10/2018

Question 1

HIV+ fever, weight loss, hepatosplenomegaly, mass consistent with lymphoma

Answer 1

Aggressive high-grade B-cell Lymphoma is most common HIV+ lymphoma

Question 2

Central line catheters Most likely to DVT? Most likely to infect?

Answer 2

Femoral MC to DVT and infect. Worse in obese patients.

Question 3

Preferred site for CVC lines? Preferred site for HD catheters?

Answer 3

Right Subclavian is best for CVC RIJ is best for HD catheter

Question 4

What is absorbed in the duodenum?

Answer 4

Fe, Ca

Question 5

What is absorbed in the ileum?

Answer 5

B12, bile salts

Question 6

What is absorbed in the ileum?

Answer 6

B12, bile salts

Question 7

Frey syndrome

Answer 7

Associated w/ parotidectomy - wrong regrowth of parasympathetics of auriculotemporal nerve to sweat glands. Ipsilateral sweating when eating.

Question 8

During parotidectomy, injury to greater auricular nerve…

Answer 8

often transected. causes numbness to lower external ear and pre & post-auricular skin.

Question 9

Anastomosis leak rates in colorectal?

Answer 9

ileocolic is lowest = 1-3% Colocolonic = 1-10% Coloanal is highest = 10-20%

Question 10

MC tumor of appendix? MC malignancy of appendix? Worse prognosis of appendiceal tumors? MC Mucinous tumor?

Answer 10

Carcinoid is MC tumor but not always malignant. Adenocarcinoma = MC malignant of appendix Worse prognosis = Signet-ring cell carcinoma MC mucinous = benign mucinous cystadenoma

Question 11

most potent stimulator of bile secretion?

Answer 11

secretin

Question 12

Coin lodged in…upper esophagus …lower esophagus …stomach

Answer 12

Use…rigid esophagoscopy for upper …flexible esophagoscopy for lower …can watch and wait (battery must be retrieved regardless)

Question 13

afferent loop syndrome symptoms and treatment

Answer 13

pain, nausea, bilious/non-bilious vomiting and RELIEF after bilious vomiting. Tx is surgical, re-connect with shorter limb (30cm), enteroenterostomy or conversion of billroth-2 to b-1 or a RY.

Question 14

Septic pelvic thrombophlebitis

Answer 14

venous seeding of microorganisms that may trigger thrombosis. 2–4 days postpartum. Cord-like mass near ovary on affected side. Tx with 7-10 days heparin + abx

Question 15

Hodgkin’s lymphoma staging

Answer 15

If “B symptoms” then get a B Stage 1 = single lymphatic site Stage 2 = 2 or more sites but doesn’t cross diaphragm Stage 3 = crosses diaphragm (spleen counts) Stage 4 = non-lymphatic organs

Question 16

Pancreas outputs during secretin test for chronic pancreatitis, panc cancer, malnutrition, ZE, end-stage pancreatitis

Answer 16

Question 17

PSC symptoms? Tx?

Answer 17

Nausea, ithcing, fatigue in setting of Crohn’s with recurrent strictures.

Stenting can help to relieve the obstructions, but the definitive treatment for PSC is liver transplantation.

Question 18

Aortic stenosis valve measurement? Tx?

Answer 18

Normal AV area = 3-4cm^2

AV stenosis is < 50% this area.

Tx electively when AV stenosis with symptoms. Tx emergent when AV stenosis with CHF.

Question 19

Mechanism of action of…SMX?

…Fluorquinolones

…Vancomycin

…Aminoglycosides

…Macrolides

Answer 19

inhibit dihydropteroate synthetase

inhibit DNA gyrase

inhibits cell wall synthesis

binds to 30s rib subunit

binds to 50s rib subunit

Question 20

Hepatitis B.

What’s the significance of: HBsAg? Anti-HBsAg? HBcAg? Anti-HBcAg? HBeAg?

Answer 20

HBsAg - infection! Acute (or chronic if persistent) infection and will clear when infection is cleared

Anti-HBs - usually appears in serum after infection is cleared or if vaccinated.

HBcAg - not detectable in serum due to intracellular

Anti-HBc - appears early after infection. Persists.

HBeAg - marker of HBV replication

Question 21

Hepatitis panel, what would you see for an Acute infections? Chronic infection? Immunity?

Answer 21