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ABSITE Flashcards

1
Q

TEG: R

A

Greater 10 min
[FFP]

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2
Q

TEG: K

A

Greater 3 min
[Cryo]

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3
Q

TEG: α Angle

A

Less 53
[Cryo & Plt]

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4
Q

TEG: MA

A

Less 50 mm
[Plts, DDAVP]

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5
Q

TEG: LY30

A

Greater 3%
[TXA]

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6
Q

BIRADS 0

A

Incomplete
Repeat Mammo or U/S

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7
Q

BIRADS1

A

Negative
Routine screening

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8
Q

BIRADS 2

A

Benign
Routine Screening

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9
Q

BIRADS 3

A

Probably
Benign
6 Month follow up

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10
Q

BIRADS 4

A

Suspicious
Tissue Diagnosis

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11
Q

BIRADS 5

A

High likelihood of malignancy
Tissue diagnosis

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12
Q

BIRADS 6

A

Biopsy proven malignancy
Excision

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13
Q

Bethesda I

A

Nondiagnostic
Repeat FNA

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14
Q

Bethesda II

A

Benign
Clinical or U/S follow up

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15
Q

Bethesda III

A

AUS/FLUS
Repeat FNA
Lobectomy/Molecular testing

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16
Q

Bethesda IV

A

Follicular Neoplasm (FN)/SFN
Molecular testing/Lobectomy

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17
Q

Bethesda V

A

Suspicious for Malignancy
Total/Lobectomy

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18
Q

Bethesda VI

A

Biopsy proven malignancy
Total/Lobectomy

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19
Q

Male Breast Cancer

A

MRM
Aromatase inhibitor

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20
Q

Inflammatory Breast Cancer

A

Neoadjuvant CT -> MRM -> ALND -> Adjuvant XRT

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21
Q

Paget Breast

A

MRM, Nipple-Areolar Complex
Palpable:MRM
Nonpalpable: Lumpectomy w/ Nipple-Areolar complex + Radiation

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22
Q

Invasive ductal carcinoma borders

A

No ink on tumor

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23
Q

DCIS Borders

A

2 mm

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24
Q

Her2neu (+)

A

Neoadjuvant (Traszumemab) + BCT

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25
Q

DCIS Treatment (Female vs Male)

A

Female: BCT + Endocrine + Radiation
Male: Mastectomy
No ALDN unless:
>4 cm
Palpable mass
Prior Mastectomy
Microinvasion

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26
Q

Li Fraumeni

A

[p53]
Leukemia
Breast
Adenocarcinoma
Sarcoma

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27
Q

PCI Scoring

A

T1 is a PCI score 1-10,
T2 is a PCI score 11-20
T3 is a PCI score 21-30
T4 is a PCI score 31-39

LS0: No tumor;
LS1: Tumor up to 0.5 cm
LS2: Tumor b/w 0.5 - 5.0 cm
LS3: Tumor >5 cm or confluent tumor

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28
Q

When primary Esophagus can be repaired primary in TEF

A

Gap is <2 vertebral bones

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29
Q

Compartment syndrome

A

12 mm Hg (Increase pressure)
20 mm Hg (Organ failure)

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30
Q

High risk IPMN

A
  1. jaundice
  2. enhancing solid component
  3. MD >1 cm
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31
Q

Worrisome IPMN

A
  1. Size >3 cm
  2. Thickened enhancing cyst walls
  3. MD 5 - 9 mm
  4. Nonenhancing mural nodules
  5. Abrupt caliber change
  6. Lymphadenopathy
  7. Pancreatitis
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32
Q

Contraindication to total or head pancreatic resection

A

Splenic or portal vein thrombosis
(Causes significant operative bleeding due to recanalization)

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33
Q

Long term Blind loop sydrome

A

Due to B2
Medium chain Triglycerides + B12

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34
Q

Muir-Torre syndrome

A

GI
GU
Breast
(MLH1, MSH2)

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35
Q

Cowden syndrome

A
  • Mucocutaneous
  • Endometrial
  • Thyroid
  • Breast
    (PTEN)
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36
Q

Gastrectomy margins

A

Proximal 6 cm
Distal 2 cm

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37
Q

Triple negative Breast CA

A

Lumpectomy + Adjuvant XT + Radiation

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38
Q

Time span anal nodule needs to be present before biopsy

A

6 Months

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39
Q

Papillary Thyroid Ca Stage III or IV

A

Age >55 yrs

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40
Q

Size of thyroid nodule not needing FNA

A

<1 cm(10 mm)

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41
Q

Desmoplastic melanoma

A

Resection + Adjuvant radiation

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42
Q

Lidocaine dosing

A

w/ Epi 7 mg/Kg
w/o Epi 5 mg/Kg

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43
Q

Bupivicaine Dosing

A

2.5 mg/kg

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44
Q

Pancreatitis Surgery: Head

A
  1. Frey
  2. Berger
  3. Whipple
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45
Q

Pancreatitis Surgery: Enlarged duct

A

Puestow
Frey

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46
Q

Side Effect: Etomidate

A

Adrenal Supression

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47
Q

Hoffman Elimination Nondepolarizing agents

A

Atracurium
Cisatracurium
(Hoffman elimination)

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48
Q

Bacitracin

A

Partial thickness burns
Nephrotoxic

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49
Q

Mupirocin

A

MRSA

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50
Q

Silvadene (Sulfadiazine)

A

Does not penetrate eschar
Prophylaxis
Neutropenia & Thrombocytopenia

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51
Q

Mafenide acetate

A

Full thickness burns
Penetrates eschar
Metaboli aidosis (carbonic anhydrase inhibitor)

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52
Q

Silver nitrate

A

Hyponatremia

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53
Q

Contraindication to lumpectomy

A
  1. prior irradiation
  2. pos margins
  3. inflammatory
  4. pregnancy (unless 3rd trimester)
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54
Q

What are the axillary node levels (1-3, and one more category)?

A

1 - lateral to pec minor
2 - beneath pec minor
3 - medial to pec minor
Rotter’s Nodes - between pec major and pec minor

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55
Q

What do you do if you can’t find radiotracer dye in SNLB?

A

ALND

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56
Q

What patient would get only mastectomy/BCT + tamoxifen for 5 years (4 characteristics)?

A
  • (-) SLN
  • old
  • ER+
  • tumor <2 cm
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57
Q

What patient would get mastectomy/BCT + tamoxifen for 5 years plus chemo (4 characteristics)?

A
  • (-) SLN
  • young
  • ER+
  • tumor >1cm
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58
Q

In what population should giant liver hemangioma be resected, how can it present in this population (name of syndrome and its 2 problems, other possible problem)?

A

pediatric population
kasabach-merit syndrome = hepatic sequestration and thrombocytopenia, AV shunting and heart failure

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59
Q

Indication for transanal excision (T stage, circumference, location, 2 criteria if invasive)?

A

stage I: polyp or T1
circumference: <40%
Location: within 8-10cm of anal verge
if invasive must be: 1) no lymphovascular invasion; 2) not poorly differentiated

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60
Q

Coloncyte fuel, and derived from where?

A

butyric acid
Short fatty acids

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61
Q

Carcinoid tumor rectum - Tx?

A

Transanal excision

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62
Q

Treatment for FAP?

A
  1. TAC
  2. Mucosal proctectomy
  3. Pouch
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63
Q

MALToma - when is surgery first line treatment?

A

gastric outlet obstruction

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64
Q

MALTOMA: 1st, 2nd, 3rd line treatment?

A
  1. Eradicate H pylori
  2. Chemo/xrt
  3. surgery
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65
Q

Gallbladder CA based on presentation

A
  1. T1a (lamina propria): Cholecystecotmy
  2. T1b>: en bloc resection of the gallbladder with at least a 2 cm margin of underlying liver bed (nonanatomic resection or anatomic resection of segments IVb and V), portal and hepatoduodenal lymphadenectomy
  3. CBD excisiont if cystic duct involved
66
Q

Treatment for types of choledochal cyst (1-5)?

A

Type I: Fusiform [Roux-en-Y hepatojejunostomy]
Type II: Diverticulum [Diverticulectomy]
Type III: Choledochal cyst [Endoscopic sphincterotomy]
Type IVa: Intra & extrahepatic [Transplant]
Type IVb: Extrahepatic [Roux-en-Y hepatojejunostomy]
Type V: Caroli disease (multiple intrahepatic) [Transplant]

67
Q

Biliary injury: Segmental or accessory duct injury

A

<3 mm & Drainage
> 4 mm HJ

68
Q

Biliary injury: Choledochotomy

A

Small: Simple repair
Large: T tube
Drainage

69
Q

Biliary injury: CBD

A

Do not cut edges
HJ

70
Q

Biliary injury: Short/ Long segment

A

Short: Repair over T tube
Long: HJ

71
Q

Crohn’s Small bowel stricture <5 cm

A

Endoscopic dilation

72
Q

Crohn’s Small bowel stricture > 5 cm

A

Heineke-Mikulicz strictureplasty >5cm
Finney strictureplasty >10 cm
Side-to-side isoperistaltic strictureplasty (SSIS) >20 cm

73
Q

Treatment for varices with splenic vein thrombosis

A

Splenectomy

74
Q

Timing of tranfusion of Platelets during Splenectomy

A

At induction
After ligation of Splenic artery

75
Q

What myeloproliferative disorder benefits from splenectomy

A

myelofibrosis – extramedullary hematopoeisis in spleen

76
Q

Esophageal leyiomyoma

A

enuculation if >5cm or symptomatic
via Thoracotomy

77
Q

Boerhave’s treament early, late, deathly ill?

A

Early: Primary repair (L thoracotomy) +/- Jtube
Late: Spit fistula, J tube, delayed restoration of GI continuity
Deathly Ill: Mediastinal washout/drainage with definitive surgery when stable

78
Q

Treatment for barrett’s esophagus and high grade dysplasia?

A

Esophagectomy

79
Q

Indications for preop neoadjuvant XRT in GE junction
cancer vs Surgery

A

Surgery if N0 T1-2
Neoadjuvant XRT if T3-4 or N+

80
Q

Arterial supply for for esophagectomy?

A

Right gastroepiploic artery

81
Q

lynch syndrome

A

(HNPCC)
DNA mismatch repair
MLH1, MSH2, MSH6, PMS2
Right sided colon ca
Endometrial ca, Small bowel, stomach, urinary tract, ovary, pancreas and brain

82
Q

APR vs LAR

A

Need 2 cm margins in rectal cancer

83
Q

Colon Ca: Surgery vs Neo XT

A

Surgery: N0, T1-2
Neo XT: T3/4, N+ (Stage II)

84
Q

Indications for surgery in hyperthyroidism

A
  • Large goiter
  • Compressive symptoms
  • Pregnant
  • Failed medical therapy
  • Autonomous thyroid nodule (Plummer syndrome)
85
Q

Hurthle cell/follicular neoplasm

A

Cannot diagnose on FNA
Tx: Lobectomy

86
Q

Preparation for I-131 scan

A

Hypothyroid for the scan
Stop thyroid hormone before scan (6 weeks for synthroid, 3 weeks for cytomel)

87
Q

MEN-1 with hypercalcemia and a gastrinoma

A

Parathyroid > Gastrinoma

88
Q

External branch of the superior laryngeal nerve: Location, innervation, injury

A

Superior thyroid artery
Cricothyroid
Weak voice, fatigue of voice at higher ranges

89
Q

Hypercalcemia (>15mg/dl)
Palpable neck mass
Primary hyperPTH

A

Parathyroid Ca

90
Q

Parathyroid Ca Tx

A

parthyroidectomy + ipsilateral
thyroid lobectomy

91
Q

Missing parathyroid gland

A

1) carotid sheath
2) tracheoesophageal groove
3) perform transcervical thymectomy
4) Ipsilateral thyroid lobectomy
5) Close but bank tissue in case devascularized gland or find it in perma section

92
Q

Vitamin Deficiency in TPN

93
Q

RQ for fat, protein, and carb?

A

Fat 0.7
Protein 0.8
Carbs 1.0

94
Q

Frey Syndrome

A

Post gustatory sweating following parotidectomy
Auriculotemporal nerve damage

95
Q

Femoral canal boundaries

A

Superior: Injuinal ligament
Medial: Lacunar ligament
Lateral: Femoral vein
Posterior: Iliacus, psoas tendons, fascia of pectineus

96
Q

Testicular mass

A

U/S, B HCG, AFP
Tx: Inguinal orchietectomy

97
Q

Humerus dislocation

A

No abduction
Axillary nerve

98
Q

Radial nerve injury

A

Spiral humerus fx
supra and intercondylar fx

99
Q

Trauma to fibular bone

A

Common peroneal nerve

100
Q

Compression to lateral knee

A

Common peroneal nerve impingement
No dorsiflex

101
Q

Worst perioperative sign on Goldman scale

A

Decompensated CHF

102
Q

Where thoracic duct empties

103
Q

Crohns with normal appendix

A

Appendectomy unless cecum involved

104
Q

Graft vs Host Disease

A

T cell mediated

105
Q

Ectopic Pheochromocytoma

A

Para-aortic tissue
zuckercandl

106
Q

Origin inferior parathyroid

A

3rd pharyngeal pouch

107
Q

Hyperacute rejection

A

Anti-Donor Abs

108
Q

Gastrochesis

A

Intestinal atresia

109
Q

Omphalocele

A

Cardiac conditions

110
Q

Cremasteric muscle

A

Internal oblique

111
Q

Heparin

A

Potentiates Anti-Thrombin III

112
Q

Abnormal fallopian tube during appendectomy

A

Appendectomy only

113
Q

Antihypertensive for Pheochromocytoma

A

1) alpha blockade (phenoxybenzamine or prazosin)
2) beta blockade ( nonselective - labetolol)

114
Q

Conn’s Disease

A

Hypertension
HypoK
HyperNa
Metabolic Alkalosis
Renin: Aldosterone 0.015

115
Q

Indications for surgery for Hepatic Adenoma

A

No resolution of mass following OCP cessation
Mass >4cm

116
Q

Hemangioma Tx if unresectable and symptomatic

A

Embolization
XRT & Steroids

117
Q

Side Effect: vinca alkaloids (vincristine/vinblastine/etc)

118
Q

Side Effect: Neutropenic Enterocolitis

A

Cytarabine

119
Q

VIPoma

A
  1. Watery diarrhea
  2. Hypo Cl-
  3. Hypo K
  4. Acidosis

Location: Tail
Tx: Distal panc w/ nodes

120
Q

Somatostatinoma

A
  1. Mild diabetes
  2. Steatorrhea
  3. Gall stones
  4. Hypo Cl

Location: Head
Tx: Resection, Cholecystectomy

121
Q

prostacyclin A2 inhibitor

A

Inhibits platelet aggregation

122
Q

Glucogonoma

A
  1. Diabetes
  2. Skin rash
  3. Glossitis/Stomatitis
  4. DVT

Location: Body & Tail
Tx: Resection
NO enucleation

123
Q

Intrabdominal tumor in children

A

< 2 years: neuroblastoma
> 2 years: Wilm’s tumor

124
Q

Most common CDH

A

Bochdalek hernia (Posterolateral)

125
Q

Morgagni hernia

A

Retrosternal CHD

126
Q

What distinguishes GIST from leiomyoma/leiomyosarcoma

126
Q

Shifts Hgb/O2 affinity to right

A

1) Inc body temp
2) Inc 2,3 DPG
3) Inc pCO2
4) Inc [H+]

127
Q

Cytokine responsible for hepatic acute phase response

128
Q

Lidocaine toxicity

A

1st sx: Peri-oral paresthesias
2nd sx: Visual and auditory hallucinations
3rd sx: Cardiac arrhythmias
Tx: Atropine

129
Q

Pancreatic enzyme secreted in active form

130
Q

Femoral Hernia boundary

A

Cooper’s ligament
Inguinal ligament
Femoral vein
Passes under inguinal ligament, bulge in anteromedial thigh, reduce through inguinal ligament division, repair with McVay or Bassini repair.

131
Q

Portal Triad

A

Lateral: CBD
Posterior: PV
Medial: Hepatic artery

132
Q

Most common amino acid in tissue and plasma

133
Q

Primary fuel for cancer cell

134
Q

Pulmonary vital capacity

A

VC= FEV+FRC.
Greatest volume that can be exhaled (FEV)+ air in lungs after normal exhalation (which increased with PEEP)

135
Q

Calcineurin Inhibitors

A

Inhibits lymphocyte activation (Inhibits IL-2)
Tacrolimus (FK506): Tremors, AMS, DM, HyperK, Nephrotoxicity
Cyclosporine: Gingival hyperplasia

136
Q

Mycophenolate mofetil

A

Prevents proliferation (Limits purine synthesis)
GI bleed, myelosuppression

137
Q

Azathioprine

A

Prevents proliferation (Limits purine synthesis)
Myelosuppresion, pancreatitis

138
Q

Sirolimus

A

mTOR inhibitor
Impaired wound healing, oral ulcers

139
Q

Belatacept

A

Binds CD80 and CD86
Increased risk of lymphoproliferative disordes (CNS ,PML, EVB)

140
Q

LCIS

A

Prophylactic treatment vs Tamoxifen + Surveillance
If positive margins, no further resection
Endocrine therapy

141
Q

DCIS

A

Lumpectomy + Radiation + Endocrine therapy
Margins: 2 mm
Mastectomy: Multicentric, multifocal, comedo type, >2.5 cm, unable to clear margins
No ALND

142
Q

Breast: Adjuvant Chemotherapy

A

Node (+) Patients
High risk Node (-) Patients:
< 35 yrs
Tumor > 2cm
(-) ER/PR
Aneuploid DNA, High proliferation
Poor histology
Her2neu, p53, Ki67

143
Q

Breast: Radiation

A

> 3 Lymph nodes
Skin or chest wall involvement
Positive margins
5 cm
Inflammatory cancer
Fixed axillary or internal mammary nodes

144
Q

Gastric Nodes

145
Q

Colon nodes

146
Q

Esophageal nodes

147
Q

Breast: Pregnancy

A

1st Trimester: MRM
2nd Trimester: Neoadjuvant Chemotherapy -> Lumpectomy -> Radiation (after delivery)
3rd Trimester: Lumpectomy, ALND, Radiation (after delivery)

148
Q

Neuroblastoma

A

Surgery
Intermediate risk: Surgery + Chemo

149
Q

Wilm’s Tumor (Nephroblastoma)

A

Small: Surgery + Adjuvant Chemo
Downstage with Neoadj Chemo
B/l regional lymph nodes
Remove tumor when extending into vein
Gets upstaged if biopsied and bursts

150
Q

Papillary Thyroid Ca

A

Low risk: Lobectomy
High risk: Total Thyroidectomy
Palpable Nodes: MRND(I-V)

151
Q

Follicular Thyroid Ca

A

Lobectomy
Palpable nodes: MRND

152
Q

Hurthle Cell Ca

A

Total thyroidectomy +central node dissection
Radical neck dissection on side of palpable nodes

153
Q

Medullary Thyroid Ca

A

Total thyroidectomy + Centeral neck dissection

154
Q

Jejunal Atresia: Type I

A

Membrane completed occludes lumen. Intestine intact

155
Q

Jejunal Atresia: Type II

A

Gap between intestine with fibrous cord

156
Q

Jejunal Atresia: Type IIIA

A

Mesenteric gap without any connection

157
Q

Jejunal Atresia: Type IIIB

A

No SMA
Short gut
Apple peel

158
Q

Jejunal Atresia: Type IV

A

Multiple atretic segments (sausage)

159
Q

Transcystic Choledochotomy Contraindication

A

8 stones> / Stones >1 cm
Common hepatic duct stone
CBD <6 mm
Cystic duct <3mm
Gallstone 6-8mm

160
Q

Insulinoma

A

Dx: Stomatostatin scintigraphy does not work
Tx:
Small: Enucleation
Large: Whipple, Distal pancreatectomy

161
Q

Gastrinoma

A

Location: CBD/Pancreas/Duodenum
Tx: Medical therapy
Surgery for malignant (can perform hepatectomy)

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