Rapid Fire Power Review

TOP 100 CLINICAL SURGICAL MICROVIGNETTES

1. Elderly woman, SBO,	Gallstone ileus
and air in biliary tract

2.Elderly woman with Obturator hernia (Howship-Romberg sign) pain down inner aspect

of thigh

3.	Abdominal pain,	Ruptured abdominal aortic aneurysm
	hypotension, and	(AAA)
	abdominal pulsatile
	mass
4.	Abdominal pain “out	Mesenteric ischemia
	of proportion” to
	abdominal exam
5.	Arm pain and syncope	Subclavian steal syndrome
	with arm movement
6.	Increasing creatinine	Renal artery stenosis
	on ACE inhibitor
7.	Child with MIDLINE	Thyroglossal duct cyst
	neck mass
8.	Child with LATERAL	Branchial cleft cyst
	neck mass
9.	Crush injury and dark	Myoglobinuria
	urine
10.	Emesis, chest pain	Boerhaave’s
	radiating to back, and
	mediastinal air
11.	Lower GI bleed	Meckel’s diverticulum
	technetium
	pertechnetate scan

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12.	Flushing, diarrhea,	Carcinoid
	and right-sided heart
	failure
13.	Pneumaturia and LLQ	Colovesicular fistula
	pain
14.	Desmoid tumor, oste-	Gardner’s syndrome
	oma, and colon cancer
15.	Epigastric pain	Hemorrhagic pancreatitis
	radiating to back and
	flank ecchymosis
16.	Pancreatitis and	Pancreatic pseudocyst
	palpable epigastric mass
17.	Liver abscess with	Amebic abscess
	“anchovy paste”
18.	RUQ pain, travel, and	Hydatid cyst
	exposure to sheep
19.	Caput medusa	Portal hypertension
20.	45-year-old woman with	Acute cholecystitis
	RUQ pain for 12 hours,
	fever, and leukocytosis

21.Elderly man with large Pancreatic cancer (Courvoisier’s sign) nontender palpable

gallbladder

22.	Female taking birth con-	Hepatic adenoma
	trol pills with liver mass
23.	Liver tumor with	Focal nodular hyperplasia
	“central scar”
24.	Pancreatic mass,	Somatostatinoma
	gallstones, diabetes,
	and diarrhea
25.	RUQ bruit and CHF in	Liver hemangioma
	young adult

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26.	Excruciating pain with	Anal fissure
	bowel movement
27.	Abdominal pain, diar-	Crohn’s disease
	rhea, and anal fistulae
28.	EKG with “peaked”	Hyperkalemia
	T waves
29.	Buccal mucosa with	Peutz-Jeghers syndrome
	pigmentation
30.	LLQ pain, fever, and	Diverticulitis
	change in bowel habits
31.	Elevated urine 5-HIAA	Carcinoid
32.	Institutionalized, abdo-	Sigmoid volvulus
	minal pain, vomiting,
	and distention, with
	proximal colonic dilation
33.	Infant with projectile	Pyloric stenosis
	vomiting
34.	Newborn with failure	Hirschsprung’s
	to pass meconium in
	first 24 hours
35.	Infant with bilious	Malrotation
	vomiting
36.	Newborn with	Omphalocele
	abdominal defect and
	umbilical cord on sac
37.	Teenager with knee	Ewing’s sarcoma
	pain and “onion
	skinning” on x-ray
38.	Pulmonary capillary	Acute respiratory distress syndrome
	wedge pressure 18,	(ARDS)
	CXR with bilateral pul-

monary infiltrates, and PaO2:FiO2 ratio 200

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39.Increased peak airway Abdominal compartment syndrome pressure, low urine

output, and urinary bladder 25 mmHg

40.	Newborn with inability	Esophageal atresia
	to “pass an NGT”
41.	Traumatic blinding	Sympathetic ophthalmia
	in one eye followed
	by blindness in the
	contralateral eye
	2 weeks later
42.	Mitotic pupil, ptosis,	Horner’s syndrome
	and anhydrosis
43.	Traumatic head	Epidural hematoma (“lucid interval”)
	injury, conscious
	in ER followed by
	unconsciousness
44.	“Worst headache of my	Subarachnoid hemorrhage
	life”
45.	Hematuria, flank pain,	Renal cell carcinoma
	and abdominal mass
	(palpable)
46.	60-year-old white	Bladder cancer
	man with painless
	hematuria
47.	RUQ pain, jaundice,	Cholangitis
	and fever
48.	Epigastric pain	Pancreatitis
	radiating to back, with
	nausea and vomiting
49. Chest pain radiating to		Aortic dissection
	back and described as
	a “tearing” pain

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50.	40-year-old man	Alcohol withdrawal
	with tachycardia/
	hypertension
	and confusion on
	postoperative day #2
51.	Marfanoid body habitus	MEN II-b
	and mucosal neuromas
52.	Psammoma bodies	Papillary thyroid cancer
53.	Sulphur granules	Actinomyces infection
54.	Thyroid tumor with	Thyroid medullary cancer
	AMYLOID tissue
55.	PALPABLE neck tumor	Parathyroid cancer
	and hypercalcemia

56.Hypertension, Pheochromocytoma diaphoresis (episodic),

and palpitations

57.	Jejunal ulcers	Zollinger-Ellison syndrome
58.	Pituitary tumor,	MEN- I
	pancreatic tumor, and
	parathyroid tumor
59.	Necrotizing migratory	Glucagonoma
	erythema
60.	Medullary thyroid	MEN-IIa
	cancer, pheochro-
	mocytoma, and
	hyperparathyroidism
61.	Hypokalemia refractory	Hypomagnesemia
	to IV potassium
	supplementation
62.	Newborn with	Necrotizing enterocolitis (NEC)
	pneumatosis
63.	Child with abdominal	Neuroblastoma
	mass that crosses midline

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64.	Child 4 years of age	Wilms’ tumor
	with abdominal tumor
	that does NOT cross
	midline
65.	“Currant jelly” stools	Intussusception
	and abdominal colic
66.	Femur fracture,	Fat embolism
	respiratory failure,
	petechiae, and mental
	status changes
67.	Hearing loss, tinnitus,	Ménière’s disease
	and vertigo

68.Adolescent boy with Juvenile nasopharyngeal angiofibroma nasal obstruction and

recurrent epistaxis

69.	Child 5 years of age	Epiglottitis
	sitting upright and
	drooling, with “hot-
	potato” voice
70.	Angina, syncope, and	Aortic stenosis
	CHF
71.	Tobacco use, asbestos	Mesothelioma
	exposure, and pleuritic
	chest pain
72.	Supracondylar fracture	Volkmann’s contracture
	and contracture of
	forearm flexors
73.	Tibia fracture, “pain out	Compartment syndrome
	of proportion,” pain on
	passive foot movement,
	and palpable pulses
74.	25-year-old man with	Fibrolamellar hepatocellular carcinoma
	liver mass with fibrous
	septae and NO history
	of cirrhosis or hepatitis

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75.	EKG with flattening of	Hypokalemia
	T waves and U waves
76.	Central pontine	Too-rapid correction of hyponatremia
	myelinosis
77.	Polydipsia, polyuria,	Hypercalcemia
	and constipation
78.	Factor VIII deficiency	Hemophilia A
79.	Abdominal pain,	Adrenal insufficiency (Addisonian crisis)
	fever, hypotension,
	HYPERkalemia, and
	HYPOnatremia
80.	Massive urine output	Diabetes insipidus
	and HYPERnatremia
81.	Increased urine	SIADH
	osmolality,
	HYPOnatremia, and
	low serum osmolality
82.	IV antibiotics, fever,	Clostridium difficile pseudomembranous
	diarrhea	colitis
83.	Bleeding gums and	Vitamin C deficiency
	wound dehiscence
84.	Fever, central line, and	Central line infection
	HYPERglycemia
85.	Appendectomy	Peritoneal abscess
	followed by fever and
	abdominal pain on post-
	operative day #7
86.	Advancing crepitus,	Necrotizing fasciitis
	fever, and blood blisters
87.	High INTRAoperative	Malignant hyperthermia
	fever
88.	Confusion, ataxia, and	Wernicke’s encephalopathy
	ophthalmoplegia

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89.	Tracheal deviation,	Tension pneumothorax
	decreased breath
	sounds, and
	hyperresonance
90.	Hypotension, decreased	Pericardial tamponade
	heart sounds, and JVD
91.	Four ribs broken in	Flail chest
	two places and
	pulmonary contusion
92.	Otorrhea (clear) and	Basilar skull fracture
	Battle’s sign
93.	Ulcer and decreased	Duodenal ulcer
	pain with food
94.	Vomiting, retching, and	Mallory-Weiss tear
	epigastric pain
95.	Fever on postoperative	Clostridial wound infection
	day #1, with “bronze”
	weeping, tender wound
96.	Hematochezia and	Rectal cancer
	tenesmus
97.	Upper GI bleed,	Hemobilia
	jaundice, and RUQ
	pain
98.	Gallstones, epigastric	Gallstone pancreatitis
	pain radiating to back,
	and nausea
99.	18-year-old woman	Ductal papilloma
	with bloody nipple
	discharge
100.	Irritability, diaphoresis,	Insulinoma
	weakness, tremulousness,
	and palpitations