surgery

Question 1

numerate the effects and complications of gall stones ?

Answer 1

1- biliary colic 
2- acute cholecystitis
3- chronic cholecystitis
4- emphyema of gall bladder 
5- mucocele
6- perforation 
7- biliary obstruction
8-acute cholangitis 
9- acute pancreatitis 
10- intestinal obstruction

Question 2

what is the differential diagnosis of acute cholecystitis?

Answer 2

common 
1- appendicitis 
2- perforated PUD
3- acute pancreatitis 
uncommon
1- MI
2- pyelonephritis 
3-rt.L.lung pneumonia

Question 3

numerate the investigation of the biliary system?

Answer 3

1- ultrasound => stones and biliary dilation
2- X-ray (plain radiograph) => calcification
3- MRCP => anatomy and stones
4- ERCP => anatomy, stones, and biliary strictures
5- radioisotope (HIDA scan) => function
6- CT => 5 points
7- PTC => anatomy and biliary strictures
8-EUS => anatomy and stones

Question 4

write the investigation of the parotid gland tumor?

Answer 4

1- fine needle aspiration
2- open surgical biopsy
3-MRI and CT
4- histological diagnosis

Question 5

what is the clinical picture of malignant salivary gland tumors?

Answer 5

1- rapid growing and swelling
2- weakness of facial nerves
3- ulceration of underlaying skin
4- enlargement of cervical nodes

Question 6

what can we in the presence of gastric cancer in the clinical examination?

Answer 6

1- virchow node
2- metastatic nodal disease
3- intra-abdominal metastasis (hepatomegaly jaundice, ascites)
4- peritoneal metastasis (blumer shelf) (rectal examination)
5- krukenburg tumor
6-sister mary joseph node

Question 7

what are the types of patients that can use PET/CT gastric disease?

Answer 7

1- patient with advanced disease

2- monitoring therapy

Question 8

in gastric disease why laparoscopy is better than laparotomy?

Answer 8

1- low risk
2- safe in patients who undergo laparotomy
3- avoiding delay in chemotherapy in patients with metastatic disease or limited life expectancy

Question 9

what do we use to determine the stage of adenocarcinoma?

Answer 9

EUS, CT, endoscopy

Question 10

what we will do if we discovered metastatic disease and asymptomatic?

Answer 10

refer the patient to oncology

Question 11

what we will do if we discovered metastatic disease and symptomatic?

Answer 11

resection

Question 12

what we will do if we discovered non-metastatic disease?

Answer 12

laparoscopy and resection

Question 13

what is the lab diagnosis of carcinoid tumor?

Answer 13

1- radiographic methods
2- the hallmark is the presence of chromogranin A and 5-HIAA
3- prostaglandin injection

Question 14

what are the clinical features of FAP?

Answer 14

1- presence of APC mutation
2- presence of 100 colonic adenomas
3- in 2/3 of the patient one or more cancers already present
4- prophylactic surgery indicated to prevent colorectal cancer
5- polyps and malignant tumor can develop in the small bowel

Question 15

what are the investigations for a patient for FAP?

Answer 15

1- use colonoscopy for the number of adenomas and biopsy to the histological features
2- it should be over 100 adenomas
3- exclude FAP when a patient is 30 years old with no polyps
4- surgery preferred in the age of 17-18 but it can be done earlier if symptoms developed

Question 16

what are the common sites of carcinoma of the colon with their associations?

Answer 16

1- MC: distal colon (Lt.) => change in bowel habits and rectal bleeding
2- proximal colon (Rt.) => iron deficiency anemia or mass
3- flexures => vafue U.abdominal syptoms

Question 17

what are the investigations used to diagnose colon cancer?

Answer 17

1- screening
2- endoscopy
3- radiology as: double contrast barium enema (apple-core), virtual CT , CT, Spiral CT