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Surgery 1 > S7 > Flashcards

S7 Flashcards

1
Q

Fibroadenoma CM?

A 
Firm,mobile and solitary mass
Enlarge in premenstrual and start of OCP
MC in age <30 
May have cyclic pain and tenderness
MC in UOQ
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2
Q

palpable breast mass approach?

A

Age > 30—Mamograph +/- Ultrasonography

Age < 30 —Ultrasonography +/- Mamography(is sucpecious for malignancy in u/s)

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3
Q

age < 30 with simple cyst?

A

FNAC

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4
Q

age < 30 with complex cyst mass or Solid mass?

A

image-guided Core needle biopsy

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5
Q

Age > 30 with suspicion for malignancy?

A

Core needle biopsy

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6
Q

Clinically diagnosed Fibroadenoma in adolescents (10-19)?

A

Evaluate after next ministration

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7
Q

what about in adults?

A

do u/s as protocol

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8
Q

major risk factor for Pan Ca?

A

Hereditary

Environmental

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9
Q

Hereditary?

A

First degree relative with Pan Ca
hereditary chronic pan.
Germline mutasion(BRCA and PJS)

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10
Q

Environmental?

A

Cigarette smoking(MS)
Obesity and non-physical activity
Non-hereditary chronic pancreatitis

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11
Q

DM and Pan Ca?

A

Long-standing DM may be a risk

New-onset DM may be a sign of occult pan.Ca

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12
Q

HCC lab?

A

Normal/elevated LE
ALP may rise due to bone metastasis
Elevated alpha-fetoprotein

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13
Q

other cause of Elevated alpha feto protien?

A

Yolk sac tumor (normally AFP is produced by fetal hepatocyte and Yolk sac)

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14
Q

what about Cholangiocarcinoma?

A

elevated CEA and Ca 19-9

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15
Q

what type of bone metastasis causes elevated ALP?

A

Osteoblastic one(not osteolytic)

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16
Q

cause of mixed germ cell tumor?

A

Yolk sac(AFP), Choriocarcinoma(HCG), and embryonal carcinoma

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17
Q

unstable Pelvic fracture (specially open book) risk?

A

Severe hemorrhage from presacral and prelumbar venous plexus and sometimes may involve iliac vessel?

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18
Q

What to do first?

A

Pelvic binder(decrease pelvic volume-cause tamponade and reduce venous bleeding)

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19
Q

Pilonidal disease MC in people?

A

Yong
Obese
sedentary life
Deep gluteal cleft

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20
Q

Pathophysiology?

A

infected and edematous Hair follicle obstruction–Spread of infection in SC tissue–abscess–Pilonidial sinus tract formation–skin stretching activity(sit and stand)–recurrent hair/foreign bodies insertion—recurrent discharge and infection

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21
Q

CM?

A

Intergulutal area pain
Fluctuant mass cephalad to the anus(Near/at coccyx age)
Blood, pus and mucoid discharge

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22
Q

Management?

A

Drain abscess and derbies
Remove sinus tract
allow open healing

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23
Q

What about hidradinitis Suprativa?

A

Due to follicular obstraction
Multiple, Papular, painful and recurrent
Not form a fluctuant mass
Can occur anywhere in the perineum and axilla, and inguinal fold.

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24
Q

what about perianal abscess?

A

Systemic symptom

Mass around anal verge

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25
Q

what about CD perianal fistula?

A

Multiple
opening Found around the anus
Pain exacerbated with defecation

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26
Q

An ulcerative tonsilar lesion in a smoker?

A

SSC

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27
Q

what sx pt may have?

A 
like other OP tumor sx
Otalgia
Sore through
ear pain
Odynophagia
Cer LDP
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28
Q

Risk for OP ca?

A

Age > 40
Smoking
ID
alcohol

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29
Q

what to do?

A

Biopsy

CT

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30
Q

Tonsil stone?

A

Due to food, cellular, and bacterial debris accumulation

remove using saline and gargling

31
Q

what about aphthous ulcers?

A

mainly affect oral cavity not oropharnex

32
Q

epidimology of vibro vulminicus?

A

G- free living in marine
ingestion of oyster or wound infection
Risk in patients with liver disease

33
Q

CM?

A

Rapidly progressive(<12 hr)
Septicemia–sepsis and bullous lesion
Cellulitis–Necrotising fascitis and heamoragic bulle

34
Q

Diagnosis?

A

Blood and wound culture

35
Q

Tx?

A

empiric in critically ill

Ceftriaxone + doxycycline

36
Q

asymptomatic femoral hernia?

A

early elective surgery(unlike supra inguinal which can be managed conservatively) B/C of high risk of strangulation

37
Q

CM of GOO?

A

nausea
Vomiting of ingested, matter
early satiety
Succession splash

38
Q

Risk factor?

A

Gastric Ca
PUD
Pyloric stricture–Acid ingestion(6-12 weeks after-
Gastric bezoars

39
Q

When to suspect DM gastropathy?

A

Decades after DM diagnosis

40
Q

pregnancy and OCP and GS pathophysiology?

A

Estrogen–Increase cholesterol production

Progesterone– decrease bile production

41
Q

incisional hernia?

A

Occur in the previous fascial incision area
vertical/midline insition is more risk
the factor for poor wound healing increase risk

42
Q

Rectus sheath diathesis?

A

No fascia breach just weakening

mass not present when supine

43
Q

A common cause for liver metastasis?

A

Colonic Ca

Do colonoscopy in MLCa even asymptomatic

44
Q

MC metastasis area of prostatic Ca?

A

Backbone

Pelvic LN

45
Q

the most specific test for osteomyelitis?

A

Bone biopsy and culture

46
Q

muffled noise, uvula deviation, and unilateral LDP?

A

peritonsillar abscess

47
Q

Complication?

A

Airway obstruction

Infn spread to parapharengial space and carotid sheeth

48
Q

Management?

A

needle aspiration
surgical intervasion inf NA ineffective
IV antibiotic

49
Q

management of gall stone w/o Sx?

A

Conservative

50
Q

gall stone with biliary colic?

A

Elective laparoscopic cholecystectomy

Ursodeoxycholic acid in poor surgical candidate

51
Q

Complicated Gall stone disease like AC and AP?

A

Early cholecystectomy (within 72 hr)

52
Q

where does endolymphatic fluid locate?

A

cemicircular chanel–Position

cochlea–Hearing

53
Q

perilymphatic fistula CM?

A

a rare complication of head injury
progressive SNHL–loss of endolymph fluid from C
Episodic vertigo with nystagmus(precipitated by Valsalva maneuver and elevation(moving in lift
Tullio phenomena(Nystagmulo induced by loud clamp near the ear)

54
Q

Management?

A

Avoid triggers

refer to ENT

55
Q

What to do in patients suspected of a urethral injury?

A

Retrograde urethrography

56
Q

Risk factor for plantar fascitis?

A

Pes planus
Obesity
Working exercise on a hard surface
Due to plantar aponurosis inflamation and degeneration

57
Q

Sx?

A

Pain at the plantar surface of heel and hindfoot

Worse at weight-bearing especially after prolonged rest

58
Q

DXs?

A

Tenderness at plantar fascia insersion
Pain with dorsiflexion of toe
Presence of heel spur(poor sensitivity and specificity)

59
Q

Treatment?

A

Activity modification
Stretching exercise
Heel pad/orthotics

60
Q

lemierre syndrome (LS)epidimology?

A

caused by fusobacterium necrophorum
normal oral flora and G-ve anarob
start as tonsilitis or secondary to dental work/infection
Spread to lateral pharynx–infect NVS–internal jugular vein thrombosis and infection
can lead to septic emboli and affect another organ?

61
Q

CM?

A 
High fever
Toxic appearing patient
Prolonged sore throght
Dysphagia
Neck pain and swelling along SCM
May have systemic septic thromboembolic SX(pneumonia with lung nodule)
62
Q

management?

A

Airway support
IV antibiotic
Surgery

63
Q

slipped capital femoral episis typical finding?

A

Referred knee pain
The inability of internal rotation
Inability to bear weight

64
Q

penile fracture pathophysiology?

A

Mainly caused by emergency trauma in the erect penis(mainly during sex)
A result from the rupture of tunica albuginea covers corpora cavernosa
The patient hears snapping sounds and sudden pain during rapture
Penile detumescence and formation of penile shaft hematoma after blood leave cavernosal

65
Q

diagnosis and management?

A

D: Clinical
M: emergency surgical repair of albuginea
Retrograde urethrography in the suspect patient(20% pt will have a concomitant urethral injury)

66
Q

patient with suspect of urethral damage?

A

Blood at meatus
Haematuria
Dysuria
Urinary retention

67
Q

etiology of small bowel bacterial growth?

A 
anatomical abnormality(stricture,surgery(Y tube)...)
motility disorder(DM and scleroderma...)
68
Q

CM?

A

Abd.pain,diharroa,blooting and flatulence

Malabsorption, weight loss, anemia, Vitamin deficiency

69
Q

organism?

A

Streptoccoci
lactobacilus
E,Coli
Bacteroid

70
Q

treatment?

A

Ab.(Amox-Clav,rifaximin..)
Avoid motility agents like narcotic
High fat and low bicarb diet
Promotility agent(metocloperamide)

71
Q

what d/t from dumping which both occur after gastric surgery?

A

In dumping syndrome there with sympathetic overactivity sx like diaphoresis and tachycardia
diarrhea within 30 min of feeding

72
Q

MC cause Hematoma formation in thyroid core needle biopsy in patient w/o other evidence of hemorrhagic disease?

A

Inadequate hemostasis

73
Q

Diagnostic immaging for apendicitis with alvarado score >4?

A

Child/Px—U/S +/- MRI

Adult—CT

Surgery 1 (11 decks)

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