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Surgery > skin, ophtho, ENT, neuro, peds > Flashcards

skin, ophtho, ENT, neuro, peds Flashcards

1
Q

BCC favors what part of body?

A

upper part of face

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2
Q

BCC either waxy raised lesion, or an ulcer. how to biopsy these?
what is resection margin requirement?

A

waxy raised lesion - excisional biopsy
ulcer - biopsy at edge
excision 1 mm margin all around

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3
Q

SCC favors what part of body?

A

upper lip, rest of body

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4
Q

SCC can metastasize to _______. excisional margins? also note that radiation therapy is a tx option

A

metastasize to lymph nodes

margin of 0.5-2cm

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5
Q

melanomas less than ____ deep require only local excision. deeper than that, require ________.
if bigger than ______ prognosis is super poor regardless of tx

A

<1 mm depth = local excision

deeper requires wider margins (2cm) + watch lymph nodes

> 4 mm has very poor prognosis

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6
Q

white pupil in baby is concern for

A

retinoblastoma or congenital cataract.

must remove former soon obvis. must remove latter sooner rather than later to prevent amblyopia

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7
Q

in closed angle glaucoma, eye feels super hard, pupil is mid dilated and dos or doesn’t react to light? is cornea clear or cloudy?

how to tx medically while you wait for optho to emergently decompress? (3 drugs +- 2)

A

does not react to light
cornea is cloudy w/ greenish hue

systemic CA inhibitors (Diamox) and topical BB and alpha 2 agonists.
can also used mannitol or pilocarpine.

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8
Q

pt has hot tender red swollen eyelid, is febrile, PUPIL IS DILATED AND FIXED. eye has limited motion. dx and tx?

A

orbital cellulitis -> emergency CT scan and drainage

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9
Q

person has tons of floaters in vision, like snowstorm vision. dx and tx?

A

retinal detachment.

emergency intervention = “spot welding” to keep rest of retina from detaching

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10
Q

elderly patient, sudden loss of vision in 1 eye. what are you worried about? management?

A

embolic occlusion of retinal artery.
emergency. rush to ER. in transit have patient breathe into paper bag to vasodilate and press on eye to move embolism to more distal artery (affect smaller portion of eye)

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11
Q

person has mass at midline of throat, at level of hyoid bone, and moves when tongue sticks out. dx? surgery specifically removes what 3 things?

A

thyroglossal duct cyst

surgery removes the cyst, middle segment of hyoid bone, and track that leads to base of tongue

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12
Q

branchial cleft cysts occur where?

A

along anterior edge of SCM muscle. aka not at midline.

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13
Q

large mushy ill defined mass at base of neck. seems to extend deeper into chest. next step in dx?

A

CT scan. cystic hygroma

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14
Q

toddler has unilateral earache or rhinorrhea or wheezing. dx? next step?

A

foreign body. stuck a toy up an orifice.

tx by endoscopy under anesthesia for extraction

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15
Q

person who had really bad toothache now has abscess in floor of mouth. what is this called? and what is special about management besides incision and drainage?

A

Ludwig angina.

it’s a threat to airway so need to do intubation and tracheostomy

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16
Q

2 meds for Bell’s palsy (general category)

A

antivirals

steroids

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17
Q

person who has sinusitis suddenly develops diplopia, facial pain, and high fever. what’s going on? dx study and tx?

A

cavernous sinus thrombosis

emergency. MRI for dx
tx: IV abx for 3-4 weeks with pencillinase resistant penicillin + 3rd or 4th generation cephalosporin. also drain sinus just bc.

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18
Q

what specific abx for cavernous sinus thrombosis (2)? (and how long)

A

3-4 weeks

pencillinase resistant penicillin + 3rd or 4th generation cephalosporin

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19
Q

18 yr old with bloody nose. prime suspects? (2) tx?

A

cocaine abuse -> septal perforation -> posterior packing

juvenile nasopharyngeal angiofibroma -> surgical resection

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20
Q

elderly with bloody nose. prime suspect? tx?

A

HTN. is life threatening.

tx: control BP, use posterior packing. sometimes surgical ligation of feeding vessels is required

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21
Q

patient is dizzy. says that room is spinning. what is pathogenesis and tx?

A

problem is in inner ear.

tx: meclizine, promethazine, diazepam

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22
Q

pt is dizzy. patient is unsteady but says the room is NOT spinning. what is pathogenesis and tx?

A

problem is in brain.

neurologic workup needed

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23
Q

tx of Meniere dz? (presents as vertigo + tinnitus +- hearing loss)

A

diuretics

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24
Q

neurovascular problems have sudden onset and have headache when they are (occlusive or hemorrhagic?) and with headache if they are (occlusive or hemorrhagic?)

A

NO headache - occlusive

headache - hemorrhagic

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25
Q

neurology. sudden onset is vascular, progressive over months is brain tumors, and developing over hours or days is _______ type of problem? what about years?

A

hours/days = metabolic. affect entire CNS.

over years = degenerative

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26
Q

ischemic stroke present for longer than ____ hours is not amenable to revascularization

A

3 hours

this includes both surgery and tPA

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27
Q

hemorrhagic stroke is from ________

subarachnoid bleeding is from ________

A

hemorrhagic stroke is from uncontrolled HTN

subarachnoid bleeding is from intracranial aneurysms

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28
Q

pt complains of thunderclap headache. but no neurologic sx. next step?

A

CT to look specifically for blood in subarachnoid space

note: pt may not have any neuro deficits bc blood is only in subarachnoid space. there is no hematoma presing on brain. pts can have meningeal irritation and nuchal rigidity

29
Q

thunderclap headache
meningeal irritation
nuchal rigidity
dx and study?

A

subarachnoid hemorrhage.

CT, then arteriogram to locate the aneurysm

30
Q

brain malignancy is more commonly metastatic than primary. what are 3 primary sites that like spreading to brain? in order!

A
  1. lung

2&3 breast and melanoma

31
Q

brain malignancy is more commonly metastatic than primary. but if it is primary, what are the 2 most common ones in adults?

A
  1. gliomas 50% (btw glioblastoma multiforme is most malignant intracranial tumor, gg)
  2. meningiomas 20% (usually benign)
32
Q

if you suspect brain tumor (progressive headache over months, worse in mornings, later on blurred vision, papilledema and projectile vomiting, maybe even some bradycardia and HTN), what study should you get?

A

MRI! bc it gives more detail it’s preferred over CT

33
Q

while waiting for pt with brain tumor surgery, how to manage them medically?

A

give high dose steroids for increased ICP.

dexamethasone aka Decadron

34
Q

where is the brain tumor:

inappropriate behavior + Foster Kennedy syndrome = ipsilateral optic nerve atrophy, contralateral papilledema, anosmia

A

base of frontal lobe

if w/out inappropriate, it could be meningioma in olfactory groove

35
Q

what and where is the brain tumor:

kid who is short for their age, bitemporal hemianopsia, calcified lesion _________on CT

A

craniopharyngioma. calcified lesion above sella

36
Q

management/tx of prolactinomas?

A

bromocriptine or similar drug.

only surgical removal if woman wants to get pregnant or bromocriptine fails

37
Q

diagnostic workup for prolactinoma? what else do you have to rule out in person with suspected prolactinoma (amenorrhea + galactorrhea in young woman)? (2 for dx, 2 for ruling out)

A

measure prolactin levels and get MRI of sella.

rule out pregnancy and hypothyroidism (measure TSH)

38
Q

acromegaly question has picture of large hands and another picture of __________

A

large prominent jaw in side view of face

39
Q

acromegaly signs/sx besides bigger hands and wedding rings and hats no longer fitting? (4)

A

headache
sweating
diabetes
HTN

40
Q

workup for acromegaly (2)

A

somatomedin C

pituitary MRI

41
Q

prolactinoma is preferred to be managed (surgically or medically)
acromegaly is preferred to be managed (surgically or medically)
brain abscess is preferred to be managed (surgically or medically)

A

prolactinoma - medical. bromocriptine

acromegaly - surgically (also can do radiation)

brain abscess- surgical resection

42
Q

person has hx pituitary tumor (headache, visual stuff, endocrine problems). now presenting with acute episodes of severe headache + more visual problems + bilateral pallor of optic nerves, and starting to have sx of stupor and hypotension. what’s going on? next step? tx?

A

pituitary apoplexy - bleeding into a pituitary tumor. acute episodes are from growing hematoma, and stupor and htn is from pituitary destruction

dx: MRI or CT
tx: hormone replacement (steroid replacement is urgent)

43
Q

upper gaze palsy (perinaud syndrome). where is the brain tumor

A

pineal gland

44
Q

brain tumors in children are most commonly found where? what type of tumors most commonly? (2)

A

posterior fossa
most common is medulloblastoma which is in cerebellum (ataxia)
2nd most common is ependymoma (headaches that relieve with knees to chest position bc it opens up CSF flow)

45
Q

seems like a brain tumor bc of space occupying sx, but timeline is couple weeks only. what do you suspect? what study to order?

A

brain abscess (usually obvious source like from otitis media -> mastoiditis)

order CT. (MRI not needed)

treat by resection, not just medically

46
Q

pt had crushing injury a few months ago. now has constant burning agonizing pain, not responsive to the usual analgesics. slightly touching it aggravataes the area. what do you expect to find on physical exam? what is dx and tx?

A

extremity will be cold, cyanotic, and most.

dx study: successful sympathetic block -> reflex sympathetic dystrophy is dx

tx: surgical sympathectomy is curative

47
Q

if you need to delay surgery to repair esophageal atresia + fistula, what intervention needs to be done in the meantime?

A

gastrostomy. to protect lungs from acid reflux

48
Q

you know that baby has most common form of esophageal atresia (proximal atresia + distal fistula) if you see what on imaging?

A

normal gas pattern in the bowel.

49
Q

what other anomalies are associated with esophageal atresia that you have to look out for before doing surgery? (VACTER)

A 
Vertebral. xray
Anal - imperforation. look.
Cardiac. ECG
Trachea
Esophageal
Radial. xray. and renal. ultrasound

theyre all associated w/ each other so if pt has one, gotta look for any of the others

50
Q

for anal imperforation, type of repair depends on where the blind pouch ends. how do you determine this?

A

xray taken upside down so tht gas in the pouch goes up, with a metal marker taped to the anus

51
Q

congenital diaphragmatic hernia is always on the LEFT. more than the mechanical obstruction problem of having bowel up against the lungs, what is the big problem?
how to tx/manage?

A

lung is hypoplastic.
surgical repair must be delayed a few days to allow lung maturation.
in the meantime, babies are in ARDS and need intubation, ventilation, sedation, and NG suction.

52
Q

how to diagnose congenital diaphragmatic hernia? which side?

A

prenatal sonogram

always on left side

53
Q

babies with gastrochisis need what intervention besides fixing the defect?

A

vascular access for parenteral nutrition. their angry looking bowel will not work for about 1month

54
Q

green vomiting and “double bubble” in xray happens in what 3 conditions?

A

duodenal atresia
annular pancreas
malrotation (esp if some normal air fluid levels beyond the double bubble)

55
Q

what 2 studies can dx malrotation

A 
contrast enema (safer but less specific)
upper GI study (more specific but more risky)
56
Q

baby with green vomiting + multiple air fluid levels on imaging

A

intestinal atresia

57
Q

if baby has intestinal atresia what other anomalies do you have to look out for?

A

trick question, none. it’s due to vascular accident in utero.

58
Q

premature baby has first feeding -> feeding intolerance, abdominal distention, rapidly dropping platelet count.
dx? tx?

A

necrotizing enterocolitis
tx: NPO, abx, IVF, IV nutrition.
if baby develops abdominal wall erythema, air in portal vein, gas in bowel wall, or pneumoperitoneum aka signs of intestinal necrosis and perforation -> surgery

59
Q

mother has cystic fibrosis (hint that baby has CF). newborn baby gets feeding intolerance and bilious vomiting. x ray shows multiple dilated loops of small bowel and ground glass appearance in lower abdomen. next step?

A

gastrografin enema - both diagnostic of meconium ileus and treatment (gastrografin draw fluid in and dissolves the pellets).

60
Q

you suspect hypertrophic pyloric stenosis (3 week old firstborn boy with nonbilious projectile vomiting after feeding) but can’t palpate an olive size mass in RUQ. what study do you order to diagnose? tx?

A

ultrasound

first fix dehydration and hypochloremic hypokalemic metabolic alkalosis
repair by balloon dilatation or pylorotomyotomy.

61
Q 
6-8 week old baby with progressing jaundice. order labs -> elevated conjugated bilirubin.
next step(s)?
A

give phenobarbital (choloretic) as a trial. if no improvement -> HIDA scan. if no bile reaches duodenum -> surgical exploration is needed (eventually 2/3 of these pts will need a liver transplant)

62
Q

if you suspect Hirschsprung dz (chronic constipiation. may have explosive expulsion w/ relief of abdominal distention) how do you dx?

A

full thickness biopsy of rectal mucosa

63
Q

if you suspect Hirschsprung dz (chronic constipiation. may have explosive expulsion w/ relief of abdominal distention) but they also have fecal soiling and it’s an older kid, what else is in your diff dx?

A

pyschogenic etiology

64
Q

6-12 month old chubby healthy looking kid, has episodes of colicky abdominal pain that makes him double up and squat. acts fine in between episodes.
physica exam shows vague mass on right side of abdomen, “empty” RLQ, and currant jelly stools. next step? dx?

A

intussusception.

barium or air enema s both diagnostic and therapeutic

65
Q

study to dx Meckel’s diverticulum?

A

technetium/radioisotope scan looking for ectopic gastric mucosa in lower abdomen

66
Q

child with abdominal mass that moves up and down with breathing is most likely what? what will be elevated in blood?

A

malignant liver tumor - HCC or hepatoblastoma.

AFP elevated

67
Q

child with abdominal mass that is deep and immobile. most likely what (2)? next step?

A

Wilms tumor - kidney
neuroblastoma - adrenal gland

order CT or MRI

68
Q

child has seemingly undescended testicle but you check on physical exam it’s in the canal and can be pulled down. next step?

A

assure parents, it’s just overactive cremasteric reflex

Surgery (7 decks)

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