Surgery Halo-halo 6

Question 1

LCIS vs DCIS in terms of bilaterality

Answer 1

LICS: 50-70% bilateral
DICS: 10-20% bilateral

Question 2

tender breasts. Ddx?

Answer 2

MASTITIS
MONDOR’S DISEASE (cord-like, string phlebitis)
†ZUSKA DISEASE (painful subareolar mass)
FIBROCYSTIC BREAST CHANGE(cyclic breast pain, tenderness)

5% of painful masses is due to breast cancer (Robbins)

†aka periductal mastitis / squamous metaplasia of lactiferous ducts

Question 3

Which is not included in Gail Model

Age at menarch
Age at menopause
Age at first live birth

Answer 3

age at menopause

GAIL MODEL
Age
Age at menarche
Number of breast biopsy specimens
Hx of atypical hyperplasia
Number of first-degree relatives with breast cancer

Gail score >1.7 —-> HIGH RISK

Question 4

Giant fibroadenomas

Answer 4

> 3 cm

Question 5

fish-eye lesion

Answer 5

IPMN
(Intraductal Papillary Mucinous Neoplasm)
-ERCP, a mucin can be seen extruding from the ampulla of Vater, a so called FISH-EYE LESION - virtually diagnostic
-mean freq of malignancy: 62%
-HENCE, resection is recommended

Question 6

most common malignant paratesticular tumor

Answer 6

children: rhambdomyosarcoma
adults: liposarcoma

m/c benign: adenomatoid tumor

Question 7

most common sarcomas of adulthood

Answer 7

LIPOSARCOMA

Question 8

common locaations of liposarcoma

Answer 8

WELL-DIFF’D

• 50-60s
• atypical spindle ceels
• deep extremity
• retroperitoneum

MYXOID LIPOSARCOMA

• 30s
• chicken wire vessels
• thigh, leg

Question 9

other name for infectious stone

Answer 9

struvite stones

magnesium ammonium phosphate

Question 10

UO cut-offs

Answer 10

adult: 0.5 mL/kg/hour
child: 1.0 mL/kg/hour
infant: 1.5 mL/kg/hour

Question 11

cricopharynx vertebral level and distance from incisor

Answer 11

C6

15cm

Question 12

aortic arch vertebral level and distance from central incisor

Answer 12

TV4

25 cm

Question 13

left main bronchus vertebral level and distance from central incisor

Answer 13

TV6

28 cm

Question 14

esophageal hiatus vertebral level and distance from central hiatus

Answer 14

TV 10

40 cm

Question 15

remarks on post-op fever

Answer 15

post-surgical wound ifnections in the first 24 hours are uncommon

Question 16

direct hernia is more common in

Answer 16

female

Question 17

hernia, which is more common, left or right?

Answer 17

right

Question 18

What is the SIRS score and mortality risk

patient came in with BP 100/60, HR 95, Temp 37.8, RR 19, SpO2 85%, PaCO2 31 mmHg, WBC 4,500. patient is lethargic

Answer 18

2 points
5% mortality

❌ TEMP ≥38ºC or ≤36ºC
✅ HR ≥90
✅ RR ≥20 or PaCO2 ≤32 or mech vent
❌ WBC ≥12,000 or ≤4,000 or ≥10% band forms

2: 5%
3: 10%
4: 15-20%
(Schwartz, Table 12-17)

Question 19

What is the qSOFA score and implication

patient came in with BP 100/60, HR 95, Temp 37.8, RR 19, SpO2 85%, PaCO2 31 mmHg, WBC 4,500. patient is lethargic

Answer 19

2 points

The qSOFA suggests potentially life-threatening SEPSIS when at least 2 of the following parameters are met:
✅ altered mental status
✅ systolic blood pressure of 100 mmHg or less, and
❌ respiratory rate greater than 22 breaths/minute

Question 20

upper endoscopy, you encountered the 2nd narrowing, at what level are you na, and how far are you from the central incisors

Answer 20

aortic arch level
TV4
25 cm