Pediatric
36 hour old baby girl with abdominal distention and failure to pass meconium. Rectal examination induces explosive stool output. Which imaging is best for work up?
What is the most common presentation of an intraductal papilloma?
Bloody nipple discharge
Most commonly injured artery from blunt mechanism?
Aorta
Innominate is second
What tests are required for biochemical work up for an incidental adrenal mass? (3/7)
urine metanephrines, VMA, catecholamines, urinary hydroxycorticosteroids, K, plasma renin, plasma aldosterone
What is the GCS of a patient who is opening eyes to verbal command, saying words but inappropriately, and localizing to pain?
3+3+5 = 11
Duodenal atresia (Double bubble sign!)
Treatment (in correct order) of biopsy proven inflammatory breast cancer?
Neoadjuvant chemo -> MRM -> XRT
Anterior, lateral, superficial posterior, deep posterior
Most patients with hyperthyroidism are managed with medical management. What are some 2 indications for surgery instead.
Large goiter with compressive symptoms, failed medical management, pregnancy, hyperthyroidism secondary to an autonomously functioning thyroid nodule
A humerus dislocation can compress which nerve?
Axillary (hold arm slightly abducted and unable to lower)
What is the most common type of tracheoesophageal fistula? (Type and explanation of anatomy)
Type C - proximal esophageal atresia with a distal TEF
Lumpectomy pathology returns LCIS with positive margins. What next?
Hormonal therapy and close observation (5% synchronous malignancy, 30% lifetime risk)
Describe nutcracker syndrome
Compression of left renal vein between SMA and aorta. Pain & henaturia.
What are the three defining pathologies of MEN 2a?
MEN 2a: Parathyroid hyperplasia, pheochromocytoma, medullary thyroid cancer
MEN 1: parathyroid hyperplasia, pituitary tumors, pancreatic islet cell tumors
MEN 2b: Marfanoid habitus, pheochromocytoma, medullary thyroid cancer
How does a radial nerve injury present?
Inability to extend wrist and MCP joints
7 year old female presenting with abdominal pain and jaundice. GB US shows no stones. MRCP shows a Type 1 choledochal cyst. Describe this type of choledochal cyst and the treatment.
Fusiform dilation of entire CBD. Resect & hepaticojejunostomy
50 year old male diagnosed with DCIS. What is the appropriate treatment?
Mastectomy
67 year old male presenting with recurrent left sided TIAs. Carotid duplex shows carotid stenosis bilaterally with PSV 220 on the left and PSV 300 on the right. Which do you perform an endarterectomy on first?
Left
Patient with MEN 1 found to have hypercalcemia and gastrinoma. In which order do you treat surgically
Parathyroids first. Normal calcium helps control acid hypersecretion, makes gastrinoma more elective.
What is the most common presentation of blunt myocardial injury?
PVCs
30 month old with a painless mass in the left hemiabdomen. Associated hematuria. What are the 2 most likely sites for this tumor to metastasize to?
Lung and bone. (Wilms)
44 year old female present with enlarging right breast mass over the last 1 year. No palpable lymphdenopathy but the mass is 14 cm. Biopsy shows marked stromal overgrowth and hypercellularity, nuclear atypia, and a leaf-like structure. What is the diagnosis and what surgery does she require.
Name 2 antibiotics that should be avoided/used in caution in patients who have known aneurysms and dissections.
Fluoroquinolones, ciprofloxacin
Patient with a 3.5 cm right adrenal mass is evaluated in SOPC. Upon evaluation you note the patient is on 2 antihypertensives and they have been mildly hypokalemic on previous labs. What is the likely diagnosis and how will you confirm?
Aldosteronoma, aldosterone:renin increased (>30)
*If unilateral, can do adrenalectomy. If bilateral, need adrenal vein sampling
TEE