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PGY1 Resident - General Surgery - tweeting through ABSITE studying (My tweets are literally just notes, not medical advice)

[MedLearn Hub @MedLearnHub]

✴️ Sibson Hernia (Cervical Lung Hernia)- It is a rare type of lung hernia where lung tissue protrudes through a defect or weakness in Sibson’s fascia (suprapleural membrane) at the thoracic inlet.

• Etiology- May be congenital (due to fascial weakness) or acquired (trauma, chronic cough, heavy lifting, increased intrathoracic pressure causing fascial laxity, tears).

∆ C/F- Soft, compressible supraclavicular neck swelling which may increase in size on coughing/Valsalva maneuver; often asymptoimatic but can cause discomfort/dyspnea.

✓Dx- It is Confirmed by Chest X-ray= abnormal shadows; CT scan with Valsalva maneuver demonstrates lung tissue herniation & defect; flexible laryngoscopy rules out other neck masses.

∆ T/t- Asymptomatic hernias may not require surgery; symptomatic hernias, especially enlarging types, may need surgical repair of the fascial defect (reinforcement of Sibson’s fascia), treating underlying causes.

[jamie. @j_mee949]

incident reports are supposed to be used for real issues but instead they’re used to bully residents:)

[jamie. @j_mee949]

a nurse asked my attending if she should file an incident report on me for having a blanket around my shoulders

[Mxim @sugeezy]

Everybody wears scrubs now. Don’t know if you’re a lash tech or a heart surgeon 🤨

[Ultimate Wildcat NBA NFL MLB FAN account @budspook]

@RoyChibuike 2-PAM (2-pyridine aldoxime methyl chloride) — also called pralidoxime — is one of a class of chemicals, called oximes that reverse the binding of cholinesterase inhibitors

[step 3 bff @USMLEbfff]

Melanoma Margins
•In situ → 0.5 cm
•≤ 1 mm depth → 1 cm
•1–2 mm → 1–2 cm
•2 mm → 2 cm

Breslow depth (not Clark level) drives prognosis and margin. SLNBx generally for ≥ 0.8 mm or ulcerated.

[Medzonetv @Medzonetv]

Pregnant woman seizing.

BP 170/110.

Drug of choice?

[step 3 bff @USMLEbfff]

Biliary stricture that occurs within 2mos s/p liver transplant usually technical issue
after 2mos strictures often related to ischemia/fibrosis/issues w healing

nonanastomotic strictures poss occur from hepatic art. thrombisis vs underlying liver disease occurence

[Oren Gottfried, MD @OGdukeneurosurg]

Nice arterial map @Hugodadisco

[step 3 bff @USMLEbfff]

LCIS is a risk marker , NOT a true breast carcinoma
-not recommended to undergo radiation after surgery
-doesnt metastasize to ax nodes, so SLNB is not warrented

[step 3 bff @USMLEbfff]

LCIS pts may benefit from tamoxifen to decrease incidence of invasive hormone positive breast cancers

LCIS : 8-10x increase of breast cancer in BOTH breast

[step 3 bff @USMLEbfff]

LCIS is frequently mammographically occult, incidental finding

[step 3 bff @USMLEbfff]

Small duodenal tumors <2-3cm = remove w endoscopic polypectomy

>2-3cm may need to be removed surgically (Ex transduodenal polypectomy)

[step 3 bff @USMLEbfff]

Tamoxifen reduces risk of cancer in both the ipsilateral and contralateral breast in women tx with BCT w/ER+ tumors.

Also dont take tamoxifen w/SSRIs

[step 3 bff @USMLEbfff]

also rec. thyroid US every 2-5yrs starting in late teenage years to screen for papillary thyroid cancer

[step 3 bff @USMLEbfff]

pts with APC gene mutation (FAP) should be screened for duodenal adenomas with
EGD at age 20-25
OR
when colon poyposis is confirmed

[step 3 bff @USMLEbfff]

bc mucosa often demonstrates no evidence of tumor infiltration

[step 3 bff @USMLEbfff]

SMALL INTESTINE LYMPHOMA:
needs TISSUE BIOPST from the SUBMUCOSA

[step 3 bff @USMLEbfff]

Gastrointestinal non hodghkin lymphona most common location is stomach and then the ILEUM

[step 3 bff @USMLEbfff]

paget dz of the nipple: large cells w pale cytoplasm and prominent nucleoli in the epidermis
noninvasive cancer of the skin of the nipple
the extent of the ca determines the tx. if diffuse or distant from nipple, mastectomy is best procedure
otherwise theres been success w/BCT