Stitelman Shelf Review

Question 1

A tachycardic, febrile patient presents with bloody diarrhea and abdominal pain. X-rays show a non-obstructed dilated colon and thick haustral markings that do not extend across the whole lumen? Diagnostic signs (4)? Major complication? Treatment? Treatment if patient has IBD?

Answer 1

Toxic Megacolon. Fever, tachycardia >120, WBC >10.5k, and anemia. Colonic perforation. IV fluids, NG, NPO, antibiotics. IC corticosteroids. Surgery if it doesn’t resolve.

Question 2

If you notice foot drop and the dorsum of the first and second toes are numb, what has been damaged?

Answer 2

Deep Peroneal Nerve injury.

Question 3

How can you tell if an anesthetic is an amide or an ester? Complications with esters?

Answer 3

Amide = 2 “i’s” - Lidocaine, Bupivacaine, Prilocaine. Ester = 1 “i” - Cocaine, Benzocaine. Esters are degraded to PABA, which can cause an allergic reaction in patients.

Question 4

What is this?

Answer 4

Intraparenchymal Hemmorrhage.

Question 5

What is this?

Answer 5

Epidural Hematoma

Question 6

What is this?

Answer 6

Acute Subdural Hemmorrhage.

Question 7

What is this?

Answer 7

Acute subarachnoid hemmorrhage.

Question 8

At what size should Thoracic Aortic Aneurysms be operated on? What about AAA?

Answer 8

6.5cm. 5.5cm.

Question 9

A milky chylous pleural effusion is suggestive of?

Answer 9

Thoracic duct injury.

Question 10

ABI < 0.9? ABI <0.6? ABI <0.4 for a patient who smokes that notices pain in their calf.

Answer 10

Claudication. Rest pain. Limb ischemia.

Question 11

A patient complains of acid reflux pain when lying down? Two types? Treatment?

Answer 11

Hiatal Hernia. 1: sliding, treat symptoms. 2. Paraesophageal, requires surgery.

Question 12

Normal Urine Specific gravity?

Answer 12

1.010-1.025

Question 13

10% rule with pheochromocytoma?

Answer 13

10% are extra-adrenal/malignant/found in children/familial/not HTN/calcified

Question 14

Drugs to treat acute rejection (4)?

Answer 14

Azathioprine/Mycophenylate (Imuran/Cellcept) - inhibit T cells (can’t make purine). Cyclosporine/Prograf (FK-506/Tac) - can’t make cytokines.

Question 15

What are MEN I tumors?

Answer 15

Parathyroid (hyperplasia). Pituitary (prolactinoma). Pancreatic (gastrinoma, insulinoma).

Question 16

What are MEN II a tumors?

Answer 16

Pheochromocytoma. Medullary Cancer. Parathyroid hyperplasia.

Question 17

What are MEN II b tumors?

Answer 17

Pheochromocytoma. Medullary Cancer. Mucosal neuroma. Marfan’s.

Question 18

Normal Hgb level for Men? Women?

Answer 18

14-17. 12-15.

Question 19

Causes of Macrocytic Anemia?

Answer 19

B12/Folate Deficiency (look out for issues in stomach or terminal ileum).

Question 20

Causes of Microcytic Anemia?

Answer 20

Iron deficiency or hemoglobinopathy.

Question 21

Warfarin inhibits what factors and proteins? Complications (apart from bleeding)? What coagulation test do you monitor?

Answer 21

Vitamin K dependent factors - II, VII, IX, X, Protein C and S. Skin necrosis. PT or INR.

Question 22

What does Heparin bind to and inhibit? What coagulation test do you monitor with use?

Answer 22

ATIII. PTT time.

Question 23

How do you know someone has an accessory spleen post splenectomy? Where should you look for it?

Answer 23

Absence of Howell-Jolly bodies. Splenic Hilum.

Question 24

A patient with HIV develops bloody diarrhea?

Answer 24

CMV infection.

Question 25

Gram positive cocci in clusters are? Pairs?

Answer 25

Staph. Strep.

Question 26

Artificial heart valve implantation requires prophylactic?

Answer 26

Antibiotics (Amoxicillin).

Question 27

Scaly skin lesions around the female the nipple? Complications?

Answer 27

Paget’s Disease of the Breast. Patient also has underlying DCIS or Ductal Carcinoma.

Question 28

A middle aged female presents with pruritis, fatigue, xanthoma, and jaundice? Lab findings?

Answer 28

Primary Biliary Chirrosis. Elevated GGT and ALK, presence of AMA and ANA

Question 29

What cancer is it associated with Primary Sclerosing Cholangitis (PSC)? What IBD is it associated with? How is it diagnosed?

Answer 29

Cholangiocarcinoma. UC. ERCP (beading of intra/extra hepatic ducts) + onion skinning on histology.

Question 30

Most common melanoma?

Answer 30

Superficial Spreading.

Question 31

Most aggressive Melanoma?

Answer 31

Nodular.

Question 32

Melanoma that presents on your palms/soles. Most common in dark skinned people?

Answer 32

Acral Lintiginous

Question 33

Non invasive facial melanoma - Hutchinson’s Freckle?

Answer 33

Lentigo Maligna

Question 34

Which nerve is most often injured during carotid endarterectomy?

Answer 34

Recurrent Laryngeal (Vagus).

Question 35

Cardiac causes of decompensation ~5 days after MI (3)?

Answer 35

Large VSD. Papillary Muscle Rupture. LV rupture.

Question 36

Four components of Tetralogy of Fallot?

Answer 36

Large VSD. Pulmonary Stenosis. Overriding aorta. RVH.

Question 37

What are the contraindications to EVAR (5)?

Answer 37

Narrow iliac arteries, e.g. ~8 mm
Sharply angulated iliac arteries
Short aneurysmal neck
Tapering aneurysmal neck
High likelihood of graft occluding a visceral vessel once deployed

Question 38

Is asbestos exposure more likely to predispose you to adenocarcinoma or mesothelioma?

Answer 38

Adenocarcinoma.

Question 39

What side of the esophagus is most likely injured in booerhaave’s?

Answer 39

Left Posterolateral side.

Question 40

Complications from terminal ileum resection?

Answer 40

Diarrhea and B12 deficiency (macrocytic anemia)

Question 41

Indications for Dialysis?

Answer 41

Acidosis. Electrolyte imbalances. Intoxicants. Overload (volume). Uremia.