Flashcards in Gen Surg Essay Exam Deck (28)
Ddx of breast mass? (9)
1. Breast cyst
3. Cystosarcoma phyllodes
4. Fat necrosis
6. Lactating adenoma
7. Juvenile hypertrophy
what are the two variations of Fibroadenoma?
1. Giant fibroadenoma: >5cm, usually in pregnant or lactating women, usually shrink
2. Juvenile fibroadenoma: adolescent females, around time of puberty
how does cystosarcoma phyllodes spread?
hematogenously NOT lymph nodes
what is cystosaracoma phyllodes? tx?
- found in 30-40yr old WOMEN
- look like fibroadenoma on US
- painless mass
-tx: local excision
what is juvenile hypertrophy? treatment?
- bilateral hypertrophy
tx: subcutaneous mastectomy or reduction mammoplasty
what are the 3 peaks of gynecomastia?
1. Neonatal: due to maternal estrogen in utero
2. Puberty: reassurance
3. 50-70 yrs: drugs, liver disease, gonadal failure
*not a risk factor for breast ca*
Ddx of calcifications/abnormal mamogram? (6)
1. Mass lesions
2. Radial scar
3. Ductal ectasia
4. Sclerosing adenosis
5. Lobular hyperplasia
Treatment of ALH/ADH?
- excision to exclude DCIS
- dont need to have negative margins
what are the contraindications to breast preservation? (5)
1. Inability to receive radiation (prior radiation, pregnancy, collagen vascular disease)
2. High tumor to breast size ratio
3. Multifocal disease
4. Inability to achieve negative margins
5. Fibrous tissue disorders
when is a SLNBx contraindicated?
if there are palpable lymph nodes in the axilla
when should you do radiation therapy after a mastectomy?
Tumor >5cm and more than 4 LN positive
what are prehepatic causes of jaundice? (4)
2. Transfusion reaction
4. Drug induced
What are intra-hepatic causes of jaundice? (5)
3. Hepatocellular diseases (gilberts, hemochromatosis, wilsons, G6PD def, crigler-najjar)
4. Hepatic abscess (pyogenic, amebic)
5. Hepatic cancer (primary or metastatic)
Posthepatic causes of jaundice? (5)
3. Biliary stricture
4. Pancreatic cancer
5. Cholestasis (pregnancy, sepsis, CHF)
What are some key things to ask about in a pt w jaundice for history?
2. dark urine
3. light stools
5. blood transfusions
What is charcots triad?
1. RUQ pain
what is reynolds pentad?
1. RUQ pain
5. Altered mental status
what lab tests should you order in jaundice pt?
1. LFTs (AST, ALT, AP, total ind/direct bili, albumin, PT)
2. CBC, peripheral blood smear
3. Pregnancy test
4. direct coombs test for autoimmune hemolysis
what is the differential diagnosis of a neck mass? (7 categories)
1. Thyroid: cyst, goiter, cancer
2. Lymph Node: infected, reactive, lymphoma, metastatic cancer
3. Salivary gland: submandibular or parotid tumor (benign or malignant)
4. Soft tissue: abscess, lipoma, sebaceous cyst, primary soft tissue tumor
5. Vascular (hemangioma, carotid body tumor, aneurysm)
6. Nerve: neuroma
7. Congenital remnants
What are the congenital remnants that can present as a neck mass?
1. Thyroglossal duct cyst
2. Branchial cleft cyst
3. Dermoid cyst
things to ask about in history for someone w a neck mass?
1. Recent URI
2. Insect bites/exposure to animals
3. family history (esp MEN syndrome)
4. Radiation exposure
5. Obstructive symptoms
mass in the midline of the neck? (4 ddx)
1. Thyroglossal duct cyst: moves w swallowing, in child
4. Sebaceous or dermoid cyst
mass in the lateral neck?
1. Inflammatory LN
2. Metastatic cancer
3. Salivary gland tumor
4. Branchial cleft cysts: usually 20-30yo, small pit in skin anterior to SCM
5. Carotid body aneurysm or tumor
treatment of thyroglossal duct cysts?
excision w a segment of hyoid bone (sistrunk procedure)
what level do you check in medullary ca of thyroid?
Differential diagnosis for dysphagia? (functional disorders) (3)
2. Chagas disease
3. Esophageal spasm syndromes
What are thee 4 esophageal spasm syndromes?
1. Nutcracker esophagus
2. Diffuse esophageal spasm
3. Hypertensive lower esophageal sphincter
4. Non-specific elongated motor disorders