Surgery Case Files

Question 1

Mallory-weiss tear

Answer 1

Proximal gastric mucosal tear follow vigorous coughing, retching, or vomiting. Usually self limiting and amenable to endoscopic and or medical management.

Question 2

Dieulafoy’s erosion

Answer 2

Bleeding from an abarrant submucosal arter located in the stomach. Endoscope is tx

Question 3

What is the most effective long-term medical therapy following upper GI bleed?

Answer 3

PPI (or H2 blockers), H. pylori testing, NSAID discontinuation and replacement with a selective COX-2

Question 4

Indications for surgery in upper GI hemorrhage:

Answer 4

Complicated peptic ulcer disease with massive, persistent, or recurrent upper GI hemorrhage or in associated with giant nonhealing ulcers (>3cm)

Question 5

ER receptor positive breast cancer is best treated with this drug

Answer 5

Aromatase inhibitors

Question 6

What is the advantage of a core needle biopsy over an FNA?

Answer 6

FNA only will show malignant cells and can not determine invasive v. in-situ. A core needle can, and is therefore needed before staging can take place.

Question 7

Which breast cancer treatment is associated with uterine cancer?

Answer 7

Tamoxifen

Question 8

What is the next step after a patient has failed PPI and has GERD with symtoms of reflux?

Answer 8

Endoscopy and 24hr pH monitoring.

Question 9

extraesophageal complications of GERD?

Answer 9

laryngitis

reactive airway disease

recurrent PNA

pulmonary fibrosis

Question 10

When do most esophageal perforations take place?

Answer 10

During endoscopic procedures

Question 11

Why do most patients with esophageal rupture have a left pleural effusion?

Answer 11

Because most spontaneous ruptures occur in the distal thrid of the esophagus

Question 12

Best intitial test to confirm an esophageal rupture?

Answer 12

Water soluble esophagogram

Question 13

Primary surgical repair of the esophagus is preferred for lesions less than this old…

Answer 13

24hrs

Question 14

Treatment offered for stage III melanoma

Answer 14

Interferon 2A

Question 15

Only promising treatment for stave IV melanoma?

Answer 15

Interleukin 2

Question 16

Which scoring system is best for melaoma?

Answer 16

Berslow system

Question 17

Difference between biliary colic and acute cholecystitis?

Answer 17

Acute cholecystitis– elevated WBC count

Biliary colic– RUQ US with stones and pain but no white count

Question 18

When should a provider suspect choledocolithiasis over cholelithiasis?

Answer 18

CBD stone should be sispected if there is a stone greater than 5mm diameter in the duct with elevated LFTs

Question 19

Why should steroids not be used for a burn greater than 10%?

Answer 19

Infection risk

Question 20

What is the interval for colonoscopy for someone with an abnormal scope? How about someone with a normal scope?

Answer 20

Surveillance every 3 if polyps identified

Repeat in 5 years if the polyp were not found to be abnormal

Question 21

Preoperative evaluation of patients with colorectal cancer should include these studies…

Answer 21

CXR

CT ABD and Pelvis

Question 22

What are the coloscopy recomendations for those with FAP? HNPCC? Strong FMHx?

Answer 22

FAP- Flex Sig every 1-2yrs starting at age 10-12

HNPCC- Screening starting at age 25

FMHx- Starting at age 40 or 10 years before the age of relative when diagnosed

Question 23

What is the most common thyroid cancer?

Answer 23

Papillary thyroid carcinoma

Question 24

MEN2 cancers

Answer 24

Medullary thyroid

pheochromocytoma

pituitary adenoma