ABSITE Flashcards
1
Q
Name the compartment of the lower extremity and their important structures
A
2
Q
Contents of the anterior v posterior triangle (2)
A
carotid
spinal accessory
3
Q
Right v left path for recurrent alryng n
A
under scv
under arch
4
Q
MC head and neck cancer
A
SCC
5
Q
what muscle is innervated by the sup laryng
A
cricothyroid
6
Q
SCC HnN risk factors
A
etoh, tobacco, hpv
7
Q
oral SCC over 4 cm gets
A
WLE + MRND ++ rads
8
Q
most malign to least malign salivary gland
A
SL>SM> parotid
9
Q
Mucoepidermoid significance and treatment
A
MC salivary gland tumor
Superficial parotidectomy w/ MRND +- chemorads
10
Q
slow growing salivary tumor, what tx is it very sensitive to
A
adenoid cystic
XRT
11
Q
MC benign salivary and tx
A
Pleomorphic
sup parotidectomy
12
Q
warthin tumor tx?
A
watch
13
Q
This nerve is often sacrificed during lower parotid pole dissection
A
greater auricular
numbness of ear
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
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
16
Q
margins for melanoma
A
1mm 1cm
2mm 2cm
17
Q
size cutoff for melanoma SLNB
A
> .8 OR <.8mm with ulceration
18
Q
ebv related hnN cancer
A
nasopharyngeal SCC
19
Q
gustatory sweating after parotidectomy
n damaged?
A
Frey’s
auriculotemporal
20
Q
swellign at angle fof jaw in elderly post op
bug?
A
supp parotiditis
S aureus
21
Q
origins of sup thyroid a and inf thyroid a
A
ext carotid
thyrocervical trunk
22
Q
consider what for re-op thyroids/invasive CA
A
laryngoscopy to assess recurrents
23
Q
these cells make thyroglobulin
Which T is active for
m
A
follicular
T3`
24
Q
lateral thyroid lobes derive from…
A
ventral 4th pharyng pouch
25
C cells develop from
4th and 5th pouches
26
thyroglossal duct cyst originates from...
foramen cecum, pyramidal lob
27
2 hyperthyroid meds and their shared side effects
PTU methimazole
PTU in preg
agran, aplastic
cretin in meth
28
Graves abs
TSH rec
29
when should RAI not be used for GRaves
optho
30
pre op med for hyper thyroid
Lugols -- decreases vascularity
31
Hashimoto abs, PE for this process
anti-thyroid peroxidase
painless goiter
32
Painful goiter most likely..
tx?
subacute gran
viral
NSAIDS, steroids
33
hard non tender goiter
Riedel
34
Bethesda
35
parameters for thyroid lobectomy
4cm
36
how does follicular ca of thyroid spread
who is this more common in
Why is this different to dg than other thyroid
hem
women
need lobe to dg
37
tx for follicular
total, MRND for pos nodes, post op RAI
38
medullary thyroid oncogene
cell type
marker
RET
c cells
calcitonin
39
med thyr ca tx
total with central
40
when should MEN kids have thyroid out
5y
or 1y if highest risk
41
most common sites for the thyroid nerves
sup - sup pole
rec -- ligament of berry
42
sup and inf PT gland origins
Thymus?
4th
3rd
3rd
43
blood supply to PT glands
inf thyroid
44
PTH is released by these cells
Chief
45
pth effect on bone and kidney
Stim osteoclasts for inc ca and phos
stim calcium resor and phos/bicarb inhibition
46
how does pth interact with vit D
Converts 25 VD to 1,25 VD via 1 a hydroxylase
47
From what organ and what cells is calcitonin secreted
kidney and bone effects
inhib ca and phos
inhibi osteoclasts
48
MCC of inpatient v outpatient hyperca
prim hyperpth
malign
49
most common causes of PTH overproduction due to malignancy
breast, squamous lung
bone
50
initial tx and secondary treatment of hyperca
NS at 300
lasix
51
MCC of primary hyperpth
adenoma
hyperplasia
PT CA
52
hyper pth cl to phosratio
normal pth level
>33
5-40
53
re-op imaging for PTH gradients
angiography with venous sampling
54
6 reasons for asymptomatic hyperparathyroid surgery
inc Ca by one
renal issues
osteo T<-2.5
stones
poor follow up
under age of 50
55
tx of secondary hyperpth
ca suppl, phosphate binders, renal diet
56
mng of tertiary hyperpth
4 gland pthectomy
57
op for pth cancer
enbloc
ipsi thyroid
+- ipsi neck disseciton
58
high pth and ca, low urine calcium
benign familial hypocalciuric hypercalcemia
59
ectopic superior pth gland
RE space or carotid
60
surgery for hyperpth in MEN 1 or 2a
4 gland with thymectomy
61
ectopic pth inferio glands
thymus, intra-thyroid
62
blood supply to esoph
inf thyr
aorta
L gastric and inf phrenic
63
upper sphincter muscle and innervation
cricopharyngeus
recurrent laryngeal
64
superior laryngeal n innervates...
cricothyroid
65
where is killians triangle and why is it improtant
superior to crico pharyng and inf to contrictors
site of Zenkers
66
MC sites of iatro and non iatro esoph perfs
cricopharyng
distal esoph
67
study of choice for esoph perf
swallow, esophagram
68
which contrast should be used first in esoph perf swallow eval?
gastrograffin,
barium if negative
69
3 antibiotic regimen for perf esoph
unasyn, metro, fluc, ceftri
70
achalasia manometry
inc relax les with aperistalsis
71
how long should heller myotomy be
cm on esoph2 cm on stomach
72
describe operation for perforated achalsia
contralateral heller with primary repair
73
hypertensive les med
CCB
74
DES meds
ccb, nitrates
75
where are the 2 pulsion divert in esoph
zenekers and epiphrenic
76
where is the esoph traction divert?
mid thoracic
77
what is the cellular change in barretts
why does this occur
how much does this inc cancer risk
squam to columnar
acid
30-60X
78
surveillane for no dysplasia barrets
2 year then q 3
4 quad bx q2cm
79
Low grade barrets follow up time
6 m
80
High grade barrets recs
EMR
81
MC benign esoph tumor
Tx?
leiomyomas
enuc
82
esoph cancer risks for each
scc: tobacco and alcohol
adeno: gerd, obes, barretts
83
staging for hyroid cacncer
stage 1 and 2 younger than 45
over 45 has all stages
84
esoph ca TNM
85
what stage gets preadj for esoph ca
t2
86
criteria for low risk esoph t1a and what tx can low risk get
2 cm, mod-well diff, no LN
ERM
87
which surgery for distal esoph tumor
what arteries are preserved
ivor lewis, right thoracotmy and laparotomy
R gastroepiploic and R gastric
88
what chemo regimens are available for esoph ca
CAPOX and FOLFOX
89
dysphagia + thickened palms
risk of ...
Fist egd when
tylosis
SCC
20y
90
shatzki ring tx
dilation
91
low urine calcium level
less than 100
92
5 risks for gastric stress ulcers
Prolonged vent
Coag
Head
Burns
PUD hx
93
percent of h pylori in gastric v duo ulcers
75%
95%
94
risk of rebleeding
arterial
visible
adherent clot
clean
80
50
20
5
95
gastric polyp size cutoff for biopsy
.5cm
96
MC mesenchymal tumor of the GI tract
cell of origin
GIST
int cells of cajal
97
appearance of cells for GIST
definitely will see this marker
maybe these 4
spindle,epithelioid
ckit(CD117)
CD34, DOG-1, desmin vimentin
98
Stage 1 A v Stage 3B for GIST
<5cm low mit
>10 cm high mit
99
How do GIST metast
hematogenously
100
bad spots for gist
esoph, colon,l rectum
101
adjuvant treatment for gist(alternative if no ckit)
surgical resection type
imatinib
sunitinib
en bloc to neg margins
102
mechanism of imatinib
tyr kin inhib
103
intest vs diffuse gastric cancer pertaining to mode of mets and diff
hematog, well
lymph, poorly
104
Hereditary diffuse gastric cancer marker
CDH1
105
general recommendations for CDH1 carriers
gastrectomy 18 to 40y
high risk screening for women for Breast ca
106
4 syndromes with inc gastric ca risk
Lynch (dna mismatch)
JPS(SMAD4)
PJS
FAP(APC)
107
what is recommended for all T2 gastric tumors
dg lapwith washings
108
tnm for gastric ca
109
who gets preadj for gastric cancer
Regimen?
T2
FOLFOX
110
general resection principles with gastric ca
distal specific
6cm margins, 16 LNs
2cm distal
111
diff between D1 and D2
stomach nodes
Celiac plexus
112
when is adj chemo rec for gastric cancer
Regimen
T3 or nodal
5FU based
113
What are the primary cells of the antrum
body and fundus
G cells
parietal cells
114
mech of early vs late dumping
hyperosmolar load
insulin surge
115
mechanism and secondary effects of afferent limb syndrome
bacterial overgrowth
steatorrhea, malnutrition, B12 def
116
gastric bx of sheets of neoplastic small lymph cells
tx?
MALToma
h pylori tx
117
5 non trauma splenectomy indications
ITP, sphero, splenic abscess sympt cyst, non hodgkins lymphoma
118
mech of itp
Initial management
Gii/giiia abs
steroids and IVIG
119
when and at what time do you give intraop plt for ITP
if bleeding occurs
after artery ligated
120
hereditary spherocytosis recs
splenectomy after 6y of age along with chole if needed
121
splenic abscess is caused by ...(4)
IV drugs, endocard, 2nd inf to trauma pseudo, SCD
122
2 types of splenic abscesses and their treatments
simple: perc
multiloc: splen
123
diff cyst from abscess for spleen
wall enhancement for abscess
124
cyst work up and treatment parameters
serology to rule out echinoccocal
take out if sympt or greater than 5cm
125
risk factors for angiosarcma spleen
vinyl chloride, thorium dioxide
126
MC splenic tumor
tx?
hemangioma
resect if sympt
127
splenic artery aneurysm tx parameters
Tx
>3cm and all pregnant or women of child bearing age(70% rupture during pregnancy)
coil
128
MC OPSI bug
S pneumo
129
treatment of wandering spleen
pexy if no infarction, splenectomy otherwise
130
fever, hemo anemia, renal failure, purpura, neuro
mech
tx
TTP
ADAMS vWF cleaver
plasmapheresis
131
ipiliminab is used in ....
mech
melanoma
anti CTLA4 promotes T cells
132
Nivolumab used in ....
mech
melanoma, lympoma, colon, gastric, head, liver
anti PDL-1:removes checkpoint inhib
133
chemo man
134
Genes involved in Lynch/HNCCS
MSH2, MLH1, MSH6, PMS2
mismatch repair genes
135
What cancers are affected by mismatch repair genes
colon, endo, gastric, SB, panc, GU, ovarian
136
screening for lynch
colon at 20
EGD at 30
endom vac at 25
137
Muir torre syndrome?
Sebacious cysts Plu colon/GU cancer
138
Fap gene, mech
APC
tumor suppressor gene beta catenin
139
FAP screening
egd 20
colon 12
thyroid 20
140
Turcot syndroms
FAP or HNPCC + brain tumor
141
Lifraumini gene
cancers
recs
TP53
breast, gastric, sarcomas, leukemia
annual WB MRI plus brain
double scopes at 25
142
what type of genes are BRCA
4 cancer risks
Screening recs
TSG
breast, ovarian, melanoma, panc ca
MRI at 25; men annual exams
143
CDH1 mutation
ca
recommendations
e cadherin
egd at 20 for gastric
consider ppx gast, possible mastetomy
144
PJS gene and type
ALLLLL the cancers
screening
STK11, TSG
hamartomas, hyper pgi, gastric polyps, breast, ovarian, fallopian, cervical, thyroid, lung, panc, testis
all scopes at 8, PILL
145
Post colectomy screening after colectomy for .....
EGD for duo ca
146
What phase is most vulnerable to rads
M phase
147
CEA assoc cancer
colon
148
19-9
panc and hpb
149
ca 125
ovarian
150
AFP
HCC, non seminomas
151
LDH
melanoma, testis
152
Her2
breast and esoph
153
Chromogranin
Carcinoid
154
Carotid sheath anatomy
155
carotid sheath nerves
156
What vessel usually overlies the carotid bifurcation
facial vein
157
first branch of the ext carotid
superior thyroid a
158
what is the doppler flow on the ext carotid
triphasic, brief reversal (high resistance
159
What nerves are encountered in order moving up past the bifurcaition
1st and second arteries off the ext carotid
Specific muscle encountered
160
Describe int carotid flow
long coninuous low res diastolic phase
161
First branch of int carotid
opthalmic
162
hoarseness after carotid
vagus clamp
163
tongue toward the cea side???
hypoglossal injury
164
ipsilateral mouth droop after cea
MMA
165
what layers are removed in CEA
disabling dysphagia after?
intima and part of media
glossopharyngeal
166
CEA indications symp v asym
50%
70% or EDV >140 and healthy
167
mng of CS symptomatic <50%
dual anti plt, statin
168
MCC of mortality CEA
MI
169
Important pre CEA workup
Cardiac
170
recent stroke, when to do CEA
2 wks
6wks(hem)
171
headache and htn post cea, normal neuro
Tx
cerebral hyprperfusion htn
Htn control emergently, s eizure ppx. CT
172
PACU CEA stroke symptoms, next steps and 2 pathways
Doppler
Patent ICA --> CT or on table angio
Thrombus--> OR
173
symptomatic BCVI mng
anticoag
then stent
174
Carotid body tumor mng
dont bx!
resect
175
bead of string appearance of renal or carotid and tx
fibromusculay dysplasia
aintiplt
ballon if recurrent
176
Thoracic outlet order
177
MC form of thoracic outlet syndrome
neurogenic
178
what anomoly sets you at risk For TOS
cervical rib
179
borders of brachial plexus
artery ant
mid scal post
180
Nerve disribution in hand
s/s of TOS
Ulnar distribution
181
first step for neurogenic TOS
PT
then surgery
182
Swimmer with blue arm
paget schroetter, SV thrombosis
thrombolysis with first rib resection same hospitalization
183
describe subclavian steal
184
fistula rules:
what 2 veins and what size cutoff
what size and characteristics for artery? why?
cephalic and basillic, 3mm
2mm, triphasic to prevent steal
185
why is the issue usually the vein with fistulas
high pressures scar down veins
186
bleeding fistula with high venous return pressures
venous stenosis on duplex
fistula gram with angioplasty
187
rules for fistula formation
6mm diam
6mm deep(not tooooo deep)
>600ml/min flow
188
3 reasons for non-maturing fistula
1. anastomotic stricture
2. side branches
3 venous outflow
189
dg for steal in hand
50% improvement in waveform analysis with compression
190
mng of steal(2)
mng of occasional mild s/s
DRIL or ligation
obs
191
Lateral fasc nerve injury
superficial peroneal with diffiulty in foot eversion
192
