Miscellaneous

Question 1

adult with new onset left varicocele…. you should be concerned about?

Answer 1

IVC obstruction with RCC being most common etiology

Question 2

sizeable rectal injury and perforation during radical prostatectomy

Answer 2

diverting colostomy

Question 3

treatment of obstructing distal ureteral stone without evidence of UTI

Answer 3

observe / medically treat, flomax, NSAIDs

Question 4

indication for prompt urinary system drainage in kidney stones

Answer 4

high grade unilateral urinary obstruction, bilateral urinary obstruction, urinary obstruction to solitary kidney, urinary obstruction with UTI or sepsis, inability to tolerate oral intake from N/V, severe pain not controlled by oral analgesics

Question 5

dilutional hyponatremia (confusion, somnolence), hypertension, bradycardia and nausea/vomiting

Answer 5

TUR syndrome – classic post op complication following transurethral resection of the prostate – due to hypotonic fluid rushing into open venous sinuses of prostate during prostatic resection

Question 6

nonvisualization of intrauterine sac with beta hCG more than 1500

Answer 6

concerning for ectopic pregnancy

Question 7

most common cause of adnexal torsion?

Answer 7

ovarian/tubal enlargement or benign neoplasms

Question 8

management of ovarian torsion with sign of tubal necrosis on imaging

Answer 8

adnexectomy. if no necrosis, can usually perform laparoscopic detorsion

Question 9

stomach cancer with mets to ovary

Answer 9

Krukenberg tumor – classically signet cell

Question 10

pelvic ovarian fibroma that causes ascites and hydrothorax

Answer 10

Meige’s syndrome – excision of tumor cures syndrome

Question 11

most common malignant tumor in female genital tract

Answer 11

endometrial cancer

Question 12

rapidly growing mass, protruding from introitus, often ‘grape like’

Answer 12

sarcoma botryoides - rhabdomyosarcoma of the bladder or vagina – good outcome

Question 13

fever and right sided abdominal pain within 1 week after delivery/C-section

Answer 13

ovarian vein thrombophlebitis –dx w/ imaging (CT/MRI), manage w/ antibiotics + systemic anticoagulation

Question 14

Bilateral parotid gland tumors

Answer 14

Warthin tumor- papillary cystadenoma lymphomatosum, strong association with smoking

Question 15

Most common benign salivary tumor

Answer 15

Pleomorphic Adenoma > papillary cystadenoma lymphomatosum

Question 16

Young adolescent severe unilateral epistaxis and nasal mass

Answer 16

Juvenile nasal angiofibroma

Question 17

Sialolithiasis most commonly arises from…

Answer 17

submandibular gland

Question 18

name thoracic outlet structures form anterior to posterior

Answer 18

subclavian vein, anterior scalene, subclavian artery, brachial plexus, middle scalene

Question 19

most commonly injured nerve during a cervical lymph node dissection

Answer 19

spinal accessory nerve

Question 20

cranial nerve most commonly injured by a temporal bone fracture

Answer 20

cranial nerve VII (facial)

Question 21

anterior vs posterior epistaxis – which is more common? what are the etiologies? what is the general management?

Answer 21

anterior more common than posterior, caused by trauma (rupture of superficial mucosal vessels - Kiesselbach plexus), posterior more dangerous most commonly from branch of the sphenopalatine artery, associated with HTN / atherosclerosis – treatment involves posterior packing

Question 22

most common type of parotid gland tumor

Answer 22

pleomorphic adenoma (benign mixed tumor)

Question 23

most common injured nerve in parotid surgery

Answer 23

greater auricular nerve

Question 24

persistent firm lateral neck mass – best diagnostic test

Answer 24

fine needle aspiration

Question 25

management of cystic hygroma

Answer 25

assoc w/ trisomy 21, Turner – lymphatic malformation, complete surgical excision preferred, however adjacent to nerves so conservative excision done, needle aspirations mahy shrink mass but temporizing measure – observing is OK in asymptomatic / not growing

Question 26

tender lateral neck mass with draining sinus – sulfur granules: dx, tx?

Answer 26

actinomyces infection - optimal tx is w/ penicillin and surgical drainage

Question 27

most common metachronous malignancy for laryngeal cancer (new primary beyond 6 months)

Answer 27

lung cancer

Question 28

most common metachronous malignancy for oral cavity / pharyngeal cancer (new primary beyond 6 months)

Answer 28

esophageal cancer

Question 29

most lip cancers occur on…(lower/upper lip)? what type?

Answer 29

lower lip (most commonly squamous cell ca); upper lip is more common to be basal cell ca

Question 30

pleomorphic adenoma risk of malignancy?

Answer 30

10-25% risk of malignant transformation

Question 31

most common malignant salivary gland tumor? second most common?

Answer 31

mucoepidermoid carcinoma #1; adenoid cystic carcinoma is #2

Question 32

neurogenic thoracic outlet syndrome most commonly affects which nerve?

Answer 32

ulnar nerve

Question 33

headache, focal neurologic deficits, fevers

Answer 33

brain abscess - most commonly strep/staph – LP contraindicated in setting of elevated ICP

Question 34

Cushing’s triad

Answer 34

bradycardia, irregular breathing, elevated systolic BP with widened pulse pressure

Question 35

SCI: muscle weakness of upper extremity with relative sparing of lower extremities

Answer 35

central cord syndrome

Question 36

SCI: loss of proprioception and vibration below level of lesion w/ preservation of most motor function

Answer 36

posterior cord syndrome

Question 37

SCI: loss of motor function, pain sensation, and temperature sensation but preservation of touch and propioception

Answer 37

anterior cord syndrome

Question 38

SCI: parasthesia of perineum, anus, external genitalia, with bowel/bladder incontinence

Answer 38

cauda equina syndrome

Question 39

ipsilateral loss of motor, proprioception and vibration with contralateral loss of pain and temperature sensation

Answer 39

brown sequard syndrome - hemitransection of spinal cord

Question 40

most common primary CNS tumors in adults? children?

Answer 40

adults - astrocytoma, children - medulloblastoma

Question 41

most frequent site of cerebral aneurysm

Answer 41

anterior communicating artery

Question 42

when to start anticoagulation in head bleed patients?

Answer 42

low bleed risk within 24 hrs, medium bleed risk within 72 hrs