Skin, Ophtho, Ent

Front 1

What is the pathophys of subclavian steal syndrome?

Back 1

i)arteriosclerotic stenotic plaque at origin of subclavian (b/4 take off of vertebral) allows enough blood to reach arm for normal activity, but not enough to meet higher demands when arm is exercised. Then, arm sucks blood away from brain by reversing flow in the vertebral.

Front 2

what are the clinical signs? x3 What is diff of Subclavian SS vs thoracic outlet syndrome? What is diagnostic test and what does it show? What is cure?

Back 2

i)a)arm claudication (tingling, cold, muscle pain); posterior neuro sxs: b)visual problems c)equilibrium disruption ii)if just vascular problems and no neuro sxs, could be TOS iii)a)arteriogram: reversal of flow b)bypass

Front 3

What is most imp thing in management of AAA? What do you need to do if suspect it on PE? When do they need elective repair?

Back 3

i)size ii)sonogram or CT iii)>6cm diameter

Front 4

When is immediate repair indicated for AAA?

Back 4

tender AAA will rupture in a day or 2

Front 5

Wha is symptom for a AAA already leaking? What is happening? What is required?

Back 5

i)back pain in pt w/AAA ii)forming hematoma in retroperitoneum, and blowout is close iii)emergency surgery

Front 6

What is first step in w/u of disabling intermittent claudication? If neg, what does this mean? If pos, what is next step? Why?x2

Back 6

i)dopplers to see if there is a pressure gradient ii)Neg: can't do surgery b/c in small vessels and need medical management iii)pos: arteriogram iv)a) ID areas of stenosis or complete obstruction b)look for good distal vessels to which a graft can be hooked.

Front 7

In disabling intermittent claudication, What do you treat short stenotic segments with? More extensive disease? If there are multiple lesions, which are repaired first? What is used for grafts originating at aorta? Bypasses b/w more distal vessels?

Back 7

i)short: angioplasty and stenting ii)bypass grafts iii)prox are repaired b/4 distal iv)a)prosthetic material b)saphenous v

Front 8

who gets arterial embolization from a distant source? x2 What are the symptoms?x6 what timeline is necessary for eval and treatment? What is initial imaging study? What is done for early incomplete occlusion? For complete? What is done several hours later?

Back 8

i)a)Afib (atrial appendage) b)MI (mural thrombus) ii)a)5P: Poikilo; pulseless; paresthesia; pain; pale; paralytic lower Extremity iii)w/in 6 hours iv)doppler studies to locate point of obstruction v)clot buster vi)embolectomy vii)fasciotomy

Front 9

What is best diagnostic test in aortic aneurysm? How are ascending treated? descending?

Back 9

i)CT (MRA or TEE also used) ii)surgery iii)medical management of HTN in ICU

Front 10

how do you diagnose any skin cancer?

Back 10

w/full-thickness incisional (or punch) biopsy at the edge of the lesion (including normal skin)

Front 11

How does Basal Cell CA present? x2 Where does it occur? how does it metastasize? What is the cure?

Back 11

i)a)waxy, raised lesion b)nonhealing ulcer ii)above the lips iii)local invasion iv)excision w/1 mm margins

Front 12

What is presentation of sq cell Ca? Where does it hit What is treatment? x3

Back 12

i)nonhealing ulcer ii)the lower lip and below iii)a)excision w/.5-2 cm margins b)nodal dissection if affected c)possible radiation

Front 13

What diameter of melanoma is concerning? What does the biopsy report need? x2 What sized lesions have good prognosis? What margins are necessary for larger lesions? what sized lesions have the worst prognosis? What sized lesions benefit the most from aggressive therapy?

Back 13

i)0.5 cm ii)a)diagnosis b)depth of invasion iii)<1.mm, just need local excision iv)2-3 cm v)>4mm vi)1-4mm; including nodal dissection

Front 14

What is interesting about mets of melanoma? what is the timetable like?

Back 14

i)can go anywhere, like muscle of LV ii)not predictable: can be dead in a few months to 20 years b/w resection of primary and metastasis

Front 15

What is amblyopia and when does it occur? What is most common expression fo this phenomenon? What happens?

Back 15

i)vision impairment resulting from interference w/processing of images by brain in first 6-7 years ii)strabismus iii)overlapping images confuses brain, so brain doesn't develop one of the eyes in cortex (same thing happens w/congenital cataract)

Front 16

How is strabismus verified? What should you do if have strabismus? If it develops later in infancy, what is treatment?

Back 16

i)reflection from a light comes from diff areas of the cornea in each eye ii)surgery iii)corrective glasses

Front 17

Is white pupil in baby bad? What are the 2 causes of this?

Back 17

i)yes: may be retinablastoma ii)a)RB b)amyblopia and both need surgery

Front 18

What are sxs of acute angle closure glaucoma? x4 What are signs x4 What is required? What do you do while waiting for ophthalmologist? x3

Back 18

i)a)headache b)severe eye pain c)at night b/c pupil dilated d)halos around lights ii)a)pupil is mid dilated b)doesn't react to light c)cornea cloudy w/greenish hue d)eye is hard as a rock iii)emergent treatment w/hole drilled thru iris w/laser to drain fluid in ant chamber iv)a)give CAI b)B block c)a-2 agonist

Front 19

What are symptoms of orbital cellulitis? x2 What is key finding when eyelids are pried open? x2 What needs to be done? x2

Back 19

i)a)red, hot, edematous eyelid b)febrile ii)a)pupil dilated and fixed b)eye has very limited motion iii)a)emergency CT scan b)drainage

Front 20

What is necessary for chemical burns of eye? x2 What is done b/4 pt sent home?

Back 20

i)a)massive irrigation and taken to ER b)remove corrosive particles in corners in ER ii)check pH to make sure no chemicals in eye

Front 21

What are sxs of retinal detachment? x2 What is bad prognostic factor?x2 What is intervention and is it an emergency?

Back 21

i)a)floaters b)light flashes ii)a)snow storm in the eye or b)dark cloud at top of visual field: horshoe piece of retina pulled away and can rip out retina at rest. iii)emergency intervention w/laser spot welding

Front 22

What is presentation of embolic occlusion of retinal artery? Is it emergency? What is the management? x2

Back 22

i)sudden loss of vision in one eye: after 30 min, will be irreversible ii)yes, tho not much can be done iii)a)breathe into paper bag b)someone presses hard on eye and releases while going to ER (vasodilate and shake clot into distal location)

Front 23

What is time line of the 3 kinds of neck masses?

Back 23

i)congenital: have had it for long time, acutely worse ii)inflammatory: days to few weeks, and resolves after few weeks. iii)neoplasm: several months of growth

Front 24

Where is thyroglossal duct cyst? x2 What are they connected to? What is removed in surgery? x3

Back 24

i)a)midline b)level of hyoid ii)tongue iii)a)cyst b)middle of hyoid c)track leading to base of tongue

Front 25

Where are branchial cleft cysts?

Back 25

along anterior edge of SCM, anywhere from in front of tragus to base of neck

Front 26

where is cystic hygroma? What does it feel and look like? What is mandatory b/4 surgery?

Back 26

i)base of neck ii)large, mushy, ill-defined mass occupying entire supraclavicular area, seemingly extending into chest iii)CT b/c may extend into chest

Front 27

What do you do for recently discovered enlarged LNs?

Back 27

usually benign, so complete H and P w/followup in 3-4 weeks. W/u if still there

Front 28

who gets lymphoma? What is presentation? x3 What is first steps? x2

Back 28

i)young people ii)a)multiple enlarged nodes b)low grade fever c)night sweats iii)a)FNA can be done, but b)node removal and give to pathology

Front 29

What is the usual source of metastatic tumor to supraclavicular nodes? How to get dx?

Back 29

i)not from head and neck but below clavicle (lung or intraabdominal tumors) ii)node removal w/pathology

Front 30

Who gets sq cc of mucosae of head and neck? x2 What is diagnostic w/u? What establishes diagnosis and what demonstrates extent? What can be done of the node itself, and what shouldn't be done? Why? what is treatment? x3

Back 30

i)a)men who smoke and drink b)AIDS pts ii)panendoscopy to find primary iii)biopsy of primary; CT shows extent iv)FNA can be done, but open BX of neck mass shouldn't v)incision in neck will interfere w/surgical approach vi)a)resection b)radical neck dissection c)radiotherapy and platinum therapy

Front 31

What are some symptoms of sqCC? x3

Back 31

i)hoarseness ii)persistent painless ulcer on floor of mouth iii)persistent unilateral earache

Front 32

What is presentation of acoustic nerve neuroma? What is best diagnostic modality?

Back 32

i)sensory hearing loss in one ear but not the other ii)MRI

Front 33

what are symptoms of facial nerve tumors? What is best study?

Back 33

i)gradual, unilateral facial nerve paralysis of forehead and lower face (paralysis suddenly=Bells palsy) ii)gadolinium enhanced MRI

Front 34

What are most parotid tumors cell type? Are they benign? What are symptoms of parotid cancer? x2 What can be done to get tissue and what can't? What is the appropriate way to excise/biopsy parotid tumor? Why? What is done for malignant tumors to treat?

Back 34

i)pleomorphic adenoma ii)yes, but malig potential iii)a)hard mass b)painful c)produces paralysis (these don't happen in benign ones) iv)FNA; open BX v)parotidectomy vi)prevents recurrence and spares facial nerve vii)nerve is sacrificed and graft is performed

Front 35

What is the cause of unilateral ENT problems in toddlers? (earache, rhinorrhea, wheezing) What is tx?

Back 35

i)foreign bodies stuck there ii)endoscopy under anesthesia

Front 36

What is ludwig angina and what is the cause? What is the problem with this that is why it is an emergency? What do you do? What may be needed? x2

Back 36

i)abscess of floor of mouth; bad tooth infxn ii)threat to the airway iii)I and D iv)intubate and tracheostomy

Front 37

What do you do for bell palsy?

Back 37

prompt administration of anti-viral meds

Front 38

Do facial nerve injuries due to trauma ever have delayed paralysis? Why do they get it later, and what will happen?

Back 38

i)no: get paralysis immediately ii)if get later, due to swelling and will resolve on own

Front 39

What is symptom of cavernous sinus thrombosis? What is it due to? How to manage? x4

Back 39

i)get diplopia ii)frontal or ethmoid sinusitis iii)a)emergent hospitalization b)IV abx c)CT scans d)drainage of affected sinuses

Front 40

what can you treat epistaxis in kids with? What do kids get it from? 18 y/o? x2 What do you need to do for each of these cases? What is management of elderly and hypertensive getting epistaxis? x2 What is last line therapy?

Back 40

i)phenylephrine spray and local pressure ii)pick nose iii)a)coke b)juvenile nasopharyngeal angiofibroma iv)a)posterior packing b)surgical resection b/c can eat at nearby structure v)a)BP control b)posterior packing vi)surgical ligation of feeding vessels

Front 41

What is diff in dizziness due to inner ear disease vs cerebral disease? What is treatment for each?

Back 41

i)inner ear: room spinning around them ii)brain: unsteady pt but room is perceived to be stable iii)a)meclizine, phenergan, or diazepam b)neurologic w/u