这些题在研究生入学考试和中期考核中也经常会碰到，故和大家一起分享！

Questions 

How do you treat DCIS ? 

How do you treat an incidentally-found ovarian/adnexal mass ? 

How do you treat a tubo-ovarian abscess ? 

How does IABP (intra-aortic balloon pump) improve hemodynamics ? 

When is IABP contraindicated ? 

What syndrome includes a necrloytic migratory erythema? 

How do you confirm the diagnosis of carcinoid syndrome? 

What criteria meet "critical" aortic stenosis ? 

What criteria meet "critical" mitral stenosis ? 

What is the most common cause of a solid renal mass in an adult ? 

How do you treat an intra-caval renal cell cancer ? 

How do you treat a testicular mass ? 

What are the serum markers in testicular cancer ? 

What is the BIRADS Classification ? 

What is the first test for a palpable breast mass ? 

What is the most effective treatment for an aspiration episode ? 

How do you treat clear, serous discharge from a single duct in the female breast
 ? 

What is the most common palpable breast mass in a pregnant female ? 

What is the operative approach to a thoracic duct leak? 

What causes most bloody nipple discharge ? 

What chromosome is responsible for Gardner's syndrome? 

What are the "Amsterdam Criteria" ? 

When do you see a bird's beak esophagus ? 

What is the most common cause of lower GI bleeding ? 

What is the most common cause of Massive lower GI bleeding ? 

What is the most common cause of Massive lower GI bleeding in patients > age 
70 ? 

How do you treat an infected urachal cyst ? 

What level differentiates colon cancer from rectal cancer? 

How do you approach a BIRADS 0 classification ? 

What is a Stage III colon cancer ? 

When do you administer preoperative neoadjuvant therapy for esophageal cancer ? 

Where is iron absorbed ? 

What is the most common cause of Portal HTN in the United States ? 

What is the Budd-Chiari Syndrome ? 

What is the best way to prevent a first bleed in a portal HTN patient ? 

What is the preferred treatment of Ascites ? 

What is the preferred treatment for Grave's Disease ? 

How do you treat a 3 cm. Appendiceal Carcinoid ? 

What are the two main risk factors for Papillary Thyroid CA? 

How does follicular thyroid cancer spread ? 

What do C-cells produce ? 

What is the origin of the Superior Thyroid Artery ? 

How do you treat a duodenal diverticulum ? 

What is the most common manifestation of the Carcinoid Syndrome ? 

What are 3 extra-colonic manifestations associated with Ulcerative Colitis ? 

What is the half-life of Parathyroid Hormone ? 

What is the best diagnostic screen for a "lost parathyroid" ? 

What is the most common cause of a "cushing's picture"? 

What is the most common cause of primary hyperparathyroidism ? 

How do you treat a 100 % occlusion of the internal carotid artery ?  


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※作者已于 2004-10-30 22:44:32 修改本文※

标准答案：

1. DCIS: wide local excision to negative margins, followed by XRT to the ipsilat
eral breast 

2. The "Incidental Ovarian Mass" 
First, always perform the operation that you went there to perform 
Remember, you can always come back 
Then, describe fully what you see 
i.e. peritoneal studding, omental caking... 
never do a wedge biopsy of the mass or ovary 
never do a TAH-BSO, at the time of initial discovery 
Antibiotics, antibiotics, antibiotics.... 

3. When you find a tubo-ovarian abscess, you are likely exploring for suspected 
appendicitis; perform the appendectomy and describe the relevant findings. Unles
s the ovary is necrotic or gangrenous, do not proceed with resection (especially
 in the pre-menopausal female). If the abscess progresses or begins to lead to s
eptic complications, you can always go back and resect.

4. 2 effects of IABP:
a. Increases coronary blood flow
b. decreases afterload

5. IABP is contraindicated in:
a. Aortic regurgitation
b. Lower limb ischemia

6. Glucagonoma 

7. Carcinoid Diagnosis: Check Urinary 5-HIAA level** 

8. Critical aortic stenosis: 
Area < 1 cm&sup2;
P > 50 mmHg

9. Critical mitral stenosis:
Area < 1.5 cm&sup2;
P > 15 mmHg

10. Renal Cell CA 

11. Resection; intracaval spread does not preclude a full and complete resection
, i.e. a radical nephrectomy without previous biosy. 

12. A testicular mass is cancer till proven otherwise and should be treated with
 an inguinal orchiectomy. Do not violate the median raphe or perform a scrotal b
iopsy. 

13. Serum markers in testicular cancer: 
AFP
B-HCG
LDH

14. BIRADS Classification:
"0" - inadequate mammogram
"I" - normal mammogram
"II" - radiographic abnormality present, likely benign
"III" - undetermined lesion, low suspicion for carcinoma
"IV" - suspicious lesion present
"V" - malignancy strongly suspected
(i.e. a solid mass with calcifications)

15. FNA 

16. Aggressive suctioning ― consider endotracheal intubation and formal broncho
scopy 

17. Ductogram followed by complete ductal excision 

18. Lactating adenoma 

19. Right Thoracoctomy ― with ligation of the duct just above the diaphragm (VA
TS if available) 

20. Papilloma 

21. Chromosome 5q 

22. Amsterdam Criteria: the Lynch Syndromes, 3 relatives, in 2 or more generatio
ns, where at least 1 is a first-degree relative 

23. Achalasia 

24. Colonic neoplasia 

25. Diverticulosis 

26. A-V Malformations 

27. Antibiotics, followed by complete excision (including the associated cuff of
 bladder) 

28. 12 cm. from the dentate line ― above is condidered "colon" & below is "
rectum" 

29. You must repeat the mammogram, and may require cone-views 

30. Duke's Colon Ca: 
A - Limited to the Bowel Wall
B - Extension through the Bowel Wall with Negative Nodes
C - Regional Node Metastasis
Duke's Modification:
C1 - Regional Node Metastasis
C2 - Node Involvement at the Point of Vessel Ligation

31. Stage II or Stage III Esophageal CA 

32. Duodenum 

33. Alcoholic cirrhosis 

34. Budd-Chiari Syndrome: hepatic vein thrombosis leading to post-sinusoidal por
tal hypertension

35. Beta-blockade is the only proven method to prevent a FIRST bleed 

36. Medical management: 
fluid & salt restriction
spironolactone
surgery carries a minimal role in the direct treatment of ascites

37. I Ablation, followed by supplemental replacement 

38. Right hemicolectomy with ileocolic anastamosis, and remember to take the reg
ional nodes. 

39. Risk Factors ― Papillary CA: 
Childhood exposure to Radiation
Positive family history

40. Follicular cancer does not spread through the lymphatics; it spreads hematog
enously to bone and lung 

41. Calcitonin 

42. The external carotid artery 

43. Resect the diverticulum 

44. Diarrhea 

45. Erythema nodosum, erythema multiforme, & pyoderma gangrensum (just to na
me a few) 

46. 8 minutes, this is why on-table PTH levels are helpful in parathyroid surger
y 

47. Sestamibi scan 

48. Exogenous steroid use 

49. A single adenoma 

50. Observation ― you do not treat a 100 % occlusion. Place on ASA qd and follo
w the contralateral carotid with surveillance duplex sreening 
 
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※作者已于 2004-10-30 22:45:20 修改本文※

顶！哪里来的？

--
小知不及大知，小年不及大年。奚以知然也？

既然有人顶，那就继续：

Question:

Which one carries a better prognosis, EDH or SDH ? 

When do you elevate table fractures of the skull ? (and why ?) 

What is the significance to 'sulfur granules'? 

What is the most common skin manifestation in HIV patients ? 

You're a surgeon ... name 2 spirochetes ? 

Which space-occupying lesion is the most common in HIV ? 

Does endoscopic banding work for gastric varices ? 

What is Grave's Disease ? 

How do you treat duodenal atresia ? 

How do you diagnose and treat malrotation ? 

When would you want to keep a PDA open ? 

What do you administer to close a PDA ? 

Will Positive Pressure Ventilation, by itself, increase or decrease CVP ? 

Where do you place a Greenfield filter for lower extremity DVT ? 

What level corresponds radiographically to the renal veins ? 

What are Ranson's Criteria at 48 hours ? 

What chromosome is responsible for MEN-II ? 

What is the primary effect of heparin ? 

What is the clinical significance of a negative D-dimer ? 

What is the normal SvO2 ? (and what PO2 does it correspond to ?) 

What are the three reasons for a marginal ulcer ? 

What is the most objective measure of a true compartment syndrome ? 

What are the three zones of the neck ? 

What is the maximal height you should raise the barium column when trying to red
uce an intussception ? 

What are the Class I antigens ? (and what cells are they found on ?) 

What is Milroy's Disease ? 

What does OKT3 target ? 

What is the usual maximal-preservation time in UW solution for the following org
ans: Kidneys ?Pancreas ?Liver ?Heart / Lungs / Small Bowel? 

How do you repair ureteral transection ? 

How do you treat CMV ? 

What causes "dimpling" of the skin in breast cancer ? 

What is the breast bud ? 

How do you treat a Phylloides Tumor ? 

What is Cushing's Syndrome ? 

What is Paget's Disease of the breast ? 

What defines Stage I breast cancer ? 

What drug can be administered in an attempt to relieve a colonic pseudo-obstruct
ion ? 

How do you treat a Type IV Gastric Ulcer ? 

Which form of Barret's esophagitis has malignant potential ? 

How do you treat a Stage II breast cancer ? 

How do you diagnose and treat inflammatory breast cancer? 

What causes early-dumping ? (how do you treat it ?) 

What causes late-dumping ? (how do you treat it ?) 

What is the Nigro Protocol ? 

How do you treat an anal melanoma ? 

How do you treat a chronic anal fissure ? 

How do you calculate the RQ ? 

When do you proceed with a lymph node dissection, in melanoma ? 

How do you treat a melanoma on the anterior face ? 

How do you treat a melanoma on the scalp or ear ? 

标准答案：

1 EDH ― there is less underlying parenchymal injury than seen in SDH 

2 When the depression is greater than 5 mm (some say 1 cm, or more than one full
-thickness width) ― this decreases the risk of seizures 

3 Actinomycosis ― remember, this is a bacterial infection (treat with high-dose
 PCN) 

4 Molluscum contagiosum 

5 2 spirochetes: 
Borrelia (Lyme disease, relapsing fever) ― Tx with ceftriaxoneTreponema (Syphil
is) ― Tx with PCN

6 Toxoplasmosis 

7 No, banding only works for esophageal varices. With gastric varices, and true 
portal hypertension, you will likely require TIPS 

8 Hyperthyroidism due to the formation of an autoimmune antibody directed agains
t the TSH receptor; treatment of choice is radioactive ablation (I 131) 

9 Duodenal atresia: side-to-side duodenoduodenostomy with a decompressive g-tube
 

10 Lower GI ― look for the cecum in the LUQ 

11 Coarctation of the aorta; you keep the PDA open by administering prostaglandi
n 

12 Indomethacin 

13 Positive pressure increases CVP 

14 Below the renal veins (if there is thrombosis of the filter, you do no want t
o occlude the renals) 

15 L2 

16 Ranson's Criteria of severity: 

17 Chromosome # 10 

18 Stimulates Anti-thrombin III 

19 A negative d-dimer effectively rules-out a pulmonary embolus 

20 75 (40) 

21 Incomplete vagotomy, incomplete antrectomy, Z-E Syndrome 

22 Intracompartmental pressures > 30 mmHg (indication for urgent fasciotomy) 

23 Zone I: from the clavicles to cricoidZone II: from cricoid to the mandibular 
angleZone III: from the mandibular angle to the base of the skull 

24 3 feet 

25 A, B ― found on all nucleated cells 

26 Milroy's: a chronic hereditary lymphedema with onset at or near birth (in a f
ew patients it does not develop until after the age of 35, i.e. 'lymphedema tard
a'). It is caused by a developmental abnormality of the lymphatics 

27 The CD3 receptor 

28 kidneys ― 48 hrs; pancreas ― 24 hrs; liver ― 12 hrs; heart, lung, small bo
wel ― 8 hrs 

29 There are several ways to repair an accidental transection; the one I prefer 
is an interrupted, primary repair using 5-0 dacron sutures over a 6fr. Double-J 
silastic stent. The stent is removed via cytsocopy 6 weeks after the repair. I a
lways leave a drain behind (but some do not). 

30 Gancyclovir 

31 Involvement of Cooper's Ligaments (not lymphatic invasion or "skin edema") 

32 The breast bud is a normal, developmental structure seen at the onset of pube
rty. It should never be biopsied ! 

33 A Phyllodes tumor is an uncommon stromal lesion consisting of both epithelial
 and mesenchymal cells. The far majority (> 90 %) are completely benign and r
elated to fibroadenoma. Treatment is via wide local excision to negative margins
 and there is no role for axillary dissection or adjuvant therapy. 

34 Cushing's Syndrome is the state of hypercortisolism. Unfortunately, the term 
has been used carelessly in the past which has led to confusion regarding the un
derlying disease process. Primary Hypercortisolism (the real, "Cushing's syndrom
e", i.e. related to a primary disease within the adrenal gland), is seen with an
 adrenal tumor. 
Cushing's Disease is due to a central process (usually a pituitary tumor) which 
release an excess of ACTH and thus produces a Secondary Hypercortisolism.***

35 Paget's disease of the breast is Invasive Ductal Carcinoma involving the nipp
le-areola complex; a palpable mass may or may not be present. It is treated by M
odified Radical Mastectomy. 

36 Stage I Breast Cancer: T1, No, Mo (a T1 lesion is less than 2 cm in total dia
meter). Treat with Breast-conserving therapy ! 

37 Neostigmine 2 mg IV over 5 minutes with EKG monitoring pt must not have perit
oneal signs or a true volvulusover 90 % effective dose may be repeated in 3 hrs.
 if necessarymay cause symptomatic bradycardia in 20 % of pts. (treated with Atr
opine) 

38 Treatment of a Type IV Gastric Ulcer: Excision. (maintaining the GE Junction 
is preferred if anatomically possible) 

39 Intestinal Metaplasia 

40 Treatment of a Stage II Breast CA: Breast-conserving therapy (i.e. lumpectomy
, XRT, & sentinel-node biopsy). At present, little role of MRM. 

41 Treatment of Inflammatory Breast CA: Biopsy the lesion. Rule out metastases w
ith mammography, bone scans and a CT scan of the chest, abdomen, brain (and axil
la ?). Begin neoadjuvant therapy with FAC/CAFV/CMF. After an initial course (4 
― 6 weeks), complete the mastectomy and axillary dissection followed by radiati
on therapy and adjuvant chemotherapy. If no response is obtained with chemothera
py initially, then proceed with radiation therapy. Proceed with mastectomy if po
ssible after radiation therapy and follow with adjuvant chemotherapy. Overall pr
ognosis is poor with a median survival of 31 months 

42 Early dumping: Hyperosmolar Load 

43 Late dumping: Inappropriate Insulin Response 

44 The Nigro Protocol ― given for all biopsy-proven anal carcinoma (except mela
noma) 
5-FU, 1000 mg IV qd for the first 3 days of therapy200 rads external beam radiat
ion, each day M ― F for 5 weeksLast 3 days of treatment, 5-FU, 1000 mg IV qdRe-
examine the pt in 2 weeksIf no visible tumor remaining, do a biopsy of the areaI
f biopsy is negative, treatment is finished and pt undergoes close follow-upIf b
iopsy is positive, Give 1000 Rads of radiation for a total of 6,000 then re-biop
syIf gross tumor remains after the 5000 Rads, then APRIf there is clinically-pos
itive nodes, then perform a superficial groin dissection (you should never irrad
iate a groin) 

45 Wide local excision 

46 Botox injection 

47 RQ = CO2 Produced / O2 Consumed 

48 When the melanoma is "Intermediate Thickness", 1 ― 4 mm 

49 Anterior face Melanoma: Wide local excision with Superficial Parotidectomy an
d Modified Radical Neck Dissection 

50 Wide Local Excision (may require plastic reconstruction after excision)  
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※作者已于 2004-10-30 23:05:12 修改本文※