Q-set: surgery - library

[ArchivalUser]

ericz, when is your exam?

[ArchivalUser]

library,
I already took the exam and are preparing for step 3 now, because step3 and 2 overlap so much and not much going on with step 3 forum. Just like a few others, I spent more time at step2 ck than step 3. It appears that my weak areas remain weak.

I see you guys doing a great job, very active with a lots of great questions and answers. I am still learning a lot and having lots of fun.

[ArchivalUser]

hi, library,

could you please explain the first question 21-17.

thanks

[ArchivalUser]

Rich, they think BS is the first step to check any esophagus ca., not the -scope. Please correct me if not right, library.

[ArchivalUser]

I don't think you have to do a barium in the 1st one, just go straight to endoscopy, you know there's a mechanical problem already, and if it is cancer(which it prob is), you can biopsy it at the same time with scopy.

Lung bullet wounds should be removed due to possible infections or mechanical obstuctions later on. If it were a big Muscle, I think you can get away with it.

FNA, I agree with.

Ca of rectum I agree with - Pencil stools usually signifies L-sided colon cancer(apple coring)

Last one is Retrograde Cystogram followed by a ct of the abd ( he is hemodynamically stable)

[ArchivalUser]

Ok, yes, I now agree with US fist for neck mass. R u supposed to do a barium 1st always before endoscopy? And why exploratory lapy for the last one? And why not remove the bullet. Can you please explain ur answers?

[ArchivalUser]

studyboy the essence of exp. lap. in the last case is not to reove the bullet. The bullet is embedded in the 'sacral promontory' and would not cause any more harm. Exp. lap. will enable the identification of possible damage caused by the bullet so that it could be repaired. According to DVD lecture on surgery... any bullet wound below the level of T4 [nipple] must entail exp. lap.

[ArchivalUser]

Yes you are right alibi, thanks a million!!! I forgot that, idiot I am!

Yes, and Barium is done 1st for the following esphageal problems:
1)Achalasia (then manometry, then EGD to rule out CA)
2)DES (confirmed by manometry)
3)Esophageal Ca (then EGD w/biopsy)
4)Esophageal Rings
5)Esop stricture
6)Zenkers Diverticulum
7)Hiatal Hernia

Now, things in the Esophagus when not to use Barium:
1)Esophageal Tears (mallory Weiss-do EGD and esph rupture-air in med)
2)Infections like candida, herpes, cmv and hiv odynophagia, do scope
3)Esophageal Webs Cinefilms (missed on Barium)

[ArchivalUser]

To studyboy, i don't agree with you though it's apparently the eso. ca. but it still need to follow the rule, right? Have u read the kaplan notes? It says do barium first then egd for the eso. ca.