100 surgical Microvignettes Flashcards by Rd Pingoy

Elderly woman, SBO, and air in biliary tract

Gallstone ileus

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Elderly woman with pain down inner aspect of thigh

Obturator hernia (Howship-Romberg sign)

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Abdominal pain, hypotension, and abdominal pulsatile mass

Ruptured abdominal aortic aneurysm (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

Thyrogossal 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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LGIB+technetium pertechnetate scan

Meckel’s diverticulum

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Flushing, diarrhea and RHF

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

Hydatid cyst

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Caput medusa

portal HPN

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45-year-old woman with RUQ pain for 12 hours, fever and leukocytosis

Acute cholecystitis

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Elderly man with large nontender palbable gallbladder

Pancreatic cancer(Courvoisier’s sign)

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Female taking birth control 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

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Excruciating pain with bowel movement

Anal fissure

Abdominal pain, diarrhea and anal fistulae

Crohn's disease

EKG with peaked T waves

Hyperkalemia

buccal mucosa with pigmentation

Peutz-Jegers syndrome

LLQ pain, fever and change in bowel habits

Diverticulitis

Elevated urin 5-HIAA carcinoid

Carcinoid

Institutionalized, abdominal pain, vomiting, and distention, with proximal colonic dilation

Sigmoid Volvulus

Infant with projectile vomiting

Pyloric stenosis

Newborn with failure to pass meconium in first 24 hours

Hirshsprung's disease

Infant with bilious vomiting

Malrotation

Infant with abdominal defect and umbilical cord on sac

Omphalocele

Teenager with knee pain, "onion skinning" on xray

Ewing's sarcoma

Pulmonary capillary wedge pressure <18, CXR - bilateral pulmonary infiltrates, PaO2:FiO2 ration <300

ARDS

Increased peak airway pressure, low urine output, and urinary bladder >25mmHg

Abdominal compartment syndrome

Newborn with inability to pass and NGT

Esophageal atresia

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

Sympathetic ophthalmia

Mitotic pupil, ptosis, and anhydrosis

Horner's Syndrome

Traumatic head injury, conscious inER followed by unconciousness

Epidural hematoma ("lucid interval")

"worst headache of my life"

Subarachnoid hemorrhage

Hematura, flank pain, and abdominal mass (palpable)

Renal cell carcinoma

60-year-old white man with painless hematuria

Bladder cancer

RUQ pain, jaundice, and fever

Cholangitis

Epigastric pain radiating to back, with nausea and vomiting

pancreatitis

Chest pain radiating to back and described as "tearing" pain

Aortic dissection

40-yea-old man with tachycardia/hypetension and confusion on POD day#2

Alcohol withdrawal

Marfanoid body habutus and mucosal neuromas

MEN II-b

Psammoma bodies

Papillar thyroid cancer

Sulphur granules

Actinomycosis infection

Thyroid tumor with AMYLOID tissue

Thyeroid medullary cancer

PALPABLE neck tumor and hypercalcemia

Parathyroid Cancer

Hypertension, diphoresis(episodic), and palpitations

Pheochromocytoma

Jejunal ulcers

Zollinger-Ellison syndrome

Pituitary tumor, pancreatic tumor, and parathyroid tumor

MEN-I

Necrotizing migratory erythema

Glaucagonoma

Medullary thyroid CA, pheochromocytoma, and hyperparathyroidism

MEN-IIa

Hypokalemia refractory to IV potassium supplementation

Hypomagnesemia

Newborn with pneumatosis

Necrotizing enterocolitis (NEC)

Child with abdominal mass that crosses midline

Neuroblastoma

Child <4years of age with abdominal tumor that does no cross the midline

Wilm's tumor

"currant jelly" stools and abdominal colic

Intussuscetpion

Femur fracture, respiratory failure, petechiae, and mental status changes

Fat embolism

Hearing loss, tinnitus, and vertigo

Menier's disease

Adolescent boy with nasal obstruction and recurrent epistaxis

Juvenile nasopharyngeal angiofibroma

Child <5 years of age sitting upright and drooling with "hot potato voice"

Epiglotittis

Angina, syncope, and CHF

Aortic stenosis

Tobacco use, asbestos exposrue, and pleuritic chest pain

Mesothelioma

Supracondylar fracture and contracture of forearm flexors

Volkmann's contracture

Tibia fracture, "pain out of proportion", pain on passive foot movement, and palpable pulses

Compartment syndrome

25 year old man with liver mass with fibrous septae and No history of cirrhosis or hepatitis

Fibrolaminar hepatocellular CA

ECG with flattening of T waves and U waves

Hypokalemia

Central Pontine Myelinosis

Too rapid correction of hyponatremia

Polydipsia, polyuria, and constipation

Hypercalcemia

Factor VIII deficiency

Hemophilia A

Abdominal pain, fever, hypotension, HYPERkalemia, and HYPOnatremia

Adrenal Insufficiency (Addison's dse)

Massive urine output and Hypernatremia

Diabetes insipidus

Increased urine osmolality, Hyponatremia, and low serum osmolality

SIADH

IV antibiotics, fever, diarrhea

C. difficile pseudomemranous colitis

Bleeding gums and wound dehisence

Vitamin C defficiency

Fever, central line, and Hyperglycemia

Central line infection

Appendectomy followed by fever and abdominal pain on POD #7

Peritoneal abscess

Advancing crepitus, fever, and blood blisters

Necrotizing fascitis

High INTRAoperative fever

Malignant Hyperthermia

Confusion, ataxia, and ophthalmoplegia

Wernick's enecephalopathy

Tracheal deviation, decreased breath sounds, hyperresonance

Tension pneumothorax

Hypotension, decreased heart sounds, JVD

Pericardial tamponade

Four ribs broken in two places and pulmonary contrusion

Flail chest

Otrorrhea (clear) and Battlesign

Basila skull fracure

Ulcer and decreased pain with food

Duodenal ulcer

Vomiting, retching, and epigastric pain

Mallory-Weiss tear

Fever on POD #1, with "bronze" weeping, tender wound

Clostridial wound infection

Hematochezia and tenesmus

Rectal cancer

UGIB, jaundice and RUQ pain

Hemobilia

Gallstones, epigastric pain radiating to the back and nausea

Gallston pancreatitis

18-year-old woman with bloody nipple discharge

Ductal papilloma

Irritability, diaphoresis, weakness, trenulousenss and palpitations

Insulinoma