetic blockade
Venous pooling can seriously impair venous return and decrease CO therefore it is impt that pt has adequate volume
Which cancer accounts for 70-80% of SVC syndrome
bronchogenic carcinoma
Knife at above second rib at level of inferior margin of fourth thoracic vertebrae.
arch of the aorta
Nonfunctioning lung tissue that is disconnected from the remaining lung with a separate blood supply
bronchopulmonary sequestration
Nasopharygneal cancer affects Asians with high titers of EBV. whats the first CN to be affected which will indicate cranial met
CNVI -abducens nerve
Carotid body tumor is the most common type of paraganglioma int he head and neck region. They may secrete? Supplied by which artery?
secrete catecholamines
supply by external carotid artery
arise from structures that respond to changes in PO2
Most common site for foreign bodies in head and neck
ear
epistaxis in children vs elderly involves
children -anterior septum
elderly -posterior septum
After thyroid surgery, cannot sing high pitch anymore. What’s affected
external larygneal nerve which supplies the cricothyroid muscle responsible for tensing the cords
EKG -low voltage precordially
Exam reveals pulsus paradoxus
What test is good to assess problem
ECHO for pericardial effusion/tamponade
SOmeone with MI, CHF, and PVCs may benefit from
internal cardiac defibrillator as most freq cause of death in this pop is ventricular arrhythmia
When do you have to do surgery or percutaneous balloon valvuloplasty (now used as initial approach) for pulmonary stenosis
moderate to severe stenosis (right ventricular/pulmonary gradient of 50-80 mmHg)
When will you perform gastrectomy in someone with peptic ulcer disease?
not common so if done, due to hemorrhage, obstruction, perforation and intractable pain
A gastric ulcer that fails to respond to medical therapy requires
surgical intervention -partial gastrectomy
Preferred treatment for non-hodgkin’s lymphoma in the stomach
radiation and chemotheraphy
Gastric ulceration with a donut sign
GIST (usually can resect; no chemo/radiation)
Acute gastric distension can occur after surgery with symptoms of pallor, sweating, bradycardia, hypotensin, abd pain. What to do
NG tube
When you do a vagotomy, it can result in stasis. A gastric drainage procedure should be done with it. What are three
- pyloroplasty
- gastrojejunostomy
- antrectomy
*drainage procedure is not necessary if you do a highly selective vagotomy
Pts with pernicious anemia have increased risk of developing which malignancy
gastric
Epiphrenic diverticulum aka supradiaphragmic diverticulum is a pulsion diverticulum assoc with which 4 conditions. It is located with 10 cm of the cardia. and is usu asymptomatic
- hiatal hernia
- achalasia
- DES
- miscellaneous
Plummer-Vinson syndrome is described as an upper esophageal web leading to dysphagia, atrophic oral mucosa, spoon-shaped brittle nails, and iron def anemia. There is an increased risk of developing esophageal cancer. Once, endoscopy reveals the esophageal web, what should be the next step
dilatation of the web
iron therapy
Schatski’s ring is a thin, circumferential scar in the lower esophagus, more common in men 65 or greater. It is acquired, most likeyl from repeated trauma leading to chronic inflam and fibrosis. How to treat
endoscopic dilation
PPI or H2 blockers can help as GERD can be assoc
How does asking a patient to attempt sitting up help evaluate a mass whether its from abdominal wall or the abdominal cavity
An abdominal mass will still be palpable while an intraabdominal one may not be. This is called fothergill’s sign
Why has prostaglandin E (misoprostol) which is effective in protecting gastric mucosa has not been useful in managing erosive gastritis
bc of diarrhea as side effect
T/F: gastric bypass patients can initially lose up to 2/3rds of the weight.
True
Pts with impaired gastric emptying from previous gastric surgeries, or with diabetes can develop bezoars. Phytobezoars (undigested vegetable matter) or trichobezoars (hair). How to make the dx and how to treat
dx by upper endoscopy or barium swallow
Nonop management is often successful. Recommended to ingest meat tenderizer (contains papain) and repeat endoscopy to further fragment and remove the bezoar
Vascular rings are congenital. They can encircle the trachea and esophagus to cause compressive symptoms. What are the two most common types and how to treat
- double aortic arch and right aortic arch
- surgery involves division of the ring
Elderly nursing pt with recent onset abd pain, distension and obstipation. x-ray showed markedly distended loop mainly in RUQ. Likely diagnosis is?
sigmoid volvulus
std initial therapy is rigid sigmoidoscopy with placement of rectal tube
Massive resection occurs if more than 75-80% is resected leaving less than 1 m of small bowel left. What are the 4 most common indications for small bowel resection
- ischemia
- Crohns
- volvulus
- trauma
Tenderness in region one-third of the distance from the anterior superior iliac spine to the umbilicus signifies
Mcburney’s point -appendicitis
Blind loop syndrome (BLS), commonly referred to in the literature as small intestinal bacterial overgrowth (SIBO) or bacterial overgrowth syndrome (BOS), is a state that occurs when the normal bacterial flora of the small intestine proliferates to numbers that cause significant derangement to the normal physiological processes of digestion and absorption. Usu. due to surgical operations involving jejunoileal bypass as well as IBD. What are some symptoms
- steatorrhea
- malabsorption (weight loss)
- macrocytic anemia
- diarrhea
- unintentional weight loss
Clinical picture of recurrent bright rectal bleeding not assoc with abdominal pain in the elderly is most commonly assoc with?
diverticulosis
Common cause of lower GI bleeding that is recurrent and painless in elderly when diverticolosis is not present is? What to do to diagnose
angiodysplasia
do angiography
Hemobilia should be suspected with history of trauma to the liver and guaiac positive stools and RUQ abdominal pain. What can be diagnostic and therapeutic
angiography can identify source of bleeding and embolize it
VIPoma is a pancreatic tumor characterized by
WDHA -watery diarrhea hypokalemia and achlorhydria
the diarrhea is secretory, treatment is excision
US showing an anechoic mass on liver indicates
hepatic cyst
A ratio of plasma insulin/glucose > 0.3 is diagnostic of what
insulinoma
What’s the imaging of choice to localize ZES since it can be really small?
somatostatin receptor scintigraphy
Biliary dyskinesia can manifest similarly to gallstone related pathologies but symptoms persist after cholecystecomy. how to manage
medically with CCB, but best with spincterotomy
Malignancy causing obstructive jaundice leads to what typical gallbladder manifestaton
enlarged –> Courvoisier’s sign
ALK phosp vs bilirubin, which one is more commonly elevated in obstructive jaundice
alk phosp
CT or MRI with contrast of liver shows initial centripetal enhancement followed by decrease in dye over 10 minutes from without to within. What is it
hemangiomas! -most common benign tumor of liver
orthotopic vs heterotopic transplant
orthotopic requires replacing recipient liver with donor liver.
heterotopic: doesn’t remove recipient’s organ but sew in the donor’s
Normal portal venous pressure is
5-10 mmHg
Someone with ITP is treated with splenectomy, but 2 yrs later, develops skin purpura and low plts. What to do?
radioactive technetium scan to see if an accessory spleen is present called splenunuclus
TTP is characterized by which 5 clinical symptoms. How to treat?
- hemolytic anemia
- neurologic changes
- renal problems
- fever
- purpura
Treat with steroids, plasmapheresis and splenectomy
Felty’s syndrome. What can splenectomy do?
Rheumatoid arthritis with splenomegaly, neutropenia. Splenectomy helps with the leukocyte count but doesn’t change clinical course of RA.
What type of hernia refers to a hernia sac that is not independent of the bowel wall.
Sliding
What to worry about during femoral hernia repair
femoral vein lies immediately lateral to the fem canal so careful attn to this is essential
After hernia repair, a pt has burning severe pain on lateral side of ipsilateral thigh due to damage of which nerve
lateral femoral cutaneous nerve
spigelian hernia
occurs at lateral edge of linea semilunaris
Woman with triad of ascites, pleural effusion leading to SOB and abdominal distension from an ovarian tumor (brenner tumor, fibroma) has?
Meigs’ syndrome
It resolves after resecton of tumor
How to treat vulvar cancer
radical vulvectomy and b/l groin disection
3 side effects of cisplatin
ototoxicity
nephrotoxicity
peripheral neuropathy
Tender uterosacral ligament is a sign of
endometriosis
Greater omentum is supplied by which artery
gastroepiploic arteries
T/F: The ureter enters the pelvis immediately distal to the bifurcation of the common iliac artery. It then passes towards the bladder where it is inferior to the uterine artery
True
testicular cancer -worry abt spread to which lymph nodes
para-aortic
Where does donor kidney get placed usually
Right iliac fossa
T/F Tamsolusin is assoc with ejaculatory dysfunction
True
cardiac tamponade from trauma usu due to ruputre of what?
myocardial rupture or coronary artery laceration
Bleeding from GSW thru left thorax leading to hemothorax requiring thoractomy usu damage of what vessels
intercostal or internal thoracic/mammary
