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ABSITE REVIEW
Medial located ulcers in leg are associated with incompetent: - Answers -Great saphenous vein or medially located incompetent perforators Lateral located ulcers on lower extremity are associated with incompetent: - Answers - small saphenous veins or laterally located perforators Phlegmasia Cerulea Dolens is: - Answers -A rare condition causing massive DVTs also assx with arterial occlusion (and compartment syndrome) The most important variable related to requiring IVC filter removal is dwell time of: - Answers -7 months or longer Colonic ischemia following abdominal aortic aneurysm repair is diagnosed with a sigmoidoscopy, treatment is: - Answers -Mucosal ischemia: supportive care/broad spectrum antibiotics, Full thickness ischemia: colon resection with end ostomy What is the "Mickey Mouse" sign? - Answers -Description of saphenofemoral junction: most upward ear is the great saphenous vein, middle is the common femoral vein, and the more lateral ear is common femoral artery These 2 muscles are most commonly associated with popliteal entrapment syndrome - Answers -Gastrocnemius and popliteus muscle Peripheral arterial emboli usually lodge at - Answers -bifurcations (aortoiliac most common then popliteal, superficial femoral, and external iliac arteries) Pregnant women with DVT can take these 3 medications for anticoagulation - Answers - Unfractionated heparin, low-molecular weight heparin, warfarin (all of these can be used while breastfeeding) This is the anticoagulation is #1 choice for pregnant women due to lower risk of bleeding, HIT, and osteoporosis - Answers -Low molecular weight heparin _____is effective for patient with train of four stimulation evident of profound levels of NM blockade - Answers -Sugammadex _____ is an effective rapid reversal of rocuronium and vecuronium with partial neuromuscular blockade (1-2 twitches) - Answers -Neostigimine/glycopyrrolate
HER2 breast cancer should be treated with neoadjuvant: - Answers -Trastuzumab along with (chemotherapy) monoclonal antibody chemotherapy - it has been proven to be more effective. Also CHF alone is not a contraindication for treatment. ddAC-T can be used as neoadjuvant therapy for: - Answers -triple negative breast cancer Neoadjuvant therapy is recommended in triple negative breast cancer greater than ___ cm - Answers -0.5cm Standard of care for ductal carcinoma in situ is: - Answers -Surgical excision with radiation and hormonal therapy Sentinel lymph node is only recommended in ductal in situ carcinoma if lesion is greater than ___cm, there is a ___mass, ___seen on pathology, or indication for bilateral ___ - Answers -Lesions >4cm, palpable mass, microinvasion, mastectomy The appropriate margins for DCIS is ___ - Answers -2mm, re-excision is indicated if this is not achieved on initial surgery Excision for DCIS is recommended since __% of these contain a foci of invasive ductal carcinoma - Answers -20% Standard of care for inflammatory breast cancer is: - Answers -modified radical mastectomy (mastectomy plus axillary lymph node dissection) ___% of patients with inflammatory breast cancer have metastases at diagnosis - Answers -30% The inability to identify a sentinel lymph node intra-operatively for breast cancer would necessitate: - Answers -axillary lymph node dissection Screening for low-risk cancer s/p lobectomy should include: - Answers -Clinical examinations every 6 months for 5 yrs then annually thereafter, and annual mammography for the contralateral non-reconstructed breast Treatment for Phyllodes tumors include: - Answers -Surgical Excision (negative margins of at least 1cm) ithere is NO indication for radiation, chemo, or mastectomy. Only do mastectomy in small breasts or inability to achieve negative margins. They rarely metastasize to the axillary lymph nodes Excision of phyllodes tumor must include negative margins of at least ___ - Answers - 1cm
____ for SNL can be used safely in pregnancy - Answers -Technetium 99 ____ for SNL can NOT be used in pregnancy - Answers -methylene blue Treatment for inflammatory breast cancer without distant metastasis includes: - Answers -Neoadjuvant chemotherapy followed by mastectomy, axillary lymph node dissection (radial mastectomy) and radiation therapy Paget's disease histologically will show: - Answers -Large cells with pale cytoplasm and prominent nucleoli (Paget cells) involving the epidermis of the nipple Standard of care for atypical ductal hyperplasia in breast cancer is - Answers - Excisional biopsy (18-50% of cases are associated with carcinoma) BRCA2 mutation is associated with a higher risk of these 3 cancers - Answers -Male breast cancer, prostate cancer, and pancreatic cancer Most common cause of spontaneous unilateral bloody nipple discharge is: - Answers - an intraductal papilloma If patient has nipple discharge (from an isolated duct) and no lesions are identified by mammogram or ultrasound, you should order a : - Answers -MRI or ductogram for further imaging, if there is an abnormality then get tissue biopsy. If not abnormality then you can pursue a duct excision. Alternative to duct excision is a f/u exam and imaging in 6 months Inflammatory breast cancer pathology shows: - Answers -Dermal lymphovascular tumor emboli For granulomatous mastitis, you should get a biopsy sample for - Answers -acid fast bacilli (r/o TB) For axillary node dissection, all of the nodal tissue with level ___ of the axilla is removed
- Answers -Level I and level II (tissue inferior to the axillary vein, and from the medial border of the pectoralis minor muscle to the lastissimus dorsi muscle) ___% of Paget disease is associated with underlying in situ or invasive carcinoma - Answers -90% HER2 breast cancer with hormone receptor positve can be treated with adjuvant ___ therapy post-operatively - Answers -Endocrine therapy (Tamoxifen) to minimize occurrence...5 yrs? On breast ultrasound, a solid mass with lobulated margins is consistent with a : - Answers -fibroadenoma
On breast ultrasound, pleomorphic calcifications are associated with: - Answers -in situ cancer On breast ultrasound, ductal dilation with intraductal mass is consistent with: - Answers -intraductal papilloma or ectasia SLND is appropriate for almost any patient with has: - Answers -early invasive breast cancer and without clinically palpable axillary lymph nodes (controversy on use on large tumors >5cm) Calcifications on screening mammogram should be further evaluated with a: - Answers - diagnostic mammogram with magnification views and likely a stereotiactic biopsy ___ syndrome is associated with p53 mutation - Answers -Li-Fraumeni syndrome Li-Fraumeni syndrome is associated with what cancers? - Answers -Breast cancer, sarcomas, brain tumors, leukemia, and adrenocortical malignancies. The thoracodorsal nerve is responsible for - Answers -arm adduction, arm extension, and internal rotation (innervates the latissimus dorsi) ___local inoculation of bacteria in an immunocompromised patient. Nodular cellulitis, sometimes draining pus as well as yellow granules - Answers -Botryomycosis Sentinel lymph node biopsy is indicated in melanomas greater than > ___ in size or in the presence of _____ - Answers -1mm in size or if there are ulcerations Initial treatment for first episode of pilonidal abscess is: - Answers -incision and drainage. Overall success is only 60% Skin lesions concerning for melanoma are typically greater than ___ in size - Answers -
6mm in size History of melanoma and new onset headaches with increasing frequency should be investigated with: - Answers -MRI to rule out brain metastasis Soft tissue lesions that are large and nonmobile should be evaluated with a - Answers - MRI! (diagnostic) and then later you can get a targeted biopsy Immunocompromised patients are at high risk for developing aggressive SCC, risk factors that warrant a sentinel node biopsy is a tumor diameter >___ for trunk/extremities and >___ for the face, scalp, hands, and feet - Answers ->2cm for trunk/extremities, >1cm for the face, scalp, hands, feet
A ___ approach is preferred site for an internal sphincterotomy - Answers -Lateral approach (hemorrhoidal columns are present on the right anterior and right posterior anal canal, increased risk of bleeding) Goal for transanal resection is to obtain ___mm negative margins - Answers -10mm Minimal genital warts are treated with - Answers -podophyllin resin in a 10% or 20% benzoin solution and bichloacetic acid Extensive genital warts or lesions found in the anal canal is treated with - Answers - Excision of lesions For low grade anal intraepithelial neoplasia, the treatment of choice is with: - Answers - Observation with surveillance every 4-12 months When considering transanal resection, inclusion criteria primarily assesses risk for: - Answers -Lymph node metastasis (want the lowest risk for LN mets since transanal resection cannot remove/assess mesorectal lymph nodes) Treatment for all stages of anal squamous cell cancer is - Answers -Chemoradiation (Nigro regimen: 5-FU, mitomycin C, and pelvic radiation therapy with 50 Gy to the primary carcinoma and 35-45 Gy to the pelvic inguinal lymph nodes) In a patient with potentially hostile abdomen who is at elevated risk for perioperative complications a ___ approach to a rectal prolapse is safer under spinal or general anesthesia - Answers -Perineal approach to rectal prolapse With early presentation <72hrs of duration, treatment for a thrombosed external hemorrhoid is with: - Answers - With late presentation >72 hrs of duration, treatment for a thrombosed external hemorrhoid is with: - Answers -non-operative therapy such as sitz baths and adequate pain control Best treatment for a healthy woman with rectal prolapse is with: - Answers - Sigmoidectomy (most patients have redundant sigmoid) with rectopexy IV duration for intra-abdominal abscess is: - Answers -Shorter 4 day fixed course of IV antibiotics For stable GI bleeds not requiring ongoing transfusions, it is recommended to perform a colonoscopy within ____ - Answers -24hrs after adequate colon preparation
Treatment for diverticulitis with a pelvic abscess should be treated with - Answers - Antibiotics and IR drain Recommendations for follow up of patient after colon cancer resection are: - Answers - Clinical exam and carcinoembryonic antigen level every 3-6 months, CT chest/abdomen/pelvis every 6-12 months, and colonoscopy at 12 months C. diff toxic megacolon is either a cecal diameter of >___ or colonic diameter of >___ - Answers ->12cm cecal diameter and >6m colonic diameter, operative management is recommended (emergent ex lap, total colectomy, end ileostomy, and PO vanco with IV metro) For a patient with ischemic colitis, if the initial ischemic involves more than just the mucosal/submucosal layers this can cause ___ - Answers -fibrosis with subsequent stricturing of the colon The antibiotic regimen for a patient with fulminant c. diff disease (fever, hypotension, leukocytosis, elevated creatinine) is PO vanco, IV metro and the addition of rectal vancomycin enemas if ___ is present. - Answers -Ileus is present Peutz-Jeghers syndrome is an autosomal dominant disorder resulting from a ____ mutation - Answers -STK11 mutation ERAS supports the use of ____ which antagonizes the peripheral effects of opioids on GI motility - Answers -Alvimopan (Entereg) Blind loop syndrome should be treated long term with: - Answers -Vitamin B replacement and medium chain triglycerides (it addresses pernicious anemia and nutrition) Nonocclusive mesenteric ischmia is linked to patients with _____ - Answers -Severe cardiac failure and low flow state Neuroendocrine tumors greater than 1 cm, multiple tumors or regional lymph node mets should be treated with: - Answers -oncologic resection of bowel and mesentery ____can be used in patients with short bowel syndrome who are unable to wean off parenteral nutrition - Answers -Teduglutide, a glucagon-like peptide 2 (GLP-2) analog (helps with restoration of intestinal function and structureal integrity through significant intestinotrophic and proabsoptive effects) Stricturoplasties are useful in Crohns disease in the management of ____ segments of disease - Answers -Longer segments to help preserve a substantial length of small bowel that would otherwise be lost with resection and primary anastomosis
High risk GIST tumors can be demonstrated by a ___ mutation - Answers -KIT (CD117) mutation, other signs include size >10cm and mitotic rate >10/50 HPF C-KIT positive tumors (GIST) respond to therapy with ____, for 3 or more years - Answers -Imatinib A patient with peptic ulcer disease with failed medical therapy for more than 12 weeks is a candidate for treatment with: - Answers -Truncal vagotomy and antrectomy (both decrease peak acid output by 85%, whereas vagotomy alone only decreases peak acid output by 50%) Type I ulcers are located: - Answers -Lesser curvature at the level of the incisura angularis Type II ulcers are located: - Answers -Located in both the gastric body and duodenum Type III ulcers are located: - Answers -The prepyloric area Type IV ulcers are located: - Answers -High on the lesser curvature Type V ulcers are located: - Answers -Anywhere in the stomach Larger perforated duodenal ulcers should be treated with: - Answers -Jejunal serosal (Thal patch)it has a lower incidence of recurrent leak in larger ulcers GIST tumors arise from ____cells and stain positive for ____ - Answers -Interstitial cells of Cajal, CD-117 (c-kit proto-oncogene) with over 80% staining positive for CD Granulation tissue can be treated with: - Answers -silver nitrate (it is painful) GIST with 5-10cm in size, no LN, low mitotic rate are stage ___ - Answers -Stage IB GIST with <5cm in size, no LN spread and no distant mets, low mitotic rate are stage ___ - Answers -Stage IA GIST with <5cm in size, no LN spread, no mets, and high mitotic rate are stage ___ - Answers -Stage II GIST with 5-10cm , no LN, high mitotic range are stage ___ - Answers -Stage IIIA GIST with size >10cm with high mitotic range are stage ___ - Answers -Stage IIIB GIST with LN mets, distant mets of any size are stage ___ - Answers -Stage IV
Zollinger-Ellison syndrome is a clinical triad of: - Answers -Gastric acid hypersecretion, severe peptic ulcer disease, and non-beta islet cell tumors of the pancreas (gastrinomas) GIST tumors metastasize through hematogenous spread, most commonly to the ___ and ___ - Answers -Liver and peritoneal surgaces. They do NOT spread through lymphatics so no lymphadenopathy necessary. The right adrenal vein comes directly off the ____ - Answers -Inferior vena cava, ligation of this vein is crucial in a right adrenalectomy Orphan annie eye is a characteristic finding of _____ - Answers -Papillary thyroid cancer Thyroid lobectomy is appropriate for papillary thyroid cancer < ___cm with no nodal met, evidence of invasion, and normal contralateral lobe - Answers -4cm According to Miami criterion for PTH s/p parathyroidectomy, PTH should drop by ___% at 10minutes following excision - Answers -50%, if this is not met then repeat PTH at 20minutes. Carcinomas are likely to have higher attenuation (>____Hounsfield units) - Answers - Parathyroid carcinoma is treated with: - Answers -Radical resection of involved gland, ipsilateral thyroid lobe, and regional lymph nodes Patients with Graves hyperthyroidism should be treated with ____ preoperatively - Answers -Antithyroid medication, to prevent thyroid storm Mainstay of treatment for recurrent parathyroid carcinoma is: - Answers -Reexploration and resection, just know that scar tissue can form following the initial procedure The ____ is the most commonly injured nerve following total thyroidectomy due to its close proximity to the superior thyroid artery - Answers -External branch of the superior laryngeal nerve For a pregnant woman requiring surgical resection of invasive ductal carcinoma, grade 3, ____ is preferred treatment. - Answers -Right mastectomy and SLNB (cant do lumpectomy due to delayed radiation given pregnancy) Risk of developing invasive breast cancer after diagnosis of LCIS is approximately ___ per year - Answers -1% For a premenopausal woman with diagnosis of atypical lobular hyperplasia, treatment should be ____ - Answers -Chemoprevention with Tamoxifen
___ is produced by acinar cells in the pancreas and help with digestion of long chain polysaccharides - Answers -amylase -- it helps with digestion of sugars To enter the lesser sac for distal pancreatectomy, the ___ should be divided - Answers - Gastrocolic ligament should be divided, with stomach reflected superiorly and the colon reflected inferiorly Pseudocyst has ___ CEA, ___ amylase, and ___fluid - Answers -Low CEA, High amylase, and serous fluid Serous cystic neoplasm shows ___ CEA, ___ amylase, and ___ fluid - Answers -Low CEA, Low amylase, and serous fluid MCN pancreatic cyst will have ___ CEA, ___ amylase, and ___ fluid - Answers -High CEA, low amylase, and mucinous fluid IPMN cyst will have: __ CEA, ___ amylase, and ___ fluid - Answers -High CEA, High amylase, and mucinous fluid Locally advanced pancreatic cancer is defined as CT evidence of arterial encrouchment of the ___ or ___ arteries or venous involvement/occlusion of the ___ or ___ veins - Answers -Celiac axis or superior mesenteric artery, and venous involvement of superior mesenteric vein or portal veins Pancreatic neoplasm that is has "ovarian type" stroma is consistent with a ____ neoplasm - Answers -Mucinous cystic neoplasm A Puestow lateral pancreaticojejunostomy is only possible with a ___ pancreatic duct - Answers -Dilated pancreatic duct An appropriate ventilator strategy for a neonate with congenital diaphragmatic hernia is:
- Answers -Pressure limited, pressure controlled (gentle) ventilator strategy to keep peak positive pressures below 24 to 25, allowing elevated CO2 (45-70) to limit volutrauma, barotrauma, and atelectrauma A bucket handle anomaly in a newborn is clue to a: - Answers -Rectoperineal fistula, get an x-ray to confirm rectal air column and priamry anoplasty if confirmed The most common abnormality associated with gastroschisis is: - Answers -Intestinal atresia Midgut volvulus in a baby is treated with active rotation of bowel in ____ fashion - Answers -Counterclockwise fashion (turning back time)
An infant with low weight, lack of enteral feeding, and is stable suddenly has distension with large volume pneumoperitoneum seen on radiograph. What is the likely condition and what should you do? - Answers -Spontaneous intestinal perforation, place a peritoneal drain, surgery (lapartomy with enterostomy) is not indicated unless patient gets extensive gangrene. Most babies resolve this, seal this spontaneously Most common reason for soiling in children with Hirschsprung disease after a pull through is: - Answers -Incomplete emptying of the colon with overflow of stool (chronic constipation) A massive air leak with continued pneumothorax is an indication for ____ - Answers - Thoracotomy Compartment syndrome often occurs after revascularization of a lumb with greater than ____hrs of profound ischemia - Answers -6-8hrs The ____ compartment of the leg is usually the first part to be affected in compartment syndrome - Answers -Anterior compartment Typically, an injury to the duodenum that is less than ___ in circumference can be managed with primary closure - Answers -50% 4 Hard signs for vascular injury are: - Answers -Absent distal pulse, Palpable thrill or audible bruit, expanding hematoma, and active pulsatile bleeding Stomal necrosis that extends below the fascia should be treated with: - Answers - Observation, it is better to let the necrotic tissue slough on its own, and let the body heal beneath it Sitz marker study is: - Answers -Study in which you injest radioopque markers followed by daily radiographs to monitor them as rthey pass through colon. It helps diagnosis colon inertia, motility of the colon The molecular marker most associated with signet ring colorectal carcinoma is: - Answers -Microsatellite instability ___ is a cream that can be used as a topical treatment for condylomatous lesions that is minimally irritating to surrounding tissues - Answers -Podofilox (works by inhibiting mitosis via tubulin inhibition?) ____ is caused by the human papillomavirus and has a distinctive pale, cauliflower like appearance and tends to run radial rings around the anus - Answers -Condylomata acuminata
of biliary tree and image guided draining of subhepatic fluid collection. Percutaneous transhepatic cholangiograms are very effective at decompressing the biliary tree Relative contraindications to a laparoscopic transcystic common bile duct exploration are: 1. gallstones in the ____ duct, small (<3mm) or friable stones, gallstones greater than ___ or more than ___ stones in the CBD - Answers -Gallstones in the common hepatic duct, gallstones greater than 6 to 8mm, more than 8 stones in the CBD Dissection of the common bile duct should only be performed on the ___ portion of the common bile duct - Answers -Anterior portion, the arterial blood supply runs on the medial and lateral portions Treatment for T1a gallbladder cancer is: - Answers -Cholecystectomy, no additional therapy needed Treatment for cholangitis (Stage II and III) is - Answers -Urgent ERCP, IVF and antibiotics for urgetn biliary drainage and medical stabilization Sphicnter of Oddi dysnfunction can be treated with empiric: - Answers -Endoscopic sphincterotomy ______ is associated with the majority of choledochal cysts - Answers -Anomalous pancreatobiliary junction: Fused long common pancreatic and biliary channel. This allows pancreatic anzymes to reflux into the biliary tree, causing inflammation that results in cystic degeneration ___% of patients have aberrant biliary anatomy - Answers -30-40%, most commonly it is insertion of the right posterior sectoral duct into the left hepatic duct Diagnostic laparoscopy for pancreatic cancer involves: - Answers -Evaluation of the liver, bowel, and abdominal wall, pelvic washings for cytology, dividing the gastrocolic omentum to access the lesser sac and send washings of lesser sac for cytology. Laparoscopic ultrasound can also be conducted to assess patency of nearby vessels, stenosis of the pancreatic duct, and to guide lymph node biopsy Treatment for pseudomyxoma peritonei involves: - Answers -Surgical debulking followed by intraperitoneal chemotherapy The most common primary malignant peritoneal neoplasm is: - Answers -Mesothelioma ___, ____, and ____ are the three most common agents used in intraperitoneal chemotherapy - Answers -Cisplatin, Doxorubicin, and Mitomycin-C Type I Hematoma is defined as: - Answers -Small, confined, does not cross the midline or dissect fascial planes
Type II Hematoma is defined as: - Answers -Confined within rectus muscle, but can dissect along the transversalis fascial plane or cross the midline Type III Hematoma is defined as: - Answers -Below the arcuate line, large in size, and presents with blood in the prevesical space of Retzius and/or hemoperitoneum ____ hernias are the most common hernias in both men and women - Answers -Indirect inguinal hernias Highest risk factor for developing an umbilical hernia is: - Answers -Pregnancy, women get umbilical hernias 3x more than men and 90% of women develop an umbilical hernia during pregnancy The artery most likely to be injured during inguinal herniorrhaphy is the - Answers - Inferior epigastric artery Asymptomatic inguinal hernias have a ___% of incarceration over 2 years - Answers - <1% chance, so you can safely observe inguinal hernias if they are asymptomatic The ____ repair is the only open, nonmesh repair that can be used to repair either inguinal or femoral hernias - Answers -McVay repair, this is because it sutures Cooper's ligament to the pubic tubercle. The last stitch (transition point) incorporates the inguinal ligament. Both TAPP and TEPP hernia repairs can be used for inguinal and/or femoral hernias If a patent cholecystectomy tube has not improved a patient's clinical presentation within 24 hours, it is likely either due to a ___ or ____ since chole tubes are not effective in these gallbladders - Answers -Perforated gallbladder or gangrenous gallbladder What feature of the biliary tree makes it particularly susceptible to ischemic injury? - Answers -The biliary tree is supplied solely by the arterial anatomy, at the 3 o'clocl and 9 o'clock positions (as opposed to hepatic parenchyma which receives both venous and arterial inflow) T2a gallbladder tumors invade the perimuscular connective tissue on the ___ side - Answers -Peritoneal side T2b gallbladder cancer invades the perimuscular connective tissue on the ___ side - Answers -Hepatic side In a patient with recurrent RUQ pain with the absence of gallstones or other causes on endoscopy, a diagnosis of ____ must be considered - Answers -Biliary dyskinesia. You can use a HIDA scan with CCK injection to demonstate an ejection fraction <35%. Cholecystectomy might be curative.
Initial treatment for suspected bacterial peritonitis is - Answers -Intraperitoneal gentamicin and ceftriaxone (or vancomycin to replace cephalosporin) If there is intraperitoneal infection in setting of peritoneal dialysis, the catheter only needs to be removed if: - Answers -1. no response to treatment in 4-5 days, there is known fungal peritonitis, the peritonitis is associated with intra-abdominal pathology ____ thermal injury of initial surgery classically presents a few days after surgery - Answers -Monopolar thermal injury Multiple lateral fissures should prompt suspicion for _____ - Answers -Crohn's disease ____ is a precursor to squamous cell carcinoma - Answers -Actinic keratosis Surgical Treatment for actinic keratosis - Answers -Cautery and destruction, shave excisions, dermaabrasion or chemical peels Medical treatment for actinic keratosis: - Answers -Topical 5FU, Imiquimod, fluorescence, or photodynamic therapy Retroperitoneal fibrosis after pelvic irradiation can initially be treated with ____ - Answers -Corticosteroids When ____ occurs in retroperitoneal fibrosis, then ____ should be performed - Answers -When renal impairment occurs, surgery to free up the ureters should be pursued. If patient is actively septic delay surgery until infection is undercontrol with IV antibiotics and drainage of ureters (bilateral percutaneous nephrostomy) Acute upper extremity DVT from Paget Shroetter syndrome (venous thoracic outlet syndrome) can be treated with: - Answers -IV Heparin and anticoagulation therapy, thrombolysis has a good success rate if done within two weeks of initial presentation Burns that extend into the muscle are classified as ___ degree - Answers -4th degree Burns that extend into the subcutaneous tissue are classified as ____ degree - Answers -3rd degree Both penetrating and blunt injuries resulting in hematoma in zone ___ should be surgically explored - Answers -Retroperitoneal zone I: Bordered by diaphragm superiorly, sacral promontory inferiorly, and renal hila laterally. It contains the aorta, vena cava, portal vein, proximal renal vessels, pancreas, and duodenum ____ (blunt or penetrating) injuries resulting in zone II hematoma need surgical intervention - Answers -Penetrating: Zone II contains the renal hila, kidneys, adrenals,
and superior ureters. Blunt injuries typically don't need exploration unless there is an associated colon injury, urinoma, or expanding hematoma. Zone III retroperitoneal hematomas includes: - Answers -Iliac vessels, rectum, distal sigmoid colon, distal ureters...it is inside the pelvis. May warrant exploration. May be associated with pelvic fractures and require fixation/angiographic embolization Caustic ingestion resulting in partial thickness injury to esophagus and hemodynamically stable is treated with - Answers -If stable perform upper endoscopy to determine severity of the disease, Observation and bowel rest (NPO and observe for 48hrs) for superficial/partial injuries Zargar I esophageal injury treatment and description: - Answers -Superficial erythema, NPO and observation, if unstable then surgery Zargar IIA esophageal injury treatment and description: - Answers -Focal ulceration, erosions and exudates (mucosa/submucosa), NPO and observation , if unstable then surgery Zargar IIb esophageal injury treatment and description: - Answers -Deep or circumferential ulcerations (mucosa/submucosa) NPO and observation, *** 3 day course of glucocorticoids to reduce risk of stricture***. If unstable then surgery Zargar IIIA esophageal injury treatment and description: - Answers -Focal necrosis: NPO, empiric antibiotics and observation, surgery if unstable Zargar IIIB esophageal injury treatment and description: - Answers -Extensive necrosis: Surgical intervention with empiric antibiotics Zargar IV esophageal injury treatment and description: - Answers -Perforation: Surgical intervention with empiric antibiotics Indomethacin is a drug of choice for closure of ___ - Answers -Persistent ductus arteriosus Signs and symptoms of atrial septic defect include: - Answers -Shortness of breath and shortness of breath, typically asymptomatic until adulthood Characteristic heart murmur in ASD is: - Answers -Fixed split S Diagnosis of ASD is confirmed by - Answers -Echocardiogram A Mild Transfusion reaction symptoms include: - Answers -Localized cutaneous reaction, pruritis
