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ABSITE Flashcards

1
Q

Name the compartment of the lower extremity and their important structures

A
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2
Q

Contents of the anterior v posterior triangle (2)

A

carotid

spinal accessory

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3
Q

Right v left path for recurrent alryng n

A

under scv

under arch

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4
Q

MC head and neck cancer

A

SCC

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5
Q

what muscle is innervated by the sup laryng

A

cricothyroid

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6
Q

SCC HnN risk factors

A

etoh, tobacco, hpv

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7
Q

oral SCC over 4 cm gets

A

WLE + MRND ++ rads

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8
Q

most malign to least malign salivary gland

A

SL>SM> parotid

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9
Q

Mucoepidermoid significance and treatment

A

MC salivary gland tumor

Superficial parotidectomy w/ MRND +- chemorads

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10
Q

slow growing salivary tumor, what tx is it very sensitive to

A

adenoid cystic

XRT

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11
Q

MC benign salivary and tx

A

Pleomorphic

sup parotidectomy

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12
Q

warthin tumor tx?

A

watch

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13
Q

This nerve is often sacrificed during lower parotid pole dissection

A

greater auricular

numbness of ear

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14
Q

unknown head/neck node work up , 4 big things

A

PE

FNA

CT head/neck/chest

OR for direct laryngoscopy, egd , ipsi tonsil

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15
Q

no primary cancer identified after finding node head and neck, MC site

tx if nothing found

A

tonsil then bas of tongue

ipsi MRND and b/l XRT

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16
Q

margins for melanoma

A

1mm 1cm
2mm 2cm

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17
Q

size cutoff for melanoma SLNB

A

> .8 OR <.8mm with ulceration

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18
Q

ebv related hnN cancer

A

nasopharyngeal SCC

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19
Q

gustatory sweating after parotidectomy

n damaged?

A

Frey’s

auriculotemporal

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20
Q

swellign at angle fof jaw in elderly post op

bug?

A

supp parotiditis

S aureus

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21
Q

origins of sup thyroid a and inf thyroid a

A

ext carotid

thyrocervical trunk

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22
Q

consider what for re-op thyroids/invasive CA

A

laryngoscopy to assess recurrents

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23
Q

these cells make thyroglobulin

Which T is active for

        m
A

follicular

T3`

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24
Q

lateral thyroid lobes derive from…

A

ventral 4th pharyng pouch

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25
Q

C cells develop from

A

4th and 5th pouches

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26
Q

thyroglossal duct cyst originates from…

A

foramen cecum, pyramidal lob

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27
Q

2 hyperthyroid meds and their shared side effects

A

PTU methimazole

PTU in preg

agran, aplastic

cretin in meth

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28
Q

Graves abs

A

TSH rec

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29
Q

when should RAI not be used for GRaves

A

optho

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30
Q

pre op med for hyper thyroid

A

Lugols – decreases vascularity

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31
Q

Hashimoto abs, PE for this process

A

anti-thyroid peroxidase

painless goiter

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32
Q

Painful goiter most likely..

tx?

A

subacute gran
viral

NSAIDS, steroids

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33
Q

hard non tender goiter

A

Riedel

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34
Q

Bethesda

A
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35
Q

parameters for thyroid lobectomy

A

4cm

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36
Q

how does follicular ca of thyroid spread

who is this more common in

Why is this different to dg than other thyroid

A

hem

women

need lobe to dg

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37
Q

tx for follicular

A

total, MRND for pos nodes, post op RAI

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38
Q

medullary thyroid oncogene

cell type

marker

A

RET

c cells

calcitonin

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39
Q

med thyr ca tx

A

total with central

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40
Q

when should MEN kids have thyroid out

A

5y

or 1y if highest risk

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41
Q

most common sites for the thyroid nerves

A

sup - sup pole

rec – ligament of berry

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42
Q

sup and inf PT gland origins
Thymus?

A

4th

3rd

3rd

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43
Q

blood supply to PT glands

A

inf thyroid

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44
Q

PTH is released by these cells

A

Chief

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45
Q

pth effect on bone and kidney

A

Stim osteoclasts for inc ca and phos
stim calcium resor and phos/bicarb inhibition

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46
Q

how does pth interact with vit D

A

Converts 25 VD to 1,25 VD via 1 a hydroxylase

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47
Q

From what organ and what cells is calcitonin secreted

kidney and bone effects

A

inhib ca and phos

inhibi osteoclasts

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48
Q

MCC of inpatient v outpatient hyperca

A

prim hyperpth

malign

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49
Q

most common causes of PTH overproduction due to malignancy

A

breast, squamous lung

bone

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50
Q

initial tx and secondary treatment of hyperca

A

NS at 300

lasix

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51
Q

MCC of primary hyperpth

A

adenoma

hyperplasia

PT CA

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52
Q

hyper pth cl to phosratio

normal pth level

A

> 33

5-40

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53
Q

re-op imaging for PTH gradients

A

angiography with venous sampling

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54
Q

6 reasons for asymptomatic hyperparathyroid surgery

A

inc Ca by one
renal issues
osteo T<-2.5
stones
poor follow up
under age of 50

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55
Q

tx of secondary hyperpth

A

ca suppl, phosphate binders, renal diet

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56
Q

mng of tertiary hyperpth

A

4 gland pthectomy

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57
Q

op for pth cancer

A

enbloc
ipsi thyroid
+- ipsi neck disseciton

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58
Q

high pth and ca, low urine calcium

A

benign familial hypocalciuric hypercalcemia

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59
Q

ectopic superior pth gland

A

RE space or carotid

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60
Q

surgery for hyperpth in MEN 1 or 2a

A

4 gland with thymectomy

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61
Q

ectopic pth inferio glands

A

thymus, intra-thyroid

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62
Q

blood supply to esoph

A

inf thyr
aorta
L gastric and inf phrenic

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63
Q

upper sphincter muscle and innervation

A

cricopharyngeus

recurrent laryngeal

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64
Q

superior laryngeal n innervates…

A

cricothyroid

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65
Q

where is killians triangle and why is it improtant

A

superior to crico pharyng and inf to contrictors

site of Zenkers

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66
Q

MC sites of iatro and non iatro esoph perfs

A

cricopharyng

distal esoph

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67
Q

study of choice for esoph perf

A

swallow, esophagram

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68
Q

which contrast should be used first in esoph perf swallow eval?

A

gastrograffin,

barium if negative

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69
Q

3 antibiotic regimen for perf esoph

A

unasyn, metro, fluc, ceftri

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70
Q

achalasia manometry

A

inc relax les with aperistalsis

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71
Q

how long should heller myotomy be

A

cm on esoph2 cm on stomach

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72
Q

describe operation for perforated achalsia

A

contralateral heller with primary repair

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73
Q

hypertensive les med

A

CCB

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74
Q

DES meds

A

ccb, nitrates

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75
Q

where are the 2 pulsion divert in esoph

A

zenekers and epiphrenic

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76
Q

where is the esoph traction divert?

A

mid thoracic

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77
Q

what is the cellular change in barretts

why does this occur

how much does this inc cancer risk

A

squam to columnar

acid

30-60X

78
Q

surveillane for no dysplasia barrets

A

2 year then q 3

4 quad bx q2cm

79
Q

Low grade barrets follow up time

A

6 m

80
Q

High grade barrets recs

A

EMR

81
Q

MC benign esoph tumor
Tx?

A

leiomyomas
enuc

82
Q

esoph cancer risks for each

A

scc: tobacco and alcohol
adeno: gerd, obes, barretts

83
Q

staging for hyroid cacncer

A

stage 1 and 2 younger than 45

over 45 has all stages

84
Q

esoph ca TNM

A
85
Q

what stage gets preadj for esoph ca

A

t2

86
Q

criteria for low risk esoph t1a and what tx can low risk get

A

2 cm, mod-well diff, no LN

ERM

87
Q

which surgery for distal esoph tumor

what arteries are preserved

A

ivor lewis, right thoracotmy and laparotomy

R gastroepiploic and R gastric

88
Q

what chemo regimens are available for esoph ca

A

CAPOX and FOLFOX

89
Q

dysphagia + thickened palms

risk of …

Fist egd when

A

tylosis

SCC

20y

90
Q

shatzki ring tx

A

dilation

91
Q

low urine calcium level

A

less than 100

92
Q

5 risks for gastric stress ulcers

A

Prolonged vent
Coag
Head
Burns
PUD hx

93
Q

percent of h pylori in gastric v duo ulcers

A

75%

95%

94
Q

risk of rebleeding

arterial
visible
adherent clot
clean

A

80
50
20
5

95
Q

gastric polyp size cutoff for biopsy

A

.5cm

96
Q

MC mesenchymal tumor of the GI tract

cell of origin

A

GIST

int cells of cajal

97
Q

appearance of cells for GIST

definitely will see this marker

maybe these 4

A

spindle,epithelioid

ckit(CD117)

CD34, DOG-1, desmin vimentin

98
Q

Stage 1 A v Stage 3B for GIST

A

<5cm low mit

> 10 cm high mit

99
Q

How do GIST metast

A

hematogenously

100
Q

bad spots for gist

A

esoph, colon,l rectum

101
Q

adjuvant treatment for gist(alternative if no ckit)

surgical resection type

A

imatinib
sunitinib

en bloc to neg margins

102
Q

mechanism of imatinib

A

tyr kin inhib

103
Q

intest vs diffuse gastric cancer pertaining to mode of mets and diff

A

hematog, well

lymph, poorly

104
Q

Hereditary diffuse gastric cancer marker

A

CDH1

105
Q

general recommendations for CDH1 carriers

A

gastrectomy 18 to 40y

high risk screening for women for Breast ca

106
Q

4 syndromes with inc gastric ca risk

A

Lynch (dna mismatch)

JPS(SMAD4)

PJS

FAP(APC)

107
Q

what is recommended for all T2 gastric tumors

A

dg lapwith washings

108
Q

tnm for gastric ca

A
109
Q

who gets preadj for gastric cancer

Regimen?

A

T2

FOLFOX

110
Q

general resection principles with gastric ca

distal specific

A

6cm margins, 16 LNs

2cm distal

111
Q

diff between D1 and D2

A

stomach nodes

Celiac plexus

112
Q

when is adj chemo rec for gastric cancer

Regimen

A

T3 or nodal

5FU based

113
Q

What are the primary cells of the antrum

body and fundus

A

G cells

parietal cells

114
Q

mech of early vs late dumping

A

hyperosmolar load

insulin surge

115
Q

mechanism and secondary effects of afferent limb syndrome

A

bacterial overgrowth

steatorrhea, malnutrition, B12 def

116
Q

gastric bx of sheets of neoplastic small lymph cells

tx?

A

MALToma

h pylori tx

117
Q

5 non trauma splenectomy indications

A

ITP, sphero, splenic abscess sympt cyst, non hodgkins lymphoma

118
Q

mech of itp
Initial management

A

Gii/giiia abs

steroids and IVIG

119
Q

when and at what time do you give intraop plt for ITP

A

if bleeding occurs

after artery ligated

120
Q

hereditary spherocytosis recs

A

splenectomy after 6y of age along with chole if needed

121
Q

splenic abscess is caused by …(4)

A

IV drugs, endocard, 2nd inf to trauma pseudo, SCD

122
Q

2 types of splenic abscesses and their treatments

A

simple: perc

multiloc: splen

123
Q

diff cyst from abscess for spleen

A

wall enhancement for abscess

124
Q

cyst work up and treatment parameters

A

serology to rule out echinoccocal

take out if sympt or greater than 5cm

125
Q

risk factors for angiosarcma spleen

A

vinyl chloride, thorium dioxide

126
Q

MC splenic tumor

tx?

A

hemangioma

resect if sympt

127
Q

splenic artery aneurysm tx parameters

Tx

A

> 3cm and all pregnant or women of child bearing age(70% rupture during pregnancy)

coil

128
Q

MC OPSI bug

A

S pneumo

129
Q

treatment of wandering spleen

A

pexy if no infarction, splenectomy otherwise

130
Q

fever, hemo anemia, renal failure, purpura, neuro

mech

tx

A

TTP

ADAMS vWF cleaver

plasmapheresis

131
Q

ipiliminab is used in ….

mech

A

melanoma

anti CTLA4 promotes T cells

132
Q

Nivolumab used in ….

mech

A

melanoma, lympoma, colon, gastric, head, liver

anti PDL-1:removes checkpoint inhib

133
Q

chemo man

A
134
Q

Genes involved in Lynch/HNCCS

A

MSH2, MLH1, MSH6, PMS2
mismatch repair genes

135
Q

What cancers are affected by mismatch repair genes

A

colon, endo, gastric, SB, panc, GU, ovarian

136
Q

screening for lynch

A

colon at 20
EGD at 30
endom vac at 25

137
Q

Muir torre syndrome?

A

Sebacious cysts Plu colon/GU cancer

138
Q

Fap gene, mech

A

APC

tumor suppressor gene beta catenin

139
Q

FAP screening

A

egd 20
colon 12
thyroid 20

140
Q

Turcot syndroms

A

FAP or HNPCC + brain tumor

141
Q

Lifraumini gene

cancers

recs

A

TP53

breast, gastric, sarcomas, leukemia

annual WB MRI plus brain
double scopes at 25

142
Q

what type of genes are BRCA

4 cancer risks

Screening recs

A

TSG

breast, ovarian, melanoma, panc ca

MRI at 25; men annual exams

143
Q

CDH1 mutation

ca
recommendations

A

e cadherin

egd at 20 for gastric
consider ppx gast, possible mastetomy

144
Q

PJS gene and type

ALLLLL the cancers

screening

A

STK11, TSG

hamartomas, hyper pgi, gastric polyps, breast, ovarian, fallopian, cervical, thyroid, lung, panc, testis

all scopes at 8, PILL

145
Q

Post colectomy screening after colectomy for …..

A

EGD for duo ca

146
Q

What phase is most vulnerable to rads

A

M phase

147
Q

CEA assoc cancer

A

colon

148
Q

19-9

A

panc and hpb

149
Q

ca 125

A

ovarian

150
Q

AFP

A

HCC, non seminomas

151
Q

LDH

A

melanoma, testis

152
Q

Her2

A

breast and esoph

153
Q

Chromogranin

A

Carcinoid

154
Q

Carotid sheath anatomy

A
155
Q

carotid sheath nerves

A
156
Q

What vessel usually overlies the carotid bifurcation

A

facial vein

157
Q

first branch of the ext carotid

A

superior thyroid a

158
Q

what is the doppler flow on the ext carotid

A

triphasic, brief reversal (high resistance

159
Q

What nerves are encountered in order moving up past the bifurcaition

1st and second arteries off the ext carotid

Specific muscle encountered

A
160
Q

Describe int carotid flow

A

long coninuous low res diastolic phase

161
Q

First branch of int carotid

A

opthalmic

162
Q

hoarseness after carotid

A

vagus clamp

163
Q

tongue toward the cea side???

A

hypoglossal injury

164
Q

ipsilateral mouth droop after cea

A

MMA

165
Q

what layers are removed in CEA

disabling dysphagia after?

A

intima and part of media

glossopharyngeal

166
Q

CEA indications symp v asym

A

50%

70% or EDV >140 and healthy

167
Q

mng of CS symptomatic <50%

A

dual anti plt, statin

168
Q

MCC of mortality CEA

A

MI

169
Q

Important pre CEA workup

A

Cardiac

170
Q

recent stroke, when to do CEA

A

2 wks
6wks(hem)

171
Q

headache and htn post cea, normal neuro

Tx

A

cerebral hyprperfusion htn

Htn control emergently, s eizure ppx. CT

172
Q

PACU CEA stroke symptoms, next steps and 2 pathways

A

Doppler

Patent ICA –> CT or on table angio

Thrombus–> OR

173
Q

symptomatic BCVI mng

A

anticoag

then stent

174
Q

Carotid body tumor mng

A

dont bx!

resect

175
Q

bead of string appearance of renal or carotid and tx

A

fibromusculay dysplasia

aintiplt

ballon if recurrent

176
Q

Thoracic outlet order

A
177
Q

MC form of thoracic outlet syndrome

A

neurogenic

178
Q

what anomoly sets you at risk For TOS

A

cervical rib

179
Q

borders of brachial plexus

A

artery ant
mid scal post

180
Q

Nerve disribution in hand

s/s of TOS

A

Ulnar distribution

181
Q

first step for neurogenic TOS

A

PT

then surgery

182
Q

Swimmer with blue arm

A

paget schroetter, SV thrombosis

thrombolysis with first rib resection same hospitalization

183
Q

describe subclavian steal

A
184
Q

fistula rules:

what 2 veins and what size cutoff

what size and characteristics for artery? why?

A

cephalic and basillic, 3mm

2mm, triphasic to prevent steal

185
Q

why is the issue usually the vein with fistulas

A

high pressures scar down veins

186
Q

bleeding fistula with high venous return pressures

A

venous stenosis on duplex

fistula gram with angioplasty

187
Q

rules for fistula formation

A

6mm diam

6mm deep(not tooooo deep)

> 600ml/min flow

188
Q

3 reasons for non-maturing fistula

A
  1. anastomotic stricture
  2. side branches

3 venous outflow

189
Q

dg for steal in hand

A

50% improvement in waveform analysis with compression

190
Q

mng of steal(2)

mng of occasional mild s/s

A

DRIL or ligation

obs

191
Q

Lateral fasc nerve injury

A

superficial peroneal with diffiulty in foot eversion

192
Q
A

Written Boards (14 decks)

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