RX Surgery

Question 1

65yo Dysphagia + smoking history + cachectic

Answer 1

Think esophageal cancer & endoscopy w/ biopsy

Question 2

Jaundice, epigastric tenderness on palpation
Liver lesion + History of alcoholism + Weight Loss
Primary cancer location? Also expect?

Answer 2

Head of the pancreas
- can have Trousseau’s syndrome (thrombotic episodes)
- Pancreatic cancer-associated antigen 19-9 may be elevated
Trousseau = thrombotic episodes (DVT, arm)

Question 3

Atypical or equivocal findings of appendicitis in kids

Next best step? Could also be?

Answer 3

Ultrasound
Mesenteric adenitis (lymphadenitis)
- inflam of mesenteric LN in abdomen (Yersinia e. )
- often preceded by sore throat

Question 4

T2N0M0 Prostate Cancer

Gold standard diagnosis = prostate biopsy

Answer 4

T2 means confined to prostate (not through prostate capsule)
Best treatment is radical prostatectomy, external bean radiation therapy, or brachytherapy + watchful waiting
T3 = extends through capsule
Hormone therapy for advanced tumors w/ mets
Chemo reserved for pt’s w/ advanced prostate cancer that is no longer responsive to hormonal therapy

Question 5

Soft tissue density w/in prevocalic fat & bowel wall thickening localized to LLQ
Add fever, elevated ESR & CRP +

Answer 5

Diverticulitis
Diverticulitis complicated by abscess formation
(less common complications = perforation, obstruction, peritonitis, fistula, pneumauria)

Question 6

Symptomatic BPH: difficulty urinating, must bear down, hesitancy, retention, nocturne
Biopsy revealed no dysplasia or atypic
Treatment?

Answer 6

Terazosin

• alpha1 adrenergic antagonist
• 1st line for pt’s w/ symptomatic BPH

Question 7

Long-standing GERD
Endoscopy guideline?
Risks?

Answer 7

Barrett’s esophagus in setting of long-standing GERD carries 1% annual risk of becoming adenocarcinoma.
Pt’s w/ 2 consecutive endoscopies w/ no dysplasia w/in 1 year then have endo every 3 years
Good = columnar metaplasia of distal esophagus w/o any signs of dysplasia

Question 8

Infant w/ bilious emesis + abd pain + tender mass in inguinal region or scrotum.
Treatment? Why?

Answer 8

Incarcerated inguinal hernia
- failure processes vaginalis to close
- loops of bowel can enter the cavity and form indirect hernia
- premies at much higher risk
Treat: emergency surgery as after 2 hours of incarceration, hernia is subject to strangulation