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ABSITE 2024 > ABSITE 2024 deck > Flashcards

ABSITE 2024 deck Flashcards

1
Q

Absolute CI and relative CI to PV embolization for hypertrophy of liver

A

overt clinical portal HTN

relative:
- PV tumor invasion
- severe coagulopathy
- uncorrected biliary obstruction/cholestasis
- renal failure

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2
Q

What is preferred site for paracentesis? (if dont have US)

A

3cm medial and 3cm superior to ASIS (either side, but pick depending on surgical scars etc)

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3
Q

Describe Z0011 trial

A

women>18 yrs
tumor <5cm
clinically node neg
0-2 +nodes on bx
who will receive whole breast rads after lumpectomy

no need for full ALND

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4
Q

absolute CI to liver txp

A
  • head bleed
  • elevated intracranial pressures
  • current or recent extrahep malignancy
  • uncontrolled sepsis
  • inadequate social/financial support
  • prohibitive cardiopulm fxn including R heart strain
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5
Q

Most important predictive factor for survival in RP sarcoma?

A

tuhmor resectability
followed by histologic grade

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6
Q

which solid organ has the best 1 and 5 year organ specific survival rates?

A

kidney
liver is second

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7
Q

Patient with TBI - best predictor of longterm outcomes?

A

motor score of POST-resuscitation GCS

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8
Q

What is tx of C diff?

A

PO fidaxomicin (1st line) - 200 BID x10d
alternative 1st line: PO vanco 125 QID x10d
Bezlotuxumab - new for recurrent epi’s (given IV)

no role for IV Vanco

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9
Q

is flagyl safe in pregnant women?

A

no

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10
Q

utility of IABP

A

decrease afterload, improve coronary blood flow during diastoleMC

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11
Q

MC indication for IABP

A

cardiogenic shock after MI

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12
Q

nonspontaneous brown or cheese-like nipple discharge?

A

MC: mammary duct ectasia

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13
Q

MC benign salivary gland tumors

A

pleomorphic adenoma (#1 tumor overall)
Warthin’s tumor (males)

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14
Q

MC malignant salivary gland tumors

A

mucoepidermoid CA
adenoid cystic (indolent, invades nerve roots, very Sn to XRT)

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15
Q

acutely bleeding gastric/esophageal varices - mgmt?

A

EGD (banding)
octreotide
abx ppx

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16
Q

TBI - best predictor of longterm outcomes?

A

motor score of POST resusc GCS

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17
Q

“good thing” about robot?

A

7 degrees of freedom

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18
Q

what do you expect on UA for ATN (in setting of AKI)?

A

granular or epithelial cell casts

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19
Q

Does hypothermia “contract” (reduce) or prolong effects of anesthetic drugs?

A

PROLONG, even with mild hypothermia

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20
Q

preferred abx for pancreatic necrosis?

A

carbapenems (ie erta) preferred; flouroquinolones (CTX), flagyl

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21
Q

vascular supply for -
TRAM flap
lat dorsi flap

A

sup epigastric
thoracodorsal vessels

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22
Q

which structure is used to guide the perineal dissection?

A

coccyx (sweep between anus and coccyx … go laterally to ID and divide the levator ani muscles)

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23
Q

what’s tx for merkel cell CA?

A

-WLE (1-2cm)
-SLNB
-Radiation if …
–primary tumor>/=1cm
–limited surgical margins
–LVI
–Head and neck primary
–Immunocompromised

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24
Q

Standard endoscopes magnify images ___ and digital zoom of ___

A

30-35x
1.5-2d

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25
Q

radial scar on breast CNB - what do you do?

A

generally, excisional biopsy (25% malignancy)

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26
Q

pediatric varicocele (kid age <9) with no genital trauma - what’s your thought?

A

think of a RP mass - US Abd

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27
Q

Treatment for varicoceles?

A

Most popular surgical: lap varicocele ligation

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28
Q

Acutely unstable patient with cardiac tamponade - best option?

A

pericardiocentesis
18G needle inserted to left of xiphoid

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29
Q

MC sites of embolic events in LE?

A

CFA
pop artery

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30
Q

what are boundaries for superficial inguinal LAD?

A

sartorius (lat)
aductor longus (med)
ing lig (sup)

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31
Q

what does portal triad contain

A

proper hepatic artery
CBD
portal vein

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32
Q

what is duration of pringle maneuver?

A

15-20 min at a time, unclamp 5 min
prevent liver ischemia + abscess

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33
Q

how to do witzel jejunostomy?

A

loop of jejunum 20cm from lig of Treitz –> purse string on anti-mesenteric side of jejunum –> enterotomy –> insert feeding tube + secure pigtail –> 4-6cm serosal tunnel with 3-0 silk interrupted lembert sutures perpendicular to and over the tube, prox to enterotomy site –> anchor jejunum to peritoneum with seromuscular bites prox and distally to prevent kinking

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34
Q

what is a latent error?

A

hidden failure of organization or system (ie EMR issue)

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35
Q

error of omission vs commission

A

omission: failure to provide a treatment
commission: doing something wrong (ie prescribing a med when there’s a documented anaphylactic reaction)

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36
Q

patients with HIV - preop workup?

A

viral load w/in last 6 mo
CD4 count w/in last 12 mo
viral load = 200 –> basically no increased risk, proceed with surgery
resume meds when taking PO
for elective surgery: viral load >/= 200, and CD4 </= 200 –> increased surgical risk; consult PCP

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37
Q

neuroblastoma (adrenals) - factors assoc with unfavorable prognosis

A
  • age > 1 year
  • N-myc amplific
  • LDH
  • NSE
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38
Q

appendicitis - what’s psoas sign?

A

assoc with retrocecal appendix
RLQ pain with passive hip extension

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39
Q

what is howship-romberg sign?

A

obturator hernia
medial rotation of thigh –> causes pain down anteromedial thigh

can also get loss of adductor reflex (obturator nerve compression)

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40
Q

what’s upper limit of LDH?

A

280

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41
Q

strongest prognostic indicator for melanoma?

A

depth

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42
Q

axillary LAD - borders?

A

medially: SA
lat: ant border of lat dorsi
post: subscapularis
sup: axillary vein

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43
Q

anatomical boundaries of axilla?
(diff from axillary LAD)

A

apex: post corder of clavicle
ant: pec major/minor
post: subscap
med: SA
lat: ant border of lat dorsi

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44
Q

define Levels I, II, III for ax LAD

A

Level I: lateral to pec minor
Level II: deep to pec minor
Level III: medial to pec minor

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45
Q

primary fuel for enterocytes?

A

glutamine

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46
Q

___ can trigger autoimmune diseases

A

type 1 IFNs

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47
Q

after Ladd procedure, where does cecum and duo go?

A

cecum in LLQ
duodenum in RUQ

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48
Q

What are Ladd’s bands?

A

cecum to RUQ

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49
Q

Which assoc with lowest mortality?
-UTI
-resp tract infection
-CLABSI
-intra-abd
-CNS

A

UTI

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50
Q

MCC sepsis source

A

resp tract infections
40-50%
(followed by GI and GU)

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51
Q

complement proteins coalesce to form ___

A

MAC –> bacterial cell wall porosity + cell death

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52
Q

Type A aortic dissection assoc with extension of dissection to __

how to eval this quickly?

A

R coronary artery –> inferior MI

bedside TTE

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53
Q

when should you use an impella in setting of MI?

A

cardiogenic shock

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53
Q

first line step for anterior abd stab wound?

A

local wound exploration

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53
Q

what med causes tinnitus?

A

lasix

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54
Q

when would digoxin’s side effects be emphasized?

A

hypoK state (competes with K ions)

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55
Q

__ can accurately differentiate between benign liver masses

A

MRI

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56
Q

hepatic adenoma is hyperintense on __

A

T2

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57
Q

1st step in lap R adrenalectomy?

A

mobilize R triangular ligament to mobilize right lobe of liver
(2nd step: retract liver and expose RP)

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58
Q

transanal hemorrhoidal dearterialization

A

Doppler guided arterial ligation with hemorrhoidopexy

-sup rectal arteries
-suture proximal to dentate line

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59
Q

pyogenic liver abscess - MC orgs?

A

e coli
klebsiella

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60
Q

MC presentation of DCIS?

A

clustered microcalcif on mammo

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61
Q

BCAA

A

leucine, isoleucine, valine

metabolized in muscle - good for ppl with chronic liver disease

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62
Q

what is innervation of EAS?

A

pudendal nerves
-inf rectal branch (S2-3)

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63
Q

acute hepatitis - serum sickness - typne of HSN?

A

3

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64
Q

HSN types

A

1: IgE (asthma, anaphylaxis)
2: cytotoxic, Ab dependent (autoimmune hemolytic anemia)
3: circulating complexes (serum sickness)
4: T cell mediated, delayed rxn (contact dermatitis, PPD)

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65
Q

indication for intra-aortic balloon pump

A

low cardiac output (cardiac index<2.2) or cardiogenic shock

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66
Q

splenectomy for ITP and still sx - next action?

A

peripheral smear
+HJ bodies = spleen still present = re-explore (not CT)
-HJ bodies = asplenia
HJ bodies=nuclear remnants

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67
Q

late prosthetic graft infection (>4 mo) due to __

early due to __

A

staph epi (late)
GP

staph aureus (early)
GP cocci, clusters

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68
Q

difference between lean process improvement vs six sigma

A

six sigma: reduce error/waste

lean: repeatedly revisit and fine tune; outcomes should continue to improve; value stream mapping

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69
Q

features of RP fibrosis

A

flank or abd pain
newly dx kidney function impairment

fibrosis can encase the aorta - if atypical features, need CT guided bx to exclude malignancy

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70
Q

early stages of wound healing - IL’s?

A

1, 6, 8
macrophages release them

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71
Q

order of cell arrival for wound healing

A

platelets
neutrophils
macro’s
lymphocytes
fibroblasts

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72
Q

CNB that sounds like intraductal papilloma - what next?

A

excisional biopsy
NOT terminal duct excision - that’s if there was no identifiable lesion despite symptoms concerning for papilloma

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73
Q

amplification of __ has worst prognosis in breast cancer

A

HER2

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74
Q

Steps to sleeve gastrectomy

A
  1. devasc greater curvature
  2. insert bougie (34-40 Fr)
  3. transect stomach starting at location 2-6 prox to pylorus
  4. specimen extraction
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75
Q

what makes PID “complicated”?

A

TOA
pregnancy
failure of outpt mgmt

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76
Q

sarcoma - what makes up grade

A

mitotic activity
atypia
differentiation
presence/absence of necrosis

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77
Q

how does alvimopan work?

A

opioid antagonist that blocks binding to mu R

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78
Q

which HPV assoc with anal dysplasia?

A

HPV 16 and 18

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79
Q

accepted indic’s for damage control surgery

A

base deficit>15
temp<34 C
pH <7.2
refractory coagulopathy
HD instability

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80
Q

what rate of bleeding can the below detect:
- angiography
- tagged RBC scan

A

angio: 0.5 mL/min
tagged scan: 0.1 mL/min

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81
Q

lap liver resection indicated for tumors ___ located in ___

A

<5cm
segments 2,3,4,5,6

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82
Q

MCC anaphylaxis?

A

NMB agents (roc + succ)
other:
-abx
-opioids
-hemostatic agents
-chlorhexidine
-blue dyes
-NSAIDs

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83
Q

Sx periop anaphylaxis?

A

Bradycardia, desat, hypotension
Difficulty ventilating
Low end tidal CO2
Rhonchi / flushing / rash / urticaria

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84
Q

Risks of brachial plexus block?

A

-ptx
-sx diaphragmatic palsy (due to accidental infiltration of phrenic nerve)

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85
Q

how to palliate intractable pain from PDAC?

A

celiac plexus neurolysis

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86
Q

Blue toe syndrome - cause and tx?

A

-shaggy aorta (atheromatous emboliz to LE)
-eval: CTA or MRA
-tx: supportive (hydration for kidney in case of myoglobinuria, risk reduction with ASA/statin/BP control/smoking cessation/BG control)

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86
Q

testicular torsion
chances of viability?
tx if viable after detorsion?

A

-just bring to OR, don’t waste time with US
-highest chances in first 4-6hr
-tx: b/l orchiopexy

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87
Q

MCC met to lung

A

CRC
other: prostate, sarcoma

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87
Q

how long dual AP course after DES

A

min 6 months

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88
Q

pleural effusions caused by TB

A

straw colored
high protein
high LDH

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89
Q

urine Ca consistent with FHH

A

urinary Ca < 100mg/24 hr
Ca:Cr clearance ratio < 0.01

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90
Q

what is an endotoxin of gram neg bacteria?

A

LPS

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91
Q

Which meds have decreased and increased absorption after gastric bypass?

A

decreased:
ampicillin, cyclosporine/tacro, erythromycin, imatinib, phenytoin, tamoxifen, warfarin (though vit K absorp decr too, so actually decrease warf dose post RYGB)

increased:
atorvastatin, digoxin, lithium, PCN

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92
Q

which pancreatic enzyme secreted in active form?

A

lipase

(enterokinase too but that’s from duo, not pancr)

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93
Q

reasons for HD?

A

AEIOU

acidosis, lytes, intoxication, vol overload, uremia

94
Q

amiodarone can mess up the ___

A

liver

95
Q

how long to wait to do surgery after:
- bare metal stent
- drug eluting stent

A

1 month
6 months

96
Q

first signs of local anesthetic systemic toxicity?

A

dizziness + LH-ness

advance to seizures + respiratory depression

97
Q

medial pec nerve innervates __
lateral pec nerve innervates __

A

both pec major+minor

lateral innervates only pec major

98
Q

most common mesenteric cystic mass? and tx?

A

cystic lymphangioma
mesenteric cystic mass w/ or w/o septations
tx: complete surgical excision

99
Q

LCIS on CNB - chance of DCIS/cancer?

A

10-20%

100
Q

malignant appearing cells with fried egg appearance?

A

Paget cells

101
Q

reasons for anterior midline or other atypical anal fissure?

A

crohns
syphylis
TB
anal cancer
HIV AIDS

102
Q

with rectal prolapse, you have ___ rectal capacity?

A

decreased

103
Q

pathophysio of duo ulcer?

A

H pylori (GN helical bacteria) colonization of duo mucosa that has undergone gastric metaplasia

104
Q

operation for a Siewart type 3 tumor?

A

2-5cm distal to GEJ

total gastrectomy + distal esophagectomy with LAD

105
Q

when would you consider EMR for gastric cancer?

A

-2cm
-well-mod diff
-no submucosal invasion (limited to mucosa)
-no LVI

106
Q

how do you minimize paraplegia risk after AAA?

A

maintain adequate prograde perfusion through internal iliac’s
(more common adverse outcome after TAA/TAAA than AAA)

107
Q

hard vascular signs?

A

bleeding
bruit or thrill
expanding hematoma
absent pulses (decr pulse = soft sign)
distal ischemia

108
Q

if FIBTEM MCF is abnormal, what do you give?

If MCF is low, but FIBTEM MCF is normal, what do you give?

A

cryo

platelets

109
Q

for CRC anastomoses - what is primary blood flow to rectal remnant?

A

inf hemorrhoidal artery, from internal iliac

110
Q

2 common causes of anastomotic leaks

A

staple failure
tension

111
Q

optimal tx of neuroendocrine tumor?

A
  • resect primary tumor
  • surgical debulking of metastatic disease to <10%
  • ppx chole (for octreotide therapy later)
112
Q

primary tx of hyperCa

A

NS resuscitation goal UOP >100/hr
(avoid LR)

113
Q

tx for aldosteronoma?

A

optimize medically 1st (spironolactone for HTN, low K)

then unilat resection

114
Q

cyanide poisoning - talk to me

A

cyanide comes from fire exposure and smoke inhalation

inhibits oxidative phosphorylation by binding to cytochrome C oxidase, blocking MTC

115
Q

afib in setting of EF<35 - tx?

A

avoid CCB or BB

instead give amio

116
Q

Gardner syndrome - 3 things it’s assoc with?

A

epidermal cysts
GI polyposis
osteomas

117
Q

MC met to adrenal?

A

lung

118
Q

MC vitamin deficiency post-bariatric surgery?

A

vit D (absorbed in small bowel)

119
Q

cyclical mastodynia - tx?

A

rule out malignancy FIRST
1st: conservative mgmt (well fitting sports bra, topical/oral NSAIDs, avoid caffeine)
2nd: SERM (max 6 months)
3rd: danazol
4th: bromocriptine

120
Q

what is intraop hypothermia assoc with?

A
  • wound infxns
  • slower clearance of anesthesia
  • worse pain
  • coagulopathy
    (random: protection against cerebral ischemia)
121
Q

when is RA iodine rec after thyroid surgery?

A

*tumor>4cm
*ETE
*postop unstimulated thyroglobulin >5-10
*bulky or >5 +LN

122
Q

w/u of solid testicular mass?

A

*US
*tumor markers (AFP, b-HCG, LDH)
*staging CT A/P + CXR
*MRI Brain only if suspicious for brain mets

123
Q

what is a coloplasty?

A

longitudinal colotomy (antimesenteric side) closed transversely
-use when narrow pelvis or not enough colonic mobility for a J pouch
-increases reservoir capacity after resection for rectal cancer

124
Q

duo switch - briefly, what is it?

A

sleeve + bypass, with short common channel (100cm)

125
Q

what is rigler triad?

A

pneumobilia
SBO
ectopic calcified gallstone on imaging

126
Q

what is assoc with high ICP?

A

Cushing triad (HTN, bradycardia, resp depression)
CN 6 palsy

127
Q

Incidental meckel’s mgmt

A

all kids </= 18: resect
males <50: resect
females <50: resect if >2cm, palpable abnormality or assoc fibrous band
adults >49: resect if palpable abnormality

128
Q

5 year survival after liver transplant for HCC (if follow milan criteria)

A

65-90%

129
Q

talk to me about gastric lymphomas

A

-non Hodgkin’s (DLBCL 55% > MALT lymphoma 40% > Burkitt 3%)
-over 50% present w anemia
-sx: early satiety, bloating
-dx: EGD + bx
-tx: CHOP

130
Q

Types of prevention:
primordial
primary
secondary
tertiary
quaternary

A

primordial: RF reduction for popul using laws/policy
1: prevent occurrence of ds (immuniz)
2: detect subclinical ds to prevent progression (Cscope, pap smear)
3: reduce severity of ds once already present (rehab)
4: reduce interventions that could actually cause more harm than good (pt’s with unexplained psych sx)

131
Q

Merkel cell carcinoma - tx?

A

WLE, SLNB +/- usually adjuvant radiation if concerning features (>1cm, +LVI, etc)

1-2mm margins to investing fascia

132
Q

supracondylar fx of humerus - fix? possible complic?

A

closed reduction + perc pinning (in kids)

Volkmann’s ischemic contracture - splint in flexion and kink neurovasc structures (brachial artery) –> cmpt syndrome –> permanent withered hand

133
Q

what’s most definitive mgmt of pancreatic duct injury?

A

ERCP (stent I’m assuming)

134
Q

side effects of sirolimus?

A

anemia
thrombocytopenia
HLD

135
Q

difference bw tacro and cyclosporine

A

tacro: diabetogenic, alopecia
cyclosporine: hirsutism, gingival hyperplasia

136
Q

imaging modality of choice for adrenal mass

A

thin cut multiphase CT

137
Q

when use endorectal US for CRC cancer?

A

mid-low rectal cancers below anterior peritoneal reflection

138
Q

TNF alpha increases __ and __

A

catabolism and insulin resistance

139
Q

how does vanco work

A

block cell wall synthesis

140
Q

CCA - most common morphology, most favorable histology?

A

sclerosing or periductal
papillary

141
Q

when would rib plating be useful?

A

> 5 fx
b/l rib fx
flail segment

*can reduce ICU LOS and ventilator days (if impaired respi mechanics)

142
Q

protein C deactivates factors __ and ___

A

Va and VIIIa

143
Q

what are major RF for postop respiratory complications?

A

operative time >2.5 hrs
»> ASA class > 3
»> preop anemia
»> advanced age

144
Q

painless hematuria + weight loss –> best imaging study?

A

CT A/P (not US)

145
Q

enteroccocus

best first line tx for normal enterococcus or VRE?

A

GP, anaerobic cocci

Unasyn

146
Q

surveillance for watch and wait (rectal cancer)

A

every 2-3 months, for 3 yrs:
- DRE
- proctoscopy
- MRI
- CEA

147
Q

tx for symptomatic or >7cm desmoids?

A

WLE with frozen section

148
Q

tx for SBP

A

cefotaxime + albumin

149
Q

Frailty Score - is 1 very frail or fit?

A

1 = most fit

150
Q

value stream mapping ___

A

cannot identify errors in the medical care system

it is a visual map to help lean processes and make them more efficient

151
Q

Six sigma __

A

identifies and correct root causes of variation

152
Q

what is urine in pyloric stenosis?

A

urine ph LOW (excrete H for Na)
Urine Na LOW (reabsorbing Na)
urine K HIGH (excrete K to preserve Na)

153
Q

cyanosis + low O2 sat - suspect?

A

metHgb-emia
methylene blue

154
Q

Bites - which bugs to think of?

A

pasteurella
human: eikenella

abx: augmentin
PCN allergy: clinda + cipro (or bactrim if pregnant/child)

155
Q

general TPN req’s

A

*25-50% carbs
*30% fats? (10-20% lipid infusion…) - aim for 2.5 g/kg/d
*protein: 1.5 g/kg/d (less for hepatic failure or renal failure not on dialysis)
*water: 30 cc/kg/d

156
Q

describe c diff

A

GP anaerobic bacilli
toxin a = enterotoxin
toxin b = cytotoxin (intestinal mucosal inflammation)

157
Q

highest RF for post op mortality after CABG?

A

prior heart surgery

158
Q

what’s other word for Mann Whitney U test?

A

Wilcoxon rank-sum test

159
Q

what is TEP

A

total extraperitoneal

160
Q

what is TAPP

A

transabd pre peritoneal

161
Q
A
162
Q

what makes an EC fistula more likely to close?

A

tract >2cm
smaller defect size
low output (<200/day)
acute etiology (ie - appendicitis, diverticulitis)
no sepsis
well nourished

163
Q

what is qSOFA score

A

GCS<15
RR>21
SBP<99

164
Q

what is purpose of preoperative exam?

A

identify, quantify, and modify any risk factors

165
Q

primary source of bilirubin?

A

senescent RBCs

166
Q

tx for gonorrhea?

A

CTX

167
Q

tx for chlamydia?

A

doxycycline

168
Q

what can nitroprusside lead to?

A

cyanide toxicity
-weakness
-confusion
-pulm edema

thiocyanate>200 –> life threatening

tx: sodium nitrate

169
Q

antidotes to cyanide toxicity?

A

sodium nitrite
sodium thiosulfate (this and above usually together)
hydroxocobalamin (1st line)
amyl nitrite (lots of side effects)

170
Q

tx for spherocytosis?

A

splenectomy + chole
wait till after age 5

171
Q

entereg - contraindic?

A

therapeutic opioid use >7 days
incr risk of MI and GI side effects

172
Q

what’s metabolic derangement in primary hyperPTH?

A

hyperchloremic metab acidosis

173
Q

what does vit C def prevent?

A

proline hydroxylation (weaker collagen)

174
Q

MC composition of kidney stone?

A

Ca oxalate

175
Q

false + rate of PET for cutaneous melanoma? (for mediastinal malig)

A

10-20%

176
Q

pelvic hemorrhage with negative FAST - what are your 3 options?

A
  1. IR
  2. preperitoneal packing
  3. REBOA into zone 3
177
Q

Lymphangitis

A

MC org: strep pyogenes
2nd MC: staph aureus

tx: keflex, ancef, CTX
PCN allergy: clinda, bactrim

178
Q

Abx for OPSI

A

IV Vanco and CTX (or cefotaxime)

179
Q

chylothorax mgmt for:
< 1 L
> 1L

A

Less than 1L:
conserv mgmt x2 wks - drain, octreotide, low fat diet/TPN

Greater than 1L or failure of med mgmt:
Thoracic duct ligation or embolization

180
Q

person on PD with watery diarrhea and peritonitis - thoughts?

A

bowel wall erosion (dialysate leaking into bowel)
peritonitis? tx: ex lap

181
Q

pt with adrenal insufficiency who’s in hospital, hypotensive - what do you do?

A

dexamethasone –> corticotropin (ACTH) stimulation test + measure basal ACTH –> if low ACTH, low cortisol, then have your dx

change to hydrocortisone + fludrocortisone

182
Q

Imaging for CCA

A

contrast enhanced MRI
or multiphasic CT

start with EUS guided FNA (esp for distal lesions), but can also do ERCP with brushings (esp if concern for biliary obstruction and need stent placement too)

183
Q

“bent inner tube”

A

volvulus
(coffee bean seems to be sigmoid, usually)

184
Q

double bubble

A

duo atresia

185
Q

high RF for basal cell

A

> 2cm
immunocompromised
poorly defined
recurrent

186
Q

what’s a normal phi angle?

A

<60 degrees

187
Q

histology of thyroid pathologies

A

*papillary: pale cytoplasm, large crowded nuclei, intranuclear cytoplasmic inclusions
*medullary: sheets of infiltrating heterogeneous neoplastic cells
*Hurthle: hypercellular, eosinophilic cells
*follicular: solid sheets of cells with no colloid

188
Q

desmoid - pos and neg for?

A

+vimentin, B-catenin, actin
-cytokeratin, S100

189
Q

how to tx SBP in a nonseptic patient?

A

intraperitoneal abx
GP coverage: ancef or vanco
GN coverage: 3/4th gen cephalosporin or aztreonam or aminoglycoside (-micin)

190
Q

MCC pyogenic liver abscesses

A

portal vein seeding from
- bowel leakage
- biliary infection

191
Q

what are degs of hypothermia?

A

90-94
84-89
<84

192
Q

which med during resuscitation after cardiac arrest can cause seizures?

A

sodium bicarb (hyperosmolar/hyperNa state)

193
Q

efferent loop syndrome

A

kinking of jejunal limb usually 2/2 herniation posterior to anastomosis

194
Q

GERD - what is an alarm symptom?

A

dysphagia

early satiety, continued pain, odynophagia (pain w swallowing)

195
Q

MC location of mets from
- extremity sarcoma?
-RP sarcoma?

A

lung
high grade = greater risk of mets

RP sarcomas tend to mets more locoregionally

196
Q

tx for choledochocele (type III choledochal cyst)?

A

ERCP w sphincterotomy

CCA risk is too low to warrant morbidity of surgery

197
Q

seatbelt sign / diffuse abd pain + free intraperitoneal fluid (blood) + lumbar vertebra fx

no signs of solid organ injury or free air

what do you do?

A

ex lap - small bowel injury

short delays increase M&M of SB injuries significantly

198
Q

VHR - recurrence rate with and w/o mesh?

A

primary open tissue repair: 30-60%
w/ mesh: 10%

199
Q

Tumor markers with:
yolk sac tumor
germ cell tumor
epithelial & sex cord stromal tumors
epithelial ovarian

A

yolk sac : AFP
germ cell : bHCG
epithelial & sex cord stromal : inhibin
epithelial ovarian : CA 125

200
Q

large (>1.5-2cm), especially sessile polyps - how remove?

A

piecemeal
sessile - try to use EMR, lift submucosa up

201
Q

is succ depolarizing or NON depolarizing?

A

-depolarizing
… so it can result in fasciculations
-nicotinic activation –> can result in bradycardia (via muscarinic stimulation)
-it is metab by plasma pseduocholinesterase

202
Q

MC site of supernumerary PTH gland? 2nd MC site?

A

thymus
2nd MC: mediastinum

203
Q

which c diff toxin causes intestinal necrosis?

A

toxin A

204
Q

OR for testicular torsion - what kind of incision?

A

midline scrotal

205
Q

appendiceal cancer - when ok to do a simple appy?

A

appendiceal mucinous neoplasm or NET that is:
<2cm
unruptured
does not involve base

If mucinous adenoCA or worse than above - R hemi

206
Q

aortic valve - indic for repair / replacement?

A

valve area < 1 cm sqd

207
Q

PPI - moa?

A

IRREV inhibition of H/K ATPase
(parietal cells)

208
Q

ICA stenosis
<50%
50-69%
>70%

A

PSV &. ICA:CCA PSV ratio
<125 … <2
125-230 … 2-4
>230 … >4

209
Q

underlying pathology of post vagotomy dysphagia?

A

periesophageal fibrosis and lower esophageal denervation (from stripping)

210
Q

ortho + GI surgery – good indicator for 30 day mortality?

A

albumin

211
Q

30 day mortality for EVAR v open AAA repair

A

1-2% vs 4-5%

212
Q

operation for SMA syndrome?

A

duodenojejunostomy

212
Q

BRCA 1 or 2 mutated + triple neg cancer = which special therapy?

A

olaparib (PARP inhibitor)

212
Q

pediatric blunt abdominal trauma - MC hollow viscous injury?

A

jejunum
then ileum I think

213
Q

ideal preop diet for bariatric pt?

A

low carb, high protein, low calorie
(some wt loss, reduce fatty liver)

214
Q

how to access intrathoracic trachea?

A

R posterolat thoracotomy

215
Q

what can tracheal injury result in?

A

mediastinitis (drainage of secretions into mediastinum)
stenosis if injury is missed

216
Q

how far must tumor be from CP to do esophagectomy?

A

> 5cm

217
Q

MCC late access issues with AVF

A

intimal hyperplasia at graft-VENOUS anastomosis (later resulting in thrombosis)

218
Q

indic for adjuvant RADIATION for extremity sarcoma

A

> 5cm
high grade
close margins

219
Q

tx of cardiac failure from AVF

A

med mgmt –> AVF banding –> if that fails, then ligation

220
Q

wtf is orlistat?

A

reversibly inhibits pancreatic & gastric lipases (weight loss med)

221
Q

Indics for resection of rectal carcinoid?

A

> 2cm
T2 (musc propria) or higher
LVI
high mitotic rate

222
Q

MCC mortality after blood transfusion

A

TRALI

223
Q

treatment of gynecomastia?

A

liposuction of adipose and surgical excision of glandular tissue

224
Q

FAP s/p TAC + ileorectal mosis - surveillance?

A

lower endoscopy annually
upper endoscopy every ?1-3 yrs

225
Q

timing of preop ppx abx?

A

1 hr of incision

226
Q

tx for resectable CRLM

A

resection + adj 6 mo chemo

227
Q

macrolides + renal insufficiency

A

QT prolongation

228
Q

MC genetic defect in CRC

A

APC - chrom 5

229
Q

presence of everted anal crypts = ?

A

rectal intussusception

230
Q

what is peripheral femoral nerve palsy

A

inject local in wrong spot
inability to extend knee

231
Q

pelvic fx with bleeding in bay .. mgmt?
unstable:
temp responder:
stable:

A

unstable: ex fix and preperitoneal packing
temp responder: IR
stable: CT

232
Q

Absolute CI to thrombolysis

A

active internal bleeding
known intracranial neoplasm
recent trauma, CVA, intra-cranial/spinal surgery (2 mo)
severe uncontrollable HTN
uncontrolled clotting disorder

233
Q

cystic artery comes off RHA and originates __ to common hepatic duct

A

POSTERIOR

234
Q

how to reverse tpa?

A

cryo
if not available - aminocaproic acid (binds lysine residues)

235
Q

protamine dose?

A

1-1.5mg for every 100u heparin
give slow - risk hypotension

236
Q

tx for lymphangiocarcoma (Stewart Treves)

A

total mastectomy with or without SLNB. Adjuvent chemo

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