Dramatic as a Brain
Feisty as a Heart
Malleable as a Bladder
Patient as a Kidney
Serious as a CBD
Whatever as an Appendix
107
A 31-year-old female presents with gum bleeding. Her platelet count is 31,000. What is the most likely diagnosis and what is the most appropriate treatment?
What are:
1. Immune thrombocytopenic purpura
2. Steroids
107
A physician from Dundee, Scotland. Dr Alan..., described in 1986 a linear gastric ulcer that occurs in the stomach at the level of the diaphragm in a hiatal hernia. What is the ulcer's name?
What is Cameron Ulcer
107
Citizens of this city found a solution for RUQ pain with a negative US test. Which pathology are we talking about?
What is the Biliary dyskinesia (EF 35-40%)
(Rome III Criteria)
107
1 cm DCIS, ER/PR/HER2 +. Treatment?
What is the Breast Conservative Therapy
(lumpectomy with 2 mm margin, Post op radiation/ endocrine, and trastuzumab therapy-controversial)
107
The patient presents with altered mental status, labs reported Calcium 15 mg/dl. What is the next step?
What is The Normal Saline solution
107
A singer lost her job because He was unable to reach high notes after a right thyroidectomy
What is The external Branch of the superior laryngeal nerve?
222
25 yo f who presents postprandial epigastric pain, nausea, and heartburn. Gastric biopsy reported the presence of a dense diffuse infiltrate of marginal‐zone cells in lamina propria with prominent lymphoepithelial lesions. What is the diagnosis and treatment?
What are:
1. Mucosa‐associated lymphoid tissue (MALT) lymphoma.
2. Antibiotics
222
After splenectomy, the immune system loses the opsonization function primarily due to the absence of IgM antibodies. What is the name of the opsonin that is absent?
What is Tuftsin?
222
Tumor markers used to detect the recurrence of Thyroid Medullary carcinoma are? (2 items)
What are:
1. The Calcitonin
2. The Carcinoembryonic antigen (CEA)
222
A 25-year-old male with a history of IV drug abuse presents with left upper quadrant pain, associated with fever and chills. A CT scan shows a 5 cm unilocular spleen abscess. Intravenous fluids and antibiotics were started. What is the next step?
What is the percutaneous drain?
222
Midline cervical mass between the hyoid bone and thyroid isthmus. What are the diagnosis and treatment?
What are the
Thyroglossal duct cyst and Sistrunk procedure?
222
A 56-year-old female has a 4 cm fibroepithelial lesion detected on mammography and confirmed on biopsy. What is the diagnosis and treatment?
What are:
1. Phyllodes Tumor
2. WLE with 1 cm margin
451
Which artery must be preserved for the stomach conduit during a trans-hiatal esophagectomy?
What is The Right Gastroepiploic Artery?
451
In this city, the protocol for intraoperative parathyroid hormone monitoring was created to indicate a successful parathyroidectomy. What is the city, and what are the criteria?
What are:
Miami (The University of Miami's Sylvester Comprehensive Cancer Center)
a >50% PTH decrease from either the highest pre-incision hormone level in 10 minutes after complete excision of all hyperfunctioning parathyroid tissue
If the 10-minute sample does not meet the criterion, a delayed sample at 20 minutes is measured and/or further neck exploration
451
45 yo female present with Right axillary lymph node. FNA reported invasive ductal carcinoma. B/L Breast US, mammography, MRI, and CT c/a/p were NEGATIVE. What is the next Step in management?
What are:
1. Right Modified radical mastectomy
451
56 yo male status post distal pancreatectomy 1 week ago. Amylase > 3 times the serum level from JP drain fluid. Patient denied abdominal pain, nauseas, emesis, fever or chills. What is the diagnosis and how you treat it ?
What are:
1. Biochemical leak
2. No intervention
451
A patient experiences pain and stops breathing during expiration upon palpation of this area. What is the nationality of the author of this sign?
Who is The American surgeon?
John Benjamin Murphy (1857–1916), was born in Appleton, Wisconsin
451
The tumor marker used to detect the recurrence of papillary thyroid cancer is?
What is the Thyroglobulin?
674
A 35-year-old female presents with a mass in the right breast. A mammogram shows focal asymmetry and skin thickening. Core needle biopsy (CNBx) reveals eosinophilic infiltration, neutrophils, lymphocytes accompanied by giant cells, and suppurative necrosis. What is the diagnosis?
What is the Granulomatous mastitis
674
The patient was diagnosed with Pancreatic Intraductal Papillary Mucinous Neoplasm. What are the high-risk features, and what is the most appropriate next step?
What are:
1. Main duct dilation > 1 cm, Jaundice, Enhancing mural > 5 mm
2. Surgical resection
674
A 61yo f was admitted due to a stroke 2 weeks ago. She has been presenting with elevated WBC (18), fever of 101, and RUQ pain. Acalculous cholecystitis was diagnosed, and an IR perc chole tube was placed 3 days ago, with 120 mL of bilious output daily. Today, her WBC is 25, tempe 100.9, she is on levophed, and her creatinine is 2.4. What is the most appropriate next step?
What is laparoscopic cholecystectomy?
674
65 yo m, hx of alcohol abuse. Presents hematemesis, BP 81/56, HR 126. How do you manage this patient? (6 items).
What are:
1. IV access
2. Massive transfuse protocol
3. Endotracheal Intubation
4. Esophagogastroduodenostomy
5. Transjugular intrahepatic portosystemic shunt
6. Distal esophageal devascularization
674
Indication for total thyroidectomy in Thyroid lymphoma?
What are the symptoms of airway compression?
674
A 46-year-old female presents with nephrolithiasis, constipation, muscle weakness, and bone pain. What is the possible diagnosis, and how do you work it up?
What are
The Hyperparathyroidism and
1. PTH
2. Calcium, PO, Cl, Creatinine
3. Vit D
4. Urine calcium in 24h
5. Neck US
881
A 37-year-old male with a history of achalasia presents with chest pain, fever, and chills 9 hours after lower esophageal sphincter balloon dilation. What is the diagnosis, and how would you manage it?"
What are:
1. Distal esophageal perforation
2. Surgical repair with opposite site myotomy
881
A 48-year-old male presents with progressive dysphagia due to a 3.2 cm mid-esophageal mass. Biopsy results report adenocarcinoma invading the muscularis propria (T2) with lymphovascular invasion, moderately differentiated. Lymph nodes are negative (N0), with no metastases (M0). What is the next step?
What is the NEOADJUVANT CHEMOTHERAPY
881
What Decreases breast cancer risk in BRCA2? (2 Items)
What are:
1. Bilateral mastectomy (80%)
2. Bilateral Oophorectomy (50%)
881
A 35-year-old male. Status post total thyroidectomy. A nurse calls you at 2:07 am because the patient is not feeling well. Evaluation at the bedside reveals Chvostek's and Trousseau's signs. What do these signs indicate, and what is the next step in management?
What are:
1. The HYPOCALCEMIA
2. IV Calcium-gluconate and Transfer the patient to ICU for cardiac monitoring
881
Ultrasound findings suggest a malignant lymph node invasion.
What are:
Loss of central fatty hilum
Increase Size
Round Shape
Peripheral or mixed vasculature
Microcalcifications
881
61 yo male with no PMHX. Who presents abdominal pain, nausea, and emesis. Labs: Ca-19-9 normal, Ct scan showed edematous pancreas, peripancreatic fluid, and lymphadenopathy. B2 microglobulin positive. What is the diagnosis and treatment?
What are:
1. Pancreatic lymphoma
2. Chemotherapy
1013
A 41-year-old male, status post Whipple procedure due to chronic pancreatitis, now presents with pancreatic adenocarcinoma of the remnant (distal body/tail) encasing the splenic vessels and the celiac axis. After neoadjuvant chemotherapy and radiotherapy, there is no progression of the tumor and no metastasis. What is the appropriate operation for him?
What is the Appleby procedure for total gastrectomy and hepatic arterial reconstruction?
1013
Autosomal dominant condition located on chromosome 17q25 presents with palmar/plantar hyperkeratosis, dysphagia, and an increased risk of 70% for developing squamous cell carcinoma of the esophagus by age 70?
What is Tylosis?
1013
What population has benefited from D3 dissection for gastric cancer?
What is In JAPAN?
1013
A 56-year-old male status post left thyroid lobectomy. Based on pathology results, what are the criteria to take the patient back to the operating room for a total thyroidectomy? (7 items)
What are:
1. Tumor >4 cm
2. Gross positive resection margins
3. Gross extra‑thyroidal extension
4. Positive Lymph Nodes
5. Confirmed contralateral disease
6. Vascular invasion
7. Poorly differentiation
1013
A 28-year-old female with a history of breast augmentation 10 years ago presents with left breast pain and a palpable mass. MRI shows a fluid collection between the implant and the capsule, irregular in distribution and homogeneous. CNBx was performed. What is the diagnosis and how do you treat it?
What are:
1. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)
2. Remove implants, Chemotherapy
1013
Indication for parathyroidectomy in primary hyperparathyroidism. (7 items)
What are:
1. Symptomatic (Nephrolithiasis, altered mental status, constipation...)
2. Age < 50 yo
3. Unable to F/U the patient
4. Serum Ca+ > 1 mg/dl above the normal range
5. Cr Clearance < 60 ml/min
5. T score< -2.5, vertebral fx
6. 24h urine Ca+ > 400