Surgery

Question 0

Benign breast histology

Answer 0

Adenosis, apocrine metaplasia, cysts, Ducati ecstasies, fibroma denims, fibrosis, mild hyperplasia, mastitis, squamous metaplasia

Question 1

Retrograde urethrogram

Answer 1

Radiologic procedure, usually used in males, to image integrity of urethra. Useful for diagnosis of urethral injury or urethral stricture.

Question 2

Breast histology that inc likelihood of breast cancer by 1.5-2 fold

Answer 2

Moderate or severe ductal hyperplasia, papillomatosis

Question 3

Breast histology that inc risk of cancer by 5 fold

Answer 3

Atypical ductal hyperplasia

Question 4

Breast histology that inc risk by 10 fold

Answer 4

Lobular carcinoma in situ, atypical ductal hyperplasia with family history of breast cancer

Question 5

BIRADS Category

Answer 5

0: incomplete assessment
1: Negative. Recommend routine annual screening mammo for women older than 40
2: benign. Same recommendations
3: probable benign findings. Recommend initial short-term imaging f/u, usually 6 months. Malignancy rate is 2%
4: suspicious abn. Consider biopsy. Malignancy rate is 3-94%. 4A is low suspicion, 4B is intermediate suspicion, 4C is moderate concerns, but not classic for malignancy.
5: highly suggestive of malignancy and requires biopsy or surgical excision (>95% malignancy).
6: known biopsy-proven malignancy

Question 6

Invasive lobular carcinoma

Answer 6

10-15% of all breast cancers. No dominant breast masses, but appears as focal thickening. Mammo tends to be negative. Detect by PE, MRI, and US.

Question 7

Chemoprevention for breast cancer

Answer 7

Tamoxifen (20mg/d for 5 years). Must be considered carefully bc of risk of VTE, endometrial cancer, and SE. Raloxifen can also be used and has less VTE occurrences.

Question 8

Glasgow Coma Scale

Answer 8

Eye opening: 4=spontaneous, 3=to speech, 2=to pain, 1=none
Motor response: 6=obeys command, 5=localized pain, 4=withdraws to pain, 3=decorticate posture (abn flexion), 2=decerebrate posture (extension), 1=no response
Verbal response: 5=oriented, 4= confused conversation, 3=inappropriate word, 2=incomprehensible words, 1=none

Question 9

Risks associated with brain injury patients

Answer 9

Hypoxia and hypotension has a 75% mortality rate. Hypotension doubles mortality.

Question 10

Epidural hematoma

Answer 10

Collection of blood outside dura but beneath skull, usu middle meningeal artery laceration. Better prognosis than other types of brain injury. Lens or bacon cave shape on CT.

Question 11

GCS grading and head injuries

Answer 11

Mild head injury is GCS 13 to 15
Moderate head injury is GCS 9 to 12
Severe head injury is GCS of 8 or less

Question 12

Burr hole

Answer 12

Hole drilled through the skull, usually on the side of the larger pupil to decompress an intracranial mass lesion.

Question 13

COHgb level indicating significant CNS dysfunction vs coma or death.

Answer 13

Greater than 30% I dictates significant CNS damage vs greater than 60% indicating coma/death

Question 14

Burn depth

Answer 14

First degree: epidermis. Erythema and pain. Heals in3-4d w/o scarring. Tx with lotions and NSAIDS.
Second degree: through epidermis and into dermis. Pink/red, weepy, swelling and blisters, very painful. Superficial dermal heal within 3 wk w/o scarring or functional impairment. Deep dermal heal in 3-8 wks but with scarring and loss of function. Tx by excise and graft deep dermal burns.
Third degree: all the way through dermis. White or dark leathery, waxy, painless. Burns can heal only by epithelial migration from periphery and contraction. Unless they are tiny, they will ned excise and grafting.

Question 15

Parkland formula

Answer 15

Used as a recommendation for initial fluid resuscitation over first 24 hours after a major burn that consists of lacerated Ringers. 24 hour volume = 4mL/kg/% burn

Question 16

Side effects of Sulfamylon

Answer 16

Metabolic acidosis and causes pain when applied for burn victims.

Question 17

Treatment for patient with intermittent claudication.

Answer 17

Aspirin does not reduce claudication, but does reduce risk of MI, strokes, and progression of claudication symptoms.
Closed ogres, anti platelet drug, is more effective than aspirin in prevention of CV ischemic events. Related to increased cost and increased bleeding complications.
Lipid lowering meds like statins, can reduce risk of major cardiovascular events in patients with peripheral vascular disease.

Question 18

Fontaine classification

Answer 18

Used for lower extremity peripheral vascular occlusive disease.
Stage I: no symptoms. 0.8<0.2 to not obtainable. Tx by stage IV plus possible major or minor amputation.

Question 19

Arterial bypass

Answer 19

Surgical procedure where one artery is connected to another artery with a conduit like saphenous vein or prosthetic material.

Question 20

TASC classification of femoral popliteal occlusive disease.

Answer 20

Type A: single stenosis less than 10cm in length or single occlusion less than 5cm.
Type B: multiple lesions (each less than 5cm);single or multiple tibial vessel lesions to impede outflow for a distant bypass; heavily calcified occlusion less than 5cm in length; single popliteal stenosis.
Type C: multiple stenosis or conclusions totaling greater than 15cm. Recurrent stenosis or occlusions that need Tx.
Type D: chronic total occlusion of common femoral artery (CFA) or SFA

Question 21

Primary assessment/survey

Answer 21

Airway, breathing and circulation

Question 22

Penetrating abdominal trauma next steps

Answer 22

Primary and secondary surveys. CXR to r/o pneumothorax, hemothorax and free air, with the study repeated in 6 hours. A focused abdominal sonography for trauma (FAST) examination can be performed to exclude pericardial effusion.
Dx laparoscopy can be performed to determine peritoneal penetration. Any suspicion of hollow viscous injury should result in celiotomy. CT can be performed to determine depth of knife penetration. If stab does not violate peritoneal cavity or go near diaphragm, pt can be observed or discharged.

Question 23

Circulation abn signs

Answer 23

Cool skin or capillary refill for more than 2 seconds is an indication of shock.
Distended neck veins or muffled heart tones, which indicate cardiac tamponade and require immediate Tx.

Question 24

Secondary survey

Answer 24

Physical findings

Question 25

Indications for celiotomy

Answer 25

Rigidity, guarding, or significant tenderness distant from stab wounds

Question 26

Local wound exploration

Answer 26

Permits determination of Fascial penetration. A sterile field is prepared around stab wound and area is infiltrated with a local anesthetic. Stab wound is enlarged to permit adequate exploration and tract of wound is followed. Look for anterior abdominal fascia penetration.

Question 27

Diagnostic peritoneal lavage

Answer 27

Sample intra-abdominal contents for blood, inflammation (WBC) or fecal matter.catheter is placed in abdomen using Seldinger (catheter over guide wire technique). Catheter is aspirated after placement to look for evidence of gross blood or fecal contents. If aspiration is negative, 1L warmed normal saline is instilled into abdomen and then removed by gravity.
Criteria for pos DPL is gross aspiration of 10mL blood, aspiration of fecal contents, or presence of greater than 100,000/mm3 RBC or 500/mm3 WBC.

Question 28

Tx for tension pneumothorax

Answer 28

Tube thoracostomy, needle decompression

Question 29

Tx for hemothorax

Answer 29

Tube thoracotomy resuscitation, possible exploration and repair