High-Yield and Frequently Missed ABSITE questions || Answered And Graded

Breast: What is presentation, treatment, prognosis for intraductal papilloma? - CORRECT ANSWER presents with bleeding/bloody nipple discharge (most common cause), usually benign, biopsy/resect via major duct excision Breast: What are contraindications to BCT (lumpectomy) in stage I breast cancer (and what specifically is not)? - CORRECT ANSWER 1) prior irradiation; 2) pos margins; 3) inflammatory; 4) pregnancy (unless 3rd trimester) Breast: what are the axillary node levels (1-3, and one more category)? - CORRECT ANSWER 1 - lateral to pec minor; 2 - beneath pec minor; 3 - medial to pec minor; Rotter's Nodes - between pec major and pec minor Breast: when is SNLB indicated (size, nodes, tumor status, metastatic risk)? - CORRECT ANSWER 1 cm, no positive nodes (obviously), primary tumor present, low risk of axillary mets, Breast: what do you do if you can't find radiotracer dye in SNLB? - CORRECT ANSWER have to do formal ALND Breast: what is treatment for DCIS in male/female? - CORRECT ANSWER female -- BCT + xrt OR mastectomy; male -- mastectomy Breast: what is not needed for patient with negative SLNB? - CORRECT ANSWER ALND -- just do BCT or mastectomy depending on tumor is fine Breast: what patient would get only mastectomy/BCT + tamoxifen for 5 years (4 characteristics)? - CORRECT ANSWER negative SLN, old, ER+, and tumor 2 cm Breast: what patient would get mastectomy/BCT + tamoxifen for 5 years plus chemo (4 characteristics)? - CORRECT ANSWER negative SLN, young, ER+, and tumor 1cm Breast: what are 3 chemo agents used for breast CA typically? - CORRECT ANSWER 1) adriamycin; 2) cyclophosphamide; 3) taxol Breast: what patient would get mastectomy/BCT + chemo (no tamoxifen)? - CORRECT ANSWER negative SLN, ER- Breast: what is main SE of taxol? - CORRECT ANSWER taxol - neuropathy Breast: what is main SE of adriamycin (doxorubacin)? - CORRECT ANSWER cardiomyopathy Breast: what is treatment for inflammatory breast cancer (in order)? - CORRECT ANSWER neoadjuvant chemo, then mastectomy (mod radical), then XRT Breast: what options are available for breast mass post neoadjuvant therapy? - CORRECT ANSWER same as de novo breast cancer -- BCT or mastectomy -- if tumor shrunk and now amenable to BCT, that's fine, even if it was big before and needed mastectomy based on size Breast: LCIS -- who primarily gets this, what is most important characteristic, what % get cancer, where, and what type? - CORRECT ANSWER - pre-menopausal - NOT premalignant itself - 30% lifetime risk 70% ductal CA Breast: LCIS -- what % have synchronous cancer? - CORRECT ANSWER 5% Breast: LCIS -- what is treatment (4 possibility, 2 things not needed ever)? - CORRECT ANSWER 1) Need to resect the lesion but do not need neg margins 2) nothing and careful F/U 3) Hormonal therapy -(pre-meno: tamoxifen; Post-meno: raloxifene) 4) bilateral subcutaneous mastectomy (no ALND) Breast: What are the benign proliferative breast lesions that have increased risk of CA? (3) Tx? - CORRECT ANSWER - LCIS - Atypical ductal hyperplasia - atypical lobular hyperplasia Tx: resect the lesion w/ (-) margins Breast: for atypical ductal hyperplasia; atypical lobular hyperplasia; LCIS, how are these characterized and what treatment should be considered? - CORRECT ANSWER benign proliferative dz. Incr risk of CA. Need to resect - don't need (-) margins Can give hormone therapy - pre-meno: tamoxifen - post-meno: raloxifene Bilateral total mastectomy (no ALND) Liver: amebic abscess - how does organism enter, what organism is it - CORRECT ANSWER through portal system Liver: amebic abscess - what are 3 presenting symptoms? - CORRECT ANSWER fever, RUQ pain, RUQ tenderness Liver: amebic abscess - what test may help diagnose? - CORRECT ANSWER indirect hemagglutination Liver: amebic abscess - what is first line treatment, when should surgery be done, and what other option exists? - CORRECT ANSWER first option metronidazole -- surgery or percutaneous drainage if failure Liver: what are 2 primary routes for pyogenic liver abscess, and what are 2 specific causes for each? - CORRECT ANSWER biliary infection (cholecystitis/cholangitis) - most common seeding from portal vein drainage (appendicitis, diverticulitis) Liver: pyogenic abscess - what are most common organisms (3)? - CORRECT ANSWER e. coli, klebsiella, strep Liver: treatment for pyogenic abscess (variuos options)? - CORRECT ANSWER abx and/or percutaneous drainage, always search for primary source Liver: echinococcal abscess - what is treatment? - CORRECT ANSWER Antiparasitics (albendazole/mabendazole) PA - Perc aspiration I - inject (w/ hypertonic saline or alcohol) R - resect Liver: echinococcal abscess - what is diagnosis (2)? - CORRECT ANSWER indirect hemagglutination / ELISA Liver: how many segments, and what is each? - CORRECT ANSWER 1) caudate; 2-4) left lobe (2-3 left lateral); 5-8) right lobe Liver: what disease is resectable? - CORRECT ANSWER unilobar or segment 1+2 Liver: how would segment 1+2 be resected? - CORRECT ANSWER left hepatic lobectomy Liver: can replaced right or left hepatic artery be ligated, and can both? - CORRECT ANSWER one or the other can be ligated if needed without significant issue Liver: when does a hepatic artery branch go posterior to portal vein, and what is anatomy? - CORRECT ANSWER replaced right hepatic, from SMA, posterior to vein Liver: focal nodular hyperplasia - what is usual size, symptom, appearance on liver scan, hallmark characteristic, and treatment? - CORRECT ANSWER size 5 cm, asymp, hot on scan, hallmark "central stellate scar", no treatment unless symptomatic (then resect) Liver: why is focal nodular hyperplasia hot on liver scan? - CORRECT ANSWER intact kupffer cells Liver: who gets hepatic adenoma, what is it associated with? - CORRECT ANSWER most common in young women, associated with OCP use Liver: what is diagnosis of choice for liver hemangioma, and when is it "giant"? - CORRECT ANSWER MRI -- giant if over 10cm Liver: in what population should giant liver hemangioma be resected, how can it present in this population (name of syndrome and its 2 problems, other possible problem)? - CORRECT ANSWER pediatric population -- kasabach-merit syndrome = hepatic sequestration and thrombocytopenia, also can present with AV shunting and heart failure Colorectal: how many levels in colon CA T staging, and what is each? - CORRECT ANSWER T1) mucosa/submucosa T2) into muscularis propria T3) through muscularis propria T4) into other organs/structures Colorectal: when is transanal excision OK (T stage, circumference, location, 2 criteria if invasive)? - CORRECT ANSWER stage - polyp or T1 circumference - 40% location - within 8-10cm of anal verge if invasive must be: 1) no lymphovascular invasion; 2) not poorly differentiated Colorectal: what is treatment for anal squamous carcinoma? - CORRECT ANSWER Nigro -- chemo (5-FU/mitomycin) + radiation; surgery reserved for failures Colorectal: coloncyte fuel, and derived from where? - CORRECT ANSWER butyric acid, from bacterial fermentation Colorectal: carcinoid tumor rectum - what is treatment? - CORRECT ANSWER transanal excision typically, unless factors for transanal excision not met (see other question) Colorectal: what is treatment for familial adenomatous polyposis (3)? - CORRECT ANSWER 1) total colectomy; 2) mucosal proctectomy; 3) pouch Colorectal: MALT tumor (lymphoma) - when is surgery first line treatment? - CORRECT ANSWER gastric outlet obstruction upper GI - MALT tumor (lymphoma) - in typical presentation, what is first, second, and third line treatment? - CORRECT ANSWER eradicate H. pylori, chemo/xrt, surgery Biliary: what is treatment for gallbladder CA based on presentation (2 major options)? - CORRECT ANSWER If T1a (confined only to lamina propria) cholecystecotmy; anything else, then skeletonize area, plus wedge segment 4/5 liver and regional nodes, consider CBD if cystic duct involved Biliary: what is treatment for types of choledochal cyst (1-5)? - CORRECT ANSWER all need resection with CCY / CBD removal, RNY hepaticojejunostomy, 4+5 need hepatectomy vs. transplant if diffuse Biliary: lap chole injury to CBD - what characterizes minor injury and what is treatment? - CORRECT ANSWER recognized intra-op, repair primarily +/- stent Biliary: what is needed normally for major CBD injury, and what is not needed? - CORRECT ANSWER need RNY hepaticojejunostomy, not hepatico or choledochoduodenostomy (never feasible) Small Bowel - what is general treatment (after failed medical management) for duodenal obstruction on Crohn's, and why? - CORRECT ANSWER gastrojejunostomy -- stricturoplasty is difficult, and resection needs Whipple; may do duodenojejunostopy if distal stricture Spleen: what are varices with splenic vein thrombosis usually associated with? - CORRECT ANSWER pancreatitis (acute) Spleen: what is the treatment for varices with splenic vein thrombosis? - CORRECT ANSWER splenectomy Spleen: if there is a very low platelet count and there is ITP, and splenectomy is needed, when should platelets be transfused, what is one exception? - CORRECT ANSWER when splenic artery is ligated, except if there is preop bleeding, then at time of incision Spleen: what myeloproliferative disorder benefits from splenectomy, what problem solved? - CORRECT ANSWER myelofibrosis -- extramedullary hematopoeisis in spleen Spleen: when do sickle cell need splenectomy? - CORRECT ANSWER they don't -- most auto-splenectomize by early age Spleen: who (splenectomy for which disease) is at highest risk for overwhelming post-splenectomy infection (OPSI)? - CORRECT ANSWER thallassemia -- kids 4 also extremely high risk, FYI Esophagus: what should never be done,for esophageal leiomyoma, when is surgery done, and what type/approach? - CORRECT ANSWER never biopsy (can form scar/difficult resection later); surgery if 5cm or symptomatic; excise (enucleate) via thoracotomy Esophagus: if they show you barium swallow pic, and it's not achalasia, what is it probably? - CORRECT ANSWER esophageal leiomyoma Esophagus: what should be suspected if patient has chest pain/fever/resp distress after emesis resulting from large meal? - CORRECT ANSWER boerhave's syndrome Esophagus: what precedes boerhave's, and what are 3 symptoms seen? - CORRECT ANSWER preceded by vomiting after large meal; 1) resp distress; 2) chest pain; 3) fever Esophagus: boerhave's - what is seen on CXR, what is confirmatory test? - CORRECT ANSWER pleural effusion on CXR, water soluble contrast esoph