10/21/2018

Question 1

Prognosis of ZES: long-term survival of unresectable disease?
5 yr survival rate of ZES with resectable liver mets?

Answer 1

20% for unresectable disease

80% for resectable disease

Question 2

GIST tumors: cells come from where and what stains are seen?

Answer 2

Interstitial cells of Cajal

stain ckit and CD34 positive

Question 3

Milrinone mechanism and use?

Answer 3

Phosphodiesterase type III inhibitor - works by blocking the degradation of cAMP

• pulmonary vessel dilation and cardiac contractility agent
• Useful in pulmonary hypertension or cardiogenic shock

Question 4

Does Pancreatic Polypeptide inhibit or stimulate pancreatic secretions?

Answer 4

Pancreatic polypeptide inhibits pancreatic secretions.

Question 5

Melanoma depths and corresponding resection margins?

Answer 5

5 mm margin for melanoma in situ
1 cm margin for lesions less than 1 mm in thickness
2 cm margin for lesions > 1mm

Question 6

At what depth do you do a SNLB for melanoma?

Answer 6

Can be considered for 0.75 to 1mm depths.
Definitely do a SNLB for lesions 1 mm or greater.
If positive then lymphadenectomy.

Question 7

What enzyme is involved in the conjugation of bilirubin?

Answer 7

Glucuronyl transferase

Question 8

What amino acids are conjugated to bile acids?

Answer 8

Taurine and glycine

Question 9

Conjugation of primary bile acids takes place…

Answer 9

In hepatocytes and further occurs in intestine (by bacteria)

Question 10

Necrolytic migratory erythema is associated with what?

Answer 10

alpha cell tumors of the pancreas, usually glucagonoma.

Resolves with resection of the tumor!

Question 11

Most common primary lung tumor in kids?

Answer 11

Pleuro-pulmonary blastomas

Some literature says carcinoids.

Question 12

Umbilical hernia with ascites management:
No skin rupture?
With skin rupture?

Answer 12

No skin rupture - TIPS and elective hernia repair

WITH skin rupture - Surgical emergency - emergent primary repair of hernia then medical management of ascites

Question 13

Absorptive capacity of the pleura?

Answer 13

5-10L / day

and carries most of the pulmonary lymphatics

Question 14

Most important measurement in considering a lobectomy?

Answer 14

FEV1
Need FEV1 > 0.8L.
If < 0.8L then follow with a V/Q scan. If the lung to be resected does not contribute as much then can still be resected.
If definitely ruled out then consider radiation of lesion.

Question 15

FNH imaging appearance?

Tx?

Answer 15

Nearly isointense on T1 & T2.
Homogeneous mass with maybe central scar that enhances rapidly during arterial phase.
Has Kupffer cells so + on sulfur colloid scan.
Tx: No resection, may stop OCPs as well.

Question 16

Integrins do what?

Answer 16

on outside of cells and involved in diapedesis. Also involved in cell signaling.

Question 17

Selectins do what?

Answer 17

When exposed to activated endothelium they influence neutrophil rolling.

Question 18

How to differentiate FNH from Fibrolemellar HCC?

Answer 18

FNH has normal AFP.

Fibrolamellar HCC has elevated AFP and neurotensin level.

Question 19

Anion gap metabolic acidosis etiologies?

Answer 19

(list all) + Thiamine deficiency

Question 20

Mechanism of Vitamin K on clotting?

Answer 20

Vitamin K activates the clotting factors via gamma carboxylation of glutamate residues 2, 7, 9, 10, protein C and S.