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Terms in this set (425)

45 yof with itching of the R nipple for 6 months and a R breast mass

Pagets Disease (infiltrating ductal carcinoma with spread to the nipple)

60 yom with nipple discharge

male breast CA

36 yof with a R breast mass after hitting her right breast on a door handle

fat necrosis

39 yof with bilateral milky breast discharge, decreased lateral vision fields, and a pituitary mass

prolactinoma

28 yof with unilateral green brown nipple discharge increasing immediately before menses

fibrocystic disease

25 yof with bloody nipple discharge

ductal papilloma

56 yof with a red breast, no fever, no leukocytosis; on exam, the skin looks swollen like an orange

inflammatory breast CA with peau d'orange on exam

40 yof without a palpable breast mass has "microcalcifications" on mammogram

ductal carcinoma in situ (DCIS)

2 weeks s/p modified radical mastectomy a 45 yof with infiltrating ductal CA of the R breast returns to the clinic and complains of her R scapula "sticking out"

winged scapula due ot injury to the long thoracic nerve

name the diagnostic modality:

26 yof with history of bloody nipple discharge mammogram is negative

galactography to look for ductal papilloma

Name the diagnostic stimulation test for the following: Conn's disease

Captopril (plasma aldosterone >15 μg/dL) or high-sodium diet (no suppression of plasma renin activity)

Name the diagnostic stimulation test for the following: insulinoma

Fasting glucose

Name the diagnostic stimulation test for the following: ZE syndrome

secretin

Name the diagnostic stimulation test for the following: Adrenal Insufficiency

ACTH stimulation test (corticotropin 250 mcg)

Name the diagnostic stimulation test for the following: Pituitary versus ectopic/adrenal source of hypercortisolism

High-dose dexamethasone suppression test: most pituitary causes will suppress

Metyrapone test: most pituitary causes will result in an increase in ACTH

Name the diagnostic modality:

37-year-old with history of palpitations, episodic diaphoresis, and his blood pressure is 210/110

MIBG (metaiodobenzylguanidine) scan, CT scan (and/or MRI), and urine VMA/metanephrines/catecholes for work up for pheochromocytoma

What is the treatment?

39-year-old female with Cushing's disease

Transsphenoidal adenomectomy

44-year-old female develops headaches and cannot see right or left peripherally

pituitary prolactinoma

Name the radiographic test for localizing the following: Conn's disease

CT scan, adrenal vein sampling for aldosterone and cortisol

Name the radiographic test for localizing the following: pheocrhomocytoma

MIBG

Name the radiographic test for localizing the following: glucagonoma

CT scan

Name the radiographic test for localizing the following: carcinoid

In-octreotide scintigraphy, MIBG

name the radiographic test for localizing the following:

Gastrinoma (Zollinger-Ellison syndrome)?

In-octreotide scintigraphy, CT scan, endoscopic ultrasound, MRI

Name the diagnostic stimulation test for the following:

Medullary thyroid carcinoma?

Pentagastrin (also calcium)

Name the most likely diagnosis:

60-year-old woman with a thyroid mass, + follicular cells on biopsy, + capsular invasion, + vascular invasion

Thyroid follicular carcinoma

Name the most likely diagnosis:

42-year-old woman with thyroid mass, + amyloid on histology, hypercalcemia

Medullary thyroid carcinoma

Name the most likely diagnosis:

25-year-old man with thyroid mass, + psammoma bodies on histology

Papillary thyroid carcinoma

Name the most likely diagnosis:

Hypothyroidism, "woody" hard thyroid, tracheal compression

Riedel's thyroiditis

17-year-old woman with upper respiratory tract infection followed by fever, neck pain, dysphagia, tender thyroid gland, + strep cultures

Acute suppurative thyroiditis

28-year-old woman with tender thyroid, hypothyroidism, elevated antimicrosomal antibodies, increased antithyroglobulin antibodies

Hashimoto's thyroiditis

Palpable parathyroid gland and hypercalcemia

Parathyroid carcinoma

50-year-old female with parathyroid hyperplasia, jejunal ulcers, loss of peripheral vision

MEN-I (parathyroid hyperplasia, gastrinoma, pituitary tumor)

45-year-old female with palpable neck mass and hypercalcemia with elevated parathyroid hormone

Parathyroid carcinoma

34-year-old female with a symptomatic hypercalcemia with low calcium level in her urine

Familial hypocalciuric hypercalcemia

Name the radiographic test for localizing the following: Hyperfunctioning parathyroid

99mTc-sestamibi scintigraphy

48-year-old male with pancreatitis now with acute onset of respiratory failure, PaO2 to FiO2 ratio of 89, nl heart echo, bilateral pulmonary edema on CXR

Severe ARDS

67-year-old female with severe diverticulitis now with acute onset of respiratory failure, PaO2-to-FiO2 ratio of 234, nl heart echo,

bilateral pulmonary edema on CXR

Mild ARDS

22-year-old male s/p MCC 48-year-old now with bleeding through liver and pelvic packs; TEG reveals a progressive narrowing of the TEG tracing over time (small tail)

Hyperfibrinolysis

22-year-old female s/p fall with severe TBI, urine output 30 to 50 cc/hr, CVP 15, sodium of 128

SIADH

45-year-old with severe pancreatitis, now with increasing peak airway pressures, decreased urine output, and hypotension

Abdominal compartment syndrome

70-year-old male with severe sepsis on three pressors (vasopressors), antibiotics, refractory to fluid bolus and progressively increasing doses of pressors

Adrenal insufficiency

44-year-old male with pulmonary contusions s/p several infusions of KCl for hypokalemia but with no increase in post-infusion potassium level

Hypomagnesemia

44-year-old female with severe pancreatitis on ventilator ABG reveals pH of 7.2, PO2 of 100, PCO2 of 65, bicarbonate 26

Respiratory acidosis (uncompensated)

65-year-old male s/p pulmonary contusion on a ventilator, ABG reveals pH 7.35, PO2 80, PCO2 of 60, bicarbonate of 35

Compensated respiratory acidosis

34-year-old female s/p liver injury from an MVC on the ventilator,

ABG reveals pH 7.23, PO2 105, PCO2 40, bicarbonate 17

Metabolic acidosis

76-year-old male with severe diverticulitis on ventilator, pH 7.35, PO2 76, PCO2 25, bicarbonate 16

Metabolic acidosis with respiratory compensation

45-year-old "found down" with pH of 7.17, PCO2 39, PO2 90, sodium 140, chloride 108, bicarbonate 26

Normal anion gap metabolic acidosis (140-108-26 = 6)

56-year-old female "found down" with pH of 7.19, sodium 140, bicarbonate 18, chloride 100

Increased anion gap acidosis (140-18-100 = 22)

What is the treatment?

34-year-old female s/p MVC with carotid dissection on CTA

Antiplatelet (aspirin and/or Plavix®) or anticoagulation (enoxaparin or IV heparin or PO anticoagulation medication, classically Coumadin®) therapy

Name the diagnostic modality:

50-year-old male with history of flushing, diarrhea, JVD with echo revealing right-sided heart failure

24-hour urinary 5-HIAA (5-hydroxyindoleacetic acid) level to work up carcinoid syndrome

Name the diagnostic modality:

40-year-old male with history of passing air with his urine

CT scan looking for colocystic fistula usually from diverticulitis

21-year-old s/p GSW to abdomen with small bowel resections develops tachycardia, fever, and green bilious wound drainage

Anastomotic leak and enterocutaneous fistula

67-year-old male smoker on Coumadin® for chronic DVT notices LLQ pain after a strenuous coughing spell; LLQ mass detected on physical exam

Rectus sheath hematoma

What is the treatment?

60-year-old male with LLQ pain and "parrot's beak" on x-ray c/w sigmoid volvulus

Proctosigmoidoscopy to decompress initially

78-year-old male with RLQ and "coffee bean" colonic dilation on x-ray c/w cecal volvulus

Ex lap with resection with primary anastomosis or ileostomy

56-year-old woman with hemorrhoids that prolapse with defecation but then retract by themselves

Second-degree internal hemorrhoids

34-year-old woman with hemorrhoids that prolapse after defecation and that she has to "push back in"

Third-degree internal hemorrhoids

56-year-old woman with hemorrhoids that are "stuck out" after a bowel movement

Fourth-degree internal hemorrhoid

22-year-old female with bright red blood from her rectum with history of extremely painful bowel movements

anal fissure

Name the diagnostic modality:

45-year-old male with dark blood per rectum

NGT aspiration to evaluate for upper GI bleed (if blood, then EGD; if bile and no blood, then work up for lower GI bleed)

Name the diagnostic modality:

45-year-old male with significant massive blood per rectum; NGT reveals bile and no blood

Angiography to find lower GI source

24-year-old man with ulcerative colitis receives Lomotil® for excessive diarrhea and develops fever, abdominal pain and tenderness, and a massively dilated colon on abdominal x-ray

Toxic megacolon

28-year-old man with nonbloody diarrhea, low-grade fever, abdominal pain, perirectal abscesses, perianal fistulae

Crohn's disease

39-year-old man with caput medusae, hemorrhoids, and splenomegaly

Portal hypertension

Elderly woman with small bowel obstruction and air in the biliary tract

Gallstone ileus

38-year-old female with progressively worse RUQ pain and ultrasound reveals a thickened gallbladder wall, pericholecystic fluid, and a sonographic Murphy's sign

Acute cholecystitis

Lap chole POD #3, fever, RUQ fluid collection, no biliary dilation

Biloma (most common cause = cystic duct leak)

POD #7 following laparoscopic cholecystectomy—jaundice and dilated intrahepatic biliary ducts

Clipping or transection of common bile duct

33-year-old woman with jaundice, fever, RUQ pain, hypotension, and confusion

Suppurative cholangitis

43-year-old woman with RUQ pain and right subscapular pain for 2 hours intermittently over 4 months

Biliary colic

Name the diagnostic modality:

22-year-old with RUQ pain with eating

Ultrasound for cholelithiasis

Name the diagnostic modality:

40-year-old female with "migratory necrolytic dermatitis," diabetes

Glucagon assay (glucagon level), CT scan for glucagonoma

What is the treatment?

2-year-old with annular pancreas

Bypass obstruction

What is the treatment?

40-year-old alcoholic with dead pancreatic tissue on CT scan develops hypotension and fever

Operative pancreatic débridement

28-year-old male with diarrhea, diabetes, and gallstones

Somatostatinoma

80-year-old with new onset of jaundice has a palpable, distended, nontender gallbladder on exam

Courvoiser's sign for head of the pancreas cancer mass

Elderly woman, SBO, and air in biliary tract

Gallstone ileus

Elderly woman with pain down inner aspect of thigh

Obturator hernia (Howship-Romberg sign)

Abdominal pain, hypotension, and abdominal pulsatile mass

Ruptured abdominal aortic aneurysm (AAA)

Abdominal pain "out of proportion" to abdominal exam

Mesenteric ischemia

Arm pain and syncope with arm movement

Subclavian steal syndrome

Increasing creatinine on ACE inhibitor

Renal artery stenosis

Child with MIDLINE neck mass

thyroglossal duct cyst

Child with LATERAL neck mass

branchial cleft cyst

crush injury and dark urine

Myoglobinuria

Emesis, chest pain radiating to back and mediastinal air

Boerhaaves

Lower GI bleed + technetium pertechnetate scan

Meckel's diverticulum

. Flushing, diarrhea, and right-sided heart failure

Carcinoid

Pneumaturia and LLQ pain

Colovesicular fistula

Desmoid tumor, osteoma, and colon cancer

Gardner's syndrome

Epigastric pain radiating to back and flank ecchymosis

Hemorrhagic pancreatitis

Pancreatitis and palpable epigastric mass

Pancreatic pseudocyst

17. Liver abscess with "anchovy paste"

Amebic abscess

. RUQ pain, travel, and exposure to sheep

Hydatid cyst

Caput medusa

Portal hypertension

45-year-old woman with RUQ pain for 12 hours, fever, and leukocytosis

Acute cholecystitis

Hearing loss, tinnitus, and vertigo

Meniere's disease

Adolescent boy with nasal obstruction and recurrent epistaxis

Juvenile nasopharyngeal angiofibroma

Child <5 years of age sitting upright and drooling, with "hot-potato" voice

Epiglottitis

Angina, syncope, and CHF

aortic stenosis

Tobacco use, asbestos exposure, and pleuritic chest pain

Mesothelioma

Supracondylar fracture and contracture of forearm flexors

Volkmann's contracture

Tibia fracture, "pain out of proportion," pain on passive foot movement, and palpable pulses

Compartment syndrome

25-year-old man with liver mass with fibrous septae and NO history of cirrhosis or hepatitis

Fibrolamellar hepatocellular carcinoma

EKG with flattening of T waves and U waves

hypokalemia

Central pontine myelinolysis

Too-rapid correction of hyponatremia

Polydipsia, polyuria, and constipation

hypercalcemia

Factor VIII deficiency

Hemophilia A

Abdominal pain, fever, hypotension, HYPERkalemia, and HYPOnatremia

Adrenal insufficiency (addisonian crisis)

Massive urine output and HYPERnatremia

Diabetes insipidus

Increased urine osmolality,

HYPOnatremia, and low serum osmolality

SIADH

IV antibiotics, fever, diarrhea

C. difficilie pseudomembranous colitis

Bleeding gums and wound dehiscence

Vitamin C deficiency

Fever, central line, and HYPERglycemia

Central line infection

Appendectomy followed by fever and abdominal pain on postoperative day #7

Peritoneal abscess

Advancing crepitus, fever, and blood blisters

necrotizing fasciitis

High INTRAoperative fever

malignant hyperthermia

Confusion, ataxia, and ophthalmoplegia

Wernicke's encephalopathy

Tracheal deviation, decreased breath sounds, and hyperresonance

Tension pneumothorax

Hypotension, decreased heart sounds, and JVD

Pericardial tamponade

Four ribs broken in two places and pulmonary contusion

Flail chest

Otorrhea (clear) and Battle's sign

Basilar skull fracture

Ulcer and decreased pain with food

duodenal ulcer

Vomiting, retching, and epigastric pain

Mallory-Weiss tear

. Fever on postoperative day #1, with "bronze" weeping, tender wound

Clostridial wound infection

Hematochezia and tenesmus

rectal cancer

Upper GI bleed, jaundice, and RUQ pain

Hemobilia

Gallstones, epigastric pain radiating to back, and nausea

Gallstone pancreatitis

18-year-old woman with bloody nipple discharge

Ductal papilloma

Irritability, diaphoresis, weakness, tremulousness, and palpitations

Insulinoma

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