Pestena 2

Question 1

virulent peptic ulcer disease, resistant to all usual therapy, with watery diarrhea

Answer 1

Zollinger-Ellison

Question 2

a devastating hypersecretion of insulin in the newborn,

requiring 95% pancreatectomy

Answer 2

Nesidioblastosis

Question 3

migratory necrolytic dermatitis in a patient with mild diabetes, anemia, glossitis, and stomatitis.

Answer 3

glucagonoma

Question 4

hypokalemia in a hypertensive

Answer 4

Primary hyperaldosteronism

also has modest hypernatremia and metabolic alkalosis

Question 5

Primary hyperaldosteronism and renin

Answer 5

Aldosterone levels are high, whereas renin levels are low

Question 6

baby whose x-rays show multiple dilated loops of small bowel and a ground-glass appearance in the lower abdomen

Answer 6

Meconium ileus in CF

Question 7

Meconium ileus in CF rx

Answer 7

Gastrografin enema is both diagnostic (microcolon and inspissated pellets of meconium in the terminal ileum) and therapeutic (Gastrografin draws fluid in, dissolves the pellets).

Question 8

should be suspected in 6- to 8-week-old babies who have persistent, progressively increasing jaundice

Answer 8

Biliary atresia

Question 9

Physical exam shows a vague mass on the right side of the abdomen, an “empty” right lower quadrant, and “currant jelly” stools

Answer 9

• Intussusception
• seen in 6- to 12-month-old healthy-looking kids
• episodes of colicky ab pain, double up and squat. •pain lasts for about 1 minute, and the kid looks happy until he gets another colic

Question 10

baby w/ stridor/ respiratory distress from pressure on the tracheobronchial tree and pressure on the esophagus

Answer 10

congenital Vascular rings

aorta “chokes” out esophagus and trachea

Question 11

kids are kept alive by an atrial septal defect, ventricular septal defect, or patent ductus (or a combination), but die very soon if not corrected

Answer 11

Transposition of the great vessels

Question 12

a low-pitched, rumbling diastolic apical heart murmur

Answer 12

Mitral stenosis

Question 13

young drug addicts who suddenly develop congestive heart failure and a new, loud diastolic murmur at the right second intercostal space

Answer 13

Acute aortic insufficiency

Question 14

Small cell cancer of the lung is treated with

Answer 14

chemotherapy and radiation

Question 15

Operability of lung cancer pre op eligibility

Answer 15

A minimum FEV1 of 800 mL is needed

Question 16

Abdominal aortic aneurysm size for repair

Answer 16

If it is 5- 6 cm or larger, the patient should have elective repair–> rupture risk is high

Question 17

A _________abdominal aortic aneurysm is going to rupture within a day or two, and thus immediate repair is indicated

Answer 17

tender

Question 18

Arterial embolization from a distant source s/s and rx

Answer 18

s/s same as compartment syndrome

• Early incomplete occlusion = clot busters. •Embolectomy w/ Fogarty catheter= complete obstructions
• fasciotomy if several hours have passed before revascularization

Question 19

raised waxy lesion or as a nonhealing ulcer.

Answer 19

basal cell carcinoma

Question 20

a nonhealing ulcer, has a preference for the lower lip

Answer 20

squamous cell carcinoma

Question 21

orbital cellulitis

Answer 21

• eyelids are hot, tender, red, and swollen, and the patient is febrile-but
• key finding: pupil is dilated and fixed, and the eye has very limited motion.

Question 22

patient reports seeing flashes of light and having “floaters” in the eye or “a snow storm” within the eye

Answer 22

retinal detachment

Emergency intervention, with laser “spot welding,” will protect the remaining retina.

Question 23

Embolic occlusion of the retinal artery rx

Answer 23

30 min damage irreversible,

breathe into a paper bag and have someone repeatedly press hard on the eye and release while going to ER

(the idea is to vasodilate and shake the clot into a more
distal location, so that a smaller area is ischemic)

Question 24

located on the midline, at the level of the hyoid

bone, and seems to be somehow connected to the tongue

Answer 24

Thyroglossal duct cyst

Question 25

occur along the anterior edge of the sternomastoid
muscle
They are several centimeters in diameter
sometimes have a little opening and blind tract in the skin overlying them

Answer 25

Branchial cleft cysts

Question 26

large, mushy, ill defined mass that occupies the entire supraclavicular area and seems to extend deeper into the chest

Answer 26

Cystic hygroma

Question 27

development of diplopia in a patient suffering from sinusitis.

Answer 27

Cavernous sinus thrombosis

emergency that requires hospitalization, IV antibiotics, CT scans, and drainage of the affected sinuses.

Question 28

Mitral stenosis for RF, initial rx

Answer 28

Mitral commissurotomy to open a stenotic mitral valve

Question 29

allows normal urinary output to flow without difficulty, but if a large diuresis occurs, the narrow area cannot handle it.

Answer 29

Ureteropelvic junction (UPJ) obstruction

classic presentation is an adolescent-drinking binge for the first time in his life and develops colicky flank pain

Question 30

little girl wet with urine all the time

Answer 30

low implantation of ureter

urine that drips into the vagina from the low-implanted
ureter

rx correction

Question 31

Most testicular cancers are radio sensitive and ___________, offering many options for successful treatment in advanced, metastatic disease.

Answer 31

chemosensitive (platinum-based chemotherapy)

Question 32

A __________ status is the only absolute

contraindication to organ donation.

Answer 32

positive HIV

Question 33

Hyperacute rejection of transplant

Answer 33

• vascular thrombosis within minutes of reestablishing blood supply to the organ.
• caused by preformed antibodies
• prevented by ABO matching and lymphocytotoxic cross match, and is thus not seen clinically

Question 34

Acute rejection of transplant

Answer 34

occurs after the first 5 day- 3 months.

Signs of organ dysfunction suggest it, and biopsy confirms it.

The first line therapy for acute rejection
is steroid boluses.

Question 35

Acute rejection of heart transplant

Answer 35

In the case of the heart signs of functional deterioration occur too late to allow effective therapy, thus routine ventricular biopsies (by way of the jugular, superior vena cava, and right atrium) are done at set intervals.

Question 36

tests for gunshot wounds to the base of the neck

Answer 36

arteriography
esophagogram (water-soluble, followed by barium if negative)
esophagoscopy
bronchoscopy

help decide the specific surgical approach

Question 37

Penetrating trauma to the neck leads to surgical exploration in all cases where there is

Answer 37

an expanding hematoma
deteriorating vital signs
clear signs of esophageal or tracheal injury (coughing or spitting up blood).