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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
what about CD perianal fistula?
Multiple opening Found around the anus Pain exacerbated with defecation
26
An ulcerative tonsilar lesion in a smoker?
SSC
27
what sx pt may have?
``` like other OP tumor sx Otalgia Sore through ear pain Odynophagia Cer LDP ```
28
Risk for OP ca?
Age > 40 Smoking ID alcohol
29
what to do?
Biopsy | CT
30
Tonsil stone?
Due to food, cellular, and bacterial debris accumulation | remove using saline and gargling
31
what about aphthous ulcers?
mainly affect oral cavity not oropharnex
32
epidimology of vibro vulminicus?
G- free living in marine ingestion of oyster or wound infection Risk in patients with liver disease
33
CM?
Rapidly progressive(<12 hr) Septicemia--sepsis and bullous lesion Cellulitis--Necrotising fascitis and heamoragic bulle
34
Diagnosis?
Blood and wound culture
35
Tx?
empiric in critically ill | Ceftriaxone + doxycycline
36
asymptomatic femoral hernia?
early elective surgery(unlike supra inguinal which can be managed conservatively) B/C of high risk of strangulation
37
CM of GOO?
nausea Vomiting of ingested, matter early satiety Succession splash
38
Risk factor?
Gastric Ca PUD Pyloric stricture--Acid ingestion(6-12 weeks after- Gastric bezoars
39
When to suspect DM gastropathy?
Decades after DM diagnosis
40
pregnancy and OCP and GS pathophysiology?
Estrogen--Increase cholesterol production | Progesterone-- decrease bile production
41
incisional hernia?
Occur in the previous fascial incision area vertical/midline insition is more risk the factor for poor wound healing increase risk
42
Rectus sheath diathesis?
No fascia breach just weakening | mass not present when supine
43
A common cause for liver metastasis?
Colonic Ca | Do colonoscopy in MLCa even asymptomatic
44
MC metastasis area of prostatic Ca?
Backbone | Pelvic LN
45
the most specific test for osteomyelitis?
Bone biopsy and culture
46
muffled noise, uvula deviation, and unilateral LDP?
peritonsillar abscess
47
Complication?
Airway obstruction | Infn spread to parapharengial space and carotid sheeth
48
Management?
needle aspiration surgical intervasion inf NA ineffective IV antibiotic
49
management of gall stone w/o Sx?
Conservative
50
gall stone with biliary colic?
Elective laparoscopic cholecystectomy | Ursodeoxycholic acid in poor surgical candidate
51
Complicated Gall stone disease like AC and AP?
Early cholecystectomy (within 72 hr)
52
where does endolymphatic fluid locate?
cemicircular chanel--Position | cochlea--Hearing
53
perilymphatic fistula CM?
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
Management?
Avoid triggers | refer to ENT
55
What to do in patients suspected of a urethral injury?
Retrograde urethrography
56
Risk factor for plantar fascitis?
Pes planus Obesity Working exercise on a hard surface Due to plantar aponurosis inflamation and degeneration
57
Sx?
Pain at the plantar surface of heel and hindfoot | Worse at weight-bearing especially after prolonged rest
58
DXs?
Tenderness at plantar fascia insersion Pain with dorsiflexion of toe Presence of heel spur(poor sensitivity and specificity)
59
Treatment?
Activity modification Stretching exercise Heel pad/orthotics
60
lemierre syndrome (LS)epidimology?
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
CM?
``` 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
management?
Airway support IV antibiotic Surgery
63
slipped capital femoral episis typical finding?
Referred knee pain The inability of internal rotation Inability to bear weight
64
penile fracture pathophysiology?
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
diagnosis and management?
D: Clinical M: emergency surgical repair of albuginea Retrograde urethrography in the suspect patient(20% pt will have a concomitant urethral injury)
66
patient with suspect of urethral damage?
Blood at meatus Haematuria Dysuria Urinary retention
67
etiology of small bowel bacterial growth?
``` anatomical abnormality(stricture,surgery(Y tube)...) motility disorder(DM and scleroderma...) ```
68
CM?
Abd.pain,diharroa,blooting and flatulence | Malabsorption, weight loss, anemia, Vitamin deficiency
69
organism?
Streptoccoci lactobacilus E,Coli Bacteroid
70
treatment?
Ab.(Amox-Clav,rifaximin..) Avoid motility agents like narcotic High fat and low bicarb diet Promotility agent(metocloperamide)
71
what d/t from dumping which both occur after gastric surgery?
In dumping syndrome there with sympathetic overactivity sx like diaphoresis and tachycardia diarrhea within 30 min of feeding
72
MC cause Hematoma formation in thyroid core needle biopsy in patient w/o other evidence of hemorrhagic disease?
Inadequate hemostasis
73
Diagnostic immaging for apendicitis with alvarado score >4?
Child/Px---U/S +/- MRI | Adult---CT

Surgery 1 (11 decks)

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