High Yield Surgery RX

Question 1

Treat DEVO hip dysplasia?

- palpable click when adduct hip and directs posterior force

Answer 1

Flexion-abduction orthosis = aka Pavlik harness

- if infant

Question 2

Treat seminoma T2N1M0?

Answer 2

Retroperitoneal radiation

- seminoma extremely sensitive to radiation

Question 3

Treat metastatic nonseminomatous germ cell tumor?

Answer 3

Orchiectomy + platinum based chemo

Question 4

Are amylase/lipase levels elevated in acute, chronic or both pancreatitis?

Answer 4

Only in acute

- get chronic get fat malabsorption + DM

Question 5

Why calculus biliary colic in burn patient?

Answer 5

Fever + dehydration

Also see calculus biliary colic in immobile and/or hospitalized pt’s

Question 6

Cystic renal lesion

• contrast enhancing
• solid component in center

Answer 6

Cystic renal cell carcinoma: RCC
- contrast enhancement makes likely malignant

DO surgical excision: nephrectomy or nephron-sparing partial nephrectomy

Question 7

If think bowel obstruction…

Answer 7

Do CT to rule out/in mechanical vs. Ogilvie
- can get PERF w/ Ogilvie
Tx: hydration, NG tube, electrolytes, stop meds that impair bowel motility
Maybe neostigmine to reverse pseudo-obstruction

Question 8

Thyroid nodule w/ symptoms suggesting pheochromocytoma/parathyroid gland hyperplasia?

Answer 8

MEN II

- do total thyroidectomy

Question 9

Imaging for pancreatic cancer?

Answer 9

Transabdominal U/S if pt has jaundice + symptoms highly suspicious of pancreatic cancer
If mass seen…
- then get CT
If no jaundice, start w/ CT

Question 10

If suspect panc cancer but CT only shows bile duct dilation…

Answer 10

Do ERCP

• look for double duct sign (obstruction CBD or pancreatic duct)
• these are very suggestive of panc tumor

Question 11

Suspect acute cholecystitis, but U/S inconclusive?

Answer 11

Do hepatobiliary imino-diacetic acid scan

Question 12

Why do elective cholecystectomy for porcelain gallbladder?

Answer 12

Risk of GB carcinoma so cut it out!

- often is adenocarcinoma

Question 13

Gastric adenomatous polyps
Weight loss + palpable mass in epigastrum + LN supraclavicular
Next step?

Answer 13

Do endoscopy w/ biopsy
- prove it’s cancer first
Likely gastric carcinoma
Virchow’s node - supraclavicular

Question 14

A 76-year-old man who has had multiple episodes of pancreatitis presents to his physician’s office with mild epigastric pain and 9.1-kg (20.0-lb) weight loss over the past 6 months. The patient also describes daily foul-smelling stools that “float” in the toilet bowl. The physician pulls up his electronic medical record and finds that the patient presented to the emergency department last week for the same symptoms. Calcified pancreas on CT

Answer 14

Chronic pancreatitis leads to an atrophic, calcified pancreas and exocrine insufficiency, leading to malabsorption, fatty stools with diarrhea, and weight loss. Patients with this condition need to take pancreatic enzymes with each meal.

Question 15

Low-dose dexamethasone suppression test?

Answer 15

Give low dose steroid: why? 
 - should suppress cortisol
 - helps diagnose Cushings into
Could also do 24 hour free urine cortisol
Or late-night salivary cortisol

Question 16

Hallucinations, diaphoresis, mental status changes

Tachycardia, fever, agitation

Answer 16

Delirium tremens: 2-4 days after alcohol

- give BDZ: lorazepam or oxazepam