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Absite 2023 > ABSITE > Flashcards

ABSITE Flashcards

1
Q

Mechanism of Action:
-Pembrolizumab
-Cyclophosphamide
-Paclitaxel
-Ipilimumab

A

-Monoclonal Ab against PD1
-Alkylating agent of DNA
-Microtubule inhibitor
-CTLA-4 Inhibitor

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2
Q

Treatment for hydrofluoric acid burn

A

Topical calcium gluconate gel & copious irrigation

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3
Q

Treatment of perianal abscess with fistula tract in patient with Crohn’s colitis

A

surgical drainage
placement of noncutting seton
short course of antibiotics

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4
Q

Necrotizing Enterocolitis:
-presenting age
-medical management
-surgical management

A

-Within 1 month of birth
-NPO, IVF, transfuse prn, Abx. 50% resolve within 7-10 days
-Surgery: only with perforation. Perform resection with stoma as anastomotic leaks & stricture are common

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5
Q

Mechanism of action:
-Aztreonam
-Ceftriaxone
-Ciprofloxacin
-Metronidazole
-Tetracycline
-Erythromycin, Clindamycin, Linezolid

A

-Monobactam blocks cell wall synthesis. Resistant to beta-lactamase. Low PCN cross-reactivity.
-Beta-lactam. Blocks cell wall synthesis.
-Inhibit DNA gyrase & topoisomerase
-Creates free radicals
-Blocks 30S ribosome for protein synthesis
-Blocks 50S ribosome

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6
Q

Step up treatment of Shatzki’s ring

A

Dilation
Steroid injection before dilation
Endoscopic incision
Surgical intervention

These are mostly mucosal without muscular involvement.
Protective against Barretts esophagus
Always have associated hiatal hernia

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7
Q

Dopamine effect at doses:
Low
Med
High

A

LOW: Dopamine receptor
-renal, mesenteric, cerebal vasodilation
MED: Beta 1
-increased cardiac contractility & HR
HIGH: Alpha 1
-vasoconstriction

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8
Q

Top two causes of morbidity in the elderly:

A
  1. Falls
  2. MVC
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9
Q

Young male, fever, elevated WBC and ESR, “Onion peel” on xray. Dx?

A

Ewings sarcoma
MC: pelvic location
T: radiation to pelvis/spine, chemo and surgery for long bones

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10
Q

Treatment of CMV infection

A

Ganciclovir, Foscarnet, Cidofovir
Inhibit DNA polymerase

[valganciclovir is a po med]

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11
Q

Burn medication side effects:
-mafenide acetate

-silver nitrate

-silver sulfadiazine

-polymyxin B, neomycin, bacitracin

-mupirocin

A

-metabolic acidosis (moa: carbonic anhydrase inhibitor) penetrates eschar

-methemoglobinemia, hyponatremia, hypochloremia

-neutropenia (good for candida coverage though) cannot penetrate eschar

-nephrotoxicity

-(treats MRSA)

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12
Q

Caprini Risk Assessment
5 points
3 points

A

5 points: poly-trauma, >6hr surgery, stroke, hip/pelvis/leg fracture, spinal cord fx/ paraplegia, major LE arthroplasty

3 points: age >75, personal/family hx of VTE, on chemotherapy, thrombophilias (inherited or hep induced)

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13
Q

Caprini Risk Assessment
2 points
1 point
Women specific

A

2 points: age 60-74, surgery >45 min, diagnosis of cancer, bedbound, central line, plaster cast, minor arthroplasty

1point: age 40-59, minor surgery, BMI>30, COPD, MI, CHF, IBD, swollen legs/varicosities, hx of major surgery, medically bed bound

Women: pregnant, hx spont abortions, OCP/hormonal therapy

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14
Q

Pancreas exocrine function tested by secretin test:
Effect on volume, bicarb, & enzyme
-cancer
-chronic pancreatitis
-malnutrition

A

Cancer: volume low, bicarb/amylase normal
Chronic: volume nml, bicarb low, amylase nml
Malnutrition: volume nml, bicarb nml, amylase low

End stage pancreatitis: all low
Zollinger Ellison: volume high

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15
Q

62F abd pain and diarrhea
CT scan: mass in ileum with desmoplastic reaction tethering small bowel and mass in liver

Diagnosis and next steps in work up

A

Carcinoid tumor
Obtain urinary 5-HIAA
(chromogranin A elevated w/ PPI use)

Imaging: 68Ga-Dotatate PET CT
Grade: Ki-67
Sx control: octreotide or lanreotide

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16
Q

GI neuroendocrine tumors originate from what cells?

A

enterochromaffin cells (Kulchitski cells)

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17
Q

Pain medication with little histamine release

A

Fentanyl & Tramadol

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18
Q

Bleomycin side effect

A

Pulmonary toxicity = fibrosis
Decreased lung volume and decreased DLCO

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19
Q

Hypothermia
Mild, Moderate, Severe, Profound

A

MILD- shivering, mental changes, tachycardia

MODERATE- agitation, combative, pupil dilation, muscle spasm, slowing respirations, decreased PVR leads to Afib and hypotension

SEVERE- flaccid, comatose, EKG w/ prolong QRS, osborne waves, leads to V fib and arrest

PROFOUND- loss of vital signs, cardiac activity, EEG

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20
Q

Gastrintestinal Stromal Tumor (GIST)
Diagnosis and management

A

Express CD117
mutation in KIT proto-oncogene

If >2cm, segmentally resect w/ R0 margin without lymphadenectomy

Can consider imatinib to shrink if needed
Prognosis based on size and mitotic count

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21
Q

Barretts Esophagus
long segment vs short segment disease

A

short segment < 3cm
long segment >3cm

Barretts without dysplasia repeat endoscopy 3-5 years

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22
Q

Barretts Esophagus surveillance intervals

A

No dysplasia: 3-5 years
Low grade dysplasia: 6-12 months +/- endoscopic ablation
High grade dysplasia: endoscopic ablation, 3 months

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23
Q

Rectal cancer indication for neoadjuvant chemoradiation

A

T3, T4, or node positive
If shrinking can make it sphincter sparing

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24
Q

Rectal cancer indication for transanal excision

A

T1 (submucosa) cancer in mid/distal rectum with:
tumor <3cm in diameter
tumor <30% of bowel lumen circumference
mobile & nonfixed
need clear margins, favorable features, no nodes
aggressive postop screening

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25
Q

Workup for proximal rectal cancer

A

CT CAP, CEA, pelvic MRI

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26
Q

Workup for colon cancer

A

CTCAP, completion colonoscopy, CEA

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27
Q

Brooke Resuscitation formula

A

2 x kg x %TBSA = total resuscitation
First half in 8 hours, Second half in 16 hours.
For >15% burns

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28
Q

Absolute contraindications for BCT + radiation

A

radiation during pregnancy
diffuse appearing microcalcifications
positive pathologic margins
disease involving >1 quadrant

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29
Q

Absolute contraindications for PEG tube

A

active infection at skin site
hemodynamic instability, peritonitis, sepsis
peritoneal carcinomatosis
uncontrolled ascites
uncontrolled coagulopathy or inability to stop anticoagulation
severe malnutrition
completely obstructing mass

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30
Q

Surgical treatment of parathyroid carcinoma

A

parathyroidectomy, en bloc ipsilateral hemi-thyroidectomy
only take central nodes if nodes appear positive

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31
Q

Imaging radiation risk (low to high)

A

chest xray
mammogram
CT head
CT Angiogram
PET CT
Nuclear Med cardiac stress test

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32
Q

Indication for radioactive iodine after total thyroidectomy for papillary thyroid cancer

A

extrathyroidal extension
primary tumor > 4cm
bulky or >5+ lymph nodes

*follow with levothyroxine to avoid hypothyroid state

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33
Q

What disease is association with genetic mutations:
KRAS, SMAD, p53, CDKN2A

A

pancreatic adenocarcinoma

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34
Q

Colonoscopy surveillance guidelines with 1 first degree relative with colon cancer

A

Start at age 40 or ten years prior to diagnosis, repeat q5 years

Average risk is 45yo start w/ q10 years repeat

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35
Q

FFP components
vs.
Cryoprecipitate components

A

FFP: Factor V, 7, 9,10,11,12, vWF, fibrinogen, thrombin

Cryo: Factor 8, 13, vWF, fibrinogen

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36
Q

Ulcerative colitis screening colonoscopy recommendations

A

8 years after diagnosis
High risk: q1 year vs Low risk: 2-5 year
Random biopsies

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37
Q

Management of ulcerative colitis with invisible high grade dysplasia or multifocal low grade dysplasia

A

total proctocolectomy

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38
Q

WAGR syndrome

A

Wilms tumor
Aniridia
Genitourinary anomalies
Mental Retardation

Chromosome 11

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39
Q

Neurogenic shock parameters

A

PCWP nml
Cardiac output LOW
SVR LOW

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40
Q

Patient in cardiac arrest is hypothermic, what is the best active rewarming technique and warm to what temp?

A

Warm lavage of chest or abdomen
Warm to 90F (0C)

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41
Q

Epidemiology of pediatric intussusception

A

Between 3month and 3 years
MC: ileocolonic
Only 1/3 get abd pain, palpable mass, & currant jelly stool

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42
Q

Transplant medications MOA:
-Tacrolimus & Cyclosporine (maintenance)

-Sirolimus (alternate maintenance)

-MMF & Azathioprine (antiproliferatives)

A

-Calcineurin inhibitor, bind FK binding protein, inhibit T cell proliferation. SE: headache, gallstones, nephrotoxic

  • binds FKBP, blocking mTOR, blocking cell proliferation

-Interfere w/ DNA synthesis (de novo purines & alkylate) SE: GI upset

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43
Q

Risk factors for gastric polyps:

A

H pylori and atrophic gastritis
MC: hyperplastic
Adenomatous can be tubular, tubulovillous, villous
Fundal polyps have no malignancy risk

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44
Q

Most common tumor of the appendix

A

Carcinoid

<2cm at tip, just appendectomy
>2cm, at base, high risk features, needs hemicolectomy

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45
Q

Colorectal surgery perioperative Abx regimen
SCIP recommendations
&
PCN allergy alternatives

A

Cefoxitan, Cefotetan, Ancef +Flagyl, Unasyn

PCN allergy:
Clinda or Vanc WITH
gentamicin, ciprofloxacin, levofloxacin, aztreonam

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46
Q

Treatment for metastatic carcinoid

A

Lanreotide (somatostatin analog) for sx relief
Tumor debulking +/- embolization

MC location for carcinoid: rectum, ileum, appendix

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47
Q

First sign of uncal herniation

A

anisocoria w/ normal motor exam
compression of CN III

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48
Q

Surgical speciality most likely to cause postoperative delirium

A

Cardiothoracic

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49
Q

Medical management of gastroparesis

A

Metoclopromide (Reglan) Dopamine receptor antagonist
Domperidone (motilium)

w/ small frequent low fat, low fiber diet

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50
Q

Abnormal gastric emptying study

A

> 60% at 2 hours
10% at 4 hours

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51
Q

Type I Error
vs
Type II Error

A

Type I: no statistically significant difference exists but you think there is one. The null hypothesis is rejected (incorrectly).

Type II: a difference exists but you do not detect it. The null hypothesis is accepted.

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52
Q

Primary lymphoid organs

Secondary lymphoid organs

A

1: liver, bone, thymus

2: lymph nodes, spleen, peyer patch, tonsil, adenoid

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53
Q

Principles of resection in colon cancer

A

total mesocolic resection w/ >12 lymph nodes
5cm margins
ligation of primary vessel at origin

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54
Q

Pancreatic fistula initial management

A

NPO, TPN, resuscitation
NPO, nasojejunal feedings, skin care

After 4-6 weeks ERCP w/ sphincterotomy and stent
High output is >200mL/day and indicate octreotide use

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55
Q

Most common tumor of the anterior mediastinum

A

Adult: Thymoma (Tx: resection)
Children: teratoma

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56
Q

Most common tumor of the posterior mediastinum

A

Neurogenic tumor

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57
Q

Signs of frostbite
1st degree
2nd degree
3rd degree
4th degreee

A

1st: no permanent damage, white plaque
2nd: to dermis, blisters
3rd: subcutaneous tissue, hemorrhagic blisters, eschar, may need skin graft or amp
4th: muscle/bone, mummification, necrosis, amputation

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58
Q

Superficial mass biopsy: spindle cells w/ CD34 staining

A

Dermatofibrosarcoma- high risk local recurrence.
Arises from fibroblasts.
Need core needle or incisional biopsy
Prognosis: grade, size, depth

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59
Q

Most common benign salivary gland tumor
Initial treatment
Treatment for recurrence

A

Pleomorphic adenoma
Treat w/ superficial parotidectomy
Treat recurrence with radiotherapy and observation if multifocal and poor surgical candidate.

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60
Q

Describe each type of fundoplication
Nissen
Dor/Toupet
Watson
Hill
Belsey Mark IV

A

-Full 360 degree wrap
-Anterior/Posterior 180-200 degree wrap
-Fix esophagus in abdomen and plicate fundus along left anteriolateral border
-Lesser gastric curve to R esophagus and pexy to median arcuate ligament
-transthoracic anterior fundoplication

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61
Q

Nigro protocol

A

Squamous Cell Carcinoma of the anus
5-flurouracil, mitomycin C, external beam radiation
Surveillance for recurrence or residual disease
10-30% need salvage APR

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62
Q

Patient w/ ITP undergoing elective splenectomy
what is desired preop platelet count
when to transfuse platelets if needed

A

> 50,000 platelets
Transfuse after ligation of splenic artery

Can give IVIG preop to boost platelets too

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63
Q

Screening test for Cushings syndrome

A

24 hour urine cortisol x2

if equivocal, can get nighttime salivary cortisol

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64
Q

Treatment of pituitary prolactinoma

A

Cabergoline- dopamine agonist therapy
or Bromocriptine
Repeat MRI in 6 months
Surgery reserved for failure or women wanting pregnancy

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65
Q

Most common tracheoesophageal fistula

A

Type C: prox esophageal atresia w/ distal TE fistula

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66
Q

Describe each treatment of Hirschprungs
Swenson
Soave
Dahumel

A

-resection w/ end to end anastomosis
-normal colon anastomosis to anus within aganglionic cuff
-colon brought through retrorectus w/ end to side anastomosis

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67
Q

T-test
ANOVA

Chi square

A

significant difference between means of 2 groups
significant difference between means of 3+ groups

is there difference in the expected frequency vs observed frequency in 1+ categories

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68
Q

Mechanism of action of ketamine

A

NMDA antagonist

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69
Q

Most common inherited hypercoagulable disorder and mechanism

A

Factor V Leiden

Factor V can no longer be inactivated by Protein C leading to hypercoagulable state

70
Q

Hepatorenal syndrome

A

Dx by decreased GFR
Postassium lost, sodium held..?

71
Q

Torsades de Pointes in stable patient
First line:

A

IV magnesium

if unstable, synchronized cardioversion
if V fib develops then defibrillate

72
Q

Most common organism for
Early graft infection
Late graft infection

A

early: staph aureus
late: steph epidermidis

73
Q

Pregnant patient with papillary thyroid cancer treatment

A

US surveillance w/ thyroidectomy post-partum

If medullary cancer, node positive, growing on US do thyroidectomy in second trimester

If anaplastic or compressive, do immediate thyroidectomy

74
Q

Treatment of small bowel lymphoma

A

wide excision with lymph node dissection and adjuvant chemoradiation

75
Q

Male patient w/ 1cm invasive ductal carcinoma ER+ HER2-, node negative, post surgical chemo treatment

A

Tamoxifen 5 years post mastectomy

76
Q

Risk factors for peri-operative pulmonary complications

A

Age >50
active smoking
COPD/ asthma / OSA
interstitial lung disease
pulmonary hypertension
heart failure
current pulmonary infection
Albumin <3

77
Q

Risk factors for gastric adenocarcinoma

A

cigarette smoking, alcohol
gastric surgery
gastric adenomatous polyps
nitrates
H.pylori and EBV infections
Pernicious anemia, Type A blood

78
Q

Function of MHC class II molecules

A

Activate cytotoxic and helper T cells
Found on: dendritic, B-cells, monocytes, and APCs
Subtypes: DR, DP, DQ
Two chains, four domains

79
Q

Reversal agents for DOAC
-Dabigatran (Pradaxa)
-Apixaban (Eliquis) & Rivaroxaban (Xeralto)

A

-Idarucizumab (Praxbind)
-Andexanet alfa (Andexxa)

80
Q

Sodium Deficit Equation

A

Na deficit = (Desired Na- Patient Na) x TBW

TBW = Kg x gender factor

women: 0.5
men: 0.6

81
Q

Prophylactic Abx for colon surgery options

A

Ancef + Flagyl
Cefoxitin
Unasyn
Cefotetan

82
Q

Treatment of marginal ulcer after RNYGB

A

PPI, first. 90% effective.
surgical intervention, second

83
Q

Contents of lactated ringers

A

NA: 130
K: 4
Cl: 109
Ca: 2.7
lactate:28

84
Q

Primary indication for liver transplant

A

Hep C infection

85
Q

Adrenocortical carcinoma biochemical workup

A

urine androgens
plasma metanephrines
aldosterone: renin ratio
dexamethasone supression test

86
Q

What foramen does the vagus nerve exit

A

Jugular foramen

87
Q

Spinal accessory nerve innervates:

A

SCM and trapezius
Motor function only: shoulder shrug
Exits jugular foramen

88
Q

Treatment of condyloma accuminata by:
Patient
Clinician

A

Patient: imiquimod, podophyllotoxin, sinecatechin
Clinician: crytherapy, acetic acid, surgery, and laser

Second line: podophyllin resin and topical 5 fu

89
Q

Treatment of esophageal cancer by T staging

A

Tis, T1a- endoscopic mucosal resection

T1b (submucosa), T2 (muscularis propria) - upfront esophagectomy
*unless high-risk, then give neoadjuvant

T3, T4 - neoadjuvant chemorads

High Risk: >3cm, LVI, poorly differentiated

90
Q

Treatment of adrenal crisis

A

IV Hydrocortisone
(mineralocorticoid)

91
Q

Branchial cleft cysts

A

MC: 2nd type. Anterior border of SCM. Near hypoglossal nerve and glossopharyngeal nerve

1st type- auditory canal to submandibular area near parotid/facial nerve

92
Q

Benefit of splenectomy in patient with ITP

A

Removes source of anti-platelet antibodies and site of destruction

93
Q

Risk factors for cholangiocarcinoma

A

primary sclerosing cholangitis
choledocal cysts
ulcerative colitis
biliary tract infections

94
Q

Aldosterone:Renin ratio in aldosteronoma

A

> 30 confirms diagnosis

BP control w/ spironolactone before adrenalectomy

95
Q

MC cause of pyogenic liver abscess
MC species

A

cholangitis
gram neg facultative anaerobes: Ecoli, Klebsiella, proteus with enterococcus species

96
Q

Hypertrophic pyloric stenosis on US findings

A

thickness of >3-4 mm
length of >15-18 mm

97
Q

Post transplant lymphoproliferative disorder

A

After chronic immunosupression
Epstein-Barr Virus

98
Q

Prothrombin Complex Concentrate
3 factor
4 factor

A

3 factor: Factor II, IX, X
4 factor: Factor II,VII, IX, X

99
Q

What is autonomic dysreflexia?

A

Effect in patient with spinal cord injury at or above T6.
Increased parasympathetic above level of injury
Increased sympathetic below level of injury

HTN, Bradycardia, Diaphoresis

100
Q

Li-Fraumeni syndrome

A

TP53
Sarcoma, Phyllodes, adrenocortical cancer, brain tumors

101
Q

Phyllodes of the breast management

A

1 cm margin and radiate

102
Q

Function of mineralocoricoids

A

Promote sodium and water retention
Lower serum potassium concentration

by increasing sodium channels in distal convoluted tubule of the kidney

103
Q

What are normal findings in a colonic transit study

A

<20% of radiopaque markers at 5 days after ingestion

104
Q

MEN 1 findings

A

pituitary lesion, parathyroid lesion, pancreatic lesion (MC: gastrinoma)

MENIN gene mutation
Present with primary hyperparathyroidism

105
Q

What class of bacteria is C. diff?

A

Anaerobic, gram positive bacilli

106
Q

Treatment of rectocele

A

Identified by bulging of the rectum into the vagina.

Initial: High fiber diet, water intake, stool softener, pelvic floor PT

Surgical: transvaginal repair where vaginal muscularis and rectovaginal tissues are plicated

107
Q

Infection with pneumocystis jiroveci:
Imaging findings
Treatment

A

Bilateral infiltrates in lung, can be disseminated

prophylaxis with bactrim

108
Q

After total thyroidectomy, what do you check for thyroid hormone status

A

TSH

109
Q

Treatment for unresectable hilar cholangiocarcinoma with no lymph node or metastatic spread

A

Neoadjuvant chemotherapy and liver transplant evaluation for R0 resection

110
Q

What cells make TNF-alpha

A

Macrophage

*Infliximab is a TNF-alpha monoclonal Ab used in autoimmune disease like Crohns

111
Q

What test is needed to diagnose GERD in a patient with typical symptoms and normal EGD

A

Esophageal pH monitoring

112
Q

Structures located in each compartment of the lower leg

A

Anterior: anterior tibial artery and deep peroneal nerve

Deep Posterior: peroneal artery, posterior tibial arter

113
Q

First line treatment of bleeding in uremic patients with platelet dysfunction

A

Desmopressin - vasopressin analog that causes vWF and Factor VIII release from vascular endotheliumF

114
Q

Esophageal Cancer TNM staging

A

T1a - lamina propria or muscularis mucosa
T1b - submucosa
T2 - mucularis propria
T3 - adventitia
T4 - invades neighbor structure

N1 - 1-2 nodes
N2 - 3-6 nodes
N3 - >7 nodes

115
Q

ASA Classification system

A

I - healthy
II - mild systemic disease
III - severe systemic disease
IV - severe systemic disease that is constant threat to life
v - moribund

116
Q

Genitourinary injuries during surgery

A

MC: bladder

Ureter injuries occur at the pelvic brim, when gonadal and ovarian vessels cross, and lateral to the uterus

117
Q

Most common bacteria in infected abdominal aortic aneurysm

A

1 is Staph Aureus

118
Q

Treatment of dumping syndrome after Billroth II reconstruction

A

1st: diet modifications
2nd: somatostatin analogs

Early dumping :hyperosmolar load into duodenum
Late dumping: rapid glucose absorption leading to insulin surge

119
Q

What order does bowel function return?

A

Small bowel, stomach, colon

120
Q

When to use 21 gene Oncotype Dx

When to give adjuvant chemo

A

Hormone positive, HER2 negative, node negative
Recurrence score >26 gets adjuvant chemo

121
Q

Breast cancer postoperative radiation

A

Not referencing BCT

Node positive, >5cm, positive pathologic margins

122
Q

Treatment of pseudomyxoma peritonei

A

Resection of as much tumor as possible
-Debulk anything >2mm

Intraperitoneal chemotherapy
-HIPEC is best at 41C

122
Q

Treatment of pseudomyxoma peritonei

A

Resection of as much tumor as possible
-Debulk anything >2mm

Intraperitoneal chemotherapy
-HIPEC is best at 41C

123
Q

Soft tissue sarcoma
Staging
Best prognostic indicator
Stage IV criteria

A

TNM + G (mitosis, differentiation, necrosis)

Prognostics: histologic grade

Stage IV if regional lymph nodes or distant mets

124
Q

What patients should not get PPI

A

severe osteoporosis

125
Q

When do you I&D a breast abscess

A

Very large, overlying skin changes, loculations, recurrent

126
Q

Treatment of squamous cell carcinoma of the anus

A

If < 2cm, no sphincter involvement, no nodes, can perform wide local excision

127
Q

Nerves & innervations during axillary dissection

A

Medial pectoral nerve - pec major & minor muscles
Lateral pectoral nerve (branch of above) - pec major

Long thoracic nerve - serratus muscle
Thoracodorsal - latissimus dorsi

128
Q

Maneuvers during IOC to remove duct stone

A

Flush with saline
Give 1.0 mg of glucagon
Flush again
( best for small 3-4mm stones)

Fogarty balloon catheter or stone retrieval basket for larger stones

129
Q

QT prolonging medications
&
Treatment of Torsades

A

ABX: Macrolides (clarithromycin) & Fluoroquinolones
Antipsychotics: haldol,
Antidepressants: amitryptiline
Methadone, Zofran

Magnesium and supportive care

130
Q

Melanoma findings requiring SLNB

A

ulceration or mitosis >1
upstages from T1a to T1b and needs SLNB

Also if lesion is >0.8mm thick needs SLNB

131
Q

Melanoma T staging

A

T1 = <1mm
T2 = 1-2mm
T3= 2-4mm
T4 is >4mm in depth

Any node makes it stage 3.

132
Q

How to perform repair of the trachea

A

single layer repair with interrupted absorbable suture
can buttress with strap muscle or SCM
trach should be placed elsewhere

133
Q

Bacteria involved with lymphangitis

A

MC: Strep pyogenes

134
Q

Cancers associated with Epstein Barr Virus

A

Burkett lymphoma
Hodgkin lymphoma
immunosuppresion related lymphoma
nasopharyngeal carcinoma
some gastric cancers

135
Q

Merkel Cell Carcinoma
Treatment

A

Aggressive skin cancer in 65+ yo sun exposed areas
Neuroendocrine carcinoma (blue cells )
Stain for CK 20.

wide local excision with SLNB
followed by radiation

136
Q

Mediastinal tumors

A

MC anterior: thymoma
MC posterior: neurogenic

137
Q

Treatment of hemodynamic instability during pheochromocytoma removal

A

Hypertensive crisis - give nitroprusside infusion

Tachyarrhythmias - give iv esmolol or lidocaine

Hypotension- give fluids, blood product, phenylephrine

138
Q

MC complication after liver transplant

A

bile leak 2/2 ischemia of donor biliary tree
eval for hepatic artery stenosis or thrombosis

139
Q

What is the respiratory quotient?

A

CO2 produced / O2 consumed

> 1: overfeeding
1: normal
0.7: pure fat metabolism

140
Q

Most common type of skin cancer

MC type of skin cancer after transplant

A

Basal cell carcinoma
tumor islands from the epidermis with peripheral palisading of nuclei and stromal retraction
*MC cancer of the upper lip

squamous cell carcinoma
*MC cancer of the lower lip

141
Q

MOA of vasopressors
Norepinephrine
Phenylephrine
Vasopressin
Epinephrine
Dobutamine

A

Norepi: alpha and beta 1
Phenyl: pure alpha
Vaso: V1
Epi: alpha, beta1, beta2
Dobutamine: mostly beta

142
Q

MENII

A

RET gene

2A: medullary thyroid, hyperparathyroidism, pheochromcytoma.
Thyroidectomy before age 5

2B: medullary thyroid, pheochromocytoma, mucosal neuromas, marfinoid habitus
Thyroidectomy before age 1

143
Q

Pancreatic Endocrine Neoplasms location

A

Insulinoma: throughout pancreas
Glucagonoma: body and tail
- necrolytic migratory erythema, diabetes
VIPoma: tail
Gastrinoma: head in gastrinoma triangle
Somatostatinoma: head

144
Q

Hepatic lesion management

A

Hemangioma- peripheral to central enhancement. Leave alone

Focal Nodular Hyperplasia- central scar, take up sulfur colloid. Leave alone.

Adenoma- hypervascular. Stop OCP or steroids. Resect due to malignant transformation potential.

145
Q

Hepatitis C curative treatment

A

Sofosbuvir and Ribavirin

146
Q

Wound healing timeline

A

4-5 days: collagen formation and wound contraction

147
Q

Local anesthestic max dose

How much lidocaine is in 1% solution

A

Lido without 5; lido with 7
marcain without 3; marcaine with 5

1% lido has 10mg per 1 mL

148
Q

Action of cytokines
IL 1
IL 4
IL 6
IL 8

TNF alpha

TGF beta

IFN gamma

A

IL1- proinflammatory marker
IL4- secretes IgE from B lymphocytes = anaphylaxis
matures B cells
IL 6- proinflammatory marker
IL8- migrate & activate neutrophils

TNF alpha - promotes inflammation, cachexia, TSS

TGF beta - decreases inflammation

IGN gamma - NK cells for immunity

149
Q

ARDS criteria

A

Acute onset, non-cardiac, b/l infiltrates, hypoxia:
PaO2: FiO2 < 300 mild
PaO2: FiO2 < 200 mod
PaO2: FiO2 < 100 severe

BAL with high neutrophils and large protein count

150
Q

Most common malignant salivary gland tumor

A

mucoepidermoid

Adenoid cystic carcinoma is slow and insidious and can have lung metastasis, spreads along nerves, poor prognosis.

151
Q

Signs of acute elevation of ICP

A

bradycardia, hypertension, respiratory depression, double vision, pain, CN VI palsy (one cross eye)

152
Q

Upper extremity nerve palsy

A

Ulnar nerve- cannot extend 4th and 5th digit

Median nerve - cant flex 2nd and 3rd digit or extend 1-3.

153
Q

MC lymphoma type in patient with AIDS

A

B cell lymphoma

154
Q

Indication to administer tetanus

A

If immunized within 10 years and small wound: none
If immunized within 5 years and large risk wound: none
otherwise, give tetanus toxoid

if not immunized and small wound: tetanus toxoid
if not immunized and high risk wound: tetanus toxid and tetanus immunoglobulin

155
Q

Thrombectomy reveals tan, gelatinous myxoid material

A

Concern for atrial myxoma, needs TTE

156
Q

Treatment for acute radiation proctitis
vs
chronic radiation proctitis (more often has bleeding)

A

Hydration and butyrate (SCFA) enemas

Sucralfate enemas

157
Q

Describe the 3 types of vWF disease

A

Type I: low circulating vWF (can give desmopressin)
Type II: poor quality vWF, needs cryo
Type III: complete abscence of vWF, needs cryo

158
Q

What is Stewart Treves syndrome

A

cutaneous angiosarcoma from chronic lymphedema
Highly malignant. Can occur 10 years after mastectomy.
Wide local excision.

159
Q

Indication for stress dose steroids

A

> 20mg prednisone for > 3weeks see below:
Minor: AM meds.
local anesthesia, hernia repair, scopes
Mod: AM meds, 50 hydrocortisone + 25q8
hemicolectomy, open chole, LE revasc,
Major: AM meds, 100 hydrocortisone, 50q8 w/ taper
esophagogastrectomy, total proctocolectomy,
whipple, liver resection

[Any dose <3 weeks or <5 mg daily just AM meds]

160
Q

Types of vagotomy

A

Truncal vagotomy - just above GE junction

Selective vagotomy- preserve nerves to liver, pancreas, small intestine

Highly selective vagotomy - spares nerves of Laterjet. Does not need drainage procedure.

161
Q

Colonoscopy follow up intervals

A

Normal, low risk : 10 years

Personal hx of cancer, hx of adenomatous polyp, 1st degree relative w/ cancer: 5 years

large sessile polyp, removed piecemeal, malignant adenoma, multiple adenomas, or incomplete scope: repeat within 6 months

After cancer resection: H&P w/ CEA q3-6 months for 3 years, annual CTCAP for 3 years, colonoscopy within 1 year and then q5 years

162
Q

Pagets disease of the anus

A

intractable pruritus
Needs full workup with Cscope, CTCAP to look for underlying malignancy
Tx: wide local excision or APR if underlying malignancy is found

163
Q

Indications for CEA

A

Symptomatic disease >70%
Asymptomatic disease >80% (actually >60 on studies)

164
Q

Indications to resect IPMN

A

All main duct
>30mm in size or growing
thickened wall or mural nodule
duct dilation >10mm
pancreatitis
intraductal mucin
change in duct caliber w. distal atrophy

165
Q

GI peptides

A

Gastrin- from G cells, promotes histamine release from enterochromaffinlike cells which then promote acid release from parietal cells.

Somatostatin- from D cells, stops ECL and parietal cells.

166
Q

Pancreatic cystic neoplasms

A

pseudocyst- benign, high amylase, low CEA
serous cystadenoma- benign, low amylase, low CEA
mucinous cystic neoplasm- low amylase, high CEA, distal pancreatectomy
IPMN- high CEA, high amylase

167
Q

Pulm function testing for lobectomy
DLCO
FEV1
Predicted postop FEV1 needed for lobectomy

A

DLCO >60%
FEV1 >60
Predicted postop FEV1 >35-40%

168
Q

Treatment of May-thurner syndrome

A

iliofemoral DVT
anticoagulation and endovascular thrombolysis and iliac vein stenting

169
Q

Goal rate of urine output in burn resuscitation adults vs children

A

Adult 0.5-1ml/kg/hr
Kids 1-2mL/kg/hr

Absite 2023 (2 decks)

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