top 100 clinical surgical micro vignettes Flashcards by Mollie Marcus

elderly woman, SBO, and air in biliary tract

gallstone ileus

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elderly woman with pain down inner aspect of thigh

what is this sign called?

obturator hernia

Howship Romberg sign

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abd. pain, hypotension, and abdominal pulsatile mass

AAA

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abdominal pain “out of proportion” to abdominal exam

mesenteric ischemia

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arm pain and syncope with arm movement

subclavian steal syndrome

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increasing creatinine on ACE inhibitor

renal artery stenosis

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child with MIDLINE neck mass

thyroglossal duct cyst

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child with LATERAL neck mass

branchial cleft cyst

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crush injury and dark urine

myoglobinuria

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emesis, chest pain radiating to back and mediastinal air

Boerhaaves

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lower GI bleed and technetium pertechnetate scan

meckel’s diverticulum

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flushing, diarrhea, and right sided heart failure

carcinoid

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pneumaturia and LLQ pain

colovesicular fistula

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desmoid tumor, osteoma, and colon cancer

Gardner’s syndrome

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epigastric pain radiating to back and flank ecchymosis

hemorrhagic pancreatitis

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pancreatitis and palpable epigastric mass

pancreatic pseudocyst

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liver abscess with “anchovy paste”

amebic abscess

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RUQ pain, travel, and exposure to sheep lol

hydatid cyst

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caput medusa

portal HTN

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45y.o F RUQ pain with 12hr, fever, leukocytosis

acute cholecystitis

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elderly man with large NONTENDER palpable gall bladder

what is this sign called?

pancreatic cancer

Curvoisier’s Sign

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female taking BC pills with liver mass

hepatic adenoma

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liver tumor with “central scar”

focal nodular hyperplasia

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pancreatic mass, gallstones, diabetes, and diarrhea

somatostatinoma

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RUQ bruit and CHF in young adult

liver hemangioma

excruciating pain with bowel movement

anal fissure

abdominal pain, diarrhea, and anal fistulae

Crohn's dz

EKG with PEAKED T waves

hyperkalemia

buccal mucosa with pigmentation

Peutz-Jegher's Syndrome

LLQ pain, fever, and change in bowel habits

diverticulitis

elevated urine 5-HIAA

carcinoid

institutionalized, abdominal pain, vomiting, distention, with proximal colonic dilation

sigmoid volvulus

infant with projectile vomiting

pyloric stenosis

newborn with failure to pass meconium in first 24 hours

Hirschsprung dz

infant with bilious vomiting

malrotation

newborn with abdominal defect and umbilical cord on sac

omphalocele

teenager with knee pain and "onion skinning" on xray

Ewing sarcoma

pulmonary capillary wedge pressure <18, CXR with bilateral pulmonary infiltrates, and PaO2:FiO2 ration <300

ARDS

increased peak airway pressure, low urine output, and urinary bladder >25mm Hg

abdominal compartment syndrome

newborn with inability to pass an NGT (nasogastric tube)

esophageal atresia

traumatic blinding in one eye followed by blindness in the contralateral eye 2 weeks later

sympathetic ophthalmia

miotic pupil, ptosis and anhydrosis

Horner's syndrome

traumatic head injury, conscious in ER followed by unconsciousness

epidural hematoma | lucid interval

worst headache of my life

subarachnoid hemorrhage

hematuria, flank pain, and abdominal mass (palpable)

renal cell carcinoma

60 year old white man with painless hematuria

bladder cancer

RUQ pain, jaundice, fever

cholangitis

epigastric pain radiating to the back, with nausea and vomiting

pancreatitis

chest pain radiating to back and described as a tearing pain

aortic dissection

40 year old man with tachycardia, HTN and confusion on post op day 2

alcohol withdrawal

marfanoid body habits and mucosal neuromas

MEN II-b (multiple endocrine neoplasia type II b)

psammoma bodies

papillary thyroid cancer

sulfur granules

actinomyces infection

thyroid tumor with AMYLOID tissue

thyroid medullary cancer

palpable neck tumor and hypercalcemia

parathyroid cancer

HTN, diaphoresis (episodic), and palpitations

pheochromocytoma

jejunal ulcers

Zollinger Ellison syndrom

pituitary tumor, pancreatic tumor, and parathyroid tumor (3Ps)

MEN-I

necrotizing migratory erythema

glucagoneoma

medullary thyroid cancer, pheochromocytoma, and hyperparathyroidism

MEN-IIa

hypokalemia refractory to IV potassium supplementation

hypomagnesemia

newborn with pneumatosis

necrotizing enterocolitis (NEC)

child with abdominal mass that crosses the midline

neuroblastoma

child <4 years old with abdominal tumor that DOES NOT CROSS the midline

Wilm's tumor

currant jelly stools and abdominal colic

intussception

femur fracture, resp failure, petechiae, and mental status change

fat embolism

hearing loss, tinnitus, vertigo

meniere's dz

adolescent boy with nasal obstruction and recurrent epistaxis

juvenile nasopharyngeal angiofibroma

child <5 y.o sitting up right and drooling with hot potato voice

epiglottitis

angina, syncope, and CHF

aortic stenossi

tobacco use, asbestos exposure, and pleuritic chest pain

mesothelioma

supracondylar fx and contracture

volkmanns contracture

tibia fx, "pain out of proportion", pain on passive foot movement and palpable pulses

compartment syndrome

25 year old man with liver mass with fibrous septa and NO history of cirrhosis or hepatitis

fibrolamellar hepatocellular carcinoma

EKG with flattening of T waves and U waves

hypokalemia

central pontine myelinolysis

too rapid correction of hyponatremia

polydipsia, polyuria, constipation

hypercalcemia

factor VIII def

hemophilia A

abd pain, fever, hypotension, HYPERkalemia, HYPOnatremia

adrenal insufficiency (Addison's dz)

massive urine output and HYPERnatremia

diabetes insipidous

increased urine osmolality, HYPOnatremia, and low serum osmolality

SIADH

IV antibiotics, fever, diarrhea

C. diff pseduomembranouscolitis

bleeding gums and wound dehiscence

vitamin C deficiency

fever, central line, and HYPERglycemia

central line infection

appendectomy followed by fever and and pain on post op day 7

peritoneal abscess

advancing crepitus, fever and blood blisters

necrotizing fasciitis

high INTRAOPERATIVE fever

malignant hyperthermia

confusion, ataxia, and opthalmoplegia

wernicke's encephalopathy

tracheal deviation, decreased breath sounds, hyperresonance

tension PTX

hypotension, decreased heart sounds, JVD

beck's triad for pericardial tamponade

4 ribs broken in 2 places and pulmonary contusion

flail chest

otorrhea (clear) and Battle's sign

basilar skull fx

ulcer and decreased pain with food

duodenal ulcer

vomiting, retching, and epigastric pain

mallory-weiss tear

fever on post op day 1, with "bronze" weeping, tender wound

clostridial wound infection

hematochezia, and tenesmus

rectal cancer

upper GI bleed, jaundice, and RUQ pain

hemobilia

gall stones, epigastric pain radiating to back, nausea

ductal papilloma

irritability, diaphoresis, weakness, tremulousness, and palpitations

insulinoma