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DHA Exam > GS > Flashcards

GS Flashcards

1
Q

Ptn who had open surgery for hernia is now having hernia again, treatment

A

Laparoscopic surgery

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2
Q

Case of cysts inside a cyst ( hydatid cyst ) treatment

A

Surgical removal

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3
Q

Female with left leg swelling with intact pulse, how to diagnose

A

Doppler venous

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4
Q

Abdominal wound by wood with fever and discharge, what to do next

A

CT abdomen

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5
Q

1-After total thyroidectomy develops hypocalcemia despite calcium replacement more than once . What to check next?

A

Correct calcium and magnesium

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6
Q

2 - Patient admitted for thyroid surgery because of progressive compression symptoms . Hemithyrodectomy done and biopsy showed 8mm papillary carcinoma , whats the next step

A

No meed for radiation

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7
Q

After right hemithyroidectomy On biopsy found follicular lesion 8cm , next

A

Complete thyroidectomy

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8
Q

Pt for thyroidectomy due to cancer and with mitral valve prolapse . Prophylaxis against infective endocarditits

A

No need

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9
Q

Pt came after thyroid surgery with dysphagia and horseness of voice. Which nerve is injured

A

Recurrent laryngeal nerve

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10
Q

7- A patient post thyroidectomy can not make high pitch sounds. Damage to which nerve is responsible

A

Superior laryngeal nerve

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11
Q

Pt with thyroid nodule and hyperthyroidism lab , radioactive iodine shows the nodule hot, but all the remaining thyroid is cold. Initial Management: antihyperthyroid drugs in Hashimoto’s increases risk of

A

Primary thyroid lymphoma

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12
Q

Normal follicular thyroid cells, how to manage?

A

Hemithyroidectomy

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13
Q

Female , with lateral mass (lymph node) , thyroid was normal , biopsy showed normal follicular cells, what is the diagnosis

A

Metastasis

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14
Q

25 years female with thyroid nodule TSH and T4 normal , FNA cytology done and according to Bethesda classification ((Stage IV )))what is the most accurate management?

A

Lobectomy

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15
Q

Bethesda stage VI ?

A

Semi total thyroidectomy ( cancer )

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16
Q

1-Pt with diffuse thyroid enlargement on exam there is 1 nodule in each lobe, labs showed hyperthyroidism what will you do?

42- 48 yo lady with diffuse goiter, high T4 low TSH, US show bilateral thyroid nodules , right 3x4 in size , left is 1x2 size what to do

A

Thyroid scan / total thyroidectomy

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17
Q

Pt Postoperative blood transfusion develops fever and pain at site of infusion ?

A

Febril non hemolytic reaction

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18
Q

Pt post op triple A repair become unstable even with fluid replacement and have negligible urine in cath decreased vascular resistance and increased cardiac out put.Type of shock ?

A

Septic shock

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19
Q

female had a hip fracture now had DVT as I remember now she is on heparin but her platelet is low 58 so what will you do?

A

Stop heparin and start another anticoagulant

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20
Q

Scar post surgery increasing in size?

A

Keloid

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21
Q

during laparoscopy doctor just start the procedure pt become hypotensive 84/50 what’s the cause?

A

rapid inflation of the abdomen (Peritoneal stretching > vagal stimulation)

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22
Q

-Most common complication post operative?

A

Atelectasis

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23
Q

patient with abdominal mass after lifting heavy objects mass not change with cough. Dx?

A

Rectus sheet hematoma

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24
Q

13yo obese boy found to have large hiatal hernia and grade 3 reflux asking about bariatric

A

Roux-en-Y Gastric Bypass

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25
Q

68-70 year old pt fall on the ground surgeon will do hip replacement surgery before surgery procedure what is the best prophylaxis thrombolytic drug for him

A

LMWH , enoxaparin .

(IF patient with CKD -→UFH

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26
Q

Pt with pelvic fx and bleeding per rectum&raquo_space; urethrogram > retroperitoneal urethra injury Mx?

A

Supa-pubic cystostomy

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27
Q

sure its cystostomy not cystectomy )

71-Membranous urethra injury management?

A

Retropubic catherter

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28
Q
  • Old patient had percutaneous cholecystostomy, presented after 24hrs with upper GI bleeding what is the most important investigation?
A

angiography

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29
Q

pt complain of melena and epigastric pain diagnosed as peptic ulcer and received ppi but not improved endoscpy done showed multiple ulcers in the antrum what is the most accurate management

A

Antrectomy

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30
Q

84-Pt is with non-acth dependent cushing for rr adrenalectomy ..what is the postoperative management

A

Preoperative cortison

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31
Q

-Echinococcus syptomatic ((calcified)?

A

Surgery(cystopericystectomy

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32
Q

Case of liver cyst (echinoccosis) treatment ?

A

Albendazole

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33
Q

Classic amebic abscess scenario with clinical and imaging findings. Management?

A

Metronidazole

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34
Q

Old male with HTNand DMpresented with claudication examination reveals
right femoral intact pulse and diminished popliteal and distal pulse and left diminished
pulse intervention

A

CT angio

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35
Q

-50 years old patient, know case of DM, HTN presented with leg pain associated with hair loss , ABI more than 0.9, what is your diagnosis

A

Chronic limb ischemia ( ABI (ankle – brachial pressure index) more than 0.9 =cronic )

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36
Q

Diabetic patient with pseudo hyper epithelialization in situ?

A

Ulcer debridement

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37
Q

Dm pt with unilateral leg erythema Increases in dependant position, Cold, Femoral pulse is present, distal pulse can be palpated No tenderness, no swelling, no fever Otherwise unremarkable

A

Superficial thrombophlebitis

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38
Q

Patient with diabetes and hypertension smoking 40 c per day came to er complaining of leg pain on examination on lower limp the pulse was intact on femoral and pupletial artery’s and diminished on distal pulse first question was what is the best appropriate next step ?

A

Heparin

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39
Q

110-60 years old patient come with epigastric pain radiating to back . He’s smoker and long standing for DM and HTN . Abdominal examination show pulsatile subra umblical mass . What’s Dx

A

AAA

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40
Q

108-Pulse abdomen mass in middle abdomen what (next step to confirm) management ? A. angiography B. CTangio ✅✅ C. US
Key word: dx is abdominal aortic aneurysm intial US, confirmation and management CT angio
- 109-Pulsatile abdominal mass Abd X ray showed no air level What (((nexst step ))) investigation to order:
A. abd Us✅ B. CT angi

A

Done

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41
Q

-Surgery was done for diabetic septic foot ,no wound healing for 2month what is the cause

A

Poor blood supply

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42
Q
  • 112-PT admitted due to MI after 2 days of discharge developed sever pain in his leg Dx?
    1/ acute arterial thrombosis 2/ Acute Arterial Embolus ✅ 3/ DVT
A

Not sure

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43
Q

Female patient after cryotherapy for varicose 2years ago complainig of leg and foot pain what nerve is damaged

A

Saphenos nerve

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44
Q

Patient with unilateral left leg non-pitting edema, skin thickening and hyperpigmentation (dermal fibrosis) for 2 months. Management?

A

Compression bandages (combination of physical therapies; two-stage approach

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45
Q

presentation lymphedema, what is the important thing in hx to ask about?

A

Trauma

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46
Q
  • 126-Bilateral great saphenous vein mange ?
A

sclerotherapy B. something endoscopic C. ablation ✅

Key word:Any bilateral great saphenous = ablation Cosmetic =sclerotherapy

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47
Q

What is hard sign of vascular surgery?

Hard sign to detect vascular injury ?

A

Bruit // pulsatile bleeding

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48
Q

pt involved in RTA stable, but there is left leg swelling and paresthesia between toes xray showed fracture tibia pressure in posterior leg compartment is 35 mmHg

A

External fixation with multiple faciotomy

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49
Q

145-decrease in left testicular size post hernia repair ?

A

pampiniform plexus occlusion✅

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50
Q

Pain with absent cremasteric reflex, management

A

Surgical consult

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51
Q

recent abdominal surgery presented by fever&otheres. what is the most cause

A

Subphrenic abscess

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52
Q

female patient complains of urinary dribbling, dyspareunia, dysuria. What is the most likely diagnosis?

A

Ureter diverticulum

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53
Q

-Female (obese) with typical appendicitis: Right iliac pain and tenderness Nausea and vomiting. Loss of appetite. Leukocytosis What is the proper management

A

Adults = CT / pregnant or child = US

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54
Q

Post appendectomy female came with LR abdomen mild tenderness Ex Normal By CT there is 2*2 collection in Retrocecal

A

Antibiotics/ if more than 5 cm do percutaneous drainage

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55
Q

Pathophysiology of appendicitis in 58 male ?

A

Peripheral Vasoconstriction

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56
Q

Young unilateral testicular swelling since 1 day, on exploration viable but cord edematous

A

Appendicular torsion

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57
Q

161-Post-appendectomy, 0.5 cm carcinoid found on the tip of the appendix, mx?

A

Nothing = If carcinoid tumor less than 2cm > appendicectomy only More than 2cm or at base of appendix> right hemicolectomy

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58
Q

After appendectomy dr found a carcinoid mass more than 5 cm on the tale of appendix Next?

A

C.T scan abdomen and chest for staging

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59
Q

after initial conservative treatment of appendicular mass :

A

Laparoscopic appendectomy after 12 weeks ✅

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60
Q

80 y old man with bilateral hydronephrosis on Us images ?

A

BPH

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61
Q

Part of urethra affected by surgical (trauma) in males ?

A

Bulbar

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62
Q

By Cyctoscopy: Redness in the dome of bladder What is the most likely diagnosis:

A

Transitional bladder cancer

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63
Q

Old M c/o urinary sx, prostate median lobe hypertrophy, what is best for this pt?

A

Annual Prostate-specific antigen

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64
Q

Old pt came with difficulty urination and low back pain with high Prostate-specific antigen
dx?!

A

Prostatic cancer wirh spine metastasize

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65
Q

Urethral trauma with bleeding post MVC. Next step?

A

Suprapubic catherter ( retrograde urethrogram is essential for diagnosis of urethral injury, or urethral stricture )

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66
Q

sclerosing patient with history of rectal bleeding, anoscopy show swelling at 3,7 o’clock, sclerosing is planned what is the most appropriate to do sclerosing therapy

-Sclerotherapy use in management of

A

sclerosing = internal hemorrhoids

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67
Q

-Patient after hemorrhoids operation develop Suprapupic pain with inability to pass urine what
is cause?

A

Anasthesia effect

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68
Q

20s years old presented with pain during defecation minimum amount of blood, on examination the doctor seen a posterior midline fissure. He couldn’t do PR (rectal examination)exam as the patient was in severe pain Vitally stable What’s your next step?

A

EUA (Examine under anasthesia EUA

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69
Q

Old patient who has constipation on and off with streakin of blood in the stool with no fulness in the rectum ( no mention of pain )?

Old pt-fatigue sign of anaemia hb8 , stools with streak of blood -has hemorrhoids stage 2

A

Rectal cancer

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70
Q

Patient came with painless blood after defecation, whats the diagnosis?

A

Hemorrhoids

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71
Q

Hemorrhoids type 4, what is the management:

A

Hemeroidectomy

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72
Q

Patient with (perianal) painful (swelling)-vitals normal, (wbc normal)? Whats the diagnosis

A

Perianal hematoma

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73
Q

Anal fissure with sentinel pile not responsive to medical therapy. Next step

A

Lateral internal sphincterotomy is an operation performed on the internal anal sphincter muscle for the treatment of chronic anal fissure. The internal anal sphincter is one of two muscles that comprise the anal sphincter which controls the passage of fece

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74
Q

streaks of blood after defecating and pain?

Anal itching and pain post defecation and ask ddx?

31 year old male with constipation and during perianal exam there was sever pain and linear laceration at 6 and 12 oclock whats the dx

A

Anal fissure

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75
Q

pt with intermittent perianal pain and discharge, on P/E theres low-lying fistula with an opening
in posterior wall above anal verge. What to do

A

Fistulogram for investigation, fistulotomy for treatment

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76
Q

Perianal pain on examination no lesion, finger exam showed internal swelling with purulent
discharge on the anal canal , Dx?

Male adult with perianal swelling and discharge, then ruptured?

A

Internal abscess / fistula

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77
Q

pt presented with 3 months bleeding after stool, a perianal mass, and weight loss. Histology confirmed adenocarcinoma. CT finding shows no lymph node involvement and mass limited to 3cm from anal verge. What’s treatment modality?

Case of perianal swelling , per rectal bleeding , investigated : it is 1 cm from anal verge biopsy: adenocarcinoma (rectal) Mx

A

Less than 6cm from anal verge > Abdominoperineal resection

More than 6cm > Lower anterior resection.

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78
Q

First evaluate surgical wound by?

A

inspection Key word:
- If there’s signs of infection* (pulurent discharge, redness, tenderness) then wound exploration if superficial > clean, dressing and you may give abx
- If deep collection suspected >* order CT
- If small collection less than 4cm >* abx
If large 4cm and more* > percuteanous drainage + abx
- If signs of peritonitis > Laparotomy

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79
Q

10 cm laceration in anterior thigh what to do?

A

Compress the wound

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80
Q

Elderly pt sacral ulcer manag?

A

Daily dressing

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81
Q

Elderly pt underwent for a major surgery ..he need blood transfusion 15 PRBCs .. after that he start bleeding from wounds, nose, from NGT (stomach) .. what is the cause:

A

Thrombocytopenia ( there was no DIC in choices)

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82
Q

Girl with stab wound in the right anterior axillary line below the costal margin, stable?

A

A. Observation.
B. immediate surgical exploration. Perform FAST
If pt stable and chooses have CT go with it. If not choose A, if unstable Go with CT if not do Fast to pt.

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83
Q

Neck stab wund

A

Zone I, and III > C.T angio
• Zone II asymptomatic > C.T angio
• If symptomatic> surgical exploration

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84
Q

pt with forearm fracture and open wound 1cm , what’s TTT :

A

Debridment, irrigation, fixation

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85
Q

Pt post-operative and leak 20ml fluid from the wound:

A

Wound exploration

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86
Q

Post open appendectomy case with pain in wound site on examination u see pus oozing from
site of surgery what will u do next?

25 year old male Pt 8th day post surgery with wound site redness & tenderness with purulent
discharge.. most appropriate?

A

Exploration of wound then IV antibiotics

Open draingec

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87
Q

After herniotomy surgery for 5yrs boy came with fever and pus discharge and part of mesh seen ?

A

Draining of pus and remove mesh

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88
Q

X Ray showing both distal ulna and radius fracture with volar displacement On examination a 1 cm wound was seen at the volar aspect of the wrist Asks about initial management:

A

Irrigation of the wound and Closed reduction with cast below elbow

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89
Q

Trauma patient with a wound on his thigh subcutaneous fat is lost vasculature underneath is
exposed what provides the best management

person with car accident on left thigh show neurovessle fat and tissue out mange ?

A

Debridemnt with secondary closure✅
Key word: fat and vascular lost = secondary closure
If crash wound = primary

Debridment with slin grafting

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90
Q

Patient post surgery, there surgical wound redness, tenderness with no discharge, abdomen is
soft and lax .what to

Patient post surgery, there pus coming from surgical wound with tenderness and leukocytosis,
abdominal examination was done it was soft lax with no tenderness all over, what to do?

A

Antibiotics

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91
Q

Patient was hit with wood 5 days ago, now he comes with severe RLQ pain. On examination there is a small opening with pus discharge, put when tried to extend his thigh there was severe pain and you couldn’t move it. What to do

Patient post resection and colostomy presents with spiking fever for 1 week. Chest is clear. Abdomen is clear. Wound is clear. Fever 38.2 Next step?

A

CT

Spiking fever = peritonitis

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92
Q

Patient with right lower chest stab wound. Fast showed free abdominal fluid. What is your next

A

Exploratory laparotomy

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93
Q

An elderly with IHD day 2 post cholecystectomy presented with sudden chest pain SOB and vitally hypotension and tachycardia whats best ?

A

EEG

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94
Q

Elderly with weight loss (10kg) and anorexia in endoscopy there is large ulcer in stomach , biopsy was taken and the result is invasive adenocarcinoma . What is the next step:

A

CT ( Abdomen , chest, pelvis )

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95
Q

-Best diagnostic method for pulmonology embolism?

A

Spiral CT ( pulmonary angiography : best definitive diagnostic test )

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96
Q

Chronic thromboe-embolism confirme

A

QV ratio ✅ B. spiral CT C. D dimer

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97
Q

supraclavicular LN metastasize what you do for primary site :

A

Gastroduodenoscopy

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98
Q

How to diagnose Adhesion post operative?

CT, but Initially > abdominal X-ray✅ (Air-fluid level, Bowel dilatation) Key word: initial x-ray

A

Wrong

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99
Q

Pt melena and fresh blood per rectum, upper and lower endoscopy negative, next investigation:

A

Endoscopic capsule

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100
Q

best diagnostic test for Coarctation of the aorta for neonate and adults?

A

Echo

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101
Q

A man who is a known case of diabetes presented with hemiparesis 15 hours after some procedure ? How to diagnose

A

CT angio

102
Q

Pt with bronchogenic carcinoma, presented with progressive SOB, there’s elevated jvp, clear lung and quiet heart sounds. What will confirm your dx:

A

Echo ( This case of cardiac tamponed so diagnosis with echo = quit heart sound )

103
Q

Pt presented with stabbed wound after wound exploration you found anterior abdominal fascia penetration, (his vitals were stable) what’s your next step?

A

CT abdomen ( definitive diagnosis is by laparoscopy )

104
Q

Best way to show cervical spine:

A

Lateral cervical X-ray

105
Q

child episode of PR bleeding, fresh ; black stool (have both melena and hematochezia) ; NGT
showed greenish fluids ; colonoscopy was negative what is next to detect source of bleeding ?

A

TC 99 ( not sure )

106
Q

Old with back pain radiated to back , CXR air under diaghram?

A

perforated peptic ulcer Key word: air under diaphragm

107
Q

Pt in ICU with coffee ground vomit?

A

Strss gastritis

108
Q

cerative on med presents with abd pain Invistigation show enlarged transver colon 15 cm or mm? Management

A

Steroids

109
Q

morbidly obese male , how to decide best reduction surgery he will have ?

A

Endoscopy

110
Q

Patient complained of abdominal pain 3 weeks after sleeve gastrectomy, what is the diagnostic test

A

CT

111
Q

Patient after pacreatitis episode develops upper GI bleeding picture , scope was done, gastric fundus bleeding was found ,sclerotherapy done Duplex ultrasound showed: splenic vein
thrombosis with patent portal vein whats is your management

A

Splenectomy?

112
Q

12 year old received a nonspecific blunt trauma on his abdomen and later presented with generalized abdominal pain. Imaging of the spleen showed a 7mm hematoma and 4 cm tear(grade 3). Your management:

A

Stage 1-2 = conservative ttt
Stage 3 = preserving surgery
Stage 4 = splenectomy

113
Q

30 years old male after RTA had a splenectomy, what will be low after hours from the surgery

A

Insulin

114
Q

Patient 3 days post splenectomy develop fever 38.5 what is the cause of bacteremia?

A

UTI

Key word: 0-2 day = atelectasis or pneumonia 3-5day= UTI
5-7=DVT
7 day = wound infection
8-15= drug fever or deep abscess

115
Q

Alcoholic present with hematemesis. Imaging shows splenic vein thrombosis. Management?

A

Splenic vein thrombosis = spleenectomy

116
Q

What type of mesh used in ventral wall hernia

A

Suply

117
Q

40 years old man underwent open hernia relain and 2 weeks later presented with tenderness at the site of hernia repair and severe parasthesia/numbness/tingling around his thigh that went down his leg= management?

Inguinal intractable pain with hyperaesthesia with pain radiating to thigh 3 weeks post inguinal hernia with mesh, upon physical exam, no recurrence or surgical site infection, what’s the mx:

A

Key word: this case of ilioinguinal nerve inj need to NSAID for long time maybe month if no response then nerve block and last resort is neurecromy can be do

118
Q

Pt with Reducable hernia comes with intestinal obstruction manifestation and on exam was redness and on Xray : multiple air fluid level

A

multiple air fluid = strangulation

119
Q

60 yo pt Post ventral hernia surgery with mesh 6yrs ago pt came with abdominal distention and on radiology cut off sign and target sign and soft tissue mass?

A

Late onset of crohns

120
Q

-8 month infant with right inflamed red hemi scrotum, on examination there was red firm irreducible painful scrotal swelling which is extended to to left inguinal region. Left testis couldn’t be palpated. What is the diagnosis

A

Incarcenated inguinal hernia

121
Q

45-year-old female developed hernia located inferior and lateral to pubic tubercle. Type?

A

Femoral

122
Q

Patient came after 5days of hernial repair complain of inguinal mass , there is no erythema , no tender and not associated with cough , what is most likely the cause :

A

Serosa

123
Q

underwent hernia repair for right inguinal hernia, presented now complaining of that ipsilateral testicular size is decreased after hernia repair. Dx

A

pampiniform plexus compression

124
Q

60 yrs old female with femoral hernia, asymptomatic, accidental finding mx?

  • 319-Old man came to you with Inguinal reducible hernia, and he was advised to do hernia repair, and PE exam was normal he is asymptomatic what will you do?
A

Asymptotic = Observation

125
Q

Case of hiatus herni’ and ask about immediate management

A

Lifestyle modification

126
Q

Pt do hernia repair “not sure about the type” then he present with mass in the inguinal hernia firm, regular, transpulsation “there was no Erythema or tender”and no fever

A

Pseudoaneurysm = A complication of laparoscopic inguinal hernia repair No erythema and no tenderness

127
Q

-year-old weight lifter developed abdominal hernia that is irreducible, tender. Imaging shows air-fluid levels in small bowel and no free air in large bowel. Type?

A

incarcerated hernia is a part of the intestine becomes trapped in the sac of a hernia—the bulge of soft tissue that pushes through a weak spot in the abdominal wall. If part of the intestine is trapped, stool may not be able to pass through the intestine.
**strangulated hernia occurs when the blood supply to the herniated tissue has been cut off. Pt like Toxic hypotensive tachy ….etc.

128
Q

18 year old healthy male was playing baseball and suddenly he felt abdominal pain. On examination he has para-umbilical mass. His vital signs Bp 100/76 RR 30 HR 100 O2 sat. 95% oxygen mask. What is your(( next)) step in management?

A

Abdominal US

129
Q

Sclerotic lesion in distal femur:

A

Osteosarcoma

130
Q

Patient w incidental finding of macroadenoma of pituitary during evaluation of
her headaches, physical and medical hx was unremarkable, what’s the best
next step?

A

A. - ant pituitary hormone scan ✅ B. - Referral to neurosurgery

131
Q

-Mid-thigh lump with normal overlying skin and (+ve fluctuating) test. diagnosis

A

sebaceous cyst low- growing ,mobile , firm, painless nodule , dark colored may be seen on cyst , localized predominantly on the face, head, neck ,or genitals
Infection possible cause (painful, erythematous, mass exude pus )

132
Q

Patient came the weight loss and abdominal distention, Ct found: Soft tissue mass retro- peritonal , and multiply hypo-dense or hyper (forget ) liver lesions

Old man came with vague abdominal pain with 20cm×20cm mass , finding in u/s multiple hypoechoic masses ( or nodule ? ) What is the diagnosis

A

Liposarcoma

133
Q

-Old man has progressive dysphagia e mass in mid esophagus ,chest x-ray normal . What is the most likely cause?

A

Key word:SCC= mild and upper Adenocarcinoma = lower

134
Q

what makes lymphadenopathy malignant more than infectious

A

Supraclavicular lymphadenopathy

135
Q

Man with high grade dysplasia of the esophagus. How will you manage?

A

Refer to surgery

136
Q

-Smoker with chronic dyspepsia, endoscopy biopsy is squamous cell with low grade dysplasia,
what is your management?

A

PPI and rescope every 6_12 month

137
Q

Most common/important risk factor for esophageal cancer is:

A

A. Heavy smoking✅ B. Barrett’s esophagus Key word : answer according to SSC or adenocarcinoma

138
Q

Low grade dysplasia barrett’s esophagus, what is the management:

A

Pantoprazole

139
Q

Epigastric pain diarrhea and peptic ulcer with + secretin

A

Gastrinoma

140
Q

klatskin tumor= is cholangiocarcinoma located at bifurcation of common hepatic duct, marker is

A

CA 19-9

141
Q

Pt known case of lung cancer and had history of (epilepsy) and on medication, medication is
contraindicantion to this pt ?

A

Bupropion = epilepsy

142
Q

pt with hypertenstion and by ct abdomen show hypoechoic on adrenal gland ? biopsy
نتاكد هل هو خبيث او لا

A

pt with hypertenstion and by ct abdomen show hypoechoic on adrenal gland ? biopsy
نتاكد هل هو خبيث او لا
if mass more than 6 cm do Adrenalectomy if less than 4 cm ? usully observantion

143
Q

-adrenal tumor with high cortisol symptoms next management :

A

Surgery

144
Q

Sarcoma notes

Sarcoma metastasis to…….
- 350-Sarcoma Biopsy most Diagnostic test:…….
Melanoma = ………
Sarcoma = …….
-Sarcoma “no incisional in choices ? Core needle biopsy

A

Lung / incisional biopsy

Melanoma = excisional biopsy

145
Q

Sarcom’ of the thigh. Whats the best imaging for staging work up?

A

CT

146
Q

Pt with mass 2 cm away from anal verge on proctoscopy appears as cauliflower

70 year old male Weight loss fatigue proctoscopy shows mass 2 cm from anal verge
cauliflower like friable mass ? Anal cancer because of wt loss

A

A. Anal cancer B.Chondalymia acuminta ✅ ( Key word: cauliflower
Chondalymia lata= syphilis
Chondalymia acuminate=cauliflower

147
Q

Cancer in body of stomach with no metastasis and no lymph node ?

A

wide local local excision with clear margins

148
Q

25 years male involved in RTA in ER he is fully continues and no abnormality in vital signs admitted for observation and a FAST scan done ,.what do you expect to find?

A

A. Pneumothorax

B. major vessel bleeding in the thorax C. peritoneum free fluid✅

149
Q

Pt came to ER after MVA with multiple trauma and hypotension, tachycardia, x ray shows cardiomegaly and sternal fracture , Dx ?

A

hemopericardium ✅

Key word: cardiac teponante cause hemoprtcardium (hypotension , high JVP ,muffeled heart sound decrease)

150
Q

Thoracocentesis: …..l.

Needle thoracotomy: …….

A

Between 8-10 ribs mid axillary line / 2nd rib space

151
Q

Elderly smoker with progressive SOB, on CXR massive Rt pleural effusion what’s your next step?

A

A. Thoracocentesis

152
Q

-Case about pleural effusion on chest tube after a while there was blood in the water under seal (Hemorrhagic Pleural Effusions and Hemothorax), how to manage

Patient had fall 50 meter, absent lung sound on the right side, CXR was provided but not clear:

A

Chest tube (tube thoracostomy )

153
Q

man presented with a gun shot wound in his chest that he received an hour ago, and you’ve done needle thoracentesis. 15 mins later 100 ml of blood is drained, what is the next most appropriate action

A

Thoracostomy

154
Q

Patient who had had multiple traumas in MVA, they mention presence of free fluid in the
abdomen and spleen laceration + thoracic aortic rupture. Next

A

Thoracotomy

155
Q

-RTA , presented with slow breath and decrease breath sound left lower lobe lung xray picture showed infiltrate in lower left lobe and he has lower limb fracture His blood pressure and HR was normal ,What is your management

A

Thoracostomy

156
Q

Patient with pneumothorax tube thoracostomy inserted after 15 min water seal bottle is filled with blood PB: 90/60 HR: 100 Rr:22

A

Thoracotomy is indicated when total chest tube output exceeds 1500 mL within 24 hours

157
Q

Patient who was hit in the chest while playing football, after it SOB, tracheal shift , hypotension and raised JVP , diagnosis :

A

Tension pneumothorax ✅

- Key word: tension pneumothorax= SOB , raised JVP, hypotension tracheal shift

158
Q

RTA , facial fractures , unconscious, what is opportunity in mx?

  • Multi trauma pt, with many facial fractures, next step?
  • man with facial bones fractures after RTA, in the ER what is the first thing to do?
A

Airway

159
Q

386-man after accident and resuscitation in small hospital u need to transfer to another hospital after stabilization, it is 30 mins far. on xray u see fracture of 2-5 left ribs. no pneumothorax what will u do?

a. intubate✅
b. call the other hospital to inform the surgeon on call c. chest tube insertion

A

Not sure

160
Q

Patient after RTA was conscious GCS 15 then suddenly collapsed u see a temporal fracture what caused his loss of consciousness?

A

Epidural hematoma

161
Q

Young male with bilateral anterior without post lower limbs 2nd degree burn who weighs 70 kgs Asks about fluid replacement according to parkland formula:

A

A. 2.5L to be given in the first 8 hrs and 2.5 L in 16 hrs✅ B. 5L in first 6 and in 16 hrs
نستعمل =parkland form
4ml x TBSA (%) x body weight (kg)
ال lower limpالوحدة فيهم = ٩ الاثنين مع بعض = 18 نضربها بالوزن الي هو 70 نضربها بالرقم الثابت الي هو 4 تساوي 5040
نقسمها على اثنين عشان نعطي اول جزء في اول ٨ ساعات والجزء الثاني في ١٦ ساعة فتساوي 2500 يعني اثنين لتر في اول

162
Q

pt with 20% back burn which indicate good response?

A

Urine output 0.9ml/kg /h

163
Q

Burn case black soot over nostrils and mouth 40% carboxyhemoglobin. (Carbon monoxide toxicity):

A

Hyperbaric oxygen

164
Q

multiple opening+ DM = ……

A

carbuncle

165
Q

Open fracture came 4 days later to ER with signs of infection ( blue, necrosis) what’s the most common organism

case about gas gangrene due to open leg fracture infected by

A

Clostridium

166
Q

Patient with liver mass Ct first stage filling periphery late washout centrally :

A

Hemangioma

167
Q

patient with post operetive ‘abdominal destintion and small and large bowel obstruction and no fever ‘nd a’bdomen not tender :

A

Hypo k ( it causes illus paralysis)

168
Q

Child Diaphragmatic hernia first thing you do?

A

NGT

169
Q

Weber in right and bilateral + rinne test?

A

Left sensorineural

Positive rinne = normal conductive hearingtest
Weber shift to right so it’s either right conductive or left sensorineural

170
Q

Colon cancer common metastasis to?

A

Liver

171
Q

Bradycardia (40 bpm) during laparoscopic procedure Is due to :

A

Rapid expansion of parietal peritoneum

172
Q

60 years old patient come with sudden onset of upper abdominal pain after a few bouts of vomiting. Examination confirme sick patient with tenderness in epigastrium and supraclavicular subconscious emphysema . What’s Dx ?

A

boerhaav’s syndrome✅(is spontaneous perforation of the esophagus )

173
Q

Pt with dysuria and cloudy urine with bubbling for 2 months, hx of recurrent left iliac fossa pain for the past 2 years ! Colonoscopy: no diverticulosis or polyp Cystoscopy: erythema on dome of the bladder. Most likely diagnosis:

A

Disease diverticular

174
Q

Patient had a hyperextension trauma, complains of distal phalanx pain and tenderness in the volar aspect, he also feels tenderness in the palm, what’s the dx

A

Rupture of flexor profondus

175
Q

-50 male came with 4 time hematochezia , no weight loss , no abdominal pain dx:

A

Diverticulosis

176
Q

patient on TPN will increased INR what to give?

A

Vit K

177
Q

Patient with jerky carotid i

A

Hypertrophic cardio myopathy

178
Q

patient came with melena and they did upper gi endoscopy and found 1cm bleeding duodenal ulcer and they ask about the duration of ppi ?

A

iv ppi for 72 hours then convert to oral✅

179
Q

Patient post graham patch surgery, what is the most appropriate management?

A

Give IV PPI for 48hours

180
Q

-6 yrs old, female presented with nausea and recurrent vomiting of every intake , pt became lethargy with decreased skin turgor and cry with tears. Investigation revealed Normal investigations apart from :High Na Low glucose What is the best next management ?

A

isotonic saline 20ml/kg

181
Q

Young female c/o fatigue and jaundice high ALP and high bilirubin Us: no any finding MRCP : multiple stricture Next step to confirm Dx ?

A

Liver biopsy

182
Q

Case of established diagnosis of biliary sludge of postoperative sleeve pt with jaundice and US report of biliary sludge. What is the management

A

Cholecystectomy

183
Q

What is the Pathophysiology of bacterial peritonitis due to E. Coli ?

A

Bowel perforation

184
Q

young male with ulcerative colitis , bloody diarrhea, abd pain and S/S of intestinal obstruction X-ray shows: megacolon What is appropriate management:

A

IV steroids

185
Q

-65 male patient present with SOB and generalized fatiguability, On Ex: non tender mass in right iliac fossa, Hemoglobin: low What the most important step in Mx

A

Colonoscopy

186
Q

Patient underwent esophageal dilation. After 12h patient had symptoms and they did gastrografin which showed leak. Temperature is 39. BP 100/50*?
A. Stent B. Esophagectomy C. Surgical drainage✅

A

Not sure

187
Q

Sacral ulcer, skin necrosis and exposed subcutaneous fat manage?

A

Debridement with secondary closure graft

188
Q

Case of cystic fibrosis with abd pain , bloating , pale stool Abd scraled or curve???

A

Chronic pancreatitis

189
Q

Patient claudication long case, then after full treatment with thrombolysis, patient is risk for what while staying in hospital

A

PE because of DVT

190
Q

Scenario Liver mass 3 cm next with splenomegaly ?

A

Triphasic CT

191
Q

Epilepsy pt posterior dislocation, which joint?

A

Subacromial

192
Q

Meigs syndrome ( ovarian tumor + ascites + pleural effusion ) How to confirm the Dx?

A

Tissue histopathology

193
Q

Sigmoid volvulus case (s&s), ttt:

A

sigmoidoscopy detorsion if stable✅

194
Q

Hepatitis B and lesion 6 cm what to do next?

A

Transcatheter arterial chemoembolization) ( if lesion is less than 5 d excision )

195
Q

24 years old with history of appendectomy 5 years ago present with abdominal pain , distintion , vomitting for 3 days Ct scan show obstruction signs And peritonitis , Whats contraindicated in this patient ?

A

Nitroz oxide

196
Q

What hormone is associated with Biliary colic?

A

cholecystokinin

197
Q
  • pt with history of crohn’s after colon surgery developed severe diarrhea what you will give ?
A

Cholystamin

198
Q

55 year old with constipation and distention, on examination there is , CXR pic with coffee bean appearance, where is the site of obstruction?

A

Sigmoid

199
Q

Euvolemic hyponatremia fluid replacement

A

Water Restriction✅
hyponatremia ttt =fluid (euvolemia)
Isotonic saline= (hypovolemia)
Hypertonic saline= (sever symptomatic hyponatremia)

200
Q

Post colectomy for colon cancer she is Diabetic, received dextrose and Insulin for 2 days, then she developed confusion and agitation. Lab : hypoNA hypoK, urine osmolality normal, serum 270. Most likely cause

A

Water overload

201
Q

What pass through deep inguinal ring:

A

round ligament in female

Spermtic cord in male

202
Q

burn patient and resuscitation done, which of the following reflect a good resuscitation has been achieved

A

Urine output

203
Q

ULQ lump increasing with time, size 15x15 cm, us show solid mass with multiple cystic spaces with posterior costic enhancement

A

= (PHYLLOID TUMOR) = simple mastectomy

204
Q

radical mastectomy complaining of loss of sensation in inner side of right arm?

A

Inner-costo brachial nerve

205
Q

Acute mastitis organism ?

A

Staph aures

206
Q

Lactaional mastitis case treatment

A

= oxacillin with continu breast feeding

207
Q

Birad 4 , next step

A
  1. 2.3.=follow up
    - 4.5 = core biopsy
    - 6= surgery
208
Q

invasive intraductal papilloma. The most appropriate management is?

A

Wide local excision

209
Q

Color of discharge in intraductal papilloma ?

duct ectasia, color of discharge?

A

Papilloma = red / Ectasia = green

210
Q

32 yo I think female concerned about breast cancer, because her mother have it and her sister has ovarian cancer. What to do?

A

BRACA

211
Q

4-5 cm phyllodes mx?

Benign breast phyllodes tumor ?

A

phylloid less than 10cm benign = wide locl excision

- Above 10 cm simple mastectomy

212
Q

hard, mobile, well-circumscribed painless left breast mass that has been increasing in size?

A

Phylloid

213
Q

typical pancreatitis: epigastric pain, high amylase what is next step?

A

best initial = Us
- Confirm= ct
- Amylase = sensitive
- Lipase = specific

214
Q

Scenario of abd pain post meal with a hx of pancreatitis month ago Fluid collection found what is it?

A

Pseudo.Cyst

Keyword; complication of pancreatitis is pseudo. cyct

215
Q

Pancreatitis 5 weeks ago. Now she has epigastric tenderness and cannot tolerate food with vomiting each time. By ultrasound you found large about 12X10 mass With thick wall and fluid inside. Labs: 346 amylase, Wbc 15k. What is the diagnosis

A

Walled of necrosis ( not sure )

216
Q

Chronic pancreatitis what you will find?

A

hyperglycemia, hypocalcemia+increase lipolysis

217
Q

40 years old woman with no pain but you noticed jaundice. She has high direct bilirubin and
high ALT what is your diagnosis?

A

Carcinoma in head of pancreas

218
Q

case of acute pancreatities ?Iv fluids and analgesic Abx for necrosis

A

acut pancreatic start with Npo and then iv fluid then analgesic

219
Q

30 y/o Cystic fibrosis with GI Symptoms what complication he might have?

A

Chronic pancreatitis

220
Q

best method for pancreatic pseudocyst drain ?

A

Endoscopic

  • pseudo cyct drain if not infective= endoscopic
  • If infective(fever , leukocytosis ) =precetsnous drainge
221
Q

Pancreatic pseudo cyst treatment

A
  • less than 6 cm and 6 week > observation - more than 6 cm and 6 week > drainage
222
Q

Gray turner sign = abdominal hemorrhage, ts sign of ?

A

Necrotizin pancreatitis

223
Q

Patient has radial nerve injury , where level of injury ?

Patient had loss of sensation on the snuff box and dorsum of the medial hand, hehad wrist drop. At which level is the radial nerve injured?

A

spiral groove humerus

224
Q

Typist c/o tingling and pis in left thumb, index and middle & problem in dorsiflexion and fingers extending which nerve affected ?

A

Radial

225
Q

-Patient with pain when writing at keyboard, some test showed hypoperfusion to superficial palmar arch, what’s the artery affected

A

Ulnar artery

226
Q

Thenar muscle atrophy ?

A

Median nerve

227
Q

Pt had surgery then Lost sensation in ear pinna and upper neck what nerve is injured ?

A

Great auricular nerve

228
Q

Male with left little finger and(( ring numbness)) or pain , raisstress test increases the symptoms, what’s dx:

A

thoracic plexus
- Keyword :little finger affected when raise his hand above and feeling numbness so thoracic plexus is block = thoracic outlet syndrome

229
Q

Athlete with pain during standing PE: tenderness in medline planter surface?

A

Plantar fasciitis

230
Q

An elderly with IHD day 2 post cholecystectomy presented with sudden chest pain SOB and vitally hypotension and tachycardia whats best ?

A

CT angio

231
Q

Most common cause of biliary colic

A

Gallstones

232
Q

pt with typical cholecystitis Mx?

A

immediate lap chole ( within 72 hours )

233
Q

Abdominal pain and US show stones in gall bladder with(( normal wall ))what is the management ?

A

a) Lap chole b) Ursodeoxycholic ✅
Ursodeoxycholic Acid, is a naturally occurring bile acid and is used to dissolve gallstones that are rich in cholesterol. It is also used to improve the flow of bile in primary biliary cirrhosis.
- 579-Old man came with jaundice and dark urine , palpable gallbladder , lab shows direct

234
Q

Old man came with painless jaundice and dark urine , palpable gallbladder , lab shows direct bilirubin?

A

klatskin tumor

235
Q

Patient during complicated lap chole the surgeon accidentally transected the CBD (common bile duct( above the level of cystic duct, what’s your management?

A

Hepao-jejunustomy

236
Q

Lowest risk for cholesterol gallstones ?

A

Nulliparity

237
Q

With RUQ pain, US showed fluid around gallbladder, management:

A

US guided aspiration

238
Q
  • Recurrent RUQ pain aggregation with morphine, temperature 36.5
A

Biliary colic

239
Q

Pt came to ER with ruq pain and jaundice, with fever i think, 2 h later patient improved, us showed multiple gallstones within normal walled gallbladder, management

A

Lab cholecystectomy

240
Q

Patient with jaundice, abd pain and on US u see stones and dilated CBD vitals show fever only asking about diagnosis?

A

fever+ jaundice +abd pain=ascending cholangitis

241
Q

Pt with DM and HTN and SCA , type of gallbladder stones will form?

Diabetic obese elderly female with sickle cell trait has Lithiasis what kind of stone she has?

A

Sickle cell disease = pigmented

SC trait= mixed

242
Q

Patient with history of lap chole few weeks ago presenting with right upper abdominal pain , respiratory symptoms , US done and show pus collection at site of gallbladder 12*6 cm What is the most appropriate in management?

A

Percutaneous drainage

243
Q

Patient post bariatric surgery complains of on and off fever for one week On examination chest,
abdomen and wound were normal How are you going tomanage

A

CT abdomen ( spiking fever = pus )

244
Q

female pt present with right upper Q pain ,febrileLab test show: increased WBCs increase ALP increase Direct bilirubin US Show : fluid around gallbladder , multiple stone What the most appropriate management ?

A

Antibiotics

245
Q

Elderly pt admitted to Icu with acute MI , and developed pneumonia on tazocin , he also have RUQ pain and tenderness. Management ?

A

us guided cholecystostomy drainage

246
Q

ulcerative colitis pt with y shape something with very enlarged transverse colon and no haustrea what is Rx ?

A

pan colectomy with ileostomy

247
Q

Obstrictive jaundice pic and cholangitis on IV abx ,US (dilated ducts, gallbladder has
stones) what else in the mx?

A

Cholengitis = ERCP

248
Q

Post lap chole presented after few days with abd distension and ascites and abd pain what will u do

A

ERCP

249
Q

laparoscopic cholecystectomy come with discharge from middle managemen

A

Explorations

250
Q

Patient on 3rd day post cholecystectomy develops fever, has no abdominal pain.What is the likely cause of fever:

A

UTI

251
Q

sign in radiology for duodenal ulcer

A

Clover leaf

DHA Exam (21 decks)

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