Handout Flashcards
(137 cards)
1
Q
aka Abrikossof tumor, derived from Schwann cells
A
Granular Cell Myoblastoma
✔in striated muscles
✔firm, submucosal swellings in the mid 1/3 of tongue
tx: wedge excision
2
Q
An 85 y/o hypertensive man is evaluated in the ER for recent onset of epistaxis. His BP is 150/80 mmHg, and Hct is 39%. What is most likely source of bleeding?
A
✔Posterior Nasal Septum
3
Q
Arise form the dental lamina associated with impacted toot.
Xray: multilocular radioluscent appearance “soap bubble”
A
✔Ameloblastoma (Adamantinoma)
4
Q
Clinically not performed;
removes: level I to V, spinal accessory nerve, IJV, and SCM,
A
✔Radical Neck Dissection or Crile’s Procedure
5
Q
Preserves spinal accessory nerve, IJV and SCM.
A
✔ Modified Radical Neck Dissection or Functional Neck Dissection
6
Q
Preserves lymphatic structures normally removed in RND or MRND.
A
✔Selective Neck Dissection
For ORAL Malignancies: Supraomohyoid Dissection (I, II, and III)
For LARYNGEAL Malignancies: Laterala Neck Dissection (II, III and IV)
For THYROID Malignancies: Posterolateral Neck Dissection (II, III, IV, and V)
7
Q
The classic complete neck dissection for palpable adenopathy in the posterior triangle of the neck includes removal of which of the following?
A
✔Transverse process, C2-C4
8
Q
Most common on the lateral and ventral surface, presents with ulcerations and exophytic masses.
A
Cancer of the Tongue
9
Q
Malignant Features of Salivary gland tumors.
A
✔rapid growth
✔paresthesia
✔pain
✔trismus
10
Q
Horizontal fracture through the maxilla superior to the maxillary dentition.
A
Le fort I
✔mobile hard palate
11
Q
Pyramidal fracture through the maxilla and orbit, outlining the nose.
A
Le Fort II
✔nasal
✔outer orbit
12
Q
Fracture of the facial bones from the skull.
A
Le Fort III
✔complete craniofacial separation
13
Q
2nd most common facial fracture; presents with trismus, malocclusion, numbness, and loose or missing teeth.
A
Mandible Fracture
14
Q
Presents acutely with nausea, vomiting, fatigue, muscle weakness, confusion and decreased level of consciousness.
A
Hypercalcemic Crisis
15
Q
Occurs among patients with chronic renal failure.
A
Secondary Hyperparathyroidism
16
Q
Persistent hyperparathyroidism and hypercalcemia following successful renal transplant.
A
Tertiary Hyperparathyroidism
17
Q
3 Normal areas of Narrowing in Esophagus
A
✔level of Cricopharyngeus: C6
✔level of Left mainstem Bronchus: T4-T5
✔level of Diaphragmatic hiatus: T10
18
Q
Gold standard in Gerd diagnosis.
A
24-hr pH monitoring
19
Q
Fundus of stomach is made to enrupt to the distal esophagus creating of new LES.
A
Nissen Fundoplication
✔Toupet: post
✔Dor: ant
20
Q
Borchardt’s triad
A
✔chest pain
✔retching with inability to vomit
✔inability to pass a ngt
21
Q
Hallmark of Intestinal metaplasia.
A
presence of intestinal goblet cells in Barrett esophagus
22
Q
Gastric pouch extending above the crural impression (at least 2cms).
A
Sliding hernia
23
Q
Area of potential weakness situated behind the esophagus at the level cricopharyngeus muscle.
A
Killian’s triangle
✔defect in Zenker’s Diverticula
Symptoms:
✔dysphagia
✔regurgitation of undigested food
✔halitosis, choking and aspiration
24
Q
Diverticula located 5cms above and below the level of carina; associated with both traction and pulsion.
A
Mid thoracic Diverticula
25
Pulsion diverticula that occurs at the distal 10cms of the esophagus.
Epiphrenic Diverticula
| ✔usually single and occurs at the right side
26
A 79 y/o retired opera singer presents with dysphagia, which has become progressively worse during the last 5 years. He states that he is sometimes aware of a lump on the left side of his neck and that he hears a gurgling sounds during swallowing. He sometimes regurgitates food during eating. What is most likely the diagnosis?
Zenker's (pharyngoesophageal) syndrome
27
A 30 y/o psychiatric patient has barium swallow after removal of a foreign body to rule out a small perforation of the esophagus. No perforation is seen, but an epiphrenic diverticula is visualized. An epiphrenic diverticulum may be associated with?
Hiatal hernia
28
Primary motility disorder characterized by loss of peristaltic waveform in the esophageal body and failure of LES to relax.
Achalasia
✔occur at any age
✔causes functional obstruction
Triad of LES:
✔Hypertensive LES
✔Aperistalsis of Esophageal body
✔Failure of LES to relax
29
Gold standard test for achalasia.
Manometry
Endoscopy: to r/o malignancy
Tx: Heller's myotomy + patial fundoplication
✔pneumatic dilatation: most effective non surgical tx
30
Most common primary esophageal disorder.
Nutcracker esophagus
✔Mean peristaltic amplitude of distal: >180 mmHg
✔Increased mean duration of contraction (>7s)
✔Normal peristaltic sequence
31
elevated LES pressure: >26 mmHg; normal LES relaxation; normal peristalsis in the esophageal body.
Hypertensive LES
32
Spontaneous rupture of esophagus with usual history of resisting vomiting; high mortality due to misdiagnosis and delayed treatment.
Boerhaave's Syndrome
✔esophageal perforation
✔true surgical emergency
✔usually occurs into the left pleural cavity or just above the GE junction
33
Indications of non operative esophageal perforation.
✔contained within the mediastinum and drain well back into the esophagus
✔mild symptoms
✔minimal sepsis
DAT resumed after 7-14 days.
34
Phases of injury in Caustic injuries
1) Acute necrotic phase: 1 to 4 days;
2) Ulceration and Granulation phase: 3 to 5 days, lasts for 10 to 12 days; ✔period when esophagus is the weakest
3) Cicatrization and Scarring: 3rd wk
35
Most common site of perforation in caustic injuries.
Mid esophagus
36
Most common type of esophageal carcinoma; most commonly located in the middle 3rd of the thoracic esophagus.
Esophageal Squamous Cell Carcinoma
✔Early: plaque-like, erosive, papillary
✔Advanced: scirrhous, medullary or fungating
37
Endoscopy: red, velvety areas between smooth, pale, esophageal squamous mucosa
Barrett's metaplasia
38
Drug induced lesions of FeSO4.
Esophageal web
✔pre-malignant lesion
✔plummer-vinson syndrome
39
Benign thin submucosal ring lesion in the lower esophagus.
Schatzki's Ring
Tx: esophageal dilatation/anti reflux procedure
40
Mucosal tears located at the GE junction
Mallory-Weis tear
41
Most common site of adenocarcinoma and ulcer.
Lesser curvature
42
Cells that release most numerous pepsinogen, lipase.
Chief cells
43
Induces acid secretion.
✔Acetylcholine
✔Histamine
✔Gastrin
44
A 50/M is involved in major motor vehicle collision and suffers multiple trauma. He is admitted to the ICU. After 2 days of hospital admission he bleed massively from the stomach. What is the probable cause?
Erosive gastritis
45
Ultimately caused by an imbalance between the action of acid and mucosal defense.
Peptic Ulcer Disease
| ✔focal defects in the gastric or duodenal mucosa which extends to the submucosa.
46
Caused by destruction of the pyloric sphincter causing abrupt delivery of hyper osmolar load to small intestines.
Dumping Syndrome
```
Early dumping:
✔15-30 mins post-prandial
✔peripheral and splanchnic vasodilatation
✔relieved by saline or recumbency
Late dumping:
✔2-3 hrs post-prandial
✔due to hyper insulinema with reactive hypoglycemia
✔relieved by glucose administration
```
47
Most common pancreatic tumor in patients with MEN I.
Gastrinoma
48
Uncontrolled secretion of gastrin by pancreatic or duodenal neuroendocrine tumor.
Zollinger-Ellison Syndrome
49
Confirmatory test of Zollinger-Elisson syndrome.
Secretin stimulation test
| ✔gastrin >200pg/ml after IV secretin
50
Universal precursor to adenocarcinoma.
Dysplasia
51
Trosseau's syndrome, acanthosis nigricans, and thrombophlebitis.
Paraneoplastic syndrome
52
Area of Virchow's node.
Left supra clavicular lymphadenopathy
53
Type of Gastric adenoma based on Lauren classification is linitis plastica.
Diffuse type
54
Most common site for primary GI lymphoma.
Gastric Lymphoma
55
Arise from interstitial cells of Cajal.
```
Gastrointestinal Stomal Tumor
✔metastasize hematogenously
✔most common type: epithelial cell stroma
✔location: submucosa
✔tx: wedge resection
```
56
Diffuse hyperplasia of surface mucus-secreting cells and decrease parietal cells.
Menetrier's disease
(hypertrophic Gastropathy)
✔associated with protein losing enteropathy and hypochlorhydria
✔large rugal folds that spares the antrum
57
Dilated mucosal blood vessels in the distal stomach, resembles portal gastropathy (proximal stomach0.
Watermelon Stomach
| Gastric Antral Vascular Ectasia
58
Congenital malformation, unusually large tortuous submucosal artery.
Dieulafoy's Lesion
✔men with UGIB which is usually intermittent
✔endoscopy: pulsating blood from a normal appearing gastric mucosa
59
Pringle maneuver what structures?
✔Portal vein
✔Hepatic artery
✔CBD
60
Final sequelae of chronic liver injury characterized by the presence of fibrous septa that leads to hepatic nodules.
Cirrhosis
61
Mainstay, 1st line treatment for spontaneous bacterial peritonitis.
Cefotaxime
62
A 45 y/o man with hepatitis C undergoes an uneventful percutaneous liver biopsy. About 6wks later, he complains of RUQ pain, is clinically jaundiced, with a Hgb of 9.2mg/dL is fecal occult blood positive. What diagnosis best explains this patient's symptoms?
Hemobilia
✔abnormal communication
✔bile enters the blood circulation
63
Normal portal pressure.
5 to 10 mmHg
✔Direct venous pressure: >5mmHg of IVC pressure
✔Splenic pressure: >15 mmHg
Most accurate method of determining portal HPN: Hepatic venography
64
Pharmacologic therapy of Acute variceal bleeding.
✔Vasopressin
| ✔Octreotide (preferred)
65
Infective stage of Entamoeba hystolytica that causes amebic liver abscess.
Cyst
Pathogenic stage: trophozoite
✔usually located at superior--anterior aspect of R lobe
66
Percutaneous ultrasound guided liver biopsy is contraindicated in what disease?
Hepatic adenoma
✔occurs in young women, typically solitary
✔Tx: Resection
✔Maligant degeneration: hepatocellular CA
67
A 35 y/o woman complains of RUQ pain after meals with nausea and vomiting. An ultrasound reveals cholelithiasis and an anechoic 3cm mass on the inferior surface of the R lobe of the liver.
Dx: Congenital Cyst
68
Occurs at hepatic duct confluence; distal
Klatskin tumor
69
Diagnostic of choice in gallbladder stones.
Proximal: Percutaneous Transhepatic Cholangiography (PTC)
Distal: ERCP
70
Normal amount of bile formed
500 to 1000 mL/day
71
Most common presentation of gallstone disease characterized by recurrent biliary colic.
Chronic Cholecystitis
✔symptoms due to partial obstruction
✔last 1 to 5 hrs
✔episodic, subsides spontaneously
72
Most accurate and specific diagnostic test for Acute cholecystitis.
HIDA scan
Definitive mgt: early cholecystectomy (2-3 days)
73
A 60 y/o diabetic man is admitted to the hospital with a diagnosis of acute cholecystitis. The WBC is 28,000 and a plain film of the abdomen and CT scan show evidence of intramural gas in the gallbladder. What is most likely the diagnosis?
Emphysematous gallbladder
74
More common type of Choledocholithiasis.
Secondary Choledocholithiasis
✔formed in the GB and migrate to CBD
✔usually cholesterol stones
75
Charcot's triad
✔fever
✔pain
✔jaundice (2/3)
76
Reynold's Pentad
```
✔fever
✔pain
✔jaundice
✔septic shock
✔disorientation
```
77
Most common gram negative aerobe causing Cholangitis.
E. coli
78
Most common type of Choledochal cyst.
```
Type 1: fusiform (MC)
Type 2: saccular diverticulum
Type 3: choledochocoele
Type 4a: Extra & intrahepatic ducts
Type 4b: extrahepatic ducts only
Type 5: intrahepatic ducts only (Caroli's disease)
```
79
Congenital cystic dilatations of the biliary tree.
Choledochal Cyst
✔more common in females
Triad of Presentation:
✔abdominal pain
✔mass
✔jaundice
80
Most specific marker for biliary and hepatic carcinoma.
Elevated CA 19-9
81
Most important factor in determining resectability of Bile duct carcinoma.
PTC
| ✔defines proximal extent
82
Worst prognosis of Periampullary CA.
Pacreatic head Periampullary CA.
83
Most common surgical disorder of the small intestines.
Small Bowel Obstruction
84
Most useful initial test for intestinal fistulas.
CT with oral contrast
| ✔show area of extravasation
85
Most common Primary malignant tumor in small intestine.
Adenocarcinoma
✔AdenoCA: Duodenum
✔Lymphoma: Ileum
86
Persistence of the vitteline/omphalomesenteric duct.
Meckel's Diverticulum
✔usually found in Ileum within 100cms from the ICV
✔most prevalent congenital anomaly of GIT
✔most often asymptomatic
children: bleeding
adults: intestinal obstruction
87
Most common cause of Acute Mesenteric ischemia.
Arterial Embolus
✔from Left atrial thrombi
✔lodges to SMA distal to middle colic
embolus: distal
thrombi: proximal
88
Peritoneal diverticulum formed in fetus, passes through lower part of anterior abdominal wall to form inguinal canal.
Processus vaginalis
89
Normally closed off just before birth; becomes closed sac invaginated from behind by testis.
Tunica vaginalis
| ✔lower expanded part of processus vaginalis
90
Nyphus classification of Direct inguinal hernia.
Type 3: Posterior wall defects
✔3a: Direct inguinal hernia
✔3b: Massive scrotal, sling or pantaloon
✔3c: Femoral hernia
91
Zieman's technique
aka 3-Finger Test
✔Index finger: deep inguinal ring (Indirect)
✔Middle finger: superficial ring (direct)
✔Ring finger: saphenous opening (femoral)
92
Hernia in relation to Pubic tubercle.
Inguinal: neck above and medial
Femoral: neck below and lateral
93
In repair of femoral hernia, the structure most vulnerable to major injury lies:
Posteriorly
94
In relation to Lumbar Triangle.
✔Grynfeltt: superior
| ✔Petit: inferior
95
In relation to Diaphragm
✔Morgagni: anterior
| ✔Bochdaleck: posterior
96
Most common etiology of Acute Pancreatitis that causes obstruction and inflammation.
Gallstone
97
Most common congenital anomaly of the pancreas.
Pancreas Divisum
✔absence of Duct of Wirsung
✔functional obstruction of duct of Santorini
98
Main blood supply of Pancreas.
Splenic artery
99
Blood dissects up to the falciform ligament and create periumbilical ecchymosis.
Cullen sign
100
Blood extends to the flank tissues resulting to flank ecchymosis.
Grey Turner sign
101
What is WDHA syndrome?
✔watery diarrhea
✔hypokalemia
✔achlorhydria
102
Usually located at the tail; usually malignant.
Vipoma
103
Presence of necrolytic migratory erythema, usually located at body and tail.
Glucagonoma
104
Used as the landmark to identify the location of the appendix.
Anterior Taenia
105
Most common acute surgical abdomen.
Acute appendicitis
MCC: fecalith
1st symptom: anorexia
106
Presents with recent onset of colicky abdominal pain, distention and obstipation. On examination, abdomen is markedly distended and typanitic. There is no marked tenderness. Plain abdominal xray shows a markedly distended loop located mainly in the RUQ. The most likely diagnosis is:
Sigmoid volvulus
107
Arise drom adenomatous polyps by accumulation of mutations.
Colorectal Cancer
108
A 35 y/o man has known ulcerative colitis. Which of the ff is an indication for total proctocolectomy?
a. Occasional bouts of colic and diarrhea
b. Sclerosing cholangitis
c. Toxic megacolon
d. Arthritides
e. Iron deficiency anemia
c. Toxic megacolon
✔complication of ulcerative colitis
✔tx: total colectomy and proctocolectomy
109
Congenital hypertrophy of pigmented retinal epithelium. desmoid tumors, epidermoid cyst, and mandibular osteomas.
Gardner's syndrome
110
Typeof polyps with highest risk of malignancy.
Adenomatous Polyps
111
Most common type and pre malignant polyp.
Hyperplastic
112
Definitive treatment of rectal prolapse in which segment of sigmoid colon was resected to shorten length.
Low anterior resection
113
Classification of internal hemorrhoids that presents with bleeding with prolapse that can be reduced manually.
3rd degree
1st: bleeding, no protrusion;
2nd: bleeding with prolapse but reduces spontaneously;
3rd: bleeding with prolapse that is reduced manually;
4th: bleeding, prolapse cannot be reduced (incarcerated)
114
A tear in the anoderm just distal to the dentate line.
Anal Fissure
✔pain causes spasm of the internal sphincter, causing further tearing
Treatment:
✔Acute: Medical (stool softener, bulk diet)
✔Chronic: Surgical (lateral internal sphincterectomy)
115
Infection of the anal glands found in the intersphincteric space (cryptoglandular).
Anorectal abscess
✔infection due to mixed cutaneous and fecal flora
✔glands open into the anal crypts at the dentate line
✔acute phase of infection
supralevator: transrectal
ischirectal: transcutaneous
116
Infected crypt forms a tract extending to an external opening as a site of drainage.
Fistula-in-ano
117
Intraepidermal Squamous Cell CA of Anus.
Bowen's Disease
Treatment: Wide excision with adequate margin
118
3rd most common site of melanoma with poor prognosis.
Anus
1st: skin
2nd: eye
3rd: anal canal
119
A 25 y/o man has recurrent, indolent fistula in ano. He also complains of weight loss, recurrent attacks of diarrhea with blood mixed in the stool, and tenesmus. Proctoscopy revealed a healthy, normal-appearing rectum. What is most likely diagnosis?
A. Crohn's colitis
B. Ulcerative colitis
C. Amoebic colitis
D. Ischemic colitis
E. Colitis associated with acquired immunodeficiency syndrome (AIDS)
A. Crohn's colitis
120
AOG mammary ridges appear.
5th or 6th week AOG
121
Presents with hypoplasia or complete absence of breast, costal cartilage and rib defects, hypoplasia of chest wall, and brachysyndactyly.
Poland's syndrome
122
Contains greatest volume of breast tissue compared to other quadrants.
Upper outer quadrant
123
Extends from the base of the skull of the sacrum; provides route for breast cancer metastases.
Batson's vertebral plexus
124
Due to MRSA transmitted via suckling neonate.
Epidermic puerperal mastitis
125
Variant of thrombophlebitis that involves superficial veins of the anterior chest wall and breast.
Mondor's disease
Involves:
✔Lateral thoracic vein
✔Thoracoepigastric vein
✔Superficial epigastric vein
Presentation:
✔acute pain at the lateral aspect of the breast
✔tender, firm cord following the distribution of the veins
126
A 35 y/o professional dancer presents with a well-defined, tense, smooth mass in the upper outer quadrant of the left breast. She states that the mass becomes larger just before onset of her periods. Aspiration yields a clear yellow fluid and mass disappears. The most likely diagnosis:
Fibrocystic disease of the breast
✔formed when breast stroma involutes quickly
✔aspirated to dryness
127
A 36 y/o woman complains of a 3-month history of bloody discharge from the nipple. At examination, a small nodule is found, dee to the areola. Careful palpation of the nipple areolar complex results in blood appearing at the 3 o'clock position. Mammogram findings are normal. What is the diagnosis?
Intraductal papilloma
✔known as DCIS
✔proliferation of the epithelium (papillary-cribriform-solid-comedo)
✔calcification occurs in the areas of necrosis
✔malignant
128
Distorted breast lobules due to ductal and stromal proliferation.
Sclerosing Adenosis
129
Tumor suppressor gene with AD inheritance with 90% lifetime risk for breast CA.
```
BRCA 1
✔associated CA are poorly differentiated and are hormone receptor negative
✔chr 17
✔involved in 45% of hereditary breast CA
✔80% of hereditary ovarian CA
```
130
Tumor suppressor gene with Ad inheritance with 85% lifetime risk for Breast CA.
BRCA II
✔chr 13
✔6% increased risk for Breast CA in men
✔associated CA are well-differentiated and express hormone receptors
131
Primary breast CA wherein cancer cells have not invaded the basement membrane.
Ca-in-situ
132
Originates from the terminal duct lobular units that develops only in female breast.
Lobular Carcinoma in situ
✔cytoplasmic mucoid globules are distinctive
✔regarded as a marker of increased risk for invasive cancer
133
Most common type of breast CA that occurs in peri/post menopausal women in their 5th and 6th decade; presents as solitary, firm mass, with poorly defined margins.
Invasive Ductal Carcinoma
✔scirrhous, simplex, NST
✔axillary LN mets in 60%
Gross hallmark: central stellate configuration with chalky white or yellow streaks
134
Chronic, eczematous, eruption of the nipple that is usually associated with DCIS and invasive cancer.
Paget's disease
✔invasive breast CA
Pathognomonic histologic findings: large pale, vacuolated cells in the rete pegs of epithelium (Paget cells)
(+) CEA: Paget's
(+) S-100: Melanoma
135
Frequent phenotype among BRCA 1 cancers, associated with DCIS in 50%.
Medullary Carcinoma
✔soft, hemorrhagic, & bulky
✔dense lymphoreticular infiltrate of lymphocytes and plasma cells
✔large pleomorphic nuclei that are poorly differentiated sheet-like growth pattern
136
With Indian file configuration and Signet ring cell carcinoma.
Invasive Lobular Carcinoma
✔multifocal, multicentric, and bilateral
✔grows insidiously with subtle mammographic features
* Indian file configuration: small cells arranged in single file orientation
* Signet ring cell carcinoma: Intra cytoplasmic mucin that displace the nucleus
137
Recommended treatment for Breast CA during 3rd trimester of pregnancy.
BCS
1st and 2nd tri: MRM
3rd tri: BCS
