Surgery Shelf

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Author:
jknell
ID:
247178
Filename:
Surgery Shelf
Updated:
2013-11-16 15:44:30
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Surgery Shelf
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Uworld surgery shelf questions (medicine)
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  1. SIDEROBLASTIC ANEMIA
    -pathophysiology
    -types
    -clinical findings
    • PATHOPHYSIOLOGY:
    • -defect in heme synthesis (protoporphyrin: precusor to heme)
    • -SCoA → ALA (via ALAS: B6 dependent)
    • -Iron able to enter mitochondria but not able to make protoporphyrin (ringed sideroblasts)

    • TYPES:
    • 1. Acquired: alcoholism, lead poisoning, B6 deficiency (INH tx)
    • 2. Congenital: X-linked ALAS defect

    • CLINICAL FINDINGS:
    • -dimorphic RBC population (one group of normochromic, one group of hypochromic)
    • - serum iron ↑
    • - ferritin ↑
    • - TIBC ↓ (vs. Iron deficiency)
    • - % Sat ↑
  2. WHIPPLE DISEASE
    -Pathophysiology
    -Clinical Presentation
    -Diagnosis
    • PATHOPHYSIOLOGY:
    • -infection with GP bacillus Tropheryma Whippelii
    • -unknown mechanism of transfer

    • CLINICAL PRESENTATION:
    • -chronic malabsorptive  diarrhea
    • -steatorhea, flatulance, abdominal distention
    • -weight loss
    • -migratory arthritis
    • -LAD
    • -low grade fever
    • -cardiac sx
    • -CNS sx

    • DIAGNOSIS:
    • -small intestinal biopsy with PAS+ foamy macrophages in lamina propria
    • -(bacilli are NOT acid fast+ vs MAC in HIV+ patients)
  3. CHRONIC VENOUS INSUFFICIENCY
    -pathophysiology
    -clinical presentation
    -treatment
    • PATHOPHYSIOLOGY:
    • -three venous systems of lower extremities: deep, superficial and perforating
    • -perforating veins (connect superficial to deep with valves to prevent flow from deep to superficial)

    • -main risk factor = h/o DVTs (destroys valves in deep and perforating systems)
    • -ambulatory venous HTN: edema, extravasation of RBCs/prots (dark pigment)

    • CLINICAL PRESENTATION:
    • -edema
    • -leg elevation relieves sxs
    • -thin/atrophic/shiny skin
    • -brawny induration (hemosiderin deposit from extravasated RBCs/prots)
    • -venous ulcers (medial malleolus)

    • TREATMENT:
    • -leg elevation
    • -avoid long periods of sitting or standing
    • -compression stockings
  4. WALDENSTROM'S MACROGLOBULINEMIA
    -Pathophysiology
    -Clinical Presentation
    -Diagnosis
    -Treatment
    • PATHOPHYSIOLOGY:
    • -malignant proliferation of plasma cells with excessive IgM production
    • -hyperviscosity

    • CLINICAL PRESENTATION:
    • -HSM, LAD
    • -Fatigue (2/2 anemia)
    • -easy bleeding/bruising (viscosity)
    • -night sweats
    • -HA/dizziness
    • -visual problems
    • -demyelinating sensorimotor neuropathy (pain/numbness)
    • -NO lytic lesions

    • DIAGNOSIS:
    • -M spike (IgM vs MM → IgG)
    • -BJ proteinuria in 10%
    • -hyperviscosity

    • TREATMENT:
    • -no definitive cure
    • -chemo
    • -plasmapheresis for hyperviscosity
  5. SMALL BOWEL OBSTRUCTION
    -Pathophysiology
    -Clinical Presentation
    -Treatment

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