Pestana's Surgery Notes

Question 1

32 y/o male is involved in head on, high speed, accident. He is unconscious at the site, regains brief consciousness, but arrives to the ER in a deep coma. He has a fixed, dilated pupil. Dx? Txmt?

Answer 1

Acute subdural hematoma more likely over acute epidural hematoma. \nAcute craniotomy

Question 2

Txmt of choice for acute epidural hematoma? Test of choice?

Answer 2

Craniotomy\nCT scan

Question 3

Txmt of chronic subdural hematoma in elderly pt with progressive loss of function?

Answer 3

Surgical decompression via craniotomy

Question 4

A car hits a pedestrian. He presents in a coma with either raccon eyes/clear rhinorrhea/clear fluid leaving from the ears/or ecchymosis behind the ears. Dx?

Answer 4

Base of the skull fx\nCT scan

Question 5

A 45 y/o male presents after a high speed automobile collision in a coma, with fixed, dilated pupils. He has multiple other injuries. His BP is 70/50, with a feeble pulse, and a HR of 150. Why low BP and high HR?

Answer 5

hypovolemic shock due to hemorrhage

Question 6

22 y/o with multiple gun shot wounds to the abd, is diaphoretic, cold, pale, shivering, and is asking for water. His BP is 60/40, and he has a feeble pulse rate of 150. Management?

Answer 6

Hypovolemic shock:\nBig Bore IV lines, Foley catheter, and IV antibiotics. Exp lap immediately and THEN fluid/blood administration. If OR not available, fluid resuscitation 1st.

Question 7

How could specifically identify tension pneumothorax on PE?

Answer 7

Respiratory distress\nTracheal deviation\nabsent breath sounds on hemithorax, that is resonant to percussion.

Question 8

What PE finding is seen in both cardiac tamponade and tension pneumothorax?

Answer 8

distened neck veins

Question 9

22 y/o with multiple gun shot wounds to the abd, is diaphoretic, cold, pale, shivering, and is asking for water. His BP is 60/40, and he has a feeble pulse rate of 150. PE also shows distended neck veins, distant heart sounds, but no respiratory distress or tracheal deviation

Answer 9

Hypovolemic shock with cardiac tamponade

Question 10

Most common presenting problem with blunt cardiac trauma?

Answer 10

45% cardiogenic, 40% arrhythmia

Question 11

Fractures to the 1st and 2nd ribs that occur during trauma should make you alert to what major secondary injury? Gold standard test for Dx?

Answer 11

TRA: traumatic rupture of the aorta\nAortogram, but CT angiography is becoming more widely accepted

Question 12

During blunt chest trauma, a widened mediastinum on CXR should raise your suspicion for? Other signs?Gold standard test?

Answer 12

TRA:\nApical pleural hematoma(cap)\nObliterated aortic knob\nDeviated NG tube

Question 13

Emergent txmt for pericardial tamponade

Answer 13

Thoractomy with decompression

Question 14

A 22 y/o presents to the ER with a gun shot to the Right chest. He has labored breathing, is cyanotic, diaphoretic, cold, and shivering. His BP is 60/40. His Pulse is 150 and feeble. He is in respiratory distress, has distended neck veins, and his trachea is deviated ot the left. The right side of chest is tympanic with absent breath sounds. Next step in management?

Answer 14

Tension pneumothorax:\nBore bore IV catheter into R pleural space, followed by tube thoracostomy into the R axillary chest wall.\nNOT XRAY!

Question 15

Initial management of pneumothorax

Answer 15

Reexpansion of the lung

Question 16

Recurrent spontaneous pneumothorax is most commonly seen in? What is most predictive of recurrence of pneumothorax?

Answer 16

Tall, thin, young males and smokers\nNumber of occurences. 80% reccurence rate after 3 incidents

Question 17

A 33 y/o woman develops “air hunger” after placement of subclavian central line

Answer 17

pneumothorax

Question 18

What PE finding may be used to differentiate pleural effusion from pneumothorax

Answer 18

Dullness to percussion over the chest wall on the affected side is seen with an effusion

Question 19

A 17 y/o girl is stung by a swarm of bees/hives after penicillin/surgery under spinal anesthesia…develops BP of 75/25, pulse of 150, and look warm and flushed, not pale and cold. CVP is low. What is it? Management?

Answer 19

Vasomotor shock:\nVasoconstrictors

Question 20

A 25 y/o is stabbed in the right chest. He is SOB, has stable vital signs. No breath sounds at R base, faint distant breath sounds at apex, dull to percussion. What is it? Next step in management?

Answer 20

Hemothorax:\nHis vital signs are stable, so do Xray 1st to confirm, then R chest tube/thoracotomy in the BASE of the pleural cavity

Question 21

A 25 y/o is stabbed in the right chest. He is SOB, has stable vital signs. No breath sounds at R base, faint distant breath sounds at apex, and resonant to percussion. What is it? Next step?

Answer 21

Pneumothorax:\nstable vital signs mean xray 1st, then Chest tube, HIGH in the pleural cavity

Question 22

What are some surgical indications for spontaneous pneumothorax?

Answer 22

Recurrence, persistant air leakage(malignancy, infection, CF), failure of lung to rexpand, scuba diver/aviator

Question 23

Dilation of a pupil with sluggish response to light is an early indication of?

Answer 23

temporal lobe herniation, usually on same side, due to fucked up CN III

Question 24

A pt is post Chest tube placement due to stab wound to Right chest. The tube recovers 450cc on the outset, followed by another 420cc in the next hr. Next step?

Answer 24

Thoracotomy to ligate intercostal vessel that has been damaged. \nNormal bleeding from lung parenchyma would have slowed down or haled.

Question 25

25 y/o stabbed in the chest and has dullness at the lung base, with resonance at the apex

Answer 25

hemo–pneumothorax

Question 26

A 33 y/o female presents with multiple rib fractures after a high speed collision. She is gasping for breath, cyanotic at the lips, with nostril flaring. BP is 60/45, and HR is 160. She has distended neck veins, is diaphoretic and the L hemithorax has no breath sounds and is tympanic to percussion?

Answer 26

tension pneumothorax

Question 27

A 54 y/o lady crashes her car against a pole. She is in moderate respiratory distress, has multiple chest bruises, and her chest wall caves in upon inspirations.What is the true problem with flail chest? Txmt?

Answer 27

Pulmonary contusion:\nfluid restriction, diuretics, colloid fluids(not crystaloid), and respiratory support. NOT ways to mechanically stabalize the chest. This is not done anymore

Question 28

A 54 y/o crashes her car at high speed. She is breathing well, but has multiple chest wall bruises and xrays shows multiple rib fractures. The lung parenchyma is clear and expanded. Two days later, a CXR shows "white out" of the lungs and she is in respiratory distress. What is it? Management?

Answer 28

Pulmonary contusion:\nDoes not always show up acutely.\nFluid restriction, diuretics, colloid fluid. If vitals fall, intubation, mechanical vent, PEEP.

Question 29

54 y/o has a head on collision with a telephone pole. She is breathing well, but has extreme tenderness over the sternum and there is crepitance upon palpation. What is she at risk for? Next step?

Answer 29

Myocardial contusion and TRA.\nCT scan and arteriogram(aortogram)

Question 30

A 54 y/o male is involved in a high–speed collision. He is respiratory distress and PE shows no breath sounds over the entire Left chest and percussion is unremarkable. CXR shows air–fluid levels in the L chest. What is it? Management?

Answer 30

Classic L diaphragmatic rupture. It is alwaus on the left.\nSurgery

Question 31

A nasogastric tube curling up into the left chest might be seen in what traumatic injury?

Answer 31

traumatic diaphragmatic rupture

Question 32

A lady with traumatic injuries and a pneumothorax develops progressive subcutaneous emphysema over her upper chest and neck. What is it? Management?

Answer 32

Traumatic rupture of the trachea or bronchus\nFriberoptic bronchoscopy to confirm dx and secure airway, then surgical repair.

Question 33

Most esophageal ruptures occur where? What does this often lead to?

Answer 33

distal 1/3rd\nLeft pleural effusion with mediastinitis, CP, and eventually sepsis

Question 34

Mortality outcome during esophageal rupture is dependent on?

Answer 34

Early dx and treatment...24hrs 40%

Question 35

Best initial diagnostic test for confirming esophageal rupture

Answer 35

water–soluble contrast esophagogram

Question 36

Most common cause of esophageal rupture

Answer 36

iatrogenic

Question 37

If after Chest tube placement, the lung fails to reexpand, and significant air leakage is noted, what should you suspect?

Answer 37

major tracheobronchial injury.\nPerform bronchoscopy to determine dx and secure airway.

Question 38

In a traumatic unstable pt in hypovolemic shock that is presumably due to an abdominal injury, what should be the initial test of choice?

Answer 38

Diagnostic peritoneal lavage or FAST scan

Question 39

Any suspicion of a hollow viscus injury injury during laparoscopy should result in?

Answer 39

celiotomy

Question 40

The FAST exam is extremely sensitive for? Not very sensitive for?

Answer 40

Pericardial injuries\nabdominal injuries

Question 41

The most important part of secondary survey during abdominal trauma?

Answer 41

abd exam:\nany peritoneal signs is an indication for celiotomy

Question 42

Primary survey for abd trauma

Answer 42

ABC's\ncapillary refill\nheart sounds\nneck vein distention\nneuro exam\nupright CXR\nFAST exam

Question 43

Is an abd CT sensitive in detecting diaphragm injuries?

Answer 43

NO!

Question 44

A 19 y/o presents with a gsw to the epigastric area left of the midline. CT shows the bullet to be lodged in the R psoas muscle. Next step in management?

Answer 44

Prepare for laparascopic surgery:\nindwelling catheter, venous line for fluids, dose of broad spectrum antibiotics.

Question 45

Pt presents after car wreck with tenderness over the left chest wall and xray shows fractures of the 8th–10th ribs. His BP is 85/68 and he has a pulse rate of 128. Next step in management? Then what?

Answer 45

Fluid resuscitation/blood transfusion, then if stable go to CT. If not stable, go to peritoneal lavage or US followed by exploratory lap.

Question 46

Administration of what, is indicated for splenectomy?

Answer 46

Vaccines for encapsulated bacteria such as polyvalent pneumococcal vaccination, Hib, and meningococcus

Question 47

Uncommon but devastating complication with splenectomy? More common in?

Answer 47

OPSS:\nMore common in children and those whose spleens are removed due to hematologic disease.

Question 48

What test may be utilized to check for retained function of the spleen after partial removal?

Answer 48

Peripheral blood smear for howell jolley bodies, heinz bodies, and pappenheimer bodies.

Question 49

Splenectomy for ITP is most likely to provide remission in what population?

Answer 49

those who respond to corticosteriods

Question 50

Dx of ITP is confirmed by? Initial txmt?

Answer 50

Bone marrow aspirate is seen as hypercellular megakaryocyte count.\nCorticosteroids

Question 51

A pt involved in a crash has a pelvic fx and blood is present in the meatus. Most likely dx? Confirmation?

Answer 51

Bladder or urethral injury\nRetrograde urethrogram because urethral injury would be compounded by foley cath

Question 52

A 19 y/o male is involved in a car crash. He presents with a pelvic fx, blood in the meatus, scrotal hematoma, and an inability to urinate. Dx?

Answer 52

Posterior urethral injury\nRetrograde urethrogram

Question 53

A pt is inovolved in a high speed auto accident and has a pelvic fx. There was no blood in the meatus and thus an indwelling catheter was placed, reached revealed frank hematuria. Dx? Test?

Answer 53

Bladder injury\nRetrograde cystogram

Question 54

John H gets smacked in the nuts with a knee, and presents with a scrotal hematoma the size of a grapefruit and is crying. Next step in management?

Answer 54

US for rupture or not. If no rputure, then treat symptoms only.

Question 55

A pt in a high speed car crash has multiple injuries. On insertion of a foley, there is gross hematuria and a retrograde cystogram is normal. Next step? Dx? Management?

Answer 55

Kidney injury:\nCT scan\nManagement:\nDoes not need surgery

Question 56

Does microhematuria in a post–trauma adult pt need to be investigated? Child?

Answer 56

No\nYes, usually signifies congenital abnormalities. Start with sonogram.

Question 57

Pt presents to the ER reporting that he slipped in the shower and injured his penis. Exam reveals a large penile shaft hematoma with normal glans. Dx?

Answer 57

Fx of the tunica albuginea, surgical emergency! consult urology!

Question 58

You get a frantic phone call from a mother who says her 7 y/o spilled drano all over her arms and legs, and she is screaming in pn. What is your initial step?

Answer 58

Copious amounts of water for at least 30 minutes before taking to the ER. \nChemical burns are treated with lots of water.

Question 59

A man is electrocuted by a high tension power line, and he has an entrance burn in the upper outer thigh and an exit burn lower down. What is often a complication and its txmt?

Answer 59

Myoglobinemia that leads to myglobinuria, and then renal failure. Due to large muscular tisue destruction.\nPt needs IV fluids, antibiotics, Mannitol(diuresis), and alkalinization of the urine.

Question 60

A man is rescued from a burning building, and is noted to have burns around the mouth and nose, with dark black soot within the mouth and throat. Initial step?Test? Management?

Answer 60

Intubation for respiratory support.\nCarboxyhemoglobin levels and bronchoscopy

Question 61

A man suffers circumferential burns to his body that are dry, white, and leatherly anesthetic. What complication must you be aware of? PE? Txmt?

Answer 61

Circumferential burns will cause edema beneath the area of leather eschar that does not expand. This leads to cut off of the circulation, and in the chest, respiratory compromise. \nMonitor capillary refill and peripheral pulses\nEscharotomy at bedside.

Question 62

Txmt for burns in child who presents with moist, painful, blistering on the buttocks.

Answer 62

silvadene(silver sulphadiazine)

Question 63

Formula for fluid resuscitation in burn victims

Answer 63

4ccxkg of weightx%burned\n1/2 dose given in 1st 8 hrs!!!\nRINGERS LACTATE!!!!

Question 64

A burn pt undergoes fluid resuscitation over a period of 3 days, however, on the 3rd day he begins to urinate heavily, filling his cath bag over. What is the problem?

Answer 64

Nothing;\nThe fluid from his edema has gone back into circulation.

Question 65

Used to treat deep burn areas such as cartilage and thick eschar? Side effect?

Answer 65

sulfamyelon\nMetabolic acidosis

Question 66

What would you monitor to ensure that you have given enough fluid resuscitation?

Answer 66

CVP= 15 or 20\nUrine output: 1ml/kg/hr

Question 67

Rule indicating % body area of certain parts

Answer 67

Rule of 9's:\nHead is 9, arms are 9 a piece, legs are 18 a piece, and trunk is 36.

Question 68

A 30 y/o man has 2nd and 3rd degree burns on his torso and chest that measure up to 20% of tbsa. What is the definitive txmt?

Answer 68

Early wound excision followed by autologous split–thickness skin graft.\n–This is done on small 3rd degree burns\n–Decreases sepsis and increases functional recovery.

Question 69

A gangleader comes in with a small, 1cm deep cut over his knuckle of the right middle finger. He says he did this with a screwdriver. Txmt?

Answer 69

Its most likely actually from a tooth that was lodged during a fight. Becuase the oral cavity is a harbinger of bacteria, ortho must come in and surigcally explore.

Question 70

A 69 y/o sailor comes in with a non–healing, indolent ulcer on the lip, 1.5 cm in size, that has been enlarging over the last year. He smokes a pipe, but has no other significant findings. Dx? Confirmation? Txmt?

Answer 70

Squamous cell carcinoma\nBiopsy\nSurgical resection with 1cm margins. Local radiation therapy is needed.

Question 71

A 65 y/o Kansas farmer shows up with with an indolent, raised, waxy 1.2 cm skin mass over the nose that has been growing for 3 yrs. There are no enlarged lymph nodes present. What is it? Dx via? Txmt?

Answer 71

Basal cell carcinoma:\nFull thickness punch biopsy at the edge\nClear 1cm margin surgical excision

Question 72

A 23 y/o freckled red head presents with an asymmetrical, 1.8cm lesion, with irregular borders and varying colors on her shoulder What is it? Managment?

Answer 72

Melanoma\nFull thickness edge biopsy\nSurigical excisoon with clear margins if superficial melanoma(

Question 73

71 y/o kansas farmer presents with a non–healing, indolent, punched out clean 2cm ulcer over the temple that has slowly enlarged over 3 yrs. What is it?

Answer 73

Basal cell carcinoma:\nSlowly grows\nBiopsy, surgical excision

Question 74

A change in the appearance of a mole is suggestive of?

Answer 74

melanoma

Question 75

A 44 y/o pt presents with multiple liver metastasis, but no primary tumor has been identified. The only PE finding is a missing toe which was removed 30 yrs ago due to a black tumor under the nail. What is it?

Answer 75

melanoma:\nCan metastasize slowly over several yrs\nAlt version: glass and history of enucleation for a tumor of the eye...

Question 76

A 23 y/o freckled red head presents with an asymmetrical, 1.8cm lesion, with irregular borders and varying colors on her shoulder What is it? Managment?

Answer 76

Melanoma\nFull thickness edge biopsy\nSurigical excisoon with clear margins if superficial melanoma(

Question 77

71 y/o kansas farmer presents with a non–healing, indolent, punched out clean 2cm ulcer over the temple that has slowly enlarged over 3 yrs. What is it?

Answer 77

Basal cell carcinoma:\nSlowly grows\nBiopsy, surgical excision

Question 78

A change in the appearance of a mole is suggestive of?

Answer 78

melanoma

Question 79

A 44 y/o pt presents with multiple liver metastasis, but no primary tumor has been identified. The only PE finding is a missing toe which was removed 30 yrs ago due to a black tumor under the nail. What is it?

Answer 79

melanoma:\nCan metastasize slowly over several yrs\nAlt version: glass and history of enucleation for a tumor of the eye...

Question 80

A 23 y/o freckled red head presents with an asymmetrical, 1.8cm lesion, with irregular borders and varying colors on her shoulder What is it? Managment?

Answer 80

Melanoma\nFull thickness edge biopsy\nSurigical excisoon with clear margins if superficial melanoma(

Question 81

71 y/o kansas farmer presents with a non–healing, indolent, punched out clean 2cm ulcer over the temple that has slowly enlarged over 3 yrs. What is it?

Answer 81

Basal cell carcinoma:\nSlowly grows\nBiopsy, surgical excision

Question 82

A change in the appearance of a mole is suggestive of?

Answer 82

melanoma

Question 83

A 44 y/o pt presents with multiple liver metastasis, but no primary tumor has been identified. The only PE finding is a missing toe which was removed 30 yrs ago due to a black tumor under the nail. What is it?

Answer 83

melanoma:\nCan metastasize slowly over several yrs\nAlt version: glass and history of enucleation for a tumor of the eye...

Question 84

A 27 y/o female Mexican immigrant has a 12x10x7 mass in her left breast. It has been there for 7 yrs and has slowly grown. The mass is firm, rubbery, and is not attached to the chest wall or overlying skin. What is it? Management?

Answer 84

Cystosarcoma phylloides\nCore or incisional biopsy(may become lamignant), with margin free resection to follow.

Question 85

An 18 y/o has a firm, rubbery mass in the left breast that moves easily with palpation. Next step in management?

Answer 85

FNA or core biopsy, or excisional biopsy.

Question 86

At what age may a mammogram be used for screening techniques?

Answer 86

28, before then, must use sonogram.

Question 87

A woman with a hx of fibrocystic disease appears with a firm, round, 2cm mass that has not gone away for 6 wks. Next step?

Answer 87

Aspiratoion of the cyst w/wo mammogram or sonogram.

Question 88

A 34 y/o has been having bloody discharge from the right nipple, on and off for several months. there are no palpable masses. Management?

Answer 88

Intraductal papilloma:\nMammogram 1st to find the papilloma, if negative, then find and resect

Question 89

A 49 y.o. has a firm, 2cm mass in the right breast, that has been present for 3 months. Management?

Answer 89

Core or excisional biopsy

Question 90

A 69 y/o woman has a 4cm hard mass in the breast, with ill defined borders, moveable from the chest wall, but not moveable within the breast. The skin overlying the mass is retracted and has ano orange peel appearance. Management?

Answer 90

Core or excisional biopsy. If the skin is involved, you could also do a punch biopsy.

Question 91

62 y/o female has an eczematous skin lesion under the areola. It has been present for 3 months and has not gone away with lotions or ointments with steriods.

Answer 91

Pagets disease\nPunch biospy or core or excisional

Question 92

A 58 y/o lady discovers a mass in her right axilla. She has a discreet, hard, moveable 2cm mass. Exam of her breast is negative. Management?

Answer 92

Mammogram to check for undetectable mass on PE

Question 93

A 62 y/o woman has a routine mammogram done, that reveals an area of increased density with microcalcifications, that is new from previous studies. Management?

Answer 93

Stereotactic core biopsy

Question 94

How does FNA and core biopsy differ in their staging of breast malignancy?

Answer 94

An FNA can identify malignant cells but cannot differentiate invasive vs in situ cancers.

Question 95

Define stage 1,2,3 breast ca via tumor size

Answer 95

T1 2cm,5cm

Question 96

Level 1,2,3 axillary nodes

Answer 96

Level 1: lateral to pec minor\nLevel 2: deep to pec minor\nLevel 3: medial to pec minor

Question 97

A 44 yr old lady presents with a 2cm mass in the upper outer quadrant of her right breast. A core(stereotactic) biopsy shows inflitrating ductal carcinoma. She has no palpable nodes. Next steps?

Answer 97

Lumpectomy with radiation and axillary lymph node disection for local control, staging, and adjuvent therapy.

Question 98

Most common chemo regime for breast cancer? At what stage is this usually given?

Answer 98

FAC:\n5–flourouracil, doxorubicin(adriamycin), and cyclophosphamide.\nStage II, due to increased risk of recurrence and metastasis.

Question 99

A 50 y/o woman presents to the ER with bleeding from her R breast. PE shows a large, ulcerating, fungating mass that is firmly attached to the chest wall, and has grown over the last couple of yrs. Next step?

Answer 99

Palliative therapy with chemo. This is advanced Breast CA and is inoperable and incurable.

Question 100

A 38 y/o female is noted to have a painless 1cm left breast mass on PE. There is no skin changes or adenopathy. A FNA reveals malignant cells. Next best step?

Answer 100

Core needle biopsy for histology, receptor status, and tumor biology.

Question 101

A 37 y/o lady has a lumpectomy and ALND for a 3cm infiltrating ductal CA. the path report states clear margins and 4/17 nodes are positive. Next step? What if she was postmenopausal?

Answer 101

Adjuvent therapy with chemo(becuase this is stage III)\nA postmenopausal women gets hormonal therapy instead of chemo

Question 102

With regards to adjuvent therapy, when is it wise to use chemo vs radiation therapy?

Answer 102

Systemic chemo is given to pts who are at risk for, or have stage III/IV. However, because the risk for recurrence is very high in stage II, most are also given the choice of systemic therapy, rather than locoregional. So essentially, only stage I is treated with radiation.

Question 103

A 60 y/o female undergoes lumpectomy for a 0.3 cm tumor. Nodes are negative. Next best step

Answer 103

radiation therapy

Question 104

A 39 year old female with a past hx of breast ca, and completed her adjuvent chemo 6 months ago, comes to the office complaining of back pn for 3 weeks, and is tender to palpation. Next step?

Answer 104

bone scan

Question 105

Generally, how long is hormonal therapy given to pts with estrogen or progesterone positive breast tumors?

Answer 105

5 yrs\nAI's have actually become the mainstay of therapy dut to their lesser side effect profile.

Question 106

What is the main role of mammography?

Answer 106

To detect non palpable breast tumors

Question 107

A 44 year old female undergoes stereotactic core biopsy of a suspicious lesion on mammography. The biopsy reveals lobular carcinoma in situ. Management?

Answer 107

Tamoxifen, clinical examination and mammography every 6 months.

Question 108

What txmt has been approved for chemoprevention in high risk breast ca pts and has been reported to reduce occurence of ca?

Answer 108

Tamoxifen

Question 109

What risk factor carries the greatest risk of breast ca?

Answer 109

BRCA gene

Question 110

Selective pts with a strong family hx of known BRCA gene mutation may be treated with?

Answer 110

bilateral prophylactic mastectomy

Question 111

A mother presents to your office with an 18 month old baby and you happen to notice that one of the pupils is white. Next step?

Answer 111

Retinoblastoma:\nOptho consult RIGHT NOW!

Question 112

A parent arrives to your office with her child that has "huge, shiny eyes." What is it?

Answer 112

congenital glaucoma

Question 113

ER management of acute glaucoma?

Answer 113

Optho consult, diamox or pilocarpine, or mannitol

Question 114

A 77 y/o man suddenly loses sight in his R eye and calls to phone you immediately. He has no pain or other neuro symptoms. Management?

Answer 114

Embolic occlusion of the retinal artery:\nSurgical emergency

Question 115

Management of orbital cellulitis

Answer 115

CT scan then surgical debridement

Question 116

A 35 yr old woman presents with increased fatigue and a whitish nipple discharge. She has no previous operations, no meds, or health concerns. Next best step?

Answer 116

HCG, to rule out preggos\nThen, do prolactin level, and TSH levels for hypothyroidism, before MRI of brain.

Question 117

What condition of nipple discharge is associated with breast CA

Answer 117

diffuse papillomatosis

Question 118

A prolactin level of what, is determined suspicious for an adenoma?

Answer 118

100ng/mL...bilateral nipple discharge

Question 119

Common causes of gallactorrhea

Answer 119

pregnancy\nmedications\nhypothyroidism\npituitary adenoma

Question 120

What test is often recommended for women with nipple dx, that is quicker and may be of more use than cytological examination? A positive result should be managed how?

Answer 120

ductogram\nBegin with mammogram for suspicious lesions, then US for retroareolar thickening, and then do ductogram.\nSurgical excisional biopsy