USMLEasy Flashcards
(26 cards)
Young straight male pt with pain with defection, slight bright red bleeding - most common cause?
Anal fissure > external hemorrhoid
Esophageal hiatal hernia - when surgery?
Esophagitis or stenosis
Patient after kidney transplant has elevated calcium – cause? Management?
Tertiary hypothyroidism (hypercalcemia secondary to time this parathyroid function after transplant)
Total parathyroidectomy and autotransplantation into forearm
Epispadias – incomplete development of? Associated with?
Anterior urethra
#Cordee (ventral curvature of the penis) #Undescended testes #Inguinal hernias
How to distinguish between acute and chronic DVT’s on duplex?
Large collaterals suggest chronic
Patient is exposed to radiation – chance of developing thyroid tumor? Type of thyroid tumor? Treatment?
40%; papillary; total thyroidectomy
Patient has splenic injury from trauma – only contraindication for non-operative management?
Peritoneal signs on abdominal exam (CT imaging of shattered spleen not an indication, positive DPL is not indication)
Resuscitation for bleeding child?
#20 mg per kilogram bolus #Repeat bolus #Repeat bolus #Blood transfusion
Preferred thrombolytic agent in occlusion of bypass graft? Reocclusion rate?
Urokinase; 20% reocclusion rate within one year
Pt with injury to common bile duct – surgical management?
choledochojejunostomy (Preferred over choledochoduodenostomy because less fistula formation)
Contrast CT shows small, circular hypodense lesion with ring-like contrast enhancement
- Cause if immunocompetent?
- Cause if Immunocompromise?
- If systemic signs of infection?
- Metastatic cancer
- Toxoplasmosis and CNS lymphoma’s
- Brain abscess
Positive crossmatch means?
Recipient has circulating antibodies that are cytotoxic to the donor lymphocytes
Thrombin time assesses?
Fibrinogen
Management of gunshot wound to the pancreas?
#Most which is simple drainage #Injury to the major pancreatic duct – distal pancreatectomy #Injury to head of the pancreas – Roux-en-Y Pancreaticojejunostomy
Sign of left-sided portal hypertension? Acute hemorrhage due to this is treated with?
Gastric varices
Splenectomy
Treatment for renal cell tumor?
#If under 4 cm, partial nephrectomy #If larger, radical nephrectomy (remove a kidney, adrenal gland, perirenal fat)
Large pulsatile mass found in right popliteal fossa. Likely diagnosis? Complications? When/what Surgery?
Popliteal artery aneurysm
#Embolization – 25% #Thrombosis – 40% with resultant gangrene #Aneurysm rupture – 5%
Surgery if symptomatic or greater than 2 cm
repair with excision of aneurysm and surgical bypass
Ogilvie syndrome?
Massive cecal and colonic dilation without mechanical obstruction
#if under 10 cm without ischemia, NPO, NG tube, resuscitation #It's over 10 cm, cautious colonoscopy
Hurthle cell CA similar to what cancer? Differences?
Type of follicular cancer
#often multifocal and bilateral #More likely to spread to local nodes and distant sites (higher mortality rate)
Surgical management of ruptured esophagus?
If Patient has underlying motility disorder, stricture, or malignancy?
Primary repair and mediastinal drainage
Esophagectomy
Patient with persistent gastric ulcer refractory to medical therapy. Also located 2 cm above pylorus – surgical management?
Partial gastrectomy with vagotomy and Billroth I reconstruction
CEA level of 100 after colorectal resection – suggests?
Liver involvement
Tracheostomy – where to enter trachea?
Second or third cartilage ring
Patient with annular pancreas – surgical therapy?
Duodenoduodenostomy
