Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ABSITE 2022 > ABSITE 2022 > Flashcards

ABSITE 2022 Flashcards

1
Q

Appendectomy: Risk factors associated with conversion to open

A
  • severe inflammation obscuring view of anatomy
  • peritonitis
  • presence of large intra-abd abscess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 types of rectus sheath hematomas

A

Type 1: unilat, within the muscle

2: uni or bi ; w/in the muscle or bw the muscle and transversalis fascia
3: extends in peritoneum and prevesical space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Common rectus sheath hematoma symptoms

A
  • sudden abd p
  • pain on trunk flexion/rotation
  • greatest comfort in a supported flexed position
  • anticoagulation/women
  • 29% assoc w cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stimuli for ductus closure in neonate

ductus arteriosus - bw PA + aorta

A
  • incr O2 tension
  • drop in pulm vascular resistance
  • decr prostaglandin levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What shunt does a PDA cause

A

left to right shunt … can cause HF if left untreated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What induces pharmacologic closure of DA?

A

indomethacin (decr PG’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What surgery is used to close a PDA

A

L posterolateral thoracotomy (can do bedside) and close PDA with clips

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Life threatening bleeding + vW disease .. what do you give?

A 
type 1 (AD; low qty): desmopressin
type 2 (AD; low quality): desmopressin
type 3 (AR; absence of): vWf/F8 concentrate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How calculate ABI

A

Higher of 2 ankle pressures (dp, pt) / higher of 2 brachial pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How are the following absorbed?
fructose
glucose
galactose

A

fructose - facilitated diffusion (GLUT5 in, GLUT2 out)
glucose - active (SGLT1, GLUT2)
galactose - active (SGLT1, GLUT2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When to consider EMR for gastric cancer?

A 
tumor <2 cm
no ulceration
no LVI
well or mod-well diff histology
limited to mucosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where do carcinoids usually occur?

How do they usually present?

A

appendix …. small bowel

abd pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is vimentin assoc with

A

melanoma, colon CA, esophageal CA, gastric CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is S100 assoc with

A

melanoma
schwannoma
neurofibroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you perform water soluble esophagography for traumatic esoph perf?

A

pt in R lat decub

if pt HD stable and nothing seen on esophagography but high suspicion for injury –> EGD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

unstable pelvic fracture … gets angioembo’ed by IR … still unstable and repeat FAST is negative. Now what?

A 
external fixation
(If FAST + --> ex lap)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

radial nerve is responsible for __ of the thumb and ___

A

abduction

supination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Injury to RLN is more common when it is running __

A

anterior to or bw the ITA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Injuries assoc with BCVI

A 
Le Fort 2 and 3 facial fx
mandibular fx
c spine fx
basilar skull fx
DAI or GCS =8
severe thoracic chest trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are cells that stain CD3 + and recognize HLA-I molecules?

A

CD8 cytotoxic T cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

After recurrent ing hernia, which lap repair is preferred?

A

totally extraperitoneal repair

lower risk of re recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what defines “severe acute pancreatitis” ?

A
  • necrosis of > 1/3 pancreas
  • MOF indic by hypotension, renal failure (Cr >2.9), GIB, resp failure (paO2 <60), and development of local complic like abscess, hemorrhage, pseudocyst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Highest risk popul for OPSI ??
highest risk within 2 yr postop

MC pathogen?

A

Pts w/ hem malignancies who undergo splenectomy

Strep pneumo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MC inherited hypercoag disorder?

A

factor V leiden - factor V cannot respond to protein C … propensity to clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is lugano stage IV disease?

A
  • lugano system - for NHL of GI tract classification
  • stomach > SB > colon
  • stage IV = disease is present above and below the diaphragm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Best way to repair umb hernia in a cirrhotic?

A

primary repair with nonabsorbable sutures

resuscitate w/ 25% albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

clinically + LN in pt dx with melanoma … what to do?

A

FNA … neg: proceed to SLNB

pos: ax dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

hypoK assoc with hypoMag can be K repletion resistant… mechanism?

A
  • To do with ROMK (renal outer medullary K channel)

- low intracellular mag causes K efflux (IC mag inhibits K secretion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Endpoints for resuscitation - on ABG

A 
pH 7.35-7.45
PaCO2: 35-45
HCO3: 21-27
paO2: >80
SaO2 >95
base excess/deficit: -2 to +2
lactate <2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Endpoints for resuscitation - on lyte panel

A

K 3.5 - 5.5
Mg 1.4-2
Ca 2.25 - 2.5 mmol/L
Phos 0.8-1.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does Mg cause hypoCa?

A

Produces PTH resistance / decrease PTH secretion

Thus - have to replete Mg first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What happens at diff temps (energy source)

A 
45 C (113 F): collagen uncoils and realigns to form covalent bonds bw opposing surfaces
60 C (140F): irrev protein denat; coag necrosis; blanching
80 C (176F): carbonization; drying/shrinking of tissue
100 C (212F): vaporization; complete cell death
above: eschar formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

recurrent malignant effusion … treatment if there’s:

  • complete lung expansion
  • lung does not completely expand
A
  • talc pleurodesis

- pleurX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Major fuel source for small bowel enterocytes?

A

glutamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Major fuel source for large bowel enterocytes?

A

SCFA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What do you find for phyllodes? that makes it similar to fibroadenoma?

A

mixed connective tissue and epithelium
phyllodes: stromal overgrowth and hypercellularity
+vimentin, +actin in phyllodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Best mgmt for pts with ventral hernia req PD catheter placement?

A

Repair of hernia with extraperitoneal prosthetic mesh at time of PD catheter placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Contraindic to PD catheter placement

A

Absolute:

  • lack of functional peritoneal membrane
  • severe protein malnutrition or proteinuria >10g/day
  • active intraabd/abd wall infection
  • freq epi’s of diverticulitis

Relative:

  • ostomy
  • obese
  • peritoneal scarring
  • large abd wall hernia
  • physical or psych impairment
  • lack of appropriate environment
  • anuria
  • active inflamm process
  • VP shunt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

BRCA2 - which chromosome?

A

13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

At what age offer ppx SPO for BRCA 1 and 2 mutations?

A

BRCA1: 35-40
BRCA2: 40-45
*once childbearing complete
*reduces ovarian CA risk by 80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Screening for BRCA1/2

A 
BREAST
--monthly self exam start at age 18
--MRI at age 25
--annual mammo at age 30
OVARIAN
--transvaginal US and CA 125 q6 mo starting age 30
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Differential dx for nonpainful groin mass in males

A

Inguinal hernia (size incr w/ valsalva
Hydrocele (communicating hydrocele can incr w/ valsalva)
Testic cancer

Can distinguish first 2 via transillumination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What can pop up after breast cancer radiation?

A

(secondary) angiosarcoma - median survival 2 yr!
tx: total mastectomy (radiation causes a field defect & these are usually multifocal - get as much skin as poss) + adjuvant chemo
spread: hematog to lung, bone … no need for SLNB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which extraintestinal manifestations of Crohns will most likely resolve with medical/surgical tx?

A

erythema nodosum
peripheral arthritis
aphthous ulcers
episcleritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the order of preferred AV fistulas?

A

RC > BC > BB > prosthetic (brachioaxillary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

If you were planning a BC fistula but there is short segment cephalic vein occlusion … what do you do

A

BB fistula instead is next step

If concern for central venous occlusion (not short segment) - do intraop venogram/mapping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is a cimino fistula?

A

radiocephalic fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what do you see on path of well diff neuroendocrine/carcinoid tumor?

A

bland cytologic features

rare mitotic figures that stain +chromogranin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

cardiac impact of reverse T

A

increase venous pooling … decreased CO and hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Common orgs in CLABSI

A

GP (coag neg staph, enterococci, staph aureus) > GN > Candida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

MC cause of fat necrosis in breast?

A

idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

male breast cancer, stage for stage, carries the same prognosis as female breast cancer - T or F ?

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

When to remove pancreatic drains?

A

drain amylase no longer suggestive of a fistula and output decreasing
leave drains till enteral feeding to see if output worsens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

metabolic disturbance caused by NS resuscitation

A

non AG hyperchloremic metabolic acidosis

excess Cl, low bicarb, normal AG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

formula for anion gap

A

Na - (Cl + HCO3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What does thoracodorsal nerve injury cause?

A

weakened arm pullups and adduction

lat dorsi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

nondisplaced scaphoid fx - mgmt?

A
  • XR can have false neg result for up to 6 wks

- thumb spica cast (hand to elbow) for 6-12 wks, with f/u XR in 2 wks …. OR immediate CT / MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

ovarian cancer - staging

A

I: involve 1 or both ovaries
II: pelvic extension (uterus, tubes, pelvic tissue)
c: denotes +malignant cells on washings
III: peritoneal mets (micro or macro-scopic)
IV: distant mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What happens to intrathoracic pressure with a tension ptx?

A

becomes increasingly positive (normal = neg) –> decreased venous return, decreased stroke volume –> body compensates by incr HR and SVR –> hypotension, poss death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what causes the hypoNa in DKA?

A

pseudohypoNA due to influx of water (bc hyperosmolar) diluting Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What cells are LPS found on? What cells do they activate?

A

found on GN bacteria

activate monocytes / macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What’s bad about meperidine?

A

mu opioid agonist
toxic metabolite, normeperidine –> can reach toxic levels in pts with renal failure –> CNS irritability, seizures
*resp depression is dose dep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

> 75% spontaneous bact peritonitis is caused by __, of which 50% is __

A

aerobic GN rods

E coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

preferred mode for fecal diversion in rectal trauma pt

A

loop colostomy (»> end colostomy; easier to reverse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

procedure done for emergency surgery of UC

A

TAC with end ileostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

indic’s for emergency surgery in UC pt

A

perforation
life threatening hemorrhage
toxic megacolon
fulminant colitis refractory to medical therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Initial mgmt for severe UC

A

NGT, bowel rest
IV hydration, lytes
+/- abx (+peritoneal signs, fulminant colitis, toxic megacolon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Definition of obesity hypoventilation syndrome - DAYTIME hypoxia and hypercapnia in obese pt

A
  1. Obesity, BMI>30
  2. Daytime hypoventilation (paCO2 > 45)
  3. Absence of other known causes

*caused by apnea/hypopnea due to change in central chemoreceptor set points, not alveolar collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

ERCP facts

A
  • fast 6-8 hr before
  • ppx abx usually given esp if biliary obstruction anticipated
  • left lat decub –> (reach D2) –> prone
  • side viewing endoscope
  • a of vater at 12 -1 o clock
  • CBD orifice at 11 o clock in ampulla
  • PD orifice at 1 o clock in ampulla
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Where are mucinous cystic neoplasms usually located in pancreas?

A

body / tail&raquo_space;> head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

histologic hallmark of Paget disease

A

malignant intraepithelial adenocarcinoma cells
pale clear cytoplasm
high grade nuclei, visible nucleoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

example of horizontal gene transfer

A

conjugation, transformation, transduction

via plasmids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

example of vertical gene transfer

A

gene resistance passed from parent –> offspring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Absolute CI to liver transplant

A
  • recent ICH
  • increased ICP
  • active substance/ETOH use
  • current or recent extrahepatic malignancy
  • uncontrolled sepsis
  • lack of social support
  • prohibitive cardiopulmonary disease including R HF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Workup for stage 1, 2 3, 4 melanoma

A

1, 2: nothing

3: CBC, LDH, CXR (consider CT’s)
4: consider PET/CT + MRI brain + above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Mechanism of flail chest

A

*inspiration: chest wall collapses inward –> air moves from bronchus of involved lung into trachea and bronchus of uninvolved lung –> mediastinal shift towards involved side
*expiration: chest wall balloons outward –> air from uninvolved side to involved side –> mediastinal shift AWAY
“paradoxical chest wall motion”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is Six Sigma?

A

honestly idk but it aims to eliminate or streamline (vs add something, such as in PDSA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what converts trypsinogen to trypsin

A

enterokinase on intestinal brush border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Key aspects of lichtenstein repair

A
  1. large sheet of mesh - 3-4cm above hesselbach’s triangle, 2cm medial to pubic tubercle, 5-6cm lat to internal ring
  2. cross tails of mesh behind spermatic cord to prevent recurrence lateral to internal ring
  3. keep mesh lax
  4. secure mesh medially to conjoint tendon with 2 interrupted sutures & laterally to ing lig with 1 continuous suture
  5. identify and protect the nerves throughout
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what’s most likely to be injured when suturing mesh into the shelving edge of ing lig

A

external iliac vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what are primary lymphoid organs

A

bone, thymus, liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what are secondary lymphoid organs

A

lymph nodes, spleen, Peyer patches, tonsils, adenoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

modifiable risk factors for SSI prevention

A
  • glycemic control (110-150 or <200)
  • smoking cessation 4-6 wk before
  • dyspnea
  • preop albumin <3.5
  • bili >1
  • obesity
  • immunosuppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what are antidotes for cyanide toxicity?

A

amyl nitrite
hydroxocobalamin
sodium nitrite
sodium thiosulfate

sx: weakness, confusion, pulm edema
check: thiocyanate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Antidotes for OD’s:

  • tylenol
  • hydrofluoric acid, CCB
  • malignant hyperthermia, NMS
  • iron
  • BZ’s
  • methotrexate
  • metHBemia
  • antichol toxicity
  • heparin reversal
A
  • acetyl-cysteine
  • Ca gluconate
  • dantrolene
  • deferoxamine mesylate
  • flumazenil
  • leucovorin calcium
  • methylene blue
  • physostigmine
  • protamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what are howell jolly bodies

A

nuclear remnants - you see them post splenectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

major diagnostic criteria for hepatorenal syndrome

A
  • Cr > 1.5 or 24 hr Cr clearance 40 mL/min
  • absence of shock, fluid losses, nephrotoxins, or bacterial infection
  • no improvement w/ 1.5L IVF
  • proteinuria >500 mg/day
  • no US evidence of parenchymal ds or obstructive uropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

hallmarks of HRS

A

spanchnic vasodilation
activation of sympathetic nervous system + RAAS
renal vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

“poorly controlled diabetic” + pic of RUQ US + cholecystitis …. dx?

A

emphysematous cholecystitis

surgical emergency or perc drain if unable to tolerate surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

After RYGB, where is marginal ulcer usually located?

A

jejunal side of GJ (irritation from gastric acid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

pregnant patients with breast cancer - mgmt by trimester

A

First trimester: mastectomy + axillary LN dissection (not SLNB bc cannot use inj … actually can use radioisotope but later I think??)
Second: ideally <2 months from surgery to radiation
Third: mastectomy vs lumpectomy/SLNB … radiation postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Characteristics of CMV colitis (transplant pt)

A
  • punched out ulcers
  • Cowdry bodies (eosinophilic inclusion bodies)
  • may or may not have +blood serology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

gold std for dx of bladder rupture?

A

CT cystogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Indications for operative repair of bladder injury

A
  • intraperitoneal rupture
  • bladder neck injury
  • concomitant rectal or vaginal injuries
  • open pelvc fx or those with fragments
  • foreign body w/in bladder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

ischemic monomelic neuropathy

A
  • women and diabetics
  • shunting of blood away from nerves of distal UE
  • sx: pain out of proportion after procedure
  • dx: clinical tho can do nerve conduction studies (shows axonal damage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

neurogenic shock vs spinal shock

A

neurogenic shock: “distributive shock” - warm extremities

  • spinal cord injury above T6 –> disruption of autonomic pathways in spinal cord –> blood pools in LE lacking sympathetic tone –> decreased SVR –> hypotension
  • bradycardia from unopposed vagal activity

spinal shock:

  • motor deficits below level of injury, loss of spinal reflexes
  • describes neuro injury, no cardio effects

*possible to have spinal shock w/o neurogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

at which GFR do you need emergent dialysis

A

=6, regardless of symptoms

at GFR 10-15 + uremic symptoms –> elective dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

absolute indications for dialysis

A 
uremic pericarditis
pleuritis
encephalopathy
^^^ all are no matter the GFR
A - acidosis (<7.1)
E - lytes (refractory hyperK)
I - intoxication (salicylates, methanol)
O - overload (refractory to diuretics, esp causing pulm edema and incr O2 needs)
U - uremia (with sx)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

what is a chance fx

A

“seatbelt fracture”

  • unstable spine fx at thoracolumbar region
  • sx: back pain +/- neuro deficits (paraplegia) … seatbelt sign on exam
  • tx: urgent NSG eval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

mechanism of action of first line tx for PTLD?

A

anti CD20 (rituximab)

*B cell prolif!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

which side of bowel is at highest risk of ischemia - mesenteric or antimesenteric?

A

antimesenteric

vasa recta originate from peripheral arcades in mesentery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

what is a 2 layer anastomosis of bowel

A

inner running absorbable (ie vicryl)

outer interrupted nonabsorbable (ie silk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

MOA mafenide acetate

A

carbonic anhydrase inhibitor

  • hyperCl metab acidosis
  • good eschar penetration
  • pain w application
  • good against GP and GN, but not staph or fungi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

SE of silver nitrate

A

metHBemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

difference bw competency and capacity

A 
competency = legal decision made in court; global (financial, medical etc)
capacity = medical decision made by physician; only for medical decision making
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

breast lesion of “central lucency with surrounding architectural distortion”
–> what is it and what histology findings??

A
  • radial scar

- fibroelastic core w/ entrapped ducts and surrounding adenosis (adenosis = enlg’ed lobules)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

“lobular lesion with increased fibrous tissue and glandular cells”

A

sclerosing adenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

signs of AIP

A

lymphoplasmacytic sclerosing pancreatitis
periductal lymphoplasmacytic infiltrate
obliterative phlebitis
acinar fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

MAP goal during septic shock

A

65 +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

when can use broselow tape

A

up to age 12, <80 lbs/36 kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

thiamine deficiency –> beri beri –> AG metab acidosis

WHY?

A

thiamine (cofactor for pyruvate dehydrogenase) –> pyruvate build up –> shifted to lactate –> refractory metab acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

type 1 vs type 2 respiratory failure

A

HYPOXIA, PaO2<60. ie - ARDS. Caused by VQ mismatch or shunts.
HYPERCAPNIA. PCO2>50, pH<7.3. Caused by TBI, CNS depression, intoxication.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

mechanism of lithium toxicity in wt loss pts

A

decreased GFR after weight loss –> lithium toxicity –> (unknown mechanism) hyperCa, hyperMg, hypocalciuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

what drugs have increased absorption after RYGB

A

digoxin, PCN, atorvastatin, lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

pancreatic trauma grades

A 
I: small hematoma, no duct injury
II: large hematoma, no duct injury
III: distal lac with duct disruption
IV: proximal injury (right of SMV)
V: massive disruption of head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

best way to dx portal HTN

A

hepatic vein pressure gradient >6

gradient bw wedged pressure and free pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

functions of leukotrienes?

A 
leukocyte attraction and adhesion
bronchoconstriction
mucus production
increased capillary permeability
release of PAF

(made from AA; released from leukocytes/myeloid cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

what kind of organism is c diff

A

anaerobic gram positive bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

name 3 gram negative bacilli

A

pseudomonas
klebsiella
escherichia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

delayed immune hemolytic transfusion reaction … what can prevent this

A

retyping and screening the pt

  • pathophys: Ab to minor antigens
  • hemolysis –> unconj bilirubin
  • fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

best incision to gain prox and distal control of L subclav artery

A

left anterior thoracotomy + separate supraclavicular incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what is winters formula

check expected PaCO2 in metab acidosis

A

paCO2 = 1.5 (bicarb) + 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

How calculate AG

A

(Na + K) - (bicarb + Cl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

treatment for subclavian vein thrombosis 2/2 thoracic outlet syndrome

A

catheter directed lysis
venogram
remove first rib/decompress + balloon angioplasty for venous narrowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

hormone receptor +, small (<2cm) breast tumor, clinically neg axilla …. what can you do diff?
(in older person I think???)

A

no axillary surgery
no radiation
use aromatase inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

nerve(s) commonly injured during laparoscopic ing hernia repair

A

genitofemoral

lat fem cutaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

what is a verrucous carcinoma

A

large >8cm, symptomatic, slow growing warty growth that is soft and cauliflower like (comes from active HPV)
-tx: WLE or APR if involving sphincters… rarely mets, do recur locally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

MCC hyperaldo

A

b/l adrenal hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

what’s going on in DI

A

alcohol abuse/TBI –> reduced ADH –> polyuria, hyperNa

  • tx for acute: desmopression
  • tx for chronic: free water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

what is pseudohyponatremia?

A

water is drawn into intravascular compartments by hyperglycemia
approx for every 100 above normal, add 2 to Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

what is included in

  • cryo
  • FFP
A

cryo: fibrinogen (factor I), factors 8 and 13, vWf
FFP: clotting factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

what does a prolonged R time need

A

FFP (clotting factors)

nml: 4-8 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

what does a prolonged alpha angle need

A

cryo (fibrinogen)

normal: ~55-70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

low MA

A

plts (clot strength)

normal: 50-70 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

what does a prolonged LY30 need

A

TXA

normal: 0-8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

If have PCN anaphylaxis … what cross-reactivity is there?

A

cephalosporins: 6%
aztreonam: not signif EXCEPT ceftazidime
carbapenems: 1-9%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

what abx to give someone undergoing L hemi, anaphylaxis to PCN

A

metronidazole or clindamycin +
aminoglycoside (-mycin) or fluoroquinolone (levo, cipro, moxi)

OR clinda + aztreonam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

What is the McVay repair (femoral hernias)

A

suture conjoint tendon to Cooper’s ligament

  1. incise transversalis fascia to enter preperitoneal space
  2. suture conjoint tendon to Cooper’s at pubic tubercle extending laterally to femoral sheath
  3. can do a relaxing incision to release tension - 6cm incision on ant rectus sheath behind EO aponeurosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

In which hernia would you primarily repair the transversus and IO muscles

A

spigelian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What is a Bassini repair

A

suture conjoint tendon to inguinal ligament (closes direct and indirect spaces)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What is a Shouldice repair

A

Multi layer repair with running suture to obliterate the hernia defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

MCC of Zone III bleeding

A

presacral or prevesical veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

optimum and maximum cold ischemia times for transplantation

A

heart: up to 4 hr; 4-6 hr
lungs: up to 6 hr; 6-8 hr
intestine: up to 6 hr; 6-18 hr (small bowel procured 1st; very susceptible to ischemia)
liver: up to 8 hr; 10-12 hr
pancreas: up to 12 hr; 12-18 hr
kidney: up to 24 hr; 72 hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Donor hepatectomy occurs during __ perfusion.

Preserve the __ vein during dissection to perfuse the liver.

A

cold

IMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

One technique for minimizing cold ischemia time?

A

en bloc multi organ procurement with back table separation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

MCC esophageal stricture

A

GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

MC side effects after EMR?

Strictures are __ after RFA.

A

EMR: bleeding, strictures (Tx: dilations)

uncommon after RFA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

When do you consider chemo and adjuvant radiation for endometrial CA?

A

chemo: when disease has spread beyond uterus (metastatic disease)
radiation: high risk of recurrence (+LVI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

what causes periumbilical pain in appendicitis?

A

VISCERAL pain from luminal distension

this pain can be present in retrocecal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

what causes RLQ in appendicitis?

A

SOMATIC nerve fibers from contact of distended appendix with parietal peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Patients in which carotid artery stenting may be considered due to “high risk” status versus CEA

A 
recent MI
contralat carotid occlusion
CHF III/IV
LVEF <30%
unstable angina
previous CEA with recurrent stenosis
previous radiation tx to neck
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

inf thyroid artery supplies PTH glands from __ side

A

medial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

normocalcemic high PTH .. what is it?

A

early primary hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

1 splenic tumor overall

A

hemangioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

1 splenic malignant tumor and also MCC splenomegaly

A

Non hodgkins lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What “margins” do you need for a whipple

A

R0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

someone w liver disease … which paralytic agent do you want?

A

cis or atracurium

most NMB agents are hepatically metabolized but cis is eliminated by Hofmann elimination and ester degradation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q 
CI to these paralytic agents:
atracurium
cisatracurium
pancuronium
roc
succ
vecuronium
A
  • HD unstable pts, 2/2 histamine release
  • none
  • short surgical procedures (<60 min); longest acting; not recommended for continuous infusion
  • none
  • high K, burn pts, malignant hyperthermia
  • none
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

How are these paralytic agents metabolized:

  • succ
  • roc
  • vecuronium, pancuronium
  • atracurium, cis
A
  • succ: only depolarizing NMB agent; pseudocholinesterase
  • roc: liver mostly
  • vecuronium, pancuronium: liver + kidneys
  • atracurium, cis: Hofmann elimination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

1st line pressor for septic shock

A

norepi

2nd: vasopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What to do with DAPT peri-op?

A

low risk of bleeding: hold plavix x5 d and continue ASA

higher risk of bleeding: hold both for 5 days preop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

an age population associ with cecal volvulus?

A

middle aged women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

pathophysio of cocaine induced mesenteric ischemia 2/2 vasoconstriction

A

inhibition of NE reuptake at presynaptic terminals –> more NE at postsynaptic terminal –> tachy, HTN, vasocons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

two types of protein c deficiency

A

type I: quantitative
type II: qualitative

deficiency results in loss of normal cleaving of factors 5/8. mechanism THO is that protein c (anticoag) has a short half life and is rapidly depleted by warfarin, resulting in a transient hypercoag state –> skin necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

what is removed in a whipple

A

distal stomach, panc head, duo, 15cm jej, GB, CBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

histology: high nucleus to cytoplasm ratio, and absent nucleoli ….. what lung cancer is this?

A

small cell

assoc w/ paraneoplastic syndromes like SIADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

what is SCC of the lung assoc with?

A

hypercalcemia (PTHrP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

what promotes gluconeogenesis?

what are the precursors?

A

promoted by: glucagon, epi, cortisol

precursors: alanine (PRIMARY), lactate, glycerol, other aa (ie glutamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

when do you use MVA (analyses) ?

A

eval relationship bw variables and outcomes while controlling for the impact of other measured variables

170
Q

when is linear regression used

A 
continuous variables (ie cholesterol or BP) and assumed to be normally distributed
output = risk difference
171
Q

how do you repair the trachea?

A

1 layer with absorbable suture and strap muscle buttress

172
Q

what is cantlie’s line

A

imaginary line that runs from GB foss to IVC (divides liver into R and L)

173
Q

what symptoms would prompt a chronic adrenal insuff workup? what do you do to test for acute and chronic adrenal insuff?

A 
chronic fatigue, anorexia, abd pain
rapid corticotropin (ACTH) stim test
174
Q

what is normal urinary cortisol level

A

<90 mcg/24 hr (250 nmol/day)

>300 mcg = cushing syndrome

175
Q

how are brown recluse spider bites usually tx’ed?

A

observation and elevation

can get necrosis, injury to nerves, secondary bact infection

176
Q

what is arteria lusora

A

aberrant right sided subclavian artery (originates from aortic arch - leftmost artery) that loops behind the esophagus usually to get to the R side ….. this results in a non recurrent laryngeal nerve

177
Q

when to consider flaps in pilonidal disease?

A

extensive (stage 4 - multiple pits bilaterally) or recurrent pilonidal disease

178
Q

where are majority of active bile salts R

A

TI, 80%

179
Q

What is
Sheehan syndrome
Waterhouse-F syndrome

A
  • sheehan: ant pit ischemia after hemorrhage/hypotension postpartum
  • WF: adrenal hemorrhage after meningococcal infec
180
Q

HV pressure gradient reqd for variceal rupture

A

at least 12

181
Q

what makes up child pugh turcotte score

A 
bili
PT
albumin
encephalopathy
ascites
182
Q

MELD score at which pt will have survival benefit from transplant surgery

A

15

183
Q

signs of renal cancer?

A

incidentally during an imaging procedure
“classic triad” (10%): hematuria, flank pain, palp abd mass
may have paraneoplastic manifestations (hyperCa, cachexia, fever etc)

184
Q

test to determine a/c during CABG?

acceptable levels?

A

ACT
400-500 secs
determines amount of protamine to reverse heparin

185
Q

which open tissue based ing hernia repair has lowest recurrence rates?

A

shouldice

186
Q

is tx with anti-TNF in 3 months prior to surgery associ with poor wound healing?

A

no

187
Q

does switching to azathioprine within 6 wks of surgery affect wound healing?

A

yeah; incr postop morbidity (leak, sepsis)

188
Q

UPJ injury with trauma … more common in kids or adults? blunt or penetrating trauma?

A

kids (hyperflexibility of spine)

blunt

189
Q

mechanism of graft v host disease?

A
  1. damage of recipient tissue
  2. differentiation of donor T lymphocytes into Th1 and Th17 effector lineages –> recognize host as foreign –> proinflamm cytokines –> host tissue destruction (ie donor NK cells target MHC-I cells)
  3. tissue dysregul from cytokines prevents tissue regeneration in host (ie skin, gut)
190
Q

pathophysio behind chronic GVHD

A

dysregulation of donor Tregs leading to fibrosis

191
Q

2 major causal factors for hepatic angiosarcoma

A

vinyl chloride
arsenic
(bladder cancer - aromatic amines)

192
Q

formula for calculating nitrogen balance -__-

A

(protein in grams/6.25) - (nitrogen excreted in urine + 4)

193
Q

mgmt for uncomplic and complic type B aortic dissection

A

uncomplic (no pain or evidence of malperfusion): esmolol drip to SBP<120
complic: impulse control, surgery (TEVAR with any reqd interventions for branches - stenting etc)

194
Q

primary tx modality for advanced cervical cancer?

I think anything IB or further

A

chemo + radiation (ext beam + brachytherapy)

*pelvic, aortic LN basins

195
Q

MC myeloprolif disorder assoc with budd chiari?

A

polycythemia vera

196
Q

critical contributor to post splenectomy sepsis?

A

loss of Ab (IgG) and complement controlled (C3b) clearance

197
Q

what are heinz bodies and are they assoc with splenectomy

A

denatured Hb

no - assoc with G6PD def

198
Q

what do you do with someone’s warfarin preop?

A

stop 5d before, no bridge if low/moderate risk with hx afib (unless high risk)

199
Q

CI to stenting and poss covering L subclavian artery (ie for PSA distal to L subclav takeoff)

A

CABG using L IMA as bypass
aberrant L vertebral artery
dominant L vertebral artery
functioning AVF in LUE

200
Q

what to do with ABO incompatible blood transfusion by mistake?!

A

stop transfusion immediately
fluids for goal UOP 100cc/hr
(diuretics if pt can tolerate)
+/- dialysis for renal failure

201
Q

MC transfusion reaction

A

nonhemolytic febrile reaction
2/2 WBC in blood
can cause anaphylaxis if bad enough
tx: antipyretics, antihistamines, epinephrine, steroids
(** prevent in future with leukocyte filters)

202
Q

when someone comes with mallory weiss, what infusion should you start immediately

A

PPI

acidic environment impairs coag cascade and platelet plugs … PPI’s yo

203
Q

why is upper outer quadrant most likely place for breast CA and benign disease?

A

highest abundance of epithelial tissue

Most benign and malignant disease derives from epithelial tissue (comprises ~10% of breast mass)

204
Q

how is SJS described

A

maculopapular rashes that evolve into painful blisters and sloughing of the skin. Also tend to involve mucous membranes

205
Q

preferred biopsy for melanoma?

A

excisional biopsy with 1-3mm margins … go back for correct margins later
IF on surface (face etc) where hard to excise completely, or >2cm, can do incisional biopsy

206
Q

do hurthle cells take up radioiodine?

A

not well

207
Q

treatment for hurthle cells on biopsy

A

if a lot, then more signif for hurthle neoplasm

  • total thyroidectomy (do not respond well to RI)
  • MRND if +nodes
208
Q

if peak levels of a drug are high, what adjustment do you make?

A

decrease amount of dose

209
Q

indics for sterotactic biopsy breast

A

nonpalp; cannot see on ultrasound; gotta be visible on mammo

relative CI: very large or thin breasts, lesions abutting chest wall, some subareolar lesions

210
Q

tx for stewart treves?

A

dx: incisional bx
tx: WLE +/- chemorads for advanced disease

211
Q

reduce a baby’s incarcerated hernia… what is timing of surgery?

A

within 24-48 hr after (not immediately, to let edema die down)
*80% of initially incarcerated hernias can be reduced

212
Q

stages of adrenocortical cancer

A

stage I: localized, <5cm T1N0M0
II: localized, >5cm T2N0M0
III: locally invasive tumors any T, N1, M0
IV: tumors invading local organs, distant mets, venous tumor thrombus in vana cava or renal veins

213
Q

RF for invasive fungal infection

A 
prolonged abx
solid organ transplantation
TPN
GI perforation
HD
ICU stay >7 days
214
Q

correl of visceral art stenosis with PSV

A

SMA: >70% –> PSV > 275

celiac: >70% –> PSV > 200
renal: >60% –> renal:aortic ratio > 3.5
renal: >80% –> renal: aortic ratio > 3.5 and renal artery end-distaolic velocity > 150

215
Q

posterior pharyngeal neck mass … with no other sx … thoughts? how dx?

A

lingual thyroid

RI uptake scan

216
Q

4 proven effects of physician in leadership (QI etc)

A

improve pt outcomes
improved efficiency
increased staff satisfaction
decrease expenditures

217
Q

2 main surgical indics for CRS HIPEC

A

appendiceal disseminated adenomucosis (not nec better resection rate but this surgery is standard for this ds)
malignant peritoneal mesothelioma

218
Q

what is included in proximal DVT?

A

popliteal
superficial femoral
iliac

219
Q

an indication for catheter-directed thrombolysis?

A

acute iliofemoral DVT

220
Q

pathology of radial scar

A

fibroelastic core with entrapped ducts with surrounding radiating ducts and lobules

221
Q

what things do you excisionally biopsy?

A 
radial scar
LCIS
ADH
Atypical lobular hyperplasia
papillary lesions
phyllodes tumors (hard to distinguish from fibroadenoma)
222
Q

what is iron bound to for storage and transport?

A

ferritin - storage

transferrin - transport

223
Q

which breast recon method wont do well in face of radiation

A

autologous tissue graft

delayed recon best

224
Q

difference bw fibroadenomas and adenomas?

A

adenomas have sparse stromal elements

225
Q

dextrose - what is the kcal/g?

A

3.4

226
Q

funtions of the Ig’s

A

IgA: breastmilk
IgD: B cells
IgE: allergy
IgG: opsonization, complement; longterm immunologic memory
IgM: 1st Ab produced for immune response; produced by naive B cells (before Ag activ)

227
Q

common hipec agents

A

doxorubicin
mitomycin C*
oxaliplatin

228
Q

surgical treatment for duodenal ulcers causing GOO?

A
  1. acid reduction
  2. tx mechanical obstruction

ie - highly selective vagotomy with GJ
or - vagotomy antrectomy with Bilroth I or II

229
Q

high risk factors for BCC

A

recurrent lesion
>2cm
poorly defined
immunocompromised

230
Q

MC site of mets for HCC

also, do you do PET?

A

lung

no

231
Q

enzyme issue in gilbert’s? cirgler najjar?

A

glucuronyl transferase, mild defect (Gilbert)

glucuronyl transferase, severe (C-N)

232
Q

Dubin-Johnson defect?

Rotor’s syndrome defect?

A

D-J: secretion deficiency; high conjug

R: storage deficiency; high conjug

233
Q

ejaculatory dysfxn after L colectomy … injury to what? inability to maintain erection - from what?

A

ejaculation: superior hypogastric plexus (during high ligation of IMA)
erection: inf hypogastric plexus (deep w/in pelvis)

234
Q

Oliguria after kidney transplant … what do you evaluate?

A
  1. vascular anastomoses via US doppler
  2. ureteral anastomosis (hydro, bladder decompressed)
  3. bladder outlet obstruction (bladder not decompressed) - can check US or just test out foley to ensure return of irrigation fluid
235
Q

preferred IVF for pt with hyperkalemia?

A

LR (K [ ] =4)&raquo_space;» NS

236
Q

what do you do with a retrorectal mass?
MC mass?
MC malignant presacral tumor?

A

TRICK QUES - surgically resect all retrorectal masses no matter what

  1. congenital masses
  2. chordoma
    * * try to preserve at least unilat S3 nerve roots **
237
Q

single most imp molecule for determining intestinal wall strength?
theory for anastomotic leaks (usually after POD3)?

A
  • collagen
  • collagen degradation + lower level of tensile strength while scar is still maturing
  • MMP start breaking down newly laid collagen only 24 hr after anastomosis formation (process of degradation and buildup for 4 days)
238
Q

incisions for exploration of injury to prox 2/3 trachea and distal 1/3 trachea?

A

prox 2/3 trachea: cervical incision

distal 1/3: R posterolat thoracotomy (also R mainstem and prox L mainstem bronchi)

239
Q

tx for Access Related Hand Ischemia (ARHI), or steal syndrome

A
  • grades 1-3 (2: ischemia with activity/HD; 3: significant pain, numbness, loss of radial flow, etc)
  • tx for chronic ARHI: distal revascularization-interval ligation (DRIL) … create bypass originating prox to access anastomosis and terminating distal to it, with ligation of artery distal to anastomosis
240
Q

child (<5 yr) with neck mass and Horner syndrome - dx??

A

cervical neuroblastoma

241
Q

what is effect modification?

A

when the magnitude of the effect of the primary exposure on the outcome differs based on a third variable

242
Q

what is lead time bias

A

when ds is dx earlier with a screening test but no actual impact on ds outcome

243
Q

latent period?

A

time bw exposure and development of sx

244
Q

what do fluoroquinolones have interactions to?

A

calcium, aluminum, mag (laxatives)

245
Q

how does cipro work?

A

inhibition of bacterial DNA gyrase and topo IV –> inhibit DNA synthesis

246
Q

which abx inhibit protein synthesis by binding to … 30S? 50S?

A

30S: aminoglycosides
50S: macrolides

247
Q

which abx inhibits cell wall synthesis?

A

vancomycin

248
Q

which abx inhibits dihydropteroate synthetase?

A

bactrim

249
Q

after hep C needlestick exposure - do you start tx right away?

A

no. ppx antivirals not recommended, bc rate of infection is low (0.1 - 1.8%). start tx if confirmed +infection to provider who was exposed

250
Q

MC site of mets for cutaneous melanoma?

A

liver –> small bowel –> colon

stomach, duo, rectum, esoph, anus

251
Q

What is TURP syndrome?

A

Absorption of irrigation fluid during prostate surgery (ESP if prostate capsule is violated) … causes hyponatremia

  • severity of hypoNa directly related to vol of irrigation fluid retained
  • decrease of Na by 10+ –> neuro sx
  • symptomatic pts, tx = hypertonic saline
252
Q

min length of roux limb to prevent bile reflux

A

40cm

253
Q

describe traumatic urethral injury grading scale

A

grade I: contusion
II: stretch injury
III: partial disruption
IV: complete disruption, no extensive separation
V: complete disruption, +extension separation
tx = urinary diversion.. can do delayed repair

254
Q

the risk of an intussusception 2/2 to specifically a pathologic lead point increases with ___

A

age

255
Q

anatomy of inguinal lig LAD:

  • saphenous vein
  • obturator nerve
  • lat fem cutaneous nerve
  • femoral triangle
A
  • at junction of sartorius and adductor muscles
  • runs bw int and ext iliac vessels
  • runs under fascia of sartorius
  • borders = ing lig, sartorius, adductor longus (contains fem a/v/n)
  • within fem canal … gateway to deep inguinal LAD
256
Q

how do you close femoral canal after ing LAD?

A

suture ing lig to pectineal lig with interrupted nonabsorbable suture … can use mesh or sartorius muscle flap

257
Q

How is tamoxifen metabolized and what drug should you not give with it?

A

CYP2D6 –> metabolizes tamoxifen into active metabolites

SSRI’s

258
Q

preop abx for colon surgery?

A 
cephalosporin + (flagyl or unasyn)
if PCN or cephalo allergy: combine the below
- clinda or vanco
plus
- gent, levo, cipro, aztreonam
259
Q

s/p lung transplant … persistent air leak, pneumomediastinum, pneumopericardium, empyema

A

bronchial dehiscence

dx - bronchoscopy

260
Q

what does the duodenum absorb?

A

Ca, iron, phos, fat soluble vits (ADEK)

261
Q

optimal diet for hepatic encephalopathy?

A

low AAA, methionine
higher BCAA

(liver metabolizes aromatic amino acids normally)

262
Q

diabetics who need enteral feeding - what formula do you start with

A

standard (non diabetic) fiber containing formula, with moderate fat and carbs

263
Q

what is dermatofibrosarcoma protuberance?

A
  • rare sarcoma, flesh colored mass on back
  • dermal/subdermal tumor with epidermis sparing (spindle shaped cells)
  • microscopic tentacles .. so need a wide excision (2-4cm margin)
  • can use imatinib (TKi) to downstage locally adv tumor
  • CD34 and vimentin + … F8a and aSMA -
264
Q

histology of BCC

A

basophilic staining basal cells infiltrating the dermis

265
Q

What cancer is common with Crohns?

A

NHL, esp due to immunosupp meds

*can be assoc with tumor lysis syndrome (w/ tx)

266
Q

which pain meds can you use for someone with renal issues?

A

tylenol
fentanyl
hydromorphone (dilaudid) – liver metabolized

267
Q

tell me about pancoast tumors

A
  • usually NSCLC, near thoracic inlet at apex

- sx: shoulder pain, ulnar distribution weakness

268
Q

What is preferred 1st line HAART regimen

A

tenofovir, lamivudine, efavirenz

269
Q

For internal carotid artery, what is PSV assoc w/:

  • 50% occlusion
  • 50-69% occlusion
  • > 70% occlusion
A

125
125-230
>230
*ext carotid art triphasic; int carotid artery is biphasic

270
Q

MC problem assoc with local anesthetic use (ie lidocaine) in neuraxial (spinal or epidural) anesthesia?

A

hypotension, 2/2 vasodilation and pooling of blood in LE
OTHER = bradycardia (esp above T5)
(1st blocked = postgang symp nerve fibers … next = sensory + motor)

271
Q

what is prednisone dose at which they don’t need stress dose

A

10mg or less, >2 wks

272
Q

abx for pancreatic necrosis

A

carbapenems (ie erta)
fluoroquinolones
metronidazole

273
Q

1st line pressor for septic shock

A

norepi

274
Q

factors w/ highest DVT risk (caprini score pts)

A 
major surgery >6 hr
elective arthroplasty
fracture of hip, pelvis, leg
acute spinal cord injury (in last month)
stroke (last month)
multiple traumas (last month)
275
Q

lung abscess … hemoptysis a couple days later. what does that mean? what is tx?

A

abscess eroded into vessel and airway

need surgical resection

276
Q

lung abscess that does not improve w/ appropriate abx tx in 7-10 days - what next?

A

catheter drainage - perc (peripheral) pr bronchoscopic (central)

277
Q

lung abscess - what indics for surgery?

A 
BP fistula
empyema
bleeding (ie - hemoptysis)
concern for malignancy
failure of medical therapy
278
Q

reversal for dabigatran (pradaxa)

A

idarucizumab

279
Q

muscles used for forced expiration?

A 
abd muscles (EO, IO, rectus, transverse abdominal)
internal and external intercostals (NOT "innermost intercostals")
280
Q

histology of paget’s disease (breast)

A

clear cells with oval nuclei and lg nucleoli … interspersed between normal nipple epidermis keratinocytes

tx: mastectomy with SLNB (excise nipple/areolar complex) … if palpable nodes, then MRM

281
Q

describe gram and shape of clostridia

A

gram pos, anaerobic, rods

282
Q

radiation ulcers … sigh

A

presentation: hx radiation + refractory sx (pruritus, pain)
dx: biopsy (epidermal atrophy, dermal sclerosis, dilated superficial vessels, loss o’ adnexal structures like hair follicles, atypical stellate shaped fibroblasts)
tx: conserv wound mgmt first … if fails, then aggressive radical excision with flap

283
Q

Normal HU of pancreas parenchyma

A

100-150

284
Q

pseudomonas ..

A

gram neg aerobic bacilli

285
Q

1st line abx of choice for infected pancr necrosis?

MC pathogens?

A

carbapenem

MC pathogens: e coli, pseudomonas, klebsiella, enteroccocus

286
Q

MC sites of melanoma recurrence

A

skin, subQ, distant LN, visceral (lung, liver, brain etc)

287
Q

what is cerebral salt wasting?

A

unknown etiology .. usually after CNS insult (usually aneurysmal SAH)
hypovolemic hypoNa, with increased urine Na
tx: iso or hyper tonic saline
*don’t confuse with SIADH (where you fluid restrict + vaptan)

288
Q

1st step in evaluating fectal incontinence 2/2 incompetent anal sphincter?

A

endoanal ultrasound

289
Q

what causes …
direct ing hernia
indirect ing hernia

A

direct: weakness of conjoint tendon / transversalis
indirect: patent processus vaginalis (defect in deep ring)

290
Q

Describe altemeier and delorme procedures!

A

Altemeier (for larger prolapse >5cm; rectosigmoid resection): exteriorize prolapse –> circumf full thickness incision 1cm above dentate line –> amputate redundant sigmoid transanally –> stapled or handsewn coloanal anastomosis

Delorme (for small prolapse <5cm): circumf full thickness incision 1cm above dentate line –> remove mucosa (from incision up to proximal extent of prolapse) –> longitud plication of m.p. –> anastomose mucosal edges

291
Q

what is involved in extrinsic and intrinsic pathways of apoptosis?

A

extrinsic: death receptors, death domain proteins
intrinsic: protein mediators (Bcl-2), incr mito membrane permeability, cytochrome C

292
Q

RF for BK virus?

A

high immunosuppression
pulse steroids (to tx rejection)
ischemia reperfusion injury

293
Q

what is monitoring for barrett’s?

A

no dysplasia: EGD q3-5 yrs
low grade dysplasia: EGD q6 mo +/- endoscopic RFA
high grade dysplasia: endoscopic eradication

294
Q

can you do a nissen if pt has barrett’s with low grade dysplasia

A

yes

295
Q

what is silver sulfadiazine assoc with?

A

transient neutropenia and thrombocytopenia

rarely - metHGBemia (watch out for G6PD)

296
Q

rapid correction of chronic hyponatremia (>5 mEq/L/hr) … causes?

A

osmotic demyelination syndrome (ODS)

  • usually hx chronic alcoholism, malnutrition, cirrhosis, refeeding syndrome
  • clinical signs delayed 2-6 days after rapid correction has occurred - dysarthria, paresis, behav disturbances, seizures, lethargy, confusion, coma
297
Q

pt s/p VARD for pancr necrosis … now w/ hematemsis. Thoughts?

A

splenic artery or GDA pseudoaneurysm

-pancr enzymes extravasate into RP space –> autodigestion of blood vessel walls –> PSA

298
Q

complications following VARD?

A

hemorrhage - early or delayed (ie from a pseudoaneurysm)
colonic injury
RP abscess with fistulization
iatrogenic ptx

299
Q

what is the strongest indicator of poor preop nutritional status?

A

albumin <3

300
Q

absolute CI to PV embo to increase FLR

A

overt clinical portal HTN

301
Q

what would rule out a BCI (blunt cardiac injury)?

A

normal EKG + normal trop I level

any EKG abnormalities (ie - occasional PVCs) warrants hospital admission for observation

302
Q

name mechanism of the following:

  • acute hemolytic reaction
  • delayed hemolytic reaction
  • nonimmune hemolysis
  • febrile non-hemolytic reaction
  • urticaria
  • TRALI
A
  • ABO incompatibility (Ab mediated; type II HSN)
  • minor Ag from donor (Ab mediated)
  • idk not imp
  • cytokines from donor WBC
  • recipient Ab against donor plasma proteins or IgA in IgA in IgA-deficient patient
  • DONOR ab to recipient WBC
303
Q

List causes of portal HTN
prehepatic
hepatic
posthepatic

A

pre: PV thrombosis
hepatic: cirrhosis
post: budd chiari, congestive cardiac failure

304
Q

how do you treat claudication

A

lifestyle + medical mgmt (stop smoking, exercise, antiplt (ASA, cilostazol-not in HF, or plavix), intensive statin) …… if no improvement or progression of symptoms –> further therapy, consider revascularization

305
Q

inflamed TI, normal appendix + cecum, pt in OR for appendicitis … what do you do

A

appy IF cecum normal

306
Q

what is chromosome for FAP

A

5q21
auto dom
may be de novo in 25%

307
Q

FAP cancer screening

A

EGD at 20-25 or when colon polyps first appear
q1-2 yr colonoscopy starting at age 10-15
q2-5 yr thyroid US starting in late teenage yrs (papillary)
look out for desmoids

other: medulloblastoma, sebaceous cysts, lipomas, osteomas, supernumerary teeth, hypertrophy of retinal pigment epithelium

308
Q

what is a complex fistula

A

simple: intersphincteric or low transsphincteric, involving <30% of external sphincter –> FISTULOTOMY
complex: >30% sphincter, ant fistulas in females, recurrent IBD, or radiation –> SETON, THEN DEFINITIVE PROCEDURE (ie - LIFT, or endoanal adv flap for high fistulas)

309
Q

pulm findings on CT: >2cm, spiculated, growing, part of solid, invasive

A

NSCLC

310
Q

pulm findings on CT: rapid growth, LAD, direct invasion, SVC obstruction, necrosis/hemorrhage common

A

small cell lung cancer

311
Q

hypodense, homogenous, well defined, contained, stable

A

lipoma

312
Q

perianal condyloma (genital warts) - tx?

A

gross excision of disease
no further screening
HPV vaccination (good for before or after exposure)

313
Q

treatment for dumping syndrome

A

dietary modifications –> meds (acarbose, octreotide) –> surgery (convert to roux en y)

314
Q

tx for triple neg breast CA after lumpectomy?

A

radiation obv

+ adjuvant chemo for tumors>0.5cm

315
Q

considerations for neoadjuvant chemo, breast cancer

A

triple neg breast cancer

HER2+

316
Q

RF for septic complics in ICU pts

A

male gender
prolonged ICU stay
prolonged ventilator req
increased age

317
Q

criteria for brain death exam

A

normothermia for >/= 6 hr
loss of all brainstem reflexes
positive apnea test (abort for decompensation: desat to <85 for >30 sec, hypotension)

if apnea test doesn’t work, do confirmatory test (4 vessel angiogram is gold std … radionuclide scintigraphy)

318
Q

what is a positive apnea test

A

paCO2 rises to 60 (or >20 above baseline) after 10min off vent

319
Q

for pts undergoing ventral hernia repair, __ is assoc w/ SSIs. using __ instead of __ for hair removal is BETTER.

A

preop bowel prep

clippers&raquo_space;» razors (latter is assoc with SSI)

320
Q

where is AFP high?

A

germ cell tumors

HCC

321
Q

3 tumor markers of testic cancer

A

AFP (seminomas never have high AFP)
b-HCG (seminomas have this high 10-20% of time)
LDH

**elevated in NONseminomatous germ cell tumors

322
Q

MCC pseudomyxoma peritonei

A

appendix

323
Q

tx for FMD of renal arteries

A

angioplasty alone
focal FMD: BP improves, no meds needed post procedure
multifocal FMD: still need meds post procedure

(I think renal atherosclerosis would need angio + stent??)

324
Q

MC genetic alteration in thyroid cancer

A

BRAF V600E

325
Q

dysphagia to both liquids and solids is suggestive of __

A

functional disorder (like achalasia)

326
Q

What are omega 3 and 6’s

A

3: ALA, DHA, EPA
6: LA, AA

327
Q

digoxin + pt with n/v …. arrhythmia. how?

A

digoxin causes dysrhythmias at low K levels

K and Na are thrown up … kidneys R more Na at expense of H and K

328
Q

which burn meds to avoid if +sulfa allergy

A

mafenide acetate
silver sulfadiazine

use silver nitrate (solution) for eschars and +sulfa allergy

329
Q

pt with pheo, was hypertensive during case where it was being resected… unresponsive postop w/ normal vitals and labs except lactate is high. what is problem and tx?

A 
cyanide toxicity (from nitroprusside used for HTN, tho it is CI in B12 def, anemia, kidney/liver ds, hypovolemia)
tx = hydroxocobalamin + sodium thiosulfate
330
Q

signs of bb overdose

A

hypotension

bradycardia

331
Q

abx tx for pouchitis

A

flagyl or fluoroquinolone

332
Q

hernia repair… enterotomy w/ no gross spillage successfully repaired - do you use mesh? how repair?

A

synthetic mesh if no evidence of strangulation or gross spillage

333
Q

hematochezia + HD instability … tx?

A

r/o UGI sources with NGT

if HD stable –> resuscitate and then Cscope

334
Q

early HA thrombosis post transplant causes __

late HAT causes __

A

primary graft nonfunction + hepatic failure

late: biliary strictures, abscesses, recurring bacteremia

335
Q

are these before or after the event occurs:

  • root cause analysis
  • failure mode & effects analysis
  • human factors analysis and classif system
  • PDSA
A

-after (focuses on system, not individual)
-before (evaluate systems in stepwise fashion)
“Failure, Forward looking”
-after (human error assoc with event)
-before

336
Q

what is order of unclamping after CEA?

A

ECA
CC
ICA
finish patch angioplasty

337
Q

1 month s/p nissen, p/w mild reflux, postprandial bloating, progressive nausea … ?

A

barium swallow 1st –> if normal, then vagal nerve injury

338
Q

small bowel mass with mesentery tethering, liver mass with central necrosis (hypodense) …… diarrhea …..
what is it and what do you test for?

A

urinary 5HAA (serotonin) .. >25 is dx
carcinoid syndrome
can check CgA but watch out for PPI use

339
Q

infant >2 wk old with persistent jaundice (conjugated hyperbili) … what do you rule out?

A

biliary atresia

differential: hepatitis

340
Q

indics for transanal excision of low-mid rectal CA/malignant polyps

A

T1, <3cm in size
<8cm from anal verge
mod well diff
< 1/3 circumference of bowel wall

341
Q

what kind of washout for benign incidental adrenaloma

A

> 50% at 10min

<10 HU

342
Q

how to tx the following:
C krusei
C glabrata
C albicans

A

voriconazole
micafungin
fluconazole

343
Q

what pain med to avoid for post dural puncture headache

A

NSAIDs (affect plt function)

344
Q

tx for C diff assoc toxic megacolon

cecal dia >12 or colonic dia >6

A

TAC with end ileo

high mortality

345
Q

how to follow incidental thyroid nodules

A

<1cm and no alarming hx or features: repeat US in 6 mo
1-1.5cm + intermed/high risk features: FNA
1-1.5cm + low risk features: follow on US
1.5 or greater: FNA no matter what US shows
if small but concerning hx … consider FNA

346
Q

absolute CI to PEG placement

A 
coagulopathy
massive ascites
completely obstructing esophageal mass
severe malnutrition
(sepsis, MOF)
347
Q

aortoenteric fistula after AAA repair

A

usually occur 1-5 yr later
MC etio: graft infection w/ anastomotic PSA that erodes into bowel
tx: fistula takedown, graft excision, oversew distal aorta, extra-anatomic bypass

348
Q

what are MCC and signs of venous HTN?

in setting of someone with AVF

A

MCC: stenosis and/or thrombosis of central venous system 2/2 to previous catheterization

sx: extremity edema, varicosities, dermatosclerosis, ulceration
also: high pressure and/or prolonged bleeding at puncture site of dialysis
dx: venogram
tx: endovascular recanalization of stenotic or occluded area

349
Q

how long to wait before surgical repair of rectovaginal fistula

A

3-6 months

350
Q

what does sclerosing adenosis look like histologically

A

central cellularity with lobules and intact myoepithelial contents

351
Q

MC defect assoc with colon cancer

A

APC

352
Q

what innervates …
thumb mostly
thumb aDduction
palmar and dorsal interossei

A

median nerve
ulnar nerve for thumb aDduction
ulnar nerve

353
Q

recurrent reflux and wt gain after hx RYGB

A

gastrogastric fistula

dx: CT w/PO con or upper GI series

354
Q

potential reactions to protamine?

A

hypotension
pulm vasoconstriction
pulm HTN

355
Q

which veins need to be repaired

A 
IVC
femoral
popliteal
BC
subclav
axillary
356
Q

MCC late death in …

  • heart transplant
  • lung transplant
  • kidney transplant
A

heart: “chronic allograft vasculopathy” (coronary atherosclerosis)
lung: bronchiolitis obliterans
kidney: MI

357
Q

how long try medical therapy for gastric ulcers, before surgical intervention?

A

12 weeks

358
Q

MC nosocomial infection in ICU

leading cause of death 2/2 hosp acquired infection

A

PNA

SSIs are also common … both are more common than UTI

359
Q

MC fungal infection in immunosuppressed pts

MC fungal pulm infection overall

A

aspergillosis (invasive, allergic, aspergilloma)

overall: histoplasmosis (itraconazole)

360
Q

flail chest or multiple rib fx … pt decompensates

A

pulm contusion!!!

361
Q

what imaging to look for accessory spleen?

A

technetium sulfur colloid scan

362
Q

what has the highest resolution rate s/p bariatric surgery?

A

pseudotumor cerebri

363
Q

1st line pressor for septic shock?

A

norepi !!!

364
Q

operative time > ___ minutes has been shown to increase risk of inc hernia

A

80

365
Q

what does motilin cause

A

migrating myoelectric complex

366
Q

ant hip disloc is assoc with __

A

femoral head fx

abduction + ext rotation

367
Q

treatment for hep C

A

atezolizumab (aPD-L1) + bevacizumab (a-VEGFA)

368
Q

indics for damage control surgery

A

base deficit > 15
ph < 7.2
temp < 34
refractory coagulopathy

369
Q

tx for lower duct resectable CCA?

A

whipple

370
Q

where make incision for SMA embolus

A

transverse arteriotomy PROX to origin of middle colic

371
Q

briefly, what is young-burgess classification of pelvic fx? (AP compression)

A

I: symphysis widening <2.5cm
II: widening > 2.5cm
III: SI disloc with vascular injury

372
Q

MCC pelvic fx

A

MVC

373
Q

imp mediator of chronic wounds

A

IFN gamma

374
Q

what tissues are obligate glucose users

A

erythrocytes, neutrophils, peripheral neurons, adrenal medulla

375
Q

neurogenic shock is loss of sympathetic tone to ___

A

vasculature (vasodilation)

376
Q

Peterson defect

A

space bw roux limb and transverse colon mesentery

377
Q

elective hernia repair not recommended for __, __, __

A

BMI>/=50
current smokers
HbA1c >/= 8

378
Q

thoracic outlet syndrome …

A

compression of subclav artery or vein and brachial plexus
MC sx = neurologic, ulnar distribution
first line tx = physical therapy
surgery if conserv therapy fails, or develop arterial complic or venous thrombosis

379
Q

surviving sepsis bundle (1 hr)

A
  • -measure lactate and repeat is >2
  • -get blood cx before start abx
  • -give broad spectrum abx immediately after blood cx drawn
  • -give 30 cc/kg crystalloid for hypotension or lactate >4
  • -pressors if hypotensive during/after fluid resusc to maintain MAP>65
380
Q

5 things to assess frailty

A 
weight loss
weak grip strength
self reported exhaustion
slow walking speed
low energy expenditure
381
Q

CI to lat internal sphincterotomy? Treatment?

A 
Hypotonic sphincter (ie previous anorectal sx or obgyn trauma)
Tx: fissurectomy w anocut adv flap
382
Q

when would you consider botox&raquo_space; lat internal sphincterotomy for fissure?

A

risk of incontinence

refused surgery

383
Q

Ehlers Danlos - which defect?

A

collagen type 3

384
Q

how to workup failure of AVF to mature?

A 
duplex US (check for arterial inflow or venous outflow issues)
then maybe fistulogram / angioplasty
385
Q

max size for EV laser ablation

A

8mm (assoc with thrombus extension)

386
Q

indic for sclerotherapy

A

varicose veins <8mm
reticular veins 2-4 mm
telangiectasias

387
Q

what is time of chronic anal fissure

A

> 6 weeks

388
Q

name the HSN reactions

A

I: anaphylaxis
II: cytotoxic mediated … Ig’s attached to surface Ag –> complement
III: Ag-Ab complexes
IV: cell mediated, w/ local injury

389
Q

MOA of silver antimicrobial properties

A

ribosomal toxicity
intercalate into dna
denature proteins
disrupt bact cell membrane

390
Q

how to treat MALToma

A

check for h pylori
if +h pylori, check t(11;18) status
if t(11;18) POS –> h pylori tx + radiation (or rituximab if latter is contraindic)
NEG –> generally just standard course of tx

391
Q

__ has the highest 5 yr kidney graft survival rate

A

cystic kidney disease (it’s >85%)

392
Q

treatment for RCC?

A 
radical nephrectomy
(w/ simultaneous intraop open IVC thrombectomy if needed)
393
Q

traumatic transection (incomplete vs complete) of LAD … treatment?

A

incomplete: primary repair
complete: CABG

394
Q

min time for DAPT for DES

A

6 mo

395
Q

occlusion of artery of ademkiewicz can cause __ __

A

spinal ischemia
*it is the main blood supply to the spine from T8-conus
urinary and fecal incontinence, impaired motor fxn of legs

396
Q

classic murmur of AI (aortic insufficiency)

A

high pitched decrescendo diastolic murmur, at 3-4th IC space at L sternal border

397
Q

where do you hear aortic stenosis murmur

A

right upper sternal border

398
Q

kid with liver mass and high AFP

A

hepatoblastoma

399
Q

desmoid markers

A

+ : B-catenin, actin, vimentin,

- : cytokeratin, S-100

400
Q

steps for examining entire duo and pancreas

A

kocher maneuver
incise gastrocolic lig and enter lesser sac
divide RP inferior to pancreas (to see post pancreas)
right medial visceral rotation (C-B)
mobilize lig of treitz

401
Q

which splenic lig contains splenic artery?

A

splenorenal

402
Q

what are the BCAA

A

isoleucine, leucine, valine

403
Q

how to dx blind loop syndrome?

A

carb breath test (carbohydrate excreted earlier than 2-3 hr)

404
Q

how do you dx dumping syndrome

A

monitored glucose challenge (incr HR or hypoglycemia)

405
Q

2 absolute CI to lap chole

A
  1. uncorrected/uncontrolled coagulopathy

2. cannot tolerate insufflation

406
Q

ideal CPP and ICP

A

CPP 60-70 (not above)

ICp <20

407
Q

difference between delorme and altemeir

A

delorme: strip mucosa and plicate muscle layers
altemeier: perineal rectosigmoidectomy ( you resect stuff)

408
Q

indications for damage control surgery

A 
base deficit >15
temp <34
pH<7.2
refractory coagulopathy
lg vol resusc > 12L
409
Q

how does high PEEP cause decreased CO

A

high PEEP –> increased intrathoracic pressure –> decreased RV filling –> decreased LV preload –> decreased stroke volume –> decreased CO (CO=SVxHR)

410
Q

tx for postthrombotic syndrome

A

compression

411
Q

what to do for psotthrombotic syndrome and involvement of iliofemoral axis?

A

venogram

412
Q

guidelines for hypotension in neurogenic shock

A

maintain MAP>85-90 for at least first 5-7 days after acute SCI

  • lesions above T6: dopamine or norepi (bc anticipate hypotension and bradycardia 2/2 injury of cardiac accelerator nerves at T1-4)
  • lesions below T6: phenylephrine
413
Q

what suggests venous HTN in a fistula pt

A

prolonged bleeding, difficulty with dialysis
limb edema/varicosity
tx: endovascular venoplasty, venous bypass

414
Q

what size must the base of the meckel diverticulum in order to do diverticulectomy

A

2cm

if larger, palpable abnormality, or unhealthy tissue: segmental resection of ileum

415
Q

primary predictor of failure of endoscopic pseudocyst drainage?

A

presence of moderate debris

416
Q

3 factors in inflamm phase of wound healing (1-3d)

A

TNFa
IL1
PDGF
(also IFNs)

417
Q

what is RQ

A

CO2 prod / O2 consumed

418
Q

can you order a HIDA in a pregnant woman?

A

yeah

419
Q

indic for catheter directed thrombolysis of DVT

A

low risk pts with iliofemoral DVT (reduces risk of post thrombotic syndrome)

420
Q

what is normal urinary ca?

A

<400 mg

ABSITE 2022 (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions