Gen Surg

Front 1

when do you not do mammogram? x2

Back 1

i)<20 yo ii)during lactation

Front 2

what is best way to BX breast?

Back 2

mammographically guided core bx (stereotactic)

Front 3

who gets fibroadenomas? How do they present? What is sufficient to establish dx? Can you remove?

Back 3

i)young 20's female ii)mobile, firm, rubbery mass iii)FNA or sonogram iv)if they want

Front 4

what is age for cystosarcoma phyllodes? What is course of disease? Are they benign? What is necessary for DX? Should you remove?

Back 4

i)late 20's ii)grow w/o invasion or fixation but take over entire breast and distort it iii)can become malignant iv)core or incisional biopsy (FNA is not sufficient) v)need to remove

Front 5

What do you do for giant juvenile fibroadenomas?

Back 5

need to remove b/c they will distort the breast and grow rapidly

Front 6

what age do pts get mammary dysplasia (fibrocystic dz, cystic mastitis)? What is presentation? What is needed if no dominant or persistent mass? If there is a persistent mass, what do you do? How do you w/u? What do you do if fluid goes away; if mass persists or recurs; or if bloody fluid is aspirated?

Back 6

i)30's and 40's, goes away after menopause ii)b/l tenderness related to menstrual cycle (worse in last 2 weeks), w/multiple lumps that come and go (cysts) and follows menstrual cycle iii)if no dominant: just a mammogram iv)persists: aspiration w/needle: a)goes away, then ok b)recurs or persists, need formal biopsy c)if bloody: send to cytology

Front 7

who gets intraductal papilloma? What is symptom? Does mammogram help? What is diagnostic?

Back 7

i)20-40 y/o ii)blood nipple d/c iii)no iv)galactogram

Front 8

What do you do for breast abscess?

Back 8

I and D w/bx of abscess wall

Front 9

Does h/o trauma r/o breast cancer?

Back 9

no

Front 10

how is breast cancer during pregnancy diagnosed? How is its treatment different? x2 Do you need to terminate pregnancy?

Back 10

i)as if it didn't exist ii)a)no radiotherapy b)no chemo in 1st trimester iii)no

Front 11

What is treatment of resectable breast cancer? x2 When can lumpectomy be offered? x3

Back 11

i)a)lumpectomy w/axillary sampling+post-op radiation b)modified radical mastectomy ii)a)small tumor b)relatively large breast c)away from nipple and areola

Front 12

How is prognosis of lobular, medullary, and mucinous breast ca different from IDC? How are they treated?

Back 12

i)better prognosis ii)same as IDC

Front 13

Does DCIS metastasize? What does this mean for treatment? What is problem w/DCIS? What is treatment if multicentric lesions throughout the breast? When can you do lumpectomy+radiation?

Back 13

i)no ii)no axillary sampling needed iii)high recurrence if only local excision is done iv)total mastectomy v)if limited to 1/4 of breast

Front 14

What is inoperability of breast cancer based on?

Back 14

local extent (not mets)

Front 15

When should you def add adjuvant chemo to breast cancer treatment? What is used? x2 what do premenopausal get and what do postmenopausal get? What about frail old women w/nonaggressive tumors?

Back 15

i)usually added, but def if axillary nodes are + ii)a)chemo b)hormone therapy if receptor + iii)pre: tamoxifen; post: anastrozole iv)hormonal therapy alone

Front 16

What does persistent h/a or back pain in women who recently had Br Ca suggest? What is next step? What protects from collapse?x2

Back 16

i)mets ii)a)Head CT for brain: irradiate or resect; b)bone scan followed by Xray for bony mets iii)a)radiation b)brace

Front 17

Is thyroid CA pts hyper, hypo, or euthyroid? How to DX? What do you do if benign? if malignant or indeteminate?

Back 17

i)euthyroid ii)FNA iii)follow iv)lobectomy and further sx depending on DX on frozen

Front 18

What do you do for hyperthyroidism when nodule is the source vs if whole gland is hyperactive ?

Back 18

remove the lobe, leave the rest of the gland; vs remove whole gland

Front 19

What is lateral aberrant thyroid? What do you do next?

Back 19

mets from follicular cancer that is in jugular chain. Look for primary

Front 20

What is 1st step in suspected cushings? What is next test? After that? What imaging do you do?

Back 20

i)low dose dexamethasone suppression test ii)if no suppression, then 24 hr urine-free cortisol is measured iii)if elevated cortisol, do a high dose suppression test. Suppression at high dose means pituitary microadenoma. No suppresion means adrenal adenoma or paraneoplastic iv)MRI for pit, CT for adrenal

Front 21

What is sxs of ZES (gastrinoma)? x2 What is next step?

Back 21

i)a)virulent PUD: very extensive w/more than one ulcer, and ulcers beyond 1st part of duodenum b)water diarrhea ii)measure gastrin and locate tumor w/CT

Front 22

What is nesidioblastosis?

Back 22

hypersecretion of insulin in newborn, needing 95% pancreatectomy

Front 23

what does glucagonoma produce? What are other signs? x4 What is diagnositc? What can help for metastatic, inoperable dz?

Back 23

i)migratory necrolytic dermatitis ii)a)diabetes b)glossitis c)stomatitis d)anemia iii)glucagon assay iv)somatostatin and streptozocin

Front 24

What is key finding in primary hyperaldo? x3 What are 2 other findings? What is response to postural changes in hyperplasia vs adenoma? What imaging? How is hyperplasia treated? What TX

Back 24

i)a)htn b)hypokalemia c)female not on diuretics ii)a)metabolic alkalosis b)hypernatremia iii)a)hyperplasia: appropriate response when change positions b)adenoma: no response when change positions iv)CT v)medically vi)surgery for adenoma

Front 25

What do you start w/u w/in pheo and which is more specific? x2 What is next test if looking for extraadrenal sites? x2 What is prep before surgery?

Back 25

i)a)VMA or metanephrine (more specific) ii)radionuclide scan or CT iii)alpha blockers

Front 26

What is presentation of coarctation of aorta? x2 What does CXR show? What imaging do you do next? What is cure?

Back 26

i)a)young pt w/high BP in upper extremities and b) normal or low BP in lower ext ii)scalloping of ribs iii)Spiral CT or MRI angiogram iv)surgery

Front 27

What is scenario for renovascular htn? What are the imaging studies? x2 What is tx in fibromuscular dysplasia?

Back 27

i)HTN resistant to usual meds w/bruit over flank or upper abdomen ii)a)scanning and doppler of renal vessels b)often need arteriographic visualization iii)stent

Front 28

What do you do for asymptomatic gallstones?

Back 28

leave alone

Front 29

What is cause of biliary colic? What is treatment?

Back 29

i)temporary stone in cystic duct ii)elective chole

Front 30

What does acute cholecystitis start as? Then what happens? x4 What is next step after US and what does it show? What is treatment? x5 Who doesn't respond (x2) and what do they need? What do you do for very sick pt w/prohibitive risk?

Back 30

i)biliary colic ii)a)GB gets distended and inflammed b)fever c)leukocytosis d)peritoneal signs in RUQ iii)HIDA: no uptake in GB iv)a)NPO b)NGT c)IVF d)Abx to cool down v)a)men b)diabetics: need emergency chole vi)perc

Front 31

What is key finding in acute ascending cholangitis? What do you do next? x1+1 (3 ways) What needs to follow later?

Back 31

i)very high AlkP ii)a)IV abx b)Decompression1)ERCP 2)Perc 3)Surgery iii)cholecystectomy

Front 32

What are the 2 things that happen in biliary pancreatitis (symptoms)? What is imaging? What is next step? x3 What is done later? If conservative management doesn't work?

Back 32

i)a)manifestations of pancreatitis (elevated amylase) b)mild and transitory episode of cholangitis ii)U/S shows stones in GB iii)a)IVF b)NG suction c)NPO iv)elective chole v)ERCP and sphincterotomy to get rid of impacted stone

Front 33

What are the 3 kinds of acute pancreatitis?

Back 33

i)suppurative ii)hemorrhagic iii)edematous

Front 34

Who gets acute edematous pancreatitis? x2 What is diagnostic? x2 What is key in establishing edematous nature? What is treatment?x3

Back 34

i)a)alcoholics b)gallstones ii)a)elevated serum amylase or lipase early on b)elevated urinary amylase or lipase after 3 days iii)elevated Hct iv)a few days of pancreatic rest w/ a)NPO b)NG suction c)IVF

Front 35

What is the laboratory clue to hemorrhagic pancreatitis (b/c it starts as edematous type)? What doesn't correlate w/severity of disease? What are the ranson criteria? x3 What happens the next morning?x5 What is the common final pathway to death? What do you do? x2

Back 35

i)lower Hct ii)amount of amylase elevation iii)a)WBC count b)elevated glucose c)low serum Ca iv)a)Hct even lower b)Ca remains low w/administration c)BUN goes up d)metabolic acidosis e)low arterial PO2 v)develop multiple pancreatic abscesses vi)drain immediately; daily CT scans

Front 36

What is scenario of pancreatic abscess development? x2 What is the treatment?

Back 36

i)a)someone not getting CTs b)fever/leukocytosis 10 days after pancreatitis ii)drainage

Front 37

what is pancreatic pseudocyst a late sequela of? x2 How much time elapses b/4 get it? What are symptoms? x3 What imaging is diagnostic?x2 What determines treatment and when do complications occur? What do you do at 6 weeks of observation if not resolved? What are the 3 ways to treat?

Back 37

i)a)trauma to pancreas b)pancreatitis ii)5 weeks iii)a)early satiety b)mass c)discomfort iv)a)U/S or b)CT v)natural hx; at 6 weeks. vi)drain it vii)a)fistula to skin b)fistula to stomach/jejunum c)endoscopic internal drainage to stomach

Front 38

What are symptoms of chronic pancreatitis? x3 What is controllable of the symptoms x2? What isnt? What may help?

Back 38

i)a)diabetes b)steatorrhea c)pain ii)a)diabetes and steatorrhea w/enzymes b)pain iii)If ERCP shows dilation and stricture, then stent the pancreatic duct

Front 39

What are the 2 exceptions to abdominal hernias not needing surgery? What do you need emergent surgery?

Back 39

i)a)umbilical hernias in pts <2y/o (close by themself) b)esophageal sliding hiatal hernia ii)hernias that become irreducible to prevent strangulation