General Surgery Flashcards
(21 cards)
A 62 year old male patient has had mild abdominal pain over the last few months. He noticed dark stools on a few occasions. He then underwent a colonoscopy documenting a large polyp in the caecum and the biopsy is consistent with adenocarcinoma. What is the most appropriate work-out to provide a clinical staging?
Chest-abdomen contrast-enhanced CT scan
The clinical staging of this patient discloses three lesions suspicious for metastases in the liver. What would be the optimal treatment?
Chemotherapy
A 74 year old female patient underwent a colonoscopy after a positive fecal occult blood test. The exam documented an adenocarcinoma located 5cm from the anal verge. What is the most appropriate work-out to provide clinical staging?
Chest-abdomen contrast-enhanced CT scan + lower abdomen MRI scan
The clinical staging of this patient rules out distant disease and its consistent with a CT3N+ rectal adenocarcinoma. What would be the optimal treatment?
Neoadjuvant chemoradiation followed by low anterior rectal resection
A 60 year old female patient recently underwent a gastroscope for dyspepsia. During the examination a 1cm ulcer was noted in the antrum and the biopsy was consistent with an adenocarcinoma, intestinal type. The contrast-enhanced chest-abdomen CT scan ruled out any distant metastasis. What would be the most likely management?
Staging laparoscopy + neoadjuvant chemotherapy + sub-total gastric resection
What would be the management in case an endoscopic examination discloses a cancer located 2cm dismally to the cardia and the clinical staging is the same?
Staging laparoscopy + neoadjuvant chemotherapy + total gastric resection
A 53 year old man has a diagnosis of stage 3 Hinchey…
Sigmoid diverticulitis
A 40 year old obese (BMI=35) woman is brought to the emergency department because of worsening abdominal pain, associated with vomiting. Pain is localised in the epigastrium with irradiation to the right upper quadrant. The clinical examination shows an acute pain by palpating of the right upper quadrant. In this quadrant the pain is elicited by palpating during inspiration with consequent cessation of inspiration. How is this clinical sign defined?
Murphy’s sign
Which type of exam do you first suggest for this patient? (A patient with murphy’s sign)
Blood test
Which are the blood tests that we have to evaluate in order to investigate a suspicious cholestasis?
Total and direct bilirubin, together with transaminases
If the patient has an increase of cholestasis at the blood tests, what is the most appropriate radiological exam to evaluate their bile ducts?
Abdominal MRI
A 60 year old man is brought to the emergency department because of worsening fatigue in the last week. The day before, the patient saw black, soft stools. His medical history includes coronary artery disease that is chronically treated by aspirin. He also smokes 2-/cigarettes/day. What is the definition of black, soft stools?
Melena
What’s the first priority at the emergency department in case of suspicious gastrointestinal bleeding in a patient referred for worsening fatigue and lipotimia?
Find resuscitation and blood transfusion by a central venous access
What is the most common cause of upper gastrointestinal bleeding?
Peptic ulcer
A 68-year-old man presents with a 9mm left thyroid nodule that is hypoechoic with microcalcifications and irregular borders at the ultrasound evaluation. His TSH is within the normal range, his past medical history is significant for chest and neck external beam radiation in childhood for Hodgkin lymphoma. The patient underwent fine needle aspiration biopsy (FNAB) with cytology of Bethesda IV (follicular neoplasm). Possible histopathological diagnoses from a patient with this cytology include all of the following except:
Medullary thyroid cancer
The most widely utilised staging system for differentiated thyroid carcinoma is:
AJCC/TNM
A 62 year old female presents with a neck ultrasound with a solitary suspicious 1.5cm nodule in the right lobe. Her thyroid hormonal evaluation is normal. Due to the suspicious features of the nodule, a fine needle aspiration biopsy (FNAB) is performed with the result of TIR 4 (Bethesda V) cytology. Which of the following is the appropriate initial operation for the patients:
Thyroid lobectomy plus eventual ipsilateral central neck dissection
A 53 year old female presents with incidental findings of elevated calcium level on a routine blood test. She reported no significant complaints. She presented with laboratory data which includes total calcium measurements of 11.2 mg/dL (normal 8.5-10.2 mg/dL), ionised calcium level 6.5 mg/dL (normal 4.64-5.28 mg/dL), PTH level was 125 pg/mL (normal 25-65 pg/mL). Creatinine level was 0.95 mg/dL (normal 0.6-1.0 mg/dL), phosphorus level was within normal range, and vitamin D25OH level was 15 ng/mL (normal above 50 ng/mL). What are criteria to establish the diagnosis of primary hyperparathyroidism?
Findings of elevated serum calcium and PTH levels
A 57 year old female presents with an incidental finding of a right adrenal mass. The patients undergone abdomen ultrasound 1 year before. The patient refers history of type II diabetes and arterial hypertension. A CT scan was performed. A 24mm right adrenal mass was described with an unenhanced density <10 Hounsfield Unit. Left adrenal is considered normal. What is the next step?
Adrenal hormonal work-up
A 44 year old female presented with a right 3cm adrenal mass. She complains of progressive weight gain. Her past medical history was significant for hypercholesterolemia, arterial hypertension, poly cystic ovary syndrome and depression. On physical examination, she showed facial plethora and abdominal purple striae. She was evaluated for Cushing’s syndrome. She had a morning cortisol level of 17.6 nmol/L (normal 3-21 nmol/L), serum ACTH level <0.05 no/L (normal 10-50 no/L) and urinary free cortisol level of 463 nmol/24h (normal 16-168 nmol/24h). Which are the criteria to establish the diagnosis of Cushing’s syndrome?
Increased 24-h urine cortisol levels
The most common location of MEN 1 related gastrinoma is:
In the proximal duodenum
