Pre-Test (Endocrine/Breast, GI)

Question 1

Isolated focus of increased uptake on a thyroid scan virtually diagnostic of

Answer 1

Hyperfunctioning adenoma

Question 2

Multifocal breast Ca means

Answer 2

Multiple tumors w/in 1 quadrant of the breast

Question 3

Important prognostic factor in papillary and follicular thyroid Ca

Answer 3

Age (>45 years worse prognosis)

Question 4

Papillary Ca thyroid description on path

Answer 4

Calcified clumps of sloughed cells

Question 5

LCIS work up

Answer 5

Frequent self breast exams and yearly screening mammograms (LCIS considered risk factor for cancer development, not precursor)

Question 6

Acute management of hypercalcemia

Answer 6

Vigorous hydration to restore intravascular volume and Lasix

Thiazides contra b/c they increase Ca

Question 7

Cushing’s dz tumor

Answer 7

Pituitary tumor

Question 8

Pre surgery pheo tx

Answer 8

Pre-op w/ alpha blockade (phenoxybenzamine) 1-3 weeks before

can add b-blockers

Question 9

Tx of breast cancer in pregnant woman

Answer 9

Immediate surgery, chemo after 1st trimester

Radiation absolutely contraindicated

Question 10

Workup for suspected Paget’s

Answer 10

Mammogram and biopsy of the affected area

Question 11

Secretin test results for ZE syndrome

Answer 11

Rise in Gastrin

Question 12

tx to prevent thyroid storm after thyroid removal in graves

Answer 12

10 days pre-op w/ Drops of Lugol iodide solution

B-blocker is tx for thyroid storm

Question 13

Tx of single PTH adenoma

Answer 13

Removal of that adenoma

Question 14

Tx for Hurtle cell thyroid tumor? What is it?

Answer 14

Surgery followed by radioiodine ablation

Is a type of follicular cancer, but is more often multifocal and bilateral

Question 15

When is thyroid lobectomy ok

Answer 15

for single adenomas less than 4cm size

Question 16

Most common cause of cushing syndrome

Answer 16

Iatrogenic

Question 17

Indication for radical mastectomy

Answer 17

Locally advanced breast cancer with wide invasion of pec major muscle in pt who can handle surgery

Question 18

Omeprazole MOA

Answer 18

Inhibits H+-K+ ATPase in secretory canaliculus of the gastric parietal cell

Question 19

Platelet transfusions in ITP reserved for? Otherwise tx?

Answer 19

Acute bleeders

Otherwise (30k-50k) tx w/ steroids and IV-IG

Question 20

Tx for adenocarcinoma of the spleen

Answer 20

Right hemicolectomy

Question 21

Safest and most effective tx of achlasia

Answer 21

Esophagomyomyotomy (modified heller myotomy –> cutting LES)

Question 22

Most frequent complication of end colostomies

Answer 22

Parastomal herniation –> commonly when stoma is placed lateral to, rather than through, rectus muscle

Question 23

When do the majority of dumping syndrome cases resolve

Answer 23

Within 3 months

Question 24

Medical mgmt of bleeding varices

Answer 24

Octreotide or vasopressin (balloon tamponade if those don’t work)
Don’t forget crystalloids

Question 25

Lesions of Peutz-Jagers? Other things seen?

Answer 25

Hamartomas | Also melanin spots on oral mucosa

Question 26

Indications for surgical intervention in dirverticular disease

Answer 26

Hemorrhage secondary to diverticulosis, recurrent episodes of diverticulitis, intractability to medical therapy, complicated (perforations with or w/out abscess and/or fistula)

Question 27

When can gallbladder polyps be measured w/ serial CT's? Sx for gall bladder cancer

Answer 27

when they are less than 1cm | Do radical cholecystectomy for gall bladder cancer

Question 28

Tx for Entamoeba histolytica liver abscess

Answer 28

metronidazole

Question 29

Important step prior to undergoing operative intervention for GERD

Answer 29

Endoscopy

Question 30

Mgmt for non-necrotic chronic ischemic colitis

Answer 30

Expectant mgmt

Question 31

Bowel Habits after colonic resection

Answer 31

Relatively normal

Question 32

What part of the colon absorbs more salt and water

Answer 32

Right

Question 33

When do you take out hepatic andenomas

Answer 33

When greater than 4cm (risk for rupture and risk for malignant transformation)

Question 34

If performing appendectomy, Chron's is noted, what do you do

Answer 34

Take out appendix as normal (90% who present like this will not progress to full blown disease)

Question 35

Tx for biliary stricture? most likely cause?

Answer 35

End-to-side choledochojejunostomy (Roux-en-Y) | Most likely iatrogenic

Question 36

90% of gastrinoma's located where?

Answer 36

"gastrinoma triangle" - junction of 2nd and 3rd portions of duodenum, junction of neck and body of pancreas, and junction of cystic and common bile duct

Question 37

Tx for insulinoma

Answer 37

Simple excision of the tumor

Question 38

Apple core lesion on colon tx

Answer 38

Bowel prep followed by removal of area (obstructing)

Question 39

Most likely dx in older person with markedly distended colon? Workup?

Answer 39

Cecal or sigmoid volvulus --> dx w/ sigmoidoscopy (also can be therapeutic) --> If neg think cecal location (do emergent celiotomy)

Question 40

Procedure of choice for cecal volvulus

Answer 40

Right hemicolectomy

Question 41

Kidney bean vs Coffee bean sign

Answer 41

Kidney bean - cecal volvulus | Coffee bean - sigmoid volvulus

Question 42

Most common non-OB related surgical condition in pregnant women

Answer 42

Appendicitis

Question 43

Paraesophageal vs Sliding hernia worse?

Answer 43

Paraesophageal (sliding hernia contained by intact pleura)

Question 44

Olgivie's syndrome tx

Answer 44

Bowel rest and NG tube (Unless >10 cm dilated)

Question 45

First line tx for major hematobilia

Answer 45

Transarterial embolization

Question 46

Crypt abscesses and superficial ulcerations in what bowel dz

Answer 46

UC

Question 47

Test for small bowel bleeding in people under 30?

Answer 47

Tech 99 pertechnetate scan -- Looking for Meckels (MCC of small bowel bleeding under 30)

Question 48

Colectomy vs Simple appendix removal in carcinoid of appendix

Answer 48

Less than 1 cm just take appendix 1-2 based on location >2 Right hemicolectomy

Question 49

Where are stress ulcers usually found

Answer 49

Usually involve lower body and funds | *Spare antrum*

Question 50

Tx for cholecystitis in critically ill

Answer 50

Tube cholecystostomy

Question 51

How long until therapy for pancreatic pseudocysts

Answer 51

At least 6 weeks**

Question 52

Where do carcinoid tumors originate? What do they look like in rectum

Answer 52

Crypts of Leiberkuhn

Question 53

Definitive operation of choice for patients with UC

Answer 53

Total proctocolectomy w/ end ileostomy or illegal J-pouch anastomosis