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Flashcards in Gen Surg Essay Exam Deck (28)
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Ddx of breast mass? (9)

1. Breast cyst
2. Fibroadenoma
3. Cystosarcoma phyllodes
4. Fat necrosis
5. Abscess
6. Lactating adenoma
7. Juvenile hypertrophy
8. Gynecomastia
9. Cancer


what are the two variations of Fibroadenoma?

1. Giant fibroadenoma: >5cm, usually in pregnant or lactating women, usually shrink
2. Juvenile fibroadenoma: adolescent females, around time of puberty


how does cystosarcoma phyllodes spread?

hematogenously NOT lymph nodes


what is cystosaracoma phyllodes? tx?

- found in 30-40yr old WOMEN
- look like fibroadenoma on US
- painless mass
-tx: local excision


what is juvenile hypertrophy? treatment?

- bilateral hypertrophy
tx: subcutaneous mastectomy or reduction mammoplasty


what are the 3 peaks of gynecomastia?

1. Neonatal: due to maternal estrogen in utero
2. Puberty: reassurance
3. 50-70 yrs: drugs, liver disease, gonadal failure
*not a risk factor for breast ca*


Ddx of calcifications/abnormal mamogram? (6)

1. Mass lesions
2. Radial scar
3. Ductal ectasia
4. Sclerosing adenosis
5. Lobular hyperplasia
6. Cancer


Treatment of ALH/ADH?

- excision to exclude DCIS
- dont need to have negative margins


what are the contraindications to breast preservation? (5)

1. Inability to receive radiation (prior radiation, pregnancy, collagen vascular disease)
2. High tumor to breast size ratio
3. Multifocal disease
4. Inability to achieve negative margins
5. Fibrous tissue disorders


when is a SLNBx contraindicated?

if there are palpable lymph nodes in the axilla


when should you do radiation therapy after a mastectomy?

Tumor >5cm and more than 4 LN positive


what are prehepatic causes of jaundice? (4)

1. Congenital
2. Transfusion reaction
3. Autoimmune
4. Drug induced


What are intra-hepatic causes of jaundice? (5)

1. Hepatitis
2. Cirrhosis
3. Hepatocellular diseases (gilberts, hemochromatosis, wilsons, G6PD def, crigler-najjar)
4. Hepatic abscess (pyogenic, amebic)
5. Hepatic cancer (primary or metastatic)


Posthepatic causes of jaundice? (5)

1. Cholecystitis
2. Choledocholithiasis
3. Biliary stricture
4. Pancreatic cancer
5. Cholestasis (pregnancy, sepsis, CHF)


What are some key things to ask about in a pt w jaundice for history?

1. itching
2. dark urine
3. light stools
4. travel
5. blood transfusions


What is charcots triad?

1. RUQ pain
2. Fever
3. Jaundice


what is reynolds pentad?

1. RUQ pain
2. Fever
3. Jaundice
4. Hypotension
5. Altered mental status


what lab tests should you order in jaundice pt?

1. LFTs (AST, ALT, AP, total ind/direct bili, albumin, PT)
2. CBC, peripheral blood smear
3. Pregnancy test
4. direct coombs test for autoimmune hemolysis


what is the differential diagnosis of a neck mass? (7 categories)

1. Thyroid: cyst, goiter, cancer
2. Lymph Node: infected, reactive, lymphoma, metastatic cancer
3. Salivary gland: submandibular or parotid tumor (benign or malignant)
4. Soft tissue: abscess, lipoma, sebaceous cyst, primary soft tissue tumor
5. Vascular (hemangioma, carotid body tumor, aneurysm)
6. Nerve: neuroma
7. Congenital remnants


What are the congenital remnants that can present as a neck mass?

1. Thyroglossal duct cyst
2. Branchial cleft cyst
3. Dermoid cyst


things to ask about in history for someone w a neck mass?

1. Recent URI
2. Insect bites/exposure to animals
3. family history (esp MEN syndrome)
4. Radiation exposure
5. Obstructive symptoms


mass in the midline of the neck? (4 ddx)

1. Thyroglossal duct cyst: moves w swallowing, in child
2. Abscess
3. Lipoma
4. Sebaceous or dermoid cyst


mass in the lateral neck?

1. Inflammatory LN
2. Metastatic cancer
3. Salivary gland tumor
4. Branchial cleft cysts: usually 20-30yo, small pit in skin anterior to SCM
5. Carotid body aneurysm or tumor


treatment of thyroglossal duct cysts?

excision w a segment of hyoid bone (sistrunk procedure)


what level do you check in medullary ca of thyroid?



Differential diagnosis for dysphagia? (functional disorders) (3)

1. Achalasia
2. Chagas disease
3. Esophageal spasm syndromes


What are thee 4 esophageal spasm syndromes?

1. Nutcracker esophagus
2. Diffuse esophageal spasm
3. Hypertensive lower esophageal sphincter
4. Non-specific elongated motor disorders


Mechanical disorders causing dysphagia?

1. Benign or malignant
2. Stricture
4. Hiatal hernia
5. Diverticuli (zenkers, epiphrenic, traction)