Surgery Clerkship Pre

Front 1

16 y.o. female with RLQ pain who is 2 weeks post menses and afebrile.

Back 1

mittelschmerz

Front 2

23 y.o. female 5 days post menses presents with RLQ pain and T102.6F.

Back 2

pelvic inflammatory disease (PID)

Front 3

18 y.o. extremely thin male with hx of recurrent episodes of right lower quadrant abdominal pain

Back 3

Crohn's disease

Front 4

20 y.o. female with acute onset of RLQ pain, afebrile, normal CBC, neg. pregnancy test, mass in right adnexa.

Back 4

Torsion of ovarian cyst

Front 5

14 y.o. male with recent episodes red blood in stool presents today with RLQ pain.

Back 5

Meckel's diverticulum

Front 6

20 y.o. female with scant menses for 2 months presents with RLQ pain and shock

Back 6

Ruptured ectopic pregnancy

Front 7

25 y.o. basketball player presents with severe pain radiating from R flank to R testis after strenuous game.

Back 7

ureteral calculous

Front 8

40 y.o. female with fever, shaking chills, N&V, right costovertebral angle and abd pain.

Back 8

acute pyelonephritis

Front 9

16 y.o. male with acute onset L testicular pain, nausea, L testis higher than R.

Back 9

testicular torsion

Front 10

18 y.o. male dull, continuous lumbar pain radiating to lower abdomen after an all night beer bust.

Back 10

acute hydronephrosis

Front 11

25 y.o. male with sudden onset of abd pain while moving a woodpile with urticaria of web space of right hand and board like rigidity of abd.

Back 11

black widow spider bite

Front 12

24 y.o. med student returned from 3rd world has wt loss, chronic cough, lethargy, weakness, pigmentation of skin and mucous membranes with epigastric and periumbilical continuous pain.

Back 12

adrenal insufficiency

Front 13

30 y.o. Greek immigrant with episodic excruciating abd pain preceded by headache with Temp of 105 F, arthralgias.

Back 13

familial mediterranean fever

Front 14

26 y.o. male with severe, episodic abd pain, peculiar taste in mouth, darkening of gum margin and abnormal peripheral smear.

Back 14

lead poisoning

Front 15

50 y.o. male with history of hysterical behavior vs. psychosis has severe colicky, generalized abdominal pain radiating to chest and back after taking a barbiturate.

Back 15

porphyria

Front 16

65 y.o. with previous abdominal complaints now presents with LLQ pain which was initially localized by now is severe, generalized with fever and leukocytosis.

Back 16

perforated diverticulitis

Front 17

19 y.o. with gradual onset of cramping periumbilical pain which has migrated to RLQ and is accompanied by nausea, vomiting, fecal tenesmus and leukocytosis.

Back 17

acute appendicitis

Front 18

24 y.o. med student returns from 3rd world country with hx of diarrhea while away but chief complaint now is RUQ pain, fever, sweats, weight loss and has RLQ mass with hepatomegaly.

Back 18

amebiasis

Front 19

40 y.o. obese, multiparous female with episodic RUQ pain precipitated by fatty foods.

Back 19

biliary colic

Front 20

70 y.o. patient with history of marked weight loss and anorexia because of episodic cramping epigastric pain lasting one to three hours after eating, is more severe after large meals.

Back 20

mesenteric ischemia

Front 21

15 y.o. black male with sudden onset of severe stabbing LUQ pain with a friction run heard over the spleen, anemia and leukocytosis.

Back 21

sickle cell disease

Front 22

82 y.o. male with long history of epigastric and back pain presents with sudden onset of abdominal pain in mid abdomen and low back with a pulsatile mid abdominal mass.

Back 22

abdominal aortic aneurysm (AAA)

Front 23

7 y.o. boy presents with abd pain of 4 hours duration associated with anorexia, nausea and on exam found to have severe pharyngitis with tender submandibular nodes as well as localized RLQ tenderness.

Back 23

mesenteric adenitis

Front 24

80 y.o. male with acute onset of diffuse sever abdominal pain with no known alleviation or aggravating circumstances and no associated GI symptoms has soft abd with normal bowel sounds. EKG shows atrial fibrillation.

Back 24

mesenteric arterial occlusion

Front 25

Elderly gentleman with Argyll Robertson pupils and Charcot’s joints presents with sudden onset of continuous epigastric pain with hyperactive abdominal reflexes and slight tenderness but no rigidity.

Back 25

tabetic crisis

Front 26

45 y.o. male presents with continuous pressing pain in epigastrium which radiates to back and neck who is diaphoretic, anxious and has nausea and vomiting but no abd tenderness or rigidity.

Back 26

myocardial infarction (MI)

Front 27

4 y.o. girl presents with prostration, chills, fever, tachypnea who had complained of sudden onset abd pain in both upper and lower quadrants and is found to be markedly distended, diffusely tender, with doughy feel to abd and marked leukocytosis and ultrasound show free fluid.

Back 27

primary peritonitis

Front 28

16 y.o. girl with past history of spotty “rash” on buttocks and lower extremities associated with recurrent joint pains, awakens at night with mid abdominal pain, anorexia and vomiting has tenderness on exam but no rigidity.

Back 28

Henoch Schlonein purpura

Front 29

7-month-old infant who is recovering from a prolonged upper respiratory infection presents with colicky abdominal pain and is passing “currant jelly” stools.

Back 29

Ileocolic intussusception

Front 30

19 y.o. male recovering from infectious mononucleosis develops abd pain, maximal in LUQ and radiates to left shoulder and complains of weakness and lightheadedness.

Back 30

ruptured spleen

Front 31

70 y.o. female with history of CHF is on treatment with digitalis when she develops diffuse abd pain which is initially colicky and then becomes continuous associated with vomiting, maroon stools and has diffuse tenderness and rebound.

Back 31

mesenteric venous occlusion (dig)

Front 32

80 y.o. female with completely negative medical and surgical history except for occasional episodes of RUQ pain presents with signs and symptoms of small bowel obstruction and found to have distended abdomen and no herniae on exam. X-rays show small bowel distention and air in biliary tree.

Back 32

gallstone ileus

Front 33

6-week-old first-born male presents with history of projectile vomiting of recently ingested feedings.

Back 33

hypertrophic pyloric stenosis

Front 34

35 y.o. illegal immigrant presents with abdominal pain which is associated with fever, anemia and ascites and a chest x-ray shows cavitary apical lesions.

Back 34

tuberculosis peritonitis

Front 35

24 y.o. med student studying for step 2 develops midepigastric pain which was initially controlled with TUMS® buy now is severe, diffuse and radiates to both shoulders is found to have board-like rigid abdomen

Back 35

perforated duodenal ulcer

Front 36

46 y.o. male with arachnodactyly, ectopia lentis and high arched palate presents with acute onset of moderate chest pain which then becomes severe abdominally and spread to the back; cold clammy legs, and gross hematuria with a soft abdomen.

Back 36

dissecting aortic aneurysm

Front 37

80 y.o. institutionalized patient with marked abdominal distention, no BM for 3 days with a long hx of constipation in whom abd x-rays show distended colon in “coffee bean” configuration and a “birds beak” on BE.

Back 37

sigmoid volvulus

Front 38

35 y.o. female G2, P2, with 3 day history of RUQ pain associated with nausea and vomiting, low grade fever, positive Murphy’s sign and leukocytosis had cholelithiasis diagnosed 3 years ago.

Back 38

acute cholecystitis

Front 39

24 y.o. female in head on collision is found to have mediastinal widening, a left apical cap, the left mainstem bronchus is depressed and the NG tube is seen to deviate to the right.

Back 39

laceration thoracic aorta

Front 40

65 y.o. male, poor informant, presents with a recent episode of hematemesis. On physical exam he is found to have a well healed abd scar from xiphoid to pubis and well healed ileo-femoral scars bilaterally.

Back 40

aortoduodenal fistula

Front 41

18 y.o. female admitted to ED after MVA in which she was unrestrained driver. Squad reports bent steering column and patient has BP 90/70, pulse 120, distended neck veins and distant heart sounds.

Back 41

cardiac tamponade

Front 42

42 y.o. red headed farmer presents with irregular bordered, hairless, elevated, pruritic, deeply pigmented, multi colored 0.6cm lesion on right shoulder which bleeds easily when scratched.

Back 42

malignant melanoma

Front 43

18 y.o. female with recent awareness of a 2cm dia freely movable smooth mass in left breast with no systemic or other local symptoms.

Back 43

fibroadenoma

Front 44

27 y.o. male presents with a massive UGI bleed after being in previous excellent health. The endoscopist sees a bleeding moderate sized vessel and the fundus of the stomach.

Back 44

Dieulafoy's lesion
This lesion, also called persistent caliber artery, is a large-caliber arteriole that runs immediately beneath the gastrointestinal mucosa and bleeds through a pinpoint mucosal erosion (Fig. 291-19). Dieulafoy's lesion is seen most commonly on the lesser curvature of the proximal stomach, causes impressive arterial hemorrhage, and may be difficult to diagnose; it is often recognized only after repeated endoscopy for recurrent bleeding. Endoscopic therapy, such as thermal coagulation, is typically effective for control of bleeding and ablation of the underlying vessel once the lesion has been identified

Front 45

48 y.o. male with Diabetes presents with one day history of scrotal irritation. Exam reveals a depressed 1cm-dia black eschar of the left scrotum.

Back 45

Fournier's gangrene

Fournier's gangrene is a necrotizing fasciitis of the male genitalia and perineum that can be rapidly progressing and fatal if not treated promptly (Fig. 40-9A). Mortality has been reported as high as 30 to 40%.30 Risk factors for Fournier's include urethral strictures, perirectal abscesses, poor perineal hygiene, diabetes, cancer, HIV, and other immunocompromised states.31 The infection spreads along the dartos, Scarpa's, and Colles' fascias. Clinical signs include fevers, perineal and scrotal pain, and associated indurated tissue. Cellulitis, eschars, necrosis, flaking skin, and crepitus may all be observed. The diagnosis is made on largely clinical suspicion, and significantly less on laboratory or radiographic findings. Classically, the patient describes pain out of proportion to the physical findings.

Front 46

18 y.o. male with recent history of unguis incarnatus notes pain and swelling with heat and redness of the ankle, with red streaking of lower leg.

Back 46

cellulitis with lymphangitis

unguis incarnatus = ingrown toenail

picture = Ingrown toenail of the lateral aspect of the right great toe showing inflammation and granulation tissue

Front 47

28 y.o. female with recent onset of weight loss, loss of hair, heat intolerance and proptosis.

Back 47

hyperthyroidism

Front 48

70 y.o. white female with pruritic, exfoliating areolar dermatitis, which has been unsuccessfully treated with steroid creams.

Back 48

Paget's disease

Front 49

60 y.o. female with 40 packs a year smoking history presents with nasal stuffiness, feeling of fullness in face, and distended jugular veins in both standing and recumbent positions.

Back 49

superior vena cava syndrome

Front 50

80 y.o. female presents with a chief complaint of increasing fatigue and lassitude (state of weakness). Routine work-up uncovers a hypochromic microcytic anemia.

Back 50

right colon cancer