NBME Clinical Science Mastery Series: Surgery Form 4 Flashcards
Don’t forget that a painless penile ulcer can also be _______________.
penile cancer
A woman has HTN discovered to be secondary to elevated aldosterone:renin ratio. You scan her and see that one adrenal has a mass. What workup do you need to do from here?
Test the adrenal glands bilaterally before and after ACTH:
- If the nodule is hypersecreting, the aldosterone levels will lateralize. That gland can be removed.
- If both sides are secreting aldosterone then it is primary hyperaldosteronism (Conn’s syndrome), with an incidental nodule. Treat with spironolactone or eplerenone before undergoing bilateral adrenalectomy.
A man gets ten units of blood and then has elevated mixed bilirubinemia. What is the likely cause?
“Overproduction” of bilirubin
This is a weird way of putting it, because bilirubin is a breakdown product, but this is how the NBME phrases it.
A woman with metastatic breast cancer has persistent bone pain and is taking 8 tablets of codeine per day. What should you do?
Increase the opiates
This is a weird point: the NBME wants you to recognize that people dying of metastatic cancer can be given much higher doses of opioids than other people because (1) they’re in tons of pain, (2) it’s the only thing that works, and (3) they’re dying.
A J-tube is placed distal to the site of small bowel anastomosis. When can it be used?
Within days of placement
Describe the initial presentation of Hashimoto’s.
The antibodies to thyroid peroxidase and thyroglobulin initially cause a release of thyroid hormones followed by enlargement of the gland. Then levels normalize. Then the T4 and T3 falls and the TSH rises.
This is distinguishable from subacute thyroiditis by the chronicity –subacute thyroiditis will be shorter.
A hepatic mass with a central scar on CT is likely to be _______________.
focal nodular hyperplasia –no further workup
A boy falls from a significant height. He is hemodynamically stable and has a negative cardiac, pulmonary, and abdominal exam. What is the next appropriate diagnostic?
C-spine x-ray
A breast mass is removed. The pathologist reports positive margins. What do you need to do now?
Re-excise further margins
Post-viral synovitis is also called _______________.
toxic synovitis
Once a barium swallow shows hiatal hernia, the next step is _______________.
EGD
An older alcoholic has hypocalcemia. What other elctrolyte imbalance could have caused this?
Hypomagnesemia
A patient demands an operation for reason X, but two physicians agree that the operation would not satisfy X and that there is no medical indication for the operation. Decision?
Refuse the operation.
A woman has decerebrate posturing and is unresponsive after an MVC. What should you do first?
Intubate
True or false: you should put pressure on a copiously bleeding head wound after a traumatic head injury.
True
Although you might press onto a skull fracture –which would be bad –if the person is bleeding a lot then they are at greater danger of dying from blood loss.
